Sts benefits brochure

EXTENDED HEALTH CARE
Prescribed Health Educational Program
contact lenses are required due to surgery after • Up to an annual limit of $100 when recommended the above maximum has been reimbursed, an ELIGIBILITY PERIOD:
additional lifetime limit of $75 per person will be 1st of the month following the date
Medical Equipment, Aids and Appliances
• Eye examinations, performed by a licensed of application provided the
An overall combined annual maximum of $10,000 Purchase, when prescribed by a physician, or repair optometrist or ophthalmologist, to a maximum of per person applies to the following benefits. Amounts $50 every 2 calendar years when you live in a application is submitted prior to the
shown are annual limits payable per covered person, • trusses, splints, crutches, casts, rib belts, cervical province where exams are not covered by a 15th of the month; otherwise, the
collars, artificial limbs or eyes, and braces which support a rigid support of metal or plastic (dental 1st of the subsequent month.
• Contact lenses prescribed for severe corneal Hospital Accommodations
braces and sports braces are excluded) and other astigmatism, severe corneal scarring, Keratoconus • 100% of the difference between standard ward prosthetic appliances at the discretion of or Aphakia, to correct vision to at least a 20/40 and semi-private or private hospital rates in your level are payable at an additional maximum of $75 province of residence up to a maximum of 50 • breast prosthesis (one every 2 calendar years)• mastectomy bra (2 every calendar year) The co-insurance for the following benefits is
• custom-made orthopaedic shoes and orthotics 75%:
UTSIDE SASKATCHEWAN
GENERAL INFORMATION
Formulary Prescription Drugs
• surgical stockings, stump socks, burn garments TRAVEL BENEFITS
• A $6.00 deductible is applied to each drug Effective Date of Coverage
dispensed. Maximum benefit is $1,700 per person.
In the event of an accident or unexpected illness You are eligible to apply for benefits if you are an • Drugs which are prescribed by a physician or • diabetic, ostomy, and incontinence supplies occurring outside province of residence, reasonable active member of the association of Superannuated • blood pressure monitors (once every 5 years) and customary charges will be paid for the following Teachers of Saskatchewan, and you and/or your Saskatchewan Prescription Drug Plan Formulary. expenses at 100% up to 60 days per trip with a dependents, if applicable, are residents of Canada • Exclusions are non-formulary drugs, experimental • geriatric chair ($1,000 lifetime maximum) lifetime maximum of $1,000,000. The rate of and are eligible for benefits under the provincial drugs, fertility drugs, smoking cessation drugs, exchange in Canadian currency will be determined at health care program in your province of residence.
erectile dysfunction drugs, vitamins, dietary aids, Your coverage would become effective on the first Rogaine, and any other drug required for cosmetic • cardiac rehabilitation ($300 lifetime maximum) • In-Patient Hospital Charges up to the cost of
of the month following the date of application Rental, when prescribed by a physician, of: provided the application is submitted prior to the 15th • Purchase quantities limited to a 90 day supply.
• wheelchair, patient walker, hospital-type bed, or • Physicians’ Charges
of the month; otherwise, the first of the subsequent other durable equipment (or purchase if approved • Prescription Drugs
Ambulance Services
by Saskatchewan Blue Cross). Lifetime maximum • Diagnostic Procedures
• Services to and from the nearest hospital that can • Private Duty Nursing up to $5,000 per year.
Late Enrollment
provide treatment, including the cost of air travel • equipment for the administration of oxygen (or • Paramedical Services of a physiotherapist, chiro-
You would be required to submit evidence of good when medically necessary. Limit of one return trip purchase if approved by Saskatchewan Blue practor or podiatrist to an annual maximum of health if you apply for coverage more than 60 days • respirator ventilator to a maximum of $500 per • Rental of a Wheelchair, Crutches and Canes
Private Duty Nursing
• coverage terminates under a spouse’s group • Services provided by an RN, RNA, LPN or VON, • Medical Transportation
as an in-patient, or in the home (excluding nursing Referral Treatment Outside Canada
• coverage terminates under any other group homes or for palliative care) to a maximum of • Physician charges, hospital room and board at ward rates up to 31 days per period of disability.
medical facility, limit of one return trip per Coverage would begin on the date the insurer Services must be recommended by a physician in Accidental Dental
Canada for treatment not available in Canada.
• Treatment required following accidental damage • If medically necessary, round-trip economy ($50,000 maximum per course of treatment / Eligible Dependents
transportation will be arranged and paid for a (from an external blow to your mouth) to your lifetime maximum of $100,000). Claim must have qualified medical attendant to accompany the natural or artificial teeth. Dental work must be prior approval from the provincial government and unmarried dependent children under 21 years of age, rendered or reported within 6 months of accident.
the insurer. Payment will not be made for any and unmarried children under 26 years of age who • Subject to medical advice to the contrary, Maximum allowable expense is $1,000.
illness commencing within 12 months of the are attending an educational institution or training at evacuation of the patient to a hospital in their a school of learning on a full-time basis. Dependent Paramedical Services
province of residence, where pre-authorized by children who are physically or mentally infirm will be • Licensed psychologist, speech therapist, podiatrist/ chiropodist, physiotherapist, chiropractor, naturo- The co-insurance for the following benefits is
• Accidental Dental emergency treatment when
path or registered massage therapist. Maximum of 100%:
natural teeth have been injured or artificial teeth Termination of Benefits
have been damaged by a direct, accidental blow to Coverage would cease on the earliest of the date Vision Care Benefits
the mouth, or a fractured or dislocated jaw that you are no longer a member of STS, or the Diagnostic and Other Procedures
• Prescription eyeglasses and contact lenses to a requires setting, up to an annual maximum of termination date of the Group Contract.
• Radiology and blood transfusions.
maximum of $75 every 2 calendar years. If new • Transportation to bedside for one member of
removal, repair and recementing fixed bridge.
your family to be with an insured person who has hospitalization within 3 months immediately been confined to a hospital for at least 7 days, or preceding departure date. Routine check-ups with • Eligible Dependent Children Only: fluoride treat- to identify the deceased prior to release of the no change in medication or treatment are not ments & oral hygiene instruction (2 per year), pit body. (limited to one round trip economy airfare). considered medical investigation, diagnosis or and fissure sealants, protective athletic appliances • Trip Interruption/Delay if your trip is interrupted
or delayed due to your (or your dependent’s) • residents traveling outside their province of hospital-ization outside your province of residence residence against their physician’s advice; Minor Dental Care Benefits
(one way economy fare or the excess cost over • referral or elective (non-emergency) treatment, • 75% co-insurance - $750 per person per year services not required for the immediate relief of • Return of Dependent Children by the most direct
acute pain or suffering which reasonably could route to their place of residence, if dependent have been delayed until returning to your province Major Dental Care Benefits
children are left unattended while travelling when • 50% co-insurance - $750 per person per year you or your spouse are hospitalized (one way • benefits payable by Saskatchewan Health or any • Crowns, inlays and onlays (not payable unless economy transportation or the excess cost of pre- there is extensive decay or breakdown which Superannuated
• confinement due to childbirth and delivery if any cannot be repaired by use of amalgam or similar • Vehicle Return for the cost (up to $2,000) of
portion of travel falls after the 32nd week of Teachers of
returning your vehicle to your home residence or a • Fixed bridges - once per tooth in a five year period rental vehicle to the nearest appropriate rental • expenses incurred as the result of participation in Saskatchewan
(not payable for the initial installation/addition agency, if an insured person is unable to do so professional sports or hazardous avocations (i.e.
unless required primarily due to teeth missing, bungee jumping, parachuting, a flight accident extracted or fractured after your effective date).
• Repatriation up to $5,000 of expenses to return
unless riding as a fare paying passenger on a • Complete and partial dentures (one upper and one commercial airline/charter aircraft with a seating • Additional Expenses for the cost of meals and
capacity of 6 people or more), criminal acts, war, hotel accommodation due to any covered person’s Dental Benefits for Late Applicants
hospitalization, up to a daily maximum of $150 up • services as the result of substance abuse, or If you, or your dependents, apply for dental benefits more than 60 days after you, or your • Worldwide Travel Assistance When a medical
**If you are uncertain about your coverage, please dependents first become eligible, the maximum BENEFITS
emergency arises which requires hospitalization, contact the insurer prior to travel.
benefit will be limited to $100 during the first 12 MEDEX must be contacted. Failure to call MEDEX months of coverage. This provision does not apply to may invalidate your claim. The MEDEX phone dental services required as a result of natural teeth numbers are listed on your identification card. The being injured or artificial teeth being damaged by a INFORMATION
following services are provided by MEDEX: DENTAL CARE BENEFITS
direct accidental blow to the mouth after the effective • 24 hour telephone services around the world; date of the late applicant’s coverage.
• confirming coverage and payment to a doctor Dental benefits are based on the usual and customary charges up to the Dental Society Fee • arrangement for medical evaluation by a Guide for general practitioners in effect in the Effective Date: May 1, 2001
qualified physician and then referral to a GENERAL EXCLUSIONS
medical facility equipped to provide treatment; Services over $500 require pre-authorization in This material summarizes the important
• transfer of patient to another medical facility if writing by the insurer. Dental claim forms are AND LIMITATIONS
features of our group program; it is prepared
as information only; and does not, in itself,
Health and Dental Benefits will not be payable for constitute an Agreement.
• referral to a local legal advisor and/or Basic Dental Care Benefits
charges in connection with the following: The exact terms and conditions of our
assistance in arranging for advances for your • 75% co-insurance - unlimited maximum.
• convalescent, custodial or rehabilitation services, Group Benefits Program are described in the
personal credit card and/or arranging for • Complete oral exam (once every 3 years), recall • services/supplies normally provided without cost or Group Benefits Policy held by STS.
family/friends to post bail and pay legal fees; at nominal cost by the government health plan, • assistance in the replacement of necessary • X-rays: full mouth & panoramic (1 of either type • benefits received or entitled to receive from any travel documents and/or tickets, in the event of every 3 years), single, cephalometric (5 every 2 government agency (i.e. Workers’ Compensation), theft or loss (the cost of obtaining replacement years), occlusal (2 every year), bitewing & insurrection, war, or self-inflicted injuries, temporo-mandibular joint (4 of each in a year).
• participation in the commission of a criminal • emergency response in any language.
• Tests and laboratory examinations.
Superannuated Teachers of Saskatchewan
• Polishing (two units every year), scaling (8 units 2317 Arlington Avenue
Travel Exclusions and Limitations
Saskatoon SK S7J 2H8
Travel Benefits will not be payable for charges in • Fillings, recementing inlays and crowns, removal • conditions not detrimental to health, or Telephone: 306-373-3879
of inlays and crowns, and cement restorations.
• dental implants or services in conjunction with Facsimile: 306-374-1122
• a pre-existing condition, illness or injury for which • Denture adjustments, repairs, rebasing, and E-mail: [email protected]
symptoms occurred and/or which required medical relining (1 every 2 years), tissue conditioning,

Source: http://www.sts.sk.ca/saskatoon/benefits/sts_ben_brochure.pdf