|
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
- $1,200 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
$3,000 in any 3 consecutive years in the patient's home by a
registered nurse, subject to prior approval by Johnson Inc.
Paramedical* Services
$600 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 ($500 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 $600 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).
Notes*
1. All medical practitioners must be provincially
licensed.
2. A note from your physician regarding the diagnosis may be
required.
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 specialty.
- 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 Cancellation – Prior to Departure –
Non-refundable portion of pre-paid travel arrangements. Maximum
$6000 per insured person. Call World Access.
Trip Interruption/Delay - Post Departure - Extra cost
of a 1-way economy airfare to the departure or destination point
and any unused non-refundable land arrangements. Maximum $6000
per insured person.
Call World Access.
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 medical emergency
(or the event forcing trip cancellation/delay)
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.
|
Click on the Link below to Download
|
|
|
For
more information you can contact World Access at one of the
following numbers:
In Canada / USA (Toll Free)
1-800-249-6556
In Mexico (Toll Free)
00-1-800-514-3702
In Other countries (Call Collect) (519)
742-6683
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.
|