Plan Details. (i) this plan shall cover the employee, the employee's spouse and all other dependents under twenty-one (21) years of age, or a dependent who is between the ages of twenty-one (21) and twenty-five (25) and is a full-time student attending an educational institution or a mentally retarded or physically handicapped child of an employee, provided such child is unmarried, twenty-one (21) years or over, dependent upon such employee for support and was mentally retarded or physically handicapped and insured as a dependent immediately prior to age twenty-one (21); (ii) expenses incurred for prescribed drugs and medicines dispensed by a physician or by a licensed pharmacist on the written prescription of a physician or dental surgeon shall be reimbursed to the employee at ninety percent (90%) of the cost; (iii) reimbursement for all reasonable and necessary eligible expenses recommended and approved by a physician or surgeon shall be made at one hundred percent (100%) of cost or as detailed in the 'master contract'. Eligible expenses include: Mαys 68 (a) Charges by a licensed hospital for room and board and for hospital services and supplies furnished for care and treatment, up to one hundred and forty dollars ($140.00) per day, effective upon 1, 2002 (for expenses incurred after that date); one hundred and fifty dollars ($150.00) per day, effective April 1, 2003; and one hundred and sixty dollars ($160.00) per day, effective April 1, 2004. (b) Charges for private duty nursing in your home by a registered graduate nurse who is not ordinarily a resident in your home and is not related to you or to your dependents, provided the service was recommended and approved by a licensed physician or surgeon.
Appears in 1 contract
Sources: Collective Agreement
Plan Details. (i) this plan shall cover the employee, the employee's spouse and all other dependents under twenty-one (21) years of age, or a dependent who is between the ages of twenty-one (21) and twenty-five (25) and is a full-time student attending an educational institution or a mentally retarded or physically handicapped child of an employee, provided such child is unmarried, twenty-one (21) years of age or over, dependent upon such employee for support and was mentally retarded or physically handicapped and insured as a dependent immediately prior to age twenty-one (21);
(ii) expenses incurred for prescribed drugs and medicines dispensed by a physician or by a licensed pharmacist on the written prescription of a physician or dental surgeon shall be reimbursed to the employee at ninety percent (90%) of the cost;
(iii) reimbursement for all reasonable and necessary eligible expenses recommended and approved by a physician or surgeon shall be made at one hundred percent (100%) of cost or as detailed in the 'master contract'. Eligible expenses include: ; Mαys 6826
(a) Charges by a licensed hospital for room and board and for hospital services and supplies furnished for care and treatment, up to one hundred and forty dollars ($140.00) per day, effective upon 1, 2002 (for expenses incurred after that date); one hundred and fifty dollars ($150.00) per day, effective April 1, 2003; and one hundred and sixty dollars ($160.00) per day, effective April 1, 2004.
(b) Charges for private duty nursing in your home by a registered graduate nurse who is not ordinarily a resident in your home and is not related to you or to your dependents, provided the service was recommended and approved by a licensed physician or surgeon.
(c) Artificial limbs and eyes, crutches, splints, casts, trusses and braces.
(d) Rental of wheelchairs, hospital beds or iron lungs required for temporary therapeutic use. A wheelchair may be purchased if recommended by the attending physician and if rental cost would exceed the purchase cost.
(e) Oxygen and its administration.
(f) Hearing aids and eye glasses if required as a result of accidental injury.
(g) Ambulance services.
(h) Dental services and supplies which are provided by a dental surgeon within a period of eighteen (18) months following accident for treatment of accidental injury to natural teeth including replacement of such teeth or for the setting of a jaw fractured or dislocated in an accident, excluding any benefits payable under any provincial medical plan.
(i) Charges for the services of a chiropractor, osteopath, chiropodist, naturopath, podiatrist, physio-therapist, speech therapist and masseur to a maximum of thirty-five dollars ($35.00) per visit for each visit not subsidized by O.H.I.P. Mαys 27
(j) Charges for the services of a psychologist up to forty-five dollars ($45.00) per half (1/2) hour for individual psychotherapy and/or testing and thirty-five dollars ($35.00) for all other visits.
(k) Fees for services rendered outside of Ontario, by a physician, surgeon or a specialist legally licensed to practice medicine, in excess of the charges which are allowed under the Provincial Health Insurance Plan, but not to exceed the amount specified in the Ontario Medical Association Tariff.
(l) Charges for surgery by a podiatrist, performed in a podiatrist's office to a maximum of one hundred and forty dollars ($140.00). It is not necessary for the employee or dependents to be confined to hospital to be eligible for benefits under this plan.
Appears in 1 contract
Sources: Collective Agreement