Some features applicable to all benefits:

• Coverage is 24 hours-a-day, 7 days-a-week;
  
  
• If family coverage is chosen, the spouse and dependents are covered under the plan;
  
  
• Conditions, terms and definitions change for each insurance carrier in Ontario. We have merely attempted to summarize each benefit description in this section;
  
  
• "Co-insurance" is an insurance term that defines the percentage of a claim that the insurance company will pay for.  (eg. If you have a $100 dental claim, and your co-insurance is 100%, the insurance company pays $100. If your co-insurance is 80%, the insurance company only pays $80);
  
  
• "Deductible" is payable by the employee only once per policy year.  There are various types of deductibles that can be worked into a plan in order to lower premiums.
  
  
  

  See a detailed description of each benefit:
  
  Life Insurance & Accidental Death
  
  Dental Benefit
  
  Extended Health
  
  Short Term Disability Insurance
  
  Long Term Disability Insurance

  
  
  

  
  

Life Insurance (mandatory benefit):

From flat $25,000 to a multiple of the employee's annual income. 

Provides low-cost term insurance for employees without evidence of insurability for amounts (typically) less than $100,000. 

The level of coverage is pretty flexible, ranging from a flat $25,000 per person to a multiple of the employee's annual income (the multiple must be the same for all persons).

Example: if 2 times annual income is chosen, an employee earning $50,000 would get $100,000 of life insurance;  an employee earning $30,000 would get $60,000).

Accidental Death and Dismemberment (AD&D) (mandatory benefit):

Equal to the amount of Life Insurance chosen.

Some companies price this benefit as a part of the Life Insurance benefit. It is a very low-cost addition to your plan, which essentially doubles the Life Insurance death benefit if the death occurs by an accident (rather than by health-related causes). The "dismemberment" portion of the benefit provides a schedule of payments for various types of injuries. The complete schedule is printed in your benefit description booklet that comes with the plan.

Dental Care (optional benefit):

To make it easier to understand, we have divided this benefit into the following categories of coverage:

1. Basic & Preventative: (mandatory portion of the dental plan) covers full dental accidents, cleaning, periodic oral examinations, periodontal examinations, x-rays, polishing and fluoride treatments, space maintainers, pit and fissure sealants on bicuspids, and minor restorative services.
   
   
2. Major Restorative: (optional benefit) augments the Basic and Preventative protection to include crowns, inlays, onlays, fixed bridgework, partial and complete dentures, repairs and adjustments, surgical services and associated costs, etc.
   
   
3. Orthodontic: (optional benefit, can only be chosen if Major Restorative is also taken) augments the dental benefit to include orthodontic procedures (braces, retainers, etc.) for insured dependent children under the age of 19.
   
   
   
   
   

Extended Health Care (optional benefit):

This benefit is the most comprehensive, covering a wide range of services.  To make it easier to understand, we have broken it up into the following categories:

1. Drugs: most prescription drugs are covered by the plan.
2. The Insurance company pays the benefit via either a drug card or by reimbursement when pharmacy receipts are submitted to them.  The level for this benefit ranges from a minimum of 50% (i.e. a $30 drug expense is submitted, and the insurance company pays $15 of it) to the full 100% reimbursement.
3. Typical prescriptions such as antibiotics, medications for treatment of skin diseases, birth control, high blood pressure, heart medication, cancer treatments, arthritis relief, etc. are covered by the plan. Options to add such pharmaceuticals as fertility drugs, male impotency medications like Viagara, smoking cessation drugs, and others.
4. Reimbursement can come in two forms: through a drug card that the employee uses like a credit card, or through mail-in reimbursement that requires a bit more administration.  Companies that have not previously had health plans are recommended to choose the drug card, as the administration is minimal, and the fee is nominal (opting for a drug card increases the overall policy premium by 1-2%).
   
   
5. Hospital Services: upgrades OHIP to cover either semi-private or private hospital accomodations.
   
   
6. Travel Insurance: premium out-of-country coverage for you and your family (or just single coverage), for peace of mind when travelling, whether it be a weekend getaway to Niagara Falls, NY, or a month in Fiji.  Also supplements OHIP when journeying to Canadian destinations outside Ontario.
   
   
7. Professional Services: is the cost of chiropractic care or a registered massage therapist keeping you from taking care of those aches and pains? This portion of the Extended Health benefit also covers physiotherapy.
   
   
8. Vision Care: (optional addition to Extended Health plan) covers prescription eyewear and contact lenses, with maximums ranging from $100 to $200 every 24 months.  As a somewhat expensive benefit, you should only opt to take this coverage if you and your employees are likely to use it extensively.
   
   
   
   
   

Short Term Disability Insurance:

This benefit provides you with a regular income to replace income lost because of a short term disability due to illness or injury. This benefit usually begins 1 day after accidents or 8 days after sickness commences and continues until you are no longer disabled as defined by the policy, to a maximum of 17 weeks.

Long Term Disability Insurance:

L.T.D. coverage provides you with a regular income to replace income lost because of a lengthy disability due to illness or injury. Benefit begins after the waiting period is over (usually 17 weeks) and continues until you are no longer disabled as defined by the policy. The benefit can be paid for a set number of years (say, five) or until age 65. The longer the coverage period, the greater the premium.