 Prescription and Dental
Prescription Drugs
Generic drug plan (name brand allowed but price paid will be deemed to be the generic equivalent price)
Shared dispensing fee to a maximum of $6.50
70% on the first $430 of eligible prescription cost to a maximum of $300 in coverage (70% of $430) per anniversary year
Exclusions - Smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription.
Dental
Dental coverage with a 70% payment for fillings, cleanings, scalings, examinations, and polishing on the first $350 of these services - to a maximum of $245 in coverage (70% of $350) per anniversary year
Recall visits every 9 months
Coverages are designed to coincide with your current provincial Dental Association Fee Guide for General Practitioners. The Flexcare ComboPlus Dental coverage will be adjusted to match any increases in the fee guide.
The following Core benefits are also included with ComboPlus Starter:
Extended Health Care (Starter)
$250,000 lifetime maximum
Best Doctors® Solutions Services - upon diagnosis of a serious illness or injury, you can receive an evaluation of your medical records by world-class specialists who confirm the initial diagnosis and recommend appropriate treatment options. This fast, yet indepth review can reduce potentially serious complications from a misdiagnosis and help your local physician determine the proper course of action. In addition to medical advice, Best Doctors provides the following services: treatment planning, identification of the most appropriate care provider, and care management.
Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist - $20 maximum per visit, 20 visit maximum per discipline per anniversary year (payable only after Government Health Insurance Plan maximums have been reached, if applicable).
Chiropractic X-ray - $35 maximum per anniversary year
Psychologist or approved social worker - $80 maximum first visit, $65 maximum subsequent visits, 10 visit maximum per anniversary year
Physiotherapist - $250 maximum per anniversary year
Homecare and Nursing, Prosthetic Appliances, Durable Medical Equipment - maximum per anniversary year for each of these three categories of benefits separately, is according to the following table:
| Year 1 |
Year 2 |
Year 3 |
Year 4 |
Year 5+ |
| $1,000 |
$1,300 |
$1,500 |
$1,700 |
$3,000 |
Note: $225 maximum per anniversary year for Orthotics, which are included as part of Durable Medical Equipment.
Speech Pathologist/Therapist - $65 maximum first visit, $45 maximum subsequent visits, 10 visit maximum per anniversary year
Lifeline® Personal Response Service - lifetime maximum of 3 months of service, not including installation fee
Accidental Dental - $2,000 maximum per anniversary year
Ambulance - unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per anniversary year (payable only after Government Health Insurance Plan maximums have been reached, if applicable).
Hearing Aid - $400 maximum per 4 consecutive benefit years
Travel
$5 million emergency health coverage for trips lasting a maximum of 9 days.
Note: A 9-month pre-existing condition clause applies to Travel. Not available to persons age 65 and over; 8 or 21 day Add-On Travel coverage not available with ComboPlus Starter.
Accidental Death & Dismemberment
Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65; up to $10,000 upon the Accidental Death or Dismemberment of an adult over 65 or a child
Additional coverage can be purchased as an Add-On.
Survivor Benefit
Provides for coverage to be continued for 1 year, following the death of an adult policyholder. Available 1 year after policy effective date.
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