Extended Health Care Benefit Summary

BENEFIT SUMMARY – POLICY 98240

EXTENDED HEALTH CARE BENEFIT FOR ACTIVE W.T.A. MEMBERS – WINNIPEG SCHOOL DIVISION

Provider: Manulife Financial

NIL deductible

100% reimbursement for Hospital and Ambulance expenses

100% reimbursement for Out-of-Province / Out-of-Canada expenses

80% reimbursement for All Other expenses

  • Semi-private Hospital coverage
  • Ambulance:
  • Emergency: Reasonable & Customary charges within Manitoba
  • Non-emergency: $500 per trip within Manitoba (physician recommendation required)
  • Emergency and Non-emergency: $500 per trip outside of Manitoba

Prescription Drugs:

  • Reimbursement of eligible drugs listed in the Manitoba Provincial formulary
  • Lowest cost generic equivalent

Professional Services:

$850 maximum per calendar year per insured per practitioner for:

  • Acupuncturist, Audiologist, Chiropractor, Dietician, Massage Therapist, Naturopath, Osteopath, Podiatrist/Chiropodist, Psychologist, Speech Therapist

Combined Practitioner maximum of $1,000 per calendar year per insured for:

  • Physiotherapist, Athletic Therapist, and Occupational Therapist

Eye Exams:

  • Reasonable & Customary, per insured, once every 2 calendar years

Medical Services and Supplies:

  • Hearing Aids – $2,000 per insured per 5 calendar years (repairs and batteries not covered)
  • Private Duty Nursing – $10,000 per insured per calendar year
  • Cardiac Rehabilitation treatment – $300 per insured, 2 calendar years
  • Surgical Brassieres – 4 per calendar year
  • Breast Prosthesis – Reasonable & Customary
  • Orthopedic Shoes – 1 pair per calendar year when part of a brace, if not part of a brace, 50% of the cost of 1 pair per calendar year
  • Custom-Made Orthotics – $500 per insured per 2 calendar years
  • Charges for the treatment of accidental injuries to natural teeth or jaw, provided the treatment is rendered within 90 days of the accident, excluding injuries due to biting or chewing
  • Wigs and hairpieces for temporary hair loss as a result of medical treatment to a lifetime maximum of $1,000 per insured

Health Service Navigator:

  • Provides health resources and information in learning more about health concerns and available health services

All Other Medical Services & Supplies

  • Expenses limited to the costs of the device or item that adequately meets the patient’s fundamental medical needs
  • Paid to Reasonable & Customary maximums

Out-of-Province/Out-of-Canada Travel Emergency Treatment:

  • Emergency medical treatment of a sickness or injury which occurs while temporarily outside the province of residence (and which occurs during the first 30-days outside the province for employees age 65 and over) provided that treatment is also covered by the Provincial Plan during the absence from province of residence
  • Physician’s services, hospital room and board, cost of special hospital services, hospital charges for out-patient treatment, all other charges incurred while outside the province of residence on the same basis as if they were incurred in the province of residence, licensed ambulance services (including air ambulance), medical evacuation for admission to a hospital or medical facility in the province of residence
  • Reasonable & Customary, unlimited maximum

Referral Treatment:

  • Referral outside of Canada for medical treatment which is available in Canada – 50% reimbursement, to a maximum of $3,000 every 3 calendar years

Emergency Travel Assistance (ETA) Benefit (Out-of-Province/Canada) ETA is provided for both Medical and Non-Medical travel emergencies

  • Medical Emergency Assistance:

24-Hour Access, Medical Referral, Claims Payment Service, Medical Care Monitoring, Medical Transportation, Return of Dependent Children, Trip Interruption/Delay, After Hospital Convalescence, Visit of Family Member, Vehicle Return, Identification of Deceased, Meals and Accommodation

  • Non-Medical Assistance

Return of Deceased to Province of Residence, Lost Document and Ticket Replacement, Legal Referral, Interpretation Service, Message Service, Pre-trip Assistance Service, Health Advice and Assistance

This information is only a brief summary of the provisions of Group Policy 98240. In the event of a discrepancy between this and the Policy, the terms of the Group Policy will apply. A more detailed booklet is available upon request from the Winnipeg School Division. W.T.A., with concurrence from the Winnipeg School Division reserves the right to amend, modify, or revoke benefits at any time.

Revised September 2015