Prime Health & Dental Plan

Extended Health Care Pre-Existing Exclusion

Our underwriters base their decision to exclude a condition or conditions on the health information you declare on the application and/or information your doctor provides during the underwriting process. Excluded conditions will not be covered under the contract.

Out of Province/Territory and/or Out of Canada Exclusions

You will not be covered for any loss or expenses you incur while outside of your province of residence and/or Canada caused or contributed to by:

1. any treatment or surgery that does not require immediate relief of acute pain or suffering, or which could reasonably be delayed until you return to the province of residence and/or Canada; or
2. treatment you may decide to receive outside of your province of residence and/or Canada following emergency treatment or diagnosis of a medical condition which, based upon medical evidence, would not have prevented you from returning to your province of residence and/or Canada for treatment or surgery; or
3. any medical or hospital services which necessitated travel specifically to obtain them, whether or not on the advice of a physician; or
4. operation of a motorized vehicle while impaired by drugs or other toxic substances or where the level of alcohol exceeds 80 milligrams per 100 millilitres of bodily fluid; or
5. participation in a professional sport, any speed contest, SCUBA diving without a basic SCUBA designation from a certified school or other licensing body, bungee-jumping, parachuting, parasailing, mountaineering, spelunking, or any airborne activity unless you are riding as a passenger on a commercially licensed airline.

General Limitation

You will only be reimbursed eligible expenses not covered by a provincial or territorial plan. You will not be reimbursed expenses covered by any government program or other program of health insurance. Manulife will be entitled to the reimbursement of any amounts it pays which are recovered from a third party. In addition, you will not receive benefits for that part of any expense in excess of those considered reasonable and customary.

Out of Province and/or Canada Limitation

The coverage period of this insurance for any one trip outside of province of residence and/or Canada is limited to the first 60 consecutive days. The coverage period of this insurance for all trips in any six-month period is limited to the first 75 days in the aggregate. This insurance does not cover any loss or expenses you incur while outside of your province of residence and/or Canada for any period beyond the coverage period.

Out of Province and/or Canada Exclusions

Any medical condition you suffer or contract when an official travel advisory issued by the Canadian government before your departure date states, "Avoid all non-essential travel" or "Avoid all travel" regarding the country, region or city of your destination. To view the travel advisories, visit the Government of Canada Travel site.

Out of Province and/or Canada Pre-existing Condition Limitation

This insurance does not cover any loss or expenses you incur while outside of your province of residence and/or Canada caused or contributed to by any injury or sickness or related condition for which you received treatment or required the use of medication during the 90 days prior to the date you left your province of residence and/or Canada. However, any condition which has been controlled by the consistent use of medication prescribed by a physician is covered, provided that during the same 90-day period the condition was stable and there had been no change in the medication or dosage.

Out of Province and/or Canada Pregnancy and Childbirth Limitation

This insurance does not cover any loss or expenses incurred for the treatment or confinement of mother or child(ren) as a result of pregnancy, miscarriage, childbirth, or complications of any of these occurring within two months of the expected date of birth.

No amount will be paid for charges for:

1. recalls occurring more frequently than once every 9 months;
2. dental services or appliances which were assessed, arranged, ordered or obtained prior to the effective date of your coverage;
3. white fillings on molars;
4. completion of claim forms;
5. dental care which is cosmetic;
6. broken appointments;
7. self-inflicted injury;
8. dental care covered under a medical plan provided by an employer or government;
9. replacement of a lost or stolen prosthesis;
10. expenses for which, in the absence of coverage, there would be no charge;
11. stainless steel crowns on permanent teeth;
12. protective athletic appliances;
13. any expense incurred after termination of coverage;
14. a full mouth reconstruction, for a vertical dimension correction, or for diagnosis or correction of a temporomandibular joint dysfunction.

Limitations

The plan will pay for reasonable and customary charges for the expenses charged by a dentist, but not exceeding the limit for that service listed in the Provincial General Practitioners Dental Fee Guide. When two or more covered dental procedures are suitable for the dental care of a specific condition, and both are consistent with good dental care, you will receive benefits for the least expensive service. The plan does not reimburse for expenses covered by any government program or other program of insurance. Manulife is entitled to reimbursement of any amounts recovered from a third party.

All applicants must have coverage under a government health care insurance plan in order to be eligible for this insurance product. If anyone on the application does not meet this requirement, please call 1-877-598-2273 for more information.

You must be a Canadian resident and under age 66 if applying for Extended Health Care, or under age 65 if applying for Dental Care. You must also fall under one of the following:

• Members (including members in training) of provincial and territorial engineering licensing associations. Also included are student engineers who are members of a student section (in those associations where a student section exists) and who are within 24 months of expected graduation from a program accredited by the Canadian Engineering Accreditation Board.
• Members of participating provincial associations of technicians and technologists.
• Members of l'Ordre des Géologues du Québec.
• Members of Geoscientists Nova Scotia.
• Members of the Association of Professional Geoscientists of Ontario.
• Members of the Ontario Society of Professional Engineers.
• Members of the Manitoba Association of Architects.
• Members of the Architects' Association of New Brunswick.
• Members of the Nova Scotia Association of Architects.
• Members of the Architects Association of Prince Edward Island.
• A full-time employee of Engineers Canada, or of one of Engineers Canada provincial/territorial constituent associations, or of one of the participating organizations, or of The Youth Science Foundation Canada.
• Limited licensees.
• Provincial licensees.

If you are applying or are already covered under Extended Health Care and/or Dental Care, you may also apply for your spouse and eligible children who are covered by government health insurance.  Children must be under 25 years of age. Children 21 to 24 must be in full-time attendance at an accredited college or university. Covered children who are incapacitated and dependent on you for support will be covered up to any age.