The benefits described in this section apply to both the Members under the age of 71 and their eligible Dependents.
The Extended Health Care benefit is designed to provide valuable supplementary protection but not to duplicate the Provincial Hospital and Medical Care Plans under which an individual is or could be protected. Therefore, the Extended Health Care Insurance excludes (1) services and supplies to the extent benefits can be obtained for them under a provincial plan by fulfilling the requirements of that plan, and (2) services and supplies where private insurance is prohibited. Additional exclusions are detailed in the section entitled Exclusions. You should read the Covered Expenses with these Exclusions in mind. Before incurring any major expenses you may submit details to the Claims Office that will inform you what benefits, if any, are available under the Plan.
Charges for Medically Necessary, eligible services or supplies will be limited to the reasonable and customary cost for the expense up to any maximums specified. Reasonable and customary means charges for services of the level usually furnished for cases of the nature and severity of the case being treated and are in accordance with representative fee practices and prices in the area.
This insurance applies to expenses you are required to pay for the treatment of pregnancies and Non-Occupational accidents and sicknesses. The supplies or services must be Medically Necessary and prescribed by a Physician, or other qualified medical practitioner deemed appropriate by the insurance carrier. A medical expense shall be deemed incurred as of the date the service or supply is furnished to you, and you must be covered on that date for the expense to be considered.