Combined Accident, Sickness and Emergencies Insurance Plan
Benefits Summary
For all benefits except Critical Illness, the following benefit amounts are payable if the loss, treatment required or expenses incurred are due to injury caused by an accident.
For complete benefit details and eligibility definitions, please review contract.
| Benefit amounts | ||
|---|---|---|
| Member/Employee and Spouse | Dependent Child | |
| Dental Treatment and Eyewear — Payable as a maximum for reimbursement of expenses. | ||
| Dental treatment within 7 years following Accident for Dependent Children (1 year for Member/Employees and Spouses) | Prov Fee Guide | Prov Fee Guide |
| Dental treatment after 7 years following Accident for Dependent Children | Not available | $1,500 |
| Dental Implants (each) | $1,750 | $1,750 |
| Orthodontics | $2,500 | $2,500 |
| Dentures and artificial teeth | $500 | $500 |
| For eyeglasses/contact lenses: Initial purchase when not previously required or worn | $250 | $250 |
| For eyeglasses/contact lenses: Repair/replacement | $250 | $250 |
| Fracture, Dislocation or Surgery — Payable as a lump sum payment | ||
| Skull (depressed) or spine (three or more vertebrae) | $1,000 | $1,000 |
| Skull (not depressed) or spine (less than three vertebrae) or pelvis | $500 | $500 |
| Arm between elbow and shoulder, or thigh, or hip, or shoulder blade, or shoulder | $300 | $300 |
| Lower leg, or knee cap, or ankle, or calcaneus (heel bone), or bone(s) of the feet (metatarsals) or hand(s) (metacarpals), or collar bone, or forearm, or wrist, or elbow | $250 | $250 |
| Sternum, or sacrum/coccyx, or upper jaw, or lower jaw, or nose, or two or more toes, fingers or ribs | $200 | $200 |
| One toe, finger or rib, or any bone not specified above | $125 | $125 |
| Surgery for: severed tendon(s) or burns (requiring skin graft), or ruptured kidney/liver/spleen, or punctured lung, or knee (when there is no fracture or dislocation), or eye surgery, or emergency surgery requiring general anaesthetic (excluding dental surgery) | $150 | $150 |
| Hospital, Paramedical, Counselling, and Prosthetics — Payable as a maximum for reimbursement of expenses | ||
| Private or semi-private room if requested by attending physician while in hospital; licensed ambulance service; registered nurse or certified nursing aid; rental of crutches, appliances, wheelchair, or hospital-type bed (limited to purchase price); prescription drugs; splints, casts and cast materials, trusses, pressure garments requested by attending Physician for curative or therapeutic purposes only | Full Cost | Full Cost |
| Rental of TV, radio, or telephone while in hospital | $25/day | $25/day |
| Treatment by a physiotherapist, athletic therapist, or registered massage therapist; treatment by a chiropractor or osteopath; acupuncture; medical supplies for the purpose of dressing changes | $800 | $800 |
| Braces prescribed by the attending Physician for curative or therapeutic purposes only (limited to one purchase per Injury) | $1,250 | $1,250 |
| Counselling | $1,000 | $1,000 |
| Purchase of artificial limbs, eyes, hearing aids, and other prosthetic appliances | $5,000 | $5,000 |
| Commercial repair of a prosthetic appliance | $500 | $500 |
| Travel and Transportation — Payable as a maximum for reimbursement of expenses | ||
| Emergency Transportation | $250 | $250 |
| Special Treatment Travel | $2,500 | $2,500 |
|
Death or Disability — Repatriation and Funeral Expense are payable as a maximum for reimbursement of expenses. All other benefits in this section are payable as a lump sum payment. |
||
| Accidental Death | $20,000 | $20,000 |
| Double Indemnity | $40,000 | $40,000 |
| Repatriation | $5,500 | $5,500 |
| Permanent Total Disability | $100,000 | $100,000 |
| Funeral Expense | $5,000 | $5,000 |
| Rehabilitation and Special Services — Confinement Disability is payable as a lump sum payment. | ||
| Confinement Disability | Not available | $750/month |
| Retraining | $10,000 | $10,000 |
| Private Tutor | Not available | $5,000 |
| Dismemberment or Total and Permanent Loss of Use — Payable as a lump sum payment | ||
| Both hands, or both feet, or one hand and one foot, or one hand or one foot and entire sight of one eye, or entire sight of both eyes, or speech and hearing | $100,000 | $100,000 |
| One entire arm or leg, or one hand or foot, or entire sight of one eye, or speech, or hearing in both ears | $60,000 | $60,000 |
| Entire thumb and index finger (same hand) | $30,000 | $30,000 |
| Thumbs, fingers, or toes (each entire thumb, finger, or toe) | $4,000 | $4,000 |
| One entire phalanx of any one finger, or hearing in one ear | $2,000 | $2,000 |
| Critical Illness — Payable as a lump sum payment | ||
| Diagnosis of a Covered Condition | $10,000 | $10,000 |