The Major Medical and Drug Plan for Pensioners pays up to $50,000 in lifetime benefits for you and each of your dependents. On January 2nd after being covered a full year, and on each subsequent January 2nd, any amount up to $1,000 which has been counted against the maximum will be automatically restored.
You are eligible for this coverage if you retire at or after age 55, and are receiving a pension from the Local 46 ICI/High Rise or Barrie Pension Plans or receive a commuted value of your pension (or a distribution from the Low Rise Pension Plan) at retirement. Note that you must remain a member in good standing of Local 46 to receive pensioner coverage.
If you retire prior to age 65, your bank will continue to be charged monthly deductions until its balance is less than one month’s deduction, or until you reach age 65. During this period your benefits coverage will continue as though you were an active member except for short term and long term disability benefits. When your bank falls below one month’s deduction, you must pay the assisted coverage rate to receive pensioner coverage to age 65. You are not eligible for assisted pensioner coverage unless you start your pension from the Local 46 ICI/ High Rise or Barrie Pension Plans or take a distribution from the Low Rise Pension Plan and have had contributions at the full Local 46 rate made on your behalf to the Health Plan (includes the Barrie Health Plan) for a continuous period of 15 years before you retire (and you did not retire on an early reduced pension prior to 2013). Periods on pay direct not exceeding 12 months in the 5 years immediately preceding retirement count towards the 15 year requirement. If you do not meet the 15 year requirement you may still qualify provided contributions on your behalf averaged at least 1,500 hours a year at the full Local 46 ICI rate from 1985 to your date of retirement. You will not qualify for assisted or free pensioner coverage if you paid direct for more than 12 months in the 5 years immediately preceding retirement. If you return to work after age 65 and are already receiving pensioner coverage, this will continue. You will not be eligible for Active Member coverage.
Following retirement, pensioner coverage will commence after you have exhausted your bank, or the month following your 65th birthday, if earlier. During the period your bank is being run out and while you are drawing a pension, Short Term and Long Term Disability Benefits do not apply. If you do not qualify for assisted or free pensioner coverage, you must pay the full pensioner premium rate (both before and after age 65) to receive pensioner coverage, provided you were covered by the Plan immediately prior to your retirement and there was no break in coverage and are not ineligible for coverage. The full pensioner premium rate is currently $180 (plus tax). You will be required to provide proof of good health if you were not covered for health benefits immediately prior to retirement, and wish to apply for reinstatement into the Plan.
HOW THE PLAN WORKS
The Major Medical plan pays 100% of the dispensing fee on prescription drugs (excluding dispensing fees required to be paid under the Ontario Drug Benefit Program), vision care and hearing aid expenses (all subject to dollar limitations), 90% of the ingredient cost of prescription drugs and 75% of all other covered expenses except stair lifts which are covered at 50%. Many have dollar or other limitations.
There is a maximum lifetime benefit of $50,000 for you and each of your dependents.
Eligible expenses are considered to have been incurred on the date the services are rendered or the product is supplied.
Major Medical will pay the following percentages of the cost for usual, reasonable, customary and necessary medical services and medical supplies prescribed by a legally qualified physician or surgeon. The Plan only covers those services not covered by Government Plans (with the exception of out of country coverage and coverage under the Assistive Devices Program); however, it will not cover any supply or service that was an eligible expense under an applicable Government Plan as at May 1, 1996 unless specifically listed as a covered expense.
Reimbursement will be considered only when the services are provided by a provider approved by the Trustees on the advice of MBC.