Benefits Included | PHS BASIC | PHS PLUS |
EHC BENEFITS
Echelon General Insurance Company | 100% Reimbursement except Drugs | 100% Reimbursement except Drugs |
|
Prescription Drugs | - 70% Reimbursment of 1st $500/year,
- 100% of next $3,000 per policy year;
- Generic Drugs;
- Dispensing fee cap of $7.50 per prescription;
- ESI Pay Direct Card.
| - 80% Reimbursement of first $500,
- 100%
of next $4,000 per policy year (except Quebec where it is based on calendar year);
- Brand name drugs;
- ESI Pay Direct Card
|
Accidental Dental | $2,500 per policy year | $2,500 per policy year |
|
Ambulance | Ground Unlimited; $4,000 air ambulance per policy year | Ground Unlimited; $4,000 air ambulance per policy year |
Home Support | $3,000 per policy year | Combined policy year maximum of $7,500 for Home Support & Durable Medical Equipment, and Prosthetic appliances and Orthotics
|
Durable Medical Equipment | $3,000 per policy year |
Prosthetics | $3,000 per policy year |
Medical Supplies | Included | Included
|
Orthopedic footwear | Custom Orthotics to $225 per policy year | Custom Orthotics to $225 per policy year as part of Durable
Medical Equipment maximum |
Private Duty Nurse | Included in Home Support up to $3,000 per policy year | Included in Home
Support & Durable Equipment maximum of $7,500 |
| $450 maximum per practitioner per policy year ($50 maximum per visit): - Acupuncturist;
- Chiropractor;
- Chiropodist;
- Naturopath;
- Osteopath;
- Physiotherapist;
- Podiatrist;
- Registered Massage Therapist.
- $35 for Chiropractic X-rays per policy year.
- Psychologist limited to 15 visits per year, maximum of $75 first visit and $60 subsequent;
- Speech Therapist $60 and $40.
| $500 maximum per practitioner per policy year ($50 maximum per visit): - Acupuncturist;
- Chiropractor;
- Chiropodist;
- Naturopath;
- Osteopath;
- Physiotherapist;
- Podiatrist;
- Registered Massage Therapist.
- $35 for Chiropractic X-rays per policy year.
- Psychologist limited to 15 visits per year, maximum of $75 first visit and $60 subsequent;
- Speech Therapist $60 and $40.
|
Hearing Aids | $400/4 years. | $400/4 years |
Vision | Eye glasses: $150/2 years;
Eye Examinations: $100/24 months; all after 6 month waiting period. | Eye glasses: $250/2 years; Eye Examinations: $100/24 months; all after 6 month waiting period. |
Hospital | Semi-private $150/day to a maximum of $4,500 per policy year | Semi-private or Private up to $200/day; maximum $25,000 per policy year |
Maximum per person |
Benefit maximums | Benefit maximums |
Lifetime Maximum | $250,000
| $250,000 |
Out-of-Country
TIC LTD | $1M –30 days, unlimited trips | $1M –30 days, unlimited trips |
DENTAL | PHS BASIC | PHS PLUS |
Preventive Services
Echelon General Insurance Company | - 80% reimbursement;
- no waiting period
- 8 units scaling;
- 9 month recall;
- Oral Surgery,
- Endodontics,
- Periodontics.
| - 80% reimbursement;
- no waiting period;
- Exams, cleaning, scaling every 9 months;
- fillings, x-rays, fluoride, space maintainers,
- extractions,
- anesthesia,
- endodontics,
- periodontics,
- denture repairs.
|
Major Restorative Services | Not Included
| - Available Year 3+ at 60% reimbursement;
- Crowns, bridges, dentures & orthodontics;
|
Orthodontia | Not Included | See above |
Maximums | - 80% to $500 year 1;
- 80% to $750 year 2+
| - 80% to $500 year 1;
- 80% to $750 year 2;
- 80% to $1,000 year 3 & 4; and
- $1,250 year 5, including combined Periodontics / Endodontics maximum of $500/year;
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