Common use of Major Medical Clause in Contracts

Major Medical. The Major Medical benefit is designed to complement the Provincial Health Plan. Should the Provincial Plan change to include any of the expenses currently eligible under this plan, the Sifto Canada Plan will automatically adjust accordingly. Major Medical benefits are extended to employees (and their eligible dependants) who continue active employment with the Company after age sixty-five (65) years of age. The benefit pays a percentage of all eligible expenses, including skilled nursing care and outpatient care, recommended as necessary by a physician which are reasonable and customary in the area in which the expenses are incurred and which are in excess of any other benefits payable under this plan and in excess of the deductible. i) The deductible is the amount of eligible expenses each calendar year which must be paid in full by the employee before any benefits are payable. The deductible is twenty-five dollars ($25.00) for those insured for employee only coverage; or fifty dollars ($50.00) for those insured for employee and dependent coverage. Eligible expenses incurred in the last three (3) months of the calendar year which are not sufficient to be applied against the deductible for that year will also be applied against the deductible for the next year. ii) The appropriate portion of the following expenses will be paid, provided the expenses charged are reasonable and medically necessary: Prescription Drugs at one hundred percent (100%) after co- pay as provided by the Prescription Card system described in the plan booklet Mental and Nervous Disorders payable at eighty percent (80%) General and Medical Expenses payable at eighty percent (80%). This benefit provides eighty percent (80%) coverage for initial placement of insulin pumps and, eighty percent (80%) coverage for insulin pump replacements every twenty-four (24) months. The Major Ontario Medical benefit shall provide coverage for emergency treatment outside Ontario. The plan will reimburse emergency treatment costs according to reasonable and customary fees for the area in which they were incurred as follows: 1) in excess of the benefits provided by the provincial hospital insurance program and under the basic hospital benefit, for a maximum of thirty-one (31) days per period of disability, 2) for the professional services of a physician over and above the amounts recognized by OHIP. This coverage is subject to any and all other plan provisions (e.g. deductible). Employees should refer to the plan booklet for details regarding all group benefits.

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

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Major Medical. The Major Medical benefit is designed to complement the Provincial Health Plan. Should the Provincial Plan change to include any of the expenses currently eligible under this plan, the Sifto Compass Minerals Canada Plan will automatically adjust accordingly. Major Medical benefits are extended to employees (and their eligible dependantsdependents) who continue active employment with the Company after age sixty-five (65) years of age. The benefit pays a percentage of all eligible expenses, including skilled nursing care and outpatient care, recommended as necessary by a physician which are reasonable and customary in the area in which the expenses are incurred and which are in excess of any other benefits payable under this plan and in excess of the deductible. i) The deductible is the amount of eligible expenses each calendar year which must be paid in full by the employee before any benefits are payable. The deductible is twenty-five dollars ($25.00) for those insured for employee only coverage; or fifty dollars ($50.00) for those insured for employee and dependent coverage. Eligible expenses incurred in the last three (3) months of the calendar year which are not sufficient to be applied against the deductible for that year will also be applied against the deductible for the next year. ii) The appropriate portion of the following expenses will be paid, provided the expenses charged are reasonable and medically necessary: Prescription Drugs at one hundred percent (100%) after co- pay as provided by the Prescription Card system described in the plan booklet % subject to a maximum dispensing fee of $8.00. Mental and Nervous Disorders payable at eighty percent (80%) % General and Medical Expenses payable at eighty percent (80%). This benefit provides eighty percent (80%) coverage for initial placement of insulin pumps and, eighty percent (80%) coverage for insulin pump replacements every twenty-four (24) months. The Major Ontario Medical benefit shall provide coverage for emergency treatment outside Ontario. The plan will reimburse emergency treatment costs according to reasonable and customary fees for the area in which they were incurred as follows: 1) in excess of the benefits provided by the provincial hospital insurance program and under the basic hospital benefit, for a maximum of thirty-one (31) 31 days per period of disability, 2) for the professional services of a physician over and above the amounts recognized recognised by OHIP. This coverage is subject to any and all other plan provisions (e.g. eg. deductible). Employees should refer to the plan booklet for details regarding all group benefits.

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

Major Medical. The Major Medical benefit is designed to complement the Provincial Health Plan. Should the Provincial Plan change to include any of the expenses currently eligible under this plan, the Sifto Compass Minerals Canada Corp. Plan will automatically adjust accordingly. Major Medical benefits are extended to employees (and their eligible dependants) who continue active employment with the Company after age sixty-five sixty‐five (65) years of age. The benefit pays a percentage of all eligible expenses, including skilled nursing care and outpatient care, recommended as necessary by a physician which are reasonable and customary in the area in which the expenses are incurred and which are in excess of any other benefits payable under this plan and in excess of the deductible. i) The deductible is the amount of eligible expenses each calendar year which must be paid in full by the employee before any benefits are payable. The deductible is twenty-five twenty‐five dollars ($25.00) for those insured for employee only coverage; or fifty dollars ($50.00) for those insured for employee and dependent coverage. Eligible expenses incurred in the last three (3) months of the calendar year which are not sufficient to be applied against the deductible for that year will also be applied against the deductible for the next year. ii) The appropriate portion of the following expenses will be paid, provided the expenses charged are reasonable and medically necessary: Prescription Drugs at one hundred percent (100%) after co- pay co‐pay as provided by the Prescription Card system described in the plan booklet Mental and Nervous Disorders payable at eighty percent (80%) General and Medical Expenses payable at eighty percent (80%). This benefit provides eighty percent (80%) coverage for initial placement of insulin pumps and, eighty percent (80%) coverage for insulin pump replacements every twenty-four twenty‐four (24) months. The Major Ontario Medical benefit shall provide coverage for emergency treatment outside Ontario. The plan will reimburse emergency treatment costs according to reasonable and customary fees for the area in which they were incurred as follows: 1) in excess of the benefits provided by the provincial hospital insurance program and under the basic hospital benefit, for a maximum of thirty-one thirty‐one (31) days per period of disability, 2) for the professional services of a physician over and above the amounts recognized by OHIP. This coverage is subject to any and all other plan provisions (e.g. deductible). Employees should refer to the plan booklet for details regarding all group benefits.

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

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Major Medical. The Major Medical benefit is designed to complement the Provincial Health Plan. Should the Provincial Plan change to include any of the expenses currently eligible under this plan, the Sifto Canada Plan will automatically adjust accordingly. Major Medical benefits are extended to employees (and their eligible dependantsdependents) who continue active employment with the Company after age sixty-five (65) years of age. The benefit pays a percentage of all eligible expenses, including skilled nursing care and outpatient care, recommended as necessary by a physician which are reasonable and customary in the area in which the expenses are incurred and which are in excess of any other benefits payable under this plan and in excess of the deductible. i) The deductible is the amount of eligible expenses each calendar year which must be paid in full by the employee before any benefits are payable. The deductible is twenty-five dollars ($25.00) for those insured for employee only coverage; or fifty dollars ($50.00) for those insured for employee and dependent coverage. Eligible expenses incurred in the last three (3) months of the calendar year which are not sufficient to be applied against the deductible for that year will also be applied against the deductible for the next year. ii) The appropriate portion of the following expenses will be paid, provided the expenses charged are reasonable and medically necessary: Prescription Drugs at one hundred percent (100%) after co- pay as provided by the Prescription Card system described in the plan booklet % subject to a maximum dispensing fee of $8.00. Mental and Nervous Disorders payable at eighty percent (80%) % General and Medical Expenses payable at eighty percent (80%). This benefit provides eighty percent (80%) coverage for initial placement of insulin pumps and, eighty percent (80%) coverage for insulin pump replacements every twenty-four (24) months. The Major Ontario Medical benefit shall provide coverage for emergency treatment outside Ontario. The plan will reimburse emergency treatment costs according to reasonable and customary fees for the area in which they were incurred as follows: 1) in excess of the benefits provided by the provincial hospital insurance program and under the basic hospital benefit, for a maximum of thirty-one (31) 31 days per period of disability, 2) for the professional services of a physician over and above the amounts recognized recognised by OHIP. This coverage is subject to any and all other plan provisions (e.g. eg. deductible). Employees should refer to the plan booklet for details regarding all group benefits.

Appears in 1 contract

Samples: Collective Agreement

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