Common use of Major Medical Clause in Contracts

Major Medical. Your major medical plan will pay reasonable charges for the following if medically necessary: - by a licensed hospital, limited to semi-private accommodations including out-patient charges, in Canada, and for a temporary period outside Canada in the case of a resident of Canada who requires hospitalization due to an emergency while travelling or on vacation or because treatment is not available in Canada. In all cases, charges by a chronic or convalescent hospital for a covered person 65 years of age or over, shall be excluded. - for services rendered outside the province of residence of the covered person, and excludes such services rendered outside Canada except when such services are required due to an emergency while travelling or on vacation or when treatment is not available in Canada, by a physician, legally licensed to practice medicine, in excess of the charges allowed under the health insurance plan of the province of residence of the covered person. The maximum amount payable by the company for such services shall not exceed the amount specified in the fee schedule of the province of residence of the covered person, except in the case of an emergency while the covered person is travelling or on vacation or when treatment is not available in Canada when the amount payable shall be unlimited. - for 90% of drugs and medicines which require the written prescription of a physician or dentist for purchase, excluding the following:

Major Medical. Your major medical plan will pay reasonable charges for the following if medically necessary: - – by a licensed hospital, limited to semi-private accommodations including out-patient charges, in Canada, and for a temporary period outside Canada in the case of a resident of Canada who requires hospitalization due to an emergency while travelling or on vacation or because treatment is not available in Canada. In all cases, charges by a chronic or convalescent hospital for a covered person 65 years of age or over, shall be excluded. - – for services rendered outside the province of residence of the covered person, and excludes such services rendered outside Canada except when such services are required due to an emergency while travelling or on vacation or when treatment is not available in Canada, by a physician, legally licensed to practice medicine, in excess of the charges allowed under the health insurance plan of the province of residence of the covered person. The maximum amount payable by the company for such services shall not exceed the amount specified in the fee schedule of the province of residence of the covered person, except in the case of an emergency while the covered person is travelling or on vacation or when treatment is not available in Canada when the amount payable shall be unlimited. - – for 90% of drugs and medicines which require the written prescription of a physician or dentist for purchase, excluding the following:

Major Medical. Your major medical plan will pay reasonable charges for the following if medically necessary: - • by a licensed hospital, limited to semi-private accommodations including out-out- patient charges, in Canada, and for a temporary period outside Canada in the case of a resident of Canada who requires hospitalization due to an emergency while travelling or on vacation or because treatment is not available in Canada. In all cases, charges by a chronic or convalescent hospital for a covered person 65 years of age or over, shall be excluded. - • for services rendered outside the province of residence of the covered person, and excludes such services rendered outside Canada except when such services are required due to an emergency while travelling or on vacation or when treatment is not available in Canada, by a physician, legally licensed to practice medicine, in excess of the charges allowed under the health insurance plan of the province of residence of the covered person. The maximum amount payable by the company for such services shall not exceed the amount specified in the fee schedule of the province of residence of the covered person, except in the case of an emergency while the covered person is travelling or on vacation or when treatment is not available in Canada when the amount payable shall be unlimited. - • for 90% of drugs and medicines which require the written prescription of a physician or dentist for purchase, excluding the following: