Summary of Health Benefits for Early Retirees

As at May 1, 2018 Print This Page

GRANDFATHERED MEMBERS ONLY – All benefits are subject to the terms of the insurance policies and the Official Plan Documents. This is a summary for your convenience.

Life Insurance

Benefit Amount $75,000 (Member only)

AD & D

Principal Amount $75,000 (Member only)

Dental

Deductible Nil.
Reimbursement 100% for Basic and Major expenses, 60% for orthodontics.
Fee Guide Current.
Maximums $2,500 per person each calendar year for Basic and Major expenses. $2,000 lifetime maximum for orthodontics.
Coverage Notes Dental implant coverage may be reimbursed at the equivalent cost of a bridge or partial denture. Orthodontic coverage is for eligible dependant children 19 years of age or younger. Members should submit a pre-determination of benefits form to the Plan for services over $500 and orthodontics.

Vision Care

Member Benefit Amount Lenses – $800 per 24 months; Frames – $150 per 24 months.
Industrial Safety Glasses $400 per 12 months with a prescription (Member only).
Laser Eye Surgery $1,750 lifetime maximum (Member only).
Dependant Benefit Amount Lenses – $550 per 24 months; Frames – $150 per 24 months.
Contact Lenses $250 per 24 months.
Basic or Retina Eye Exam One exam per calendar year (when not covered by the provincial government plan).

* Medical Benefit Enrollment in Provincial Health Care Plan is mandatory. Provincial Plan is the first payer.

Lifetime Maximum Unlimited.
Reimbursement 100% of most eligible expenses subject to maximums and limits; prescription drugs are reimbursed at the lower of the brand name or generic drug ingredient cost. If no generic drug is available, the Plan will pay 100% of the brand name drug ingredient cost.
Practitioners

Chiropractor, Speech Therapist, Osteopath, Naturopath, Homeopath, and Podiatrist – Expenses are reimbursed at 100%, up to a maximum of $300 annually, per practitioner.

Acupuncture and Massage Therapy – Expenses are reimbursed at 50%, up to a maximum of $300 annually.

Certified Athletic Therapist, Physiotherapist and Occupational Therapist – Expenses are reimbursed at 100%, up to a maximum of $75 per treatment and $5,000 annually.

Psychologist – Expenses are reimbursed up to a maximum of $2,000 annually, and up to a maximum of $200 per hour. Please consider using the Plan's member assistance program for free private counselling.

Prescription Drugs Reimbursement (as described above) for drugs which by law require the written prescription of a physician. Includes oral contraceptives, fertility drugs ($2,500 per family), diabetic supplies, smoking cessation (100% for 1st course of treatment up to $400, 50% for 2nd course of treatment up to $200), erectile dysfunction ($400 per calendar year), anaesthesia, vaccinations and immunizations (subject to individual maximums). Over the counter drugs, vitamins or minerals are not covered. Medical cannabis including derivates is not covered.
Deductible Nil. Maximum dispensing fee of $9.50 per prescription.
Ambulance Reimbursement for land ambulance services when used to transport to the nearest hospital. If ambulance services provided by air or rail, there is a $500 maximum per individual, per calendar year.
Accidental Dental $5,000 per dental accident.
Hospital The difference between ward room and semi-private hospital room. Rehabilitation hospital room allowance is $10 per day up to a maximum of 100 days of confinement per disability prior to age 65.
Medical Services and Supplies Medical equipment and supplies, custom foot orthotics (maximum $400 per year) and orthopedic shoes (at 50%, maximum $400 per year), PSA tests, oxygen and oxygen supplies.
Hearing Aids $1,500 for each 48 month period.
Private Duty Nursing Up to $10,000 per year.
Mobility Assistance Equipment Benefit Member only reimbursement of 75% of the expenses associated with specific mobility equipment and its installation. Subject to a lifetime maximum benefit of $5,000.
Age 65 Provincial Plan Benefit $200 annual maximum benefit to reimburse the actual cost incurred to enroll in the individual's provincially sponsored health care plan. Covers premium, deductibles and co-payments.
Travel Costs related to Medical Treatment Reasonable expenses associated with travelling at least 100km to receive medically necessary treatment otherwise unavailable. 80% of such expenses are reimbursed for members or eligible dependants, subject to a lifetime maximum benefit per family of $1,000. Includes accommodation, meal and gas/travel expenses.

Emergency Travel Assistance (ETA)

Lifetime Maximum $1,000,000
Coverage Emergency medical coverage and travel assistance services for Members and eligible dependants while travelling for periods of up to 90 days per trip. Must be in a condition of stable health prior to departure.

Member Assistance Program

Coverage Confidential counselling services providing crisis support, advice and information by telephone, face-to-face, or online. Tel# 1.866.990.1113, TTY: 1.888.234.0414, Website: myfseap.com. Please contact the Plan Administration Office for group name and password.

Current Benefit Contribution

Contribution Amount $175 per month for the 1st 12 months; $250 per month thereafter. Pay direct amounts are subject to change. Retail Sales Tax (RST) is added where applicable.

* Medical expenses must be medically necessary, reasonable and customary in the circumstances.