Common use of ORDINATION OF BENEFITS Clause in Contracts

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. - 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 environmental control items, or items which may be used for non-medical reasons. - Smoking cessation products (Nicorettes and nicoderm patches) to a life time maximum of $200 The Dental Plan provides coverage for a full range of services based on the Ontario Dental Association (ODA) Fee Guide, with a one year lag. There is no deductible under the Dental Plan. If you or a member of your family needs dental work exceeding $300, ask your dentist to prepare a treatment plan. Submit the treatment plan to our insurance company, Manulife Financial. They will let you know what procedures the plan covers, and how much it will pay. You are reimbursed for 100% of the cost of the following preventative services once every six months: - Oral examinations; - X-rays; - Cleaning; - Fluoride treatments You are reimbursed for 100% of the cost of the following minor restorative services; - Fillings; - Root canals; - Gum disease treatment; - Extractions; - Oral surgery; - Denture repairs; relining and rebasing - Anesthesia; - Crown/bridgework repair, resurfacing or re-cementing - Antibiotic drug injections You are reimbursed for 50% of the cost of the following major restorative services for teeth extracted while insured, to a maximum of $1,500 per person per year. - Onlays and inlays; - Crowns and bridges; - Dentures (including replacement of dentures at least five years old) - - Retentive pins

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. - 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 a 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 environmental control items, or items which may be used for non-medical reasons. - Smoking cessation products (Nicorettes and nicoderm patches) to a life time maximum of $200 The Dental Plan provides coverage for a full range of services based on the Ontario Dental Association (ODA) Fee Guide, with a one year lag. There is no deductible under the Dental Plan. If you or a member of your family needs dental work exceeding $300, ask your dentist to prepare a treatment plan. Submit the treatment plan to our insurance company, Manulife Financial. They will let you know what procedures the plan covers, and how much it will pay. You are reimbursed for 100% of the cost of the following preventative services once every six months: - Oral examinations; - X-rays; - Cleaning; - Fluoride treatments You are reimbursed for 100% of the cost of the following minor restorative services; - Fillings; - Root canals; - Gum disease treatment; - Extractions; - Oral surgery; - Denture repairs; relining and rebasing - Anesthesia; - Crown/bridgework repair, resurfacing or re-cementing - Antibiotic drug injections You are reimbursed for 50% of the cost of the following major restorative services for teeth extracted while insured, to a maximum of $1,500 per person per year. - Onlays and inlays; - Crowns and bridges; - Dentures (including replacement of dentures at least five years old) - - Retentive pinsPLUS ANY OTHER CHANGES THAT MAY FROM TIME TO TIME BE MADE IN THE SALARIED MEDICAL PLAN.

ORDINATION OF BENEFITS. If you have medical you for up to 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. - Semi-private deductible 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 a 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 environmental control items, or items which may be used for non-medical reasons. - Smoking cessation products (Nicorettes and nicoderm patches) to a life time maximum of $200 The Dental Plan provides coverage for a full range of services based on the Ontario Dental Association (ODA) Fee Guide, with a one year lag. There is no deductible under the Dental Plan. If you or a member of your family needs dental work exceeding $300, ask your dentist to prepare a treatment plan. Submit the treatment plan to our insurance company, Manulife Financial. They will let you know what procedures the plan covers, and how much it will pay. You are reimbursed for 100% of the cost of the following preventative services once every six months: - Oral examinations; - X-rays; - Cleaning; - Fluoride treatments You are reimbursed for 100% of the cost of the following minor restorative services; - Fillings; - Root canals; - Gum disease treatment; - Extractions; - Oral surgery; - Denture repairs; relining and rebasing - Anesthesia; - Crown/bridgework repair, resurfacing or re-cementing - Antibiotic drug injections You are reimbursed for 50% of the cost of the following major restorative services for teeth extracted while insured, to a maximum of $1,500 per person per year. - Onlays and inlays; - Crowns and bridges; - Dentures (including replacement of dentures at least five years old) - - Retentive pinsPLUS ANY OTHER CHANGES THAT MAY FROM TIME TO TIME BE MADE IN THE SALARIED MEDICAL PLAN.