Effective April 1, 2018, Plan Members and Dependents who use insulin to manage their diabetes are eligible for FreeStyle Libre Flash glucose monitor and sensors. For more information Click here

Major Medical

Other Major Medical Coverages

Convalescent/Rehabilitation Hospital
(Within Home Province)

Ambulance Benefit

Out of Hospital Nursing

Accidental Dental

Foot Care

Hearing Care Benefit

Oxygen & its administration

Semi-Private room & board rate

Covered

$10,000.00 per calendar year

Covered

Orthotics covered to a maximum of $500.00 every 3 years

$500.00 in any 60 month period, excludes repairs or batteries

Covered

 

Convalescent/Rehabilitation Hospital(within Home Province)

For daily room and board in excess of ward, provided the individual is admitted to the Convalescent Hospital immediately following a minimum 14 consecutive day confinement in a Hospital. The confinement must be for the continued care of the same condition for which the patient was hospitalised. All confinements in a Convalescent Hospital will be considered as one period of disability unless confinements are separated by at least 90 days. Disability must commence prior to age 65.

Ambulance

Service charges, including emergency air ambulance service within Canada, in excess of the amount payable under the Insured Person’s Provincial Health. The services must be required to transport the person from the place of injury (or where illness struck) to the nearest Hospital where treatment is available, or directly from that Hospital to the nearest Hospital for needed specialized treatment not available at the first Hospital, or from Hospital to a Convalescent/Rehabilitation Hospital.

Out of Hospital Nursing

For services of a Registered Nurse (R.N.), a certified/licensed Nursing Assistant (C.N.A., R.N.A., R.P.N., L.P.N. or L.N.A.), or a member of the Victorian Order of Nurses (V.O.N.) while the patient is not confined to a Hospital, and up to the limit specified. The nursing service must have been ordered by a Physician as Medically Necessary and requiring the specialized training of a registered nurse. The nurse must not ordinarily reside in the Member's home or be a member of the family. Charges for services that are mainly custodial or assist the individual with the functions of daily living, or for personal counseling are not covered. Coverage is subject to obtaining prior approval.   

Accidental Dental

Dental Care for Accidental Injury for customary charges for necessary dental care by a licensed dentist or oral surgeon for the prompt repair of sound natural teeth when required for a Non-Occupational accidental injury, external to the mouth, which occurs while insured. The dental work must be completed within 6 months of the accident or treatment of a fractured jaw to be a covered medical expense.

Hearing Aid Benefit

Hearing Aid charges, excluding replacement, repairs, or batteries, when provided by a certified, clinical Audiologist, up to the amount specified.

Foot Care

Foot Care benefits are subject to the limits specified. Orthotics must be prescribed, for each occurrence, by either a Physician or Chiropodist/Podiatrist, and must be dispensed by a Physician, Chiropodist/Podiatrist, Orthotist or Pedorthist. Charges for orthotics which have been specially designed and molded for the insured person and are required to correct a diagnosed physical impairment, provided that the following information is supplied:

  • a diagnosis, including list of symptoms and the primary complaint;
  • a description of the physical findings from the clinical examination;
  • a brief description of the gait abnormality associated with the diagnosis; and
  • confirmation that the product has been custom-made.

Please note: Custom made orthotics prescribed or dispensed by a chiropractor are NOT covered by this plan.

Insulators Local 95 Benefit Trust Fund c/o Benefit Plan Administrators 
90 Burnhamthorpe Road West, Suite 300 Mississauga, Ontario L5B 3C3