The Health Care Benefit is underwritten by Manulife Financial and the Travel Assistance Program is delivered through World Access.

The Health Care Benefit has been designed to help you meet the wide variety of medical and hospital expenses which are not covered by your Provincial Medicare Plan.

Manulife will base its liability on the least expensive service, supply or course of treatment which will achieve a professionally adequate result, with respect to all eligible Health Care Benefit expenses.

Before incurring any major expenses, the insured member should submit details to Manulife to determine to what extent benefits are payable. For some benefit coverage a letter will be required from a licensed physician describing the necessity and nature of the expenses.

Co-Insurance, Annual Reinstatement and Dispensing Fees

A. Hospital Expenses (Within Your Home Province)

B. Hospital & Medical Expenses (Outside your Home Province But Within Canada)

Contact World Access

C. Drug Expenses

D. Other Medical Expenses

1. Medical Practitioners & Services

2. Medical Equipment & Supplies

3. Vision Care (Benefit Levels 03, 04)

4. Hearing Aids

5. Dental Accident

E. Out of Country Emergency Care Expense

i) Medical Assistance Services

ii) Emergency Medical Care

iii) Transportation Services

iv) Personal and Legal Services

Is the country you are visiting open for travel?

Claiming

Call World Access

Exclusions and Limitations

Co-Insurance, Annual Reinstatement and Dispensing Fees

Co-insurance:

The co-insurance percentage refers to the percentage of eligible expenses payable by Manulife as outlined in the Schedule of Benefits. You will be required to pay the amount of the remaining eligible expenses that exceed the co-insurance percentage.

Annual Reinstatement:

When an insured person’s lifetime maximum is at least $10,000 lower than the Out-of-Country Benefit Maximum, you may apply to have up to $10,000 reinstated to the Out-of-Country Benefit Maximum by submitting evidence of insurability satisfactory to Manulife.

Dispensing Fees:

A dispensing fee of up to a maximum of $7 per prescription or refill will be paid by the Plan each time you purchase a prescription drug. You will be responsible for the cost of any dispensing fees in excess of the Plan maximum.

Eligible Expenses

Eligible expenses include charges for services, supplies and treatment incurred while you are covered under this Plan and, provided you are covered under your Provincial Medicare Plan and the expenses are:

• reasonable and customary in your province of residence, or in the province where incurred after first submitting the expenses to your provincial medicare plan.
• subject to the maximum in the Schedule of Benefits
• permitted by law to be insured, and
• specified as follows:

1. Hospital Expenses (within your Home Province)

Charges while confined to a hospital up to the semi-private room rate in excess of the public ward accommodation and subject to the maximum shown in the Schedule of Benefits,

Semi-private room and board charges in excess of ward accommodation in a convalescent home or rehabilitation hospital for a maximum of 180 days. Charges will be eligible provided the individual was confined to a hospital for at least 5 consecutive days and was admitted to the convalescent home within 48 hours of hospital discharge.

A convalescent home is a legally licensed nursing home or rehabilitation hospital with 24 hour nursing service and is not (other than incidentally) a place for rest, or treatment for the aged, or rehabilitation due to substance abuse.

2. Hospital and Medical Expenses (outside your Home Province but within Canada)

Eligible expenses are charges for services, supplies and treatment incurred while you are covered under this Plan and, provided you are covered under your Provincial Medicare Plan and the expenses are:

• reasonable and customary in the province where incurred
• first submitted to your provincial medicare plan.
• subject to the maximum in the Schedule of Benefits
• permitted by law to be insured.

Eligible expenses include:

• hospital charges:
• while confined to a hospital up to the semi-private room rate in excess of the public ward accommodation and subject to the maximum shown in the Schedule of Benefits,
• other inpatient and outpatient medical services
• a licensed physician
• professional licensed ambulance service, including air or rail ambulance service, to transport the covered person back to a hospital within their home Province
• blood, blood products and their transfusion.

Contact World Access

If you have a medical emergency and require hospital services while you are outside your home Province, you must contact World Access to ensure that expenses incurred during your treatment are fully covered. Should you decide not to contact WA, you will be responsible for paying any required deposits and/or expenses incurred. In this situation, you must keep all your receipts and submit these expenses to your Provincial Medicare Plan first and any eligible unpaid balance may then be submitted to Manulife for reimbursement. Please refer to your Emergency Travel Assistance brochure for details.

3. Drug Expenses

Eligible Drug Expenses include:

• drugs (including oral contraceptives) and medicines obtainable only with a written prescription from a physician or dentist, and dispensed by a licensed pharmacist,
• anti-smoking agents when available by prescription only, up to a lifetime maximum of $500 per individual,
• eligible injectible prescription drugs when administered by a physician,
• fertility and invitro procedures and drugs up to a combined lifetime maximum of $5,000,
• insulin and diabetic supplies

Reimbursement for eligible drug expenses are subject to the following:

• all drugs may be purchased using your MaritimeScript Drug card except: injectible drugs dispensed by a physician and fertility drugs
• a maximum dispensing fee of $7 per prescription or refill is paid
• reimbursement will be limited to the generic drug cost unless the physician indicates "no substitution" on the prescription.

• once a drug is classed as a "maintenance drug", one dispensing fee up to a maximum of $7 will be paid for each 90 day drug supply.

Eligible Drug Expenses do not include:

• vaccines, immunizations, serums (other than allergy serums), vitamins, minerals and anorexiants,
• dietary foods or supplements,
• drugs or preparations for cosmetic purposes,
• experimental and investigational drugs,
• food and food products, such as but not limited to, infant formula, sugar and salt substitutes, and
• household products, such as but not limited to, soap, toothpaste and shampoo.

4. Other Medical Expenses

1) Medical Practitioners & Services:

• Private duty nursing for acutely ill patients when not confined to a hospital, based on a minimum of one 4 hour shift per day, provided by a Registered Graduate Nurse, Registered Nursing Assistant, Registered Practical Nurse, Certified Nursing Assistant or Licensed Practical Nurse who is not a relative or normally a resident in the individual's home, to a maximum of $5,000 per individual per Plan Year. Medically necessary nursing services must be recommended by a doctor and include an outline of nursing duties required.
• Services of the Victorian Order of Nurses to a maximum of $400 per individual per Plan Year. Medically necessary nursing services must be recommended by a doctor and include an outline of nursing duties required.

• Licensed Practitioners to a maximum of $600 per practitioner per Plan Year, (the practitioner must meet Income Tax Act and Provincial legislation requirements), plus $25 per x-ray per Plan Year per type of practitioner, for the services of a/an:

Note:

- Supplies and/or remedies are excluded from this expense.

• All practitioners must be licensed with the appropriate provincial body. Please contact your union office or Manulife if you require further information.
• The Plan pays after provincial maximums have been reached for some practitioners in some provinces.

• Charges in excess of the amount payable under your Provincial Medicare Plan for emergency professional ambulance service to the nearest hospital at which adequate treatment is available. If an alternative mode of transportation is necessary, the benefit payable will be limited to the least expensive appropriate mode of transportation available.
• Charges for eye examinations (including refractions) when no coverage exists under the medicare plan in your province of residence, when performed by an Ophthalmologist or Optometrist, and limited to a maximum of $40 per examination once every 24 consecutive months.
• x-rays, radium therapy and diagnostic laboratory services.

2) Medical Equipment & Supplies:

• Rental (or purchase, at Manulife's option) of a wheelchair, or other durable medical equipment when approved by Manulife,
• When recommended by a physician, charges for the initial purchase of prosthetic appliances and replacements when needed because of changes in physical condition, up to a lifetime maximum of $10,000 per individual.
• Ileostomy, colostomy and glucose monitoring equipment.
• Charges for orthopaedic appliances including casts, splints, trusses, braces, and orthotic devices when prescribed by a licensed podiatrist, chiropodist, chiropractor, or physician; and orthopaedic shoes (if they are attached to and form part of a brace), limited to a maximum of $450 per individual per Plan Year.
• Charges for orthopaedic shoes when prescribed by a licensed podiatrist, chiropodist, chiropractor, or physician which are not attached to and forming part of a brace to a maximum of $300 per individual per Plan Year.
• Respiratory equipment including oxygen.
• Charges for intrauterine devices prescribed by a licensed physician will be covered to a maximum of 2 per Plan Year.

Before incurring any major expenses, the insured member should submit details to Manulife to determine to what extent benefits are payable. For some benefit coverage a letter will be required from a licensed physician describing the necessity and nature of the expenses.

3) Vision Care (Benefit Levels 03, 04):

• Necessary services or supplies as prescribed by a physician, ophthalmologist or optometrist for the following:

1. frames, prescription lenses (including contact lenses) and the fitting of glasses up to the amount specified in the Schedule of Benefits,

• Contact lenses prescribed following cataract surgery or for treatment of certain medical or surgical conditions to correct vision that cannot be improved to a level of 20/40 with regular eye glasses, (e.g., aphakia, keratoconus) up to the amount specified in the Schedule of Benefits.

- Optical expenses do not include plain sunglasses or safety glasses.

4) Hearing Aids:

- When recommended by a physician, the purchase, repair or replacement of hearing aids to a maximum of $600 every 5 consecutive plan years.

5) Dental Accident:

• accidental injuries to sound natural teeth, (excluding injuries caused by objects knowingly or unknowingly placed in the mouth) if expenses are incurred within 90 days of the accident, and the accident occurred while the individual was insured, to a maximum of $5,000 per injury per individual.
• Dental accident benefits will be paid up to the benefit maximums shown in the Schedule of Benefits but will not be combined with the dental benefit.

5. Emergency  Out of Country Coverage 

You and your eligible dependents are covered while travelling, working or vacationing outside Canada for up to 90 consecutive days.

Eligible expenses incurred for Out of Country Emergency Medical Care of a covered member, will be fully reimbursed up to the Lifetime Maximum of $1,000,000.

The following charges will be considered Eligible Out of Country Expenses provided they are incurred on an Emergency Basis:

• while confined to a hospital up to the average public ward accommodation rate, and
• other inpatient and outpatient medical services
• a licensed physician
• professional licensed ambulance service, including air or rail ambulance service, to transport the covered person back to a hospital within their home Province
• blood, blood products and their transfusion.

Emergency Travel Assistance Services for Out of Province or Country:

Manulife offers Emergency Travel Assistance (ETA) services which are administered by World Access Canada Inc. (WA), part of a global travel assistance company serving over 40 million people worldwide. If you should require medical assistance while traveling, contact World Access as soon as possible (before seeking treatment) so they can ensure you get the care you need without incurring unnecessary expenses. WA’s multilingual Call Centre is available 24 hours a day, 365 days a year worldwide. And because WA guarantees payment for many services, your out-of-pocket costs will be minimal. You can reach WA at either of the telephone numbers listed on your Emergency Travel Assistance card.

Emergency Travel Assistance has four main components:

1. Medical Assistance Services:

If you or your dependents become sick or injured while you are traveling, WA will help you locate a doctor or medical facility and will monitor the service they provide to ensure you receive adequate care. They will also confirm your coverage with Manulife and advise the service provider that payment for their (covered) services has been guaranteed. In this way, WA can eliminate the burden of most up-front payments for emergency medical care.

2. Emergency Medical Care:

Eligible expenses will be reimbursed for emergency hospital inpatient services. For example, if your illness or injury requires an overnight stay in hospital, you will be covered for:

• Room and board expenses in excess of the ward rate covered by your Provincial Health Insurance Plan
• Medical and surgical fees including physician fees;
• Cost of prescription drugs, x-rays, etc. incurred during your hospital stay

Eligible expenses will also be reimbursed for emergency hospital outpatient services. For example, if you should break your leg and are treated at a hospital as an outpatient, then physician fees, laboratory tests and medical supplies or appliances (i.e. casts) are covered. Physiotherapy and/or other paramedical expenses will be covered as the result of an outpatient emergency only if covered under your health care benefit.

3. Transportation Services

• Ambulance services (land, air, rail) will be provided if it’s necessary to transport you to a different hospital or treatment centre, either within the province or country where the illness or injury happened or to your home province. Medical supervision will also be provided if necessary.
• *If a medical emergency and hospitalization delays your trip home, you will be covered for the cost of a one-way economy fare for your insured traveling companion(s) to their province of residence.
• *If your hospitalization leaves your eligible dependent children unattended, you will be covered for the cost of transporting them home, and WA will arrange such transportation. This may include an escort if necessary.
• *If you have been traveling alone and are hospitalized for more than seven days, you will be covered for transportation costs (return, economy fare) for one immediate family member (i.e., spouse, parent, child, brother, or sister) to visit you.
• If your car is left behind due to illness, injury or death and no alternative driver is available, WA will arrange to have the vehicle returned to your home province or to the rental agency (up to $500. Cdn.).

• In the event an insured member dies while traveling, you will be covered for the cost of returning the deceased to their place of former residence or cremation at the place of death (up to $5,000. Cdn.).

* These three services are subject to a combined maximum benefit of $5,000 Cdn. per emergency.

4. Personal and Legal Services

Pre-Trip Services

Call World Access:

• For information concerning visa, inoculation, passport or immunization requirements of the foreign countries in which you’ll be traveling;
• To help you find the nearest embassy or consulate in the country in which you will be traveling.

Legal Services

Call World Access:

• To help locate a lawyer or arrange bail, if required;
• To arrange for the secure pick-up and delivery of any important documents (where possible)

Personal Assistance

Call World Access:

• For help in obtaining funds by wire or bank transfer (the funds and any costs of wire transfer would be your personal responsibility);
• To leave or receive messages during an emergency, 24 hours a day. This will help you keep family members informed during a critical situation;
• For assistance in reporting missing baggage and following up with the transportation company;
• If you luggage has been lost or stolen;
• If you need assistance in obtaining replacement travel documents or tickets (the costs of a replacement would be your responsibility);
• For translation services required during an emergency.

Emergency Travel Assistance will not cover charges that are excluded under your health benefit, as show in this benefit booklet or contract, or charges that are not incurred as a result of an emergency while travelling.

Is the Country You are Visiting Open for Travel?

It’s important to call World Access in advance of your travels, if there’s a chance the country you’ll be traveling to is in distress or strife (i.e. experiencing a military uprising, war, labour disturbance, or even hurricanes or other severe weather patterns), to ensure there is no problem getting emergency assistance while traveling.

The Department of Foreign Affairs and International Trade publishes and updates a list of countries that are currently affected. You can obtain this list by calling World Access (see your card or this booklet for telephone numbers).

Claiming:

If the expense you incur is for $200 or less, you will be required to pay for these costs yourself and seek reimbursement upon your return. Please ensure you keep your receipts for these expenses to submit to either your Provincial Health Care Plan or Manulife upon your return.

Call World Access:

In the U.S.A. (toll-free) 1-877-252-9857

Elsewhere (call collect) 1-519-742-8073

You’ll need to quote your World Access # 9994 if you need emergency assistance.

And remember … store your card with other important travel documents and take it with you when you travel.

Even in non-medical emergency situations, you should contact WA before incurring any out-of-pocket expenses. WA can then help you find the most cost-effective solution to your problem.

Eligible Out of Country Expenses will be:

• reduced by any amounts which may be payable elsewhere under the Health Care Benefit,
• reduced by any amounts payable, or which would have been payable had proper application been made or had the individual been insured thereunder, by the insured's Provincial Health Insurance Plan.

• 2 years after the date of your death,
• the termination of the Group Policy,
• the remarriage of the Spouse (children will continue to be insured up to the maximum 2 year benefit period),
• the date the dependent child ceases to qualify as a dependent.
• the date coverage for your dependents terminates for any reason.

Eligible expenses do not include and no payments will be made for:

• services or supplies, if the payment is prohibited by law,
• services or supplies for which no charge would have been made in the absence of this coverage,
• services, supplies or treatment payable by your Provincial Medicare Plan or by Workers' Compensation or any similar Act,
• periodic check-ups, expenses incurred for the purposes of a third party, or during travel for health reasons,
• services, supplies or treatment received from the medical or dental department maintained by an employer, association, union, or any other similar type group,
• any dental services or supplies other than those provided under the a accidental dental provision, or
• room and board accommodation in a chronic care facility or a chronic care wing of a Hospital or Convalescent Home, or

- claims resulting from:

• self-inflicted injuries or illnesses,
• insurrection, rebellion, war whether declared or not, or participation in a riot or civil commotion
• committing or attempting to commit a criminal offence,
• cosmetic surgery or treatment unless necessitated by an accident and commenced within 90 days of the accident,
• medical, surgical or dental treatment in any way related to the correction of temporomandibular joint dysfunction.