Extended Health Care (EHC) Benefits Summary

Extended Health
Care Benefits (EHC)
Echelon General Insurance Co.

80% Reimbursement. Health evidence in the form of a Personal Health Declaration must be approved by the Insurer.

Pay-direct drug card utilized for Drug and claims.

Prescription Drugs

Payable up to $5,000/ policy year – No Formulary, but generic drugs unless Physician specifies "No substitution".

Accidental Dental

Up to $2,500/ policy year

Ambulance

Up to $250/trip for Ambulance services not covered by Provincial Plan

Durable Medical Equipment
& Prosthetics

Up to $1,750/policy year

Medical Supplies

Up to $1,500/policy year

Orthopedic Footwear

Up to $150/policy year for Orthopedic shoes

Private Duty Nursing Services Out of Hospital

Maximum $2,000/policy year

Paramedical Services

Up to $300 per practitioner per policy year after any provincial benefits, including:

• Chiropractor
• Chiropodist
• Nutritionist
• Osteopath
• Podiatrist
• Registered Massage Therapist
• Physiotherapist
• Speech Therapist.

Psychologist

Up to $360 per two policy years

Hearing Aids

$300/5 years

Hospital

Semi-private room up to $170 per day for 30 days ($5,100 maximum/policy year)

Vision

Up to $150 every 2 years, after 6 month waiting period.

Out-of-Country Travel Insurance

100% up to $2 Million for trips of up to 30 days plus Emergency Travel Assistance Services;

Emergency Travel Assistance

Provides worldwide assistance in the event of a medical emergency

Policy Year Maximum / person

$25,000 per person per policy year

Dental Benefits Summary

Dental
Echelon General Insurance Co.

80% Reimbursement after Deductible. May only be purchased in conjunction with EHC.

Pay Direct Card may be accepted by dentist, although not all dentists can file claims electronically. If not, traditional
paper claim submission process used.

Dental Services

Basic Preventive Care including:

• diagnostics,
• laboratory services,
• surgical services,
• denture repair,
• Endodontics,
• Periodontics (at 50%),
• oral surgery,
• anesthetic, and
• minor restorations.

Recall examinations once every 9 months, complete oral examinations every 36 months.

Restorative Services

Not Included

Orthodontia

Not Included

Maximum Benefit

Up to $1,000 per person per policy year

Optional Benefits Summary

Designed to provide additional protection for potential catastrophic drug claims that may exceed the limits of the underlying prescription drug benefit ($5,000) to $25,000 per person ($100,000 Family maximum)

Accidental Death & Dismemberment (AD&D)
ACE INA Insurance

24 Hour protection may be purchased in units of $50,000 to a maximum of $300,000 for the employee only, or for all members of the family. Under the family coverage, the spouse is insured for 60% of the employee's selected coverage amount; if there are children, the spouse is covered for 50%, and each child for 15%. If there is no spouse, only dependent children they are covered for 20%. No health evidence is required.

Critical Illness Insurance
ACE INA Insurance

Critical Illness Insurance available in units of $10,000, $25,000 or $50,000 for participant and spouse. Provides a tax-free lump sum benefit in the event one is diagnosed with one of the following life-threatening conditions:

• Cancer;
• Kidney Failure;
• Stroke;
• Deafness;
• Hearth Attack;
• Multiple Sclerosis;
• Paralysis;
• Blindness;
• Coronary By-Pass Surgery;
• Recipient Major Organ Transplant.

Diagnosis must be made after insurance becomes effective and you survive for 30 days. In the case of Cancer, diagnosis must be made 90 days after effective date.

Menuflex™ Disability Insurance
Lloyd's of London

The Disability Program provides a Temporary Total Disability benefit of 66.7% of weekly earnings, subject to a maximum of $1,000 per week, payable for 24 months following a 30 day waiting period.

Also available is a lump sum tax-free Permanent Total Disability Benefit of 5 X annual earnings after 25 months of continuous total disability.

Additional 24 hour AD&D is available on an optional basis.