Common use of Prescriptions Clause in Contracts

Prescriptions. 100% prescription coverage based on National Formulary; 70% coverage for prescriptions not covered under the National Formulary • Dispensing fee cap of $8.50 • 100% subject to plan maximums and “reasonable and customary” expenses • 100% for Diabetic supplies and equipment • Semi-private hospital room • Private duty nursing $10,000 calendar year ($25,000 lifetime maximum) • Paramedical $500 per practitioner per year for Chiropractor/Osteopath/ Naturopath/Podiatrist/Massage Therapist/Acupuncture • Unlimited Physiotherapy for reasonable and customary charges • Psychologist/Speech Therapist $1,000 per year • $500 every 60 months for Hearing Aids • Full coverage for one pair of Orthopedic Shoes per year for reasonable and customary charges • $300 per year for prescribed custom-made Orthotics • To the nearest Canadian hospital equipped to provide essential care • Air transport when time is critical or condition prevents use of another mode of transport • Transport from one hospital to another when original hospital inadequate • Charge for an attendant when medically necessary • Oxygen blood and blood plasma • Lab tests and diagnostic services (not under gov. plan) • Ostomy and ilestomy supplies • Walkers, canes and cane tips, crutches, splints, casts, collars and trusses, but not elastic or foam supports • Rigid support braces and permanent prostheses (maximum $10,000 per prostheses) • Post-mastectomy bras 2 per calendar year • Xxxxx socks 6 pairs per calendar • Wigs and hair pieces for medical treatment, injury alopecia ($500 per lifetime) • Manual wheelchairs, manual-type hospital beds, and necessary accessories • Medical heart and blood glucose monitors, and cardiac screeners • Bio-osteogen systems and growth guidance systems • Breathing machines and appliances including respirators, compressors, precursors, suction pumps, oxygen cylinders, masks, and regulators (charges for rental) • Insulin infusion set, not including pumps • $200 for prescription eyewear every 24 months (12 months for dependent children) including sunglasses and safety lenses (employees may use benefit for a one-time application towards laser eye surgery) • 1 eye exam every 24 months (12 months for dependent children) up to $60 Dental Coverage • 100% of routine treatment (based on fee guide used in province of residence) • Nine (9) month recall period for preventative treatment (polishing, fluoride, recall exams) • Scaling (more than 6 units in a 12-month period may require pre-authorization) • Complete exam 1 every 24 months • Specific exam 1 every 6 months • Panoramic x-ray 1 every 3 years • Complete mouth x-ray series once every 24 months • 50% of major treatment with a $1,500 maximum per calendar year • Crowns or bridge replacements are limited to 1 every 5 years • One upper and one lower denture (complete or partial) are limited to the cost of the gold restoration • Veneers, crowns, bridges, inlays, and onlays are subject to the condition outlined in the fee schedule. Where other material would suffice, you will be responsible for the difference between the cost of the chosen material and the cost of the alternative material • 50% of orthodontic treatment with a $2,000 lifetime maximum • No benefit is payable for the replacement of appliances which are lost or stolen • Services done for the correction of temporomandibular joint (TMJ) dysfunction are not covered • Treatment performed solely for splinting is not covered • 100% coverage for emergency treatment due to accident or injury while traveling outside of your province/country Confidential, short-term counseling sessions for employees and dependents such as: • marital and family problems • substance abuse • stress, anxiety, depression • career-related concerns • family advisory services • child care, eldercare • critical incident (trauma) • bereavement • advise or referral by a lawyer • financial services • referral to longer-term and/or specialized services, if required Where appropriate, the provider may refer you or your dependents to specialists and community resources for additional guidance and/or assistance We respect your confidentiality and privacy at all times. No one received information concerning your use of the program without your written consent. A strict code of ethics concerning confidentiality governs the work of all EFAP professionals.

Prescriptions. 100% prescription coverage based on National Formulary; 70% coverage for prescriptions not covered under the National Formulary Formulary. • Dispensing fee cap of $8.50 8.50. • 100% subject to plan maximums and “reasonable and customary” expenses • 100% for Diabetic supplies and equipment • Semi-private hospital room • Private duty nursing $10,000 calendar year ($25,000 lifetime maximum) • Paramedical $500 per practitioner per year for ChiropractorChripractor/Osteopath/ Naturopath/Podiatrist/Massage Therapist/Acupuncture • Unlimited Physiotherapy for reasonable and customary charges • Psychologist/Speech Therapist $1,000 per year • $500 every 60 months for Hearing Aids • Full coverage for one pair of Orthopedic Shoes per year for reasonable and customary charges • $300 per year for prescribed custom-made Orthotics • To the nearest Canadian hospital equipped to provide essential care • Air transport when time is critical or condition prevents use of another mode of transport • Transport from one hospital to another when original hospital inadequate • Charge for an attendant when medically necessary • Oxygen blood and blood plasma • Lab tests and diagnostic services (not under gov. plan) • Ostomy and ilestomy supplies • Walkers, canes and cane tips, crutches, splints, casts, collars and trusses, but not elastic or foam supports • Rigid support braces and permanent prostheses (maximum $10,000 per prostheses) • Post-mastectomy bras 2 per calendar year • Xxxxx socks 6 pairs per calendar • Wigs and hair pieces for medical treatment, injury alopecia ($500 per lifetime) • Manual wheelchairs, manual-type hospital beds, and necessary accessories • Medical heart and blood glucose monitors, and cardiac screeners • Bio-osteogen systems and growth guidance systems • Breathing machines and appliances including respirators, compressors, precursors, suction pumps, oxygen cylinders, masks, and regulators (charges for rental) • Insulin infusion set, not including pumps • $200 for prescription eyewear every 24 months (12 months for dependent children) including sunglasses and safety lenses (employees may use benefit for a one-time application towards laser eye surgery) • 1 eye exam every 24 months (12 months for dependent children) up to $60 Dental Coverage • 100% of routine treatment (based on fee guide used in province of residence) • Nine (9) month recall period for preventative treatment (polishing, fluoride, recall exams) • Scaling (more than 6 units in a 12-month period may require pre-authorization) • Complete exam 1 every 24 months • Specific exam 1 every 6 months • Panoramic x-ray 1 every 3 years • Complete mouth x-ray series once every 24 months • 50% of major treatment with a $1,500 maximum per calendar year • Crowns or bridge replacements are limited to 1 every 5 years • One upper and one lower denture (complete or partial) are limited to the cost of the gold restoration • Veneers, crowns, bridges, inlays, and onlays are subject to the condition outlined in the fee schedule. Where other material would suffice, you will be responsible for the difference between the cost of the chosen material and the cost of the alternative material • 50% of orthodontic treatment with a $2,000 lifetime maximum • No benefit is payable for the replacement of appliances which are lost or stolen • Services done for the correction of temporomandibular joint (TMJ) dysfunction are not covered • Treatment performed solely for splinting is not covered • 100% coverage for emergency treatment due to accident or injury while traveling outside of your province/country Confidential, short-term counseling sessions for employees and dependents such as: • marital and family problems • substance abuse • stress, anxiety, depression • career-related concerns • family advisory services • child care, eldercare • critical incident (trauma) • bereavement • advise or referral by a lawyer • financial services • referral to longer-term and/or specialized services, if required Where appropriate, the provider may refer you or your dependents to specialists and community resources for additional guidance and/or assistance We respect your confidentiality and privacy at all times. No one received will receive information concerning your use of the program without your written consent. A strict code of ethics concerning confidentiality governs the work of all EFAP professionals.

Prescriptions.  100% prescription coverage based on National Formulary; 70% coverage for prescriptions not covered under the National Formulary • Formulary.  Dispensing fee cap of $8.50 • 8.50.  100% subject to plan maximums and “reasonable and customary” expenses •  100% for Diabetic supplies and equipment •  Semi-private hospital room •  Private duty nursing $10,000 calendar year ($25,000 lifetime maximum) •  Paramedical $500 per practitioner per year for ChiropractorChripractor/Osteopath/ Naturopath/Podiatrist/Massage Therapist/Acupuncture •  Unlimited Physiotherapy for reasonable and customary charges •  Psychologist/Speech Therapist $1,000 per year •  $500 every 60 months for Hearing Aids •  Full coverage for one pair of Orthopedic Shoes per year for reasonable and customary charges •  $300 per year for prescribed custom-made Orthotics •  To the nearest Canadian hospital equipped to provide essential care •  Air transport when time is critical or condition prevents use of another mode of transport •  Transport from one hospital to another when original hospital inadequate •  Charge for an attendant when medically necessary •  Oxygen blood and blood plasma •  Lab tests and diagnostic services (not under gov. plan) •  Ostomy and ilestomy supplies •  Walkers, canes and cane tips, crutches, splints, casts, collars and trusses, but not elastic or foam supports •  Rigid support braces and permanent prostheses (maximum $10,000 per prostheses) •  Post-mastectomy bras 2 per calendar year •  Xxxxx socks 6 pairs per calendar •  Wigs and hair pieces for medical treatment, injury alopecia ($500 per lifetime) •  Manual wheelchairs, manual-type hospital beds, and necessary accessories •  Medical heart and blood glucose monitors, and cardiac screeners •  Bio-osteogen systems and growth guidance systems •  Breathing machines and appliances including respirators, compressors, precursors, suction pumps, oxygen cylinders, masks, and regulators (charges for rental) •  Insulin infusion set, not including pumps •  $200 for prescription eyewear every 24 months (12 months for dependent children) including sunglasses and safety lenses (employees may use benefit for a one-time application towards laser eye surgery) •  1 eye exam every 24 months (12 months for dependent children) up to $60 Dental Coverage •  100% of routine treatment (based on fee guide used in province of residence) •  Nine (9) month recall period for preventative treatment (polishing, fluoride, recall exams) •  Scaling (more than 6 units in a 12-month period may require pre-authorization) •  Complete exam 1 every 24 months •  Specific exam 1 every 6 months •  Panoramic x-ray 1 every 3 years •  Complete mouth x-ray series once every 24 months •  50% of major treatment with a $1,500 maximum per calendar year •  Crowns or bridge replacements are limited to 1 every 5 years •  One upper and one lower denture (complete or partial) are limited to the cost of the gold restoration •  Veneers, crowns, bridges, inlays, and onlays are subject to the condition outlined in the fee schedule. Where other material would suffice, you will be responsible for the difference between the cost of the chosen material and the cost of the alternative material •  50% of orthodontic treatment with a $2,000 lifetime maximum •  No benefit is payable for the replacement of appliances which are lost or stolen •  Services done for the correction of temporomandibular joint (TMJ) dysfunction are not covered •  Treatment performed solely for splinting is not covered •  100% coverage for emergency treatment due to accident or injury while traveling outside of your province/country Confidential, short-term counseling sessions for employees and dependents such as: •  marital and family problems •  substance abuse •  stress, anxiety, depression •  career-related concerns •  family advisory services •  child care, eldercare •  critical incident (trauma) •  bereavement •  advise or referral by a lawyer •  financial services •  referral to longer-term and/or specialized services, if required Where appropriate, the provider may refer you or your dependents to specialists and community resources for additional guidance and/or assistance We respect your confidentiality and privacy at all times. No one received will receive information concerning your use of the program without your written consent. A strict code of ethics concerning confidentiality governs the work of all EFAP professionals.

Prescriptions. 100% prescription coverage based on National Formulary; 70% coverage for prescriptions not covered under the National Formulary Formulary. • Dispensing fee cap of $8.50 8.50. • 100% subject to plan maximums and “reasonable and customary” expenses • 100% for Diabetic supplies and equipment • Semi-private hospital room • Private duty nursing $10,000 calendar year ($25,000 lifetime maximum) • Paramedical $500 per practitioner per year for ChiropractorChripractor/Osteopath/ Naturopath/Podiatrist/Massage Therapist/Acupuncture • Unlimited Physiotherapy for reasonable and customary charges • Psychologist/Speech Therapist $1,000 per year • $500 every 60 months for Hearing Aids • Full coverage for one pair of Orthopedic Shoes per year for reasonable and customary charges • $300 per year for prescribed custom-made Orthotics • To the nearest Canadian hospital equipped to provide essential care • Air transport when time is critical or condition prevents use of another mode of transport • Transport from one hospital to another when original hospital inadequate • Charge for an attendant when medically necessary • Oxygen blood and blood plasma • Lab tests and diagnostic services (not under gov. plan) • Ostomy and ilestomy supplies • Walkers, canes and cane tips, crutches, splints, casts, collars and trusses, but not elastic or foam supports • Rigid support braces and permanent prostheses (maximum $10,000 per prostheses) • Post-mastectomy bras 2 per calendar year • Xxxxx socks 6 pairs per calendar • Wigs and hair pieces for medical treatment, injury alopecia ($500 per lifetime) • Manual wheelchairs, manual-type hospital beds, and necessary accessories • Medical heart and blood glucose monitors, and cardiac screeners • Bio-osteogen systems and growth guidance systems • Breathing machines and appliances including respirators, compressors, precursors, suction pumps, oxygen cylinders, masks, and regulators (charges for rental) • Insulin infusion set, not including pumps • $200 for prescription eyewear every 24 months (12 months for dependent children) including sunglasses and safety lenses (employees may use benefit for a one-time application towards laser eye surgery) • 1 eye exam every 24 months (12 months for dependent children) up to $60 Dental Coverage • 100% of routine treatment (based on fee guide used in province of residence) • Nine (9) month recall period for preventative treatment (polishing, fluoride, recall exams) • Scaling (more than 6 units in a 12-month period may require pre-authorization) • Complete exam 1 every 24 months • Specific exam 1 every 6 months • Panoramic x-ray 1 every 3 years • Complete mouth x-ray series once every 24 months • 50% of major treatment with a $1,500 maximum per calendar year • Crowns or bridge replacements are limited to 1 every 5 years • One upper and one lower denture (complete or partial) are limited to the cost of the gold restoration • Veneers, crowns, bridges, inlays, and onlays are subject to the condition outlined in the fee schedule. Where other material would suffice, you will be responsible for the difference between the cost of the chosen material and the cost of the alternative material • 50% of orthodontic treatment with a $2,000 lifetime maximum • No benefit is payable for the replacement of appliances which are lost or stolen • Services done for the correction of temporomandibular joint (TMJ) dysfunction are not covered • Treatment performed solely for splinting is not covered • 100% coverage for emergency treatment due to accident or injury while traveling outside of your province/country Confidential, short-term counseling sessions for employees and dependents such as: • marital and family problems • substance abuse • stress, anxiety, depression • career-related concerns • family advisory services • child care, eldercare • critical incident (trauma) • bereavement • advise or referral by a lawyer • financial services • referral to longer-term and/or specialized services, if required Where appropriate, the provider may refer you or your dependents to specialists and community resources for additional guidance and/or assistance We respect your confidentiality and privacy at all times. No one received information concerning your use of the program without your written consent. A strict code of ethics concerning confidentiality governs the work of all EFAP professionals.country