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Desjardins Financial Security
SUMMARY OF
BENEFITS - SOLO HealthCare
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Health Plus (Basic Plan)
►
Health Plus (Enhanced Plan)
Optional
Benefits (can be
purchased with any Health Plus plans):
►
Hospitalization (Basic and Enhanced)
►
Prescription Drugs (Basic and Enhanced)
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Dental Benefits (Basic and Enhanced)
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SOLO Health Plus plans
|
Benefits |
Health Plus (Basic Plan) |
Health Plus (Enhanced Plan) |
|
Medical & Paramedical Services
|
Combined Maximum:
$250,000 for the life of the contract |
Combined Maximum:
$350,000 for the life of the contract |
|
Chiropractor, Registered Massage Therapist, Acupuncturist |
$20 maximum
per visit, and up to a $400 maximum per person per year
for all these services combined |
80%
co-insurance and
$750 per year
per person for all these services combined |
|
Homeopath, Naturopath, Osteopath, Orthotherapist, Podiatrist, Chiropodist |
$20 maximum
per visit, up to a $400 per year per insured person per
specialty |
|
Physiotherapist |
$25 maximum
per visit, up to a $250 per year per insured person |
|
Speech
Therapist, Hearing Therapist |
$40 maximum
per visit, up to a $400 per year per insured person for
all these services combined |
80%
co-insurance and
$400 per year
per person for all these services combined |
|
Psychologist, Physiatrist, Guidance
Counselor, Family and Couple Therapist, Social Worker |
$80 maximum
for the first visit and $65 for subsequent visits, up to a $400 per year, per insured person for
all these services combined |
80%
co-insurance and
$400 per year
per person for all these services combined
|
|
Accidental Dental
|
$1,000
maximum per accident per insured person |
$2,000
maximum per accident per insured person |
|
Ambulance Services |
$1,000 per
year, per insured person |
$2,000 per
year per insured person |
|
Durable Medical
Equipment and Orthopedic Devices |
$1,000 per
year, per insured person for all these services combined |
$2,500
per year, per insured person for all these services
combined |
|
Prostheses
and Orthopedic appliances |
$500 per year, per insured person for all these
services combined |
$1,000 per year, per insured person for all these
services combined |
|
Orthopedic Shoes and Foot
Orthotics |
$200 per year
per insured person |
$200 per year
per insured person |
|
Hearing Aids
(excluding batteries) |
$300 per 36
months, per insured person |
$500 per 36
months, per insured person |
|
Home Nursing Care, Occupational Therapy
|
$2,500 per
year per insured person |
$5,000 per
year per insured person |
|
Lab tests: Blood tests
(including PSA), Urinalyses,
Throat swabs, X-ray (including Pet scans), Ultra-sound, MRI, CT scans |
$200 per
year per insured person for all these services combined |
$500 per
year, per insured person for all these services combined |
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Travel Insurance
|
30 days
of trip,
$5,000,000; per insured person,
90 days per year. |
30 days
of trip,
$5,000,000; per insured person,
90 days per year. |
Vision Care
|
$100 for
glasses, lenses, laser eye surgery and $50 for
consultation with an optometrist every 2
years per insured person |
$100 for
glasses, lenses, laser eye surgery and $50 for
consultation with an optometrist every 2
years per insured person |
NOTE: This summary
explains some of the key coverage details of SOLO Healthcare. The
policy contract contains important information concerning details,
terms, provisions and specific limitations.
Term "year" is every 12 consecutive
months following the effective date of the policy
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Hospitalization
(can be purchased with any SOLO
Health Plus plans)
|
Basic Plan |
Max benefit per person |
|
Semi-Private or
Private Room |
100% coverage of
a cost of a semi-private room, up to $150 per day,
No limit on
number of days |
|
Cash benefit as
of the 4th day of hospitalization if a private or
semi-private room is not available |
$25 per day,
30-day maximum |
|
Enhanced
Plan |
Max benefit per person |
|
Semi-Private or
Private Room |
100% coverage of
a cost of a semi-private room, up to $200 per day,
No limit on
number of days |
|
Cash benefit as
of the 4th day of hospitalization if a private or
semi-private room is not available |
$50 per day,
60-day maximum |
NOTE: This
Hospitalization summary explains some of the key coverage details of Solo
Healthcare. The policy contract contains important information
concerning details, terms, provisions and specific limitations.
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Prescription Drugs
(can
be purchased with any
SOLO Health Plus plans)
|
Basic Plan |
Reimbursement percentage |
Max benefit per person per year |
|
Eligible prescription drugs
are generic or original brand name drugs that can only be
obtained by prescription.
Reimbursement is
based on the lowest-cost generic equivalent, if available |
70 % reimbursement for
first $4,285 of eligible prescribed medications |
$3,000
of eligible prescribed
medication
|
|
Enhanced
Plan |
Reimbursement percentage |
Max benefit per person per year |
|
Eligible prescription drugs
are generic or original brand name drugs available only
by prescription, including contraceptives (oral
contraceptives, patches, injections and Mirena
intra-uterine device)
Reimbursement is
based on the lowest-cost generic equivalent, if available |
70 % reimbursement for
first $4,285 of eligible prescribed medications and 90%
thereafter |
No limit |
|
Reimbursement is
made with a payment card |
NOTE: This Prescription
Drugs
Benefit summary explains some of the key coverage details of Solo
Healthcare. The policy contract contains important information
concerning details, terms, provisions and specific limitations.
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Dental
Benefit
(can be purchased with any
SOLO Health Plus plans)
|
Dental Benefit (Basic
Plan) |
|
1) Preventive Care |
Period |
Reimbursement percentage |
Max benefit per person per year |
|
Complete oral
examination,
Complete set
of radiograph and panoramic radiograph |
Once every 36
months |
80% |
$700 for all
these services combined |
|
Recall
examination,
Cleaning
(scaling and polishing),
Topical
application of fluoride ( for dependents age 15 and
younger) |
Once every 9
months |
|
2) Basic Care |
Reimbursement percentage |
|
Metal
Fillings (Amalgam restorations),
Non-metallic
fillings (Composite resin restorations),
Periodontal
curettage and root planning (deep scaling under the
gum),
Extractions
of erupted teeth (uncomplicated),
Extractions
of retained roots,
Emergency
care out of Canada |
50% |
|
Reimbursement is
made with a payment card |
|
Dental Benefit (Enhanced
Plan) |
|
1) Preventive Care |
Period |
Reimbursement percentage |
Max benefit per person per year |
|
Complete oral
examination,
Complete set
of radiograph and panoramic radiograph |
Once every 24
months |
100% |
• $750 for
the first year
• $750 for
the second year
• $1,000 as
of the third year |
|
Recall
examination,
Cleaning
(scaling and polishing,
Topical
application of fluoride ( for dependents age 15 and
younger) |
Once every 6
months |
|
2) Basic Care |
Reimbursement percentage |
|
Metal
Fillings (Amalgam restorations),
Non-metallic
fillings (Composite resin restorations),
Periodontal
curettage and root planning (deep scaling under the
gum),
Extractions
of erupted teeth (uncomplicated),
Extractions
of retained roots,
Emergency
care out of Canada |
60% |
|
3) Major Care |
Reimbursement percentage |
Max benefit per person per year |
|
Root canal
treatment,
Gingival
graft,
Appliance (occlusal
guard for bruxism (grinding of the teeth),
Extractions
of erupted teeth (with complication),
Extraction of
unerupted teeth (inside gum, such as wisdom teeth),
Removable
prosthodontics.
Fixed
prosthodontics (bridges)',
Recovery,
veneer, inlays and crowns (including CEREC technology)
|
60% |
As of the 3rd
year,
$500 per
year |
|
4) Orthodontics Care |
Reimbursement percentage |
Max benefit per person |
|
Complete
orthodontics treatment |
60% |
As of the 3rd
year,
$1,000 for contract duration |
|
Reimbursement is
made with a payment card |
NOTE: This Dental Care
Benefit summary explains some of the key coverage details of Solo
Healthcare. The policy contract contains important information
concerning details, terms, provisions and specific limitations.
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