INDIVIDUAL HEALTH PLANS

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INDIVIDUAL HEALTH

PLANS

®*The Blue Cross symbol and name, Colour of Caring, mybluecross and BlueAdvantage are registered marks of the Canadian Association of Blue Cross Plans, independently licensed by Manitoba Blue Cross.*†Blue Shield is a registered trade-mark of the Blue Cross Blue Shield Association. ®My Good Health is a registered trade-mark of Pacific Blue Cross and used with permission.

IN PERSON

599 Empress Street 9:00 a.m. - 5:30 p.m. Monday through Friday

BY TELEPHONE

204.775.0151 Customer Service Centre 8:00 a.m. - 5:30 p.m. Monday through Friday Toll-free at (1.800.USE.BLUE) 1.800.873.2583

(within Manitoba only)

8:00 a.m. - 5:30 p.m. Monday through Friday

BY MAIL

Manitoba Blue Cross PO Box 1046 Stn Main Winnipeg MB R3C 2X7

mb.bluecross.ca

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EXTENDED HEALTH BENEFITS Co-insurance 20% 10% Accidental Dental $1000 per accident Artificial Limbs/Eyes 80% of eligible expenses 90% of eligible expenses Assisted Care $40/day (14 day maximum) per hospitalization $40/day (14 day maximum) per hospitalization Athletic/Occupational Therapy $250/calendar year per person-combined

Blood Pressure Monitor

included under special equipment maximum $250/5 years per person included under special equipment maximum BlueNet (POS) no coinsurance yes yes

Braces, cervical collars,

elastic stockings 80% of eligib le expenses 90% of eligib le expenses

Breast Prostheses &

Surgical Bras (single/double)

$400/$800

per calendar

year per person

$400/$800

per calendar

Cardiac Rehabilitation

$500 lifetime

maximum per person

$500 lifetime

maximum per person

Clinical Psychology

$450/calendar year

per person

$450/calendar year

per person

Crutches, splints, casts & canes

80% of eligib le expenses 90% of eligib le expenses

Day Surgery - Assisted Care

$20-$40/day;

maximum $200/surgery

maximum $400/surgery

Eye Exam

1 Eye Exam every

24 months per person

Hearing Aids

no coinsurance

$300 every 5 calendar

years per person

Hospital Bed

$1000 lifetime

maximum per person

$1000 lifetime

maximum per person

Hospital In-patient Allowance

(no coinsurance) $10/day per hospitalized illness Nutritional Counselling $450/calendar year per person $450/calendar year per person Orthopedic Shoes $200/calendar year per person $200/calendar year per person Orthotics $100/calendar year per person Physiotherapy $450/calendar year per person

Podiatry/Foot Care by Nurses

$450/calendar year per person $450/calendar year per person Prescription Drugs no coinsurance $160/calendar year per certificate $400/calendar year per certificate $130/calendar year per certificate $200/calendar year per certificate

Private Duty Nursing

$2000/calendar year per person $2500/calendar year per person $3000/calendar year per person Respirator $1000 lifetime

maximum per person

$1000 lifetime

maximum per person

Special Equipment including

medical devices used to aid

daily living

$250 lifetime

maximum per person

$250 lifetime

maximum per person

Specialist Referral

$0.30/km; $200 per calendar year for treatment not

available

within a 150km radius of your residenc

Travel Protection

$1000/calendar year

maximum per person

$2500/calendar year

maximum per person

Tutorial Benefits

$15/hour; maximum $1500 per illness

Vision Care - no coinsur

ance

$100/24 months

per person

Walker

$500 lifetime

maximum per person

$500 lifetime

maximum per person

Wheelchair

$1000 lifetime

maximum per person

$1000 lifetime

maximum per person

Wigs

$1000 lifetime

maximum per person

$1000 lifetime

maximum per person

AMBULANCE/HOSPITAL BENEFITS

Emergency Ambulance

No maximum; services provided by a participating

operator within Manitoba.

Non Emergency Ambulance

No maximum; services must be recommended

by the attending physician

if patient cannot walk and cannot be transported by any other means.

Treat No Transport Ambulance

Ambulance called to

scene and provides treatment but does not transport to hospital.

Air Ambulance $5000/trip; annual maximum $10,000/person. Out of Province Ambulance $500 maximum/trip.

Hospital - Semi Private Room

Maximum 60 days/hospital/calendar

year/person

.

Stretcher Service (Medical Van)

$400 lifetime maximum/person.

Hostel Care

Available

for those requiring

medical treatment/diagnostic testing in a hospital located outside a 60 kilometer radius of your home.

Hospital Allowance

In the event that

semi-private accommodations

are unavailable;

$20/day, maximum 60 days/cale

ndar year/person. BASIC BLUE MEDI-BLUE MEDI-BLUE DELUXE GENX PLUS PLAN

PLUS PLAN DELUXE

We have Manitoba covered

...

2 Is a Manitoba Blue Cross

plan right for you?

...3

Why choose Manitoba

Blue Cross?

...

4 Our Plans

...5

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This brochure is intended to assist you in understanding the terms and benefits of Manitoba Blue Cross Individual Health

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We have Manitoba covered.

Manitoba Blue Cross covers over 548,000 Manitobans. That’s more Manitobans than any other carrier. We dedicate the time, energy and resources into understanding the needs of our plan members, and the dynamics affecting their lives.

As a not-for-profit organization, we ensure that every dollar made is reinvested back into our infrastructure, our people and our province, with the goal of expanding our community impact, broadening our health care knowledge and providing better, more comprehensive care for our members.

WE

HAVE MANITOBA

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Coverage you want and peace of mind you need.

Is a Manitoba Blue Cross plan

right for you?

Manitoba Blue Cross plans have been created to cover health and dental costs that exceed services covered by Manitoba Health, Healthy Living and Seniors. Our plans ensure that Manitobans have the coverage they want and the peace of mind they need. We cover Manitobans who are:

• Retired • In between jobs • Self-employed • Students • Employed part-time • Contract workers

• Professionals not covered by their

employer

Manitoba Blue Cross plans are available to all residents of Manitoba who are covered by Manitoba Health, Healthy Living and Seniors. Our plans have no age limit and no medical examination is required to receive coverage (though a medical questionnaire is required for the Deluxe plans).

If you choose family coverage, your spouse (or common-law spouse) and dependent children under the age of 21 (unmarried and unemployed) will all be covered.

IS

A MANITOBA BLUE CROSS PLAN RIGHT

FOR

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Why choose Manitoba Blue

Cross?

• We’re local. We are focused on helping the

community and have a firm understanding of the health care needs of Manitobans.

• We are a not-for-profit organization that puts

the needs of Manitobans first.

• We offer personalized service by phone,

email or in person.

• We are the only carrier in Manitoba with a

walk-in customer service centre to give you personalized face-to-face service.

• We do our best to make using our coverage

easy for our members and have made arrangements with a number of service providers to reimburse them directly, saving you from paying costs up front and waiting for reimbursement.

• Our mybluecross®site provides easy

self-service features including Online Claims Submission and access to coverage details and claims’ status.

• The health and well-being of Manitobans is

important to us. We provide all of our plan members with access to My Good Health®, a health resource site to help get you on the road to better health.

• Our Blue Advantage®program helps our

members save on products, services, and health and wellness items.

WHY CHOOSE

MANITOBA

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Plans designed to accommodate varying

needs.

5 Our Plans

We understand that depending on age and life situation, Manitobans will have varying health care needs. That is why Manitoba Blue Cross has six unique health and dental plans. Each plan has been specifically designed to accommodate these varying needs.

From basic services, like ambulance and stretcher service, to more comprehensive coverage, ranging from physiotherapy to cardiac rehabilitation to major dental, Manitoba Blue Cross plans were created with the needs of Manitobans in mind.

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BASIC BLUE

Are you looking for a plan to simply cover the basics?

Basic Blue is our most basic plan and covers ambulance and hospital benefits only. This plan is a good option for individuals who are primarily concerned about ambulance and semi-private hospital coverage.

Benefits covered include:

Ambulance/Hospital Benefits

• Air ambulance

• Emergency ambulance

• Hostel care

• Semi-private hospital room

• Stretcher service (medical van)

• Treat and release coverage

Note: 3-month unpaid waiting period applies to Basic Blue Plan.

BASIC BLUE PLAN

We’ve made arrangements to pay

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Manitoba Blue Cross plans were created with

the needs of Manitobans in mind

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MEDI-BLUE

Do you need coverage for extended health care but don’t require dental coverage?

Medi-Blue is an intermediate plan designed for people who want the assurance of knowing they have a solid mix of health care benefits but do not require dental coverage.

Benefits covered include:

Extended Health Benefits

• Accidental dental • Assisted care • Athletic therapy • Cardiac rehabilitation • Foot care • Medical appliances • Nutritional counselling • Occupational therapy • Orthopedic shoes • Physiotherapy • Prescription drugs

• Private duty nursing

• Prosthetic and remedial equipment

• Psychological counselling

• Travel health care

Additional coverage for U.S.or international travel is recommended.

Contact us or talk to your agent if you need further information about our travel health plans.

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Ambulance/Hospital Benefits

• Air ambulance

• Hostel care

Accidental Death

and Dismemberment

Up to $5,000 accidental death and dismemberment benefit.

Note: 3-month unpaid waiting period applies to Medi-Blue Plan.

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MEDI-BLUE

DELUXE

Does Medi-Blue sound appealing, but you’re looking for a little more coverage?

The Medi-Blue Deluxe Plan offers the same benefits as Medi-Blue with some additional benefits. This plan also offers higher benefit maximums for prescription drugs and private duty nursing.

Benefits include the same coverage

offered by Medi-Blue and:

• Blood pressure monitors

• BlueNet drug card

• Day surgery assisted care

• Foot orthotics

• Hearing aids

• Increased maximum for prescription

drugs

• Increased maximum for private duty

nursing

BlueNet point-of-sale drug card

With your BlueNet card, claims are

automatically processed when you present your card at a participating pharmacy. The BlueNet system will notify the pharmacist if the drug is covered under your plan or if you have reached your prescription drug maximum. Note: 3-month unpaid waiting period applies to Medi-Blue Deluxe Plan.

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We are a not-for -profit organization that puts the

needs of Manitobans first

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PLUS PLAN

Looking for coverage that is similar to an employer-sponsored plan?

The Plus Plan provides a highly comprehensive benefits package similar to benefits provided under an employer-sponsored group plan, including dental coverage.

Benefits covered include:

Extended Health Benefits

• Accidental dental

• Assisted care

• Athletic therapy

• BlueNet drug card

• Cardiac rehabilitation • Foot care • Medical appliances • Nutritional counselling • Occupational therapy • Orthopedic shoes • Physiotherapy • Prescription drugs

• Private duty nursing

• Prosthetic and remedial equipment

• Psychological counselling

• Specialist referral

• Travel health care

• Tutorial allowance

• Vision care

Additional coverage for U.S. or international travel is recommended.

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Ambulance/Hospital Benefits

• Air ambulance

• Hostel care

BlueNet point-of-sale drug card

With your BlueNet card, claims are

automatically processed when you present your card at a participating pharmacy. The BlueNet system will notify the pharmacist if the drug is covered under your plan or if you have reached your prescription drug maximum.

Dental Benefits

• Basic services

• Major services

• Orthodontics

Accidental Death and

Dismemberment

Note: 3-month paid waiting period applies to Plus Plan.

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PLUS PLAN

DELUXE

Do you like the benefits offered with Plus Plan but would like additional benefits and coverage?

Plus Plan Deluxe is the most comprehensive benefit package that Manitoba Blue Cross offers to individuals. In addition to the full range of benefits offered by the Plus Plan, the Plus Plan Deluxe provides further benefits and enhanced coverage for some of our most requested benefits.

Benefits include the same coverage

offered by Plus Plan and:

• Blood pressure monitors

• Day surgery assisted care

• Foot orthotics

• Increased maximum for prescription drugs

• Increased maximum for hearing aids

Note: 3-month paid waiting period applies to Plus Plan Deluxe.

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We cover more Manitobans than any other carrier

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G

EN

X

Are you under 30 and looking for affordable coverage?

The GenX Plan has been designed to cover young adults under 30 who may not be receiving benefits from their employer. This plan offers a full range of benefits at an affordable rate.

GENX PLAN

GENX plan provides

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Benefits covered include:

Extended Health Benefits

• Accidental dental • Athletic therapy • Eye exams • Occupational therapy • Physiotherapy • Prescription drugs

• Prosthetic & remedial equipment

• Tutorial allowance

Ambulance/Hospital Benefits

• Air ambulance

• Hostel care

Dental Benefits

• Basic services

• Major services

• Orthodontics

Accidental Death and

Dismemberment

Note: 3-month paid waiting period applies to GenX Plan.

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Value Added

At Manitoba Blue Cross, customer service is a priority. We understand that how people communicate depends on the individual, and so we provide a number of ways for you to connect with us.

mybluecross

mybluecross® is an electronic service offered by Manitoba Blue Cross to allow you access to your plan information online

anytime, anywhere.

You will have quick access to:

• Online Claims Submission

• Send us your claims electronically. Visit our website for details.

• Direct Deposit

• Have claim payments deposited directly into your bank account. Receive your payments faster by no longer waiting for a cheque in the mail.

• Plan Information • Benefit Details • Benefit Eligibility • Claim Information • Claim Forms • Temporary ID Cards

• Receipts for income tax purposes

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Take control of your health and well-being today!

My Good Health®, an online health resource site, is available to all Manitoba Blue Cross plan members in mybluecross®.

My Good Health is full of information to get you on the road to better health. Here are some of the great things you can do at My Good Health:

• Discover new prevention and treatment

options

• Learn the details of drugs prescribed to you

• Find out more about natural products and

remedies

• Calculate your health risks

• Count calories

• Test your health knowledge

• Check your symptoms

• Sign up for our health e-newsletter

• Access community support

Registration is easy. Just go to mb.bluecross. ca. Look for the mybluecross icon and click Register.

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Walk-In Customer Service Centre

Many people feel more comfortable with face-to-face service and Manitoba Blue Cross is the only coverage provider in the province to offer a walk-in customer service centre. Conveniently located at 599 Empress Street, across from Polo Park Shopping Centre in Winnipeg, we see approximately 45,000 people walk through our doors annually.

Call Centre

We also have a number of information services representatives on hand to answer the over 400,000 phone call inquiries we receive each year with a system in place to ensure that you are given consistent information and your call is answered effectively, efficiently and in a timely manner.

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We realize, even with Extended Health Care coverage, it can still be difficult to pay for products and services that exceed the coverage of a benefit plan. For this reason, we introduced our Blue Advantage® program, which allows Blue Cross plan members to save on products and services offered by participating providers across Canada. These savings are available to all of our members, regardless of your group or individual plan coverage.

Just present your Blue Cross ID card and mention the Blue Advantage program to the participating provider.

What products and services are available?

• Vision care products

• Medical supplies and equipment

• Dental products

• Hearing products and services

• Items that favour health and wellness,

including discounts on magazine

subscriptions, gym memberships, vitamins and supplements

For a current list of participating providers and types of savings visit the Blue Advantage

website at blueadvantage.ca

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Application Procedure

Applying for a Manitoba Blue Cross plan can be done any of the following ways:

• Through your agent

• Online at mb.bluecross.ca

• In person at 599 Empress Street in Winnipeg

• By calling our offices at 204.775.0151 or

1.800.USE.BLUE (873.2583) to request an application

Coverage will become effective the first of the month following three months from the date the application is received.

If you are a new resident to Manitoba, or have recently lost benefits with an employer group, please contact our office as enrollment procedures may differ.

APPLICATION

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Conversion Privilege

If you had coverage with a different carrier or an employer group plan you may be eligible for Manitoba Blue Cross coverage

immediately.

There is no waiting period providing you apply within 60 days of losing your previous coverage. Your coverage will become effective the first of the month following the termination date of your previous coverage. (A letter from the previous carrier or your employer is required unless the coverage was with Manitoba Blue Cross.)

Payment Schedule

Making payments for your plan is hassle-free through Pre-Authorized Debit (PAD). Payments will be made through your bank account on a schedule that works best for you. You have the option to pay for your plan on a monthly, quarterly, semi-annual or annual basis.

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Recently retired or switching coverage from another carrier? Ask us about our conversion privilege

CONVERSION PRIVILEGE/

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DENTAL BENEFITS Basic 80% of prevailing fee guide Major 80% of prevailing fee guide Orthodontic Treatment

(commenced prior to child’s

17th birthday) 80% of prevailing fee guide Annual Maximum $300 per person $600 per person

ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS

Underwritten

by Blue Cross Life

Insurance Company of Canada

$5,000 $10,000 CONTRACT MAXIMUMS Ambulance Benefits No Overall Lifetime Maximum

Extended Health Benefits

$5,000 annual, $40,000 lifetime/person $40,000 lifetime/person Dental Benefits No Overall Lifetime Maximum BASIC BLUE MEDI-BLUE MEDI-BLUE DELUXE GENX PLUS PLAN

PLUS PLAN DELUXE

This information is intended to provide an overview of

the benefits provided.

(In

all

cases the coverage provisions

shall

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EXTENDED HEALTH BENEFITS

Co-insurance 20% 10%

Accidental Dental $1000 per accident

Artificial Limbs/Eyes _{eligible expenses}80% of _{eligible expenses}90% of

Assisted Care (14 day maximum) $40/day

per hospitalization

$40/day (14 day maximum) per hospitalization

Athletic/Occupational Therapy _{per person-combined}$250/calendar year

Blood Pressure Monitor included under special _{equipment maximum} $250/5 years _{per person} included under special _{equipment maximum} $250/5 years _{per person}

BlueNet (POS) no coinsurance yes yes

Braces, cervical collars,

elastic stockings 80% of eligible expenses 90% of eligible expenses

Breast Prostheses &

Surgical Bras (single/double) $400/$800 per calendar year per person $400/$800 per calendar year per person

Cardiac Rehabilitation _{maximum per person}$500 lifetime _{maximum per person}$500 lifetime

Clinical Psychology $450/calendar year _{per person} $450/calendar year _{per person}

Crutches, splints, casts & canes 80% of eligible expenses 90% of eligible expenses

Day Surgery - Assisted Care _{maximum $200/surgery}$20-$40/day; _{maximum $400/surgery}$20-$40/day;

Eye Exam _{24 months per person}1 Eye Exam every

Hearing Aids

no coinsurance $300 every 5 calendar years per person $500 every 5 calendar years per person $800 every 5 calendar years per person

Hospital Bed _{maximum per person}$1000 lifetime _{maximum per person}$1000 lifetime

Hospital In-patient Allowance

(no coinsurance) hospitalized illness$10/day per hospitalized illness$10/day per

Nutritional Counselling $450/calendar year _{per person} $450/calendar year _{per person}

Orthopedic Shoes $200/calendar year _{per person} $200/calendar year _{per person}

Orthotics $100/calendar year _{per person} $100/calendar year _{per person}

Physiotherapy $450/calendar year _{per person}

Podiatry/Foot Care by Nurses $450/calendar year _{per person} $450/calendar year _{per person}

Prescription Drugs

no coinsurance $160/calendar year per certificate $400/calendar year per certificate $130/calendar year per certificate $200/calendar year per certificate $800/calendar year per certificate Private Duty Nursing $2000/calendar year _{per person} $2500/calendar year _{per person} $3000/calendar year _{per person}

Respirator _{maximum per person}$1000 lifetime _{maximum per person}$1000 lifetime

Special Equipment including medical devices used to aid daily living

$250 lifetime

maximum per person maximum per person$250 lifetime

Specialist Referral $0.30/km; $200 per calendar year for treatment not _{available within a 150km radius of your residence.} Travel Protection _{maximum per person}$1000/calendar year _{maximum per person}$2500/calendar year

Tutorial Benefits $15/hour; maximum $1500 per illness

Vision Care - no coinsurance $100/24 months _{per person}

Walker _{maximum per person}$500 lifetime _{maximum per person}$500 lifetime

Wheelchair _{maximum per person}$1000 lifetime _{maximum per person}$1000 lifetime

Wigs _{maximum per person}$1000 lifetime _{maximum per person}$1000 lifetime

AMBULANCE/HOSPITAL BENEFITS

Emergency Ambulance No maximum; services provided by a participating operator within Manitoba.

Non Emergency Ambulance No maximum; services must be recommended by the attending physician if patient cannot walk and cannot be transported by any other means. Treat No Transport Ambulance Ambulance called to scene and provides treatment but does not transport to hospital.

Air Ambulance $5000/trip; annual maximum $10,000/person.

Out of Province Ambulance $500 maximum/trip.

Hospital - Semi Private Room Maximum 60 days/hospital/calendar year/person.

Stretcher Service (Medical Van) $400 lifetime maximum/person.

Hostel Care Available for those requiring medical treatment/diagnostic testing in a hospital located outside a 60 kilometer radius of your home. Hospital Allowance In the event that semi-private accommodations are unavailable; $20/day, maximum 60 days/calendar year/person.

BASIC BLUE MEDI-BLUE MEDI-BLUE DELUXE GENX PLUS PLAN PLUS PLAN DELUXE

We have Manitoba covered

...

2 Is a Manitoba Blue Cross

plan right for you?

...

3 Why choose Manitoba

Blue Cross?

...

4 Our Plans

... ....

5 Basic Blue Plan

...

6-7

Medi-Blue Plan

...

8-9

Medi-Blue Deluxe Plan

...

10-11

Plus Plan

...

12-13

Plus Plan Deluxe

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