Combo Life - medical Expenses - Travel
Eligibility
No pricing without medical examination
- Member only
- Member with spouse
- Subscriber and child(s)
- Member with a spouse and child(ren)
- With paramedics
- Without paramedics
Important features
- Group insurance on an individual basis (9% tax in Quebec, 8% Ontario and 0% NB)
- The life insurance coverage, medical expenses and travel insurance are inseparable
- Premiums are increasing by steps of 5 years until the age of 65 years. The rate may also vary for the 1 of January of each year based on the experience of the plan of the ASE/GC
- Pre-existing Conditions 12-24, applicablesà life insurance :
- No allowance of life insurance is payable during the 24 months following the date on which the member became insured under this warranty and that is the result of a sickness or injury for which you received treatment or medication in the 12 months preceding the effective date or that the disease has been diagnosed in the course of this 12-month period or as a result of a prescription, the insured would have had to follow a treatment or taking medication. The provisions of the preceding paragraph do not apply in the case of a member covered under a warranty similar to a previous contract of group insurance in effect immediately prior to the effective date of this agreement.
Life insurance of the participant o Amount at death : 15 000 $
- Reduction : the amount of insurance is reduced by 50% when the member reaches the age of 65 years o Termination : when the warranty on the life insurance is in force, the agreement shall terminate when the member reaches the age of 70 years old
- Life insurance premiums are tax-exempt during the period in which the participant is entitled to insurance benefits to pay for long-term or after 6 months of total disability, whichever occurs first
Insurance dependent life o Amount death benefit: $ 10,000 for the spouse and $ 5,000 for dependent children o Reduction : the amount of insurance is reduced by 50% when the spouse reaches the age of 65 years o Termination : when the warranty on the life insurance is in force, the agreement shall terminate when the spouse reaches the age of 70 years old
- When the participant is exempt from the payment of premiums, guaranteed life insurance, the premiums of the insurance dependent life are also exempt
Medical costs o Costs that are not shared :
- Franchise : no
- Coinsurance : 100% of eligible expenses o Cost-shared : o Deductible : $ 50 per individual or family plan, by year
- Coinsurance : 100% of eligible costs (except for diagnostic services – see sheet below)
- Termination at the age of 70 years old
Travel insurance o Franchise : no o Coinsurance : 100% o Maximum : $ 5,000,000 per insured person per calendar year for all the costs o Any trip of 180 days or less o Maximum for trip cancellation : $ 5,000 per insured person, for the proposed journey o Termination at the age of 70 years old
Table summary of covered medical expenses
| Fresh, non-shared | The excess of the costs of stay in a hospital, in Canada, semi-private room compared to the living room to the public. |
| Shared cost | Coverage |
| Convalescent home | The excess of the costs of stay in a nursing home, in Canada, semi-private room compared to the living room to the public, up to a maximum of 60 days for life, as long as the insured is allowed in this establishment within 14 days after the end of a hospital stay. |
| Ambulance | a. the cost of transportation by ambulance to the nearest hospital where the insured can receive the appropriate care; b. when the state of health of the insured requires it, and on doctor's prescription, the cost of transportation for the return trip home; c. the costs of air transportation if it is carried out in case of emergency, subject to the condition that there is no other means of conventional transportation. These costs are then limited to a maximum of $ 2,000 per calendar year. |
| Nursing home | A Maximum of $ 5,000 per calendar year, per covered person. |
| Home care | The care or services received within the 30 days immediately following a hospital where the insured person is unable to perform his daily activities, up to an overall maximum of $ 500 per calendar year, per covered person : a. the fees of a provider of home care services to assist the insured in the performance of its basic activities of daily living or for the guarding of minor dependent children. b. the costs of public transportation for the insured person, including an escort, if necessary, to benefit from medical treatment or medical follow-up after a hospitalization, or for reasonable travel expenses, in the event that the accompanying adult is a parent or friend of the insured. |
| Diagnostic Services | Prescription of the attending physician, are reimbursed to the x-rays, scans, tests, magnetic resonance, ultrasound and laboratory examinations performed for the purpose of diagnosis, to the exclusion of genetic testing, up to a maximum of$1,500/calendar year. Co-insurance : 80% of eligible expenses. |
| Orthotics and prosthetics | Prescription of the attending physician, shall be reimbursed for the following expenses : a. the eyes and the artificial limbs : initial cost only, up to a maximum of $ 5,000 for a single member to the condition that the event that caused the loss of the member, and that the purchase of the member occurs while the insured person is insured under this clause; b. orthopedic shoes, orthotic and prosthetic podiatric and arch support : up to a maximum of $ 300 per calendar year. Sneakers and sandals are not covered by these warranties; c. breast prosthesis as required by following a mastectomy, radical, including the purchase of a maximum of two (2) bra for breast implants : up to a maximum of $ 200 per period of 24 months. The breast prosthesis does not require a doctor's prescription; d. capillary prosthesis, as a necessary result of chemotherapy treatments : up to $ 200 to life. The capillary prosthesis does not require a doctor's prescription; e. hearing aid : up to a maximum of $ 300 per period of 36 months. The costs of repairs and maintenance are included in the amount of maximum reimbursement. |
| Medical supplies | Prescription of the attending physician, shall be reimbursed for the following expenses (purchase or rental, at the discretion of the insurer) : a. the casts, the scarves, the walking aid or crutches, trusses, and articles to burn; b. the supports for the arms, hips or legs, support for the ribs or the coccyx, corset metallic or made of equivalent materials, in the condition that the brace is essential for the support of the spine, support the neck; up to a maximum of $ 500 per calendar year; c. a wheelchair, non-motorized, except if the state of health of the person requires the use of a wheelchair; d. a hospital bed, the costs are limited to the basic model; e. catheters and supplies directly related to colostomy, ileostomy and the urethrostomy; f. compression stockings compression of 20 mm HG or more, in the case of insufficiency of the venous system or the lymphatic system ; up to a maximum amount of $ 80 per calendar year; g. iuds ; up to a maximum of $ 60 per 24-month period; h. glucose monitors ; up to a maximum of $ 300 per 36-month period; i. the expenses of the clinic or hospital as an outpatient; j. blood, blood plasma and blood transfusion. |
| Dental care after an accident | The fee for the professional services of a dentist for the repair of damage caused by an accident to your natural teeth healthy or the purchase cost of a dental prosthesis initial made necessary the result of an accident shall be reimbursed, subject to the condition that the accident occurred while this warranty is in effect and that the services are rendered, or the purchase is completed, within one (1) year after the accident. |
| Treatments and cures | A prescription from a treating physician are reimbursed detoxification treatment : the cost of room and board at a curative treatment center or clinic, recognized and specialized in rehabilitation for alcoholics or drug addicts, is carried out under the control of a doctor and under constant supervision of a registered nurse, up to a maximum of $ 80 per day for a maximum of 2 $ 500 per period of 120 months; |
| Health professionals (If the option WITH paramedics is selected) | The professional fees of the following specialists are reimbursed, provided they are members in good standing of their corporation or professional association recognized by the insurer.
The x-rays, when taken by a chiropractor are reimbursed, up to a maximum of $ 50 per calendar year. * Required training : These specialists require that they have completed a minimum of 1000 hours of training from a recognized institution. |
| Cosmetic surgery | The costs of cosmetic surgery, following an accident that occurred while the person was insured, subject to the condition that the treatments are started in the twelve (12) months of the date of the accident and will be completed within thirty-six (36) months of that date, up to a maximum of $ 5,000 per accident. |
