Apply early. When enrolling in ARTA's Health Plan, your acceptance will be guaranteed without a medical exam provided you apply for coverage before, or within, 60 days of leaving another group insurance plan. After this date, medical evidence is required by the insurer, Manulife Financial, and Health coverage may be declined. IN PROVINCE Eligible extended health care expenses (incurred in province of residence) will be reimbursed at 80% according to the various maximums and limits outlined in the certificate of insurance up to a combined annual maximum per person of $10,000 in each calendar year. OUT-OF-PROVINCE/CANADA Eligible international Travel Emergency Medical expenses incurred due to an unforeseen accident or sudden illness while traveling outside your province of residence, including outside Canada, will be reimbursed at 100% to a lifetime maximum of $1,000,000 per person. Note* All limits shown are the maximum payable per person each calendar year, unless indicated otherwise.
The Extended Health Care Plan pays for eligible expenses which are not covered by your Provincial Government Health Insurance Plan (GHIP) and which are recommended as medically necessary by a legally qualified physician. Tests or procedures not recognized by Health and Welfare Canada, or the Provincial Health Ministry, which are considered experimental or cosmetic in nature, are not covered under the Plan. ARTA is not responsible for any government actions implemented during the policy year which may impact on the ARTA plans. IN-PROVINCE EXTENDED HEALTH CARE ELIGIBLE EXPENSES Eligible Expenses - 80% reimbursement up to a combined annual maximum per person of $10,000 in each calendar year. All amounts shown are annual calendar year limits payable per covered person, unless otherwise stated. Drugs - $1,100 Per Year Drugs which by law require a prescription from a physician or dentist, including sera and injectibles, and diabetic supplies. Non-prescription drugs required as a result of colostomy or ileostomy and/or treatment of cystic fibrosis, diabetes or Parkinsonism. Vision Care $175 in any 2 calendar years - Prescription eyeglasses and contact lenses. $200 in any 2 calendar years - Subject to approval by Johnson Inc., contact lenses to correct vision to at least 20/40 level when it cannot be so improved by eyeglasses. Private Duty Nursing $1,500 in any 3 consecutive years in the patient's home by a registered nurse, subject to prior approval by Johnson Inc. Paramedical Services $500 per calendar year for Massage Therapist, Physiotherapist, Athletic Therapist and Chiropractor combined. $225 per calendar year for each other eligible specialty: Psychologist, Speech Therapist, Naturopath, Acupuncturist, Osteopath, Podiatrist/Chiropodist. Ambulance Service To and from the nearest hospital that can provide treatment, including the cost of air travel when medically necessary. Diagnostic Services Radiology, blood transfusions, and oxygen. Aids and Appliances (purchase or repair of): - Trusses, splints, braces, crutches, casts, artificial limbs or eyes. - Breast prosthesis. - Custom-made orthopaedic shoes ($500 in any 3 consecutive years). - Orthotics ($300 in any 3 consecutive years). - Elastic support stockings ($200). - Hearing aids ($400 in any 3 consecutive years). Rental of: Wheelchair, hospital bed, respirator or ventilator Accidental Dental - $1,000 Per Year Treatment required following accidental damage (from an external blow to your mouth) to your natural or artificial teeth. Dental work must be completed within 6 months of accident. Referral Treatment Outside Canada Physician charges, hospital room and board at ward rates up to 31 days per period of disability. Prescribed Health Educational Program Up to an annual limit of $100 (recommended by your physician). Hospital Difference between standard ward and semi-private, private and preferred hospital rates up to a daily maximum of $100 per covered person. Coverage includes confinement in a hospital, convalescent and rehabilitative hospitals. Home Care After a hospital stay of at least 24 hours, 80% of home care expenses are covered up to a maximum of $50 a day for up to 10 days. Upon written recommendation of a physician, completion of a Johnson Inc. authorization form and provided in your own home, the level of care includes: - Activities of daily living (eating, bathing, dressing). - Ambulation and exercise. - Self-administered medications. - Homemaker services or home health aide services. - Functional ability improvement. - Respite care for your primary caregiver. - Outpatient services and supplies not covered by the Provincial Government. Educational Programs Medically recommended educational programs include wellness or rehabilitation (maximum $100 per calendar year). Nutritionist/Dietician Nutritionist/Dietician paramedical services (maximum $225 per calendar year). Chiropractic/Podiatrist Chiropractic/Podiatrist from first visit (maximum $500 per calendar year, combined with Physiotherapy, Massage, Athletic Therapy) A maximum of $225 applies to each of the other practitioners, such as speech therapy. Visual Enhancement Equipment Visual Enhancement Equipment (maximum $200 per 2 calendar years). Note: All medical practitioners must be provincially licensed. OUT-OF-PROVINCE/CANADA ELIGIBLE EXPENSES (Optional Coverage)
100% Reimbursement of unforeseen Out-of-Province or International Travel Emergency Medical Expenses to a lifetime maximum of $1,000,000 per person, for multiple trips up to 60 days duration. If you become ill or injured while traveling outside your province of residence, or Canada, comprehensive medical and supplementary benefits are payable through ARTA's Extended Health Care Plan WITH 60-Day Travel. The Plan provides assistance through the services of World Access Inc. for your eligible emergency medical expenses. Eligible emergency expenses include: - In-patient hospital charges up to the cost of semi-private accommodation. - Physicians' charges. - Prescription drugs. - Diagnostic procedures. - Private duty nursing up to an annual maximum of $5,000. - Paramedical services of a chiropractor, podiatrist or physiotherapist to an annual maximum of $225 per speciality. - Rental of a wheelchair, crutches and canes when ordered by a physician. Medical Transportation - Licensed ground or air ambulance for emergency transport to the nearest medical facility, limit of one return trip a year. - If medically necessary, round-trip economy transportation will be arranged and a qualified medical attendant to accompany the patient. Accidental Dental - emergency treatment and stabilization due to accidental injury to natural teeth or accidental damage to natural or artificial teeth from an external blow to the mouth to an annual maximum of $1,000. Transportation to Bedside - provides one round trip economy airfare for one member of your family to be with an insured person who has been confined to a hospital for at least 7 days. Trip Interruption/Delay - POST DEPARTURE - one way economy far or the excess cost over and above any prepaid travel plan, if your trip is interrupted or delayed due to your or your dependent's hospitalization outside your province of residence. Return of Dependent Children - one way economy transportation or the excess cost of pre-paid travel arrangements for the return of your children by the most direct route to their place of residence, if dependent children are left unattended while traveling when you or your spouse are hospitalized. Vehicle Return - arrange and cover the cost of returning your vehicle to the nearest appropriate rental agency, up to a maximum of $2,000, if an insured person is unable to do so due to sickness, injury or death. Repatriation - provides up to $5,000 to return the deceased to the home province. Additional Expenses - covers the cost of meals and hotel accommodation due to your hospitalization, up to a daily maximum of $150 up to 10 days. Note* Prior approval must be obtained from World Access to guarantee payment of your claim expenses. You can contact them 24 hours a day, 365 days a year. World Access must be notified within 48 hours of the emergency in order to provide for your medical expenses and effectively monitor your care. If World Access is not contacted within 48 hours of the emergency, payments will be limited to $2,000. Each insured may be required to provide proof of departure in the event of a claim. Proof can take any form, identifying you, specifying the date, and indicating that the transaction took place in your province of residence. Examples include a purchase made at the Canadian duty-free store, a stamped passport, an airline ticket or a credit card receipt. For more information you can contact World Access at one of the following numbers: Canada & USA: 1-800-249-6556 (toll-free) Other countries: (519) 742-6683 (call collect) Fax: (519) 742-8553 In addition to the certificate number, World Access will require your Provincial Government Health Insurance Plan number and the ARTA/World Access Identification No. 9520 to process payments. |