CUPE Local 3261, Full-time and Part-time: Schedule of Benefits

Health Benefit Plan

This schedule describes the deductibles, co-pays and maximums that may be applicable if you are included in this Employee Group.

Complete benefit details are provided in the Description of Health Benefits section of this website. Be sure to read these pages carefully. They show the conditions, limitations and exclusions that may apply to the benefits. All dollar maximums are based on paid Canadian dollars. You are covered for only those specific benefits for which you are enrolled.

This group benefit plan is intended to supplement your provincial health insurance plan. The benefits shown below will be eligible, if they are medically necessary for the treatment of an illness or injury, and reimbursement will be limited to reasonable and customary charges, in addition to specific limitations stated in the Schedule of Benefits below.

Deductible
Hospital Accommodation, Hearing Care, and Vision Nil
All Other Health Benefits $25 per family every 12 months
Overall Maximum
Unlimited
Your Co-Pay
Prescription Drugs:

  • Insulin, and injectable serums and vitamins
  • All other covered drugs

Continuous Glucose Monitor (CGM) Supplies:

0%

All dispensing fee amounts in excess of $6.50 per prescription or refill

10%

All Other Health Benefits 0%

 

Your plan covers: Maximum plan pays:
Prescription Drugs – Pay Direct Drug Card
Insulin, and injectable serums and vitamins Unlimited
Erectile dysfunction drugs 30 tablets every 3 months
All other covered drugs Unlimited
Hospital Accommodation
Public general hospital or convalescent or rehabilitation hospital – semi-private room or private room Reasonable and customary charges
Public chronic hospital – semi-private room $3 per day to a maximum of 120 days per calendar year
Hearing Care
  • $500 for one left hearing aid and $500 for one right hearing aid every 36 months
Medical Items and Services
Footwear

  • custom-made foot orthotics
  • custom-made boots or shoes, and adjustments to custom-made boots or shoes or stock item footwear
 

2 pairs per calendar year up to a maximum of $400 per pair; and reasonable and customary charges

Blood glucose monitor Once every 60 months
Insulin pump supplies $1,200 every 12 months
Continuous Glucose Monitor (CGM):

  • Receiver
  • Transmitter
  • Supplies
 

$600 every 36 months
$1,000 every 12 months
$2,000 every 12 months

Bra (mastectomy) 6 per calendar year
Cataract eyewear Once per lifetime
Compression stockings 6 pairs per calendar year
Wigs Once per lifetime
Viscosupplementation therapy 8 treatments per lifetime
Other items and services – see the Description of Health Benefits section for details Reasonable and customary charges
Emergency Transportation
Reasonable and customary charges
Private Duty Nursing in the Home
Reasonable and customary charges
Paramedical Services
Chiropractor, Physiotherapist, Registered Massage Therapist, Naturopathy (ND designation), Homeopath, Acupuncture (Acupuncturist of Ontario Accreditation), Osteopaths and Occupational Therapy $800 per benefit year for all practitioners combined
Psychologist, Master of Social Work or Psychotherapist $2,000 per benefit year
Speech Therapist
(Physician (M.D.) prescription required if there are no benefits on file within the preceding 12 months)
Reasonable and customary charges
Accidental Dental
Reasonable and customary charges
Vision
  • Prescription eye glasses or contact lenses, or medically necessary contact lenses, or eye examinations
  • Optometric eye examinations
$400 every 24 months

$90 every 24 months

For a full description of the Health Benefit, refer to the Description of Health Benefits.

 

Travel Benefit Plan

This schedule describes the deductibles, co-pays and maximums that may be applicable if you are included in this Employee Group.

Complete benefit details are provided in the Description of Travel Benefits section of this website. Be sure to read these pages carefully. They show the conditions, limitations and exclusions that may apply to the benefits. All dollar maximums are based on paid Canadian dollars. You are covered for only those specific benefits for which you are enrolled.

This group benefit plan is intended to supplement your provincial health insurance plan. Hospital and medical services are eligible only if your provincial health insurance plan provides payment toward the cost of incurred services. The benefits shown below will be eligible, if they are medically necessary for the treatment of an illness or injury, and reimbursement will be limited to reasonable and customary charges, in addition to specific limitations stated in the Schedule of Benefits below.

Reimbursement of eligible benefits for emergency services will be made only if the services were required as a result of emergency illness or injury that occurred while you were vacationing or traveling for other than health reasons.

The patient must contact Green Shield Canada Travel Assistance within 48 hours of commencement of treatment. Failure to notify us within 48 hours may result in benefits being limited to only those expenses incurred within the first 48 hours of any and each treatment/incident or the plan maximum, whichever is the lesser of the two.

Deductible: Does not apply
Overall Maximum: Does not apply
Your Co-Pay: Does not apply

 

Your Plan Covers: Maximum Plan Pays:
Maximum Number of Days per Trip Equal to the number of days under Provincial plan or as long as comparable OHIP covered is in effect
Emergency Services $1,000,000 per covered person per calendar year
Referral Services $50,000 per covered person per calendar year

 

For a full description of the Travel Benefit, refer to the Description of Travel Benefits.

 

Dental Benefit Plan

This schedule describes the deductibles, co-pays and maximums that may be applicable if you are included in this Employee Group.

Complete benefit details are provided in the Description of Dental Benefits section of this website. Be sure to read these pages carefully. They show the conditions, limitations and exclusions that may apply to the benefits. All dollar maximums are based on paid Canadian dollars. You are covered for only those specific benefits for which you are enrolled.

Deductible: Nil
Fee Guide: The current Ontario Dental Association Fee Guide for General Practitioners

For independent Dental Hygienists, the lesser of, the current Ontario Dental Hygienists’ Association Fee Guide or Ontario Dental Association Fee Guide for General Practitioners

 

Your Plan Covers: Your Co-Pay Maximum Plan Pays:
Basic and Comprehensive Basic Services 0% Unlimited
Major Services 20% $1,800 per covered person per benefit year
Orthodontic Services 50% $2,650 per covered person per lifetime, for dependent children 24 years of age and under only

 

For a full description of the Dental Benefit, refer to the Description of Dental Benefits.