Extended Health Care

You may choose the level of coverage that best suits your and your family’s needs. You also have the option of just choosing coverage for yourself; or yourself and one dependent; or for you and all your dependents; or you may opt out of coverage altogether.

If you elect a lower level of coverage, you will have more Flex Credits to use elsewhere. If you elect Option 3, you may be required to pay for the cost of this coverage through payroll deduction.

*If you elect Option 3, you must remain with that election for two benefit years.

Core coverage is the default coverage (member only) if you do not enroll in the plan.

	Opt-Out	Option 1	Option 2	Option 3
Benefit Details
Lifetime Maximum (per person)	No coverage	Unlimited	Unlimited	Unlimited
Termination Age	No coverage	Retirement	Retirement	Retirement
Eligible Expense Reimbursed at	No coverage	90% until out of pocket maximum is reached, then 100%	80% until out of pocket maximum is reached, then 100%	90% until out of pocket maximum is reached, then 100%
Annual Deductible	No coverage	$500 for member $750 for member + 1 $1,000 for member + 2 or more	$25 for member $50 for member + 1 $75 for member + 2 or more	No deductible
Out of pocket Maximum	No coverage	$1,500 for member $2,000 for member +1 $2,500 for member +2	$1,500 for member $2,000 for member +1 $2,500 for member +2	$1,500 for member $2,000 for member +1 $2,500 for member +2
Covered Expenses
Prescription Drugs (legally requiring a prescription)	No coverage	90%	80%	90%
Dispensing Fee Cap	No coverage	$7	$7	$7
ManuScript Pay-direct Drug card	No coverage	Yes	Yes	Yes
Vision	No coverage	No coverage	Prescription glasses/contacts or laser eye surgery: $250 per 24 consecutive months Medically necessary contacts: $200 per 24 consecutive months Eye Exams: 1 per 24 consecutive months for adults 1 per 12 consecutive months for children	Prescription glasses/contacts or laser eye surgery: $350 per 24 consecutive months Medically necessary contacts: $200 per 24 consecutive months Eye Exams: 1 per 24 consecutive months for adults 1 per 12 consecutive months for children
Hospital Coverage	No coverage	No coverage	No coverage	100% for private room up to $125 a day (including chronic care)
Medical Supplies and Services
See Medical Supplies and Services Listed Below	No coverage	No coverage	80%	90%
Private Duty Nursing	No coverage	No coverage	Maximum of $10,000 per calendar year	Maximum of $25,000 per 3 calendar years
Hearing Aids	No coverage	No coverage	$300 every 4 calendar years	$500 every 4 calendar years
Paramedical Services
Physiotherapist Osteopath, Podiatrist / Chiropodist, Chiropractor, Massage Therapist, Speech Therapist, Naturopath, Psychologist, Acupuncturist	No coverage	No coverage	$500 maximum per practitioner, per calendar year	$600 maximum per practitioner, per calendar year

Eligible Expenses

The following are descriptions of eligible expenses for your Extended Health Care options. To qualify for coverage, the expenses must be allowable under the Plan, reasonable and customary, medically necessary and recommended by a physician.

Prescription Drugs

Extended Health Care includes drugs available only if prescribed by a physician or dentist. Once you reach the out-of-pocket maximum, regardless of the extended health option you choose, your option will pay 100% of the cost of prescription drugs for the balance of the year. All options include a dispensing fee maximum of $7.00 per prescription.

As a Plan participant you receive a Manulife Card displaying information such as your plan policy number and your personal identification number. This also serves as a pay-direct drug card. Once the information on your Manulife member card is entered into your pharmacistâ��s computer, you will only need to pay the co-insurance (10% or 20%), plus any deductible as required. Your pharmacist will bill Manulife for the balance. Be sure to keep your drug receipts in case you need them for income tax purposes or for coordination of benefits with a spouse’s plan.

Manulife Financial has created an information sheet with tips to help plan members to be Smarter Consumers. We need to help manage our prescription drug costs, save money and help keep the drug plan affordable. To learn more access Drug$mart by clicking here.

Note: If your Provincial Health Insurance Plan includes a Pharmacare Plan, you must send Manulife proof that you have registered with that plan, together with the amount of any required annual deductible. Otherwise, you may not be eligible for the maximum coverage provided under your Extended Health Care option.

Vision Care

Vision Care is provided under your Extended Health Care benefit. It provides coverage up to a specific maximum for services provided by an ophthalmologist, optometrist, or oculist:

• Depending on the option you have chosen, 80 or 90% of the cost of one eye exam every 24 months (every twelve months for children)
• Corrective eyeglasses, contact lenses and laser eye surgery, every 24 months for each covered person

Paramedical Services

Paramedical Service includes coverage for services of the following licensed, certified and registered paramedical practitioners:

• Psychologist
• Speech therapist
• Acupuncturist
• Podiatrist (plus up to $100 for the surgical removal of toenails or the excision of plantar warts)
• Chiropractor (plus up to $25 for one x-ray per calendar year)
• Physiotherapist
• Osteopath (plus up to $25 for one x-ray per calendar year)
• Naturopath
• Massage therapist

Please note that in some provinces, except for the services of a psychologist or speech therapist, benefits are not paid to the practitioners until the yearly maximum benefit under the Provincial Health Insurance Plan has been paid.

Medical Supplies and Services

Depending on the level of coverage chosen, the following services and supplies may be covered:

• Diagnostic procedures, radiology, blood transfusions and oxygen (including the necessary equipment)
• Services of a Registered Nurse (or if not available) a Registered Nursing Assistant or Licensed Practical Nurse, provided the individual does not ordinarily reside in your home, is not a member of your own family and is not a sibling or parent to you or your spouse
• Ambulance service to and from the nearest medical facility for immediate treatment, including air ambulance or any vehicle normally used for public transportation (if medically necessary)
• Hospital charges for services and supplies provided on an out-patient basis
• Trusses, braces (other than foot braces), crutches, artificial limbs or eyes
• Surgical stockings, surgical brassieres (up to 4 pairs per year)
• Wigs and hairpieces ($250 lifetime maximum)
• Orthopedic shoes that are attached to or form part of a brace (if the shoes do not form part of a brace, allowable expenses will be limited to two pairs per calendar year, to the greater of the actual cost of the adjustment or 50% of the total cost of the shoes)
• Casted, custom-made orthotics (click for brochure)
• Hearing aids including related services
• Rental or purchase (at Manulife’s option) of a hospital bed, wheelchair or respirator/ventilator
• Dental treatment directly required as a result of an accidental injury to your natural teeth, provided treatment begins within twelve months of the accident (payment will be based on the least expensive procedure that provides a professionally adequate result).
• Semi-private or private hospital accommodation (option 3 only)
• Convalescent or chronic hospital care and accommodation, up to $125 per day (option 3 only)

Expenses Not Covered

The Extended Health Care Plan does not cover the following expenses:

• Charges that are considered an insured service under your Provincial Health Insurance Plan
• Periodic health examinations, examinations required for use of a third party, or travel for health
• Charges for physician’s time spent traveling, broken appointments, transportation costs, room rental charges or advice given by the telephone or any other means of telecommunication
• Surgical procedures or treatments performed primarily for beautification or hospital confinement for such surgical procedures or treatments, unless such surgery or treatment is for eligible accidental injuries and commenced within 90 days of the accident
• Charges resulting from an occupational injury or disease covered by any Workers’ Compensation law
• Charges that would not normally have been incurred but for the presence of this coverage, or for which you or your dependent is not legally obligated to pay
• Services or supplies due to bodily injury resulting directly or indirectly from insurrection, war, service in the armed forces of any country or participation in a riot
• Services or supplies resulting from any intentionally self-inflicted injury or illness, while sane or insane
• Drugs, sera, injectable drugs or supplies that are not approved by Health and Welfare – Canada or that are experimental or limited in use whether or not so approved
• Experimental medical procedures or treatment not approved by the Provincial Medical Association or the appropriate medical specialty society
• Charges that the insurer is not permitted, by any law or regulation, to cover.