Paragon Health Solutions

Plan Benefit Comparison

Benefit	Manulife FlexCare	Paragon Select
Maximum	Life time combined maximum of all claims: $100,000 for EHC not including travel coverage	No life time maximum $25,000 overall maximum per person per policy year
Extended Health Care
Core
Co-insurance	100% unless otherwise specified	80% unless otherwise specified
Vision Care	No eligibility guideline $100 per every two benefit years $30 for optometrist per every two benefit years	Eligible after 6 months on the plan Eye glasses and contact lenses: $150 per 2 calendar years Eye exams: $100 every 24 months
Paramedical	Chiropractor, Chiropodist, Osteopath, naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist $20/visit – max. 20 visits per practitioner per year Psychologist - $80 for 1st visit, $65 for each subsequent visit, 10 visits max. per year Physiotherapist - $250 max. per year Speech Therapist - $65 for 1st visit, $45 for each subsequent visit, 10 visits max. per year	Physiotherapist, Massage therapist, Chiropractor, Naturopath, Chiropodist, Podiatrist, Osteopaths, Speech therapist, Psychologist, Acupuncturist Per practitioner max: $300 per policy year on a “top-up” basis to any provincial benefits payable Per visit max: $50 For Psychologist: $360 per two policy years
Hospital	Not offered in either Basic or Enhanced but can be added with an additional cost	Semi-private - up to $170 per day for 30 days to a maximum of $5,100 per policy year
Ambulance	Unlimited for ground ambulance $4,000 max for air ambulance/year	For services not covered by provincial benefits: up to $250 per trip
Private Duty Nursing	$3,000 per policy year	$2,000 per calendar year
Accidental Dental	$2,000 per person per policy year	$2,500 per person per policy year for accidental damage to natural teeth
Medical Services & Supplies	$3,000 per person per policy year	$1,750 per calendar year combined maximum for all appliances and support
Hearing Aid	$400 max. per 4 consecutive years	$300 per 5 calendar years
Out-of-Province, Out-of-Country	$1 million lifetime maximum - on trips 9 days or shorter	100% up to $1 million for trips of up to 30 days plus Emergency Travel Assistance Services
AD&D	$25,000	Not offered
Funeral Expenses	Not offered	Not offered
Survivor Benefit	12 months	Not offered
Prescription Drugs
Basic	Reimbursement plan Generic Drugs only, no brand name drugs allowed Dispensing fee covered 1st $765 of drug expenses: 70% coinsurance Next $3,850 of drug expenses: 90% coinsurance (total annual drug maximum: $4,000 per year)	ESI Pay Direct Drug Card 80% coinsurance to a maximum of $5,000 per calendar year Generic substitution No Dispensing fee cap
Catastrophic Drug Protection (optional)	Unlimited 100% coverage for generic and brand name prescription drugs when annual claims exceed $4,500 per policy year	Increases the annual drug maximum to $25,000 per family member
Enhanced	No Pay Direct Drug Card Include brand name drug Also include birth control and fertility drugs 1st $2,200 of drugs expenses: 90% coinsurance Next $6,000 of drug expenses: 100% coinsurance (total annual drug maximum: $8,000 per year)	Same as Basic
Dental
Basic Dental	No waiting period No Endodontic or Periodontic services 1st year: 50% coinsurance for the first $1,150 (max. $575 per year) After that: 80% coinsurance for the first $300; then 50% coinsurance for the next $850 (max. $665 per year) 9 months recall	No waiting period 8 units of scaling 9 months recall Basic and Preventative care including oral surgery; endodontics and periodontics No Major Restorative or Orthodontia coverage Annual maximum $1000 per person per policy year Periodontic coinsurance is 50%
Enhanced Dental	No waiting period No Endodontic or Periodontic services for the first two years 1st year: 60% coinsurance for the first $1,200 (max. $720 per year) After that: 90% coinsurance for the first $500; 60% coinsurance for the next $700 (max. $870 per year) Year 3 and beyond: combined maximum of $1,250 per 3 years period for the following 6 services: Oral surgery; Periodontics; Endodontics: Orthodintics; Crowns, Bridges; Dentures (Oral surgery, endo, and perio are at 80% coinsurance, and ortho, crowns, bridges and dentures are at 60% coinsurance) 6 months recall	Same as Basic
Combo	Offers Starter, Basic & Enhanced Same core EHC	Not offered
Starter	Drugs generic drugs only dispensing fee cap at $6.50 70% coinsurance for the first $430 (max. $300 per year) Dental Basic (no endo or perio) 70% coinsurance for the first $350 (max. $245 per year) 9 months recall	N/A
Basic	Drugs generic drugs only dispensing fee allowed 1st $765: 70% coinsurance Next $3,465, 90% coinsurance (max. $4,000 per year) Dental basic (no endo or perio) 1st $300: 80% coinsurance Next $850: 50% coinsurance (max. $665 per year) 9 months recall	N/A
Enhanced	Drugs brand name drugs allowed dispensing fees allowed 1st $2,200: 90% coinsurance Next $6,000: 100% coinsurance (max. $8,000 per year) Dental basic (no endo or perio) 1st $500: 100% coinsurance Next $700: 60% coinsurance (max. $920 per year) 6 months recall	N/A