- 100% for preventative and routine services (such as exams, polishing, routing scaling, extractions, basic surgery).
- 100% for minor restorative (such as stainless steel crowns, fillings, gum surgery, root canal).
- 100% prosthodontic services (such as dentures, bridges)
- 50% for major restorative (such as inlays, onlays, crowns); and
- 100% for orthodontics (such as braces)
- $1,500 maximum per covered person, per year for all dental services combined.
- Payment of claims is based on the fee guide that was in place two years before the Ontario Dental Association’s current fee guide.
Drug
- 100% for Level 1 formulary drugs (based on the Ontario government’s drug formulary, and includes at least one drug for every medical condition);
- 80% for Level 2 formulary drugs (any drug not included in Level 1 coverage); and
- 80% for maintenance drugs (those you are required to take for a long period of time) not purchased through Alliance Pharmacy Group, regardless of Level 1 or Level 2 status.
- You must pay all pharmacy dispensing fees.
- Overall maximum of $20,000 per year, per covered person for all health benefits, including drugs.
Health
- Eligible expenses not covered by OHIP are reimbursed at 100%
- Accidental dental
- Ambulance (one way only)
- Convalescent hospital
- Diagnostic and outpatient services provided in a hospital
- Hearing aids (excluding costs for testing, repairs and batteries)
- In home care by a registered nurse, with Green Shield Canada approval
- Medical aids and appliances authorized by a doctor
- Medical Alert bracelet, with Trustee approval
- Paramedical – acupuncturist, chiropractor, chiropodist, Christian Science practitioner, naturopath, osteopath, podiatrist or massage therapist if prescribed by a doctor. Note: Massage therapist is covered only for the plan member, and must be performed by a registered massage therapist.
- Psychological assessments by a registered clinical psychologist, if prescribed by a doctor (excludes treatment)
- Physiotherapy, if prescribed by a doctor
- Prosthetics, if authorized by a doctor.
Vision
Up to $300 for single vision, bi-focal, tri-focal lenses, frames, safety glasses, contact lenses and eye examination
- Once per calendar year (January – December) for active members
- Once every two calendar years for dependents, retirees with reduced coverage and surviving family
OR
- One set of contact lenses, per calendar year.
Travel Medical
- Reasonable expenses for services and supplies required because of a medical emergency while you or your family are traveling outside of your home province or territory
- Coverage is for a maximum of 90 days and up to $1 million per person, per calendar year.
Short term disability
- Disability due to injury or illness not related to work
- Benefit is only payable if Employment Insurance (EI) is denied or has been exhausted
- Weekly benefit of $450
- If you are disabled for less than a week, the daily benefit rate is $90
- Waiting period for illness of 7 days
- No waiting period for injury
- Maximum disability period is 26 weeks
- Benefit payments are considered taxable income
Long term disability
- Disability that extends beyond a period of 26 weeks of STD
- Maximum monthly benefit of $2,400
- Maximum benefit period is the last day of the month in which you reach age 62
- Benefit payments are considered taxable income
Life insurance
- $20,000 benefit payable to your names beneficiary (ies) or estate; $10,000 for local 666 retirees.
- Advance life insurance payment of up to 50% ($10,000) of your coverage is available for terminal illness with less than two years to live. This amount will be deducted from final payment made to your beneficiary (ies) after your death.
- Life insurance applies to the member’s life only.
Take a look at the latest Welfare Benefit Plan Booklet