Manulife Flexcare DentalPlus, ComboPlus Starter Plans^®

This is not a contract. Actual terms and conditions for Guaranteed Issue Manulife Flexcare plan are detailed in the policy issued upon application approval.

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

Table of Contents

General Information

• Effective Date of Coverage
• Acceptance Period
• Hospitalization/Pregnancy
• Maximums
• Newborns
• Core Benefits Variations

Health Care Plans

• Snapshot of Plans and Benefits (useful when comparing different plans)
• DentalPlus^™ (Dental Care Plans with Core Benefits)
• Basic
• Enhanced
• Core Benefits (Basic and Enhanced Plans)
• ComboPlus^™ (Prescription Drug and Dental Care Plans with Core Benefits)
• Starter
• Core Benefits (Starter Plan)

Seniors’ Adjustments

• DentalPlus (Basic/Enhanced), Vision, Hospital
• Travel
• ComboPlus Starter (Drug Coverage)

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General Information

Effective Date of Coverage

• Coverage is effective no earlier than the first day of the month following final approval of the application.

Acceptance Period

• If you and/or your family’s medical history is such that a higher premium is required or that special conditions be applied to benefits (see Medically Underwritten), you will be notified in writing prior to your decision to accept the coverage. If at that time you decide not to proceed with the coverage, any initial payment will be returned and your application cancelled.

Hospitalization/Pregnancy

• Full coverage is available for expectant mothers who qualify for a Flexcare Core plan and the additional Hospital Coverage benefit within the first 20 weeks of pregnancy (Maternity Hospital stay is limited to 2 days). Manulife cannot guarantee the availability of private or semi-private hospital accommodation. – Table of Contents –

Maximums

• Unused portions of benefits cannot be accumulated and added to coverage in future months or years.
• All maximums are per person, and not per family, unless otherwise stated.

Newborns

• Newborns of parents who are enrolled in the FlexCare plan are automatically added to the same coverage if an application is made within 30 days of birth. If the application is after their 30th day, medical information will be required.

Core Benefits Variations

• Although Core Benefits come with all FlexCare Plans there is a very slight variation in Core Benefits, depending on the type of FlexCare Plan you choose (e.g. DrugPlus Basic, DentalPlus Enhanced, etc.)

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Health Care Plans

Snapshot of Plans and Benefits (you can click on any coloured text for further details)
CORE BENEFITS	CORE PLANS (Note: All plans come with core benefits)
	DentalPlus Basic	DentalPlus Enhanced	ComboPlus Starter
Vision (Basic), Chiropractor, Dietitian, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist, Psychologist, Clinical Counsellor, Psychotherapist, Speech Pathologist/Therapist, Physiotherapist, HomeCare and Nursing, Prosthetic Appliances, Durable Medical Equipment, Accidental Dental, Ambulance, Hearing Aid, Emergency Travel Health Coverage, Accidental Death and Dismemberment, Survivor Benefits   Solutions Services	Ongoing Maintenance 9 month recall   Total Benefits Payable: Year 1: 50% of first $1,150. Total payable per anniversary year: $575   Year 2+: 80% of first $400, 50% of next $860. Total payable per aniversary year: $750   DentalPlus Basic and Enhanced have an escalating yearly maximum for Home Support, Durable Medical Supplies and Prosthetic Appliances   No medical questionnaire required	Ongoing Maintenance 6 month recall   Total Benefits Payable: Year 1: 70% of first $1,200. Total payable per anniversary year: $840   Year 2+: 100% of first $500, 60% of next $700) Total payable per anniversary year: $920   Combined maximum of $1,250/3 year period for: Oral Surgery, Endodontics, Periodontics: Year 1: 0%; Year2: 60% Year 3+:80%   Major Restorative First 2 Years: 0%, Subsequent Years: 60%   No medical questionnaire required	DENTAL: Ongoing Maintenance – 9 month recall – 70% of 1st $575.   PRESCRIPTION DRUGS: – Generic Drug Plan – 70% of 1st $750: $525 maximum per year – Dispensing Fee Cap is $6.50.   Escalating yearly maximum for Home Support, Durable Medical Supplies and Prosthetic Appliances   – Now comes with $150 of Vision basic for every two benefit years   No medical questionnaire required
Seniors Adjustments
(Age 65 and up)   No travel coverage available (ends at age 70)   AD&D decreases to $10,000   Vision is now included	Travel coverage not available (ends at age 70)	Travel coverage not available (ends at age 70)	Prescription Drugs: Increases to 100% of first $750.   Residents of Nova Scotia – Drugs increased to 100% of first $300.   Travel coverage not available (ends at age 70)
NOTE: Unless otherwise mentioned benefits are based on anniversary year except for Vision and Hearing Aid benefits, which are based on Benefit year.

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DentalPlus (Dental and Core Benefits)

You can choose either the Basic or Enhanced Plan, both come with Core Benefits

 IMPORTANT: Dental coverage commences at age 17 for residents of Prince Edward Island, age 13 for residents of Newfoundland and age 11 for residents of Nova Scotia. Also, coverage is designed to concur with your current provincial Dental Association Fee Guide for General Practitioners. The FlexCare DentalPlus coverage will be adjusted to match any increases in the fee guide.

Basic Plan (DentalPlus)

• No medical questionnaire required, guaranteed acceptance.
• Coverage for fillings, cleanings, scalings, examinations, polishings, and certain extractions.
• Recall visits every 9 months.
• Coverage table:

Year	Copay	To a maximum of (per anniversary year)
One	First $1,150: 50%	$575
Subsequent years	First $400: 80% Next $860: 50%	$750

• Note: core benefits are listed beneath the Enhanced Plan details below.

Enhanced Plan (DentalPlus)

• No medical questionnaire required, guaranteed acceptance.
• Coverage for fillings, cleanings, scalings, examinations, polishing, and certain extractions.
• Recall visits every 6 months.
• Coverage Table:

Year	Copay	To a maximum of (per anniversary year)
One	First $1,200: 70%	$840
Two and after	First $500:100% Next $700: 60%	$920

• The following 6 dental services (Enhanced plan only) have a combined maximum of $1,250 per 3 year period. For oral surgery, periodontics and endodontics (root canal), benefits are available beginning Year 2; for orthodontics, crowns, bridges and dentures. No benefit is available until Year 3. The payment percentage increase from the effective date of contract is as follows:

	Anniversary Year 1	Anniversary Year 2	Anniversary Year 3 and beyond
Oral Surgery	0%	60%	80%
Periodontics	0%	60%	80%
Endodontics (Root Canal)	0%	60%	80%
Orthodontics	0%	0%	60%
Crowns, Bridges	0%	0%	60%
Dentures	0%	0%	60%

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Core Benefits (Included with DentalPlus Basic and Enhanced Plans)

Vision (Basic)

• $250 maximum per 2 consecutive benefit years to cover the cost towards prescription lenses, frames, contact lenses and laser eye surgery.
• $70 maximum for Optometrist fees per person per 2 consecutive benefit years (payable only after Government Health Insurance Plan maximum has been reached, if applicable)
• Eyeglasses are covered against breakage and scratches by a repair guarantee for a period of 2 benefit years. This warranty applies to lenses and frames purchased with the Vision benefit of FlexCare.
• No deductible is charged to you if your eyeglasses can be repaired. If beyond repair, your glasses will be replaced and; a $50 deductible charged for eyeglasses originally purchased for up to $250; or a $75 deductible, if the original purchase price was $251 to $300; or a $100 deductible, if your eyeglasses originally cost $301 or more.

Extended Health Care

• $250,000 lifetime maximum.
• Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist: $25 max. per visit, 20 visit maximum per person per discipline per anniversary year.
• Chiropractic X-ray: $35 maximum per anniversary year.
• Psychologist and Psychotherapist: $80 max. first visit, $65 max. subsequent visits, 15 visit max. per anniversary year.
• Speech Pathologist/Therapist – $65 max. first visit, $45 max. subsequent visits, 10 visit maximum per anniversary year.
• Physiotherapist – $250 max. per anniversary year.
• HomeCare and Nursing, Prosthetic Appliances, Durable Medical Equipment: maximum per anniversary year for each of these 3 categories of benefits as follows:
• Year 1: $1,000
• Year 2: $1,300
• Year 3: $1,500
• Year 4: $1,700   
• Year 5+: $3,000
• NOTE: $225 max. per anniversary year for custom-made Orthotics, which are included as part of Prosthetic Appliances.
• Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.
• Lifeline Personal Response Service: max. of 6 months of service per 3 anniversary years. Note: coverage has been expanded to include extended family such as grandparents, parents and in-laws.
• Accidental Dental: $2,000 maximum per anniversary year.
• Ambulance: unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per anniversary year.
• Hearing Aid: $400 maximum per 4 consecutive benefit years.  

Travel

• $5 million emergency health coverage for trips lasting a maximum of 9 days (a $100 deductible applies per claim). Additional coverage for either 8 or 21 days can be purchased as an Add-On.
• NOTE: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period preceding the effective date of coverage. Not available to persons age 70 and over; 8 or 21 day Add-On Travel coverage now available with ComboPlus Starter Plan.

Accidental Death & Dismemberment

• $25,000 for adults under the age of 65; $10,000 for children and adults age 65 and over, or a child.
• Additional coverage can be purchased as an Add-on.

Survivor Benefits

• Provides for coverage to be continued for 1 year, following the death of an adult policyholder.
• Available 1 year after policy effective date.

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ComboPlus (Prescription Drug, Dental and Core Coverage)

• You can choose either the Starter, Basic or Enhanced Plan, all come with Core Benefits.
• Note that Core Benefits for the Starter Plan are different than the Core Benefits that come with the Basic and Enhanced Plans.
• For drug and dental coverage with Core Benefits, without a medical questionnaire, choose the Starter Plan.
• For more extensive drug and dental coverage with Core Benefits, select either the Basic or Enhanced Plan.

Starter Plan (ComboPlus)

• No medical questionnaire – guaranteed acceptance

Starter Drug Coverage:

• Generic drug plan (name brand drugs allowed, but price paid will be deemed to be the generic equivalent price).
• Shared dispensing fee to a maximum of $6.50.
• 70% on the first $750 to maximum of $525 per person per year.
• Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription.
• British Columbia and Saskatchewan residents: Prescription drug benefit maximums based on calendar year.

Starter Dental Coverage:

• Dental coverage with a 70% payment for fillings, cleanings, scalings, examinations and polishing on the first $575 of these services.
• Recall visits every 9 months.
• IMPORTANT: Dental coverage commences at age 17 for residents of Prince Edward Island, age 13 for residents of Newfoundland and age 11 for residents of Nova Scotia.

Starter Core Benefits:

Vision (Starter)

• $150 maximum per 2 consecutive benefit years to cover the cost towards prescription lenses, frames, contact lenses and laser eye surgery.
• $70 maximum for Optometrist fees per 2 consecutive benefit years (payable only after Government Health Insurance Plan maximum has been reached, if applicable)
• Eyeglasses are covered against breakage and scratches by a repair guarantee for a period of 2 benefit years. This warranty applies to lenses and frames purchased with the Vision benefit of FlexCare.
• No deductible is charged to you if your eyeglasses can be repaired. If beyond repair, your glasses will be replaced and; a $50 deductible charged for eyeglasses originally purchased for up to $250; or a $75 deductible, if the original purchase price was $251 to $300; or a $100 deductible, if your eyeglasses originally cost $301 or more.

Extended Health Benefits (Starter)

• $250,000 lifetime maximum.
• Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist: $25 max. per visit, 20 visit maximum per discipline per anniversary year (payable only after Government Health Insurance Plan maximums have been reached, if applicable).
• Chiropractic X-ray: $35 maximum per anniversary year.
• Psychologist and Psychotherapist: $80 max. first visit, $65 max. subsequent visits, 15 visit max. per anniversary year.
• Speech Pathologist/Therapist: $65 max. first visit, $45 max. subsequent visits, 10 visit maximum per anniversary year.
• Physiotherapist: $250 max. per anniversary year.
• HomeCare and Nursing, Prosthetic Appliances, Durable Medical Equipment: maximum per anniversary year for each of these 3 categories of benefits is as follows:
• Year 1: $1,000
• Year 2: $1,300
• Year 3: $1,500
• Year 4: $1,700
• Year5+: $3,000
• NOTE: $225 max. per anniversary year for custom-made Orthotics, which are included as part of Prosthetic Appliances.
• Lifeline Personal Response Service: max. of 6 months of service every 3 anniversary years.
• Accidental Dental: $2,000 maximum per anniversary year.
• Ambulance: unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per anniversary year (only payable after Government Health Insurance Plan maximums have been reached, if applicable).
• Hearing Aid: $400 maximum per 4 consecutive benefit years.
• Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.

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Travel

• $5 million emergency health coverage for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.)
• Additional coverage for either 8 or 21 days can be purchased as an Add-on.
• NOTE: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9 month period preceding the effective date of coverage.
• Not available to persons age 70 and over; 8 or 21 day Add-On Travel coverage now available with this ComboPlus Starter Plan.

Accidental Death & Dismemberment

• Up to$25,000 for adults under the age of 65; up to $10,000 for children and adults age 65 and over.
• Additional coverage can be purchased as an Add-On.

Survivor Benefits

• Provides for coverage to be continued for 1 year, following the death of an adult policyholder.
• Available 1 year after policy effective date.

Senior’s Adjustments

• If you are 65 years of age or over, you are likely to have special health priorities. That is why the Flexcare health plan coverage is adjusted to reflect your needs
• Under the Seniors’ Adjustments, all of your benefits are as outlined in your chosen Core plan with the following changes:

DentalPlus (Basic/Enhanced), Vision, Hospital

• There is no change to these Core plan benefits from what has been previously described.

Travel

• Travel coverage not available.

ComboPlus Starter (Drug Coverage)

• 100% on the first $750 of eligible prescription costs.
• Full coverage of reasonable and customary dispensing fees.
• Residents of Nova Scotia: 100% generic drugs on first $300.
• Residents of British Columbia and Saskatchewan: Prescription drug benefits based on calendar year.
• IMPORTANT: For residents of New Brunswick, Manitoba and Saskatchewan prescription drug Seniors’ adjustments do not apply.

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