Personal Health Plans Effective February 1, 2015 You can trust Blue Cross® For more than 65 years Saskatchewan Blue Cross has been providing quality health care coverage to the people of Saskatchewan. We are accessible, caring, helpful and here when you need us. Why Blue Choice®? Blue Choice® Personal Health Plans are your assurance of protection for yourself and the ones you love. Our plans are designed with you in mind, whether you are an individual, a couple or a family. What benefits are available? Blue Choice® plans are all about choice. Your Personal Health Plan comes with an excellent range of Core Health Benefits. You can customize your plan to meet your specific needs by choosing from our list of Optional Benefits: • Prescription Drugs •Dental • Hospital Cash • VIP Annual Travel Plan • Student Accident • Critical Conditions • Term Life Insurance This brochure contains an overview of the Blue Choice® Personal Health Plans offered by Saskatchewan Blue Cross. This is not a contract or policy, nor a complete description of all benefits. 1 Core Health Benefits Ambulance Services • Unlimited emergency services. Why apply now? Qualify now and you’ll secure coverage for the future when you may need it. When you apply for a Blue Choice® Personal Health Plan, we may review your medical history. If you wait until a health problem occurs, you could be denied coverage. Are there tax advantages? Yes. The premiums for Blue Choice® Core Health Benefits and most Optional Benefits meet the current Canada Customs and Revenue Agency tax guidelines for eligible medical expenses. Hospital Services • Preferred accommodations for acute care. • In-hospital drugs. • Maximum 30 days per person per contract year. Private Duty Nursing Services • In hospital and/or immediately following discharge from a hospital. • 80% up to a maximum of $5,000 per person per contract year. Accidental Dental Services • Unlimited coverage for accidental damage to natural teeth. Medical Equipment • Purchase or rental of a wheelchair and/or hospital bed to a maximum of $500 per person. • Purchase or rental of a patient walker to a maximum of $300 per person. • Oxygen equipment rental to a maximum of $500 per person per contract year. • Aggregate lifetime maximum for Medical Equipment benefit is $1,500 per person. Hearing Aids • Up to $500 per person in a 5-year period. • Up to $500 per dependent child in a 3-year period. • 12-month waiting period. Prosthetic & Medical Appliances • Artificial eyes, limbs, crutches, casts, braces, wigs, etc. Breast Prosthesis • Unlimited coverage once in a 24-month period. Diabetic Supplies • Unlimited coverage for needles, syringes, swabs, test strips, lancets. 2 3 Core Health Benefits Diabetic Equipment • 80% to a maximum of $500 per 5-year period for poking devices, glucose meters, etc. Ostomy Supplies • Unlimited coverage. Registered Therapists & Health Practitioners • Up to $300 per specialty per person per contract year for chiropractor, chiropodist/podiatrist, physiotherapist/athletic therapist, registered massage therapist, clinical psychologist, naturopath and acupuncturist. Orthopaedic Shoes & Supplies • 80% to a maximum of $200 per person per contract year. Blood Pressure Monitors • Once every 5 years. Mobility Aids • Unlimited coverage for bathroom rails, etc. Vision Care • Up to $75 per person once every 24 months for eye examinations. • Up to $100 per person once every 24 months for prescription eyewear or laser eye surgery. Out-of-Province Referral Services • Lifetime maximum of $50,000 for pre-approved medical services not available in Saskatchewan. Out of Saskatchewan (Within Canada) Emergency Services • Unlimited coverage of emergency hospital and medical benefits. Funeral Expense (age 65 and over) • Up to $4,000 when death is accidental. Optional Benefits Choose any or all of the following benefits to personalize your Blue Choice® Health Plan. 1 PRESCRIPTION DRUGS Choose this benefit which includes a drug card for convenient pharmacy-direct payment. • 80% for prescribed drugs listed in the Saskatchewan Prescription Drug Plan Formulary. Unlimited coverage. 2 DENTAL This popular choice covers a major portion of your dental expenses. First Contract Year 75% for Basic Dental Services, up to a maximum of $500 per person. Second Contract Year 80% Basic, 50% Major, up to an overall maximum of $750 per person. Third and Following Contract Years 80% Basic, 50% Major, up to overall m aximum of $1,000 per person per contract year. Basic Dental Services include procedures such as examinations, x-rays, tests, c leaning, filling, root canals, oral surgery, denture repairs, etc. Major Dental Services include inlays, onlays, crowns, dentures, bridges, some orthodontic services. Dental Benefits are subject to a 6-month waiting period. Accidental Death & Dismemberment (under age 65) • Maximum amount payable: $25,000 for insured and/or spouse; $5,000 for each dependent child. Payments vary, depending upon nature of loss. 4 5 Optional Benefits 3 HOSPITAL CASH Choose this benefit for financial help to meet expenses due to hospitalization. Under age 65: $100 per day up to 50 consecutive days of hospitalization. Age 65 and over: $100 per day up to 30 consecutive days of hospitalization. Benefits begin on: 1st day of hospitalization due to an accident. 4th day of hospitalization due to an illness. 8th day of hospitalization due to maternity. 4 VIP ANNUAL TRAVEL PLAN Choose this coverage if you make frequent trips outside of Saskatchewan. • Coverage up to 30 consecutive days per trip with no limit on the number of trips. • $5 million in emergency hospital and medical benefits. • $100,000 in air flight and common carrier accident insurance. • Up to $1,000 for trip interruption. • Up to $1,000 for baggage and personal effects. • Up to $1,500 for meals and accommodations if trip is delayed due to injury or illness. 5 STUDENT ACCIDENT 6 Choose year-round accident coverage for the students in your family. • Special benefit for out-of-province treatment. • Dread disease benefit. • Rehabilitation benefit. • Fracture and dislocation indemnity. • Confinement benefit. • Tutorial benefit. • Special treatment travel expense. • Travel accident emergency expense. • Total and permanent disability. • Optional Life Insurance with optional Double-Up feature. Optional Benefits 6 CRITICAL CONDITIONS (under age 65) Choose to receive a lump sum cash payment to help cope with a severe critical illness or disease. When such illnesses strike, there are often significant lifestyle changes that can more easily be managed when financial security is less of an issue. Eligible Conditions: severe heart attack, severe stroke, life-threatening cancer, Alzheimer’s disease, coma, major organ failure, major organ failure requiring transplant, motor neurone disease, paralysis, senile dementia, blindness, deafness, loss of speech, Multiple Sclerosis, Parkinson’s disease, severe burns. Maximum Amount Payable: (choose Level 1 or Level 2) Person Covered Insured or Spouse under age 65 Level 1 Level 2 $10,000 $25,000 Each dependent child $5,000$10,000 The critical condition must result from illness or disease. Pre-existing c onditions are not covered. Benefits are subject to a 30-day survival period. 7 TERM LIFE INSURANCE Choose affordable life insurance for you and your family. • $25,000 to $100,000 coverage. • Special rates for non-smokers. • Optional $10,000 coverage for each dependent child. • Apply up to age 55. • Renew up to age 70. • Coverage remains constant as long as you maintain it. • Premiums increase when you enter a new age bracket. 7 Monthly Premiums Personal Health Plans AGE** Blue Choice® Personal Health Plans Core Health Benefits and Optional Benefits are priced separately. Standard monthly premiums* are shown in the following tables. Saskatchewan Blue Cross reserves the right to change rates if required. Based on your medical history, you may be given a higher rating, excluded from specific benefits or declined. To calculate an approximate monthly premium, add the Core Health premium to the appropriate fee for each Optional Benefit you choose, or use the Rate Calculator at http://www.sk.bluecross.ca/ personal/rate_calculator/ FAMILY STATUS*** CORE HEALTH BENEFITS PRESCRIPTION DRUGS BENEFITS DENTAL BENEFITS HOSPITAL CASH BENEFITS VIP ANNUAL TRAVEL BENEFITS Under 35 Single Couple Family 9.25 18.55 23.20 5.35 9.25 15.45 20.80 41.35 62.70 2.00 3.00 5.00 1.45 2.90 2.90 35–44 Single Couple Family 10.90 21.85 28.45 7.90 12.30 20.20 26.95 54.20 81.40 2.75 4.25 5.50 2.35 4.70 4.70 45–54 Single Couple Family 13.55 27.20 33.50 16.00 24.10 26.80 28.15 56.75 85.30 3.00 5.75 6.25 3.55 7.10 7.10 55–64 Single Couple Family 16.25 32.55 38.40 26.35 40.00 47.10 28.15 56.75 85.30 5.00 7.50 8.25 4.20 8.40 8.40 65–74 Single Couple Family 20.20 40.40 60.50 21.30 31.70 47.25 28.15 56.75 85.30 10.00 14.00 18.00 7.20 14.40 14.40 75–84 Single Couple Family 22.15 44.35 67.65 27.00 40.45 60.40 26.95 54.20 81.40 12.00 16.00 20.00 11.35 22.70 22.70 85+ Single Couple Family 25.65 51.35 72.70 29.20 44.05 65.60 24.95 50.15 75.40 14.00 18.00 22.00 11.35 22.70 22.70 Critical Conditions Benefit Age Under 35 35–44 45–54 55–64 SINGLE $10,000 $25,000 Level 1 Level 2 0.50 1.25 1.00 2.50 3.00 6.50 8.50 21.00 *C overage must be purchased for 1 year. Monthly payment option requires completion of the Pre-authorized Debit (PAD) Agreement 8 included in this brochure. Available under age 65 only. COUPLE $10,000 $25,000 Level 1 Level 2 0.75 2.00 2.00 5.00 5.50 13.50 15.00 37.00 FAMILY $10,000 $25,000 Level 1 Level 2 1.00 2.50 2.50 5.50 6.00 14.00 16.00 38.00 ** The oldest person on the application determines the age band and rate. ***Family Status definitions: single rate is for 1 person, couple rate is for 2 persons, and family rate is for 3 or more persons. 9 Monthly Premiums Term Life Insurance – Non-Smokers & Smokers Both applicant and spouse must be non-smokers to qualify $ 25,000 AGE* $ 50,000 $ 75,000 $ 100,000 $ 10,000 SINGLE COUPLE SINGLE COUPLE SINGLE COUPLE SINGLE COUPLE CHILDREN** Under 35 Non-smoker Smoker 2.90 4.40 4.50 6.90 5.80 8.80 9.00 13.80 8.70 13.20 13.50 20.70 11.60 17.60 18.00 27.60 3.35 3.35 35–44 Non-smoker Smoker 4.60 7.00 8.10 12.40 9.20 14.00 16.20 24.80 13.80 21.00 24.30 37.20 18.40 28.00 32.40 49.60 3.35 3.35 45–54 Non-smoker Smoker 11.30 17.20 18.80 28.70 22.60 34.40 37.60 57.40 33.90 51.60 56.40 86.10 45.20 68.80 75.20 114.80 3.35 3.35 55–64*** Non-smoker Smoker 25.40 38.90 41.40 63.30 50.80 77.80 82.80 126.60 76.20 116.70 124.20 189.90 101.60 155.60 165.60 253.20 3.35 3.35 65–69*** Non-smoker Smoker 45.50 69.60 74.40 113.80 91.00 139.20 148.80 227.60 136.50 208.80 223.20 341.40 182.00 278.40 297.60 455.20 3.35 3.35 Student Accident Insurance Monthly Premiums **** Single Student........................$0.50 Family (3 or more students).....$1.25 Optional Life Insurance Applicable to Student Accident Option only $5,000............... $0.35 per student OR $10,000............. $0.75 per student Double-Up........... $0.20 per student Double indemnity for accidental dismemberment and for total and permanent disability. 10 for the non-smoker couple premium. *The oldest person on the application determines the age band and rate. **Optional Children’s Benefit provides $10,000 coverage per dependant child. This rate covers all children in the family. Newborns less than 15 days old, however, are not covered. *** Renewal only, no new applications accepted. ****Coverage must be purchased for 1 year. Monthly payment option requires completion of the Pre-authorized Debit (PAD) Agreement included in this brochure. Critical Conditions, Accidental Death & Dismemberment, Term Life and Student Accident & Life benefits are underwritten by Blue Cross Life Insurance Company of Canada®, an independent licensee of the Canadian Association of Blue Cross Plans, Box 220, Moncton, NB E1C 8L3. 11 Frequently Asked Questions Who is considered a dependent? An applicant’s spouse, unmarried child up to 18 years of age (or up to 25 years of age if undergoing full time education) or any infirm child unable to leave the care of the applicant. Is coverage guaranteed? No. It is important to apply for coverage before health problems occur as an applicant may be given a higher rating, excluded from specific benefits, or declined based on medical history. When does my coverage begin? Your coverage will become effective on the first day of the month following the approval of your application and the receipt of your premium. How do I apply? 1. C hoose the coverage options that are right for you. 2. C omplete the application form(s) included in this brochure according to your choices, as below. Core Health Benefits Complete PARTS I, II, III, IV and VI. If you answer YES to any question in PART IV, also 12 complete PART V of the Blue Choice® Personal Health Plans Application included in this brochure. The Optional Benefits below are available only with the purchase of Core Health Benefits. Prescription Drugs, Hospital Cash, Critical Conditions If you are applying for 1 or more of these benefits, complete all PARTS of the Blue Choice® Personal Health Plans Application included in this brochure. Dental, VIP Annual Travel Plan, Student Accident If you are applying for 1 or more of these benefits, complete PARTS I, II, III, IV and VI of the Blue Choice® Personal Health Plans Application included in this brochure. Term Life Insurance If you are applying for this benefit, complete the Term Life Insurance Application included in this brochure. 3. W hen you have completed all applicable forms, submit them to Saskatchewan Blue Cross in the enclosed envelope. Your application will be reviewed and you will receive confirmation of coverage. You will be notified if your premium is adjusted, based on age and medical evidence. 13 Contact Us If you have any questions about Blue Choice® Personal Health Plans or what these benefits mean for you and your family contact your local insurance broker or call us toll-free at 1-800-USEBLUE® (873.2583) within Saskatchewan 1.800.667.6853 within Canada or visit www.sk.bluecross.ca Saskatoon Office Regina Office 516 2nd Avenue North 100 -1870 Albert Street PO Box 4030 Regina SK Saskatoon SK S4P 4B7 S7K 3T2 Phone 306.244.1192 Phone 306.525.5025 Fax 306.652.5751 Fax 306.525.2124 Our business hours are 8:30am to 5:00pm w eekdays. ® Saskatchewan Blue Cross, Blue Cross, Blue Cross Life Insurance Company of Canada, Blue Choice and 1-800-USEBLUE are registered trade-marks of the Canadian Association of Blue Cross Plans, used under licence by Medical Services Incorporated, an independent licensee. MSI 16 - 20M - 01/15