Common use of Major Medical Benefit Clause in Contracts

Major Medical Benefit.  The Major Medical Benefit portion of the plan is subject to a deductible of $25.00 per family, per calendar year.  There is no longer a lifetime maximum amount of $43,000. per individual.  The Major Medical expenses are subject to 80% reimbursement for the following covered expenses: Services of a licensed physiotherapist to an annual maximum of $1000.00 per eligible individual.  Services of a registered nurse - charges for home nursing care, by a registered nurse (R.N.) or when unavailable a registered nursing assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home; - when ordered by a licensed doctor (M.D.) as medically necessary for a disability that requires the specialized training of an R.N. or R.N.A. - charges for nursing care in a hospital if such charges are not covered under the insured person’s Provincial Health Plan, by a Registered Nurse (R.N.) or when unavailable a Registered Nursing Assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home.  Diagnostic and x-ray services, blood and blood plasma, oxygen and rental of equipment for its administration  Purchase of durable medical equipment, crutches, artificial limbs, etc., including elastic support stockings and orthopaedic shoes  Rental or purchase of a wheelchair, hospital bed or iron lung  Licensed ambulance, including air ambulance to and from the nearest hospital  Dental treatment for accidental injury to natural teeth Expenses Not Covered: No payment is made for the following expenses:  Cost of a semi-private and a private hospital room  Convalescent or nursing home care  Drugs which can be purchased without prescription (with certain exceptions). For example: patent medicines, vitamins, health foods, cough and cold preparations, aspirin and similar products are ineligible. General Exclusions The plan does not cover services and supplies in the following situations:  injury sustained by employees while working for pay or profit other than with their employer  injury of a dependent while working for pay or profit, any portion of medical expense covered under Workers' Compensation or similar program  services to which the patient is entitled without charge, or for which there would be no charge if there were no coverage  services, or portions thereof, provided under government sponsored programs In the event that a service covered by a government sponsored program is suspended, the Extended Health Care Plan will not assume coverage of such service. Co-ordination of Benefits Some employees and their dependants are eligible for benefits from other group type plans. In these cases, the benefits payable under all plans will be co-ordinated to ensure that the maximum benefits are made available but that the total amount paid does not exceed the actual expenses incurred. Terms and conditions are more fully described in the governing insurance company policy.

Major Medical Benefit.  The Major Medical Benefit portion of the plan is subject to a deductible of $25.00 per family, per calendar year.  There . This benefit is no longer subject to a lifetime maximum amount of $43,00040,000. per individual.  . The Major Medical expenses are subject to 80% reimbursement for the following covered expenses: . Services of a licensed physiotherapist to an annual maximum of $1000.00 per eligible individual.  Services of a registered nurse - charges for home nursing care, by a registered nurse (R.N.) or when unavailable a registered nursing assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home; - when ordered by a licensed doctor (M.D.) as medically necessary for a disability that requires the specialized training of an R.N. or R.N.A. - charges for nursing care in a hospital if such charges are not covered under the insured person’s Provincial Health Plan, by a Registered Nurse (R.N.) or when unavailable a Registered Nursing Assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home.  . Diagnostic and x-ray services, blood and blood plasma, oxygen and rental of equipment for its administration  . Purchase of durable medical equipment, crutches, artificial limbs, etc., including elastic support stockings and orthopaedic shoes  . Rental or purchase of a wheelchair, hospital bed or iron lung  . Licensed ambulance, including air ambulance to and from the nearest hospital  . Dental treatment for accidental injury to natural teeth Expenses Not Covered: No payment is made for the following expenses:  . Cost of the difference between a semi-private and a private hospital room  . Convalescent or nursing home care  . Cost of treatment by chiropractors, osteopaths, podiatrists, speech therapists and psychologists . Hearing aid expenses . Drugs which can be purchased without prescription (with certain exceptions). For example: patent medicines, vitamins, health foods, cough and cold preparations, aspirin and similar products are ineligible. General Exclusions The plan does not cover services and supplies in the following situations:  . injury sustained by employees while working for pay or profit other than with their employer  . injury of a dependent while working for pay or profit, any portion of medical expense covered under Workers' Compensation or similar program  . services to which the patient is entitled without charge, or for which there would be no charge if there were no coverage  . services, or portions thereof, provided under government sponsored programs In the event that a service covered by a government sponsored program is suspended, the Extended Health Care Plan will not assume coverage of such service. Co-ordination of Benefits Some employees and their dependants are eligible for benefits from other group type plans. In these cases, the benefits payable under all plans will be co-ordinated to ensure that the maximum benefits are made available but that the total amount paid does not exceed the actual expenses incurred. Terms and conditions are more fully described in the governing insurance company policy.. APPENDIX "F"

Major Medical Benefit.  The Major Medical Benefit portion of the plan is subject to a deductible of $25.00 per family, per calendar year.  There . This benefit is no longer subject to a lifetime maximum amount of $43,000. per individual.  . The Major Medical expenses are subject to 80% reimbursement for the following covered expenses: . Services of a licensed physiotherapist to an annual maximum of $1000.00 per eligible individual.  Services of a registered nurse - charges for home nursing care, by a registered nurse (R.N.) or when unavailable a registered nursing assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home; - when ordered by a licensed doctor (M.D.) as medically necessary for a disability that requires the specialized training of an R.N. or R.N.A. - charges for nursing care in a hospital if such charges are not covered under the insured person’s Provincial Health Plan, by a Registered Nurse (R.N.) or when unavailable a Registered Nursing Assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home.  . Diagnostic and x-ray services, blood and blood plasma, oxygen and rental of equipment for its administration  . Purchase of durable medical equipment, crutches, artificial limbs, etc., including elastic support stockings and orthopaedic shoes  . Rental or purchase of a wheelchair, hospital bed or iron lung  . Licensed ambulance, including air ambulance to and from the nearest hospital  . Dental treatment for accidental injury to natural teeth Expenses Not Covered: No payment is made for the following expenses:  . Cost of the difference between a semi-private and a private hospital room  . Convalescent or nursing home care  . Cost of treatment by chiropractors, osteopaths, podiatrists, speech therapists and psychologists . Hearing aid expenses . Drugs which can be purchased without prescription (with certain exceptions). For example: patent medicines, vitamins, health foods, cough and cold preparations, aspirin and similar products are ineligible. General Exclusions The plan does not cover services and supplies in the following situations:  . injury sustained by employees while working for pay or profit other than with their employer  . injury of a dependent while working for pay or profit, any portion of medical expense covered under Workers' Compensation or similar program  . services to which the patient is entitled without charge, or for which there would be no charge if there were no coverage  . services, or portions thereof, provided under government sponsored programs In the event that a service covered by a government sponsored program is suspended, the Extended Health Care Plan will not assume coverage of such service. Co-ordination of Benefits Some employees and their dependants are eligible for benefits from other group type plans. In these cases, the benefits payable under all plans will be co-ordinated to ensure that the maximum benefits are made available but that the total amount paid does not exceed the actual expenses incurred. Terms and conditions are more fully described in the governing insurance company policy.. APPENDIX "F"

Major Medical Benefit.  The Major Medical Benefit portion of the plan is subject to a deductible of $25.00 per family, per calendar year.  There • This benefit is no longer subject to a lifetime maximum amount of $43,000. per individual.  • The Major Medical expenses are subject to 80% reimbursement for the following covered expenses: • Services of a licensed physiotherapist to an annual maximum of $1000.00 per eligible individual.  • Services of a registered nurse - charges for home nursing care, by a registered nurse (R.N.) or when unavailable a registered nursing assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home; - when ordered by a licensed doctor (M.D.) as medically necessary for a disability that requires the specialized training of an R.N. or R.N.A. - charges for nursing care in a hospital if such charges are not covered under the insured person’s Provincial Health Plan, by a Registered Nurse (R.N.) or when unavailable a Registered Nursing Assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home.  • Diagnostic and x-ray services, blood and blood plasma, oxygen and rental of equipment for its administration  • Purchase of durable medical equipment, crutches, artificial limbs, etc., including elastic support stockings and orthopaedic shoes  • Rental or purchase of a wheelchair, hospital bed or iron lung  • Licensed ambulance, including air ambulance to and from the nearest hospital  • Dental treatment for accidental injury to natural teeth Expenses Not Covered: No payment is made for the following expenses:  • Cost of the difference between a semi-private and a private hospital room  • Convalescent or nursing home care  • Cost of treatment by chiropractors, osteopaths, podiatrists, speech therapists and psychologists • Hearing aid expenses • Drugs which can be purchased without prescription (with certain exceptions). For example: patent medicines, vitamins, health foods, cough and cold preparations, aspirin and similar products are ineligible. General Exclusions The plan does not cover services and supplies in the following situations:  • injury sustained by employees while working for pay or profit other than with their employer  • injury of a dependent while working for pay or profit, any portion of medical expense covered under Workers' Compensation or similar program  • services to which the patient is entitled without charge, or for which there would be no charge if there were no coverage  • services, or portions thereof, provided under government sponsored programs In the event that a service covered by a government sponsored program is suspended, the Extended Health Care Plan will not assume coverage of such service. Co-ordination of Benefits Some employees and their dependants are eligible for benefits from other group type plans. In these cases, the benefits payable under all plans will be co-ordinated to ensure that the maximum benefits are made available but that the total amount paid does not exceed the actual expenses incurred. Terms and conditions are more fully described in the governing insurance company policy.

Major Medical Benefit.  The Major Medical Benefit portion of the plan is subject to a deductible of $25.00 per family, per calendar year.  • There is no longer a lifetime maximum amount of $43,000. per individual.  • The Major Medical expenses are subject to 80% reimbursement for the following covered expenses: Services of a licensed physiotherapist to an annual maximum of $1000.00 per eligible individual.  • Services of a registered nurse - charges for home nursing care, by a registered nurse (R.N.) or when unavailable a registered nursing assistant (R.N.A.) who: EBPSA - 13 - is not a member of your family; and - does not normally live in your home; - when ordered by a licensed doctor (M.D.) as medically necessary for a disability that requires the specialized training of an R.N. or R.N.A. - charges for nursing care in a hospital if such charges are not covered under the insured person’s Provincial Health Plan, by a Registered Nurse (R.N.) or when unavailable a Registered Nursing Assistant (R.N.A.) who: - is not a member of your family; and - does not normally live in your home.  • Diagnostic and x-ray services, blood and blood plasma, oxygen and rental of equipment for its administration  • Purchase of durable medical equipment, crutches, artificial limbs, etc., including elastic support stockings and orthopaedic shoes  • Rental or purchase of a wheelchair, hospital bed or iron lung  • Licensed ambulance, including air ambulance to and from the nearest hospital  • Dental treatment for accidental injury to natural teeth Expenses Not Covered: No payment is made for the following expenses:  • Cost of a semi-private and a private hospital room  • Convalescent or nursing home care  • Drugs which can be purchased without prescription (with certain exceptions). For example: patent medicines, vitamins, health foods, cough and cold preparations, aspirin and similar products are ineligible. General Exclusions The plan does not cover services and supplies in the following situations:  injury sustained by employees while working for pay or profit other than with their employer  injury of a dependent while working for pay or profit, any portion of medical expense covered under Workers' Compensation or similar program  services to which the patient is entitled without charge, or for which there would be no charge if there were no coverage  services, or portions thereof, provided under government sponsored programs In the event that a service covered by a government sponsored program is suspended, the Extended Health Care Plan will not assume coverage of such service. Co-ordination of Benefits Some employees and their dependants are eligible for benefits from other group type plans. In these cases, the benefits payable under all plans will be co-ordinated to ensure that the maximum benefits are made available but that the total amount paid does not exceed the actual expenses incurred. Terms and conditions are more fully described in the governing insurance company policy.EBPSA - 14

Major Medical Benefit.  The Major Medical Benefit portion of the plan is subject to a deductible of $25.00 per family, per calendar year.  There This benefit is no longer subject to a lifetime maximum amount of $43,00040,000. per individual.  The Major Medical expenses are subject to 80% reimbursement for the following covered expenses: • Services of a licensed physiotherapist to an annual maximum of $1000.00 per eligible individual.  • Services of a registered nurse - ⬝ charges for home nursing care, by a registered nurse (R.N.) or when unavailable a registered nursing assistant (R.N.A.) who: - ⬝ is not a member of your family; and - ⬝ does not normally live in your home; - ⬝ when ordered by a licensed doctor (M.D.) as medically necessary for a disability that requires the specialized training of an R.N. or R.N.A. - ⬝ charges for nursing care in a hospital if such charges are not covered under the insured person’s Provincial Health Plan, by a Registered Nurse (R.N.) or when unavailable a Registered Nursing Assistant (R.N.A.) who: - ⬝ is not a member of your family; and - ⬝ does not normally live in your home.  • Diagnostic and x-ray services, blood and blood plasma, oxygen and rental of equipment for its administration  • Purchase of durable medical equipment, crutches, artificial limbs, etc., including elastic support stockings and orthopaedic shoes  • Rental or purchase of a wheelchair, hospital bed or iron lung  • Licensed ambulance, including air ambulance to and from the nearest hospital  • Dental treatment for accidental injury to natural teeth Expenses Not Covered: No payment is made for the following expenses:  ∙ Cost of the difference between a semi-private and a private hospital room  ∙ Convalescent or nursing home care  ∙ Cost of treatment by chiropractors, osteopaths, podiatrists, speech therapists and psychologists ∙ Hearing aid expenses ∙ Drugs which can be purchased without prescription (with certain exceptions). For example: patent medicines, vitamins, health foods, cough and cold preparations, aspirin and similar products are ineligible. General Exclusions The plan does not cover services and supplies in the following situations:  ∙ injury sustained by employees while working for pay or profit other than with their employer  ∙ injury of a dependent while working for pay or profit, any portion of medical expense covered under Workers' Compensation or similar program  ∙ services to which the patient is entitled without charge, or for which there would be no charge if there were no coverage  ∙ services, or portions thereof, provided under government sponsored programs In the event that a service covered by a government sponsored program is suspended, the Extended Health Care Plan will not assume coverage of such service. Co-ordination of Benefits Some employees and their dependants are eligible for benefits from other group type plans. In these cases, the benefits payable under all plans will be co-ordinated to ensure that the maximum benefits are made available but that the total amount paid does not exceed the actual expenses incurred. Terms and conditions are more fully described in the governing insurance company policy.. APPENDIX "F"