Better Business Bureau

Personal Group Insurance Coverage Details

Please use the following table for a complete description of the Personal Group Insurance plan. Note that there are executive upgrades available.

You can also talk with a personal group insurance expert by clicking here.

Description Coverage Details
Drug Coverage Senior Adjustments 65+
• Generic drugs vs brand-name drugs Generic equivalent1
• Shared dispensing fee $6.50 maximum No maximum
Exclusions - smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs and drugs not requiring prescription All excluded.
• Re-imbursement of eligible prescription costs 70% of first $750 100% of first $750
• Anniversary year maximums per person $525 $750
Dental Coverage
Coverages are designed to coincide with the current provincial Dental Association Fee guide for General Practitioners. Dental coverage will be adjusted to match any increases in the fee guide.
• Reimbursement for ongoing maintenance service: fillings, cleanings, scalings, examinations, polishings, and select extractions. 70% of first $575
• Anniversary year maximums for basic dental services. $400
• Recall visits. 9 months
• Oral surgery, periodontics, endodontics (root canal). Not covered
• Major restorative (orthodontics, crowns, bridges and dentures). Not covered
Vision Care $150 maximum per 2 consecutive benefit years
Covers the costs towards prescription lenses and laser eye surgery. This benefit does not include industrial safety glasses2. $50 maximum for optometrist visit per 2 consecutive benefit years
Extended Health Care Benefits Lifetime maxium $250,000 Lifetime maximum $260,000
Registered Specialists and Therapists (Paramedical Services): Chiropractor, Chiropdist Osteopath, Naturopath, Podiatrist, Massage Therapist, Acupuncturist (per person per anniversary year)
• Maximum claims paid 20 visits maximum per specialist
• Per visit maximum $20
• Chiropractic x-rays $35
Registered Psychologist (per person per anniversary year)
• Maximum per first visit $80
• Maximum per subsequent visit $65
• Maximum visits 10
Registered Speech Pathologist/Therapist (per person per anniversary year)
• Maximum per first visit $65
• Maximum per subsequent visit $45
• Maximum visits 10 15
Registered Physiotherapist (per person per anniversary year) $250 maximum
Homecare and Nursing,Prosthetic Appliances and Durable Medical Equipment For each of Homecare & Nursing, Prosthetic Appliances3 and Durable Medical Equipment:
Covers the services of registered health professionals including Registered Nurse, Registered Practical Nurse, Certified Home Support Worker, Occupational Therapist, Registered Dietician, Registered Nursing Assistant or healthcare aide; includes surgical bandages and dressings and the purchase or rental of medically necessary equipment. Payment will be coordinated where benefits are available through the Assistive Devices Program. Year 1: $1,000
Year 2: $1,300
Year 3: $1,500
Year 4: $1,700
Year 5: $3,000
Year 1: $1,100
Year 2: $1,500
Year 3: $1,700
Year 4: $2,000
Year 5: $3,500
Lifeline® Personal Response Service
Provides 24-hour monitoring service people coping with medical problems at home. Installation charges are not eligible benefits.
Lifetime maximum of 3 months of services per person Lifetime maximum of 6 months of services per person
Accidental Dental
Covers dental treatment required as a result of an accidental blow to the head or mouth. Treatment must be sought within the 90-day period following the accident.
$2,000 maxiumum per person per anniversary year
Ambulance Services
Unlimited ground transportation to hospital and $4,000 maximum for air ambulance per person per annivaersary year.
Included
Hearing Aids
Covers the costs to purchase and/or repair up to the allowed maximum.
$400 maximum per person per 4 consecutive benefit years $500 maximum per person per 4 consecutive benefit years
Travel Coverage (to age 65)4
$5,000,000 emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.)
Included Not covered
Accidental Death and Dismemberment
Payment for accidental death or dismemberment resulting.
$2,000 maxiumum per person per anniversary year
World-Class Second Opinions
Offers evaluation of medical records upon diagnosis of serious illness or injury.
Included
Survivor Benefit
Provides for continuous coverage for 1 year, following the death of an adult policyholder.
Available 1 year after the policy effective date.

1 Generic drug - A generally less expensive alternative to an interchangeable brand-name drug product. Please note: Not all drugs have a generic equivalent. If a non-generic drug is purchased, payment will be based on the lowest generic drug cost equivalent. If no generic brand exists, payment of the brand-name price will be made at the co-payment level of your plan.

2 Eyeglasses are covered against and scratches by a repair guarantee for a period of 2 benefit years. This warranty applies to lenses and frames purchased with the Flexcare vision benefit. No deductible is charged to you if your eyeglasses can be repaired. If beyond repair, your eyeglasses will be replaced and a $50 deductible charged for eyeglasses originally purchased for up to $250; a $75 deductible if the original purchase price was $251 to $300; and a $100 deductible if your eyeglasses originally cost $301 or more.

3 Note: $225 maximum per anniversary year for custom-made orthotics, which are included as part of Prosthetic Appliances.

4 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. Trips over the maximum length are not covered. Travel coverage is not available to persons aged 65 and over.