We’ve Got You Covered!
For just $8.75 per month for you and your family, we feel thisTravel/Catastrophic Medical Coverage provided by Western Life is a smart addition!
Sometimes there are unexpected health expenses incurred while traveling, and potentially “big ticket”, accidental health expenses incurred locally. These expenses are reimbursed by this insurance policy, rather than claiming them through the plan.
Who is Eligible?
If your business is incorporated and/or you have full time employees on payroll, this is an OPTIONAL (but valuable) add on to your Canada Smart Plan.
If, however, your business is a Proprietorship (unincorporated-self employed) and have no additional employees on payroll, this is a REQUIRED (valuable and inexpensive) insurance added to meet CRA requirements that make you eligible to set up and benefit from the Canada Smart Plan.
All permanent employees under the age of 70, working a minimum average of 24 hours per week are eligible for coverage. There is no enrollment medical underwriting required.
For family coverage, a spouse or common law spouse (min 1 year cohabitation) under the age of 70 is covered. Dependent children under 21 or 25 (if a full time student) are also covered.
One annual policy is added for each employee included in the plan. One plan covers the employee, their spouse and dependent children. If both husband and wife are employees of a business, only one policy is required, as they are part of the same family.
Emergency Travel Medical Insurance: helps protect you from unexpected costs due to medical emergencies while travelling outside of Canada or your province of residence.
• $1,000,000 lifetime maximum
• 60 day per trip coverage
• No deductible
• Travel Assistance service included
• return of vehicle
• meal and accommodation to a max of $1,500 ($150 per day, 10 days)
• family transportation (accommodation max $750)
• repatriation (return of body)
• dental injury to a max of $2,000
• hotel convalescence to a max of $1,000
• No pre-existing exclusion if 2 or more employees covered in group,
• 6 month pre-existing exclusion applies if only 1 employee is covered in the group (see details below).
Excess Medical Insurance: provides reimbursement of reasonable and necessary charges for services or supplies received in Canada within two (2) years following the date a calendar year deductible ($2,500) is satisfied for such eligible expenses.
• Semi-private hospital room differential, to a max of $25,000/calendar year
• Nursing, to a max of $25,000/calendar year
• prescription drugs, to a max of $25,000/calendar year
• ambulance, to a max of $25,000/calendar year
• paramedical services, to a max of $25,000/calendar year
• durable equipment, to a max of $25,000/calendar year
• dental injury, to a max of $25,000/calendar year
• $50,000 lifetime maximum (for each expense category) over a maximum of 104 weeks per injury or sickness
• $125,000 maximum – total of all expenses per calendar year, per injury or sickness
• $250,000 lifetime maximum per injury or sickness, all expenses
• $2,500 deductible per calendar year per injury or sickness, all expenses
• No pre-existing exclusion if 2 or more employees are insured in the group
• 2 year pre-existing exclusion applies if 1 employee is covered in the group (see details below)
Pre-existing Exclusion Details
Pre-Existing Condition Determination Clause:
A pre-existing exclusion applies to: Travel Emergency Medical where less than 2 employees are enrolled and Excess Medical where less than 2 employees are enrolled
Emergency Travel Medical Pre-existing Exclusion
Travel Emergency Medical does not cover loss (fatal or non-fatal) or expenses caused by or resulting from any condition for which the insured person received medical advice, consultation or treatment within six (6) months prior to the commencement of a trip, with the exception of a chronic condition which is under treatment and stabilized by the regular use of prescribed medication.”Chronic Condition” means a disease or disorder that has existed for a minimum of six (6) months.“Stabilized” means there has not been a change in the medical condition requiring medical or psychiatric intervention for a minimum of six (6) months.
Excess Medical Pre-existing Exclusion
No Excess Medical benefits are payable as a result of any injury, illness, nervous disorder or any symptom or other condition for which medical advice, consultation, investigation, diagnosis or treatment, including medication, was required or recommended by a physician, or for which a reasonable person would have sought treatment or advice, during the twenty-four (24) month period prior to the effective date of insurance.
The premium for each policy is only $8.75 per month per employee.
You must be enrolled in the Canada Smart Plan to purchase this policy.
This insurance is added automatically if your business is a Proprietorship, (Unincorporated with no additional employees on payroll) since it is a CRA compliance requirement. The premium is collected directly and annually once your account is set up.
If your business is incorporated or you have additional employees on payroll, you can elect to have this insurance added at plan set up or later, or not at all. When added, the premium is collected directly and annually, once your account is set up, not with your initial enrollment fee.
Note: This outline is an overview of the group insurance portion of the Canada Smart Plan Catastrophic Medical policy MYH1001. Limitations and maximums apply to each area of coverage and are detailed in the policy wording.