The benefits described in this section apply to both the eligible member and their eligible dependents. Following a description of the benefits covered, you will find a description of how and when to file claims for these benefits.

Extended Health Care

Effective February 1, 2016, Lifetime Maximum Benefit increase from $250,000 per individual to $1,000,000 for active members under age 65.

For active & Retiree members 65 & over, Lifetime Maximum Benefit remains at $250,000 per individual.

Lifetime Maximum

The Lifetime Maximum is the maximum amount this Trust Fund will allow any one individual for Extended Health Care benefits in their lifetime.

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

• services and supplies to the extent benefits can be obtained for them under a provincial plan by fulfilling the requirements of that plan, and
• 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 Department that will inform you what benefits, if any, are available under the Trust Fund.

Extension of Benefits in the Event of Your Death

If you die while your dependents are insured for Extended Health Care Benefits under this Trust Fund, their Health Care benefits will continue to the earlier of:

1. The date they cease to qualify as insurable dependents; or
2. 2 years after your death.

If your child is born after your death, the child is considered an insurable dependent.

Any extended benefits payable are subject to the provisions and limitations of the Trust Fund.

Covered Expenses

This insurance applies to expenses you are required to pay for the treatment of pregnancies and non-occupational accidents and sicknesses. The charges will only be considered eligible expenses provided the charges are Reasonable and Customary. 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. The insurance will pay the following covered expenses incurred by you or an eligible dependent up to the limits described in this website.

Reasonable & Customary

Means the amount usually charged for treatment, services or supplies to provide an appropriate level of care given the severity of the condition being treated, in the geographical location where the treatment, services or supplies are being provided.