Percentage Payable. Drug Benefit Early Retirees Drug Benefit Active Employees Other Covered Charges Hospital (Within Home Province) Room and Board Limit semi-private Hospital Room and Board Limit per day Maximum Stay (per period of disability) Out-of-Hospital Nursing Benefit Maximum (per lifetime) days HEALTH CARE BENEFITS HEALTH BENEFITS Health Practitioners' Limits (per calendar year) Chiropractor, Osteopath, Naturopath, Podiatrist, Chiropodist or Christian Science Practitioner Psychologist (for diagnosis and assessment Physiotherapy Amount per visit, per disability for x-rays, up to a calendar year limit of for all charges combined Unlimited Reasonable and Customary Charges Vision Care Benefit Maximums (in any 24-month period) Prescription Lenses and Frames or Contact Lenses or Laser Eye Surgery per employee and dependent HEALTH CARE BENEFITS SCHEDULE HEALTH CARE BENEFITS Out-of-Province Benefit Maximum Emergency Care Hospital Maximum Stay Hospital Room and Board Limit In Canada Out of Canada Non-Hospital Expenses Benefit Maximums (per Lifetime) Drug Benefit: Maximum Period Early Retirees * coverage ceases: Amount days semi-private average semi-private if the employee becomes employed or if the employee becomes deceased; whichever occurs first.
Percentage Payable. Hospital (Within Home Province) and Drugs Psychoanalyst (for Quebec residents only) Other Covered Charges Hospital (Within Home Province) Room and Board Limit Convalescent Hospital Room and Board Limit Maximum Stay (per period of disability) Outsf-Hospital Nursing Benefit private, but not a suite lesser of per day or semi-private days Maximum subject to the Overall Lifetime Benefit Maximum HEALTH CARE BENEFITS SCHEDULE HEALTH CARE BENEFITS Health Practitioners’ Limits (per calendar year) Chiropractor, Podiatrist, Speech T Physiotherapist or Psychologist Masseur Out-of-Province Benefit Maximum (per lifetime) Emergency Care Hospital Room and Board Limit In Canada Out of Canada Amount per type of practitioner ear per visit, up to a calendar limit of subject to the Overall Lifetime Benefit Maximum semi-private average semi-private INDEX Schedules General Provisions Employee Dependent Eligibility Effective Date of Coverage Temporary Absence From Work of Coverage Continuation of Health Care and Dental Care Benefits for Incapacitated Children Benefit Descriptions Employee Life Insurance Employee Weekly Disability Employee Long Term Disability Dental Care Health Care Coordination of Benefits Claim Provisions How to Claim Beneficiary Proof of Loss Page Front Cover Pocket GENERAL PROVISIONS GENERAL PROVISIONS Employee Eligibility To be eligible for coverage you must an active, permanent employee of an Employer covered under this plan, working full-time and not working on a seasonal basis; in a class shown in the Schedule; and covered under a Provincial Health Insurance Plan. You will become eligible for coverage on the later of: the Effective Date of this plan; or with respect to the Life and Long Term Disability Benefits, upon commencement of employment; with respect to all other benefits, on the first of the month following the completion of month of continuous service. Canada
Percentage Payable. This is the part of Covered Charges that Maritime Life pays after the Calendar Year Deductible is satisfied. Covered Charges are reasonable and customary charges for needed medical care, services or supplies, as described below, and received while the person is covered, for either an illness or injury that is non-occupational or for pregnancy:
Percentage Payable. This is the part of Covered Charges that the Administrator pays after the Calendar Year Deductible is satisfied. Covered Charges are reasonable and customary charges for needed medical care, services or supplies, as described below, and received while the person is covered, for either an illness or injury that is non- occupational or for pregnancy:
Percentage Payable. Crowns, including gold and porcelain, when the major portion of the clinical crown is decayed, heavily filled or the cusps are fractured and cannot be restored using basic restorative materials. When crowns are rendered on molar teeth, only the cost of metal material will be considered. when the major portion of the clinical crown is decayed, heavily filled or the cusps are fractured and cannot be restored using Basic Services. Inlays when 3 or more surfaces are involved and the tooth cannot be restored using basic restorative materials. If only 1 or 2 tooth surfaces are involved, the inlay will be considered for reimbursement under Basic Services and payment will be determined based on the cost of a comparable amalgam or composite restoration. Relining, or the repair of an existing denture or existing bridge. The creation of an initial bridge or initial denture. The replacement of an existing bridge or denture, under one of the following circumstances:
Percentage Payable. All necessary dental treatment which has as its objective the correction of malocclusion of the teeth. EXPENSES NOT COVERED (Health Care) No payment will be made for expenses resulting from: Self-inflicted injuries or illness while sane or insane. Injury resulting directly or indirectly from insurrection, war, service in the armed forces of any country or participation in a riot. Any injury or illness for which the person is entitled to benefits under any workers’ compensation act. Examinations required for the use of a third party. Travel for health reasons. Xxxxxxx levied by a physician or dentist for time spent travelling, broken appointments, transportation costs, room rental charges or for advice given by telephone or other means of telecommunication. Cosmetic surgery or treatment (when so classified by Financial) unless such surgery or treatment is for accidental injuries and commenced within days of an accident.
