Better Business Bureau

Manulife Flexcare® Health Plan Details

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

General Information

Health Care Plans

Stand-Alone and Add-On Benefits

Seniors' Adjustments


General Information

How Flexcare Plans Work

  • You can choose either a Core Plan or you can choose one or more Stand-Alone packages
  • If you choose a Core Plan then you also have the option of increasing your coverage with one or more Add-On packages.

Medically Underwritten

  • If the plan is "medically underwritten", or "requires a medical questionnaire", you must disclose any medical condition, injury or illness that occurred or existed on or before the date of your application, regardless of whether you went to see a doctor about the condition or were given a diagnosis, or whether or not you believe that it is important. The premium charged and/or benefits offered could be subject to adjustment or modification of coverage, or declined based on your or your family's medical background. This will be determined after an evaluation of the information provided on the enclosed medical questionnaire.

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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.

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.

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.

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.

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

Snapshot of Plans and Benefits (you can click on any coloured text for further details)
CORE BENEFITS CORE PLANS (Note: All plans come with core benefits)
DentalPlus
Basic
DentalPlus
Enhanced
DrugPlus
Basic
DrugPlus
Enhanced
ComboPlus
Starter
ComboPlus
Basic
ComboPlus
Enhanced
Vision (Basic), Chiropractor,
Chiropodist, Osteopath, Naturopath, Podiatrist,
Registered Massage Therapist, Acupuncturist, Psychologist,
Speech Pathologist/Therapist, Physiotherapist,
HomeCare and Nursing,
Prosthetic Appliances,
Durable Medical Equipment, Accidental Dental, Ambulance,
Hearing Aid,
Emergency Travel Health Coverage, Accidental Death and Dismemberment, Survivor Benefits
 
Solutions Services
 

Ongoing Maintenance
9 month recall
 
Total Benefits Payable:
Year 1:
50% of first $1,150.
Total payable per anniversary year: $575
 
Year 2+:
80% of first $400, 50% of next $860.
Total payable per aniversary year: $750
 
DentalPlus Basic and Enhanced have an escalating yearly maximum for Home Support, Durable Medical Supplies and Prosthetic Appliances
 
No medical questionnaire required

Ongoing Maintenance

6 month recall
 
Total Benefits Payable:
Year 1:
70% of first $1,200.
Total payable per anniversary year: $840
 
Year 2+:
100% of first $500, 60% of next $700)
Total payable per anniversary year: $920
 
Combined maximum of $1,250/3 year period for: Oral Surgery, Endodontics, Periodontics:
Year 1: 0%; Year2: 60%
Year 3+:80%
 
Major Restorative
First 2 Years: 0%, Subsequent Years: 60%
 
No medical questionnaire required
Generic Drug Plan
70% first $750, 90% next $4,972 per year
 
Total benefits payable per year $5,000
 
NOTE: for Saskatchewan, 70%
of 1st $1,150 per family per 6 months, 100% on further claims to max. of $5,000/calendar year
 
Full coverage of customary and reasonable dispensing fees
 
Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription
 
Name Brand Drug Plan
90% first $2,222, 100% next $8,000 per year
 
Total benefits payable per year $10,000
 
NOTE: for B.C and Saskatchewan, prescription drug benefits based on calendar year
 
Name brand or generic drugs, including birth control and fertility drugs
 
Full coverage of customary and reasonable dispensing fees
 
Exclusions: smoking cessation drugs, over-the-counter drugs, and drugs not requiring a prescription
DENTAL:
Ongoing Maintenance
- 9 month recall
- 70% of 1st $575.
 
PRESCRIPTION DRUGS:
- Generic Drug Plan
- 70% of 1st $750: $525 maximum per year
- Dispensing Fee Cap is $6.50.
 
Escalating yearly maximum for Home Support, Durable Medical Supplies and Prosthetic Appliances
 
- Now comes with $150 of Vision basic for every two benefit years
 
No medical questionnaire required
DENTAL: 
Ongoing Maintenance
- 9 month recall
- 80% of 1st $400, 50% of next $860 with total benefit payable $750 per year.
 
PRESCRIPTION DRUGS:
Ongoing Maintenance
- 70% of
first $750, 90% next $4,972:$5000 maximum per year
 
Residents of Saskatchevan
- 70% of
first $1,150 per family/6 mos, 100% on further claims to $5000 maximum
 
Medical questionnaire required
DENTAL:
Ongoing Maintenance
- 6 month recall
- 100% of first $500 of filling, cleanings, scalings, examinations, polishing and certain extractions.
- 60% of next $700
- Total maintenance benefits payable per year $920.
 
Oral Surgery, Endodontics, Periodontics
First 2 Years: 60%, to a maximum of $400.
3rd Year: 80%.
Max. payable first year is $400.
 
Major Restorative
(crowns, bridges and dentures, etc.)
First 2 Years: 0%, Subsequent Years: 60%.
Ongoing max. of $1,250/3 years.

 
PRESCRIPTION DRUGS:
Same as DrugPlus Enhanced coverage
 
- TOTAL BENEFITS PAYABLE FIRST YEAR IS $1,320 -
 
Medical questionnaire required
 Seniors Adjustments              
(Age 65 and up)
 
No travel coverage available
 
AD&D decreases to $10,000
 
Vision is now included
Travel coverage not available
 
Travel coverage not available
 
Generic Drug Plan
100% first $750
90% next $4,722/year
of costs not covered by the provincial drug plan. $5,000 maximum.
 
Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
(All other provinces have adjustment)
 
Residents of Nova Scotia
Increases to 100% of first $380.
 
Travel coverage not available
Name Brand Drug Plan
100% first $750
90% next $10,278/year
of costs not covered by the provincial drug plan. $10,000 maximum.
 
Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
(All other provinces have adjustment)
 

 
Travel coverage not available
Prescription Drugs: Increases to 100% of first $750.
 
Residents of Nova Scotia
- Drugs increased to 100% of first $300.
 
Travel coverage not available
 
Generic Drug Plan
- 100% first $750
-90% next $4,722/year
of costs not covered by the provincial drug plan. $5,000 maximum.
 
Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
(All other provinces have adjustment)
 
Residents of Nova Scotia
- 100% of first $380

 
Travel coverage not available
Name Brand Drug Plan
100% first $750
90% next $10,278/year
of costs not covered by the provincial drug plan. $10,000 maximum.
 
Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
All other provinces have adjustment)
 
Travel coverage not available
NOTE: Unless otherwise mentioned benefits are based on anniversary year except for Vision and Hearing Aid benefits, which are based on Benefit year.

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DrugPlus (Drug and Core Benefits)

You can choose either the Basic or Enhanced Plan, both come with Core Benefits

Basic Plan (DrugPlus)

  • Medical questionnaire required
  • Generic drug plan (name brand allowed, but price paid will be deemed to be the generic equivalent).
  • Full coverage of reasonable and customary dispensing fees
  • Coverage Table*:
  Percentage
Paid
On your first $750 of eligible
prescription costs
70%
On your next $4,972 of eligible
prescription costs
90%
  • Total benefits payable per anniversary year*: $5,000
    * Saskatchewan: 70% on first $1,150 per family/6 mos, 100% on further claims to $5,000 maximum.
  • Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription.
  • Core Benefits are listed beneath the Enhanced Plan details.

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Enhanced Plan (DrugPlus)

  • Medical questionnaire required
  • Name brand or generic drugs, including birth control and fertility drugs.
  • Full coverage of reasonable and customary dispensing fees
  • Coverage Table*:
  Percentage
Paid
On your first $2,222 of eligible
prescription costs
90%
On your next $8,000 of eligible
prescription costs
100%
  • Total benefits payable per anniversary year*: $10,000
     * British Columbia and Saskatchewan: Prescription drug benefits based on calendar year.
  • Exclusions: smoking cessation drugs, over-the-counter drugs, and drugs not requiring a prescription.

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Core Benefits (included with DrugPlus 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 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.

Extended Health Care (Basic)

  • $250,000 lifetime maximum.
  • 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, 15 visit max. per anniversary year.
  • Physiotherapist: $250 max. per anniversary year.
  • HomeCare and Nursing, Prosthetic Appliances, Durable Medical Equipment:
    • $3,500 per category per year for under age 65
    • $4,000 per category per year for age 65-plus
    • NOTE: $225 max. per anniversary year for Orthotics, which is part of Durable Medical Equipment.
  • Speech Pathologist/Therapist: $65 max. first visit, $45 max. subsequent visits, 10 visit maximum per anniversary year.
  • Lifeline Personal Response Service: max. of 6 months of service for every 3 anniversary years. A simple press of a button, worn in the home, alerts our 24-hour monitoring service that help is needed.
  • 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.
  • Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.

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Travel

  • $5 million emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductable 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 (Basic)

  • Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65; up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over, or a child. Additional coverage can be purchased as an add-on.
  • All FlexCare plan members receive a newsletter packed with information on everything from family fitness to treating colds and flu, to dealing with common problems such as allergies, asthma and back problems.
  • Only available with DrugPlus Enhanced Core Plan
  • Toll-free telephone access to a Registered Nurse on a wide range of health matters, including:
    • Whether an illness or injury can be safely treated at home, or requires a visit to a doctor or emergency room.
    • Possible prescription drug side effects.
    • Symptoms and treatments of medical conditions, and more.

Survivor Benefits

  • Provides survivor benefits for continuous coverage for 1 year, following the death of subscriber or co-subscriber

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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. Also, 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.

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:
Year Copay To a maximum of
(per anniversary year)
One First $1,150: 50% $575
Subsequent years First $400: 80%
Next $860: 50%
$750
  • Note: core benefits are listed beneath the Enhanced Plan details below.

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:
Year Copay To a maximum of
(per anniversary year)
One First $1,200: 70% $840
Two and after First $500:100%
Next $700: 60%
$920
  • 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:
  Anniversary
Year 1
Anniversary
Year 2
Anniversary
Year 3 and beyond
Oral Surgery 0% 60% 80%
Periodontics 0% 60% 80%
Endodontics
(Root Canal)
0% 60% 80%
Orthodontics 0% 0% 60%
Crowns, Bridges 0% 0% 60%
Dentures 0% 0% 60%

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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.

Extended Health Care

  • $250,000 lifetime maximum.
  • 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, 15 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 as follows:
  • Year 1: $1,000
  • Year 2: $1,300
  • Year 3: $1,500
  • Year 4: $1,700   
  • Year 5+: $3,000
  • NOTE: $225 max. per anniversary year for custom-made Orthotics, which are included as part of Prosthetic Appliances.
  • Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.
  • Lifeline Personal Response Service: max. of 6 months of service per 3 anniversary years.
  • 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.  

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.

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.

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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 the Basic and Enhanced Plans.
  • 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 to maximum of $525 per person per year.
  • 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.

Starter Core Benefits:

Vision (Starter)

  • $150 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 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.

Extended Health Benefits (Starter)

  • $250,000 lifetime maximum.
  • 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, 15 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 is as follows:
  • Year 1: $1,000
  • Year 2: $1,300
  • Year 3: $1,500
  • Year 4: $1,700
  • Year5+: $3,000
  • NOTE: $225 max. per anniversary year for custom-made Orthotics, which are included as part of Prosthetic Appliances.
  • Lifeline Personal Response Service: max. of 6 months of service every 3 anniversary years.
  • 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.
  • Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.

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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.

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.

Basic Plan (ComboPlus)

Basic Drug Coverage:

  • Medical questionnaire required.
  • Generic drug plan (name brand allowed but price paid will be deemed the generic equivalent price).
  • Full coverage of reasonable and customary dispensing fees.
  • Coverage Table:
  Percentage
Paid
On your first $750 of eligible
prescription costs
70%
On your next $4,972 of eligible
prescription costs
90%
  • Total benefits payable per anniversary year is $5,000*
  • * Saskatchewan: 70% of first $1,150 per family/6 mos, 100% on further claims to $5,000 max per calendar year.
  • Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs and drugs not requiring a prescription.

Basic Dental Coverage:

  • Dental coverage is for fillings, cleanings, scalings, examinations, polishing and certain extractions.
  • Ongoing Maintenance: 80% of first $400, 50% next $860. Total benefit payable per year $750.
  • 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.
  • Core Benefits are listed beneath the Enhanced Plan details below.

Enhanced Plan (ComboPlus)

Enhanced Drug Coverage:

  • Medical questionnaire required
  • Name brand or generic drugs, including birth control and fertility drugs.
  • Full coverage of reasonable and customary dispensing fees.
  • Coverage Table:
  Percentage
Paid
On your first $2,222 of eligible prescription costs 90%
On your next $8,000 of eligible
prescription costs
100%
  • Total benefits payable per anniversary year*: $10,000
  • * British Columbia and Saskatchewan: Prescription drug benefits based on calendar year.
  • Exclusions: smoking cessation drugs, over-the-counter drugs, and drugs not requiring a prescription.

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Enhanced Dental Coverage:

  • Coverage for fillings, cleanings, scalings, examinations, polishing and most extractions.
  • Recall visits every 6 months.
  • Coverage: see snapshot above (coloured table).
  Percentage
Paid
On your first $500 of eligible prescription costs 100%
On your next $700 of eligible
prescription costs
60%
  • Total benefits payable per anniversary year: $920
  • NOTE: 100% for examinations, scaling and diagnostic services only. For all other Ongoing Maintenance Services, percentage paid is 90%.
  • The following 6 dental services have a combined, first anniversary year maximum of $400, and a combined, 3 consecutive years max. of $1,250. For orthodontics, crowns, bridges and dentures, no benefit is available until year 3. The payment percentage increase from the effective date of the contract is as follows:
  Anniversary
Year 1
Anniversary
Year 2
Anniversary
Year 3
Oral Surgery 60% 60% 80%
Periodontics 60% 60% 80%
Endodontics
(Root Canal)
60% 60% 80%
Orthodontics 0% 0% 60%
Crowns, Bridges 0% 0% 60%
Dentures 0% 0% 60%

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.

Core Benefits (included with ComboPlus Basic and Enhanced Plans)

Vision (Basic, also comes with Starter Plan)

  • $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 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.

Extended Health Care (Basic)

  • $250,000 lifetime maximum.
  • Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.
  • 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, 15 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:
    • $3,500 per category per year for under age 65
    • $4,000 per category per year for age 65-plus
    • NOTE: $225 max. per anniversary year for Orthotics, which is part of Prosthetic Appliances.tic Appliances.
  • Lifeline Personal Response Service: max. of 6 months of service every 3 anniversary years.
  • 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.

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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

  • 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.

Survivor Benefits

  • Provides survivor benefits for continuous coverage for 1 year, following the death of an adult policyholder.

Stand-Alone and Add-On Benefits

  • Stand-Alones are available without a Core Plan, and are used to create your own "one of a kind" plan.
  • Add-Ons are only available with a Core Plan, and allow you to customize and augment your FlexCare DentalPlus, DrugPlus or ComboPlus plan.

1. Hospital (Basic)

  • Available as a Stand-Alone or Add-On.
  • Medical questionnaire required.
  • Semi-private room coverage.
  • 100% during the first 30 days, 50% of the next 100 days (per anniversary year).
  • The reasonable and customary provincial room rates will be paid up to a maximum of $150/day.
  • Cash Benefit: $15 per day for Alberta residents and $25 per day for all other provinces, beginning on the 4th day of hospitalization, for a maximum of 30 days, if a semi-private room is not obtained.
  • For pregnant applicants please click here to see an Important Notice.

2. Hospital (Enhanced)

  • Available as a Stand-Alone or Add-On.
  • Medical questionnaire required.
  • Semi-private room coverage.
  • 100% coverage of the daily room maximum during the first 30 days, 50% for the next 100 days, per person per anniversary year.
  • The reasonable and customary provincial room rates will be paid up to a maximum of $150/day.

3. Vision (Enhanced)

  • Total $500 maximum per 3 consecutive benefit years to cover the costs, towards prescription lenses, frames, and contact lenses, including $100 towards laser eye surgery.
  • $50 maximum for Optometrist fees 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 3 benefit years. This warranty applies to lenses and frames purchased under the Vision benefit of your FlexCare contract.

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4. Catastrophic Coverage

  • Available as a Stand-Alone or Add-On.
  • Medical questionnaire required.
  • Catastrophic coverage is ideal for people who currently have group or individual health coverage but are looking for protection from an unforeseen, serious accident or medical emergency. People without health coverage will also find Catastrophic coverage an excellent way to protect themselves from large, unplanned medical expenses.
  • This coverage provides the following benefits:
  • Unlimited 100% coverage for generic and name brand prescription drugs when annual claims exceed $4,500 per anniversary year (available as Add-On to DrugPlus Basic/ComboPlus Basic plans, or as Stand-Alone); OR:
  • Unlimited 100% coverage for generic and name brand prescription drugs when annual claims exceed $10,200 per anniversary year (available as Add-On to DrugPlus Basic/ComboPlus Basic plans, or as Stand-Alone);
  • Additional $25,000 in coverage for Homecare and Nursing, Durable Medical Equipment (wheelchairs, etc.) and Prosthetic Appliances when annual claims exceed $7,500 per anniversary year. Lifetime maximum of $100,000.
  • In the event of an accident that requires a hospital stay of at least 24 hours, Catastrophic coverage provides unlimited Chiropractor and Physiotherapist coverage for one year following the accident.
  • All benefits are paid at the reasonable and customary level, and are coordinated with any other health plan coverage you may have.

5. Travel (8 days of additional coverage)

  • Available as an Add-On
  • 8 days of additional coverage, added to the 9 day coverage available through the Core Plan.
  • Trips of up to 17 days are covered, up to $5,000,000 per covered person per trip.
  • NOTE: A 9-month pre-existing condition clause applies to Travel. Trips over the selected number of days, i.e. 9, 17, or 30 days are not covered; to purchase separate coverage, please call us at 1-800-474-4474. Travel coverage not available to persons age 65 and over

6. Travel (21 days of additional coverage)

  • Available as an Add-On
  • 21 days of additional coverage, added to the 9 day coverage available through the Core Plan.
  • Trips of up to 30 days are covered, for any number of trips, up to $5,000,000 per covered person per trip.
  • NOTE: A 9-month pre-existing condition clause applies to Travel. Trips over the selected number of days, i.e. 9, 17, or 30 days are not covered; to purchase separate coverage, please call us at 1-800-474-4474.

7. Accidental Death & Dismemberment (Enhanced)

  • Available as an Add-On Only.
  • The total for both Core and Add-On coverage is equal to $50,000 for adults under 65, and is equal to $20,000 for children under age 21 and adults age 65 or over.
  • Enhanced coverage describes the total benefits provided in conjunction with the corresponding Basic coverage benefits.

Senior's 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:

DrugPlus (Basic)

  • Covers 100% of the first $750, 90% of the next $4,722 for a total of $5,000 per anniversary year, not covered by a government health insurance drug plan*.
  • NOTE: Prescription Drug Seniors' Adjustments do not apply to the provinces of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan.
  • * Residents of Nova Scotia: 100% generic drugs on first $380.

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DrugPlus (Enhanced)

  • Covers 100% of the first $750, 90% of the next $10,278 for a total of $10,000 per anniversary year of costs not covered by a Government health insurance drug plan
  • NOTE: Prescription Drug Seniors' Adjustments do not apply to the provinces of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan.

DentalPlus (Basic/Enhanced), Vision, Hospital

  • There is no change to these Core plan benefits from what has been previously described.

Travel

  • Travel coverage not available.

Extended Health Care (Basic)

  • Speech Pathologist/Therapist visits increase from 10 to 15 visits per anniversary year.
  • Lifeline benefit increases to a lifetime maximum of 6 months, not including the installation fee.
  • Homecare and Nursing, Durable Medical Equipment and Prosthetic Appliances maximum increase per anniversary year to:
  Year 1 Year 2 Year 3 Year 4 Year 5+
DrugPlus $3,500 $3,500 $3,500 $3,500 $3,500
DentalPlus $1,100 $1,500 $1,700 $2,000 $3,500
ComboPlus
Starter
$1,100 $1,500 $1,700 $2,000 $3,500
ComboPlus
Basic/Enhanced
$3,500 $3,500 $3,500 $3,500 $3,500
  • Hearing Aid maximum increases to $500 per 4 consecutive benefit years.
  • Lifetime maximum increases to $260,000.

Extended Health Care (Enhanced)

  • Speech Pathologist/Therapist visits increase from 12 to 20 visits per anniversary year.
  • Lifeline benefit increases from 3 to 6 months of service per 3 anniversary years, not including installation fee.
  • Homecare and Nursing, Prosthetic Appliances, and Durable Medical Equipment combined maximums increase to $9,500 per year.
  • The Hearing Aid maximum increases to $700 per 5 consecutive benefit years.

Accidental Death and Dismemberment (Basic)

  • Decreases to $10,000.

Accidental Death and Dismemberment (Enhanced)

  • The total for both core and Add-On coverage decreases to $20,000.

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.

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ComboPlus Basic (Drug Coverage)

  • 100% on first $750 of eligible prescription costs.
  • 90% on next $4,722, to a maximum of $5,000.
  • Full coverage of reasonable and customary dispensing fees.
  • Residents of Nova Scotia: 100% generic drugs on first $380.
  • Residents of British Columbia and Saskatchewan: Prescription drug benefits based on calendar year.
  • IMPORTANT: For residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan Seniors' adjustments for prescription drugs do not apply.

ComboPlus Enhanced (Drug Coverage)

  • 100% on first $750 of eligible prescription costs (name brand).
  • 90% on next $10,278.
  • Full coverage of reasonable and customary dispensing fees.
  • IMPORTANT: For residents of Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan prescription drug Seniors' adjustments do not apply.

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