1.      Is there an age limit for this plan?

   The plan is applicable to the following age groups

·  65 years and under

·  65 years & over

2.     What is the coverage for persons 65 and under?

   There are two (2) limit options:

·  $300,000 & $500.000.

3.      What is the coverage for persons 65 years & over?

            It is limited to $300,000.

4.     How does the drawdown system work?

        Each claim is deducted from the major medical maximum.

5.     How is the major medical applied?

     The major medical maximum applies to every three (3) consecutive years

6.     What is the process for deductibles?

·  

             There are no deductibles if the member remains within service provider network

·              However, outside of the network, the annual deductible will be $300 per person.

7.      When can a member start the medical plan?

Members can start to use the medical plan immediately upon their acceptance, however, claims for pre-existing conditions will be limited to $1,500 during the first 24 months of coverage.

8.    Dependents | Spouses/Children:

·         One (1) spouse per member

·         Member must show proof of dependent children over 18 years being at school full time

·         Dependents of blended families eligible. If children carry different surnames from the primary insured, must show proof that primary insured is the parent/step-parent of child

·         A member can add or remove dependents anytime

·         any change in status of spouse or dependents may affect premium coverage 

9.  How does co-ordination of benefits work? 

           Co-ordination of Benefits applies when member or dependent is enrolled on more than one health plan. The Primary policy pays first,               followed by Secondary policy paying on the difference not covered by the Primary policy.

10.   How are maternity benefits paid?

Maternity benefits are payable if conception occurs after 30 days from start date of coverage. 

11.  Other Benefits

Vision

·         Must be a member for 3 months before one is able to claim

·         $1,800 limit per calendar year per person

·         Lenses and vision exams allowed every 12 months

·         Frames allowed every 24 months

Dental

·         $3,000 limit per calendar year per person

·         Must be a member for 3 months before claiming

Life Insurance Option

·         Option available to members <60yrs

·         Only the member is covered; no dependents

·         Two (2) life coverage options | $20,000 or $50,000

·         Accidental death and dismemberment are included as an add-on on the Life policy

·         If death is due to accidental causes, the beneficiary receives double the Life insurance amount