Blue Choice (Ontario Blue Cross) Health Plan

                                   This is not a contract. Actual terms and conditions are detailed in the policy issued upon application approval.

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Table of Contents (you can click on any coloured text to get to that section)

- General Information

- Dependents

- Applying as a Single Applicant

- Review of Medical History

- Blue Cross Assistance

- Health Plans

- 1. Core Health Benefits

- Extended Health Benefits

- Travel Benefits

- Accidental Death and Dismemberment

- LifeLink Critical Illness Benefit

- 2. Hospital Coverage

- 3. Core Health and Hospital Coverage

- Optional Coverage

- Prescription Drug Benefits

- Dental Benefits

GENERAL INFORMATION

Dependents

• Your dependents are covered: up to age 25 if they're in full-time attendance at an accredited institution,
college or university; or to age 21 if they're unmarried, unemployed and living at home.

Applying as a Single Applicant

• If you are a member of a couple or family , you may not apply as a single applicant unless your spouse is
already covered under a similar plan and proof of coverage is provided.

Review of Medical History

• You must provide medical history information using the application form.

• Review of medical history may result in a higher than standard premium, or you may be declined or
excluded for specific benefits. Special conditions may be applied as a result of your and /or your family's
medical history. If this is the case, you will be notified by Blue Cross prior to your decision to accept
coverage.

Blue Cross Assistance

• All Blue Choice Health Care Plans include 24-hour toll-free telephone assistance for your health related
questions.

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HEALTH PLANS

1. Core Health Benefits

Extended Health Benefits

• The following extended health benefits are reimbursed at 80%, up to the specified maximum.
Amounts refer to each covered person.

• Accidental Dental - up to $2,000 per year.

• Ambulance Services - amount of coverage equals costs not covered by OHIP.

• Medical Devices and Supplies - artificial limbs, wheelchair rental, etc. Up to $2,500 per year.

• Hearing Aids - up to $300 (excluding batteries) every 5 years. Subject to a 3 month waiting period.

• Nursing Care Services - RNA and Health Care Aides. Up to $2,500 per year.

• Orthopedic Shoes - up to $175 per year.

• The following extended health benefits are reimbursed at 100%, up to the specified maximum.
Amounts refer to each covered person.

• Registered Therapists and Specialists - coverage and the number of covered visits vary depending on
                                                         the type of specialist involved (see table below).
                                                       - Note that benefits are payable only after the yearly maximum
                                                         allowed under OHIP has been reached.

SPECIALIST	INITIAL VISIT	SUBSEQUENT VISITS	MAXIMUM # OF VISITS
Psychologist	$75	$60	20
Speech Therapist	$60	$40	12
Massage Therapist	$20	$20	20
Chiropodist	$20	$20	25
Podiatrist	$20	$20	25
Naturopath	$20	$20	25
Physiotherapist	$20	$20	25
Osteopath	$20	$20	25
Chiropractor	$20	$20	25
Acupuncturist	$20	$20	25

• Vision Care - up to $150 over 2 years, and subject to a 3 month waiting period.

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Travel Benefits

• Coverage applies to persons who are residents of Ontario, and benefits are provided as a result of an
accident or unexpected illness.

• 15 day annual travel plan that provides emergency medical coverage while traveling outside the province.

• Benefits are paid at 100%, with an unlimited number of trips per year (15 day maximum per trip).

• Covers emergency hospital and medical expenses.

• Worldwide Assistance Service. There are also no deductibles.

• Available top-up coverage. There is also emergency financial assistance.

• Up to $5 million in coverage, and coverage is available up to age 75.

• Medical conditions for which the covered person has been treated or has requested medical treatment or
advice during a period of 90 days preceding the date on which travel is to commence will not be covered.

• Certain limitations may apply, refer to your contract for details.

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Accidental Death and Dismemberment

• Maximum amount payable is: $25,000 per applicant; $25,000 per spouse; and $5,000 per dependent child
(note that the term "principal sum" refers to these payable amounts just mentioned).

• Not available over the age of 75.

• Loss of Life - 100% of principal sum.

• Loss of, or loss of use of, both hands or both feet or sight in both eyes - 100% of principal sum

• Loss of, or loss of use of, one hand and sight in one eye - 100% of principal sum.

• Loss of, or loss of use of, one foot and sight in one eye - 100% of principal sum.

• Loss of, or loss of use of one hand or foot or sight in one eye - 50% of principal sum.

• Exposure and Disappearance - 365 days after an accident, losses due to exposure may be claimed. 365
days after a disappearance, a covered person will be presumed to be
deceased.

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LifeLink Critical Illness Benefit

• Provides a lump sum cash payment to help an insured person cope with a severe critical illness or condition.

• Conditions except for severe burns must result from sickness or disease. The following conditions are
medically defined in the contract, and are covered according to degrees of severity:

	Under Age 55	Age 55-64
Applicant	$10,000	$5,000
Spouse	$10,000	$5,000
Dependents	$5,000	N/A

• Not available over the age of 64.

• The severe critical illness must manifest itself 90 days after the effective date of the policy.

• Any conditions existing prior to the coverage will exclude you from this benefit. Note that benefits are
subject to a 30-day survival period (refer to your contract for further details).

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2. Hospital Coverage

• 100% coverage for up to $200 per day for semi-private or private accommodation in a public general
hospital.

• Coverage for up to 90 days per year.

• Benefits are not paid for hospitalization due to a pregnancy or pregnancy-related condition during the first
8-month period after the effective date of coverage.

3. Core Health Benefits and Hospital Coverage

• Combined benefits of both Core Health and Hospital Coverage.

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OPTIONAL COVERAGE

Note: You can add to or change the options to your plan at any time, according to your needs (medical
evidence will be required).

Prescription Drug Benefits

• 80% reimbursement for eligible prescribed medications.

• Pay Direct Card.

• Available only to persons under 65 years of age.

• $10,000 per year per person maximum.

• Reimbursement is based on the lowest-cost generic equivalent if available (a generic drug is a generally
less expensive alternative to an interchangeable brand name drug product).

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Dental Benefits

• Three month waiting period applies to this benefit.

• First year - 70% for Basic Services, up to $750 per person per year.

• Second year - 75% for Basic Services, up to $1,000 per person per year.

• Third and following years - 80% for Basic Services, up to $1,250 per person per year.

- 50% Major Restorative, up to $500 per person per year, (included in overall
maximum of $1,250).

• Basic Dental Services include procedures such as examinations, x-rays, tests, cleaning, filling, root canals,
oral surgery, denture, repairs, etc.

• Coverage is paid in accordance with the current Ontario Dental Association Fee Schedule.

• Recall visits covered every 9 months.

• Major Restorative Services include inlays, onlays, crowns, dentures and bridges.