Some Definitions For Better Understanding!

Reasonable and Customary Amounts

The health and dental plans cover services only up to the “reasonable and customary” amount charged for the service. If your provider charges more than the reasonable and customary amount, the extra charges won’t be covered.

You can call Canada Life to find out what the reasonable and customary amount is for a service. If your practitioner charges more than the reasonable and customary amount, you should ask if the practitioner will reduce the charge to the reasonable and customary amount. You can also consider shopping for a different practitioner.

Deductibles

In some cases, you may have to pay a portion of your covered costs yourself before the plan begins to pay benefits. The amount you pay yourself is called a “deductible.” Once you’ve met the deductible, the plan begins to reimburse your covered costs.

Coverage Limits

Your Health and Dental plans cover certain services and medical supplies only up to a set amount per year (or per two years). Note that for coverage limits, a year is the period from April 1^st to March 31^st. If you get services or medical supplies beyond those limits, you will be responsible for paying the full cost.

Out-of-pocket Maximum

For Health coverage, you have an out-of-pocket maximum of $4,000 per year. Once you have paid $4,000 for covered services during a year, the plan will pay 100% of the cost of any further covered services you require during that period. The 100% coverage will not apply, however, to any service or medical supply for which you’ve already met the annual or biennial coverage limit.

All Benefit Details

You will find all the details regarding your benefits, including limits, in the TimCare Flex booklet published on GroupNet Flex.