| Manulife Flexcare® DentalPlus, ComboPlus Starter Plans | ||||||||||||||||||||||||||||
| This is not a contract. Actual terms and conditions are detailed in the policy issued upon application approval. | ||||||||||||||||||||||||||||
| If you have questions please call us at 1-800-474-4474, or email us at inquiries@healthquotes.ca | ||||||||||||||||||||||||||||
| Table of Contents (you can click on any coloured text to go to that section) | ||||||||||||||||||||||||||||
| - General Information | ||||||||||||||||||||||||||||
| - Effective Date of Coverage | ||||||||||||||||||||||||||||
| - Acceptance Period | ||||||||||||||||||||||||||||
| - Hospitalization/Pregnancy | ||||||||||||||||||||||||||||
| - Maximums | ||||||||||||||||||||||||||||
| - Newborns | ||||||||||||||||||||||||||||
| - Core Benefits Variations | ||||||||||||||||||||||||||||
| - Health Care Plans | ||||||||||||||||||||||||||||
| - Snapshot of Plans and Benefits (very useful when comparing the different plans, includes Seniors Adjustments) | ||||||||||||||||||||||||||||
| - DentalPlus™ (Dental Care Plans with Core Benefits) | ||||||||||||||||||||||||||||
| - Basic | ||||||||||||||||||||||||||||
| - Enhanced | ||||||||||||||||||||||||||||
| - Core Benefits (Basic and Enhanced Plans) | ||||||||||||||||||||||||||||
| - ComboPlus™ (Prescription Drug and Dental Care Plans with Core Benefits) | ||||||||||||||||||||||||||||
| - Starter | ||||||||||||||||||||||||||||
| - Core Benefits (Starter Plan) | ||||||||||||||||||||||||||||
| - Seniors' Adjustments | ||||||||||||||||||||||||||||
| - DentalPlus (Basic/Enhanced), Vision, Hospital | ||||||||||||||||||||||||||||
| - Travel | ||||||||||||||||||||||||||||
| - ComboPlus Starter (Drug Coverage) | ||||||||||||||||||||||||||||
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| GENERAL INFORMATION | ||||||||||||||||||||||||||||
| Effective Date of Coverage | ||||||||||||||||||||||||||||
| • Coverage is effective no earlier than the first day of the month following final approval of the application. | ||||||||||||||||||||||||||||
| Acceptance Period | ||||||||||||||||||||||||||||
| • If you and/or your family's
medical history is such that a higher premium is required or that special conditions be applied to benefits (see Medically Underwritten), you will be notified in writing prior to your decision to accept the coverage. If at that time you decide not to proceed with the coverage, any initial payment will be returned and your application cancelled. |
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| Hospitalization/Pregnancy | ||||||||||||||||||||||||||||
| • Full coverage is available for
expectant mothers who qualify for a Flexcare Core plan and the additional Hospital Coverage benefit within the first 20 weeks of pregnancy (Maternity Hospital stay is limited to 2 days). Manulife cannot guarantee the availability of private or semi-private hospital accommodation. |
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| - Table of Contents - | ||||||||||||||||||||||||||||
| Maximums | ||||||||||||||||||||||||||||
| • Unused portions of benefits
cannot be accumulated and added to coverage in future months or years. All maximums are per person, and not per family, unless otherwise stated. |
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| Newborns | ||||||||||||||||||||||||||||
| • Newborns of parents who are
enrolled in the FlexCare plan are automatically added to the same coverage if an application is made within 30 days of birth. If the application is after their 30th day, medical information will be required. |
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| Core Benefits Variations | ||||||||||||||||||||||||||||
| • Although Core Benefits come with
all FlexCare Plans there is a very slight variation in Core Benefits, depending on the type of FlexCare Plan you choose (e.g. DrugPlus Basic, DentalPlus Enhanced, etc.) |
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| HEALTH CARE PLANS | ||||||||||||||||||||||||||||
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| - Table of Contents - | ||||||||||||||||||||||||||||
| DentalPlus (Dental and Core Benefits) | ||||||||||||||||||||||||||||
| (You can choose either the Basic or Enhanced Plan, both come with Core Benefits) | ||||||||||||||||||||||||||||
| IMPORTANT - Dental coverage commences at
age 17 for residents of Prince Edward Island, age 13 for residents of Newfoundland and age 11 for residents of Nova Scotia. - Coverage is designed to concur with your current provincial Dental Association Fee Guide for General Practitioners. The FlexCare DentalPlus coverage will be adjusted to match any increases in the fee guide |
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| Basic Plan (DentalPlus) | ||||||||||||||||||||||||||||
| • No medical questionnaire required, guaranteed acceptance. | ||||||||||||||||||||||||||||
| • Coverage for fillings, cleanings, scalings, examinations, polishings, and certain extractions. | ||||||||||||||||||||||||||||
| • Recall visits every 9 months. | ||||||||||||||||||||||||||||
Coverage Table:
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| • Core Benefits are listed beneath the Enhanced Plan details. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| Enhanced Plan (DentalPlus) | ||||||||||||||||||||||||||||
| • No medical questionnaire required, guaranteed acceptance. | ||||||||||||||||||||||||||||
| • Coverage for fillings, cleanings, scalings, examinations, polishing, and certain extractions. | ||||||||||||||||||||||||||||
| • Recall visits every 6 months. | ||||||||||||||||||||||||||||
Coverage Table:
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| • The following 6
dental services (Enhanced plan only) have a combined maximum of $1,250 per 3 year period. For oral surgery, periodontics and endodontics (root canal), benefits are available beginning Year 2; for orthodontics, crowns, bridges and dentures. No benefit is available until Year 3. The payment percentage increase from the effective date of contract is as follows:
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| - Table of Contents - | ||||||||||||||||||||||||||||
| Core Benefits (Included with DentalPlus Basic and Enhanced Plans) | ||||||||||||||||||||||||||||
| Vision (Basic) | ||||||||||||||||||||||||||||
| • $250 maximum per 2
consecutive benefit years to cover the cost towards prescription
lenses, frames, contact lenses and laser eye surgery. | ||||||||||||||||||||||||||||
| • $50 maximum for Optometrist
fees per person per 2 consecutive benefit years (payable only after
Government Health Insurance Plan maximum has been reached, if applicable) | ||||||||||||||||||||||||||||
| • Eyeglasses are covered against breakage and
scratches by a repair guarantee for a period of 2 benefit years. This warranty applies to lenses and frames purchased with the Vision benefit of FlexCare. | ||||||||||||||||||||||||||||
| • No deductible is charged to
you if your eyeglasses can be repaired. If beyond repair, your
glasses will be replaced and; a $50 deductible charged for eyeglasses originally purchased for up to $250; or a $75 deductible, if the original purchase price was $251 to $300; or a $100 deductible, if your eyeglasses originally cost $301 or more. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| Extended Health Care (Starter) | ||||||||||||||||||||||||||||
| • $250,000 lifetime maximum. | ||||||||||||||||||||||||||||
| • Best Doctors®
Solutions Services – upon diagnosis of a serious illness or injury, you
can receive an evaluation of your medical records by world-class specialists who confirm the initial diagnosis and recommend appropriate treatment options. This fast, yet indepth review can reduce potentially serious complications from a misdiagnosis and help your local physician determine the proper course of action. In addition to medical advice, Best Doctors® provides the following services: treatment planning, identification of the most appropriate care provider, and care management. | ||||||||||||||||||||||||||||
| • Chiropractor, Chiropodist,
Osteopath, Naturopath, Podiatrist, Registered Massage Therapist,
Acupuncturist: - $20 max. per visit, 20 visit maximum per person per discipline per anniversary year. | ||||||||||||||||||||||||||||
| • Chiropractic X-ray - $35 maximum per anniversary year. | ||||||||||||||||||||||||||||
| • Psychologist - $80 max. first visit, $65 max. subsequent visits, 10 visit max. per anniversary year. | ||||||||||||||||||||||||||||
| • Speech Pathologist/Therapist -
$65 max. first visit, $45 max. subsequent visits, 10 visit maximum per anniversary year. | ||||||||||||||||||||||||||||
| • Physiotherapist - $250 max. per anniversary year. | ||||||||||||||||||||||||||||
| • HomeCare and Nursing, Prosthetic
Appliances, Durable Medical Equipment: - maximum per anniversary year for each of these 3 categories of benefits separately, is according to the following table:
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| • Lifeline® Personal Response Service - lifetime max. of 3 months of service, not including installation fee. | ||||||||||||||||||||||||||||
| • Accidental Dental - $2,000 maximum per anniversary year. | ||||||||||||||||||||||||||||
| • Ambulance - unlimited ground
transportation to hospital and $4,000 maximum for air ambulance transportation per anniversary year. | ||||||||||||||||||||||||||||
| • Hearing Aid - $400 maximum per 4 consecutive benefit years. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| Travel | ||||||||||||||||||||||||||||
| • $5 million emergency health
coverage for trips lasting a maximum of 9 days. (A $100 deductible
applies per claim). Additional coverage for either 8 or 21 days can be purchased as an Add-On. | ||||||||||||||||||||||||||||
| • NOTE: Coverage may be limited
or excluded for any illness or condition which first manifested
itself within the 9-month period preceding
the effective date of coverage. Not available to persons age 65 and over; 8 or 21 day Add-On Travel coverage now available with ComboPlus Starter Plan. | ||||||||||||||||||||||||||||
| Accidental Death & Dismemberment | ||||||||||||||||||||||||||||
| • $25,000 for adults under the age
of 65; $10,000 for children and adults age 65 and over, or a
child. Additional coverage can be purchased as an Add-on. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| Survivor Benefits | ||||||||||||||||||||||||||||
| • Provides for coverage to be continued for 1 year, following the death of an adult policyholder. | ||||||||||||||||||||||||||||
| • Available 1 year after policy effective date. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| ComboPlus™ (Prescription Drug, Dental and Core Coverage) | ||||||||||||||||||||||||||||
| • You can choose either the
Starter, Basic or Enhanced Plan, all come with Core Benefits. Note that Core Benefits for the Starter Plan are different than the Core Benefits that come with both the Basic and Enhanced Plan (Core is the same for both Basic and Enhanced). | ||||||||||||||||||||||||||||
| • For drug and dental coverage
with Core Benefits, without a medical questionnaire, choose the Starter Plan. | ||||||||||||||||||||||||||||
| • For more extensive drug and
dental coverage with Core Benefits, select either the Basic or Enhanced Plan. | ||||||||||||||||||||||||||||
| Starter Plan (ComboPlus™) | ||||||||||||||||||||||||||||
| (No medical questionnaire - guaranteed acceptance) | ||||||||||||||||||||||||||||
| Starter Drug Coverage | ||||||||||||||||||||||||||||
| • Generic
drug plan (name brand drugs allowed, but price paid will be deemed to be
the generic equivalent price). | ||||||||||||||||||||||||||||
| • Shared dispensing fee to a maximum of $6.50. | ||||||||||||||||||||||||||||
| • 70% on the first $750. | ||||||||||||||||||||||||||||
| •
Exclusions - smoking cessation drugs, over-the-counter drugs, fertility
drugs, birth control drugs, and drugs not requiring a prescription. | ||||||||||||||||||||||||||||
| • British Columbia and Saskatchewan residents:
Prescription drug benefit maximums based on calendar year. | ||||||||||||||||||||||||||||
| Starter Dental Coverage | ||||||||||||||||||||||||||||
|
• Dental coverage with a
70% payment for fillings, cleanings, scalings, examinations and
polishing on the first $575 of these services. | ||||||||||||||||||||||||||||
| • Recall visits every 9 months. | ||||||||||||||||||||||||||||
|
IMPORTANT - Dental coverage commences at age 17 for
residents of Prince Edward Island, age 13 for residents of Newfoundland and age 11 for residents of Nova Scotia. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||
| Extended Health Benefits (Starter) | ||||||||||||||||||||||||||||
| • $250,000 lifetime maximum. | ||||||||||||||||||||||||||||
| • Best
Doctors® Solutions Services – upon diagnosis of a serious illness or
injury, you can receive an evaluation of your medical records by world-class specialists who confirm the initial diagnosis and recommend appropriate treatment options. This fast, yet indepth review can reduce potentially serious complications from a misdiagnosis and help your local physician determine the proper course of action. In addition to medical advice, Best Doctors® provides the following services: treatment planning, identification of the most appropriate care provider, and care management. | ||||||||||||||||||||||||||||
| •
Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered
Massage Therapist, Acupuncturist: - $20 max. per visit, 20 visit maximum per discipline per anniversary year (payable only after Government Health Insurance Plan maximums have been reached, if applicable). | ||||||||||||||||||||||||||||
| • Chiropractic X-ray - $35 maximum per anniversary year. | ||||||||||||||||||||||||||||
| • Psychologist - $80 max. first visit, $65 max. subsequent visits, 10 visit max. per anniversary year. | ||||||||||||||||||||||||||||
| • Speech
Pathologist/Therapist - $65 max. first visit, $45 max. subsequent visits,
10 visit maximum per anniversary year. | ||||||||||||||||||||||||||||
| • Physiotherapist - $250 max. per anniversary year. | ||||||||||||||||||||||||||||
| • HomeCare
and Nursing, Prosthetic Appliances, Durable Medical Equipment: - maximum per anniversary year for each of these 3 categories of benefits separately, is according to the following table: NOTE: $225 max. per anniversary year for custom-made Orthotics, which are included as part of Prosthetic Appliances. | ||||||||||||||||||||||||||||
| • Lifeline® Personal Response Service - lifetime max. of 3 months of service, not including installation fee. | ||||||||||||||||||||||||||||
| • Accidental Dental - $2,000 maximum per anniversary year. | ||||||||||||||||||||||||||||
| •
Ambulance - unlimited ground transportation to hospital and $4,000 maximum
for air ambulance transportation per anniversary year (only payable after Government Health Insurance Plan maximums have been reached, if applicable). | ||||||||||||||||||||||||||||
| • Hearing Aid - $400 maximum per 4 consecutive benefit years. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| Travel | ||||||||||||||||||||||||||||
| • $5
million emergency health coverage for trips lasting a maximum of 9 days.
(A $100 deductible applies per claim.)
Additional coverage for either 8 or 21 days can be purchased as an Add-on. | ||||||||||||||||||||||||||||
| •
NOTE: Coverage may be limited or excluded for any
illness or condition which first manifested itself within the 9 month
period
preceding the effective date of coverage. Not available to persons age 65 and over; 8 or 21 day Add-On Travel coverage now available with this ComboPlus Starter Plan. | ||||||||||||||||||||||||||||
| Accidental Death & Dismemberment | ||||||||||||||||||||||||||||
| • Up
to$25,000 for adults under the age of 65; up to $10,000 for children and
adults age 65 and over. Additional coverage can be purchased as an Add-On. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| Survivor Benefits | ||||||||||||||||||||||||||||
| • Provides for coverage to be continued for 1 year, following the death of an adult policyholder. | ||||||||||||||||||||||||||||
| • Available 1 year after policy effective date. | ||||||||||||||||||||||||||||
| IMPORTANT
- Dental coverage commences at age 17 for residents of Prince Edward
Island, age 13 for residents of Newfoundland and age 11 for residents of Nova Scotia. - Coverage is designed to concur with your current provincial Dental Association Fee Guide for General Practitioners. The FlexCare DentalPlus coverage will be adjusted to match any increases in the fee guide. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| SENIORS' ADJUSTMENTS | ||||||||||||||||||||||||||||
| • If you are 65 years of age or
over, you are likely to have special health priorities. That is why
the Flexcare health plan coverage is adjusted to reflect your needs | ||||||||||||||||||||||||||||
| • Under the Seniors' Adjustments,
all of your benefits are as outlined in your chosen Core plan with the following changes: | ||||||||||||||||||||||||||||
| DentalPlus | ||||||||||||||||||||||||||||
| • There is no change to these Core plan benefits from what has been previously described. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| Travel | ||||||||||||||||||||||||||||
| • Travel coverage not available. | ||||||||||||||||||||||||||||
| ComboPlus Starter (Drug Coverage) | ||||||||||||||||||||||||||||
| • 100% on the first $750 of eligible prescription costs. | ||||||||||||||||||||||||||||
| • Full coverage of reasonable and customary dispensing fees. | ||||||||||||||||||||||||||||
| • Residents of Nova Scotia: 100% generic drugs on first $300. | ||||||||||||||||||||||||||||
| • Residents of British Columbia and Saskatchewan: Prescription drug benefits based on calendar year. | ||||||||||||||||||||||||||||
|
• IMPORTANT: For residents of New Brunswick, Manitoba and Saskatchewan prescription drug Seniors' adjustments do not apply. | ||||||||||||||||||||||||||||
| - Table of Contents - | ||||||||||||||||||||||||||||
| ™/® Trademarks are held by Manulife Financial. | ||||||||||||||||||||||||||||
| ® Lifeline is a trademark of Lifeline Systems Inc. | ||||||||||||||||||||||||||||
| Best Doctors®
is a registered trademark of Best Doctors, Inc. in the United States and
other countries and is used under license. |
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