ORDINATION OF BENEFITS. This plan includes a Co-ordination of Benefits Provision. This provision operates in the event that you or your dependents are covered under more than one Group Health or Dental plan and ensures that while claim may be made under all plans, total reimbursement received does not exceed the actual expenses incurred. In order to implement a compressed work schedule (twelve (12) hour continuous shift rotation) in the mill, the following understanding is agreed to by the parties:
ORDINATION OF BENEFITS. If you have medical or dental coverage through another plan (for example, through your spouse's employer), you can submit claims under both plans. In this way, you may receive reimbursements for up to 100% of your eligible expenses. Co-ordination of benefits works like this: If your other plan does not include a coordination of benefits provision, send all claims to that plan first. If both plans include a coordination of benefits provisions, send claims first to the plan under which you are enrolled as an 'employee'. Once you receive your reimbursement from the first plan, send all information regarding your claim to the second plan; you may be entitled to receive the amount not covered by your first plan. Send claims for dependent children first to the plan of the parent whose birthday is earlier in the year. COVERAGE - Semi-private or preferred hospital accommodation ($75 per day above OHIP coverage); no deductible - Drugs requiring a prescription and certain other life-sustaining drugs; - Private duty registered nurse (up to $10,000 in 36 consecutive months); - Physiotherapy prescribed by a physician up to the provincial fee schedule maximum after provincial coverage is exhausted - Convalescent hospital ($10 per day up to 120 days); - Treatment for sound natural teeth injured in an accident; - Hearing aids (up to $450 per person in every 36 consecutive months); no deductible - Orthopedic foot devices, when prescribed by an Orthopedic Surgeon for arch supports, molds, or orthotic devices, but not for sports up to $200 per 24 month period or 12 month period if under age 18; - Orthopedic shoes, up to $100 per person per year. - Vision care (up to $175 per person every 24 consecutive months for glasses or contact lenses, and repairs; a special one time contact lenses benefit of $250 (maximum) is payable only once during a lifetime); - Reasonable and customary expenses for emergency treatment required while traveling outside the province for up to 14 days (or more if you cannot be moved to a hospital near your home) less any amount paid by OHIP. - Services of a Psychologists or Speech Therapist (prescribed by a Physician), Chiropractic, Christian Science Practitioner, Naturopath, Osteopath, or Podiatrist, up to a maximum of $200 per person per year for each service. - Professional emergency ambulance services - Medical equipment, special supplies, diagnostic lab and x-rays, but excluding personal comfort, convenience, exercise, safety, self-help or environm...
ORDINATION OF BENEFITS. This plan will pay either its regular benefits in full, or a reduced amount which, when added to the benefits available under the other plan, or plans, will equal 100% of covered expenses. ‘Plan’ means any plan under which medical or dental benefits or services are provided by:
ORDINATION OF BENEFITS. If you have similar benefits through any other insurer, the amount payable through this benefit plan shall be coordinated so that payment from all coverages shall not exceed one hundred (100%) percent of the allowable expenses. EHB (EXTENDED HEALTH BENEFITS) The benefits described below are available to you through the Benefits Carrier’s Extended Health Benefits. Refer to the "Summary of Benefits" for information regarding reimbursement of this benefit. GENERAL INFORMATION No medical examination is required. Benefits apply anywhere in the world. Reimbursement will be in Canadian funds up to the reasonable and customary charges for the services received, plus the rate of exchange if any, as determined from the date of the last service provided. Pre-existing conditions are covered from the moment this Agreement takes effect, except for dental care as a result of an accident.
ORDINATION OF BENEFITS. This applies to you if you have a spouse who has medical or dental coverage under another plan: • Claim your personal expenses under the ARAMARK Plan first. If the ARAMARK Plan does not reimburse 100% of your expenses, then claim the unpaid balance under your spouse's plan. • Claim your spouse's expenses under your spouse's Plan first. If your spouse's Plan does not reimburse 100% of your spouse's expenses, then claim the unpaid balance under the ARAMARK Plan. • Claim your dependent children's expenses under the Plan of the parent whose birthday occurs first in the calendar year. If that Plan does not reimburse 100% of your dependent children's expenses, then claim the unpaid balance under the other Plan.
ORDINATION OF BENEFITS. When payment provided under this Agreement is available to a person under any other prepaid health service contract, insurance policy or plan, benefits shall be coordinated and the amount payable under this Agreement shall be pro-rated and limited to the extent that the total amount available under all coverage does not exceed of the allowable expenses. Benefits will be coordinated according to the current industry standards Reimbursement Reimbursement shall be made for expenses incurred and paid by a participant for any of the eligible services, substances and appliances set out in and in accordance with the provisions set forth in the Green Shield Benefit Plan Group Agreement, provided such expenses:
ORDINATION OF BENEFITS. When payment provided under this Agreement is available to a person under any other prepaid health service contract, insurance policy or plan, benefits shall be coordinated and the amount payable under this Agreement shall be pro-rated and limited to the extent that the total amount available under all coverage does not exceed 100% of the allowable expenses. Benefits will be coordinated according to the current industry standards.
ORDINATION OF BENEFITS. If a person, who is covered for benefits under this plan is also covered simultaneously under any other plan which provides similar benefits, the amount of benefits payable under this plan for allowable expenses incurred during any benefit year shall be co-ordinated and/or reduced, so that the benefits payable from all plans shall not exceed 100% of the actual allowable expenses. If a person is covered as an employee, and a spouse is also an employee, under the basic Dental Plan only, both employees will be allowed to be eligible for benefits. The amount of benefits payable under this particular plan shall be co-ordinated and/or reduced so that the benefits shall not exceed 100% of the allowable expenses.
ORDINATION OF BENEFITS. In the event that benefits may be claimed under more than one section of the health care plan, the claim will be assessed in a manner that provides the greatest benefit to the employee. If you are eligible for similar benefits under another group benefit plan the amount payable through this plan shall be co-ordinated with all benefit plans and will not exceed 100% of the eligible expense. Where both spouses of a family have coverage through their own employer benefit plans, the first payer of each spouse’s claim is their own employer’s plan. Any amount not paid by the first payer can then be submitted for consideration to the other spouse’s benefit plan (the second-payer). Claims for dependent children should be submitted first to the benefit plan of the spouse who has the earlier birth month in the calendar year, and then to the other spouse’s benefit plan. When submitting a claim to a second payer, be sure to include payment details provided by the first payer. Benefit payments will be co-ordinated with any other plan or arrangement, in accordance with the Canadian Life and Health Insurance Association (CLHIA) guidelines.
ORDINATION OF BENEFITS. If a member or dependent is insured under another policy, payment of benefits under this policy will be determined as follows: If the other policy does not contain a co-ordination of benefits clause, payment under the other policy must be made before we will pay under this provision. If the other policy does contain a co-ordination benefits clause, priority of payment will be attributed the following order: Member: The plan where the person is covered as a member, If a person is covered under two plans, priority goes the plan where the member is a full-time employee The plan where the person is covered as a member. Child: The plan of the parent with the earlier in the calendar year. The plan of the parent whose first name begins with earlier letter in the alphabet, if the parents have same birth date. In situations where parents are then the following order applies: The plan of the parent with custody of the dependent child, The plan of the spouse of the parent with custody of the dependent child, The plan of the parent not having custody of the dependent child, The plan of the spouse of the parent not having custody of the dependent child. Following payment under another policy, the amount benefits payable under this policy will not exceed the amount of eligible expenses incurred less the amount by the other policy. AT TERMINATION: If on the date in question, If the member has a medically determinable physical mental impairment due to injury or disease prevents him from performing the regular duties of occupation in which he participated just before the impairment started: regardless of the availability of work for him, or The insured dependent has a medically determinable physical or mental impairment due to injury or disease, is receiving treatment from a physician and is confined to a hospital or his home. will be payable for eligible expenses related to the provided they are incurred within days of the ate of termination and this provision continues in force. No benefit shall be payable for: Expenses for which benefits are payable under a Worker's Safety Insurance Board Act or similar statute, Expenses incurred due to internationally self-inflicted injuries, Expenses incurred due to civil disorder or war, whether or not war was declared, Expenses for services and products rendered or prescribedby a person who is ordinarily a resident in the patient's home or who is related to the patient by blood or marriage, Expenses for which benefits are payable un...
