Your DGC Benefits Plan provides you and your family with valuable, affordable mental and physical health coverage and financial protection if you experience an illness, injury or disability. In this section, we explain how the plan works and what’s covered under each level.
There are few things in life as important as good health. The DGC Benefits Plan is designed to help ensure you get the health and medical care you need — when you need it.
The DGC Benefits Plan provides three distinct levels of coverage, plus Life Member and Enhanced Life Member coverage. See Coverage Level Overview for a summary of each coverage level and Life Member coverage.
Each year, during the re-enrolment period, you’ll be assigned an automatic coverage level for the upcoming plan year based on your producer contributions. If your automatic coverage level doesn’t meet your benefit needs, you can, if you wish, upgrade your coverage. If you upgrade your coverage, keep in mind that your new coverage level will apply to all of your DGC Benefits – except Short-Term Disability (STD).
Remember, you can use your Healthcare Spending Account (HSA) to offset the cost of those services and procedures not covered (or not fully covered) under your coverage level.
If you have Level I, II or III coverage, there is a $250,000 per person per calendar year coverage limit for all healthcare coverage (excluding Out-of-province/country emergency medical insurance).
If you have Life Member or Enhanced Life Member coverage, there is a $100,000 per person per calendar year coverage limit for all healthcare coverage (excluding Out-of- province/country emergency medical insurance).
Benefit maximums and deductibles run on a calendar year basis (January 1 to December 31), with the exception of eye exams and vision care, which run on a 24-month cycle, based on the date of your last claim.
Remember, you can use your HSA to offset the cost of those services and procedures not covered (or not fully covered) under your coverage level.
If you’ve been issued a health insurance card by the Régie de l’assurance-maladie du Québec (RAMQ), the Quebec government requires that you must have basic prescription drug insurance from either:
Private plan coverage must meet the minimum RAMQ requirements.
DGC Benefits Quebec Drugs Only covers 75% of eligible prescription drug expenses for you and your eligible dependants. Once you have paid $800 out-of-pocket, the plan will reimburse you at 100% for the balance of the plan year. A drug card is provided. Quebec Drugs Only coverage is available only if you are a resident of Quebec, as required by provincial legislation. That said, you do not need to add Quebec Drugs Only, or upgrade if have drug coverage through another source (e.g., your spouse’s plan).
If you do not qualify for coverage under the DGC Benefits Plan, and you don’t have enough money in your dollar bank to cover the full cost, and you are not eligible for coverage under another private plan, you must register for the Quebec prescription drug insurance plan (RAMQ).
You must upgrade your coverage to Level I, or to Level II or III (to get family drug coverage if you have dependents), or at least add Quebec Drugs Only coverage for yourself and your dependants.
Individual drug coverage is included in Level I coverage. If you have dependants, you must upgrade your coverage to Level II or III (to get family drug coverage), or at least add Quebec Drugs Only coverage for your dependants.
You must upgrade your coverage to Level II, III or Enhanced Life Member coverage (to get family drug coverage), or at least add Quebec Drugs Only coverage for you and your dependants.
You have the option to upgrade your coverage to Level II, III or Enhanced Life Member coverage (to get family drug coverage), or add Quebec Drugs Only coverage for you and your dependants. Or, you can continue to have Life Member coverage and choose to be covered under the (RAMQ) drug plan (from age 65, you have the choice).
At age 65, you are automatically covered under the (RAMQ) drug plan unless you advise them that you do not need it. RAMQ charges a premium which you pay through your income tax return. You have the option to purchase Quebec Drugs Only for yourself or your family.
Prescription drugs and drug supplies, as described below, that are prescribed by a physician or other qualified health professional (as allowed by law) and are provided in Canada are covered:
Reimbursement will be based on the lowest cost alternative (usually a generic drug). Generic drugs typically cost 75% – 80% less than their brand name counterpart — even though they have the same active ingredients and are equally effective.
Drug purchases must be limited to what can reasonably be used within 34 days. The exception is maintenance drugs (e.g., antiasthmatics, anticoagulants, cardiac agents, oral contraceptives, etc.). Purchases for maintenance drugs should be limited to what can reasonably be used within 100 days.
Pre-approval is required by our insurance carrier for some drugs. You will be advised if pre-approval is required when you present your prescription to the pharmacist. Alternatively, you can find out which drugs require pre-approval by contacting Canada Life.
The following services and supplies are covered (based on your coverage level, as well as applicable deductibles and reimbursement rates), provided they are:
All services and supplies covered under the DGC Benefits Plan must represent reasonable treatment — meaning they must be accepted by the Canadian medical profession, proven to be effective, and of a form, intensity, frequency and duration that is essential to diagnose or manage a disease or injury.
R&C limits are the normal range of fees for services and supplies in a given geographical area. You can contact Canada Life about R&C limits for your area before any service or treatment.
Provincial drug programs provide eligible Canadians with access to prescription drugs.
Coverage varies from province to province, but includes seniors, recipients of social assistance, and individuals with diseases or conditions that are associated with high drug costs.
For details on the drug program in your province, click on the appropriate link below:
Treatment for an accidental injury to sound, natural teeth, provided:
A sound tooth is any tooth that did not require restorative treatment immediately before the accident. A natural tooth is any tooth that has not been artificially replaced.
Only treatment that is completed within 12 months of your injury will be covered.
Expenses for smoking cessation drugs prescribed by a licensed medical practitioner are covered up to $500 per person per lifetime. Non-prescribed medications are not covered.
The drug portion of the vaccine is covered under the plan. Any additional admin fees or lab fees are not covered.
LEVELS II, III & ENHANCED LIFE MEMBER
Up to $1,500 per person per calendar year for all services combined. Services must be provided by a qualified and licensed practitioner. Covered services include:
Benefits for these services are paid only after the maximum annual benefit has been paid under your provincial health plan. No benefits are paid for podiatric treatments eligible for any reimbursement (partial or full) under your provincial health plan.
Contact Canada Life to confirm coverage if using a practitioner for the first time. To be eligible for reimbursement, each of the above practitioners must be licensed by their respective provincial governing bodies that regulate the services they provide. Governing bodies and eligible practitioners are not consistent in every province.
EYE EXAMS (LEVELS I, II, III, LIFE MEMBER & ENHANCED LIFE MEMBER)
Expenses for eye examinations (including refractions) are covered when performed by a licensed ophthalmologist or optometrist and coverage is not available under your provincial plan. You have up to $100 per person every 24 months for Levels I, II, III, Life Members and Enhanced Life Members.
EYEGLASSES AND CONTACT LENSES (LEVELS I, II, III, LIFE MEMBER & ENHANCED LIFE MEMBER)
Expenses for prescription eyeglasses and contact lenses are covered at up to $400 per person per 24 months for Levels I, II, Life Member and Enhanced Life Member coverage; and up to $500 per person per 24 months for Level III coverage.
LASER EYE SURGERY (LEVEL III ONLY)
Expenses for laser eye surgery performed by a licensed ophthalmologist are covered up to a $2,000 lifetime maximum per person.
AMBULANCE SERVICES (LEVELS I, II, III, LIFE MEMBER & ENHANCED LIFE MEMBER)
Transportation by a licensed ambulance service (including air ambulance) to the nearest medical facility where adequate treatment is available. If transportation is to a facility other than the closest one, alternative benefits will be provided, based on the cost of transportation to the nearest centre where essential treatment is available. Coverage is paid at 70% for Level I, 75% for Level II, and 100% for Level III and Life Members.
CONVALESCENT CARE (LEVELS I, II, III, LIFE MEMBER & ENHANCED LIFE MEMBER)
Room and board in a convalescent care facility for a condition that will significantly improve as a result of continuing care. Convalescent care must begin immediately following three or more days of confinement in an acute care facility.
DIAGNOSTIC TESTS AND X-RAYS (LEVELS I, II, III & ENHANCED LIFE MEMBER)
The cost of eligible diagnostic tests and x-rays (excluding administration fees), when coverage is not available under your provincial health plan.
HEARING AIDS (LEVELS I, II, III, LIFE MEMBER & ENHANCED LIFE MEMBER)
Hearing aids (including tubing and ear molds provided at the time of purchase) when prescribed by a doctor. Up to $1,000 per person every five years.
HOME NURSING CARE (LEVELS I, II, III, LIFE MEMBER & ENHANCED LIFE MEMBER)
The home nursing services of a registered nurse, licensed practical nurse or registered practical nurse, based on the level of skill needed to provide essential acute, convalescent or palliative care. The nurse cannot be a member of the patient’s family. A pre-care assessment by Canada Life is required to determine the appropriate level of care. Coverage is limited to a maximum of $10,000 per person in a calendar year.
HOSPITAL (SEMI-PRIVATE) (LEVELS I, II, III, LIFE MEMBER & ENHANCED LIFE MEMBER)
The difference between the public ward allowance under your provincial health plan and the cost of semi-private accommodation, provided you are confined to a licensed hospital.
*The DGC Benefits Plan will only cover digital castings created by “anatomical volumetric foot model” (AVFM). Please contact Canada Life before purchasing your orthotics. See the Canada Life bulletin for further information.
Regardless of your coverage level, the DGC Benefits Plan will not pay any benefit or accept liability for any claims relating to expenses such as (but not limited to) the following:
Your coverage will continue as long as you earn producer contributions, use money from your dollar bank, or pay out of your pocket to buy coverage (provided you are a member in Active Good Standing). For more about continuing coverage, see Determining Coverage Levels.
If you are a Life Member — your coverage will continue as long as you remain a DGC member.
Your spouse’s coverage ends when your coverage ends, or if you move to Level I coverage, which does not include family coverage. Coverage for a dependent child ends when your coverage ends, you move to Level I, or the child no longer qualifies as a dependant… whichever is first.
If you die while a member in Active Good Standing, the Trustees may offer to continue coverage to your dependants (spouse and dependant children) for a period of time based on your years of membership in the DGC (see table below).
The minimum coverage is Level II, which includes family coverage. If you have Level I or II coverage at the time of your death, your survivors will receive Level II coverage. If you have Level III coverage at the time of your death, then your survivors will receive Level III.
YEARS OF DGC MEMBERSHIP | PERIOD OF CONTINUING COVERAGE |
|---|---|
Less than 15 years | 3 years |
15 – 19 years | 4 years |
20+ years | 5 years |
