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Halton district school board

HALTON DISTRICT SCHOOL BOARD
Secondary Teachers
EMPLOYEE
GROUP
CUSTOMIZER
Effective Date: September 1 , 2005
Important: Keep this Schedule with your Employee Benefit Plan Booklet. EMPLOYEE LIFE INSURANCE BENEFIT

Classification Basic


*subject to a Maximum of $450,000.
Notes:

• Your Employee Life Insurance will terminate at age 65, upon retirement, resignation or termination. You may convert up to $200,000 of your life insurance coverage without supplying evidence of good health if done within 31 days of termination. • A retroactive change in Earnings will be deemed to be effective on the • Late applicants will be required to complete a health questionnaire and may have to submit medical evidence of good health satisfactory to the insurer in order to be insured. • If an employee dies while insured, employee life insurance will be paid to the named beneficiary(ies), if living, otherwise to the employee’s estate. DENTAL CARE BENEFITS

All claims must be submitted within 90 days following December 31 of the
benefit year in which expense occurred.
Fee Guide
Payments under this plan will be based on the current Ontario Dental
Association Fee Guide for Dental Practitioners.
Percentage Payable
Calendar Year Deductible
Benefit Maximum (per calendar year)
• Routine Care, Dentures, Crowns and Bridgework (combined maximum) $1,500 • oral exams, including the cleaning of teeth, twice per calendar year, but not more than once every 9 months. Complete exams, once every 24 months; • scaling and root planing (limited to 9 units per calendar year, a maximum of 14 units if supported by dental evidence); • occlusal equilibration (limited to 8 units per calendar year); DENTAL CARE BENEFITS
• topical application of sodium or stannous fluoride, twice per calendar year, but not more than once every 9 months; • dental x-rays - complete x-rays once every 24 months; bite-wing x-rays twice per calendar year, but not more than once every 9 months;
Benefit Maximum (per lifetime)

Orthodontics (for dependent children only)** ** Includes coverage for adult orthodontia, only when medically necessary. Medically necessary is considered to mean, as a result of a traumatic accident or surgery, the only means of restoring the teeth back to their original position is by active orthodontic treatment. HEALTH CARE BENEFITS

Overall Benefit Maximum

Calendar Year Deductible

Drug Dispensing Fee Maximum
life-sustaining, e.g. insulin & supplies, Percentage Payable


Hospital (Within Home Province)


Convalescent Hospital (Within Home Province)


Out-of-Hospital Nursing Benefit*
Maximum (per lifetime)
$25,000
HEALTH CARE BENEFITS

Health Practitioners' Benefit
Maximum (per calendar year)

One x-ray per calendar year per practitioner is included in the Benefit Maximum for Chiropractor, Podiatrist and Osteopath.
Out-of-Province Benefit Maximum
(Travel Assistance Plan)

Emergency Care



On Referral

HEALTH CARE BENEFITS

Vision Care Benefit Maximums
(in any 24-month period)

For the non-surgical treatment of keratoconus, for the lifetime of the covered individual, no amount will be paid for charges in excess of $150 and for expenses incurred within 6 months of each surgical procedure, no amount will be paid for charges in excess of $150. One eye examination by an optometrist per 24-month period, 12 months if under age 18.
Hearing Care Benefit Maximum
(in any 36-month period)


Maximum Drug Benefit

HEALTH CARE BENEFITS

Durable Medical
Equipment & Supplies

Foot Care Benefit Maximums


(24 month period, 12 months if under age 18)

Source: http://chatt.hdsb.ca/~spisaks/FOV1-00103C83/FAV1-001044D1/SECONDARYTEACHERSCUSTOMIZER.pdf

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