Benefits - Health and Welfare Plan

(Hourly)

Extended Health Care

Extended Health Care (EHC) coverage is an important part of your Plan. EHC provides some additional medical coverage for you and your Dependents above the level of coverage available through any other government or private plan (collectively referred to as “Other Coverage”).

All claims for a calendar year MUST BE RECEIVED by Green Shield Canada by JUNE 30 of the following year. It is recommended you submit claims monthly or quarterly.

EHC benefits will not be paid for any expense that is the responsibility of a third party. Some examples would be WCB, ICBC or other insurers or individuals.

Eligible Expenses incurred by Plan members and Dependents who live in the vicinity of the Alberta and B.C. border and receive treatment in Alberta will be reimbursed on the same basis as if the Eligible Expenses were incurred in B.C.

Paramedical Practitioners - all paramedical practitioners must be registered with their appropriate professional body

Eligible Extended Health Care Expenses
In addition to the information provided in the table above, below is a general summary of the expenses covered by the EHC Benefit.

The following are considered Eligible Expenses when incurred as a result of necessary treatment of injury or Illness and, where applicable, when ordered by a Physician. These expenses do not include any Benefits that are included in Other Coverage.

Additional Eligible Expenses

• Drugs prescribed by a Physician or a Dentist, plus a maximum $10 dispensing fee, as long as a generic drug is available the Plan will only cover the cost of the generic.

• Emergency ambulance service to the nearest acute care general hospital

• Private duty nursing for acute cases by a registered nurse, who is neither living with nor related to the Plan member, nor an employee of the hospital, when recommended by a Physician, to a maximum of $100,000 per year.

• Orthopaedic shoes and orthotic inserts prescribed by a Physician or podiatrist; to a limit of $1,000 per calendar year.

• Cost of oxygen, blood or blood plasma, artificial limbs or eyes, crutches, splints, casts, trusses and braces

• Cost of durable equipment (e.g., wheelchairs, hospital beds) including repairs and replacement parts

• Accidental dental treatment to natural teeth when treatment occurs within one year of the accidental injury (excluding orthodontic services)

• Oral contraceptives and contraceptive devices for female members and dependents prescribed by a Doctor

• Medical Travel Benefit:
  
  — You must be referred by your physician to a specialist who is at least 250km from your place of residence. There must not be an equivalent specialist within 250km from your place of residence
  
  — Only travel (auto, train, air, bus, etc.), and accommodation in a commercial facility are covered
  
  — A special claim form must be used for these expenses which you should obtain before your referral to the specialist.

  Travel Insurance:
  
  — $1,000,000.00 of travel insurance is included as part of the Plan. This coverage applies to each member and dependant individually.

Coordination of Benefits
EHC expenses recoverable under any other plan will be coordinated with payment from this Plan so that total
reimbursement will not exceed the actual cost of treatment.

Limitations and Exclusions
EHC has various limitations and exclusions. Some examples of items generally excluded from coverage are:

• expenses for treatment from a practitioner where a doctor’s
  referral is required and not present;

• expenses for medical treatment for cosmetic purposes; or

• expenses for medical treatment as a result of a workplace
  injury or an accident for which a third party is liable.

If you plan to make a non-routine Benefit claim, we recommend that you check with the Administration Office in advance.

Termination of Coverage
EHC coverage terminates at the earlier of the end of the month in which you cease to be an Employee, or at the end of the month in which Regular Full-Time Employment ends, the day your employer ceases to be a member of the Plan or the day this Benefit terminates.

Once your coverage terminates, you may be eligible to convert your EHC coverage to an individual plan. To be eligible, you must apply within 60 days following termination. For further information, please contact the Administration Office.

FIA Disclosure

The Interior Lumbermen's Health and Welfare Plan exists for the sole purpose of providing employee life and health benefits to eligible members and their covered dependents. The Plan is not an insurance company, and the extended health, dental, weekly indemnity and long-term disability benefits provided through the Plan are not insured by an insurance company regulated under the British Columbia Financial Institutions Act or the Alberta Insurance Act  The Plan is exempt from the regulatory requirements of both these statutes.