plan information
The plan information described here relates to the plan that is
in effect as of 01 Apr 2001, with an ending date of 31 Dec 2002. This plan is currently insured by the Great Canadian Insurance Company.
eligibility
You and each
of your family members are eligible for benefits, after you have satisfied a waiting
period of 3 months following your date of employment.
An eligible family member includes your spouse, and all dependent children
living with you who have not yet reached age 19. Students attending university in Canada on a full-time basis
are considered eligible for benefits until they reach age 26.
plan maximum
The maximum
amount that will be paid under this plan in respect of eligible expenses for any one
family member, is $25,000.00 in any 3
year period.
plan deductible
You are
responsible for paying the first $25.00 of the eligible
expenses for each of your family members, subject to a family maximum of $50.00 in any one calendar year.
percentage paid (coinsurance)
Unless otherwise
modified by the table below, the plan will reimburse you for 100% of all your eligible expenses
which are in excess of the plan deductible.
eligible expenses
The following
is a summary of the benefits covered by your plan with applicable limits, which are in
turn still subject to the plan maximum, coinsurance and deductible features described
above.
The unit
maximums are the maximum amounts that will be considered as an eligible expense, which are
then subject to any coinsurance and deductible features.
The interval
maximum, if any, is simply the maximum dollar amount that will be paid in the interval,
regardless of any coinsurance or deductible features.
| Code |
Description |
Percent Paid |
Unit Maximum |
1st Unit Maximum |
Max No Units |
Interval Maximum |
Interval |
| pdrg1 |
Prescription
Drugs |
80.00 |
|
|
|
|
|
| visi1 |
Vision
Care |
|
|
|
|
500.00 |
24
months |
| hosp1 |
Semi
Private Hospital |
|
|
|
|
|
|
| para1 |
Paramedical
Services |
|
15.00 |
25.00 |
10 |
|
12
months |
| nurs1 |
Nursing
care |
|
|
|
|
10,000.00 |
lifetime |
| ambu1 |
Ambulance
Services |
|
|
|
|
200.00 |
per
trip |
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
confidentiality
The
information which is maintained by your plan administrator with respect to your benefit
coverage is confidential. This information is only available to you or your authorized
agent.