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贵湖大学的“补充医保计划”
[ 编辑:admin | 时间:2014-09-28 18:47:04 | 浏览:3601次 | 来源:isbbs | 作者:加拿大小蝌蚪 ]

Supplemental Health

All benefits payable through the Student Plan are based on reasonable and customary charges.

Ambulance
Your plan covers of 100% for licensed ground ambulance or emergency air service that transports the patient to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation. If the patient requires the services of a registered nurse during the flight, the services and return airfare for a registered nurse are covered.

Practitioners
Student benefits are payable after any Provincial Health Care benefits have been exhausted. This plan does not cover user fees. Student specific rates are available for some of the indicated services, information can be found in Select Savings. Practitioners must be registered and licensed in their field of practice.

The services of the following practitioners are covered at 80% to a combined maximum of $500, per benefit year.

• chiropractor, including one x-ray examination per benefit year
• naturopath
• physiotherapist*
• psychologist or social worker*

*physician’s prescription/referral required for indicated services

Medical Services & Supplies
It is recommended that an application for pre-approval be submitted to the insurer for any item that would be claimed under the Medical Services & Supplies benefit.

Braces, Crutches, Splints, Trusses
Your plan covers 80% of reasonable and customary charges when prescribed by a physician and are not solely for athletic use for braces, crutches, splints, and trusses.

Diaphrams, Cervical Caps, Intrauterine Devices
Your plan covers 100% of reasonable and customary charges for diaphrams, cervical caps, intrauterine devices. Insertion fees are not covered.

Orthotics
Your plan covers 80% up to a maximum of $300 per pair, every 24 months for custom-made foot orthotics when required for the correction of deformity of the bones and muscles provided they are not solely for athletic use and are prescribed by a physician, podiatrist, chiropodist or chiropractor. Modifications, repairs and adjustments to custom-made foot orthotics are covered without a prescription.

Prosthesis
Your plan covers 100% of reasonable and customary charges when prescribed by a physician for artificial limbs or other prosthetic appliances.

Wigs and Hairpieces

Your plan covers 100% up to a maximum of $500 in a 24 month period for wigs and hairpieces required as a result of Alopecia Universalis, chemotherapy, or radiation therapy.

Dental Accident
IMPORTANT! Dental Accident Pre-determination: An estimate for all dental accident services MUST be submitted to the health plan insurer. If you go ahead with treatment without a pre-determination being approved, you are doing so at the risk of the expenses being yours.

The plan covers 100% of the cost of the services of a dental surgeon, limited to the fees provided in the current General Practitioners fee guide, including dental prosthesis, required for the treatment of a fractured jaw or accidental injuries to natural teeth or jaw if caused by external, violent and accidental means. Services must be performed within 12 months of the accident. Dental Accident benefits are payable through the Health plan and limited to $1,000 per benefit year.

Select Health Savings
To enhance your existing coverage, select providers have agreed to help students by providing savings on certain plan eligible services. You must present your myBenefits Card at each visit. For further information on participating providers check out the Select Savings tab.

Dental
Payment of dental benefits is based on the General Practitioners Dental Association suggested fee guide or the Insurance Reimbursement Rate set by the Canadian Life and Health Insurance Association Inc. (CLHIA) when a fee guide is not available. For services provided by a dental specialist, payment is based upon the General Practitioners Dental Association suggested fee guide.

Alternate Benefit - When there are two or more courses of treatment available to adequately correct a dental condition, reimbursement may be based on the cost of the least expensive treatment, which provides adequate care to the Insured.

IMPORTANT! Please submit a pre-determination/pre-authorization to the insurance carrier prior to treatment of specialist services and any treatment plan exceeding $300.

Your plan covers up to a maximum of $500 per benefit year.

Diagnostic & Preventative
Your plan covers 100% of diagnostic and preventative procedures including:
• recall examination, 1 per benefit year
• complete oral examination, 1 per dentist in a lifetime
• emergency or specific examination
• consultation, once per benefit year
• complete series of x-rays, (not eligible for dependents under 12) up to 16 films including bitewings, 1 in any 36 month period
• bitewings, not more than 4 films per benefit year
• panoramic, 1 in any 36 month period
• occlusal radiographs (no more than 4 films in any benefit year)
• periapical (no more than 16 films in any 36 consecutive months)
• polishing, 1 unit per benefit year
• scaling, 2 units per benefit year
• fluoride, 1 treatment per benefit year

Minor Restorative
Your plan covers 75% for services associated with dental health restoration, including:
• space maintainers and maintenance, under 15 years of age
• amalgam (silver) fillings, 1 per tooth in any period of 24 months
• composite resin (tooth colored) fillings, 1 per tooth in any period of 24 months, limited to once every two years on the same tooth surfaces
• silicate fillings, 1 per tooth in any period of 24 months

Oral Surgery
Your plan covers 75% for services associated with surgical extractions, including:
• wisdom teeth removal
• residual root removal
• anaesthesia, eligible when done in conjunction with oral surgical procedures


Vision

Your plan covers 100% the cost of one eye examination, eyeglasses or contact lenses by an ophthalmologist
or optometrist, limited to a combined maximum of $120 in a 24 month period for a cost that is considered reasonable and customary.

There is also up to a 20% discount for eyewear provided through PVS (Preferred Vision Services). PVS is a network of eyewear centres. For information on participants in your area, call 1-800-668-6444, or visit their website at www.pvs.ca.

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