Schedule of Benefits
Benefit Level 04
(default)

MEMBER LIFE INSURANCE

All Eligible Members

Amount of Insurance

Under age 65

$ 100,000

Age 65 to age 69

$ 50,000

Age 70 and over

$ 5,000

MEMBER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE

All Eligible Members

Amount of Insurance

Under age 65

$ 100,000

Age 65 to age 69

$ 50,000

Age 70 and over

Nil

MEMBER WEEKLY DISABILITY BENEFIT
All Eligible Members Amount of Insurance
Under age 75 $ 700

MEMBER CRITICAL CONDITION BENEFIT

All Eligible Members

Amount of Insurance

Under age 65

$ 50,000

MEMBER & FAMILY ASSISTANCE PROGRAM

Counseling available through Family Services for you and your family.

MEMBER & FAMILY ALCOHOL & DRUG COUNSELING PROGRAM

Alcohol & Drug counseling services available for you and your family through Family Services.

MEMBER & FAMILY DENTAL BENEFIT

Co-Insurance (paid by the Plan): 90%: of all eligible Basic & Restorative expenses

Maximum: Basic & Restorative (combined) - no annual maximum

60%: of all eligible Major expenses paid by the plan

50%: of all eligible orthodontic expenses paid by the plan

Maximum: Basic, Restorative & Major (combined) - $1,500 per individual per Plan Year

Orthodontic - $2,500 per lifetime per dependent child up to and including age 18.

Provincial Fee Guide: Reimbursement will be based on the Current Dental Association Fee Guide for Dental Practitioners of:

  • the province where charges are incurred, if incurred in Canada; or
  • the covered person’s home province, if incurred outside of Canada; or
  • for Plan Members who reside primarily outside of Canada, payment will be based on reasonable and customary charges in Canada.

Your dental benefits and those of your dependents will terminate when you reach age 75.

MEMBER & FAMILY HEALTH CARE BENEFIT

Co-Insurance (paid by the plan):

90%: of all eligible expenses (except 100% of all eligible out of country emergency expenses).

   

Maximum - Eligible Members:

 
   

Under age 70:

  • Unlimited (subject to appropriate benefit maximums shown in this booklet).

Age 70 to age 74:

  • All Health Care Benefit expenses (except Emergency Out of Country  Coverage, which terminates on March 31st following the Member’s 70th birthday) to an annual maximum of $3,000 per person starting on the April 1st following the Member’s 70th birthday.

Age 75 or over:

  • No Health Care Benefits for you or your family.
   

HEALTH CARE BENEFITS

BENEFIT MAXIMUMS

   

Prescription Drugs:

  • Manulife Financial: Pay Direct Drug Card,
  • drugs available only by prescription, and with the following limits:
  a) Maximums:
  • up to $7 dispensing fee per prescription or refill
  • up to generic drug expense unless the physician indicates "no substitution" on the prescription.
  b) Maintenance
Drugs:
  • 90 day supply at one time, once classed as a maintenance drug (i.e. one $7 dispensing fee per 90 days).

Vision Care:

  • Prescription lenses (including contact lenses), frames, and the fitting of glasses; up to $500 in any consecutive 24 month period.
  • Contact lenses for certain specified conditions; up to $200 every 24 consecutive months.
Hospital (in Canada):
  • Semi-private Hospital Room and Board charges in excess of ward accommodation up to $10,000 per Plan Year.

Convalescent Hospital:

  • Semi-private room and board charges in excess of ward accommodation in a convalescent home or rehabilitation hospital for a maximum of 180 days per disability.

Nursing (out of hospital):

  • Private duty nursing for acutely ill patients when not confined to a hospital, based on a minimum of one four hour shift per day to a maximum of $5,000 per Plan Year.
   
HEALTH CARE BENEFITS

BENEFIT MAXIMUMS

Victorian Order of Nurses:
  • To a maximum of $400 per Plan Year.

Medical Practitioners:

  • Up to $600 each per Plan Year for licensed/registered medical practitioners
  • Practitioners must meet Income Tax Act and Provincial Legislation requirements.

Eye Examinations:

  • When no coverage exists under the medicare plan in your province of residence, to a maximum of $40 per examination once every 24 consecutive months.

Hearing Aids:

  • Purchase, repair or replacement to a maximum of $600 every 5 consecutive Plan Years.
   

Orthopaedic Appliances:

  • When prescribed to a maximum of $450 per Plan Year
   

Orthopaedic Shoes:

  • When prescribed and not attached to or forming part of a brace, to a maximum of $300 per Plan Year
   

Prosthetic Appliances:

  • For initial purchase up to a lifetime maximum of $10,000
  • Replacements are only eligible when needed due to changes in physical condition.
   

I U D ’s:

  • When prescribed by a licensed physician to a maximum of 2 per Plan Year.
   

Fertility Drugs & InVitro:

  • Up to a combined lifetime maximum of $5,000.
   

Anti-Smoking Aids:

  • Available by prescription only and up to a lifetime maximum of $500.
   
Accidental Dental:
  • Up to $5,000 per injury.
   
Out of Province Benefits:

 

  • All claims incurred outside your province of residence, must first be submitted to your provincial Health Plan for reimbursement. Any eligible unpaid balance may then be submitted to Manulife for payment under the Benefit Plan. The Plan will reimburse eligible health care expenses incurred outside your province of residence, but within Canada, at the same benefit level as expenses incurred within your province of residence
Out of Country Benefits (Emergency Only):
  • Emergency Out of Country expenses (limited to a 90 day absence):

Lifetime maximum - $1,000,000 per person's lifetime

Annual Reinstatement - $10,000 per individual

  • Average ward accommodation in Canada
  • Benefit terminates on March 31st following the Member’s 70th birthday.

 

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