Health & Dental Care Benefits

There’s no time like the present if your employer-sponsored health and dental benefits are about to terminate. You and your spouse are eligible to enroll provided you:

• had coverage under an employer-sponsored group insurance plan while employed;
• are between the ages of 50-80 (inclusive);
• are a Canadian resident; and
• are currently covered under a government health plan.

If you choose to enroll in a MROO Health & Dental Plan, you may also be eligible for our Annual Travel Insurance plan. Click here for more information.

It makes sense to enroll as soon as your employer benefits stop.

• If you enroll within 90 days of the termination of your employer-sponsored benefits, your acceptance is guaranteed. No medical questions will be asked.
• Enroll in the optional MROO Annual Travel Insurance Plan now. You only have one chance to enroll in the MROO Annual Travel Insurance Plan and that is when you are applying for a Health Care Plan. See Annual Travel Insurance for details.
• Acceptance in the MROO Annual Travel Insurance Plan is contingent on acceptance in the Health Care Plan. For Health and Dental Plans, Conditions, limitations, and exclusions may apply. Please see policy for full details.

If you missed the 90-day guaranteed acceptance period, you can enroll up to age 80 (inclusive). Acceptance is subject to the completion of a medical questionnaire and approval by Manulife.

Hospital Accommodation – Up to $5,000 per calendar year

This benefit pays the difference between the cost of ward and semi-private hospital accommodation while in Canada. If you are unable to obtain semi-private accommodation, the plan pays a benefit of $50 for each 24-hour period of ward hospitalization.

Prescription Drugs and Medicine – Up to $2,400 per calendar year

You are covered for up to 90% of the combined cost of prescription drugs and dispensing fees with a written prescription from a physician or dentist and dispensed by a licensed pharmacist. Dispensing fees are limited to $7 per prescription. Medical marijuana coverage will be approved if a doctor authorizes it for a condition where there is evidence supporting its use, such as: stiffness and involuntary muscle spasms in people suffering from Multiple Sclerosis, nausea and vomiting in people undergoing chemotherapy, and chronic neuropathic pain. 

With your Manulife drug card, you can submit your claims online quickly and easily.

Orthopedic Shoes – Up to $200 per calendar year

One pair of orthopedic shoes per calendar year is covered when prescribed by a physician or podiatrist.

Ambulance Service – Unlimited ground and air transportation per calendar year

The plan pays the cost of professional ground or air ambulance transportation to a hospital.

Home Nursing – Up to $5,000 per calendar year

The plan pays fees for private duty in-home registered nursing care when recommended by a physician.

Accidental Dental – Up to $10,000 per calendar year

Within one year of the accident, the plan will pay the services of a dental surgeon for treatment of a fractured jaw or charges for repair or replacement of natural teeth due to an accidental external blow to the head.

Paramedical Services – Up to $400 per specialty per calendar year

You can claim for fees incurred for visits to licensed practitioners. There is a $50 maximum per visit to a: chiropractor, physiotherapist, podiatrist, chiropodist, speech therapist, osteopath, naturopath, acupuncturist and Registered Massage Therapist. For chiropractors, the plan also pays a $15 maximum for one x-ray per calendar year. All paramedical fees are paid after you reach your government health plan limit.

Psychologist – Up to $500 per calendar year

The plan covers the fees of a psychologist, psychotherapist, or social worker for treatment/therapy up to $50 per visit.

Hearing Aids – Up to $500 within any consecutive 36-month period

You can claim for the purchase or repair of prescribed hearing aids when initially required, or if required due to a change in prescription.

Diagnostic Services – One per calendar year

The cost of one Prostate Specific Antigen (PSA) test per calendar year is covered.

Medical Supplies and Prostheses – Up to $5,000 per calendar year

After reimbursement by any government plan, the plan will cover:

• ostomy and diabetic supplies
• glucometer (lifetime maximum of one up to $400)
• mastectomy brassieres (two per calendar year)
• wigs (lifetime maximum of $300)
• prescribed orthotic appliances ($500 per calendar year)
• oxygen
• diagnostic laboratory services and radiology treatments (x-rays and radium therapy)
• artificial limbs or eyes
• trusses
• wheelchairs (lifetime maximum of $2,500)
• hospital beds
• iron lungs
• braces, canes, walkers and crutches
• surgical stockings (four pairs per calendar year)
• Continuous Positive Airway Pressure (CPAP) devices and supplies

Vision Care – Up to $300 within any consecutive 24-month period

The plan covers the cost of prescription lenses and frames, contact lenses and laser eye surgery. Supplementary coverage is also included for expense incurred (in excess of reimbursement by any government health care plan) for one optometrist visit within any consecutive 24-month period.

This plan provides all the benefits included in the Health Care Plan, PLUS an extensive Dental Care plan.

Dental Care – Up to $1,500 per insured, per calendar year for Basic and Major Restorative Services (combined)

Benefits paid are based on the current year’s Dental Association Fee Guide for your province/territory of residence.

Basic Services

The plan covers 80% of the fee charged for the following services:

• dental x-rays
• minor restorative fillings
• preventative care, which includes routine examinations and cleanings to a maximum of one treatment every six months
• minor surgical benefits (includes extractions and oral surgical procedures)
• periodontics (treatment of gums and mouth tissue)
• endodontics (root canal therapy)
• denture work, which includes repairs, rebasing and relining
• consultation required by the attending dentist

Major Restorative Services

The plan covers 50% of the fee charged for the following services:

• inlays, onlays and crowns
• dentures and bridgework
• denture adjustments
• dental implants (up to an amount equal to the least expensive cost of a denture or bridge)
  

Pre-determination

If covered dental charges of more than $300 are to be incurred during any six-month period, prior approval must be obtained from Manulife. For Health and Dental Plans, Conditions, limitations, and exclusions may apply. Please see policy for full details.
 

Maple Virtual Health Care Service

Connect instantly with a Canadian-licensed physician by mobile phone, tablet or computer, anytime 24/7. Just like your regular doctor, Maple physicians can provide medical advice, diagnosis and treatment for many conditions such as chronic conditions, joint pain, UTIs, cold/flu, skin issues, eye/ear/bladder infections, and more. Avoid waiting rooms and unnecessary trips to the clinic and receive care at your convenience. 

Visit getmaple.ca/victor for more details.

Review Your Policy Right Away

Once you have received your policy you will have 10 days to review it. If you are not completely satisfied, simply return it within that time for a full refund of premiums less any claims paid.

Survivor Benefits

If you die while you and your spouse are both enrolled under a MROO health plan, your spouse may keep their insurance coverage as long as premium continues to be paid. Premium would be reduced to the single coverage rate at the time MROO is notified of your death.

Exclusions

The following prescription drug expenses are not eligible:

• drugs prescribed for sexual dysfunction
• drugs prescribed for obesity control
• experimental drugs

The following dental services are not eligible:

• dental treatment that began before the effective date of your MROO plan
• fluoride treatments
• appliances, restorations or treatments related to temporomandibular (jaw) joint dysfunction

The following exclusions apply to all plans:

• services not listed as allowable expenses
• self-inflicted injuries
• expenses incurred outside Canada for Hospital and Physicians’ services
• anything resulting from war, terrorism or services in the Armed Forces
• cosmetic surgery or treatment unless required as the result of accidental injury
• charges for broken or missed appointments
• telephone advice
• fees or services covered by another insurance plan or government agency