Global Blue Vision Plan Details

This is not a contract. Actual terms and conditions for the Global Blue Vision Plan Details are detailed in the policy issued upon application approval.

If you have any questions please call 1-800-474-4474, or email us
at inquiries@healthquotes.ca.

Table of Contents

General Information

• Eligibility
• Benefit Commencement

Coverage Information

• Prescription Drug Benefits
• Extended Health Benefits
• Dental Benefits
• Travel
• Exclusions

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General Information

Eligibility:

• You must be a beneficiary in the meaning of the health and hospital insurance legislation in your province of residence
• You may not be hospitalized and/or disabled on the day the contract comes into effect.

Benefit Commencement:

• Blue Vision Global Health Plan benefits take effect when the application is approved by Blue Cross®, provided it is approved without modification, and that no
  changes in your insurability have occurred since the application was signed.
• Otherwise, the benefits only take effect when delivered to the policyholder, provided no changes in your insurability have occurred since
  the application was signed.

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Extended Blue Vision Global Health Plan Benefit

• Coverage for medical and hospital expenses caused by illness, injury or pregnancy.
• Private or semi-private (hospital) accomodations, covered up to a maximum refund of $200/day, with a max. duration of 90 days per calendar
  year.
• Specialists:
• Benefits are payable only after yearly maximum allowed under OHIP has been reached.
• Items 1-9 listed below DO NOT require a written recommendation from a physician.

Specialist	First Visit		Subsequent Visit		Maximum Number
	Regular	Enhanced	Regular	Enhanced	Regular	Enhanced
1) Chiropractor: x-rays, up to max. of $30 for Regular coverage and $40 for Enhanced coverage	$20	$25	$20	$25	25	25
2) Acupuncturist	$20	$25	$20	$25	25	25
3) Osteopath	$20	$25	$20	$25	25	25
4) Physiotherapist	$20	$25	$20	$25	25	25
5) Podiatrist or Chiropodist	$20	$25	$20	$25	25	25
6) Psychologist	$80	$80	$65	$65	12	20
7) Speech therapist	$65	$65	$45	$45	12	12
8) Naturopath	$20	$25	$20	$20	25	25
9) Ophthalmologist or Optometrist (for insured under 65 years of age).				Up to max. of $50 per 2 calendar years
10) Registered massage therapist	$20	$25	$20	$25	20	20

• Following eligible expenses covered at 80% without deductible (Regular and Enhanced):
• Hearing aids: up to $300 (excluding batteries) every 60 months for Regular coverage and $400 for Enhanced coverage,
  subject to 3-month waiting period.
• Prostheses and accessories: up to a maximum refund of $2,500 per calendar year.
• Nursing services and homecare services: up to a maximum refund of $2,500 per calendar year.
• Surgical stocking: up to a maximum of $100 per calendar year.
• Orthopedic shoes or podiatric ortheses: up to maximum refund of $200 per calendar year for both combined.
• Purchase or rental of equipment (crutches, walkers, canes, etc.): up to a maximum refund of $2,500 per calendar year.
• Ambulance: amount equals costs not covered by your government plan.
• Dental treatment due to accident: up to a maximum of $2,000 per calendar year.
• Vision care:
• Only comes with Enhanced extended health benefits.
• Covered at 100% without deductible.
• Lenses, frames, contact lenses and visual training including eye patches or laser vision corrective surgery.
• Up to a maximum of $150 per two (2) calendar years.
• Subject to a 3-month waiting period.

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Drug Benefit

• If you select the Drug Benefit you must also purchase the Extended Health Benefit (Regular or Enhanced).
• Coverage is classified as Basic or Deluxe.
• Prescription drugs covered at 80% without deductible.
• Pay Direct Card
• No lifetime maximum
• Reimbursement is based on lowest-cost generic equivalent if available (a generic drug is a generally less expensive alternative to an
  interchangeable brand name drug product)
• Maximum Overall Reimbursement (per insured):
• Basic: $5,000 per calendar year.
• Deluxe: $10,000 per calendar year
• Coverage ends on the contract anniversary coinciding with or following your 65th birthday.
• For any portion of a calendar year during which this benefit is effective, the maximum overall reimbursement is prorated for the number
  of complete months between the effective date of the benefit and December 31 of the same year.

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Dental Care Benefit

• If you select the Dental Care Benefit you must also purchase the Extended Health Benefit.
• If you discontinue your DENTAL CARE benefit, you are no longer eligible, unless you can prove that you were covered by the DENTAL CARE
  benefit of another contract during this period.
• The eligible amount for any insured service is the amount specified in the Suggested Fee Guide for Dental Services for General
  Practitioners (in effect on the date the services were rendered).
• Two levels of coverage: Basic and Enhanced.
• Basic Plan Coverage:
• Preventive and basic care services reimbursed at 70% up to $750 per insured per calendar year.
• Preventive care:
• Examinations and diagnostic services.
• Radiographs and laboratory tests.
• Preventive services.
• Case presentation and treatment planning.
• Basic care:
• Removal of erupted teeth (uncomplicated surgery).
• Restorative services.
• Endodontics, periodontics.
• Denture services.
• Surgical services.
• Adjunctive services.
• Enhanced Plan Coverage:
• Preventive and basic care services reimbursed at: 70% for first calendar year, up to up to $750 per insured;
  75% for the second calendar year, up to $1,000 per insured; 80% thereafter, up to $1,250 per insured (includes major restorative)
• What is covered is the same as Basic Plan Coverage above, with the addition of Major Restorative Services such as:
• Prosthodontic removable services.
• Prosthodontic fixed bridge services.
• Extensive restorative procedures.
• Major Restorative Services are reimbursed up to a maximum of $500 per calendar year. This maximum limit is within,
  and not in addition of, the MAXIMUM OVERALL REIMBURSEMENT.
• All of the eligible dental services listed above are subject to the maximums specified in your contract.

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Travel

• Only comes with Enhanced extended health benefits.
• Covers trips that are 15 days or less.
• $5,000,000 hospital and medical benefits such as:
• Hospitalization in private or semi-private room.
• Physician, private nursing and professional services fees.
• Laboratory test costs.
• Prescription drugs for emergency treatment while traveling.
• Purchase or rental of medical equipment.
• Dental expenses due to an accident.
• Costs associated with hospitalization.
• Transportation costs such as:
• Repatriation to your province of residence.
• Land or air ambulance services.
• Baggage return and pet return.
• Family visits to insured in hospital.
• Repatriation of deceased.
• $3,000 subsistence allowance.
• Round-the-clock CanAssistance travel assistance.
• Medical Follow-Up in Canada:
• In case of repatriation to Canada at the Insurer’s expense after a hospital stay out of Canada. Coverage reimburses the
  following costs if incurred within 15 days of repatriation:
• Up to $1,000 for semi-private room in a hospital, rehabilitation center or convalescent home.
• Up to $50 per day (maximum of 10 days) for home nursing care when medically required.
• Up to $150 for rental of medical devices such as crutches, standard walkers, canes, trusses, orthopedic corsets and
  oxygen.
• Up to $250 for transportation (e.g. ambulance and/or taxi) to get medical care.
• Important: there are PRE-EXISTING CONDITIONS for insureds age 61 or over (refer to your insurance policy), as well
  as EXCLUSIONS AND REDUCTIONS that are applicable to this benefit (see below for Exclusions).

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Exclusions

• These exclusions do not apply to all benefits, and some benefits may have additional exclusions.
• No benefits are payable for claims arising directly or indirectly from any of the following:
• Abuse of alcohol or drugs, or use of illegal drugs.
• An accident sustained by insured while participating in a sport for remuneration or in a motor vehicle competition, race or speed contest.
• Care in a residential and long-term care facility or a private convalescent home.
• Cosmetic care or treatment.
• Expenses payable under any other insurance plan or services insured under any federal or provincial legislation or its regulations.
• Experimental care or treatments, or new procedures or therapies not commonly used.
• Attempted suicide or intentional self-injury, regardless of insured’s state of mind.
• Voluntary or involuntary inhalation of gas or ingestion of poison or drugs.
• The insured’s active participation in a public confrontation, riot, insurrection, war or act of war (declared or not)
  or any other warlike act.
• The insured’s direct or indirect commission or attempted commission of a criminal act under the Criminal Code or
  under a similar law in another country.
• The insured’s operation of a motor vehicle or a boat with an alcohol level exceeding 80 mg per 100 mL of blood or
  under the influence of any drug.
• The insured’s participation in a flight or a flight attempt in any aircraft in any sort in any capacity other than
  that of a passenger.
• The insured’s service as an active member of the armed forces of any country.

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