Local 1928 Health & Welfare

Claims Payment Service

Plan Summary

Select a benefit below to view the summary

Overall Maximum

$1,000,000. All expenses covered by the Plan must be medically necessary, reasonable & customary in the circumstances

Overall Deductible

$75 for single Members
$150 per couple
$200 per family

Co-Insurance

Extended Health benefits are provided at the rate of 80% of the first $1,000 of eligible paid expenses, followed by 100% of all other eligible expenses incurred in the balance of the calendar year

$30,000 – Members only

Reimbursement for drugs require the written prescription of a physician.

Drugs and medicines are limited to a 90 day supply.

Fertility drugs are covered to a maximum of $5,000 per lifetime.

Excludes oral contraceptives, smoking cessation, over the counter drugs, vitamins, preventative drugs, dietary foods and supplements

Deductible

No deductible

Reimbursement Level

90% Basic Services

50% Major Services

of the Dental Association Fee Guide in the Province of treatment

Maximums

$2,500 combined maximum per year

Basic Services

Includes diagnostic, preventative, surgical, restorative, prosthetics, root canals, periodontia, anesthesia

Major Services

Includes crowns, bridges, dentures, inlays, onlays

Orthodontic Services

Not Covered

Benefit Amount

100% reimbursement

$500 every 24 months for eye exams, glasses, frames, and contacts. Limit of 1 pair of glasses per person, per 24 months. Rx Sunglasses and Safety Glasses are excluded

Laser Eye Surgery

100% reimbursement up to $1,000 lifetime maximum, provided there was no vision claim within the 24 months prior to surgery, and no vision claim will be available until 24 months after the surgery.

Reimbursement Level

80% reimbursement

Benefit Amount

$350 per year, per covered person for each practitioner

Eligible practitioners include; massage therapist, speech therapist, acupuncturist, psychologist (includes registered clinical counsellors and licensed social workers), podiatrist, chiropodist, chiropractor, naturopath or physiotherapist

Orthopedic Shoes

80% reimbursement

One pair, including replacement pairs, of custom-fitted orthopedic shoes, when prescribed by a physician or podiatrist every 12 consecutive months

Orthotics

80% reimbursement

$350 per calendar year

Reimbursement

80% reimbursement

Eligible Supplies

Oxygen, blood or blood plasma, ostomy, ileostomy supplies, walkers, canes and cane tips, crutches, splints, casts, collars and trusses but not elastic or foam supports, testing supplies, needles and syringes for diabetics, surgical stockings (maximum of 4 pair per calendar year), stump socks, surgical brassieres (4 per calendar year), rigid support braces and permanent prostheses (artificial eyes, limbs, larynxes and mastectomy forms).

Reimbursement Level

80% reimbursement. Subject to reasonable and customary limits

Eligible Equipment

Purchase of durable equipment for therapeutic treatment including wheelchairs and hospital beds. Electric wheelchairs are covered only when a doctor certifies the patient is incapable of operating a manual wheelchair (e.g. Paraplegic).

CPAP machines (maximum of 1 per 5 years), CPAP masks (maximum of 2 masks per year), hose (tubing) (1 per year), filters (maximum of 2 per year), water chamber (maximum of 1 per year)

80% reimbursement

$500 lifetime maximum

80% reimbursement

Semi-private or private hospital room

60 day maximum.

Charges for out-of-hospital private duty nurse services when medically necessary. Services must be for nursing care, and not for custodial care. The private duty nurse must be a nurse, or nursing assistant who is licensed, certified or registered in the province where you live and who does not normally live with you. The services of a registered nurse are eligible only when someone with lesser qualifications cannot perform the duties.

Members – $30,000

Spouse – $20,000; Child – $5,000

$400 per week

26 weeks maximum

Integrated with E.I.

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

Coverage Period: 90 days per trip

Maximum for Members up to 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: DAT00013348

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