SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. 39.1 The Employer shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan. 39.2.1 Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles 39.2.2 to 39.2.15. Effective January 1, 2003 reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. 39.2.1.1 Not later than November 1, 2006 the Employer agrees to provide employees with a Drug Card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date. 39.2.1.2 The Drug Card program shall include the following elements: 1) Employees shall be obliged to enrol themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. 39.2.2 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s health care; 39.2.5 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.6 Effective June 1, 2002, charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.7 Effective June 1, 2002, artificial limbs and eyes, crutches, splints, casts, trusses and braces; seventy-five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.

Appears in 4 contracts

Samples: Collective Agreement, Collective Agreement, Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. 39.1 The Employer shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan. 39.2.1 Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles 39.2.2 to 39.2.15. Effective January 1, 2003 reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. 39.2.1.1 Not later than November 1, 2006 the Employer agrees to provide employees with a Drug Card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date. 39.2.1.2 The Drug Card program shall include the following elements: 1) Employees shall be obliged to enrol themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. 39.2.2 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s health care; 39.2.5 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.6 Effective June 1, 2002, charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.7 Effective June 1, 2002, artificial limbs and eyes, crutches, splints, casts, trusses and braces; seventy-five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of ~~one~~ one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. 39.1 The Employer shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan. 39.2.1 Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles 39.2.2 to 39.2.15. Effective January 1, 2003 reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. 39.2.1.1 Not later than November 1, 2006 the Employer agrees to provide employees with a Drug Card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date. 39.2.1.2 The Drug Card program shall include the following elements: 1) Employees shall be obliged to enrol themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the ~~benefits~~ beneﬁts of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. 39.2.2 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s health care; 39.2.5 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.6 Effective June 1, 2002, charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.7 Effective June 1, 2002, artificial limbs and eyes, crutches, splints, casts, trusses and braces; seventy-five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.

Appears in 2 contracts

Samples: Collective Agreement, Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. ~~39.1~~ The Employer shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan~~. 39.2.1~~ . Effective June ~~1, 2002,~~ the Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. .The ~~Supplementary Health~~ SupplementaryHealth and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the ~~difference between~~ differencebetween the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June ~~1, 2002,~~ the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles ~~39.2.2~~ to ~~39.2.15.~~ Effective January ~~1, 2003~~ reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. 39.2.1.1 Not later than November ~~1, 2006~~ the Employer agrees to provide employees with a Drug Card, ,which ~~shall provide~~ shallprovide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date~~. 39.2.1.2~~ . The Drug Card program shall include the following elements: 1) Employees shall be obliged to enrol themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. 39.2.2 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s health care; 39.2.5 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.6 Effective June 1, 2002, charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.7 Effective June 1, 2002, artificial limbs and eyes, crutches, splints, casts, trusses and braces; seventy-five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.

Appears in 1 contract

Samples: Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. 39.1 The Employer shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan. 39.2.1 Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a ~~physician’s~~ physician‟s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles 39.2.2 to 39.2.15. Effective January 1, 2003 reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. 39.2.1.1 Not later than November 1, 2006 the Employer agrees to provide employees with a Drug Card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date. 39.2.1.2 The Drug Card program shall include the following elements: 1) Employees shall be obliged to enrol themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. 39.2.2 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the ~~employee’s~~ employee‟s home, by a registered nurse or a registered nursing assistant who is not normally resident in the ~~employee’s~~ employee‟s home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the ~~employee’s~~ employee‟s health care; 39.2.5 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.6 Effective June 1, 2002, charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.7 Effective June 1, 2002, artificial limbs and eyes, crutches, splints, casts, trusses and braces; seventy-five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a ~~podiatrist’s~~ podiatrist‟s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the ~~Employer’s~~ Employer‟s intranet and ~~Union’s~~ Union‟s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.

Appears in 1 contract

Samples: Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. ~~39.1~~ 21.4.1 The ~~Employer~~ Agency shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan. ~~39.2.1 Effective June 1, 2002, the~~ 21.4.2 The Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. ~~Effective June 1, 2002, the~~ The Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles ~~39.2.2~~ 21.4.5 to ~~39.2.15~~21.4.18. ~~Effective January 1, 2003 reimbursement~~ Reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. ~~39.2.1.1 Not later than November 1, 2006 the~~ 21.4.3 The Employer agrees to provide employees with a Drug Card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date. ~~39.2.1.2~~ 21.4.4 The Drug Card program shall include the following elements: 1) Employees shall be obliged to ~~enrol~~ enroll themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to ~~enrol~~enroll, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. ~~39.2.2~~ 21.4.5 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; ~~39.2.3~~ 21.4.6 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; ~~39.2.4~~ 21.4.7 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s 's home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s 's health care; ~~39.2.5 Effective June 1, 2002, charges~~ 21.4.8 Charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and ~~practising~~ practicing within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($~~1200~~1,200) per type of practitioner following O.H.I.P. and speech therapist, up to ~~twenty~~ twenty-five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($~~1400~~1,400); ~~39.2.6 Effective June 1, 2002, charges~~ 21.4.9 Charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($~~1400~~1,400);. ~~39.2.7 Effective June 1, 2002, artificial~~ 21.4.10 Artificial limbs and eyes, crutches, splints, casts, trusses and braces; ~~seventy-~~seventy- five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of ~~one~~ one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; ~~39.2.8~~ 21.4.11 Rentals of ~~wheel chairs~~wheelchairs, hospital beds or iron lungs required for temporary therapeutic use. A ~~wheel chair~~ wheelchair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); ~~39.2.9~~ 21.4.12 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; ~~39.2.10~~ 21.4.13 Oxygen and its administration; ~~39.2.11~~ 21.4.14 Blood transfusions outside hospital; ~~39.2.12~~ 21.4.15 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; ~~39.2.13~~ 21.4.16 Hearing aids and eye glasses, if required as a result of accidental injury; ~~39.2.14 Effective June 1, 2002, charges~~ 21.4.17 Charges for services of physicians, surgeons and specialists legally licensed to ~~practise~~ practice medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; ~~39.2.15~~ 21.4.18 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100);. ~~39.2.16 Effective August 1, 2005, the~~ 21.4.19 The services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan~~. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website;~~. ~~39.2.17 Effective August 1, 2005 the~~ 21.4.20 The Supplementary Health & Hospital Plan will ~~be amended to~~ include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of ~~two thousand dollars (~~$~~2,000)~~ 2,000 every 5 years per person. 2) Purchase of Insulin Jet Injectors to a maximum of $1,000, lifetime. 3) Purchase and/or repair of one Blood Glucose monitoring machine per consecutive 4-year period to a maximum of $400 per person. 4) 100% of the purchase of supplies required for the use of the above referenced diabetic appliances to a calendar year maximum of $2,000 per person (Insulin will continue to be reimbursed as an eligible drug, not through this article). 21.4.21 The Employer agrees to pay eighty percent (80%) of the monthly premiums for vision care and sixty percent (60%) of the monthly premiums for hearing aid coverage, under the Supplementary Health and Hospital Plan, with the balance of the monthly premiums being paid by the employee through payroll deduction. This coverage includes a ten dollar ($10.00) (single) and twenty dollar ($20.00) (family) deductible in any calendar year and provides for vision care (maximum three hundred and forty dollars [$340.00] per person in any twenty-four [24] month period) and the purchase of hearing aids (maximum twelve hundred dollars [$1200.00] per person every four (4) years) equivalent to the vision and hearing aid component of the Blue Cross Extended Health Care Plan. The eligible expenses outlined in the vision care coverage under the Supplementary Health and Hospital Plan will include laser eye correction surgery. 21.4.22 It is not necessary for an employee or dependents to be confined to hospital to be eligible for benefits under this plan. If an employee is totally disabled or his or her dependent is confined to hospital on the date his or her Supplementary Health and Hospital Insurance terminates, benefits shall be payable until the earliest of: the date the total disability ceases, the date his or her dependent is discharged from hospital, or the expiration of six (6) months from the date of termination of insurance. 21.4.23 Where an employee is totally disabled, coverage for Supplementary Health and Hospital Insurance will cease at the end of the month in which the employee receives his or her last pay from the Employer, except as provided in Article 16.16 (

Appears in 1 contract

Samples: Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. 39.1 The Employer shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan. 39.2.1 Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles 39.2.2 to 39.2.15. Effective January 1, 2003 reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. 39.2.1.1 Not later than November 1, 2006 the Employer agrees to provide employees with a Drug Card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date. 39.2.1.2 The Drug Card program shall include the following elements: 1) Employees shall be obliged to enrol themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. 39.2.2 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s home, and who is not related to either the employee or ~~his or her~~ their dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s health care; ~~39.2.5~~ 39.2.5.1 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); ~~39.2.6~~ 39.2.5.2 Effective ~~June~~ January 1, ~~2002~~2023, charges for the services of a ~~psychologist~~ chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (~~which shall include Master~~ if licensed and practising within the scope of ~~Social Work) up~~ their license), to ~~twenty-five~~ a maximum of thirty dollars ($2530) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per ~~half-hour~~ type of practitioner following O.H.I.P. and speech therapist, up to thirty dollars ($30) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); ~~39.2.7~~ 39.2.5.3 Effective ~~June~~ January 1, ~~2002~~2024, ~~artificial limbs~~ charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and ~~eyes, crutches, splints, casts, trusses~~ masseur (if licensed and ~~braces; seventy-five percent (75%)~~ practising within the scope of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pairtheir license), to a maximum of thirty-five dollars ($35) for each visit to an annual maximum of one thousand and two hundred dollars ($~~500~~1200) per ~~calendar year. Notwithstanding the forgoing~~type of practitioner following O.H.I.P. and speech therapist, ~~coverage for employees of institutions shall be two~~ up to thirty-five dollars (2$35) ~~pairs of orthotics~~ per ~~calendar year~~ half hour, to a an annual maximum of ~~five~~ one thousand and four hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($5001400); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.

Appears in 1 contract

Samples: Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. 39.1 The Employer shall pay one hundred percent (100%) of the monthly premium of the Supplementary Health and Hospital Plan. 39.2.1 Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles 39.2.2 to 39.2.15. Effective January 1, 2003 reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. 39.2.1.1 Not later than November 1, 2006 the Employer agrees to provide employees with a Drug Card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below. The Employer will provide a copy of the drug card plan prior to the implementation date. 39.2.1.2 The Drug Card program shall include the following elements: 1) Employees shall be obliged to enrol themselves and all eligible participants in the Drug Card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the Drug Card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. 4) The sum of $3.00 shall be paid by the employee for each individual drug dispensed. 39.2.2 Charges for accommodation, for employees sixty-five (65) and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s health care; 39.2.5 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.6 Effective June 1, 2002, charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.7 Effective June 1, 2002, artificial limbs and eyes, crutches, splints, casts, trusses and braces; seventy-five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ~~ready~~ ready-made, off-the-shelf with a limit of ~~one~~ one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.two

Appears in 1 contract

Samples: Collective Agreement

Appears in 1 contract

Samples: Collective Agreement

SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE. ~~39.1~~ 37.1 The Employer shall pay one hundred percent (100%) % of the monthly premium of the Supplementary Health and Hospital Plan. ~~39.2.1 Effective June 1, 2002, the~~ 37.2.1 The Supplementary Health and Hospital Plan shall provide for the reimbursement of ninety percent (90%) of the cost of prescribed drugs and medicines that require a physician’s prescription. The Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the generic equivalent where a generic equivalent exists. Where the brand name product is dispensed, the employee will pay the difference between the cost of the brand name product and the ninety percent (90%) of the generic equivalent product cost that is reimbursed by the Supplementary Health and Hospital Plan. Notwithstanding the foregoing, if no generic product exists the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of the brand name product. Effective June 1, 2002, the Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of one hundred and twenty dollars ($120) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Articles 39.2.2 to 39.2.15. Effective January 1, 2003 reimbursement of prescription drugs will include a three dollar ($3) deductible per prescription to be paid by the employee. Effective April 1, 2009, the Supplementary Health and Hospital Plan shall provide reimbursement for ninety percent (90%) of the cost of medically necessary vaccinations or immunizations when prescribed and administered by a qualified health care practitioner where such vaccine or immunization is not covered by a provincial health plan. ~~39.2.1.1 Not later than November 1, 2006 the~~ 37.2.2 The Employer agrees to provide employees with a ~~Drug Card~~drug card, which shall provide for direct payment of drug costs at the point of purchase, subject to the limitations set out below~~. The Employer will provide a copy of the drug card plan prior to the implementation date~~. ~~39.2.1.2 The Drug Card program shall include the following elements:~~ 1) Employees who have not already done so shall be obliged to enrol themselves and all eligible participants in the ~~Drug Card~~ drug card program before coverage shall be provided to the respective employee or eligible participant. If an employee fails to enrol, paper claims will continue to be accepted. 2) The Employer and the carrier shall have the right to ensure that the benefits of the employee and other eligible participants under the ~~Drug Card~~ drug card program shall be coordinated with any other drug plan under which the employee and the eligible participants may be entitled to coverage. 3) The ~~Drug Card~~ drug card program shall include a feature known as “~~drug utilization review~~Drug Utilization Review”, which ensures that drugs are dispensed safely and responsibly to employees. 37.2.3 The Supplementary Health and Hospital Plan will be amended to include expanded coverage for diabetic pumps and supplies as follows: 1) Purchase of insulin jet infusion pumps to a maximum of two thousand dollars ($2,000) every five years per person. 2) Purchase of insulin jet injectors to a lifetime maximum of one thousand dollars ($1,000). 3) Purchase and/or repair of one blood glucose monitoring machine for consecutive four (4)-year period to a maximum of four hundred dollars ($400) per person. 4) ~~The sum~~ 100% of the purchase of supplies required for the use of the above referenced diabetic appliances to a calendar year maximum of two thousand dollars ($~~3.00 shall~~ 2,000) per person. (Insulin will continue to be ~~paid by the employee for each individual drug dispensed~~reimbursed as an eligible drug, not through this Article). ~~39.2.2~~ 37.2.4 The Supplementary Health and Hospital Plan shall provide for the reimbursement of one hundred percent (100%) of the cost of semi-private or private hospital accommodation to a maximum of two hundred and ten dollars ($210) per day over and above the cost of standard xxxx care, and one hundred percent (100%) of the cost for the following services, as set out in Article 37.3.1(a) to 37.3.1(n). 37.3.1 (a) Charges for accommodation, for employees ~~sixty-five (65)~~ 65 and over, in a licensed chronic or convalescent hospital up to twenty-five dollars ($25) per day and limited to one hundred and twenty (120) days per calendar year for semi-private or private accommodation; 39.2.3 Charges made by a licensed hospital for out-patient treatment not paid for under a provincial plan; 39.2.4 Charges for private-duty nursing in the employee’s home, by a registered nurse or a registered nursing assistant who is not normally resident in the employee’s home, and who is not related to either the employee or his or her dependents, provided such registered nursing service is approved by a licensed physician or surgeon as being necessary to the employee’s health care; 39.2.5 Effective June 1, 2002, charges for the services of a chiropractor, osteopath, naturopath, podiatrist, physiotherapist, and masseur (if licensed and practising within the scope of their license), to a maximum of twenty-five dollars ($25) for each visit to an annual maximum of one thousand and two hundred dollars ($1200) per type of practitioner following O.H.I.P. and speech therapist, up to twenty five dollars ($25) per half hour, to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.6 Effective June 1, 2002, charges for the services of a psychologist (which shall include Master of Social Work) up to twenty-five dollars ($25) per half-hour to an annual maximum of one thousand and four hundred dollars ($1400); 39.2.7 Effective June 1, 2002, artificial limbs and eyes, crutches, splints, casts, trusses and braces; seventy-five percent (75%) of the cost of specially modified orthopaedic shoes (factory custom) ready made, off-the-shelf with a limit of one (1) pair to a maximum of five hundred dollars ($500) per pair per calendar year, if medically necessary and prescribed by a licensed physician; and one hundred percent (100%) of the cost of orthotics, if medically prescribed, up to a limit of one (1) pair, to a maximum of five hundred dollars ($500) per calendar year. Notwithstanding the forgoing, coverage for employees of institutions shall be two (2) pairs of orthotics per calendar year to a maximum of five hundred dollars ($500) per pair and two (2) pairs of orthopaedic shoes per calendar year to a maximum of five hundred dollars ($500) per pair; 39.2.8 Rentals of wheel chairs, hospital beds or iron lungs required for temporary therapeutic use. A wheel chair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost. Fifty percent (50%) of the cost of repair (including batteries) and modifications to purchased wheel chairs provided that reimbursement for any one repair, battery or modification shall in no event exceed five hundred dollars ($500); 39.2.9 Ambulance services to and from a local hospital qualified to provide treatment, excluding benefits allowed under a provincial hospital plan; 39.2.10 Oxygen and its administration; 39.2.11 Blood transfusions outside hospital; 39.2.12 Dental services and supplies, provided by a dental surgeon within a period of twenty-four (24) months following an accident, for the treatment of accidental injury to natural teeth, including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medicare plan; 39.2.13 Hearing aids and eye glasses, if required as a result of accidental injury; 39.2.14 Effective June 1, 2002, charges for services of physicians, surgeons and specialists legally licensed to practise medicine which, when provided within Canada but outside the Province of Ontario, exceed the O.H.I.P. fee schedule, the allowance under this benefit being up to one hundred percent (100%) of the O.M.A. fee schedule when added to government payments under the O.H.I.P. fee schedule; 39.2.15 Charges for surgery by a podiatrist, performed in a podiatrist’s office, to a maximum of one hundred dollars ($100); 39.2.16 Effective August 1, 2005, the services and supplies set out in the Liberalization List, dated May 1, 2003 shall be incorporated into the Supplementary Health and Hospital Plan. Details may be found in the information booklet described in article 39.6 and on the Employer’s intranet and Union’s website; 39.2.17 Effective August 1, 2005 the Supplementary Health & Hospital Plan will be amended to include expanded coverage for Diabetic Pumps and Supplies as follows: 1) Purchase of Insulin Infusion Pumps to a maximum of two thousand dollars ($2,000) every 5 years per person.

Appears in 1 contract

Samples: Collective Agreement

Common use of SUPPLEMENTARY HEALTH AND HOSPITAL INSURANCE Clause in Contracts