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Health and Dental Benefits may be purchased by an individual who does not have coverage by his/her employer. There is a variety of plans that can be customized to each individual’s needs.
EXTENDED HEALTH CARE BENEFITS
The extended health care benefits are designed to reimburse the person insured and his/her dependents for expenses that are not covered by provincial plans. Some of these expenses include:
- Prescription drugs – depending on the plan, you may have a pay direct card, or a reimbursement plan where you would submit a receipt to the insurer for reimbursement. Some plans will also have a deductible of $25/$50 or $50/$100 and a co-insurance amount per prescription usually 80%.
- Nursing care – usually with a lifetime maximum of $10,000
- Ambulance costs
- Semi-private or private room hospital accommodation
- Vision Care – eyeglasses coverage either $150 or $200 every 2 years
- Services by practitioners such as chiropractors, massage therapists etc. with an annual maximum of $500 per practitioner.
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DENTAL PLANS
The dental plans that are available to group policyholders can be from simple preventative and maintenance services or complex orthodontic procedures.
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Preventative services would include examinations, X-rays, diagnostic procedures, oral hygiene instruction, scaling, fluoride and polishing treatments. Extractions and fillings are also included.
- Major Restorative services include fixed bridgework, maintenance and replacement of appliances and crowns and inlays.
- Endodontics include treatment of gum disease, root canal work, and major surgery.
- Orthodontics would include services such as braces usually for children.
With dental plans it is very common to see different co-insurance amounts like 100% for preventatives and endodontics, 80% for major restoratives, and 50% for orthodontics.
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