Extended Health Care* 

Insurer: Self-Insured 
Policy #: 9000 

Benefits:

• Overall Maximum: $1,000,000 Lifetime
• 80% reimbursement up to first $1000 (paid) 100% thereafter, per calendar year
• Hospital: private & semi-private (deductible does not apply)
• Drugs: Prescription – DRUG CARD – Generic only
  • Oral ContraUnifortives and IUD’s Included
  • Includes Fertility drugs limited to Lifetime maximum of 3 cycles
  • Smoking Cessation limited to 3 months supply / lifetime
• Paramedics: Reimbursed @ 80% per practitioner:
  • Chiropractor, Naturopath and Podiatrist maximum $200 per calendar year
  • Speech Therapy & Acupuncture maximum $100 per calendar year
  • Massage Therapy maximum $300 per calendar year
  • Physiotherapy unlimited
• Private Duty Nursing: $10,000/yr; $25,000 lifetime max
• Hearing Aids: 80% to a maximum of $2500 every 5 years
• Orthopedic Shoes: 1 pair / yr to a maximum of $150
• Foot Orthotics: 1 pair / yr to a maximum of $300
• Eye exams: $65 / 24 months
• Emergency ambulance charges to nearest hospital equipped to provide medical treatment
• Wigs: $1,000 lifetime maximum (for hair loss due to chemotherapy treatment)
• Medical Supplies and Equipment including but not limited to:
  • canes and walkers, crutches, casts, burn garments, eye prosthesis, apnea monitors, CPAP machines, splints, oxygen and oxygen supplies, mastectomy bras ( two per calendar year) – [some of these items will need medical evidence to support the purchase]
• Out of Country referrals: 80% to a $50,000 lifetime maximum

*An employee can waive these benefits if that individual provides proof that he/she has comparable benefits through their spouse’s plan. If no proof is provided all benefits will be considered mandatory.