Common use of SUPPLEMENTARY HEALTH AND HOSPITAL Clause in Contracts

SUPPLEMENTARY HEALTH AND HOSPITAL. 36.1 The Supplementary Health and Hospital Insurance Plan shall provide to every employee who joins the plan, a) Effective July 1, 2006, reimbursement for ninety percent (90%) of the cost of all prescription drugs that by law require a physician’s prescription, including injectable drugs, and medicines prescribed by a licensed physician or other licensed health professional who is legally authorized to prescribe such drugs, and dispensed by a licensed pharmacist or by a physician legally authorized to dispense such drugs and medicine (excluding drugs that may be purchased over-the-counter). Provided that a generic drug is listed in the Canadian Pharmaceutical Association Compendium of Pharmaceuticals and Specialities, reimbursement will be at ninety percent (90%) based on the lowest price generic version of the drug. This reimbursement will remain at this level regardless of whether the employee chooses to purchase the generic or the brand-name drug. However, if the prescribing physician or health professional stipulates no substitution, reimbursement will be based on the cost of the drugs prescribed provided that the employee submits a photocopy of the physician’s or health professional’s direction, together with the claims submission. For clarity, a photocopy of the prescription containing the prescribing physician’s or health professional’s substitution direction would be sufficient. If no generic equivalent exists, reimbursement will be at ninety percent (90%) of the reasonable and customary cost of the brand name product. The total prescription cost for claims will be composed of the drug ingredient cost plus up to nine dollars ($9) per prescription for the pharmacies’ professional fee (dispensing fee.) Effective with the introduction of the Drug Card, this provision will no longer apply. The plan covers erectile dysfunction drugs including Viagra to a maximum of five hundred dollars ($500) per year. The Employer will provide every employee who joins the plan 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 Drug Card shall include the following elements: (i) 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. (ii) 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. (iii) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. (iv) The sum of three dollars ($3) shall be paid by the employee for each individual drug dispensed. b) Reimbursement for charges for private or semi-private room hospital care made by a hospital within the meaning of the Public Hospitals Act or by a hospital that is licensed or approved by the governing body in the jurisdiction in which the hospital is located not exceeding one hundred and twenty dollars ($120) above the charge by the hospital for standard xxxx room hospital care for each day to every employee; c) Charges incurred for out-of hospital services of a legally licensed Chiropractor, Osteopath, Chiropodist, Podiatrist, Naturopath, Masseur or Physiotherapist who renders a service within the scope of his/her license, to a maximum of thirty-five dollars ($35) per visit for each visit not subsidized by OHIP and to an annual maximum of twelve hundred dollars ($1,200) for each type of service. Charges for the services of a Speech Therapist who renders a service within the scope of his/her license, to a maximum of forty dollars ($40) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). Effective January 1, 2014, charges incurred for out-of hospital services of a legally licensed Chiropractor, Osteopath, Chiropodist, Podiatrist, Naturopath, Masseur or Physiotherapist who renders a service within the scope of his/her license, to a maximum of twenty-five dollars ($25) per visit for each visit not subsidized by OHIP and to an annual maximum of twelve hundred dollars ($1,200) for each type of service. Effective January 1, 2014, charges for the services of a Speech Therapist who renders a service within the scope of his/her license, to a maximum of twenty-five dollars ($25) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). d) Effective July 1, 2006 until December 31, 2013, charges for the services of an Acupuncturist who renders a service within the scope of his/her license, to a maximum of thirty-five dollars ($35) per visit, to an annual maximum of twelve hundred dollars ($1,200). e) Effective July 1, 2006, charges for the services of a Psychologist who renders a service within the scope of his / her license, to a maximum of forty dollars ($40) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). Coverage shall also include services rendered by a Social Worker with a Master’s Degree in Social Work and within the scope of his/her license, where such services are equivalent to the services that would otherwise be provided by a Psychologist. Effective January 1, 2014, charges for the services of a Psychologist who renders a service within the scope of his / her license, to a maximum of twenty-five dollars ($25) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). f) Expanded Diabetic Supplies coverage for, (i) Insulin infusion pumps – two thousand dollars ($2,000) every five

SUPPLEMENTARY HEALTH AND HOSPITAL. 36.1 The Supplementary Health and Hospital Insurance Plan shall provide to every employee who joins the plan, a) Effective July 1, 2006, reimbursement Reimbursement for ninety percent (90%) of the cost of all prescription drugs that by law require a physician’s prescription, including injectable drugs, and medicines prescribed by a licensed physician or other licensed health professional who is legally authorized to prescribe such drugs, and dispensed by a licensed pharmacist or by a physician legally authorized to dispense such drugs and medicine (excluding drugs that may be purchased over-the-counter). Provided that a generic drug is listed in the Canadian Pharmaceutical Association Compendium of Pharmaceuticals and SpecialitiesSpecialties, reimbursement will be at ninety percent (90%) based on the lowest price generic version of the drug. This reimbursement will remain at this level regardless of whether the employee chooses to purchase the generic or the brand-name drug. However, if the prescribing physician or health professional stipulates no substitution, reimbursement will be based on the cost of the drugs prescribed provided that the employee submits a photocopy of the physician’s or health professional’s direction, together with the claims submission. For clarity, a photocopy of the prescription containing the prescribing physician’s or health professional’s substitution direction would be sufficient. If no generic equivalent exists, reimbursement will be at ninety percent (90%) of the reasonable and customary cost of the brand name product. The total prescription cost for claims will be composed of the drug ingredient cost plus up to nine dollars ($9) per prescription for the pharmacies’ professional fee (dispensing fee.) Effective with the introduction of the Drug Card, this provision will no longer apply. The plan covers erectile dysfunction drugs including Viagra to a maximum of five hundred dollars ($500) per year. The Employer will provide every employee who joins the plan 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 Drug Card shall include the following elements: (i) 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. (ii) 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. (iii) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. (iv) The sum of three dollars ($3) shall be paid by the employee for each individual drug dispensed. b) Reimbursement for charges for private or semi-private room hospital care made by a hospital within the meaning of the Public Hospitals Act or by a hospital that is licensed or approved by the governing body in the jurisdiction in which the hospital is located not exceeding one hundred and twenty dollars ($120) above the charge by the hospital for standard xxxx room hospital care for each day to every employee; c) Charges incurred for out-of hospital services of a legally licensed Chiropractor, Osteopath, Chiropodist, Podiatrist, Naturopath, Masseur or Physiotherapist who renders a service within the scope of his/her license, to a maximum of thirtytwenty-five dollars ($3525) per visit for each visit not subsidized by OHIP and to an annual maximum of twelve hundred dollars ($1,200) for each type of service. Charges for the services of a Speech Therapist who renders a service within the scope of his/her license, to a maximum of forty twenty-five dollars ($4025) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). . d) Effective January 1, 20142014 until May 16, 2019, charges incurred for out-of hospital the services of a legally licensed Chiropractor, Osteopath, Chiropodist, Podiatrist, Naturopath, Masseur or Physiotherapist Psychologist who renders a service within the scope of his/her license, to a maximum of twenty-five dollars ($25) per visit for each visit not subsidized by OHIP and to an annual maximum of twelve hundred dollars ($1,200) for each type of service. Effective January 1, 2014, charges for the services of a Speech Therapist who renders a service within the scope of his/his / her license, to a maximum of twenty-five dollars ($25) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). d) . Effective July 1May 17, 2006 until December 31, 2013, charges for the services of an Acupuncturist who renders a service within the scope of his/her license, to a maximum of thirty-five dollars ($35) per visit, to an annual maximum of twelve hundred dollars ($1,200). e) Effective July 1, 20062019, charges for the services of a Psychologist who renders a service within the scope of his / her license, to a maximum of forty dollars ($40) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). Coverage shall also include services rendered by a Social Worker with a Master’s Degree in Social Work and within the scope of his/her license, where such services are equivalent to the services that would otherwise be provided by a Psychologist. Effective January 1, 2014, charges for the services of a Psychologist who renders a service within the scope of his / her license, to a maximum of twenty-five dollars ($25) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). fe) Expanded Diabetic Supplies coverage for, (i) Insulin infusion pumps – two thousand dollars ($2,000) every five

SUPPLEMENTARY HEALTH AND HOSPITAL. 36.1 The Supplementary Health and Hospital Insurance Plan shall provide to every employee who joins the plan, a) Effective July 1From August 1 to August 31, 20062003, reimbursement for ninety percent (90%) of the cost of drugs and medicine dispensed by a legally qualified medical practitioner or by a pharmacist within the meaning of Part VI of the Health Disciplines Act on the written prescription of a legally qualified medical practitioner; Effective September 1, 2003 reimbursement for ninety percent (90)% of the cost of all prescription drugs that by law require a physician’s prescription, including injectable drugs, and medicines prescribed by a licensed physician or other licensed health professional who is legally authorized to prescribe such drugs, and dispensed by a licensed pharmacist or by a physician legally authorized to dispense such drugs and medicine (excluding drugs that may be purchased over-the-counter). Provided that a generic drug is listed in the Canadian Pharmaceutical Association Compendium of Pharmaceuticals and Specialities, reimbursement will be at ninety percent (90%) based on the lowest price generic version reasonable and customary cost of the generic drug. This reimbursement will remain at this level regardless of whether the employee chooses to purchase the generic or the brand-name drug. However, if the prescribing physician or health professional stipulates no substitution, reimbursement will be based on the cost of the drugs prescribed provided that the employee submits a photocopy of the physician’s or health professional’s direction, together with the claims submission. For clarity, a photocopy of the prescription containing the prescribing physician’s or health professional’s substitution direction would be sufficient. If no generic equivalent exists, reimbursement will be at ninety percent (90%) of the reasonable and customary cost of the brand name product. The ; Effective September 1, 2003, the total prescription cost for claims will be composed comprised of the drug ingredient cost plus up to nine eight dollars ($98.00) per prescription for the pharmacies’ professional fee (dispensing fee.). Effective January 1, 2005 the pharmacies’ professional fee (dispensing fee) Effective with the introduction of the Drug Card, this provision will no longer apply. The plan covers erectile dysfunction drugs including Viagra be increased to a maximum of five hundred nine dollars ($5009.00) per year. The Employer will provide every employee who joins the plan 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 Drug Card shall include the following elements: (i) 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. (ii) 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. (iii) The Drug Card program shall include a feature known as “drug utilization review”, which ensures that drugs are dispensed safely and responsibly to employees. (iv) The sum of three dollars ($3) shall be paid by the employee for each individual drug dispensed.prescription; b) Reimbursement reimbursement for charges for private or semi-private room hospital care made by a hospital within the meaning of the Public Hospitals Act or by a hospital that is licensed or approved by the governing body in the jurisdiction in which the hospital is located not exceeding one hundred and twenty dollars ($120) above the charge by the hospital for standard xxxx room hospital care for each day to every employee; c) Charges From August 1 to August 31, 2003, charges incurred for out-of-hospital services of a legally licensed Chiropractor, Osteopath, Chiropodist, Podiatrist, Naturopath, Speech Therapist, Masseur or Physiotherapist who renders a service within the scope of his/her license, to a maximum of twelve dollars ($12) per visit for each visit not subsidized by OHIP; Effective September 1, 2003 charges incurred for out-of hospital services of a legally licensed Chiropractor, Osteopath, Chiropodist, Podiatrist, Naturopath, Masseur or Physiotherapist who renders a service within the scope of his/her license, to a maximum of thirty-five dollars ($35) per visit for each visit not subsidized by OHIP and to an annual maximum of twelve hundred dollars ($1,200) for each type of service. Charges Effective September 1, 2003, charges for the services of a Speech Therapist who renders a service within the scope of his/her license, to a maximum of forty dollars ($40) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). Effective January 1, 2014, charges incurred for out-of hospital services of a legally licensed Chiropractor, Osteopath, Chiropodist, Podiatrist, Naturopath, Masseur or Physiotherapist who renders a service within the scope of his/her license, to a maximum of twenty-five dollars ($25) per visit for each visit not subsidized by OHIP and to an annual maximum of twelve hundred dollars ($1,200) for each type of service. Effective January 1, 2014, charges for the services of a Speech Therapist who renders a service within the scope of his/her license, to a maximum of twenty-five dollars ($25) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). d) Effective July September 1, 2006 until December 31, 20132003, charges for the services of an Acupuncturist who renders a service within the scope of his/her license, to a maximum of thirty-five thirty dollars ($3530) per visit, to an annual maximum of twelve hundred dollars ($1,200).; e) From August 1 to August 31, 2003, charges for the services of a psychologist up to sixteen dollars ($16) per half-hour for individual psychotherapy and/or testing and twelve dollars ($12) per visit for all other visits; Effective July September 1, 20062003, charges for the services of a Psychologist who renders a service within the scope of his / his/her license, to a maximum of forty thirty-five dollars ($4035) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). Coverage shall also include services rendered by a Social Worker with a Master’s Degree in Social Work and within the scope of his/her license, where such services are equivalent to the services that would otherwise be provided by a Psychologist. Effective January 1, 2014, charges for the services of a Psychologist who renders a service within the scope of his / her license, to a maximum of twenty-five dollars ($25) per half hour, to an annual maximum of fourteen hundred dollars ($1,400). f) Effective September 1, 2003, the Supplementary Health and Hospital Insurance Plan will include Expanded Diabetic Supplies coverage for, (i) , • Insulin infusion pumps – two thousand pumps-$2,000/5 years • Jet Injectors-$1,000/lifetime • Blood Glucose monitoring machines--reasonable and customary costs for the purchase and /or repairs of one machine per person per consecutive 4 year period • 100% of reasonable and customary costs of supplies related to the use of the above-referenced diabetics appliances; these supply costs shall not be subject to appliance maximums. g) Effective September 1, 2003, coverage will include Orthopaedic Shoes and Orthotic benefits as follows: • Orthopaedic shoes: seventy-five percent (75%) of the cost of one pair or one repair per year to a maximum of five hundred dollars ($2,000500) every fiveper year;