|
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.
|
