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Mar 21 2020

Manulife personal health insurance #Manulife #FlexCare #Health #Insurance: #Plan #- #Coverage #Details



Manulife personal health insurance

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Flexcare Health & Dental

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  • +1 800 474 4474

Manulife Flexcare ® Health Plan Details

This is not a contract. Actual terms and conditions are detailed in the policy issued upon application approval.

If you have questions please call us at 1-800-474-4474, or email us at inquiries@healthquotes.ca.

Table of Contents

General Information

Health Care Plans

  • Snapshot of Plans and Benefits (useful when comparing different plans)
  • DrugPlus ™ (Prescription Drug Plans with Core Benefits)
  • Basic
  • Enhanced
  • Core Benefits (Basic and Enhanced Plans)
  • DentalPlus ™ (Dental Care Plans with Core Benefits)
  • Basic
  • Enhanced
  • Core Benefits (Basic and Enhanced Plans)
  • ComboPlus ™ (Prescription Drug and Dental Care Plans with Core Benefits)
  • Starter
  • Core Benefits (Starter Plan)
  • Basic
  • Enhanced
  • Core Benefits (Basic and Enhanced Plans)

Stand-Alone and Add-On Benefits

  • Hospital (Basic) – available as Stand-Alone and Add-On
  • Hospital (Enhanced) – available as Stand-Alone and Add-On
  • Vision (Enhanced) – available as an Add-On to Basic or Enhanced Core Plans Only
  • Catastrophic Coverage – available as Stand-Alone and Add-On
  • Travel (8 days of additional coverage) – available as an Add-On to Basic or Enhanced Core Plans Only
  • Travel (21 days of additional coverage) – available as an Add-On to Basic or Enhanced Core Plans Only
  • Accidental Death and Dismemberment – available as an Add-On Only

Seniors’ Adjustments

General Information

  • You can choose either a Core Plan or you can choose one or more Stand-Alone packages
  • If you choose a Core Plan then you also have the option of increasing your coverage with one or more Add-On packages.
  • If the plan is “medically underwritten”, or “requires a medical questionnaire”, you must disclose any medical condition, injury or illness that occurred or existed on or before the date of your application, regardless of whether you went to see a doctor about the condition or were given a diagnosis, or whether or not you believe that it is important. The premium charged and/or benefits offered could be subject to adjustment or modification of coverage, or declined based on your or your family’s medical background. This will be determined after an evaluation of the information provided on the enclosed medical questionnaire.
  • Coverage is effective no earlier than the first day of the month following final approval of the application.
  • If you and/or your family’s medical history is such that a higher premium is required or that special conditions be applied to benefits (see Medically Underwritten), you will be notified in writing prior to your decision to accept the coverage. If at that time you decide not to proceed with the coverage, any initial payment will be returned and your application cancelled.
  • Full coverage is available for expectant mothers who qualify for a Flexcare Core plan and the additional Hospital Coverage benefit within the first 20 weeks of pregnancy (Maternity Hospital stay is limited to 2 days). Manulife cannot guarantee the availability of private or semi-private hospital accommodation.
  • Unused portions of benefits cannot be accumulated and added to coverage in future months or years.
  • All maximums are per person, and not per family, unless otherwise stated.
  • Newborns of parents who are enrolled in the FlexCare plan are automatically added to the same coverage if an application is made within 30 days of birth. If the application is after their 30th day, medical information will be required.
  • Although Core Benefits come with all FlexCare Plans there is a very slight variation in Core Benefits, depending on the type of FlexCare Plan you choose (e.g. DrugPlus Basic, DentalPlus Enhanced, etc.)

Health Care Plans

Vision (Basic), Chiropractor,
Chiropodist, Osteopath, Naturopath, Podiatrist,
Registered Massage Therapist, Acupuncturist, Psychologist,
Speech Pathologist/Therapist, Physiotherapist,
Psychotherapist,
HomeCare and Nursing,
Prosthetic Appliances,
Durable Medical Equipment, Accidental Dental, Ambulance,
Hearing Aid,
Emergency Travel Health Coverage, Accidental Death and Dismemberment, Survivor Benefits


Ongoing Maintenance
9 month recall

Total Benefits Payable:
Year 1:
50% of first $1,150.
Total payable per anniversary year: $575

Year 2+:
80% of first $400, 50% of next $860.
Total payable per aniversary year: $750

DentalPlus Basic and Enhanced have an escalating yearly maximum for Home Support, Durable Medical Supplies and Prosthetic Appliances

No medical questionnaire required


Ongoing Maintenance

6 month recall

Total Benefits Payable:
Year 1:
70% of first $1,200.
Total payable per anniversary year: $840

Year 2+:
100% of first $500, 60% of next $700)
Total payable per anniversary year: $920

Combined maximum of $1,250/3 year period for: Oral Surgery, Endodontics, Periodontics:
Year 1: 0%; Year2: 60%
Year 3+:80%

Major Restorative
First 2 Years: 0%, Subsequent Years: 60%

No medical questionnaire required

Generic Drug Plan
70% first $750, 90% next $4,972 per year

Total benefits payable per year $5,000

NOTE: for Saskatchewan, 70%
of 1st $1,150 per family per 6 months, 100% on further claims to max. of $5,000/calendar year

Full coverage of customary and reasonable dispensing fees

Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription

Name Brand Drug Plan
90% first $2,222, 100% next $8,000 per year

Total benefits payable per year $10,000

NOTE: for B.C and Saskatchewan, prescription drug benefits based on calendar year

Name brand or generic drugs, including birth control and fertility drugs

Full coverage of customary and reasonable dispensing fees

Exclusions: smoking cessation drugs, over-the-counter drugs, and drugs not requiring a prescription

DENTAL:
Ongoing Maintenance
– 9 month recall
– 70% of 1st $575.

PRESCRIPTION DRUGS:
Generic Drug Plan
– 70% of 1st $750: $525 maximum per year
– Dispensing Fee Cap is $6.50.

Escalating yearly maximum for Home Support, Durable Medical Supplies and Prosthetic Appliances

– Now comes with $150 of Vision basic for every two benefit years

No medical questionnaire required

DENTAL:
Ongoing Maintenance
– 9 month recall
– 80% of 1st $400, 50% of next $860 with total benefit payable $750 per year.

PRESCRIPTION DRUGS:
Ongoing Maintenance
– 70% of
first $750, 90% next $4,972:$5000 maximum per year

Residents of Saskatchevan
– 70% of
first $1,150 per family/6 mos, 100% on further claims to $5000 maximum

Medical questionnaire required

DENTAL:
Ongoing Maintenance
6 month recall
– 100% of first $500 of filling, cleanings, scalings, examinations, polishing and certain extractions.
– 60% of next $700
– Total maintenance benefits payable per year $920.

Oral Surgery, Endodontics, Periodontics
First 2 Years: 60%, to a maximum of $400.
3rd Year: 80%.
Max. payable first year is $400.

Major Restorative
(crowns, bridges and dentures, etc.)
First 2 Years: 0%, Subsequent Years: 60%.
Ongoing max. of $1,250/3 years.

PRESCRIPTION DRUGS:
Same as DrugPlus ™ Enhanced coverage

– TOTAL BENEFITS PAYABLE FIRST YEAR IS $1,320 –

Medical questionnaire required

No travel coverage available (ends at age 70)

AD&D decreases to $10,000

Vision is now included

Travel coverage not available (ends at age 70)

Travel coverage not available (ends at age 70)

Generic Drug Plan
100% first $750
90% next $4,722/year
of costs not covered by the provincial drug plan. $5,000 maximum.

Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
(All other provinces have adjustment)

Residents of Nova Scotia
Increases to 100% of first $380.

Travel coverage not available (ends at age 70)

Name Brand Drug Plan
100% first $750
90% next $10,278/year
of costs not covered by the provincial drug plan. $10,000 maximum.

Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
(All other provinces have adjustment)

Travel coverage not available (ends at age 70)

Prescription Drugs: Increases to 100% of first $750.

Residents of Nova Scotia
– Drugs increased to 100% of first $300.

Travel coverage not available (ends at age 70)

Generic Drug Plan
– 100% first $750
-90% next $4,722/year
of costs not covered by the provincial drug plan. $5,000 maximum.

Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
(All other provinces have adjustment)

Residents of Nova Scotia
– 100% of first $380

Travel coverage not available (ends at age 70)

Name Brand Drug Plan
100% first $750
90% next $10,278/year
of costs not covered by the provincial drug plan. $10,000 maximum.

Residents of New Brunswick, B.C., Quebec, Manitoba and Saskatchewan:
No seniors adjustment
All other provinces have adjustment)

Travel coverage not available (ends at age 70)

DrugPlus (Drug and Core Benefits)

You can choose either the Basic or Enhanced Plan, both come with Core Benefits

  • Medical questionnaire required
  • Generic drug plan (name brand allowed, but price paid will be deemed to be the generic equivalent).
  • Full coverage of reasonable and customary dispensing fees
  • Coverage Table*:
  • Total benefits payable per anniversary year*: $5,000
    * Saskatchewan: 70% on first $1,150 per family/6 mos, 100% on further claims to $5,000 maximum.
  • Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription.
  • Core Benefits are listed beneath the Enhanced Plan details.
  • Medical questionnaire required
  • Name brand or generic drugs, including birth control and fertility drugs.
  • Full coverage of reasonable and customary dispensing fees
  • Coverage Table*:
  • Total benefits payable per anniversary year*: $10,000
    * British Columbia and Saskatchewan: Prescription drug benefits based on calendar year.
  • Exclusions: smoking cessation drugs, over-the-counter drugs, and drugs not requiring a prescription.
  • $250 maximum per 2 consecutive benefit years to cover the cost towards prescription lenses, frames, contact lenses and laser eye surgery.
  • $70 maximum for Optometrist fees per 2 consecutive benefit years (payable only after Government Health Insurance Plan maximum has been reached, if applicable)
  • Eyeglasses are covered against breakage and scratches by a repair guarantee for a period of 2 benefit years. This warranty applies to lenses and frames purchased with the Vision benefit of FlexCare.
  • No deductible is charged to you if your eyeglasses can be repaired. If beyond repair, your glasses will be replaced and; a $50 deductible charged for eyeglasses originally purchased for up to $250; or a $75 deductible, if the original purchase price was $251 to $300; or a $100 deductible, if your eyeglasses originally cost $301 or more.

Extended Health Care (Basic)

  • $250,000 lifetime maximum.
  • Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist: – $25 max. per visit, 20 visit maximum per discipline per anniversary year (payable only after Government Health Insurance Plan maximums have been reached, if applicable).
  • Chiropractic X-ray: $35 maximum per anniversary year.
  • Psychologist and Psychotherapist – $80 max. first visit, $65 max. subsequent visits, 15 visit max. per anniversary year.
  • Physiotherapist: $250 max. per anniversary year.
  • HomeCare and Nursing, Prosthetic Appliances, Durable Medical Equipment:
    • $4,000 per category per year for under age 65
    • $4,500 per category per year for age 65-plus
    • NOTE: $225 max. per anniversary year for Orthotics, which is part of Durable Medical Equipment.
  • Speech Pathologist/Therapist: $65 max. first visit, $45 max. subsequent visits, 10 visit maximum per anniversary year.
  • Lifeline Personal Response Service: max. of 6 months of service for every 3 anniversary years. A simple press of a button, worn in the home, alerts our 24-hour monitoring service that help is needed.
  • Accidental Dental: $2,000 maximum per anniversary year.
  • Ambulance: unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per anniversary year (only payable after Government Health Insurance Plan maximums have been reached, if applicable).
  • Hearing Aid: $400 maximum per 4 consecutive benefit years.
  • Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.
  • $5 million emergency health coverage per person for trips lasting a maximum of 9 days. (A $100 deductable applies per claim). Additional coverage for either 8 or 21 days can be purchased as an Add-On.
  • NOTE: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period preceding the effective date of coverage. Not available to persons age 70 and over; 8 or 21 day Add-On Travel coverage now available with ComboPlus Starter Plan.

Accidental Death & Dismemberment (Basic)

  • Up to $25,000 upon the Accidental Death or Dismemberment of an adult under 65; up to $10,000 upon the Accidental Death or Dismemberment of an adult 65 and over, or a child. Additional coverage can be purchased as an add-on.
  • All FlexCare plan members receive a newsletter packed with information on everything from family fitness to treating colds and flu, to dealing with common problems such as allergies, asthma and back problems.
  • Only available with DrugPlus Enhanced Core Plan
  • Toll-free telephone access to a Registered Nurse on a wide range of health matters, including:
    • Whether an illness or injury can be safely treated at home, or requires a visit to a doctor or emergency room.
    • Possible prescription drug side effects.
    • Symptoms and treatments of medical conditions, and more.
  • Provides survivor benefits for continuous coverage for 1 year, following the death of subscriber or co-subscriber

DentalPlus (Dental and Core Benefits)

You can choose either the Basic or Enhanced Plan, both come with Core Benefits

IMPORTANT: Dental coverage commences at age 17 for residents of Prince Edward Island, age 13 for residents of Newfoundland and age 11 for residents of Nova Scotia. Also, coverage is designed to concur with your current provincial Dental Association Fee Guide for General Practitioners. The FlexCare DentalPlus coverage will be adjusted to match any increases in the fee guide.

  • No medical questionnaire required, guaranteed acceptance.
  • Coverage for fillings, cleanings, scalings, examinations, polishings, and certain extractions.
  • Recall visits every 9 months.
  • Coverage table:
  • Note: core benefits are listed beneath the Enhanced Plan details below.
  • No medical questionnaire required, guaranteed acceptance.
  • Coverage for fillings, cleanings, scalings, examinations, polishing, and certain extractions.
  • Recall visits every 6 months.
  • Coverage Table:
  • The following 6 dental services (Enhanced plan only) have a combined maximum of $1,250 per 3 year period. For oral surgery, periodontics and endodontics (root canal), benefits are available beginning Year 2; for orthodontics, crowns, bridges and dentures. No benefit is available until Year 3. The payment percentage increase from the effective date of contract is as follows:

Core Benefits (Included with DentalPlus Basic and Enhanced Plans)

  • $250 maximum per 2 consecutive benefit years to cover the cost towards prescription lenses, frames, contact lenses and laser eye surgery.
  • $70 maximum for Optometrist fees per person per 2 consecutive benefit years (payable only after Government Health Insurance Plan maximum has been reached, if applicable)
  • Eyeglasses are covered against breakage and scratches by a repair guarantee for a period of 2 benefit years. This warranty applies to lenses and frames purchased with the Vision benefit of FlexCare.
  • No deductible is charged to you if your eyeglasses can be repaired. If beyond repair, your glasses will be replaced and; a $50 deductible charged for eyeglasses originally purchased for up to $250; or a $75 deductible, if the original purchase price was $251 to $300; or a $100 deductible, if your eyeglasses originally cost $301 or more.

Extended Health Care

  • $250,000 lifetime maximum.
  • Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist: $25 max. per visit, 20 visit maximum per person per discipline per anniversary year.
  • Chiropractic X-ray: $35 maximum per anniversary year.
  • Psychologist and Psychotherapist: $80 max. first visit, $65 max. subsequent visits, 15 visit max. per anniversary year.
  • Speech Pathologist/Therapist – $65 max. first visit, $45 max. subsequent visits, 10 visit maximum per anniversary year.
  • Physiotherapist – $250 max. per anniversary year.
  • HomeCare and Nursing, Prosthetic Appliances, Durable Medical Equipment: maximum per anniversary year for each of these 3 categories of benefits as follows:
  • Year 1: $1,000
  • Year 2: $1,300
  • Year 3: $1,500
  • Year 4: $1,700
  • Year 5+: $3,000
  • NOTE: $225 max. per anniversary year for custom-made Orthotics, which are included as part of Prosthetic Appliances.
  • Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.
  • Lifeline Personal Response Service: max. of 6 months of service per 3 anniversary years.
  • Accidental Dental: $2,000 maximum per anniversary year.
  • Ambulance: unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per anniversary year.
  • Hearing Aid: $400 maximum per 4 consecutive benefit years.
  • $5 million emergency health coverage for trips lasting a maximum of 9 days (a $100 deductible applies per claim). Additional coverage for either 8 or 21 days can be purchased as an Add-On.
  • NOTE: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9-month period preceding the effective date of coverage. Not available to persons age 70 and over; 8 or 21 day Add-On Travel coverage now available with ComboPlus Starter Plan.

Accidental Death & Dismemberment

  • $25,000 for adults under the age of 65; $10,000 for children and adults age 65 and over, or a child.
  • Additional coverage can be purchased as an Add-on.
  • Provides for coverage to be continued for 1 year, following the death of an adult policyholder.
  • Available 1 year after policy effective date.

ComboPlus (Prescription Drug, Dental and Core Coverage)

  • You can choose either the Starter, Basic or Enhanced Plan, all come with Core Benefits.
  • Note that Core Benefits for the Starter Plan are different than the Core Benefits that come with the Basic and Enhanced Plans.
  • For drug and dental coverage with Core Benefits, without a medical questionnaire, choose the Starter Plan.
  • For more extensive drug and dental coverage with Core Benefits, select either the Basic or Enhanced Plan.

Starter Plan (ComboPlus)

  • No medical questionnaire – guaranteed acceptance

Starter Drug Coverage:

  • Generic drug plan (name brand drugs allowed, but price paid will be deemed to be the generic equivalent price).
  • Shared dispensing fee to a maximum of $6.50.
  • 70% on the first $750 to maximum of $525 per person per year.
  • Exclusions: smoking cessation drugs, over-the-counter drugs, fertility drugs, birth control drugs, and drugs not requiring a prescription.
  • British Columbia and Saskatchewan residents: Prescription drug benefit maximums based on calendar year.

Starter Dental Coverage:

  • Dental coverage with a 70% payment for fillings, cleanings, scalings, examinations and polishing on the first $575 of these services.
  • Recall visits every 9 months.
  • IMPORTANT: Dental coverage commences at age 17 for residents of Prince Edward Island, age 13 for residents of Newfoundland and age 11 for residents of Nova Scotia.
  • $150 maximum per 2 consecutive benefit years to cover the cost towards prescription lenses, frames, contact lenses and laser eye surgery.
  • $70 maximum for Optometrist fees per 2 consecutive benefit years (payable only after Government Health Insurance Plan maximum has been reached, if applicable)
  • Eyeglasses are covered against breakage and scratches by a repair guarantee for a period of 2 benefit years. This warranty applies to lenses and frames purchased with the Vision benefit of FlexCare.
  • No deductible is charged to you if your eyeglasses can be repaired. If beyond repair, your glasses will be replaced and; a $50 deductible charged for eyeglasses originally purchased for up to $250; or a $75 deductible, if the original purchase price was $251 to $300; or a $100 deductible, if your eyeglasses originally cost $301 or more.

Extended Health Benefits (Starter)

  • $250,000 lifetime maximum.
  • Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, Acupuncturist: $25 max. per visit, 20 visit maximum per discipline per anniversary year (payable only after Government Health Insurance Plan maximums have been reached, if applicable).
  • Chiropractic X-ray: $35 maximum per anniversary year.
  • Psychologist and Psychotherapist: $80 max. first visit, $65 max. subsequent visits, 15 visit max. per anniversary year.
  • Speech Pathologist/Therapist: $65 max. first visit, $45 max. subsequent visits, 10 visit maximum per anniversary year.
  • Physiotherapist: $250 max. per anniversary year.
  • HomeCare and Nursing, Prosthetic Appliances, Durable Medical Equipment: maximum per anniversary year for each of these 3 categories of benefits is as follows:
  • Year 1: $1,000
  • Year 2: $1,300
  • Year 3: $1,500
  • Year 4: $1,700
  • Year5+: $3,000
  • NOTE: $225 max. per anniversary year for custom-made Orthotics, which are included as part of Prosthetic Appliances.
  • Lifeline Personal Response Service: max. of 6 months of service every 3 anniversary years.
  • Accidental Dental: $2,000 maximum per anniversary year.
  • Ambulance: unlimited ground transportation to hospital and $4,000 maximum for air ambulance transportation per anniversary year (only payable after Government Health Insurance Plan maximums have been reached, if applicable).
  • Hearing Aid: $400 maximum per 4 consecutive benefit years.
  • Health Service Navigator Services: upon diagnosis of a serious illness or injury, you can get quick answers (including second opinions) to your medical questions from a world-class hospital. They also offer support for navigating the Canadian health care system.
  • $5 million emergency health coverage for trips lasting a maximum of 9 days. (A $100 deductible applies per claim.)
  • Additional coverage for either 8 or 21 days can be purchased as an Add-on.
  • NOTE: Coverage may be limited or excluded for any illness or condition which first manifested itself within the 9 month period preceding the effective date of coverage.
  • Not available to persons age 70 and over; 8 or 21 day Add-On Travel coverage now available with this ComboPlus Starter Plan.

Accidental Death & Dismemberment

  • Up to$25,000 for adults under the age of 65; up to $10,000 for children and adults age 65 and over.
  • Additional coverage can be purchased as an Add-On.
  • Provides for coverage to be continued for 1 year, following the death of an adult policyholder.
  • Available 1 year after policy effective date.

Basic Drug Coverage:

  • Medical questionnaire required.
  • Generic drug plan (name brand allowed but price paid will be deemed the generic equivalent price).
  • Full coverage of reasonable and customary dispensing fees.
  • Coverage Table:


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