Pacific Cross Insurance Company

MEDICAL PLANS: Health Insurance Plan

GENERAL INFORMATION


	DENTAL BENEFITS
	A completed Oral Examination Report must be submitted with the first dental claim. All conditions requiring treatment as of the first dental visit are deemed to be pre-existing conditions.
	EXCLUSIONS (Extract from the policy)
	Medical plans do not cover care, treatment, services or supplies for: Pre-existing conditions not declared to and accepted by the Company; Which the Insured Person is entitled to indemnity from a third party or other benefit plan; Birth control; treatment of impotence or infertility (including artificial insemination, in-vitro fertilization, embryo transfer); sterilization reversal or elective abortion ; Congenital conditions and genetic deformities or diseases ; Weight treatment and management ; Custodial Care, routine medical check-ups, or any treatments considered unnecessary by the Company, vaccinations, counselling, hearing tests, refractive defects of the eye, corrective eye surgery for refractive error, corrective devices, or dental treatment unless covered under the optional benefits cover of this policy for vision, dental, or medical check-up ; Disability resulting from war or any act thereof, service in the military, naval or air force, riot, civil commotion ; Hazardous or professional sports unless declared to and accepted by the Company ; Intentionally self-inflicted injury, suicide, abuse of alcohol, drug addiction or venereal diseases; Cosmetic or reconstructive surgery ; Prosthesis, orthotic devices, corrective devices and medical appliances not required for a surgical operation ; AIDS, AIDS Related Complex, or Human Immunodeficiency Virus (HIV) and related illnesses which manifest at any time within five years from the Insured Person's effecitve date; and Expenses incurred for provision of medical documentation required by the Company.
	14-DAY FREE LOOK
	You may return your policy within fourteen days after receipt for a full refund of the premiums paid.
	FREE New Born Child Coverage
	A child of a female Insured Person is eligible for the same medical plan as the Insured Person 15 days after the later of the date of birth or the date of discharge on submission of application to the Company until the Insured Person's next renewal for free.
	GEOGRAPHICAL LOADING
	Applies to the Medical Plan (& Optional Benefits) premium for residents to cover the high cost of medical care in that particular area.
	MATERNITY BENEFIT
	Expenses are covered where applicable after a 12-month waiting period. Miscarriage, therapeutic abortions, hydatiform mole and etopic pregnancy are covered after 90 days. Benefit shall include all pre-natal and post-natal care, hospital room and board, professional fees, miscellaneous charges, and up to 7 days of nursery care. When both parents are insured for the same medical plan, the maximum benefit shall be increased by 50%.
	NO CLAIM DISCOUNT
	A No Claim Discount will be offered to Insured Persons who are not entitled to Group Discount and whose policy remains claims-free at each renewal. The No Claim Discount will be applied as follows: Year 0 No discount Year 1 10% discount Year 2 15% discount Year 3 20% discount (the maximum) If a claim is made by any Insured Person under the policy during a policy year, any No Claim Discount achieved will be lost and the status of the discount will be as at Year 0 shown above. If a claim relating to the previous year is subsequently submitted and accepted, and a No Claim Discount has already been given, the Company reserves the right to deduct the equivalent monetary amount of the No Claim Discount from the value of the claim. The No Claim Discount applies only to the premium in respect of the basic benefits. Claims against any Additional Benefit Plans will not affect the No Claim Discount.
	OCCUPATIONAL CLASS
	Personal Accident cover is based on the hazard class associated with an occupation and its duties. Class 1 : very light hazards; Class 2 : light hazards; Class 3 : non-hazardous manual labor; and, Class 4 : hazardous occupations. Class 3's are quoted on request and Class 4's have no cover.
	PRE-EXISTING CONDITION
	Any Disability which existed before the policy effective date in respect of an Insured Person, which presented signs and symptoms of which the Insured Person was aware or should reasonably have been aware.
	PREMIUMS
	Are based on the Insured Person's age on the first day of the policy year; the rate table in effect on the premium due date; and, residence, family status, payment mode and other factors which affect the cost of insurance. Premiums may be revised based on claims experience or other criteria which the Company, at its sole discretion, may determine. Policies renew automatically upon payment of renewal premium.
	TREATMENT AREA LIMIT
	Does not apply to inpatient expenses incurred for emergency treatment of injury or acute illness which occurs wholly after the start of travel for up to 30 days of travel to the affected areas in any one policy year.
	WAITING PERIOD
	Benefits are not paid for sickness during the first 30 days of coverage. Benefits for injuries due to covered accidents occurring wholly after the effective date are covered immediately.

MEDICAL PLANS: Health Insurance Plan

GENERAL INFORMATION