HomeMy WebLinkAbout00 083 GreenShield Contr Amend
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THE CORPORATION OF THE MUNICIPALITY OF KINCARDINE
BY-LAW
NO. 2000 - 83
BEING A BY-LAW TO ACCEPT A CONTRACT AMENDMENT FOR
EMPLOYEE HEALTH BENEFITS
WHEREAS the Council for The Corporation of the Municipality of Kincardine
deems it expedient to accept a contract amendment for employee health benefits.
NOW THEREFORE the Council for The Corporation of the Municipality of
Kincardine ENACTS as follows:
1. That the contract amendment of Green Shield Canada, as the terms
outlined in the attached Schedule 'A' be hereby accepted.
2. That the Deputy Mayor and Deputy CAO/Deputy Clerk be hereby
authorized to sign, on behalf of the Council for The Corporation of the
Municipality of Kincardine any contracts and other documents required to
authorize such work to commence, and to affix the corporate seal of The
Municipality of Kincardine.
3. This by-law shall come into full force and effective as of April 1 , 2000.
4. This by-law may be cited as the "Green Shield Benefit Amendment By-
law".
READ a FIRST, SECOND, and a THIRD time and DEEMED TO BE PASSED this
14th day of June, 2000.
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Mayor
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Gìèen. Shield
CANADA
Where quality is more than a claim
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CONTRACT AMENDMENT
COMPANY NAME:
MUNICIPALITY OF
GROUP NO.:
6928
EFFEC~DATE
BENEFIT PLAN CHANGES
The eligibility date for all benefits for new employees will be the first day
Employment (no waiting period).
;:~ ~=:e:!(to~=~mum has been changed from $500.00
Acupuncture Services at 100% co-insurance with a maximum of $500.00
per calendar year has been added to your Paramedical Services Benefit.
Private Duty Nursing maximum has been changed from $25,000.00
every 3 rolling calendar years to $25,000.00 per calendar year.
Accommodation Benefit has been upgraded to include coverage for
private room in a public general hospital at 100% co-insurance.
Hearing Aids Benefit has been changed from "reimbursement for standard
hearing aids, repairs or replacement parts up to a maximum of $400.00 once
every 3 years" to "reimbursement for the acquisition cost of the stanliard hearing
aid by the provider, plus the pre-cletermined dispensing fee, once every 3 years". April 1, 2000
The Vision Benefit maxif'num ha&-beenUpgraded to $200.00 every 24 months
(12 months for dependent children under age 18) for prescription eye glasses
and/or contact lenses. April 1, 2000
ApriI1,2000
April 1 , 2000
April 1 , 2000
April 1 , 2000
April 1 , 2000
The dental recall examinations have been changed from once every 9
once every 6 months. April 1 , 2000
The co-insurance for the Major Restorative Services has been upgraded to 80%. April 1 , 2000
Adjustments to the monthly premium rates will be concurrent with May 1, 2000 renewal.
This amendment to the Benefit Plan Group Contract, as of the effective dale, hereby forms part of the
completed contract between Green Shield Canada and the above named company. Any change to the
terms or conditions, benefit levels or plan designs are described herein and overrides that portion of the
contract previously issued.
.../2
HPLTD
Gteen. Shield
Where quality is more than a claim
CANADA
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HP LID
GREEN SHIELD CANADA
G...-
uthorized
ADriI 26. 2000
Date
ADriI26. 2000
Date
MUNICIPALITY OF KINCARDINE
~?- '--
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June 14, 2000
Date
OUTLINE OF BENEFITS
Municipality of Kincardine
Group No. 6928
. Services shown below will be eligible if they ani usual, reasonable and customary, and aN medically necessary for the
. .. treatment of an illness or injury. Please contact your benefit representative, broker/consultant, or the Green Shield Customer
Service Centre at 1-888-711-1119 to determine benefit eligibility and coverage details.
HEAL TH SERVICES
· Your overall Health deductible is nil
· Your co'¡nsurance for Health Ser.ñces is 100%
DRUG
· A co-payment of $2.00 applies to each prescription
· The Ontario Drug Benefit co-payldeductible for seniors is not a benefit
Benefits include legally prescribed drugs, needles and ayringes (Including emoking cesaation products). Serums and
vitamins are ineligible unless injected.
EMERGENCY TRANSPORTATION
· Ambulance Tranaportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment.
ACCIDENTAL DENTAL BENEFITS
Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following
the accident.
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ACCOMMODATION
SEMI-PRIVATE
. Seml-Private Room In a public general hospital
PRIVATE
. Private Room in a public general hospital
AUDIO
· Reimbursement will be made for the acquisition cost of the standard hearing aid by the provider, plus the PÆ-
determined dispensing fee, once every 3 years
· Balleries are not eligible
MEDICAL ITEMS
Prosthetic Appliances and Durable Medical equipment as well as replacements, repairs, fillings and adjustments of such
devices. Contact the Customer Service Centre to verify eligibility of a particular benefit.
PARAME~CALSER~CES
· Phyelotheraplst
· Chiropractor, Podlatriat, Chiropodist, 0a1leo l61h, Acupuncturist (physiclan/aurgeon or anyone licensed through the
Acupunctunl Foundation of Canacla to perform acupunctunll, Naturopath, Speech Therapist/Plo.....logist, RegisI8nld
Massage Therapist (medical referral required) or Clinical Psychologist up to a $500.00 maximum per practitioner per
calendar year
· PrIvate Duty Nursing Benefits cany a maximum of $25,000.00 per calendar year for the services of a regl8lenld nurse
(R.N.), registered nursing aasistant (R.N.A.), a practical nursing aaaistant (P.N.A.) or a licensed practical nurse In the
home on a full or part ahllt basis.
e
~SION
· Your VISion Benefit carries a maximum of $200.00 every 24 months (12 months for dependant chlldnln aged 18 and
under) for prescription eye glaases and/or contact lenses or $250.00 every 24 months (12 months for dependant
childnln aged 18 and under) for medically necessary contact lenses provided they aN dispeneed by an Optometrist, an
Optician or an Ophthalmologist.
Vision benefits do not Include eye examinations.
DENTAL
·
·
Your deductible is nil
Your overall Dental maximum ie $1,500.00 aMusl1y excluding Orthodontic Benefits
Your lifetime maximum for Orthodontic Benelit& Is $1,500.00
·
·
Your co-insurance is 100% for Basic ServIces and for Comprehensive Basic Services, 80% for Major Restorative_.
Services and 50% for Orthodontic Services
BasIc Services cover: recalls once every 8 months, other exams and full mouth x-rays every 3 years
Comprahenslve Basic cover dentufe felines once every 3 years
Major Restorative Services cover dentures, crowns and bridges once every 5 years.
Applicable lab, drug and other expenses are eligible to a maximum of 40% of the professional fee.
Your eligible claims are reimbursed at the level stated above and In accordance with the current minus 1 (one) year
Ontario Dental Association Fee Guide for General Practitioners
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·
·
·
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BASIC SERVICES
· Recalls include exams, bitewing X-rays, cleanings and fluoride treatments.
· Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays.
· Basic restorations including fillings and inlays.
· Extractions and surgical services including general anaesthetics and intravenous sedation.
COMPREHENSIVE BASIC SERVICES
· Endodontic treatment including root canal therapy.
· Periodontal treatment including scaling and/or root planing.
· Standard denture services including relining and rebasing of dentures plus denture adjustments after 6 months from
installation
MAJOR RESTORATIVE SERVICES
· Dentures, complete, immediate and partial.
· Crown restorations or onlays on natural teeth.
· Repair or recementing of crowns, onlays and bridgework on natural teeth. .
· Bridges, including ponties, abutment retainers/crowns on natural teeth based on the date of the toothJteeth extractions,
ORTHODONTIC SERVICES
· Orthodontic services require a treatment plan to be submitted by your DentistlOrthodontist for prior approval of coverage
eligibility.
TRA VEL BENEFITS
· Your maximum Is $1,000,000.00 per calender year for Emergency Services; and $50,000.00 per calendar year for
Referral Services.
· Hospital and medical services are eligible only if your provincial goverrvnent health plan provides payment toward the
cost of the eervices received.
Green Shield must be contacted by phone within 48 hours of commencement of treatment Green Shield, through
consultation with the Assistance Medical Team, reserves the right to repatriate the patient for trealment upon medical verification of
the tolerance for trevel. Cany your Green Shield identification card with you when !ravening.
Hospital services and accommodstion up to a stendsrd ward rate in a public general hospitel.
Medical/surgicsl services
Land ambulance to the nearest qualified medical facility.
Emergency Air ambulance to your province of residence (including a medicel sttendant when necessary)
Services of s Registered Private Nurse up to a maximum of $5,000.00
Disgnostic laboratory tests and x.....ys.
Drugs, serums and injectibles which require a prescription by law.
Medical appliances including cests, crutches, canes, slings, splints and/or the temporary rental of a wheelchair a
Treatment by a dentist due to a direct accidental blow to the mouth up to a maximum of $2,000.00 for treatments within 90 .
days of the accident.
Coming Home:
For one way economy aiñare, plus a stretcher, to retum you to your province of residence.
For a medical attendant who is not your relative to accompany you home.
For returning your vehicle, up to a maximum of $1,000.00.
Meals and accommodstlon up to $1,500.00 ($150.00 par day for 10 days) for commercisl sccommodation and mesls
when the trip is delayed or interrupted due to sn illness or accident to a travelling companion.
Transportstion to the bedside for one FOUnd trip economy airfare, for one spouse, parent, child, brother or sister, up to
$150.00 per day for five dsys to:
be with a covered person confined in hospital for more than 7days
identify deceased prior to release of the body.
Return of Vehicle if your private vehicle is stolen or rendered inoperable due to an accident, and for one way economy
airfare home.
Return of deceased up to a maximum of $5,000.00 for preparation (including cremation) and homeward transportation of a
deceased covered person.
. GREEN SHIELD CANADA TRAVEL ASSISTANCE SERVICE
Available 24 hours per day, 7 days per week through Green Shield's international medical service organization. Some services
include:
Verification of insurance coverage for entry and admissions into hospitals and other medical care providers
Arrangement of emergency medical transportation and evacuation
Knowledgeable legal referral assistance
Assistance in replacing lost or stolen travel documents
Emergency and payment assistance for major health expenses over $200.00 Canadian.
HOW GREEN SHIELD CANADA'S TRAVEL ASSISTANCE SERVICE WORKS
As soon as you have a medical emergency:
1. The patient!!!!!!! contact Green Shield within 48 hours of commencement of treatment by dialling 1-800-936-6226 within
Canada or USA or call collect 0519-742-3556. Failure to call within 48 hours or refusal to be repatliated may resutt in
benefits not being covered beyond 48 hours.
2. Quote your group number and patient number, found on your Green Shield Identification Card, and explain your medical
emergency. You must also be able to provide your Provincial Health Insurance Plan number.
3. Our physicians will follow your progress to ensure that you are receiving the best available medical treatment. These
physicians also keep in constant communication with your family physician and your family, depending on the severity of
your condition.
. Please Note:
. As we are not able to guarantee assistance services in areas of political or civil unrest, please contact Green Shield for pre-
travel or claims inquiries.
. Referral services are only eligible if the required medical treatment is not readily available in your province of residence.
.You must receive pre-authorization from your provincial govemment health plan and Green Shield prior to the
commencement of any referral treatment. Your Provincial Govemment Health Plan may cover this referral benefit
entirely. You must provide Green Shield with a letter from your attending physician stating the reason for the referral,
and a letter from your provincial govemment health plan outlining their liability. Failure to comply in obtaining pre-
authorization may result in non-payment.
Travel benefits do not Include:
1. Treatment or service required for ongoing care, rest cures, health spas, elective surgery, check-ups or travel for heatth
purposes, even if the tlip is on the recommendation of a physician.
2. Hospital and medical care for childbirth occurring within 8 weeks of the expected delivery date from the date of departure, or
deliberate tennination of pregnancy.
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GENERAL INFORMA TlON
UMITED BENEFIT CLAUSE
Green Shield will detennine the amount of benefits payable, giving consideration to limited procedures, services, or courses of
treatment that may be perfonned to accomplish the desired result. The attending physician/dentist and the patient have the option
of which procedure to use, atthough payment for the procedure may be based on the "limited treatment" principle. The Umited
Benefit Clause is a financial limitation and not intended as a comment regarding any treatment reconvnended or performed by a
physician/dentist.
PREDETERMINATION
If the cost of any proposed treatment is expecIed to exceed $300.00, submit to Green Shield a detailed treatment plan from your
provider before your treatment begins. If a ........i¡.o1iu.1 of the procedures to be perfonned and an estinate of the charges are not
submlltsd In advance, Green Shield reserves the right to make a detennination of benefits payable, taking into account attemate
procedures, services or course of treatment, based on accepted standards of medicaVdental practice.
GENERAL OVERALL EXCLUSIONS
Eligible Services do not include and reimbursement will not be made when we are aware of or have been apprised of:
1. Services or supplies received as a resutt of disease, illness or injury due to any of:
inlentionaUy seIf~nflicted injury while sane or insane
an act of war, declared or undeclared
participation in a rtot or civil commotion
committing a crtminal offence
2. Failure to keep a scheduled appointment with a licensed medical/dental praclilioner.
3. Services or supplies which are cosmetic in nature.
.
4. The completion of any daim forms and/or insurance reports.
5. Services or supplies which do not meel accepled standards of medicaVdentaVophthalmic practice, induding charges for
services or supplies which are expertmental in nature.
6. Services or supplies normally paid through any provincial govemment health plan, Workers' Compensation Board, the
Assistive Devices Program or any other Government Agency, or which would have been payable under such a plan had
proper application for coverage been made, or had proper and timelydaims submission been made.
7. Services or supplies from any govemmental agency which are obtained without cost by compliance with laws or regulations
enacted by a federal, provincial, municipal or other governmental body.
8. Services or supplies which are not recommended or approved by the attending physician/dentist.
9. Services or supplies that you are not obligated to pay for or for which no charge would be made in the absence of benefi1
coverage.
10. Services or supplies which are legally prohibited by the govemment from coverage.
11. The replacement of lost, missing or stolen items, or items which are damaged due to negligence.
12. Any eligible service that relates to treatment of injurtes arising out of a motor vehide accident.
CO-ORDINATION OF BENEFITS (COB) .
Where you or your dependents have coverage with more than one carrier, daims shall be co-ordinated so that reimbursement from
all coverages shall not exceed 100% of the actual daim. Ask for our COB brochura for infonnation on how your family can receive . .
this service.
SUBROGATION
Green Shield retains the rtght to subrogation if benefits have or should have been paid or provided by a third party. In cases of third
party liability, you must advise your lawyer of these lights.
GROUP CONVERSION PACKAGE
Any employee who will be terminating employment where there is an active Green Shield group benefits program in force and
who will lose their group benefits may enroll in the Green Shield Group Conversion Program.
Dependent children who are no longer eligible for benefits under their parents Green Shield group benefits program may also
enroll in the Green Shield Group Conversion Program.
Call (416) 601-0429 in the Toronto area or tol~free at 1 800667-0429 for an information package. You must apply within 60
days of termination of your benefits from your Green Shield group program.
.
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