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MEDICAL PLAN

Your Provincial Health Care Plan provides limited coverage for many medical expenses. Details of coverage and benefits can be obtained directly from your Provincial Health Care Office. To supplement this coverage, My Choice offers the following coverage options:

	Benefits	Co-Insurance	Maximum Benefit
Bronze	Out-of-Province (Country) Medical Emergency Emergency Global Medical Assistance (GMA)) Semi-Private Hospital Hearing Aids* Prescription Drugs (with drug card) Dispensing Fee Paramedical Services*	100% 100% 70% Not covered 70% generic 100% Not covered	Unlimited Unlimited Unlimited Not covered Unlimited $6 limit
Silver	Out-of-Province (Country) Medical Emergency Emergency Global Medical Assistance (GMA)) Semi-Private Hospital Hearing Aids* Prescription Drugs (with drug card) Dispensing Fee Paramedical Services*	100% 100% 80% 80% 80% generic 100% 80%	Unlimited Unlimited Unlimited $300/5 years Unlimited $6 limit $300/person/practitioner
Gold	Out-of-Province (Country) Medical Emergency Emergency Global Medical Assistance (GMA)) Private Hospital Hearing Aids* Prescription Drugs (with drug card) Dispensing Fee Paramedical Services* After $1,000 Out-of-Pocket Maximum	100% 100% 90% 90% 90% generic 100% 100% 100%	Unlimited Unlimited Unlimited $500/5 years Unlimited $10 limit $500/person/practitioner **

* Dollar limits and other restrictions apply per eligible person insured (see the Medical Plan Details in the following pages).

** Applies to benefits with no internal maximum or limits. Benefits with internal limits are excluded from Out-of-Pocket maximum.

MEDICAL PLAN DETAILS

The following is a further description of some of the specific elements of your medical plan.

g Ambulance	■ Other than airline, to and from the nearest hospital qualified to provide the necessary treatment. ■ Emergency transportation within the insured's province of residence by airline to and from the nearest hospital, subject to a maximum benefit equal to the economy airfare for the insured, and, if medically required, a medical attendant who is neither a resident in your home nor a relative of your family.
g Hearing Aids	■ Charges for the purchase of hearing aids (excluding batteries). Covered expenses, per insured person, are limited to the stated maximum for each consecutive 60 month period.
g Preferred Accommodation in Canadian Hospitals	■ In Canada – either semi-private or private coverage (depending on Option chosen) in a licensed Canadian hospital. ■ Outside Canada – semi-private.
g Convalescent Hospital	■ Maximum of $75 per day, up to a maximum of 60 days.
g Orthopaedic Shoes, Orthotics and Arch Supports	■ Purchase of orthopaedic shoes, orthotics and arch supports specially designed and molded, prescribed in writing by a physician and are required to correct a diagnosed physical impairment. ■ Limited to an overall maximum benefit of $500 per plan year.
g Out-of-Province and Country Medical & Emergency Global Medical Assistance (GMA))	■ Emergency care outside Canada is covered if it is required as a result of a medical emergency arising while the person is temporarily outside Canada for vacation, business, or education; and the person is covered by the government health plan in his home province or the government coverage replacement plan sponsored by the employer. ■ Travel Assistance Services - provides on the spot help in case of emergency for covered Associates and family members travelling outside province of residence. Full details can be downloaded.
g Outside Canada Referral	■ If referred by a physician for non-emergency treatment outside your province of residence, or for non-emergency treatment outside Canada, when treatment is unavailable in Canada and for which there is no medically sufficient alternate treatment available in Canada, the following are covered, in excess of any provincial government plan allowance, provided they are eligible for reimbursement in whole or in part by any provincial government plan: - Semi-private accommodation in hospital (reasonable & customary charges). - Services of a physician (reasonable & customary). - Hospital services and supplies furnished during hospitalization, and for x-ray examinations and laboratory tests related to medical treatment rendered without hospitalization. - Outside Canada referral expenses are subject to a maximum benefit of $100,000 per policy year.
g Prescription Drugs	■ There is a dispensing fee cap on drugs for each Medical Plan option; therefore any amount charged over the cap will be the responsibility of the insured. ■ Drugs or medicine (including preventive vaccines) required for therapy and which can only be obtained on the written prescription of a physician and dispensed by a pharmacist. ■ No benefit will be payable for any single purchase of drugs which would not reasonably be used within 100 days from the date of purchase for maintenance drugs and 34 days from the date of purchase for other drugs. ■ Fertility drugs are covered to a maximum of $3,000/lifetime. ■ Generic drug is a term for products that contain the same medicinal ingredient(s) as the original brand name drug.
g Private Duty Nursing	■ If recommended by a physician and only if medically necessary charges for services of a Registered Nurse, licensed practical nurse, Certified Nursing Assistant or member of Victorian Order of Nurses, while not confined to a hospital, provided such nurse is not a resident in your home or a relative of your family. ■ Limited to an overall maximum benefit of $10,000 per calendar year.
g Paramedical Services	■ Services, without written medical recommendation, of a Physiotherapist, Psychologist/ Social Worker, Chiropractor, Naturopath, Podiatrist/ Chiropodist and Speech Therapist to a maximum of $300 or $500 per plan year, per insured person. X-ray examinations made by a Chiropractor are limited to a maximum of four per policy year, at a maximum rate of $25 per examination. ■ Services, with written medical recommendation, of an Osteopath and Massage Therapist to a maximum of $300 or $500 per policy year, per insured person. ■ Eligible expenses are limited to one professional visit per day for each type of specialist.
g Durable Medical Equipment	■ Rental (or initial purchase at the option of Insurer) of a non-motorized wheelchair, crutches, manual hospital bed, respiratory equipment and any other durable medical equipment, excluding batteries and repairs, required on a temporary basis for therapeutic purposes (as approved by Insurer).
g Laboratory tests/x-rays	■ Which are not covered by any provincial government plan.
g Extension of Coverage	■ Upon your death, eligible dependents’ Medical insurance is extended, without premium payment, for twenty-four months from the date of death or to the date the policy or benefit terminates, whichever is earlier.
g Exclusions	■ Eligible expenses shall not include any of the following: - charges which are considered an insured service of any provincial government plan, - charges for general health examinations, and examinations required for use of third party, - charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment, - charges for medical treatment or surgical procedure by a physician other than as provided under Out of Province and Country expenses, - charges for transport or travel, other than as specifically provided under eligible expenses, - charges not specified in the foregoing list of eligible medical expenses, - charges for services or supplies which are furnished without the recommendation and approval of a physician acting within the scope of his license, - charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy, - charges which are from an occupational injury or disease covered by any Workers' Compensation law or similar legislation, - charges which would not normally have been incurred but for the presence of this insurance or for which you are not legally obligated to pay, - charges which the Insurer is not permitted, by any law or regulation, to cover, - charges for dental work where a third party is responsible for payment for such charges, - charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind, - charges for services or supplies resulting from any intentionally self-inflicted wound, - charges for drugs, sera, injectable drugs or supplies which are not approved by Health and Welfare - Canada or are experimental or limited in use whether or not so approved, - charges for experimental medical procedures or treatment not approved by the Canadian Medical Association or the appropriate medical specialty society, - charges made by a physician for travel, broken appointments, communication costs, filling in of forms, or physician's supplies, - eye examinations
g Termination of Benefit	■ Age 70 or earlier retirement.

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