Summary of Health Benefits for Retired Members 65+

As at January 1, 2019 Print This Page

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 $30,000 (Member only)

AD & D

Principal Amount $5,000 (Member only)

Dental

Deductible Nil.
Reimbursement 100% for Basic and Major expenses.
Fee Guide Current.
Annual Maximum $2,500 per person each calendar year for Basic and Major expenses.
Coverage Notes Dental implant coverage will be reimbursed at the equivalent cost of a bridge or partial denture. No orthodontic coverage.

* Medical and Vision Care Enrollment in Provincial Health Care Plan is mandatory.

Lifetime Maximum $50,000 per covered person.
Annual Reinstatement Maximum Commencing on the January 1st, following the year in which the balance of the lifetime maximum reduces below $5,000, the lifetime maximum becomes a $5,000 annual maximum. At that time, annual reinstatement also commences each January 1st to restore up to $5,000 each benefit year.
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.
Paramedical Practitioners

Acupuncture, Chiropractor, Homeopath, Massage Therapy, Naturopath, Osteopath, Speech Therapy – Expenses are reimbursed at 50%, up to an annual maximum of $200 per practitioner.

Chiropodist or Podiatrist – Expenses are reimbursed at 100%, up to an annual maximum of $200.

Physiotherapist or Certified Athletic Therapist – Expenses are reimbursed at 100%, up to a maximum of $75 per treatment and an annual maximum of $250.

Psychologist – Expenses are reimbursed at 100%, up to an annual maximum of $250. Please consider using the Plan's member assistance program for free private counselling.

Vision Care

Lenses – $300 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).

Prescription Drugs Prescription drugs, oral contraceptives, diabetic supplies, smoking cessation (1st treatment maximum of $400 at 100%, 2nd treatment maximum of $400 at 50%; lifetime maximum of $600), erectile dysfunction ($400 per calendar year maximum), anesthetics, 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 Land/air/rail maximum; $200 per calendar year.
Dental Accident $5,000 per dental accident.
Hospital $5,000 semi-private hospital per calendar year.
Medical Services and Supplies, Durable Medical Equipment Oxygen services and supplies, Prostate-Specific Antigen (PSA) tests, anaesthesia, surgical and compression stockings (2 pairs per calendar year, maximum annual benefit of $200), radiation treatment (subject to a maximum annual benefit of $200), CPAP machine, wigs, surgical brassieres, rental or purchase (at the Plan's discretion) of an iron lung, oxygen tent, hospital bed, wheelchair, electronic heart pacemaker or other durable medical or surgical equipment required for therapeutic purposes (subject to a combined $2,000 maximum annual benefit).
Private Duty Nursing $10,000 per calendar year.
Hearing Aids $1,500 per 48 months.
Foot Orthotics & Orthopaedic Shoes 50% reimbursement subject to a combined $400 maximum benefit each 36 months.
Mobility Assistance Equipment Benefit Reimbursement of 75% of the expenses associated with specific mobility equipment and its installation, subject to a Lifetime Maximum benefit of $5,000. (Member only)
Over Age 65 Provincial Health Care Plan Fee $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 family maximum benefit of $1,000. Includes accommodation, meal and gas/travel expenses.

Emergency Travel Assistance (ETA)

Lifetime Maximum 30 day trip duration maximum, 6 month health stability period; lifetime maximum of $250,000 per covered person. Must be in a condition of stable health prior to departure. Top-up plan is available.

Member Assistance Program

Coverage Confidential counselling services providing crisis support, advice and information by telephone, face-to-face, or online, video, e-mail or two-way chat. 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 Depends on the number of Health and Welfare hours paid into the Plan before retirement. Based on these hours, a percentage of the cost is paid by the Plan and the remainder is paid by the member.

* Medical expenses must be necessary, reasonable and customary (R&C) in the circumstances.