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Schedule of Benefits
The Schedule of Benefits contains a brief summary of your benefits. Please refer to the appropriate page in this booklet for a more detailed benefit description.
Extended Health Care
| Deductible |
No Deductible |
Reimbursement |
In-Province Eligible Expenses |
Myoelectric
Prostheses |
80% |
Visual Training |
50% |
| Other |
100% |
Outside Canada
Emergency and Non-Emergency Eligible Expenses: |
100%
|
Outside Canada Medical Referrals |
50%
|
| Plan Maximum |
The lifetime maximum amount of benefits payable for a member or Dependent is umlimited, subject to the terms and conditions of the Plan. |
| Dependent Children |
See difinition of Dependent. |
Employee and Family Assistance Program
| Reimbursement |
We will make payment directly to the Provider for eligible EFAP services. |
| Dependent Children |
See definition of Dependent . |
Dental Care
| Deductible |
No Deductible |
| Reimbursement |
Plan A |
Plan B |
Plan C |
| Basic Services |
Major Restorative Services |
Orthodontics |
| 100% |
75% |
50% |
| Frequency Plan Limits |
Each Calendar Year |
Each Calendar Year |
Lifetime |
| Financial Limit Per Dependent Child |
$2,000 Combined with Plan B |
$2,000 Combined with Plan A |
$2,000 |
| Financial Limit Per Member of Spouse |
$2,000 Combined with Plan B |
$2,000 Combined with Plan A |
$2,000 |
| Dependent Children |
See definition of Dependent . |
Group Term Life
| Benefit Amount |
$2,000 plus 1 times annual basic earnings rounded to the next higher $1,000, if not already a multiple of $1,000. |
| Living Benefit Amount |
50% of the Group Term Life Benefit Amount. |
| Termination |
Age 65 or earlier termination. |
Survivor Income Benefit
| Monthly Benefit Amount |
25% of annual basic earnings divided by 12. |
Dependent Life
| Benefit Amount |
Spouse
$25,000 |
Child
$5,000 |
| Dependent Children |
Eligible from live birth to the ages specified in the definition of Dependent. |
| Termination |
Dependent insurance terminates on you 65th birthday or earlier termination. |
Accidental Death & Dismemberment (AD&D)
| Principal Sum |
$100,000 |
| Aggregate Limit |
$1,000,000 |
| Termination |
Age 65 or earlier termination. |
Short Term Disability (STD)
| Weekly Benefit Amount |
58% of the weekly basic earnings rounded to the next higher $1, if not already a multiple of $1, to the Employment Insurance (EI) maximum. |
| Elimination Period |
Injury
7 days |
Hospital
7 days |
Sickness
7 days |
| Maximum Benefit Period |
17 weeks . |
| Termination |
Insurance terminates when employment terminates. |
Long Term Disability (LTD)
| Benefit Amount |
65% of gross monthly earnings rounded to the next higher $1, if not already a multiple of $1, to a maximum of $1,700. |
| Non Evidence Limit |
$1,700 |
| Elimination Period |
119 Days (i.e. 17 weeks) . |
| Maximum Benefit Period |
Age 65 or earlier termination. |
| Termination |
Age 65 or earlier termination. |
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