2018 HEALTH AND DENTAL CARE PLANS ANNUAL TRAVEL INSURANCE PLAN. Smile. Smile knowing you have comprehensive coverage.

Transcription

1 2018 HEALTH AND DENTAL CARE PLANS ANNUAL TRAVEL INSURANCE PLAN Smile. Smile knowing you have comprehensive coverage.

2 An extra measure of security for your retirement years. Most people appreciate retirement for the freedom it offers: time to travel, pursue leisure activities or just live at your own pace. Along with this freedom from working comes the new responsibility to obtain affordable health care protection for you and your spouse, while maintaining adequate income. That s where we can help.

3 HEALTH AND DENTAL CARE PLANS ANNUAL TRAVEL INSURANCE PLAN Smile. ENCON has you covered. We understand that today s seniors are looking for health and dental care plans that offer protection when their group coverage ends; benefits that they can keep throughout retirement. According to published statistics: Age is the strongest risk factor for stroke, 80% of all strokes happen to those over the age of In 2014, one in eight Canadians aged 65 and older had at least two of the four major chronic diseases cardiovascular disease, cancer, chronic respiratory disease or diabetes. 2 Cancer is the leading cause of death in Canada and is responsible for 30% of all deaths. It mostly affects Canadians aged 50 and older. 3 The ENCON Health and Dental Care Plans offer valuable benefits at a reasonable cost, including coverage for prescription drugs, medical supplies, paramedical services and vision care. In addition, an optional Annual Travel Insurance Plan can be added for a minimal premium. Sources: 1 Heart and Stroke Foundation, Different Strokes 2017 Stroke Report, online: stroke-report/strokereport2017en; 2 Public Health Agency of Canada, How healthy are Canadians?, 2017, online: 3 Canadian Cancer Society, Cancer statistics at a glance, online: -at-a-glance/?region=on. 1

4 ENCON S HEALTH AND DENTAL CARE PLANS, AND THE OPTIONAL ANNUAL TRAVEL INSURANCE PLAN, provide many of the same benefits you enjoyed under your employer s group health plan. Both you and your spouse can enroll and, provided the premium is paid, there is no age limit on coverage. ELIGIBILITY You and your spouse are eligible to apply for benefits in the ENCON Health and Dental Care Plans, and the optional ENCON Annual Travel Insurance Plan, provided you: are between the ages of (inclusive); and are a Canadian resident and have provincial/territorial health plan coverage. APPLY FOR BENEFITS WHEN YOUR HEALTH CARE BENEFITS STOP. If you apply for benefits within 90 days of the termination of your employer-sponsored benefits or any other health plan, and you meet the eligibility criteria, your acceptance is guaranteed. No medical questions will be asked at the time of enrollment. If you missed the 90-day guaranteed acceptance period, you can apply for benefits any time up to age of 75 (inclusive); however, acceptance will be subject to the completion of a medical questionnaire and approval by Manulife. Apply for benefits under the optional ENCON Annual Travel Insurance Plan now. You only have one chance to apply for benefits in the ENCON Annual Travel Insurance Plan and that is when you are applying for a Health Care Plan. See page 9 of this brochure for details. Acceptance in the ENCON Annual Travel Insurance Plan is contingent on acceptance in the Health Care Plan. 2

5 HEALTH AND DENTAL CARE PLANS CHOOSE FROM TWO PLANS HEALTH CARE PLAN HOSPITAL Up to $5,000 This plan pays the difference between the cost of ward and semi-private hospital accommodation ACCOMODATION per calendar year while in Canada. If you are unable to obtain semi-private accommodation, the plan pays a benefit of $50 for each 24-hour period of ward hospitalization PRESCRIPTION Up to $1,700 You are covered for up to 90% of the combined cost of prescription drugs and dispensing fees DRUGS AND per calendar year with a written prescription from a physician or dentist and dispensed by a licensed pharmacist. MEDICINE 100% coverage for eligible prescription drugs and dispensing fees under your ENCON Health Care Plan when your prescriptions are filled by the Alliance Pharmacy Group. Dispensing fees are limited to $7 per prescription. With your ManuScript card, you can submit your claims online quickly and easily. ORTHOPEDIC Up to $200 One pair of orthopedic shoes per calendar year is covered when prescribed by a physician SHOES per calendar year or podiatrist. AMBULANCE Unlimited ground The plan pays the cost of professional ground or air ambulance transportation to a hospital. SERVICE and air transportation per calendar year HOME Up to $2,500 The plan pays fees for private duty in-home registered nursing care when recommended NURSING per calendar year by a physician. ACCIDENTAL Up to $3,500 Within one year of the accident, the plan will pay the services of a dental surgeon for treatment DENTAL per calendar year of a fractured jaw or charges for repair or replacement of natural teeth due to an accidental external blow to the head. PARAMEDICAL Up to $400 You can claim for fees incurred for visits to licensed practitioners. There is a $35 maximum per SERVICES per specialty visit to a: chiropractor, physiotherapist, podiatrist, chiropodist, speech therapist, osteopath, per calendar year naturopath, acupuncturist and Registered Massage Therapist (when treatment is recommended by a physician). For chiropractors, the plan also pays a $15 maximum for one x-ray per calendar year. All paramedical fees are paid after you reach your provincial/territorial health plan limit. PSYCHOLOGIST Up to $400 The plan covers the fees of a clinical psychologist for treatment/therapy recommended by a per calendar year physician up to $20 per half-hour for the initial assessment, and up to $40 per subsequent visit. HEARING AIDS Up to $500 within You can claim for the purchase or repair of prescribed hearing aids when initially required, any consecutive or if required due to a change in prescription. 36-month period DIAGNOSTIC The cost of one Prostate Specific Antigen (PSA) test per calendar year is covered. SERVICES MEDICAL Up to $5,000 After reimbursement by any government plan, the plan will cover the following items: SUPPLIES AND per calendar year ostomy supplies, diabetic supplies, glucometer (lifetime maximum of one up to $400), two PROSTHESES mastectomy brassieres per calendar year, wigs as required due to chemotherapy treatment ($300 lifetime maximum), prescribed orthotic appliances (maximum of $300 per calendar year), oxygen, diagnostic laboratory services, and radiology treatments including x-rays and radium therapy, artificial limbs or eyes, trusses, wheelchairs ($2,500 lifetime maximum), hospital beds, iron lungs, braces, canes, walkers, crutches and surgical stockings (four pairs per calendar year), Continuous Positive Airway Pressure (CPAP) devices and supplies. VISION CARE Up to $225 within The plan covers the cost of prescription lenses and frames, contact lenses and laser eye surgery. any consecutive Supplementary coverage is also included for expense incurred (in excess of reimbursement by 24-month period any government health care plan) for one optometrist visit within any consecutive 24-month period. HEALTH AND DENTAL CARE PLAN The plan provides all the benefits included in the Health Care plan, PLUS an extensive Dental Care plan. See page 4 of this brochure for more information 3

6 HEALTH AND DENTAL CARE PLAN The Dental Care plan pays benefits based on the current year s Dental Association Fee Guide for your province/ territory of residence. The maximum amount payable for Basic and Major Restorative Services combined is $1,100 per insured, per calendar year. BASIC SERVICES The plan covers 80% of the fee charged for the following services: dental x-rays minor restorative fillings preventative care, which includes routine examinations and cleanings to a maximum of one treatment every six months minor surgical benefits (includes extractions and oral surgical procedures) periodontics (treatment of gums and mouth tissue) endodontics (root canal therapy) denture work, which includes repairs, rebasing and relining consultation required by the attending dentist MAJOR RESTORATIVE SERVICES The plan covers 50% of the fee charged for the following services: inlays and crowns dentures and bridgework denture adjustments PRE- DETERMINATION If covered dental charges of more than $300 are to be incurred during any six-month period, prior approval must be obtained from Manulife. 4

7 Consider the added value of these moneysaving services offered in addition to your insurance benefits. ENCON S PREFERRED PHARMACY ALLIANCE PHARMACY GROUP (APG) When you fill your prescription drugs with Alliance Pharmacy Group, you are covered 100% for eligible prescription drugs and dispensing fees. Overnight courier delivery is always free. APG also offers the choice of MedPack packaging for your medications instead of vials. Visit or DISCOUNTS ON EYEWEAR AND HEARING AIDS When you are enrolled in the ENCON Health Care Plan, you are eligible to receive discounts of 10% or more on your eyewear, laser surgery and hearing devices through Preferred Vision and Hearing Services (PVS). The insurer cannot guarantee the availability of this benefit indefinitely. PVS is a preferred provider network that includes a variety of national chains and independent retailers throughout Canada. Visit YourNurse CAREGIVER SUPPORT SERVICE Insured persons and their families have access to YourNurse services offering personalized nursing expertise for the challenges caregivers are faced with. YourNurse Care Specialists are experts in helping solve eldercare/caregiving challenges. With YourNurse, you are never alone. Visit

8 HEALTH AND DENTAL CARE PLANS 2018 MONTHLY RATES HEALTH CARE PLAN Retiree Retiree & Spouse British Columbia $92.30 $ Alberta $ $ Saskatchewan $96.40 $ Manitoba $ $ Ontario $ $ Quebec $ $ NS; NB; PE; NL $ $ YT; NT; NU $98.00 $ HEALTH AND DENTAL CARE PLAN Retiree Retiree & Spouse British Columbia $ $ Alberta $ $ Saskatchewan $ $ Manitoba $ $ Ontario $ $ Quebec $ $ NS; NB; PE; NL $ $ YT; NT; NU $ $ Rates differ due to variations in provincial/territorial health plans. Rates are guaranteed until December 31, 2018, providing there are no changes to your provincial/territorial health care plan. After December 31, 2018, rates will be subject to change. Premium for the ENCON Annual Travel Insurance Plan (optional) will be added to the Health and Dental Care Plan premium. 6

9 IMPORTANT NOTES AND EXCLUSIONS The ENCON Health and Dental Care Plans are underwritten by The Manufacturers Life Insurance Company (Manulife). POLICY Once you have received your policy you will have 10 days to review it. If you are not completely satisfied, simply return it within that time for a full refund of premiums less any claims paid. ENROLLMENT AFTER 90 DAYS If you and your spouse have not had health care benefits for 90 days or more, you and/or your spouse may enroll in an ENCON health care or health and dental care plan, subject to completion of a medical questionnaire, and approval by Manulife. You must be between the ages of 50 and 75 (inclusive), a Canadian resident and currently covered under a provincial/territorial health plan. SURVIVOR BENEFITS If you die while you and your spouse are both enrolled under an ENCON health plan, your spouse may keep their insurance coverage as long as premium continues to be paid. Premium would be reduced to the single coverage rate at the time ENCON is notified of your death. COVERAGE FOR LIFE Provided your premium is paid, only you can cancel your coverage. Your policy cannot be cancelled by Manulife because of your personal health or number of claims incurred while these plans are in force. Benefits paid under the Health and Dental Plans are subject to a lifetime maximum of $300,000 per insured. 7

10 HEALTH AND DENTAL CARE PLANS EXCLUSIONS The following prescription drug expenses are not eligible: drugs prescribed for sexual dysfunction drugs prescribed for obesity control experimental drugs The following dental services are not eligible: dental treatment that began before the effective date of your ENCON plan fluoride treatments appliances, restorations or treatments related to temporomandibular (jaw) joint dysfunction dental implants The following exclusions apply to all plans: services not listed as allowable expenses self-inflicted injuries expenses incurred outside Canada for Hospital and Physicians services anything resulting from war, terrorism or services in the Armed Forces cosmetic surgery or treatment unless required as the result of accidental injury charges for broken or missed appointments telephone advice fees or services covered by another insurance plan or government agency PRIVACY AND CONFIDENTIALITY STATEMENT Health and Dental Care Plans The specific and detailed information requested on your Enrollment Form is required to process your application. To protect the confidentiality of this information, Manulife and its agent, ENCON, will establish a financial services file from which this information will be used to process your application(s), and administer services and claims. Access to this file will be restricted to those Manulife employees, agents, mandataries or administrators who are responsible for the assessment of risk (underwriting), administration of services and the investigation of claims, and to any other person you authorize or as authorized by law. These people, organizations and service providers may be in jurisdictions outside Canada, and subject to the laws of those foreign jurisdictions. Your participation in the Retirees Insurance Program may be made known to the administering broker in order to bring other products and services offered under the program to your attention. The use of such information to offer products and services is optional, and if you wish to discontinue such use, you may write to ENCON Group Inc., at Standish Court, Mississauga ON L5R 4B2, or to Manulife at the address provided below. Your file is secured in the office of Manulife or its agents. You may request to review the personal information it contains and make corrections by writing to: Privacy Officer, Consumer Markets, Manulife, P.O. Box 1602, Del. Stn A, Waterloo, Ontario N2J 4C6. 8

11 Optional ENCON Annual Travel Insurance Plan Travel with confidence. Travel is full of unexpected adventures. In an emergency medical situation, however, you may not always know where to turn, or be prepared to deal with sudden additional expenses to get you well and get you home. Your provincial health care coverage is limited, even within Canada. With ENCON s Annual Travel Insurance Plan, you can travel with confidence, knowing that help is just a phone call away. ENROLL NOW ELIGIBILITY When you and/or your spouse apply for the ENCON Health Care Plan, this will be the only chance to enroll in the ENCON Annual Travel Insurance Plan. When you are accepted in the ENCON Health Care Plan you are guaranteed acceptance into the ENCON Annual Travel Insurance Plan. If you and your spouse are enrolling in the ENCON Health Care Plan as a couple and you are adding the ENCON Annual Travel Insurance Plan, you must take couple coverage for both plans. 9

12 ANNUAL TRAVEL INSURANCE PLAN ENCON ANNUAL TRAVEL INSURANCE PLAN OPTIONS Choose the plan that meets your travel needs from unlimited trips of up to 30, 45, 60, 90, 120, 150 or 180 days during the policy year. $1 million of coverage per insured person, per trip Favourable stability period for pre-existing medical conditions three months for high blood pressure and six months for other conditions Once enrolled, there is no age limit for coverage Opportunity to change trip duration annually at renewal WORLDWIDE ASSISTANCE ON CALL After enrollment, you will be issued a medical assistance card with emergency telephone numbers that you can call in the event of a medical emergency. PRE- EXISTING MEDICAL CONDITIONS If you have a pre-existing medical condition, coverage is available provided it has remained stable for a period of six months immediately prior to departure. For high blood pressure conditions only, the stability period is three months. Your policy will include the definition of stable. Refer to your policy for the complete list of benefits, exclusions and limitations. TOP UP INSURANCE If you are taking a longer trip than your ENCON Annual Travel Insurance Plan allows, you can contact our travel insurance provider directly at to purchase a separate, individual travel insurance plan for the additional days. They also offer non-medical coverage, which includes Trip Cancellation, Trip Interruption, and Baggage and Personal Effects benefits. 10

13 EMERGENCY MEDICAL EXPENSES Benefit (per trip) Limit Hospital accommodation reasonable and customary costs Physician charges reasonable and customary costs Diagnostic services reasonable and customary costs Paramedical services $250 per profession Prescription drugs 30-day supply per prescription Ambulance services reasonable and customary costs Medical appliances reasonable and customary costs Private duty nurse up to $5,000 Emergency air transportation reasonable and customary costs Transportation to bedside economy round-trip airfare Return of travel companion one-way airfare Treatment of dental accidents up to $2,000 Meals and accommodation up to $150 per day, to $3,000 per trip Vehicle return up to $5,000 Return of deceased up to $5,000 Incidental expenses up to $ MONTHLY PREMIUM RATES Annual Monthly Rate* Monthly Rate* Travel Days Retiree Only Retiree and Spouse 30 $26 $52 45 $37 $74 60 $47 $94 90 $71 $ $96 $ $123 $ $177 $354 * Plus applicable tax Premium is added to your health care plan premium 11

14 ANNUAL TRAVEL INSURANCE PLAN IMPORTANT NOTICE ABOUT YOUR PERSONAL INFORMATION ENCON Annual Travel Insurance Plan Royal & Sun Alliance Insurance Company of Canada ( we, us ) collects, uses and discloses personal information (including to and from your agent or broker, our affiliates and/or subsidiaries, referring organizations and/or third party providers/suppliers) for insurance purposes, such as administering insurance, investigating and processing claims and providing assistance services. Typically, we collect personal information from individuals who apply for insurance, and from policyholders, insureds and claimants. In some cases we also collect personal information from and exchange personal information with family, friends or travelling companions when a policyholder, insured or claimant is unable, for medical or other reasons, to communicate directly with us. We also collect and disclose information for the insurance purposes from, to and with, third parties such as, but not necessarily limited to, health care practitioners and facilities in Canada and abroad, government and private health insurers and family members and friends of policyholders, insureds or claimants. In some instances we may additionally maintain or communicate or transfer information to health care and other service providers located outside of Canada, particularly in those jurisdictions to which an insured may travel. As a result, personal information may be accessible to authorities in accordance with the law of these other jurisdictions. For more information about our privacy practices or for a copy of our privacy policy, visit 12

15 ENROLL TODAY! 1. Complete both sides of the Enrollment Form. Make sure to indicate Health Care Plan or Health and Dental Care Plan, and if you wish to enroll in the ENCON Annual Travel Insurance Plan. If you wish coverage for your spouse, please fill out the required section. Sign and date the Enrollment Form. 2. Do not send money. All that is required is a blank cheque marked VOID to set up the convenient Personal Preauthorized Debit Agreement for your monthly premiums. 3. Mail your Enrollment Form and your void cheque to ENCON in the postage-paid envelope provided or fax them to , or scan and them to retireeplan@encon.ca. Coverage begins on the later of the Effective Date that you requested on your Enrollment Form or the date your Enrollment Form and your void cheque are received at ENCON. If applying for coverage under the ENCON Annual Travel Insurance Plan, coverage begins on the later of the Effective Date of your Health and Dental Care Plan or the termination date of your existing annual travel insurance plan, as provided on your Enrollment Form. If applying for a Health and Dental Care Plan after the 90-day guaranteed acceptance period, please contact us to obtain the appropriate medical questionnaire. Our ENCON toll free number is or you may us at retireeplan@encon.ca. BENEFITS REMINDER SERVICE If your benefits do not terminate in the near future, and you would like to consider the ENCON program when they do, simply fill out your name, contact information and the date your benefits terminate, and mail it in the envelope provided. We will contact you in advance of the date you have indicated. 13

16 HEALTH AND DENTAL CARE PLANS ANNUAL TRAVEL INSURANCE PLAN PERSONAL PRE-AUTHORIZED DEBIT PAYMENTS The Personal Pre-authorized Debit Agreement, set up through your bank, trust company or credit union saves you time and the cost of writing and mailing your cheques. It also helps ensure that your payments are always on time. Please note the following important information: You may cancel your Personal Pre-authorized Debit Agreement at any time, subject to providing written 30-days notice to ENCON Group Inc. Retiree Benefits, Standish Court, Mississauga ON L5R 4B2. You may obtain a sample cancellation form by contacting your financial institution or by visiting You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with your Personal Preauthorized Debit Agreement. To obtain more information on your recourse rights, contact your financial institution or visit QUESTIONS? If you have any questions about coverage, the Personal Pre-authorized Debit Agreement or about completing your Enrollment Form, please contact our ENCON retiree insurance specialists toll free at , or send an to retireeplan@encon.ca. Accessible formats and communication supports are available upon request. Visit for more information. 14

17 ENCON RETIREE BENEFITS ENROLLMENT FORM SPOUSAL INFORMATION Please complete for spousal coverage: Spouse s Name (last) (first) Birthdate (YYYY/MM/DD) Sex M F Date previous health and dental care coverage ceased (YYYY/MM/DD) Are you covered under your spouse s plan? Yes No If yes, please specify the date spousal coverage ends (YYYY/MM/DD) PAYMENT OF PREMIUM PERSONAL PRE- AUTHORIZED DEBIT AGREEMENT I/We authorize ENCON Group Inc. to withdraw my/our monthly premium (as determined by my/our plan choices on the previous page of this Enrollment Form) from my/our bank, trust company or credit union account on the first banking day of every month and have enclosed a blank personal cheque marked VOID. I/We have read and understand the Personal Pre-authorized Debit Payments section on page 14 of this brochure. Monthly withdrawals are to be made from this Account Number Signature of Account Holder Date Signature of Joint Account Holder (if applicable) Date DECLARATION ( PLEASE READ AND SIGN) I/We acknowledge that the statements contained herein are true and together with any other forms signed by me/us in connection with this Enrollment form the basis for my/our coverage. I/We have read and agree with the Privacy and Confidentiality Statements on pages 8 and 12 of this brochure. I/We further understand my/our coverage will begin on the later of the Effective Date requested or the date my/our Enrollment Form and void cheque are received by ENCON. I/We understand that the contents of the 2018 Health and Dental/Annual Travel Insurance brochure form an integral part of this Enrollment and Pre-authorized Debit Agreement. If hospitalized on that date, coverage will not begin until the date of discharge from hospital. I/We further understand that if I/we am/are enrolled in an existing annual travel insurance plan, coverage under the ENCON Annual Travel Insurance Plan will begin on the termination date of the existing annual plan. Signed at City/Town Province/Territory Retiree s Signature Spouse s Signature (if applying for coverage) Date signed (YYYY/MM/DD)

18 HEALTH AND DENTAL CARE PLANS ANNUAL TRAVEL INSURANCE PLAN ENCON RETIREE BENEFITS ENROLLMENT FORM CHOOSE YOUR PLAN Please select one: Health Care Plan or Health & Dental Care Plan (See Rate Charts on pages 6 and 11) Health Care Retiree Retiree and Spouse Annual Travel Insurance Plan (optional) Annual Travel Days Health & Dental Care Retiree Retiree and Spouse Annual Travel Insurance Plan (optional) Annual Travel Days RETIREE INFORMATION Retiree s Name (last) Address Unit No. Province/Territory (first) City/Town Postal Code Phone (area code) Birthdate (YYYY/MM/DD) Sex M F Retirement Date (YYYY/MM/DD) (if applicable) Name of former employer Date employer health and dental care coverage ceased (YYYY/MM/DD) Effective Date requested for new coverage (YYYY/MM/DD) Date of termination of an existing or previous annual travel insurance plan (YYYY/MM/DD) Name of insurer that provided the annual travel insurance plan Please provide the name of your Plan Advisor (if applicable) Name of Company Contact Name As the Retiree Insurance Program Manager, ENCON receives a commission from Manulife, Royal & Sun Alliance Insurance Company of Canada, CharterRx and First Health Care. If you have any questions about this Benefits coverage or our compensation, please feel free to call us at

19 EXPERIENCE AND EXPERTISE YOU CAN COUNT ON ENCON Group Inc. has been providing post-retirement benefits services, including plan design, distribution and administration, for over 30 years. Our retiree insurance specialists are readily available to answer your questions and advocate on your behalf. ENCON Group Inc Standish Court Mississauga, Ontario L5R 4B2 Toll free phone number: Facsimile: Website: ENCON Group Inc. This brochure is intended to provide a brief summary of the ENCON Health and Dental Care Plans and the ENCON Annual Travel Insurance Plan. It contains some information about coverages but it does not list all of the conditions and exclusions that apply to the described coverages. The actual wording of the policies governs all situations. The products described are subject to change without notice at any time. Health and Dental Coverage is underwritten by: The Manufacturers Life Insurance Company (Manulife) Underwriting and claims management for the ENCON Health and Dental Care Plans are provided by The Manufacturers Life Insurance Company (Manulife). Manulife and the Block Design are trademarks of The Manufacturers Life Insurance Company and are used by it and its affiliates under licence. PVS Preferred Vision and Hearing Services are offered through The Manufacturers Life Insurance Company. Trademarks of The Manufacturers Life Insurance Company. ENCON Annual Travel Insurance Plan: Underwritten by: Medical Assistance and Claims Services by: 2017 Royal & Sun Alliance Insurance Company of Canada. All rights reserved. RSA, RSA & Design and related words and logos are trademarks and the property of RSA Insurance Group plc, licensed for use by Royal & Sun Alliance Insurance Company of Canada. ENCON Annual Travel Insurance Plan is underwritten by Royal & Sun Alliance Insurance Company of Canada and is offered through its Viator Group Out-of-Province/Canada Travel Medical Emergency Insurance product. Viator, Viator & Design and related words and logos are trademarks and the property of RSA Travel Insurance Inc., licensed for use by Royal & Sun Alliance Insurance Company of Canada. Global Excel and the Global Excel logo are registered trademarks of Global Excel Management Inc. ENCON HDP 11/17