Supplementary plans typically provide coverage for the individual
who is a member, along with eligible dependents such as his/her spouse or partner and children under 19 (or older if they are full-time students or disabled).
Eligibility criteria vary, so check your plan for details.
Deductibles, Coinsurance and Maximums
Supplementary plans typically do not pay 100 per cent of eligible expenses.You may have to pay for a small amount of your expenses and those of any covered dependents at the beginning of each plan year, called a deductible.
Common deductible amounts are $25 or $50 per covered person. Alternatively, you may pay a family deductible, which might be the first $75 in eligible expenses incurred by any two covered members of your family at the beginning of each year. Some plans also include a per service deductible (e.g., $5 per drug prescription).
If your plan has a coinsurance feature, you will also be required to coinsure, or pay, a percentage of your eligible expenses in excess of your deductible. The coinsurance percentage is typically 10 per cent or 20 per cent of an eligible expense, but may be higher for certain types of services (e.g., 50 per cent for major restorative dental services or orthodontic treatments).
Many plans also place dollar limits, called maximums, on the amount of benefits that will be paid for certain services, such as eyeglasses or orthodontic treatments, in a specified period.
Sometimes a maximum applies to the total benefits that will be paid during a year or during the covered person’s lifetime.
It is very important to know what deductibles, coinsurance percentages
and maximums apply to your eligible expenses. Check your plan literature carefully.
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