ENCON

Plan I – Semi-Private Hospital

$5,000 per calendar year;

Prescription Drugs and Medicine – pays up to 90% of the cost of drugs and medicine (including dispensing fees up to $7 per prescription) with a written prescription from a physician or dentist and dispensed by licensed pharmacist. The plan uses the ManuScript® Drug Card system, which enables pharmacists to bill Manulife Financial directly. The benefit covers generic drugs or, in cases where there is no generic equivalent, brand name drugs.

Click here for an explanation of benefits co-ordination with the Ontario Drug Benefit Plan.

$1,700 per calendar year

Convalescent Care – pays for care in an eligible convalescent facility, when referred by a doctor for a specified period following day surgery or a hospital stay due to sickness or accident.

$30 per day up to 120 days, per accident or sickness

Nursing Care – fees for private duty in-home registered nursing care when recommended by a physician.

$2,500 per calendar year

Ambulance Service – pays the cost of professional ground or air ambulance transportation to a hospital

Unlimited ground transport
$4,000 air ambulance per calendar year

Medical Supplies and Prostheses – after reimbursement by any government plan, the plan will cover:

• ostomy and diabetic supplies,
• glucometer (lifetime maximum of one up to $400),
• mastectomy brassieres (two per calendar year),
• wigs (lifetime maximum of $300),
• prescribed orthotic appliances ($500 per calendar year),
• oxygen,
• diagnostic laboratory services, radiology treatments (x-rays and radium therapy),
• artificial limbs or eyes,
• trusses,
• wheelchairs (lifetime maximum of $2,500),
• hospital beds,
• iron lungs,
• braces, canes, walkers, crutches,
• surgical stockings (four pairs per calendar year),
• Continuous Positive Airway Pressure (CPAP) devices and supplies.

$5,000 per calendar year

Diagnostic Services – pays the cost of one Prostate Specific Antigen (PSA) test per calendar year.

one per calendar year

Accidental Dental – within one year of an accident, the plan will pay the services of a dental surgeon for treatment of a fractured jaw or charges for repair or replacement of natural teeth due to an accidental external blow to the head.

$2,000 per calendar year

Orthopedic Shoes – pays for one pair of orthopaedic shoes per calendar year.

$200 per calendar year

Vision Care – pays for prescription lenses and frames, contact lenses and laser eye surgery.

Supplementary/additional coverage is also included for expenses incurred (in excess of reimbursement by any government health care plan) for one optometrist visit within any consecutive 24-month period.

$225 per consecutive 24-month period

Hearing Aids – pays for the purchase or repair of prescribed hearing aids when initially required, or if required due to a change in prescription.

$500 per consecutive 36-month period

Psychologist – pays the fees of a clinical psychologist for treatment/therapy recommended by a physician up to $20 per half-hour for the initial assessment, and up to $20 per subsequent visit.

$400 per calendar year

Paramedical Services – pays for fees incurred for visits to licensed practitioners. There is a $35 maximum per visit to a: physiotherapist, chiropractor, chiropodist, podiatrist, speech therapist, osteopath, naturopath, acupuncturist and masseur (if the treatments are recommended by a physician). For chiropractors, the plan also pays a $15 maximum for one x-ray per calendar year.

All paramedical fees are paid after you reach your provincial health plan limit.

$400 per specialty per calendar year

Plan I Semi-Private Hospital

$5,000

Plan II Extended Health Care

various coverage maximums

Dental Care – pays benefits based on the current year’s Dental Association Fee Guide for your province of residence.

Basic Dental Care – pays 80% of fees charged for the following services:

• dental x-rays
• minor restorative fillings
• preventative care, which includes routine examinations and cleanings to a maximum of one treatment every six months
• minor surgical benefits (includes extractions and oral surgical procedures)
• periodontics (treatment of gums and mouth tissues)
• endodontics (root canal therapy)
• denture work, which includes repairs, rebasing and relining
• consultation required by the attending dentist

Major Restorative Services – pays 50% of fees charged for the following services:

• inlays and crowns
• dentures and bridgework
• denture adjustments

$1,500 per calendar year (combined Basic and Major Restorative)

Predetermination: If covered dental charges of more than $300 are to be incurred during any six-month period, prior approval must be obtained from Manulife Financial.