Canadian Benefits BC Forum Extended Plan

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BC Forum Standard and Conversion Health Benefits & Optional Dental Plan
Overview of Extended Healthcare & Optional Dental Plans*

STANDARD PLAN: Standard rates apply if: You did not have a previous group policy within the last 90 days or you are a new applicant (pre-existing conditions are not covered).

CONVERSION PLAN: Conversion rates apply if you are converting from a previous group plan within 90 days (pre-existing conditions will be covered, subject to policy limitations, wordings and exclusions).
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* The plan overview is intended for descriptive use only. See policy wordings for coverage’s limitations, and exclusions.

Extended Health Care Benefits

IN-PROVINCE EXPENSES:
80% up to $1,000 per year.
After first $1,000, 100% of eligible expenses, subject to contract maximums*
* The maximum EHB benefit is $35,000 for in-province and out-of-province expenses combined.

HOSPITAL ACCOMMODATION:Semi-private or private ward charges.

PROFESSIONAL SERVICES:
Total combined benefit of $500 per calendar year per person:

  • Chiroprator
  • Physiotherapist
  • Massage Therapist
  • Naturopath

PODIATRISTS: $500.00 per calendar year per person.

REGISTERED NURSE (RN): Up to 720 hours per calendar year for an acutely ill patient in hospital in BC. Up to $1,000 per calendar year when the insured person is acutely ill and bedridden at home. The lifetime maximum benefit payable is $5,000 per person.

HEARING AIDS: Up to $500 per 5-year period per person.

PRESCRIPTION DRUGS (NO Pay Direct Card):
80% (or 100% if an out-of-province emergency) of prescription drug costs not paid (but otherwise recognized as eligible) by Pharmacare.

ALSO WHEN PRESCRIBED BY A PHYSICIAN:

  • Oxygen masks and regulators
  • Blood and blood plasma
  • Rigid support braces and permanent prostheses
  • Certain types of crutches, splints, casts and trusses
  • Essential ostomy and ileostomy supplies
  • Wigs or hairpieces up to $500 per lifetime
  • Surgical stockings up to $200 per calendar year
  • Wheelchairs, beds, iron lung, respirator, cardiac screener.
    Lifetime maximum reimbursement is $5,000.

AMBULANCE SERVICE:
This plan covers ambulance service (including air ambulance) in emergency situations only.

EYE GLASSES/CONTACT LENSES:
after completion of 12 continuous months of membership in this plan: Eyeglasses are covered up to $125 every 24 months.

EMERGENCY OUT OF PROVINCE ELIGIBLE EXPENSES: 100%
While travelling outside your province of residence, benefits are payable for the following eligible expenses incurred IN AN EMERGENCY ONLY and when ordered by the Attending Physician:

  • Local ambulance services
  • Air ambulance (maximum $1,000)
  • The hospital room charge and charges for services and supplies to a maximum of 90 days.

EMERGENCY TRAVEL ASSISTANCE (MEDEX)

  • Locating the nearest appropriate medical care.
  • Handling medical evacuations and related transportation needs.
  • Handling the repatriation to BC of remains.
  • Replacing lost passports, locating qualified legal assistance, language interpreters, etc.

EMERGENCY OUT OF PROVINCE ELIGIBLE EXPENSES: 100%
Your $35,000 lifetime EHB coverage will be automatically increased to $500,0000 whenever you leave BC on trips lasting 4 days or less.

HOSPITAL INDEMNITY BENEFIT
If you or your injured dependents are hospitalized, a hospital indemnity benefit of $10 per day will be paid from the 5th to the 90th day of hospitalization provided it is not due to any pre-existing condition.ACCIDENTAL DEATH & DISMEMBERMENT
The maximum benefit payable in the event of death or dismemberment resulting within 365 days of an accident is $25,000. Other benefits are listed in the policy wordings. This coverage terminates at age 70.

FINAL EXPENSE BENEFIT
Reimbursement will be based on actual funeral expenses of up to $5,000 per insured person if death occurs from any cause after 24 months of continuous coverage; otherwise at any time if death occurs as a result of accident.

Dental (Optional only with Extended Health Care)
You must maintain coverage for two (2) years if you opt for Dental coverage.

During the first 12 months of coverage under this dental plan, eligible expenses will be reimbursed at 70% of the PBC fee schedule. Thereafter, the reimbursement percentage will be increased to 80%. Dental coverage will begin 3 months from the date you (and/or your dependants) are covered under the EHC plan.

  • Oral examination, x-rays, dental prophylaxis, topical fluoride treatment (including prophylaxis).
  • Restorative services (fillings, tooth-coloured restorations).
  • Endodontics, root canal therapy, periapical services.
  • Prosthetic services (minor denture adjustments, denture repairs, denture rebasing or relining).
  • Oral surgery.

Removable Prosthetics:
After 12 continuous months on this plan, the insured will be entitled to reimbursement (within the policy limits):

  • One upper and one lower partial or complete denture in a 5 year period.

The maximum amounts payable are:

  • complete single upper or lower denture immediate (within 21 days): $270
  • complete single or upper/lower denture: $260
  • complete upper/lower dentures immediate (within 21 days): $500;
  • complete upper/lower dentures: $490;
  • partial dentures (upper/lower) acrylic base: $150;
  • or cast chrome cobalt: $350.

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