Health with Optional Hospital Insurance

Couple in goggles playing squash

The Extended Health Care (EHC) Plan covers many medical expenses not eligible under government plans, such as vision care, hearing aids, practitioners and drug coverage, which is often a family’s single largest health care expense.

 

Covered expenses:

Prescription Drugs (100% co-insurance): 

  • Generic drugs that legally require a prescription and are dispensed by a pharmacist are eligible. If no generic drug/interchangeable drug is available, the prescription will be reimbursed based on the brand-name drug. . 
  • The calendar maximum is $2,000, with a lifetime maximum of $60,000 per insured.

The plan does not cover:

  • Fertility drugs, treatment for erectile dysfunction, smoking cessation aids, or anabolic steroids;

  • Drugs that can be purchased without a physician’s prescription (some exceptions may apply).

Benefits at 80% co-insurance:

  • Vision Care
    • Prescription eyewear (lenses, frames, and contact lenses) and laser eye surgery to a maximum of $225, and one eye exam, every two calendar years (one year for dependent children).
  • Professional Services
    • Services of a licensed physiotherapist, chiropractor, chiropodist, osteopath, speech therapist, podiatrist, or registered massage therapist as recommended by a physician to a maximum of $500 per calendar year per practitioner.
    • In addition, $50 for one X-ray per calendar year per practitioner is covered.
  • Private Duty Nursing
    • In-home nursing care by a registered nurse or nursing assistant, licensed practical nurse, or certifi ed nursing assistant is covered when recommended by a physician for a calendar year maximum of $10,000; $5,000 if over age 65.
  • Aids and Appliances
    • Purchase, rental or repair of medically necessary items including: hospital beds, braces, wheelchairs, prosthetic appliances, diabetic supplies, respiratory equipment, TENS machines, and orthotics.
  • Ambulance
    • Emergency ground ambulance to and from the nearest medical facility.
  • Dental Care for Accidents
    • Dental treatment required as a result of an accidental blow to the mouth.
  • Hearing Aids
    • Purchase or repair of hearing aids to a maximum of $600 every three calendar years.
  • Professional Counselling Services
    • Treatment for depression, substance abuse, family/work concerns, bereavement, and child/elder care issues through the ONA Member Assistance Plan – MAP.

 

Optional Hospital:

The Optional Hospital benefit can be added to, and is only available with, the EHC coverage.

  • Coverage begins on the first day of hospitalization, and pays 100% of the cost of a semi-private room for a maximum of 60 consecutive days in a calendar year.
  • The lifetime maximum is $30,000 per insured.
  • Coverage includes a Convalescent Home Care benefit at 80% reimbursement up to a maximum of $75 per day, for a maximum of 30 days following an active, acute care hospital stay for a minimum of 24 hours, and a maximum of three days following non-elective day surgery.

 

EHC Plan – 60-day open enrollment:

If you are losing coverage, you can enroll in the EHC Plan without providing medical evidence (subject to being actively at work) within 60 days of:

  • the first day you became an ONA Member;
  • the day you lost coverage due to a change from full-time to part-time status;
  • the day you lost coverage under your (or your spouse’s) employer benefit program, or any other group plan; or
  • the day you lost coverage due to retirement.

Note: Retired Members can enroll without providing medical evidence within 60 days of losing retiree or spousal coverage.

 

Additional information on plans and application form: 

File Health Rates 2017.docx

Application Form for Extended Health & Dental Plans

 

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