Health Care Benefits Details

Description of Benefits

The benefits described in this section apply to both the Member and their eligible Dependents.  Following a description of the benefits covered, you will find a description of how and when to file claims for these benefits.
 
The Extended Health Care benefit is designed to provide valuable supplementary protection but not to duplicate the Provincial Hospital and Medical Care Plans under which an individual is or could be protected.  Therefore, the Extended Health Care Insurance excludes (1) services and supplies to the extent benefits can be obtained for them under a provincial plan by fulfilling the requirements of that plan, and (2) services and supplies where private insurance is prohibited.   Additional exclusions are detailed in the section entitled “Exclusions”.  You should read the Covered Expenses with these exclusions in mind.  Before incurring any major expenses you may submit details to the Claims Department that will inform you what benefits, if any, are available under the Plan.
 
Charges for eligible services or supplies will be limited to the reasonable and customary cost for the expense up to any maximums specified in the “SUMMARY OF BENEFITS”.

Percentage Payable

The percentage payable is the maximum percentage of your costs that the plan will reimburse you, for your and your Dependents’ Covered Expenses, after any deductible is satisfied. 

Deductible

The deductible is the amount of Covered Expenses which you must pay each calendar year before benefits are payable under this plan.   

Calendar Year Maximum

The Calendar Year Maximum is the maximum amount the plan will allow any one individual for Extended Health Care Benefits in a single calendar year.

Lifetime Maximum

The Lifetime Maximum is the maximum amount this plan will allow any one individual for Extended Health Care benefits in their lifetime.