OAMRS Health & Dental PLan
Residents of OntarioWHY GET HEALTH INSURANCE?
You don’t hesitate to insure your home, car, practice and other valuable possessions, so why wouldn’t you insure your most valuable asset — your health?
The OAMRS Health & Dental Plan starts where government coverage ends. Without a plan like this, you may have to pay 100% out of your own pocket for common health care expenses like prescription drugs, dental care, vision care, therapeutic services and more.
After researching many plans OAMRS selected the Manulife program as the best value for our Members. Please tell your co-workers about this exciting new program.
More choices to better fit your needs and budget
The OAMRS Health & Dental Plan has 5 different options for you to choose from — helping you find one that best suits your family’s individual needs and budget.
WHAT’S IN IT FOR YOU?
- Plans include most core benefits
You don’t have to pay extra for benefits like vision care, registered specialists and therapists, ambulance services
and more. - No waiting period
Your benefits start on the first day of the month following registration. There is no waiting period for eligibility. - Fast, convenient claims submission
Your Benefit Card makes it easy for most prescription drug and dental claims to be processed for you electronically so you keep money in your pocket. - Acceptance is guaranteed for the Base Health & Dental Plan, and all 4 Dental Plans
Above plans require no medical questionnaire so your acceptance is guaranteed!
Ready to take the next step and apply? Read on to discover which plan suits you and your family best, check out the 2021 rate guide, or download the application form.
Completed application forms can be returned by email to our Life Department, or you may fax your printed form to 416-778-4492. Please note, all applicants must complete Parts A, B, C and D, and Section A.
BASE HEALTH & DENTAL PLAN
Guaranteed to Issue (No Medical Information Is Required) †
† All applicants must complete Parts A, B, C and D, and section A.
| Prescription Drugs † | |
| Generic vs brand-name coverage | Generic |
| Shared dispensing fee (subject to applicable co-payment) | $6.50 maximum |
| Birth control | Covered |
| Fertility drugs | Not covered |
| Reimbursement on first amount per anniversary year†† | 70% of first $750 |
| Reimbursement on next amount per anniversary year†† | None |
| Maximum per anniversary year†† | $525 |
| Dental Services ‡ | |
| Reimbursement on exams, cleanings, fillings, scaling, polishing, root planing, diagnostic, select extractions and other basic dental services | 70% |
| Reimbursement on extensive services including oral surgery, endodontics, periodontics and denture services | 70% |
| Reimbursement on crowns, bridges, dentures and orthodontics | Not covered |
| Combined anniversary year maximums | $400 per year |
| Recall visits | 9 months |
| Hospital Benefits | |
| Type of accommodation | n/a |
| Maximum charge per day | n/a |
| Reimbursement per anniversary year | n/a |
| Cash benefit in lieu of accommodation | n/a |
| Travel Coverage (to age 65) – maximum $5,000,000 per trip. Unlimited number of trips; Maximum trip length | 5 days |
| Core Benefits | |
| Registered Specialists & Therapists** Maximum claims paid |
$500 combined per year Chiropractor ($35 chiropractic x-rays per year), Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist, Dietician. |
| Per visit maximum | $25 |
| Chiropractic X-rays | $35 per year |
| Registered Psychologist or Psychotherapist | |
| Maximum per first visit | $80 |
| Maximum per subsequent visit | $65 |
| Maximum visits per year | 10 |
| Registered Speech Therapist | |
| Maximum per first visit | $65 |
| Maximum per subsequent visit | $45 |
| Maximum visits per year | 10 |
| Vision | $100 per 2 benefit years plus $60 for Optometrists visits per 2 benefit years |
| Homecare & Nursing, Prosthetic Appliances, and Durable Medical Equipment |
|
| For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment: |
Year 1: $1,000 Year 2: $1,300 Year 3: $1,500 Year 4: $2,000 Year 5+: $2,500 |
| Custom-made Orthotics | $225 |
| Accidental Death and Dismemberment Per adult under 65 Per child or adult 65 and older |
$10,000 $4,000 |
| Accidental Dental | $2,000 per year |
| Hearing Aids | $300 per 4-year period |
| Akira by TELUS Health (Virtual Healthcare App) | Included |
| TELUS LivingWell Companion | Included |
| TELUS SmartHome Security | Included |
| Health Service Navigator®* | Included |
| Ambulance Services | Unlimited ground and air transportation |
| Survivor Benefit | Available 1 year after policy effective date |
| Lifetime Maximum | $100,000 |
† Prescription drug coverage applies to costs not covered by your provincial prescription drug insurance plan, up to the maximums stated above. †† Prescription drug coverage is based on Calendar Year for residents of British Columbia and Saskatchewan. For all other provinces, coverage is based on Anniversary Year. Generic Drug – A generally less expensive alternative to an interchangeable brand-name drug product. Please note: Not all drugs have a generic equivalent. If a non-generic drug is purchased, payment will be based on the lowest generic drug cost equivalent, if applicable. If no generic brand exists, payment of the brand-name price will be made at the co-payment level of your plan. Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, erectile dysfunction drugs, and drugs not requiring a prescription. Other exclusions apply; please consult your policy for details.
DENTAL PLAN
Prescription drugs are not included.
| Base Dental Plan |
Bronze Dental Plan | Silver Dental Plan |
Gold Dental Plan | |
| Dental Services ‡ | ||||
| Reimbursement on exams, cleanings, fillings, scaling, polishing, root planing, diagnostic, select extractions and other basic dental services | Year 1: 50% Year 2+: 70% |
Year 1: 50% Year 2+: 70% |
Year 1: 60% Year 2+: 80% |
Year 1: 60% Year 2+: 80% |
| Reimbursement on extensive services including oral surgery, endodontics, periodontics and denture services | Year 1: 50% Year 2+: 70% |
Year 1: 50% Year 2+: 70% |
Year 1: 60% Year 2+: 80% |
Year 1: 60% Year 2+: 80% |
| Reimbursement on crowns, bridges, dentures and orthodontics | Not covered | Not covered | Not covered | Year 1 & 2: 0% Year 3+: 60% ($800 maximum every 2 consecutive years) |
| Combined anniversary year maximums | $400 per year | $500 per year | Year 1: $600 Year 2+: $900 |
Year 1: $750 Year 2: $1,000 Year 3: $1,200 Year 4: $1,200 Year 5+: $1,500 |
| Recall visits | 9 months | 9 months | 9 months | 6 months |
|
Core Benefits |
|
|
Registered Specialists & Therapists** |
$500 combined Chiropractor ($35 chiropractic x-rays per year), Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist, Dietician. |
|
Per visit maximum |
$20 |
|
Chiropractic X-rays |
$35 per year |
|
Registered Psychologist or Psychotherapist |
|
|
Maximum per first visit |
$80 |
|
Maximum per subsequent visit |
$65 |
|
Maximum visits per year |
10 |
|
Registered Speech Therapist |
|
|
Maximum per first visit |
$65 |
|
Maximum per subsequent visit |
$45 |
|
Maximum visits per year |
10 |
|
Vision |
$100 per 2 benefit years plus $60 for Optometrists visits per 2 benefit years |
|
Homecare & Nursing, Prosthetic Appliances, and Durable Medical Equipment |
|
|
For each of Homecare & Nursing, Prosthetic Appliances and Durable Medical Equipment |
Year 1: $1,000 |
|
Custom-made Orthotics |
$225 |
|
Accidental Death and Dismemberment |
$10,000 per adult under 65 |
|
Accidental Dental |
$2,000 per year |
|
Hearing Aids |
$300 per 4-year period |
|
Akira by TELUS Health (Virtual Healthcare App) |
Included |
|
TELUS LivingWell Companion |
Included |
|
TELUS SmartHome Security |
Included |
|
Health Service Navigator® |
Included |
|
Ambulance Services |
Unlimited ground and air transportation |
|
Survivor Benefit |
Available 1 year after policy effective date |
|
Lifetime Maximum |
$100,000 |
All references to “year” refer to Anniversary Year. When it relates to Hearing Aids and Vision benefits, year refers to Benefit Year. Anniversary Year refers to the consecutive 12-month period following the effective date of your policy, and each 12-month period thereafter. Benefit Year refers to the consecutive 12-month period following the date a claim for a specific benefit is first incurred under your policy. Calendar Year means the 12-month period commencing January 1 and ending December 31. ‡ Note: If applicable, dental coverage begins at the age when dental coverage under your provincial health insurance plan coverage ends. ** Benefits are only payable after yearly maximums allowed under your provincial health insurance plan have been reached, if applicable. *Manulife cannot guarantee the availability of this benefit indefinitely.
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825 Queen Street East
Toronto, Ontario
M4M 1H8
(416) 778-8000
sales@bairdmacgregor.com