Local 1S Health & Welfare

Claims Payment Service

Plan Summary

Select a benefit below to view the summary

Overall Maximum = Unlimited. All expenses covered by the Plan must be medically necessary, reasonable & customary in the circumstances

Overall Deductible = None

$50,000 – Members only

Prescription Drugs

90% reimbursement; subject to mandatory generic pricing and reasonable and customary dispensing fees

Deductible

No deductible

Reimbursement Level

90% Basic Services

70% Major Services

50% Orthodontic Services

Maximums

$2,500 per year for Major Services; $4,000 per lifetime for Orthodontic Services

Basic Services

Includes diagnostic, preventative, minor restorative, endodontics, periodontics

Major Services

Includes crowns, bridges, dentures, inlays, onlays

Orthodontic Services

For dependents under age 21 only

Benefit Amount

100% reimbursement

$400 every 24 months for glasses, contacts, laser eye surgery. Rx Safety Glasses are excluded.

Eye Exams

One eye exam every 24 months

Reimbursement Level

80% reimbursement

Benefit Amount

$500 annual maximum each: Audiologist, Chiropractor, Clinical Psychologist, Licensed Massage Therapist, Naturopath, Registered Dietician, Osteopath, Reflexologist, Speech Therapist, Cardiac Rehab, Athletic Therapist

$500 combined annual maximums: Acupuncturist/Physiotherapist and Podiatrist/Foot Care Nurse

Orthotics & Orthopedic Shoes

80% reimbursement. $400 per 24 months combined

Custom Orthotics are limited to $300 in a calendar year out of the overall combined maximum
1 pair of shoes per calendar year, per covered person, out of the overall combined maximum

Reimbursement

80% reimbursement

Eligible Supplies

Oxygen (maximum $1,000 per calendar year), ostomy and ileostomy supplies, intrauterine contraceptive devices (IUD’s), walkers, canes and cane tips, crutches, casts, and trusses, splints and collars, rigid support braces and permanent prostheses (artificial eyes, limbs, and mastectomy forms). Mastectomy brassieres ($250 per calendar year), stump socks ($250 per calendar year), surgical stockings ($250 per calendar year), compression garments (30 mmHg and up), wigs and hairpieces.

Myoelectrical limbs are excluded, but the Plan will pay the equivalent of a standard prosthesis

80% reimbursement

80% reimbursement

$2,500 per 60 consecutive months

100% reimbursement

$2,500 per month maximum, for no more than a total of 12 months for one stay

Semi-private or private hospital room

80% reimbursement

$3,000 per 12 consecutive months

$50,000

Weekly benefit matches EI maximum

Payable from 8th day of accident or illness, to a maximum of 26 weeks
EI benefits are payable for weeks 27-52
Benefits are taxable

*To be eligible for disability coverage, full-time members must have 3 years of continuous service and part-time members must have 6,240 hours of service.

$1,000 per month

Payable after elimination period (later of 301 days or expiration of EI sickness benefits)

Payable up to age 65 as long as total disability continues
Total disability: unable to perform own occupation for first 12 months; thereafter any occupation

Pre-existing condition clause applies

Benefits are taxable

*To be eligible for disability coverage, full-time members must have 3 years of continuous service and part-time members must have 6,240 hours of service.

Voluntary, confidential, short-term counseling and advisory service that connects you and your eligible family members to a network of dedicated professionals who are available to give you assistance 24/7

Phone: 1-844-880-9137
Web: one.telushealth.com
username: unifor1s
password: eap

Benefit insured by Manulife. Global Excel is the claims service provider.

Coverage Period: 90 days per trip

Maximum for Members up to and including age 69: $5,000,000 per insured person, per trip
Maximum for Members age 70-79: $100,000 per insured person, per trip

Maximum Age: 79

Policy Number: DAT00013334

Must be in a stable medical condition before travelling. Consult ETA Booklet for other restrictions.

Click here for wallet card and schedule of benefits.