For Active Members

Member – $200,000*

Spouse – $20,000

Dependent Child – $10,000

$10,000 within 48 hours – Advance from Principal Sum

Member – $300,000

Spouse – $60,000

Dependent Child – $8000

Member – $400,000

Member – $300,000

Member – $32,500

Spouse – $10,000

Child – $10,000*

Daily Maximum Benefit – $200 (50% after the age of 70)

Benefit Duration – 120 consecutive days maximum

Waiting Period – 3 consecutive days

Maximum Indemnity Benefit – $50 per day for Long Term Care Services

Daily Reimbursement Benefit – $100 per day for eligible Long Term Care Expenses

Lifetime Maximum per person – $300,000*

Maximum Weekly Benefit – Weekly Benefit is $500

Approved Claims Only – $100 initial claim form completion fee

Benefits Payable – 1st day Accident

Benefits Payable – 8th day Illness

Total Period of Coverage – 104 weeks Maximum

Monthly Benefit Maximum (Years 1-5) – $1,000 per month*

Monthly Benefit Maximum (Years 6-10) – $to 600 per month*

100% (Rx drugs prescribed by a Physician and dispensed by a Pharmacist)

$50,000 Lifetime Maximum on Opioids*

$200 per visit, up to a lifetime maximum of $10,000 per dependent child only

$100 per visit / maximum of $1,500 per calendar year

$100 1st visit

$75 subsequent visits

Maximum of $1,500 per calendar year combined

$90 per visit

Maximum of $1,500 per calendar year combined

$80 per visit

Maximum of $1,500 per calendar year combined

$80 per visit

Maximum of $1,500 per calendar year combined

$80 per visit

Maximum of $1,500 per calendar year combined

$80 per visit

Maximum of $1,500 per calendar year combined

$80 per visit

Maximum of $1,500 per calendar year combined

$80 per visit

Maximum of $1,500 per calendar year combined

Covered after OHIP excluding air and rail

1 pair every 24 months / Maximum $500

50% / Maximum $250 per calendar year

One set / $3,000 maximum every 36 months (including replacement, repair, batteries)

$5,000 Lifetime Maximum

One set (lenses & frames) / $450 maximum every 24 months

Calendar Year Maximum – $3,000 (per family member

Reimbursement – 2023 O.D.A Fee Guide

Member Advantage Card – Dental Reimbursement

Coinsurance – 100%

• Basic/Preventative:
  
  • Oral Exams/Light Scaling/Polishing – Up to once every 6 months per procedure
  • Scaling/Root Planing/Occlusal Equilibration – 8 units per calendar year for all procedures combined

Repairs/Relines/Rebases – Once every 24 months

Implants – $3,000 per family member per year (inclusive of all dental care services)

Orthodontics (Dependent Child Only) – 60% (under age of 21)

Orthodontics Lifetime Maximum – $2,500

24 Hour Coverage

Maximum Per Trip Benefit – $5,000,000 / up to age 80

Period of Coverage – Maximum of 90 consecutive days per trip

Navigation of Healthcare System

Specializing in Cancer Care Assistance / Navigation

Second Opinion Medical Opinion Benefit

Immediate access to residential treatment beds

Prompt treatment for all forms of mental health and substance abuse

Substance Management & Recovery Program

Outpatient Treatment Service for confidential opioid therapy & treatment

MRI / CT Scans / Ultrasound / Endoscopy / Colonoscopy

• Specialists Healthcare Services
  • Dermatologist
  • Endocrinologist
  • Gynecologist
  • Podiatrist
  • Respirologist
  • Cardiology
  • Gastroenterology
  • General Surgery
  • Neurosurgery,
  • Ear, Nose & Throat
  • Orthopaedics
  • Ophthalmology
  • Rheumatology
  • Urology
  • Neurology
• Specialists Healthcare Services (Member Only)
  • Orthopaedic Surgery – ACL, Elbow, Foot, Ankle, Toe, Hand, Wrist, Hip, Knee & Shoulder
  • General Surgery – Cataract Ear, Nose, & Throat, Gallbladder & Hernia

Online platform for Non-Emergency Medical Support

Online training platform for Smoking Cessation / Weight Loss / Alcohol / Stress / Diabetes / Sleep etc.

Confidential 1-on-1 coaching support around diabetes & heart health

Home delivery for prescription medications

$300 per day

$200 per day

Maximum of 3 days for the death of family members

$300 per day

Member – $400,000

Member – $300,000

Spouse – $60,000

Dependent Child – $8000