"Small Town" Group Health Insurance Plan


Eligibility

All permanent full-time and part-time employees (minimum 15 hours per week) as well as elected officials are eligible for coverage.  The waiting period for new employees is 3 months of continuous employment.

All eligible employees must participate. If coverage is extended to elected officials, all Councillors must participate. Health and/or dental coverage may be waived if provided by another plan.

Evidence of insurability will be required for Towns with less than 4 employees.

Life Insurance

Amount of coverage Flat $50,000

Accidental Death and Dismemberment Insurance

Amount of coverage Flat $50,000

Optional Life Insurance

Amount of coverage As selected by the employee units of $10,000 to a maximum of $200,000

Proof of good health is required on all amounts of optional coverage. (Not waived for open enrolment period.)

Dependent Life Insurance

Dependent Life Spouse $5,000
Child $2,500

Supplementary Health Care

Deductible None
Lifetime maximum Unlimited
Eligible expenses: Reimbursement level
In-province hospital 100% semi-private hospital room
Prescription drugs 80% (20% co-pay with drug card)

Coverage is provided for drugs and supplies prescribed in writing by a doctor or dentist and obtained from a pharmacist:

  • Medication listed in the Federal or Provincial Drug   Schedules with a  DIN that requires a prescription.
  • Injectable drugs and vitamins, insulin and allergy extracts with a DIN.
  • Preparations and compounds of which at least one ingredient is an eligible drug under this benefit.
  • Diabetic supplies.

Medical services and equipment – 80%

  • Out-of-hospital private duty nurse – maximum $5,000 per person per benefit year
  • Hearing aids – maximum $300 per person, over 5 benefit years
  • Ground ambulance to and from the hospital – if medically necessary (air ambulance is also covered where medically necessary)
  • Custom-made orthopaedic shoes prescribed by a doctor – maximum of $500 per person per year
  • Custom made orthotic inserts when prescribed up to a maximum of $350 per benefit year
  • Breast prostheses following surgery – maximum $200 per year
  • Glucometers prescribed by a diabetologist – lifetime maximum of $700
  • Accidental dental – treatment rendered within 6 months of the accident
  • Equipment rented (or purchased when necessary), casts, splints, trusses, braces or crutches
  • Artificial limbs and eyes, excluding myoelectric appliances
  • Ophthalmologist or optometrist – maximum $50 per person over 2 benefit years
  • Paramedical services: 100% – maximum of $250 per person per benefit year for each specialty, including:  psychologist, social worker, massage therapist, speech therapist, physiotherapist, naturopath, acupuncturist, osteopath, chiropractor, podiatrist or chiropodist, including a maximum of one x-ray examination per specialty each benefit year. (Massage Therapists, psychologist or social workers require a doctor’s referral.)

Vision care

Contact lenses, eyeglasses or laser eye correction surgery 100% – maximum of $100 in any 12 month period for a person under age 18 or in any 24 month period for any other person

Dental Care


Deductible None
Reimbursement level 80% of Preventive and Basic Dental Procedures
Benefit year maximum $1,000 per person
Fee guide The current dental fee guide for general practitioners

Preventive dental procedures:

  • Oral examinations; recall frequency – every 9 months
  • X-rays
  • Tests and lab examinations
  • Polishing (cleaning of teeth), – 1 unit of 15 minutes every 9 months
  • Scaling and root planing (tartar removal) – 10 units of 15 minutes in any 12 month period
  • Topical fluoride treatment – once every 9 months for children under 19
  • Oral hygiene instruction – 1 unit of 15 minutes every 36 months
  • Space maintainers and maintenance after removal of primary tooth
  • Caries, trauma and pain control (sedative fillings).
  • Basic dental procedures
  • Fillings – white (front teeth only) and silver.
  • Prefabricated metal or plastic restorations – replacements separated by 36 months.
  • Pit and fissure sealants on permanent molar tooth
  • Endodontics (root canal therapy) – 1 standard treatment per tooth every 5 years.
  • Periodontal surgery (treatment of bone and gum disease) – once every 12 months on same surgical site.
  • Oral surgery.
  • Related surgical services – anaesthesia, conscious sedation, therapeutic injections.
  • Denture repairs – including 6 month follow-up care.
  • Dentures relining or rebasing – 1 reline or rebase every 12 month period. Includes 6 month follow-up care.

Transportation Expense

If an employee or a dependent requires necessary medical services, including x-rays and examinations, which are not readily available in their area, and they must travel more than 200 kilometres round trip to receive such services, the plan will pay for transportation expenses to the nearest hospital or specialist.  (Certain conditions apply – see Travel Expense Coverage).

If you need more information, please contact us.