MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. π private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π hospital charges for other than room and board not paid by the provincial plan π oxygen and its administration π blood and blood plasma π rental of wheel chair, hospital bed or respirator/ventilator π splints, trusses, braces, crutches, casts π artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π services of duly qualified and licensed physiotherapists other than members of the insured's family π local ambulance services π emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π services provided by the following: Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist, Speech Therapist. All practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for such services. π frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $250.00 every twenty-four (24) months for each eligible insured person, and $250.00 every twelve months for dependent children under the age of eighteen (18) years. π Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. π As of January 1, 2018, eye exam reimbursement will be made every twenty four (24) months at 70% of receipted costs. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows:
Appears in 2 contracts
Samples: Collective Agreement, Collective Agreement
MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π ❐ drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. π ❐ private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π ❐ hospital charges for other than room and board not paid by the provincial plan π ❐ oxygen and its administration π ❐ blood and blood plasma π ❐ rental of wheel chair, hospital bed or respirator/ventilator π ❐ splints, trusses, braces, crutches, casts π ❐ artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π ❐ services of duly qualified and licensed physiotherapists other than members of the insured's family π ❐ local ambulance services π ❐ emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π ❐ services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π ❐ services provided by the following: Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist, Speech Therapist. All practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for such services. π ❐ frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $250.00 every twenty-four (24) months for each eligible insured person, and $250.00 every twelve months for dependent children under the age of eighteen (18) years. π ❐ Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. π As of January 1, 2018, eye exam reimbursement will be made every twenty four (24) months at 70% of receipted costs. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows:
Appears in 1 contract
Samples: Collective Agreement
MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π drugs • Drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. π Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. Effective January 1, 2018 a maximum of $8.00 dispensing fee per prescription will be reimbursed. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π • hospital charges for other than room and board not paid by the provincial plan π • oxygen and its administration π • blood and blood plasma π • rental of wheel chairwheelchair, hospital bed or respirator/ventilator π • splints, trusses, braces, crutches, casts π • artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π • services of duly qualified and licensed physiotherapists other than members of the insured's family π • local ambulance services π • emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π • services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π • services provided by the following: of a licensed Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist, Speech Therapist. All These practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for such these services. π • Services of a licensed Psychology, Psychotherapist, Social Worker, Marriage and Family Therapist, or Clinical Counsellor to a total annual maximum of $750 for these services. • Wigs limited to 1 per lifetime • Gender affirmation procedures covered up to $15,000 per lifetime. Insurer standard provisions will apply. • Viscosupplementation • Hearing Aids - $500 every 3 calendar years • Out of country emergency medical travel coverage. Insurer standard provisions will apply. The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $250.00 200.00 every twenty-four (24) months for each eligible insured person, and $250.00 200.00 every twelve months for dependent children under the age of eighteen (18) years. π Effective January 1, 2009 the total payment increases to $250 / 24 months per person. Effective January 1, 2023 the total payment increases to $300 / 24 months per person (children every 12 months). • Eye examinations limited to 1 exam every 24 months per person, and every 12 months per child. • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. π As • contact lenses, up to a total payment of January 1$180.00 per person in any two (2) consecutive calendar years, 2018if they are prescribed for severe corneal astigmatism, eye exam reimbursement will severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be made every twenty four (24) months improved by contact lenses to at 70% of receipted costsleast the 20/40 level. • You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The deductible will be eliminated as of January 1, 2018 The amount of benefit payable is determined as follows:
Appears in 1 contract
Samples: Collective Agreement
MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. There is a lifetime maximum of $750,000 for all major medical expense benefits for active seniority employees. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π • drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. π A maximum of $10.00 per prescription will be reimbursed for dispensing fees. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π • hospital charges for other than room and board not paid by the provincial plan π • oxygen and its administration π • blood and blood plasma π • rental of wheel chair, hospital bed or respirator/respirator/ ventilator π • splints, trusses, braces, crutches, casts π • artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π • services of duly qualified and licensed physiotherapists other than members of the insured's family π • local ambulance services π • emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π • services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π • services provided by the following: of a licensed Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist, Psychologist or Speech Therapist. All These practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for such these services. π The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $250.00 200.00 every twenty-four (24) months for each eligible insured person, and $250.00 200.00 every twelve months for dependent children under the age of eighteen (18) years. π • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. π As • contact lenses, up to a total payment of January 1$180.00 per person in any two (2) consecutive calendar years, 2018if they are prescribed for severe corneal astigmatism, eye exam reimbursement will severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be made every twenty four (24) months improved by contact lenses to at 70% of receipted costsleast the 20/40 level. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows:
Appears in 1 contract
Samples: Collective Agreement
MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π drugs and medicines (except over-the-counter drugs) dispensed on the written Page 39 of 76 prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. π private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π hospital charges for other than room and board not paid by the provincial plan π oxygen and its administration π blood and blood plasma π rental of wheel chair, hospital bed or respirator/ventilator π splints, trusses, braces, crutches, casts π artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π services of duly qualified and licensed physiotherapists other than members of the insured's family π local ambulance services π emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π services provided by the following: Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist, Speech Therapist. All practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for such services. π frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $250.00 every twenty-four (24) months for each eligible insured person, and $250.00 every twelve months for dependent children under the age of eighteen (18) years. π Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. π As of January 1, 2018, eye exam reimbursement will be made every twenty four (24) months at 70% of receipted costs. You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The amount of benefit payable is determined as follows:
Appears in 1 contract
Samples: Collective Agreement
MAJOR MEDICAL EXPENSE BENEFIT. Basic medical benefits are provided for you and your family under your provincial health plan (OHIP). The major medical expense benefit under the Company's group insurance plan provides benefits for you and your covered dependents for certain expenses not covered by the provincial hospital and medical plans. Expenses allowed under the major medical expense benefit are listed below. Effective January 1, 2009 there is a lifetime maximum of $750,000 for all major medical expenses per person. Benefits are payable only if the services are recommended by a physician and if provincial legislation does not prohibit insurance of any such expense. π drugs • Drugs and medicines (except over-the-counter drugs) dispensed on the written prescription of a physician. Reimbursement will be based on the cost of the generic equivalent of a prescription drug, if such an equivalent exists. You will receive full reimbursement of a brand name drug only if a generic equivalent does not exist, or if your physician provides specific instructions prohibiting substitution. π Effective January 1, 2009 a maximum of $10.00 dispensing fee per prescription will be reimbursed. Effective January 1, 2018 a maximum of $8.00 dispensing fee per prescription will be reimbursed. • private duty nursing by registered graduate nurses who are not ordinarily resident in your home and are not related to you or your dependents π • hospital charges for other than room and board not paid by the provincial plan π • oxygen and its administration π • blood and blood plasma π • rental of wheel chair, hospital bed or respirator/respirator/ ventilator π • splints, trusses, braces, crutches, casts π • artificial limbs and eyes provided the loss of the natural limb or eye occurred while insured under this plan π • services of duly qualified and licensed physiotherapists other than members of the insured's family π • local ambulance services π • emergency transportation by a licensed ground ambulance, including air ambulance, to and from the nearest hospital in which treatment can be provided (subject to one round trip per calendar year). π • services of a licensed chiropractor or osteopath when operating in their recognized field of expertise (eligible only after provincial plan maximum has been reached). π • services provided by the following: of a licensed Acupuncturist, Podiatrist, Homeopath, Massage Therapist, Naturopath, Psychologist, Psychologist or Speech Therapist. All These practitioner services are reimbursable only after any applicable provincial plan maximum has been reached and subject to a total annual maximum benefit of $500 for such these services. π The following items are covered when prescribed by a physician or optometrist: • frames, lenses and the fitting of any type of prescription glasses (including contact lenses), when prescribed by a physician or optometrist up to a total payment of $250.00 200.00 every twenty-four (24) months for each eligible insured person, and $250.00 200.00 every twelve months for dependent children under the age of eighteen (18) years. π Effective January 1, 2009 the total payment increases to $250.00 / 24 months per person. • Laser surgery once in a lifetime for employees only with an optometrist’s recommendation. Maximum reimbursement is $1,000. π As • contact lenses, up to a total payment of January 1$180.00 per person in any two (2) consecutive calendar years, 2018if they are prescribed for severe corneal astigmatism, eye exam reimbursement will severe corneal scarring, keratoconus or aphakia, and if visual acuity can only be made every twenty four (24) months improved by contact lenses to at 70% of receipted costsleast the 20/40 level. • You are required to pay the first $10 of expenses incurred in each calendar year. This is known as the "deductible" and is applied to each insured person, employee or dependent, except that the total deductible for all members of your family will not be more than $20 in each calendar year. If expenses which are included in the deductible occur within the last three months of the calendar year the same expenses may be applied against the deductible for the next calendar year. If two or more insured members of your family are injured in a common accident only one deductible will be applied against their resulting combined expenses incurred in any one calendar year. The deductible will be eliminated as of January 1, 2018 The amount of benefit payable is determined as follows:
Appears in 1 contract
Samples: Collective Agreement
