Hospital Benefits. Coverage is provided for the hospital's additional charge for a semi-private room in any Manitoba hospital (the Government plan covers standard xxxx charges) and payment for additional semi-private charges by hospitals outside Manitoba at the rate in effect at that time in the Province of Manitoba. If a subscriber requires diagnostic testing or treatment, on the recommendation of a medical practitioner, at a Manitoba hospital located more than 60 kilometres from the subscriber's home, and if the subscriber is placed in a recognized medical hostel associated with the hospital, Blue Cross will pay the reasonable and customary per diem charge for such hostel accommodation. In addition, the Extended Health Benefits Plan shall pay for 80% of eligible health care services listed below subject to the terms and conditions of the contract. Note: Annual maximums are effective for each calendar year. Eligible Health Care Service Description of coverage Max per person per year (unless noted otherwise) Accidental Dental Treatment Required as a result of accidental injury where natural teeth have been damaged or broken or a dislocated jaw requires setting. Treatment must start within 90 days of the accident. Athletic Therapy Services rendered by a Certified Athletic Therapist. $100 Breast Prosthesis and Surgical Bras Upon the written prescription of a physician. $350 Cardiac Rehabilitation For cardiac patients when prescribed by the attending physician after myocardial infarction, coronary bypass surgery, or valve replacement or for the management of angina pectoris or other diagnosed cardiac disease. $350 Chiropractic Services rendered by a Chiropractor. $350 Clinical Psychology Charges of a registered Clinical Psychologist. $350 Hearing Aids Purchase or repair when prescribed by an Otologist or Audiologist. (charges for regular maintenance, batteries or recharging devices are not eligible) $1,000 during any 5 consecutive year period Massage Therapy Services rendered by a licensed Massage Therapist. $350 Nutrition Counseling Services provided by a registered dietician when you are referred by a physician. $350 Orthotics When prescribed by a physician, physiotherapist, or podiatrist. $350 Physiotherapy Diagnosis and treatment by licensed Physiotherapist. (excludes diagnostic x-rays and examinations) $350 Podiatry Diagnosis and treatment by licensed Podiatrist. (excludes diagnostic x-rays and examinations) $350 Private Duty Nursing Services provided in a hospital by a professional nurse (not an employee of the hospital) when recommended by a physician. Charges for nursing visits in the home of the subscriber by a professional nurse (not a relative) during the 12 months following discharge from the hospital for services consistent with in-patient treatment. $3,000 Prosthetic Appliances and Remedial Equipment When, as a result of illness or accidental injury, and when prescribed by a physician, occupational therapist, physiotherapist, or Athletic Therapist, charges are incurred for: - artificial limbs and eyes, splints, trusses, braces, lumbar-sacro supports, corsets, traction equipment, knee braces, cervical collars, surgical elastic stockings, crutches*, casts*, canes* (*do not require prescription from physician.) Orthopedic Shoes & Modifications to Orthopedic Shoes Orthopedic shoes custom made form a mould, orthopedic shoe modifications or stock shoes which are modified to accommodate, relieve, or remedy a mechanical foot defect or abnormality (excludes orthotics or insoles, removable or permanently-affixed). $300 Rental or Purchase of Equipment For rental or purchase costs of an iron lung, wheelchair, hospital-type bed or respirator, when prescribed by a physician. Lifetime max $1,000/item Rental or purchase of other prescribed medical equipment. Lifetime max $250/person Travel Protection (separate from Travel Health Insurance) Medical, surgical, and hospital service charges resulting from an emergency illness or injury when you are travelling outside Manitoba. Claims are paid in Canadian dollars at the exchange rate in effect when the claim was incurred. $2,500 Wigs or Hairpieces When necessitated by illness or accidental injury, and upon the written prescription of a physician. Lifetime max $1,000/person Vision Care Benefit The Vision Care benefit to employees and each eligible dependant shall be to a maximum of $400.00 once every 24 consecutive month period for each family member. The plan includes: eyeglasses (frames and/or lenses including contact lenses) which are prescribed as a result of an eye examination by a licensed medical doctor, ophthalmologist or optometrist, and which are purchased while coverage is in force; repairs to existing glasses (frames and/or lenses); charges for fitting of safety glasses; the cost of eye examinations (one exam every 24 consecutive months); laser eye surgery. The vision care benefit does not cover the following: charges for fitting of eyeglasses (other than safety glasses); non-prescription safety glasses; charges for expenses covered in whole or in part by the Workers Compensation Board, or any other agency or department of any federal, provincial, or municipal government, or any third party. Prescription Drug Plan The Prescription Drug Plan provides coverage for 80% of annual (April 1 to March 31) prescription drug expenses (listed (formulary) and de-listed (non-formulary) drugs, serums, injectibles and insulin) up to the maximum of each employee’s Manitoba Pharmacare Annual Deductible amount. A Claimsecure pay-direct prescription drug plan card is provided. Effective April 1, 2015, the dispensing fee cap increased to $10.10. The dispensing fee cap will be increased every two years from that date to reflect the average increase (if any) to dispensing fees charged in Manitoba, based on actual claims experience of Hydro employees. This cap does not apply to "compound prescriptions". The plan does not cover vitamins and vitamin preparations (unless injected), patent or proprietary drugs and "over the counter" drugs, fertility drugs and anabolic steroids. The plan covers smoking cessation products to a maximum of $350 per contract. The parties will review the impact of a change in the amount of the deductible in provincial Pharmacare design if the change results in an increased cost to the Corporation for prescription drugs of 5% or more. The purpose of this review is to mitigate the impact of the Pharmacare change on the Corporation. If a mutually agreeable resolution is not reached within 45 days of the change, the issue will be referred to an independent third party for resolution. Dental Plan Coverage is as follows – subject to plan restrictions: Basic: 90% reimbursement of costs Major: 75% reimbursement of costs Orthodontics: 50% reimbursement of costs to a lifetime maximum of $2,000/dependent child up to the age of 19. - The maximum coverage for all dental claims in a calendar year is $1750/person (including orthodontics). - When both spouses are employed by Manitoba Hydro, or if an employee and the employee's spouse are provided with similar dental benefits under any other dental plan, payment of benefits shall be coordinated and/or reduced to the extent that total benefits payable do not exceed 100% of the actual incurred expenses. - Pre-treatment authorization is required if treatment will cost more than $500.00 and in all cases of orthodontic services. - Termination or suspension of coverage: as outlined in Corporate Policy P521, or in the case of orthodontic coverage, when a dependent child attains 19 years of age. Except, where an impression for a denture has been taken before the termination or suspension of coverage date and the denture is installed after the termination or suspension of coverage date, dental services in connection with this procedure and incurred within 30 calendar days after the termination or suspension of coverage date, are eligible for coverage. Coverage is reinstated upon return from leave, if previously eligible as outlined in Corporate Policy P521. - The fee guide is the Manitoba Dental Association Fee Schedule in effect at the time services are rendered. - The plan year consists of 12 consecutive months commencing January 1st. Payment for coverage will be based on the year that services are rendered.
Appears in 2 contracts
Samples: Supervisory Employees, Supervisory Employees
Hospital Benefits. Coverage is provided for the hospital's additional charge for a semi-private room in any Manitoba hospital (the Government plan covers standard xxxx charges) and payment for additional semi-private charges by hospitals outside Manitoba at the rate in effect at that time in the Province of Manitoba. If a subscriber requires diagnostic testing or treatment, on the recommendation of a medical practitioner, at a Manitoba hospital located more than 60 kilometres from the subscriber's home, and if the subscriber is placed in a recognized medical hostel associated with the hospital, Blue Cross will pay the reasonable and customary per diem charge for such hostel accommodation. In addition, the Extended Health Benefits Plan shall pay for 80% of eligible health care services listed below subject to the terms and conditions of the contract. Note: Annual maximums are effective for each calendar year. Eligible Health Care Service Description of coverage Max per person per year (unless noted otherwise) Accidental Dental Treatment Required as a result of accidental injury where natural teeth have been damaged or broken or a dislocated jaw requires setting. Treatment must start within 90 days of the accident. Athletic Therapy Services rendered by a Certified Athletic Therapist. $100 Breast Prosthesis and Surgical Bras Upon the written prescription of a physician. $350 Cardiac Rehabilitation For cardiac patients when prescribed by the attending physician after myocardial infarction, coronary bypass surgery, or valve replacement or for the management of angina pectoris or other diagnosed cardiac disease. $350 Chiropractic Services rendered by a Chiropractor. $350 Clinical Psychology Charges of a registered Clinical Psychologist. $350 Hearing Aids Purchase or repair when prescribed by an Otologist or Audiologist. (charges for regular maintenance, batteries or recharging devices are not eligible) $1,000 during any 5 consecutive year period Massage Therapy Services rendered by a licensed Massage Therapist. $350 Nutrition Counseling Services provided by a registered dietician when you are referred by a physician. $350 Orthotics When prescribed by a physician, physiotherapist, or podiatrist. $350 Physiotherapy Diagnosis and treatment by licensed Physiotherapist. (excludes diagnostic x-rays and examinations) $350 Podiatry Diagnosis and treatment by licensed Podiatrist. (excludes diagnostic x-rays and examinations) $350 Private Duty Nursing Services provided in a hospital by a professional nurse (not an employee of the hospital) when recommended by a physician. Charges for nursing visits in the home of the subscriber by a professional nurse (not a relative) during the 12 months following discharge from the hospital for services consistent with in-patient treatment. $3,000 Prosthetic Appliances and Remedial Equipment When, as a result of illness or accidental injury, and when prescribed by a physician, occupational therapist, physiotherapist, or Athletic Therapist, charges are incurred for: - artificial limbs and eyes, splints, trusses, braces, lumbar-sacro supports, corsets, traction equipment, knee braces, cervical collars, surgical elastic stockings, crutches*, casts*, canes* (*do not require prescription from physician.) Orthopedic Shoes & Modifications to Orthopedic Shoes Orthopedic shoes custom made form a mould, orthopedic shoe modifications or stock shoes which are modified to accommodate, relieve, or remedy a mechanical foot defect or abnormality (excludes orthotics or insoles, removable or permanently-affixed). $300 Rental or Purchase of Equipment For rental or purchase costs of an iron lung, wheelchair, hospital-type bed or respirator, when prescribed by a physician. Lifetime max $1,000/item Rental or purchase of other prescribed medical equipment. Lifetime max $250/person Travel Protection (separate from Travel Health Insurance) Medical, surgical, and hospital service charges resulting from an emergency illness or injury when you are travelling outside Manitoba. Claims are paid in Canadian dollars at the exchange rate in effect when the claim was incurred. $2,500 Wigs or Hairpieces When necessitated by illness or accidental injury, and upon the written prescription of a physician. Lifetime max $1,000/person Vision Care Benefit The Vision Care benefit to employees and each eligible dependant shall be to a maximum of $400.00 once every 24 consecutive month period for each family member. The plan includes: • eyeglasses (frames and/or lenses including contact lenses) which are prescribed as a result of an eye examination by a licensed medical doctor, ophthalmologist or optometrist, and which are purchased while coverage is in force; • repairs to existing glasses (frames and/or lenses); • charges for fitting of safety glasses; • the cost of eye examinations (one exam every 24 consecutive months); • laser eye surgery. The vision care benefit does not cover the following: • charges for fitting of eyeglasses (other than safety glasses); • non-prescription safety glasses; • charges for expenses covered in whole or in part by the Workers Compensation Board, or any other agency or department of any federal, provincial, or municipal government, or any third party. Prescription Drug Plan The Prescription Drug Plan provides coverage for 80% of annual (April 1 to March 31) prescription drug expenses (listed (formulary) and de-listed (non-formulary) drugs, serums, injectibles and insulin) up to the maximum of each employee’s Manitoba Pharmacare Annual Deductible amount. A Claimsecure pay-direct prescription drug plan card is provided. Effective April 1, 2015, the dispensing fee cap increased to $10.10. The dispensing fee cap will be increased every two years from that date to reflect the average increase (if any) to dispensing fees charged in Manitoba, based on actual claims experience of Hydro employees. This cap does not apply to "compound prescriptions". The plan does not cover vitamins and vitamin preparations (unless injected), patent or proprietary drugs and "over the counter" drugs, fertility drugs and anabolic steroids. The plan covers smoking cessation products to a maximum of $350 per contract. The parties will review the impact of a change in the amount of the deductible in provincial Pharmacare design if the change results in an increased cost to the Corporation for prescription drugs of 5% or more. The purpose of this review is to mitigate the impact of the Pharmacare change on the Corporation. If a mutually agreeable resolution is not reached within 45 days of the change, the issue will be referred to an independent third party for resolution. Dental Plan Coverage is as follows – subject to plan restrictions: Basic: 90% reimbursement of costs Major: 75% reimbursement of costs Orthodontics: 50% reimbursement of costs to a lifetime maximum of $2,000/dependent child up to the age of 19. - The maximum coverage for all dental claims in a calendar year is $1750/person (including orthodontics). - When both spouses are employed by Manitoba Hydro, or if an employee and the employee's spouse are provided with similar dental benefits under any other dental plan, payment of benefits shall be coordinated and/or reduced to the extent that total benefits payable do not exceed 100% of the actual incurred expenses. - Pre-treatment authorization is required if treatment will cost more than $500.00 and in all cases of orthodontic services. - Termination or suspension of coverage: • as outlined in Corporate Policy P521, or • in the case of orthodontic coverage, when a dependent child attains 19 years of age. Except, where an impression for a denture has been taken before the termination or suspension of coverage date and the denture is installed after the termination or suspension of coverage date, dental services in connection with this procedure and incurred within 30 calendar days after the termination or suspension of coverage date, are eligible for coverage. Coverage is reinstated upon return from leave, if previously eligible as outlined in Corporate Policy P521. - The fee guide is the Manitoba Dental Association Fee Schedule in effect at the time services are rendered. - The plan year consists of 12 consecutive months commencing January 1st. Payment for coverage will be based on the year that services are rendered.
Appears in 2 contracts
Samples: Supervisory Employees, Supervisory Employees
Hospital Benefits. Coverage is provided for the hospital's additional charge for a semi-private room in any Manitoba hospital (the Government plan covers standard xxxx charges) and payment for additional semi-private charges by hospitals outside Manitoba at the rate in effect at that time in the Province of Manitoba. If a subscriber requires diagnostic testing or treatment, on the recommendation of a medical practitioner, at a Manitoba hospital located more than 60 kilometres from the subscriber's home, and if the subscriber is placed in a recognized medical hostel associated with the hospital, Blue Cross ClaimSecure will pay the reasonable and customary per diem charge for such hostel accommodation. In addition, the Extended Health Benefits Plan shall pay for 80% of eligible health care services listed below subject to the terms and conditions of the contract. Note: Annual maximums are effective for each calendar year. Eligible Health Care Service Description of coverage Coverage Max per person per year (unless noted otherwise) Accidental Dental Treatment Required as a result of accidental injury where natural teeth have been damaged or broken or a dislocated jaw requires setting. Treatment must start within 90 days of the accident. Athletic Therapy Services rendered by a Certified Athletic Therapist. $100 Breast Prosthesis and Surgical Bras Upon the written prescription of a physician. $350 Cardiac Rehabilitation For cardiac patients when prescribed by the attending physician after myocardial infarction, coronary bypass surgery, or valve replacement or for the management of angina pectoris or other diagnosed cardiac disease. $350 Chiropractic Services rendered by a Chiropractor. $350 500* Clinical Psychology Charges of a registered Clinical Psychologist. $350 Hearing Aids Purchase or repair when prescribed by an Otologist or Audiologist. (charges for regular maintenance, batteries or recharging devices are not eligible) $1,000 during any 5 consecutive year period Massage Therapy Services rendered by a licensed Massage Therapist. $350 500* Nutrition Counseling Services provided by a registered dietician when you are referred by a physician. $350 Orthotics When prescribed by a physician, physiotherapist, or podiatrist. $350 Physiotherapy Diagnosis and treatment by licensed Physiotherapist. (excludes diagnostic x-rays and examinations) $350 Podiatry Diagnosis and treatment by licensed Podiatrist. (excludes diagnostic x-rays and examinations) $350 Private Duty Nursing Services provided in a hospital by a professional nurse (not an employee of the hospital) when recommended by a physician. Charges for nursing visits in the home of the subscriber by a professional nurse (not a relative) during the 12 months following discharge from the hospital for services consistent with in-patient treatment. $3,000 Prosthetic Appliances and Remedial Equipment When, as a result of illness or accidental injury, and when prescribed by a physician, occupational therapist, physiotherapist, or Athletic Therapist, charges are incurred for: - artificial limbs and eyes, splints, trusses, braces, lumbar-sacro supports, corsets, traction equipment, knee braces, cervical collars, surgical elastic stockings, crutches*, casts*, canes* (*do not require prescription from physician.) No limit Orthopedic Shoes & Modifications to Orthopedic Shoes Orthopedic shoes custom made form from a mould, orthopedic shoe modifications or stock shoes which are modified to accommodate, relieve, or remedy a mechanical foot defect or abnormality (excludes orthotics or insoles, removable or permanently-affixed). $300 Rental or Purchase of Equipment For rental or purchase costs of an iron lung, wheelchair, hospital-hospital- type bed or respirator, when prescribed by a physician. Lifetime max $1,000/item Rental or purchase of other prescribed medical equipment. Lifetime max $250/person Travel Protection (separate from Travel Health Insurance) Medical, surgical, and hospital service charges resulting from an emergency illness or injury when you are travelling outside Manitoba. Claims are paid in Canadian dollars at the exchange rate in effect when the claim was incurred. $2,500 Wigs or Hairpieces When necessitated by illness or accidental injury, and upon the written prescription of a physician. Lifetime max $1,000/person *$500 effective January 1, 2022, $350 prior to this date Vision Care Benefit The Vision Care benefit to employees and each eligible dependant dependent shall be to a maximum of $400.00 once every 24 consecutive month period for each family member. The plan includes: • eyeglasses (frames and/or lenses including contact lenses) which are prescribed as a result of an eye examination by a licensed medical doctor, ophthalmologist or optometrist, and which are purchased while coverage is in force; • repairs to existing glasses (frames and/or lenses); • charges for fitting of safety glasses; • the cost of eye examinations (one exam every 24 consecutive months); • laser eye surgery. The vision care benefit does not cover the following: • charges for fitting of eyeglasses (other than safety glasses); • non-prescription safety glasses; • charges for expenses covered in whole or in part by the Workers Compensation Board, or any other agency or department of any federal, provincial, or municipal government, or any third party. Prescription Drug Plan The Prescription Drug Plan provides coverage for 80% of annual (April 1 to March 31) prescription drug expenses (listed (formulary) and de-listed (non-formulary) drugs, serums, injectibles injectables and insulin) up to the maximum of each employee’s Manitoba Pharmacare Annual Deductible amount. A Claimsecure ClaimSecure pay-direct prescription drug plan card is provided. Effective April 1, 20152021, the dispensing fee cap increased to $10.1010.80. The dispensing fee cap will be increased every two years from that date to reflect the average increase (if any) to dispensing fees charged in Manitoba, based on actual claims experience of Hydro Efficiency Manitoba employees. This cap does not apply to "compound prescriptions". The plan does not cover vitamins and vitamin preparations (unless injected), patent or proprietary drugs and "over the counter" drugs, fertility drugs and anabolic steroids. The plan covers smoking cessation products to a maximum of $350 per contract. The parties will review the impact of a change in the amount of the deductible in provincial Pharmacare design if the change results in an increased cost to the Corporation Organization for prescription drugs of 5% or more. The purpose of this review is to mitigate the impact of the Pharmacare change on the CorporationOrganization. If a mutually agreeable resolution is not reached within 45 days of the change, the issue will be referred to an independent third party for resolution. Dental Plan Coverage is as follows – subject to plan restrictions: Basic: 90% reimbursement of costs Major: 75% reimbursement of costs Orthodontics: 50% reimbursement of costs to a lifetime maximum of $2,000/dependent child up to the age of 19. - The maximum coverage for all dental claims in a calendar year is $1750/person (including orthodontics). - When both spouses are employed by Manitoba HydroEfficiency Manitoba, or if an employee and the employee's spouse are provided with similar dental benefits under any other dental plan, payment of benefits shall be coordinated and/or reduced to the extent that total benefits payable do not exceed 100% of the actual incurred expenses. - Pre-treatment authorization is required if treatment will cost more than $500.00 500 and in all cases of orthodontic services. - Termination or suspension of coverage: • as outlined in Corporate Policy P521Appendix D, or • in the case of orthodontic coverage, when a dependent child attains 19 years of age. Except, where an impression for a denture has been taken before the termination or suspension of coverage date and the denture is installed after the termination or suspension of coverage date, dental services in connection with this procedure and incurred within 30 calendar days after the termination or suspension of coverage date, are eligible for coverage. Coverage is reinstated upon return from leave, if previously eligible as outlined in Corporate Policy P521. Appendix D. - The fee guide is the Manitoba Dental Association Fee Schedule in effect at the time services are rendered. - The plan year consists of 12 consecutive months commencing January 1st. Payment for coverage will be based on the year that services are rendered.
Appears in 1 contract
Samples: Public Employees
