On Topic

Health Insurance

Scales of Coverage

With four different levels of coverage, our health plans offer you the flexibility to scale coverage to meet your needs.

Each scale provides health and dental coverage. There are also four Optional Coverages you can add to enhance your chosen scale of coverage.

Scale 1
Our basic plan, provides coverage for a range of medical and dental expenses for you and your family.
Scale 2
Provides more comprehensive coverage for the same expenses covered under Scale 1, plus visioncare and hearing aids.
Scale 3
Our broadest plan, provides more generous coverage for the same expenses covered under Scale 2, plus major dental services such as crowns, bridges and dentures.
Scale 4
Provides the same generous coverage as scale 3 but with no coverage for prescription drugs.
 Scale 1Scale 2Scale 3Scale 4
1 Reimbursement: Refers to reimbursement for eligible expenses.
2 Generic and brand name prescriptions: The plan pays for the lower cost alternative drug, unless the physician has directed that a particular brand name prescription drug not be interchanged.
3 Waiting Period: A three-month waiting period applies to Dentalcare Services and Supplies. This means no benefits are payable for Dentalcare Services and Supplies expenses incurred during the period starting on your policy's effective date and ending on the last day of the third month following your policy's effective date.
Prescription Drugs Drugs that by law require a prescription: 70% Reimbursement1 for both generic and brand name prescriptions2.
$750 per person annual maximum.
$5 maximum dispensing fee per prescription.		 Drugs that by law require a prescription: 75% Reimbursement1 for both generic and brand name prescriptions2.
$10,000 per person annual maximum.
$5 maximum dispensing fee per prescription.		 Drugs that by law require a prescription: 90% Reimbursement1 for both generic and brand name prescriptions2.
$10,000 per person annual maximum.
$7 maximum dispensing fee per prescription.		 No coverage.
Ambulance 100% Reimbursement1 for ground or air transport. 100% Reimbursement1 for ground or air transport. 100% Reimbursement1 for ground or air transport. 100% Reimbursement1 for ground or air transport.
Dental Benefits Waiting Period3: 3 month no claims waiting period. Waiting Period3: 3 month no claims waiting period. Waiting Period3: 3 month no claims waiting period. Waiting Period3: 3 month no claims waiting period.
  Deductible of $25 per person to a maximum of $50 per family per calendar year. Deductible of $25 per person to a maximum of $50 per family per calendar year. Deductible of $25 per person to a maximum of $50 per family per calendar year. Deductible of $25 per person to a maximum of $50 per family per calendar year.
  70% Reimbursement1 for selected routine services (e.g. cleanings, scalings, fillings and examinations).
$350 per person annual maximum.		 50% Reimbursement1 for endodontic, periodontal and oral surgery services.
75% reimbursement for other covered routine services.
$500 per person annual maximum.		 60% Reimbursement1 for endodontic, periodontal and oral surgery services.
80% reimbursement for other covered routine services.
$750 per person annual maximum.		 60% Reimbursement1 for endodontic, periodontal and oral surgery services.
80% reimbursement for other covered routine services.
$750 per person annual maximum.
  100% Reimbursement1 for accidental injury to natural teeth. 100% Reimbursement1 for accidental injury to natural teeth. 100% Reimbursement1 for accidental injury to natural teeth. 100% Reimbursement1 for accidental injury to natural teeth.
      50% Reimbursement1 for major services (e.g. crowns, bridges, dentures, etc.).
$500 per person annual maximum.		 50% Reimbursement1 for major services (e.g. crowns, bridges, dentures, etc.).
$500 per person annual maximum.
Visioncare No coverage. 100% Reimbursement1 to a maximum of $100 every two years.
$50 every two years for eye exams.		 100% Reimbursement1 to a maximum of $200 every two years.
$50 every two years for eye exams.		 100% Reimbursement1 to a maximum of $200 every two years.
$50 every two years for eye exams.
Paramedicals 70% Reimbursement1 to a $300 annual maximum for all practitioners combined. 80% Reimbursement1 to a $400 annual maximum for all practitioners combined. 90% Reimbursement1 to a $500 annual maximum for all practitioners combined. 90% Reimbursement1 to a $500 annual maximum for all practitioners combined.
In-home Nursing Benefits & Home Care 100% Reimbursement1 to a $2,500 annual maximum.
Home care not included.		 100% Reimbursement1 to a $3,500 annual maximum. 100% Reimbursement1 to a $5,000 annual maximum. 100% Reimbursement1 to a $5,000 annual maximum.
Medical Supplies 100% Reimbursement1 for selected medical supplies. 100% Reimbursement1 for selected medical supplies. 100% Reimbursement1 for selected medical supplies. 100% Reimbursement1 for selected medical supplies.
Hearing Aids No coverage. 100% Reimbursement1 up to $400 every five years. 100% Reimbursement1 up to $500 every five years. 100% Reimbursement1 up to $500 every five years.
Preferred Vision Services (PVS) Discount on prescription eyewear at participating outlets. Discount on prescription eyewear at participating outlets. Discount on prescription eyewear at participating outlets. Discount on prescription eyewear at participating outlets.

Benefits payable for certain healthcare and dentalcare services and supplies are subject to a limitation. A limitation may apply to a dollar amount which is payable under the policy or the frequency for which benefits will be payable.