| Prescription Drugs |
| Prescription formulary | - 100% coverage of eligible drugs including coverage of reasonable & customary drug ingredient cost mark-ups (15% drug markup limit)
- No deductible
- Drugs legally requiring a prescription, diabetic supplies, preventative vaccines (excluding non-life-sustaining over-the-counter [OTC] vaccines)
- May be subject to Prior Authorization
- Pay-direct drug card available
- Lowest cost alternative limitation
- Therapeutic class pricing
- $8 maximum dispensing fee
- Limit of five dispensing fees paid by the plan per maintenance medication per year (note, this limit does not apply to drugs purchased in Quebec)
- $5,000 lifetime maximum for fertility drugs (except as may be provided by law, such as in Quebec)
- $700 lifetime maximum for smoking cessation products and expenses (counselling, nicotine replacement and certain medications)
|
Paramedical Services:
- Acupuncturist
- Chiropodist/Podiatrist
- Chiropractor
- Dietitian
- Naturopath
- Osteopath
- Registered massage therapist
- Speech therapist/Speech language pathologist/ Audiologist
| - Maximum $550, per practitioner, per benefit year
|
Mental Health Services:
- Psychologist/Social worker/ Psychotherapist/Registered family therapist
| - Maximum $3,000 per benefit year (combined)
|
| Physiotherapist/ Athletic therapist and Occupational therapist | - Maximum $1,500 per benefit year (combined)
|
| Vision Care |
| Glasses and contacts | - Maximum $500 per 24 months
|
| Eye exam | - Maximum $120 per 24 months
|
| Laser eye surgery | |
| Medical Services and Supplies |
| Orthotics | |
| Orthopedic shoes | |
| Hearing aids | |
| Ambulance | - Transport to nearest facility
- Includes air ambulance
|
| Private duty nursing (nursing care) | |
| Semi-private hospital | - Covered (the trust will pay the difference between semi-private and ward accommodation)
|
| Emergency Travel Medical Coverage |
| Global Medical Assistance and Out-of-Country Emergency Care | - 100% coverage
- Up to 60 days/trip
- $1 million per trip
|
| Dental |
| Reimbursement Guide | - Based on current fee guide for province of treatment
|
| Basic Services | - 100% of checkups, x-rays, fillings, etc.
- No annual maximum
- Recall exams every nine months for adults; every six months for children under age 19
- 10 units of basic/periodontal scaling (combined) per rolling 12 months
|
| Major Restorative Services | - 65%
- $2,500 maximum per benefit year
|
| Periodontics/Endodontics | - 100% coverage of root canals and related services
- 100% coverage of scaling, root planing, gum treatments, etc.
|
| Orthodontics | - 50% coverage for adults and children
- $3,000 lifetime maximum
|
| Life insurance |
| Basic Life (member only) | - 2x annual salary, up to $1,000,000 combined maximum with Member Optional Life
- No reduction at age 65
- Ends at retirement
|
| Member Optional Life | - Member-paid, based on gender, age and smoking status
- Up to $500,000, in units of $10,000
|
| Spousal Optional Life | - Member-paid, based on gender, age and smoking status
- Up to $500,000, in units of $10,000
|
| Child Optional Life | Member-paid
Up to $25,000, in units of $5,000 |
| Optional Critical Illness insurance |
| Member Optional Critical Illness | - Up to $250,000, in units of $10,000
- $50,000 non-evidence maximum
|
| Spousal Optional Critical Illness | - Up to $250,000, in units of $10,000
- $50,000 non-evidence maximum
|
| Accident (AD&D) insurance |
| Basic AD&D (member only) | - 2x annual salary, up to $500,000 maximum
- No reduction at age 65
- Ends at retirement or age 70 (whichever is earlier)
|
| Member Optional AD&D | - Member-paid
- Up to $250,000, in units of $10,000
- Ends at retirement or age 70 (whichever is earlier)
|
| Spousal Optional AD&D | - Member-paid
- Up to $250,000, in units of $10,000
- Coverage ends at member’s retirement or when member or spouse turns age 70 (whichever is earlier)
|
