Detailed Comparison

Stand Alone Policy Premiums (BC) and Multi-Life Plans

 

Benefits

Basic
issue to age 64, coverage to 75

Deluxe
issue to age 64,
coverage to 75

Platinum
issue to age 64, coverage to 75

Prescription Drugs
Pay-direct, up to generic equivalent
(not just prov. formulary)

80%      (Drug Card)
Maximum $1,000
per benefit year

90%        (Drug Card)
Max: $1,000-yr 1; $1,500-yr 2; $2,000/ benefit year thereafter

90%      (Drug Card)
Max: $1,500-yr 1; $2,500-yr 2;
$3,500/ benefit year thereafter

Health Services

No deductible, 100%,
No aggregate maximum

No deductible, 100%,
No aggregate maximum

No deductible, 100%, 
No aggregate maximum

Vision Care

Nil (examination costs)
(33% discount arranged through Bay/Sears on lenses/frames)

Eye exams $60 every 2 years
+(33% discount)

Eye exams $60 every 2 years + $250 every 2 yrs for glasses, contacts or laser surgery  +(33% discount)

Accidental Dental

$10,000 per benefit year

$10,000 per benefit year

$10,000 per benefit year

Ambulance (Air/Ground)

Included

included

included

Hearing Aid

$500 /3yrs

$500 /3yrs

$500 /3yrs

Practitioner Services:
Physiotherapist, Clinical Psychologist, Speech Therapist  /Pathologist

$400 /practitioner/year
/per family member

$400 /practitioner/year
/per family member

$400 /practitioner/year
/per family member

Chiropractor; Osteopath; Homeopath;  podiatrist /chiropodist or Naturopath;

$400 /practitioner/year
/per family member

$400 /practitioner/year/year
/per family member

$400 /practitioner/year/year
/per family member

Registered Massage Therapist

$20 per visit to max of 20 visits

$20 per visit to max of 20 visits

$20 per visit to max of 20 visits

Acupuncturist

$20 per visit to max of 20 visits

$20 per visit to max of 20 visits

$20 per visit to max of 20 visits

Private Duty Nurse
 / Home Support

$5,000 per benefit year

$7,500 per benefit year

$10,000 per benefit year

Laboratory & Diagnostic
        Services

Yes

Yes

Yes

Medical Equipment / CPAP / Prosthetic Appliances

When physician recommended
~ no max indicated

When physician recommended
~ no max indicated

When physician recommended
~ no max indicated

Braces for legs, arms neck or back

included

included

included

Wheelchair /
manual hospital  bed

Included

Included

Included

Walker, crutches, cane

Included

Included

Included

Orthopaedics   
(where prescribed)

Custom made boots or shoes to maximum of $300 /2yrs

Custom made boots or shoes to maximum of $300 /2yrs

Custom made boots or shoes to maximum of $300 /2yrs

Travel
Medical Coverage

60 days, $1 million annual
no ‘pre-existing exclusions’

60 days, $1 million  annual
no ‘pre-existing exclusions’

60 days, $1 million  annual
no ‘pre-existing exclusions’

Hospital

Nil

Nil

Semi-private

Dental  (Rider only)

** No waiting period **

** No waiting period **

**No waiting period **

Maximums   /per family member

$ 750 first 12 months;
$1,000 each subsequent year

$1000/yr in years 1 & 2;
$1,200/yr thereafter

$1000/yr in years 1 & 2;
$1,200/yr thereafter

Preventive Services

80%

80%

80%

General exams

every 3 years

every 3 years

every 3 years

Recall exams

every 9 months

every 9 months

every 6 months

Preventative cleaning, etc.

every 9 months
as part of recall
+ periodontal scaling available as part of minor (below)

every 9 months as part of recall + periodontal scaling available as part of minor (below)

every 9 months as part of recall + periodontal scaling available
as part of minor (below)

Minor Restorative Services:
Endodontic + denture services + comprehensive oral surgery

70%
Periodontal scaling/cleaning 
– 6
 time units per 12 months
Root Canals

70%
Periodontal scaling/cleaning
– 8 time units per 12 months
Root Canals

80%
Periodontal scaling/cleaning
– 8 time units per 12  months
Root Canals

No coverage for Major Restorative (gold work)  or Orthodontics

Discounted Premiums with purchase of Disability Coverage*(BC)

Monthly Premiums

Basic     (2011)
issue to age 64,
coverage to

Deluxe    (2011)
issue to age 64,
coverage to 75

Platinum    (2011)
issue to age 64,
coverage to 75

Health Only

Health + Dental

Health Only

Health + Dental

Health Only

Health + Dental

Single

51.60

94.27

58.93

108.00

72.67

124.13

Couple

88.13

172.40

102.40

198.13

129.07

229.60

Family

111.47

222.40

130.53

258.13

166.27

300.13

 

Monthly Premiums

Basic     (2011) 
issue to age 64, 
coverage to 75

Deluxe    (2011) 
issue to age 64,
coverage to 75

Platinum    (2011)
issue to age 64,
coverage to 75

Health Only

Health + Dental

Health Only

Health + Dental

Health Only

Health + Dental

Single

42.27

84.93

49.60

98.67

63.33

114.80

Couple

78.80

163.07

93.07

188.80

119.73

220.27

Family

102.13

213.07

121.20

248.80

156.93

290.80

*    Rates change at age 70 to the published rates in force at that time.
** Where another Edge policy is already in force – or when one is eventually put into force.

Pre-existing Exclusions & Underwriting…

If an applicant and/or dependent is on a type of medication for a pre-existing condition, that medication and any other drugs that fall within the categories of drugs used for treatment of that condition will be excluded from coverage.
If an applicant is currently being treated concurrently for multiple conditions, and medications being taken are not condition specific, coverage for that applicant would most likely be declined.

Once an application has been reviewed by our medical underwriting department the application will be either…

  1. Approved. Everyone listed will receive coverage as applied for. Policy is issued along with the drug card, initial cheque is processed. Coverage will take effect the 1st of the month following approval.
  2. Approved with an exclusion and/or limitation. Unable to provide everyone with the level of coverage applied for. A letter explaining the exclusion/limitation will be sent to the applicant with a copy to the writing producer. The deposit and void cheque is retained by The Edge. If the applicant wishes to accept the coverage as offered, a Notice of Authorization to Proceed Form (enclosed with the letter of offer) must be signed and returned within 30 days from the date of the letter. Coverage will take effect the 1st of the month following receipt of Notice to Proceed. If not received, the file is presumed closed and both the deposit and void cheque is returned to the applicant.
  3. Declined Unable to offer coverage due to client’s health concerns.