Health Plans
Provided by Green Shield Canada. Issue ages 18-64, coverage to age 75.
    OPTIONAL UPGRADES
  BASE HEALTH PLAN
[Guaranteed Issue]
HEALTH Upgrade
[Guaranteed Issue]
DRUG Upgrade
[Underwritten]
PRESCRIPTION DRUGS
Quebec residents: prescription drug coverage not available unless RAMQ Top Up product is selected.
Maximum Paid at 70%
$400 per person, per year
  Paid at 90% per person
$1,000 1st year
$1,500 2nd year
$2,000 3rd+ years
 
EXTENDED HEALTH CARE   
Professional Services / Registered Therapists: $1,000 per year combined for all practitioners $1,500 per year combined for all practitioners  
Acupuncturist, Chiropractor, Chiropodist/Podiatrist, Registered Massage Therapist, Naturopath, Osteopath, Physiotherapist $20 per visit,
$400 per year
$40 per visit,
$500 per year
 
Psychologist/Registered Social Worker $400 per year combined $500 per year combined  
Speech Therapist $400 per year $500 per year   
Accidental Dental $3,000 per person, per year $10,000 per person, per year  
Ambulance Transportation Includes land and air Includes land and air  
Hearing Aids Not covered $500 every 36 months  
Medical Services:
Diagnostic tests and x-rays, dialysis equipment, laboratory tests
$2,000 per person, per year $3,000 per person, per year  
Medical Items and Home Support Services (in-home nursing) Year 1: $1,500
Year 2: $2,000
Year 3: $3,000
Year 4+: $4,000 per person, per benefit category, per year
$10,000 per person, per year combined  
 
TRAVEL   
Emergency Medical Travel Coverage out of Province / Country 15 days per trip
$5,000,000 per person, per year
15 days per trip
$5,000,000 per person, per year
 
 
VISION CARE
Prescription eyeglasses, contact lenses, laser eye surgery Not covered $250 every 24 months  
Eye examinations Not covered $65 per person, every 24 months  

 

Dental Plans
Provided by Green Shield Canada. Issue ages 18-64, coverage to age 75. Not available as a stand-alone product – must purchase a Health plan in order to purchase a Dental plan.
  OPTIONAL UPGRADE
  BASE DENTAL PLAN
[Guaranteed Issue]
DENTAL Upgrade
[Guaranteed Issue]
Maximum Paid at 70%
$450 per person, per year
Paid at 80% per person 
$1,000 1st year
$1,000 2nd year
$1,250 3rd+ years
 
BASIC PREVENTIVE & RESTORATIVE SERVICES   
Recall exams, preventive cleaning, fluoride for children Paid at 70%
Available every 9 months
Paid at 80%
Available every 9 months
Bitewing x-rays Paid at 70%
Available every 12 months
Paid at 80%
Available every 9 months
Complete oral exams, full x-rays Paid at 70%
Available every 3 years
Paid at 80%
Available every 3 years
 
ENDODONTIC & PERIODONTAL TREATMENT AND DENTURE SERVICES
Periodontal scaling, occlusal equilibration Paid at 70%
8 units every 12 months
Paid at 70%
8 units every 12 months
Denture cleaning Paid at 70%
Available once every 12 months
Paid at 70%
Available once every 12 months
Denture relining or rebasing Paid at 70%
Available once every 3 years
Paid at 70%
Available once every 3 years

 

*Québec residents only: To be eligible for prescription drug coverage under this benefit plan, residents of Québec are required to enroll in the public drug plan, RAMQ (Régie de l’assurance maladie du Québec). As a resident of Quebec, you must submit all your drug claims to RAMQ first. The unpaid balances (including co-payments and deductibles) for drugs eligible for coverage under RAMQ, as well as claims for drugs not covered by RAMQ, may then be submitted to GSC for consideration. In the case of drugs requiring special authorization, claims may be submitted to GSC for consideration according to the terms of the benefit plan described in this booklet, only when the RAMQ criteria has been met.

This is a brief overview of the Benefits, providing some key definitions, exclusions and limitations only. A complete policy booklet will be issued once coverage is purchased, and we suggest you review for details on all policy provisions when received.
 
Green Shield Canada reserves the right to perform a claim audit from time to time to verify the accuracy of the medical information provided. All Health & Dental clients are able to submit claims online.
Note: Except where otherwise indicated, coverage maximums are based on a Benefit Year. Benefit Year means the consecutive 12 month period following the effective date of coverage and each 12 month period thereafter. All maximums shown are per covered person.

Important Premium Information
Please note that all Edge Benefits plans renew annually based on the pooled experience of all policyholders, as well as many other market factors impacting premiums. These adjustments are generally effective on the 1st of October.  In addition, our Health and Dental products are Age-Banded, with scheduled premium increases at ages 45, 55, and age 60.
 
Please note: Benefits do not include smoking cessation products, medication for the treatment of obesity, erectile dysfunction or fertility. Serums and vitamins are also ineligible unless injected and medically necessary.