Benefits Tables

GENERAL INFORMATION

OUR COMMITMENT TO PRIVACY

The Green Shield Canada Privacy Code balances the privacy rights of our group and benefit plan participants, and our employees, with the legitimate information requirements to provide customer service and to meet our human resource requirements. It consists of the following key principles:

1. We ask for your personal information for the following purposes:

To establish your identification
To provide you and/or your dependants with the applicable benefit coverage
To protect you and us from error and fraud
To provide ongoing services

2. Consent
When you enrolled in your group benefit plan as a plan participant, your personal information was obtained and used only with your consent. We obtained your consent before we:

Provided benefit coverage
Offered you other Green Shield Canada services
Obtained, used or disclosed to other persons, information about you unless we were obliged to do so by law or to protect our interests
Used your personal information in any way we did not tell you about previously

Your consent can be either express or implied. Express consent can be verbal or written.

Consent can be implied or inferred from certain actions. For our existing group and benefit plan participants, we will continue to use and disclose your personal information previously collected in accordance with our current privacy code, unless you inform us otherwise and will infer that consent has been obtained by your continued use.

3. Withdrawal of Consent
You can withdraw your consent any time after you've given it to us, provided there are no legal or regulatory requirements to prevent this.

If you don't consent to certain uses of personal information, or if you withdraw your consent, we will no longer be able to administer your benefit coverage. If so, we will explain the situation to you to help you with your decision.

For further information on our privacy policies and procedures, please refer to the Green Shield Canada web site at www.greenshield.ca

LIMITED BENEFIT CLAUSE

Green Shield will determine the amount of benefits payable, giving consideration to limited procedures, services, or courses of treatment. The attending physician/dentist and the patient have the option of which procedure to use, although payment for the procedure may be based on the "limited treatment" principle. The Limited Benefit Clause is a financial limitation and not intended as a comment regarding any treatment recommended or performed by a physician/dentist.

PREDETERMINATION

If the cost of any proposed treatment is expected to exceed $300.00, submit to Green Shield a detailed treatment plan from your provider before your treatment begins. If a description of the procedures to be performed and an estimate of the charges are not submitted in advance, Green Shield reserves the right to make a determination of benefits payable, taking into account alternate procedures, services or course of treatment, based on accepted standards of medical/dental practice.

GENERAL OVERALL EXCLUSIONS

Eligible Services do not include and reimbursement will not be made when we are aware of or have been apprised of:

1. Services or supplies received as a result of disease, illness or injury due to any of:

intentionally self-inflicted injury while sane or insane
an act of war, declared or undeclared
participation in a riot or civil commotion
committing a criminal offence

2. Failure to keep a scheduled appointment with a licensed medical/dental practitioner.

3. Services or supplies which are cosmetic in nature.

4. The completion of any claim forms and/or insurance reports.

5. Services or supplies which do not meet accepted standards of medical/dental/ophthalmic practice, including charges for services or supplies which are experimental in nature.

6. Services or supplies normally paid through any provincial government health plan, Workplace Safety & Insurance Board, the Assistive Devices Program or any other Government Agency, or which would have been payable under such a plan had proper application for coverage been made, or had proper and timely claims submission been made.

7. Services or supplies from any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipal or other governmental body.

8. Services or supplies which are not recommended or approved by the attending physician/dentist.

9. Services or supplies that you are not obligated to pay for or for which no charge would be made in the absence of benefit coverage.

10. Services or supplies which are legally prohibited by the government from coverage.

11. The replacement of lost, missing or stolen items, or items which are damaged due to negligence.

12. Any eligible service that relates to treatment of injuries arising out of a motor vehicle accident.

CO-ORDINATION OF BENEFITS (COB)

Where you or your dependents have coverage with more than one carrier, claims shall be coordinated so that reimbursement from all coverages shall not exceed 100% of the actual claim. Ask for our COB brochure for information on how your family can receive this service.

SUBROGATION

Green Shield retains the right to subrogation if benefits have or should have been paid or provided by a third party. In cases of third party liability, you must advise your lawyer of these rights.

GROUP CONVERSION PACKAGE

Any participant who will no longer be eligible under the Member Benefits Trust plan and who will lose their group benefits may enroll in the Green Shield Group Conversion Program.

Dependent children who are no longer eligible for benefits under their parents Green Shield group benefits program may also enroll in the Green Shield Group Conversion Program.

Call (416) 601-0429 in the Toronto area or toll-free at 1 800 667-0429 for an information package. You must apply within 60 days of termination of your benefits from your Green Shield group program.

June 1, 2010

Top of Page

MEMBER BENEFITS TRUST

CLASS – 2

OUTLINE OF BENEFITS

Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact the Member Benefits Trust at (604) 685-1678, or the Green Shield Customer Service Centre toll free at 1-888-711-1119 to determine benefit eligibility and coverage details. Green Shield Canada’s Customer Service Centre is available 5:30 am to 4:30 pm Pacific Standard Time.

BENEFIT YEAR

Your benefit year runs from June 1 to May 31 each year. Where applicable, your deductible, co-pay and/or maximums will be calculated for this 12 month period each year.

DRUG

A co-payment of 25% of the drug cost plus the dispensing fee applies to each prescription.
Your overall Drug maximum is $5,000 per participant, per calendar year.
Drugs are eligible only if the drug is a benefit of your current provincial medical plan.
Drugs may be submitted on a Pay Direct basis at your pharmacy.
Benefits include drugs legally requiring a prescription by law, diabetic needles and syringes.
Benefits do not include medication for the treatment of anti-obesity, erectile dysfunction, and fertility. Serums and vitamins are also ineligible unless injected and medically necessary.
Smoking cessation products are covered with a $200 lifetime maximum per person. Products available over the counter are ineligible.
If you are a resident of Ontario, The Ontario Drug Benefit co-pay for seniors is not a benefit.
In the province of Quebec, legislation states that Green Shield Canada is obligated to follow RAMQ reimbursement guidelines for all residents of Quebec. For those 65 years of age and under, Green Shield Canada is primary payor.

HEALTH SERVICES

Your overall Health deductible is Nil.
Your co-payment for Health Services is 5%.
Co-payments do not apply to Accommodations, Vision, Audio and Travel Benefits.
Co-payments apply to Emergency Transportation, Medical Items, Paramedical Services, Dental Accident, and Eye Exams.

EMERGENCY TRANSPORTATION

Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment.

ACCIDENTAL DENTAL BENEFITS

Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident.

ACCOMMODATION

SEMI-PRIVATE

Semi-Private Room in a public general hospital

AUDIO

Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a maximum of $750 once every 5 years.
Batteries are not eligible.

MEDICAL ITEMS

Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit.

OPTOMETRIST EYE EXAMS

Optometrist eye examinations performed by a licensed Optometrist limited to one exam up to a maximum of $65 per 24 months. Applicable co-payment will be applied. Note: the Provincial Health Care Plan must be used first (where applicable).

PARAMEDICAL SERVICES

Physiotherapist, Registered Clinical Psychologist, Registered Clinical Counselor, Registered Social Worker, Chiropractor, Osteopath, Podiatrist/Chiropodist, Naturopath, Registered Massage Therapist (medical referral required), Speech Therapist, Acupuncturist (physician/surgeon or anyone licensed through the Acupuncture Foundation of Canada to perform acupuncture) up to a $500 maximum per paramedical discipline per benefit year (June 1 to May 31)

NOTE:

The above listed paramedicals are subject to a combined overall maximum of $900, per participant, per benefit year (June 1 to May 31).
All paramedical services, excluding Psychologist benefits, are subject to a maximum reimbursement of $30 per visit (June 1 to May 31). Applicable co-payment will apply.
Paramedical services are only eligible when the practitioner rendering the service is licensed by their provincial association and that association is recognized by Green Shield Canada. Please contact the Green Shield Customer Service Centre to confirm eligibility when in doubt.
Private Duty Nursing Benefits carry a maximum of $15,000 per benefit year (June 1 to May 31) for the services of a registered nurse (R.N.) or registered nurses assistant (R.N.A.) in the home on a full or part shift basis.

VISION

Your Vision Benefit carries a maximum of $250 every 24 months (or $250 every 12 months if a change in prescription occurs) for prescription eye glasses (including prescription sunglasses) and/or contact lenses and/or towards laser eye surgery provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist.

Commencement of your benefit period is based on the initial date you receive vision benefits. This service date is the actual pick-up date of the eyewear.

As a Green Shield subscriber, you have access to our national preferred provider vision network arrangement with “The Bay Optical” and “Zellers Vision Centre” stores.

All Green Shield subscribers are eligible to receive a discount of 33% off the regular prices available at “The Bay Optical” and “Zellers Vision Centres”. This offer applies to all extra coatings and upgrades. (Excludes disposable contact lenses).

Features of this great value-added service include:

offer applies to any Green Shield subscriber, regardless of whether you have Green Shield vision benefits or not
direct billing to Green Shield by the provider; the subscriber just pays any portion not covered
trustworthy retail chains with convenient locations
discount offer applies to everything such as coatings, upgrades and accessories
hundreds of the latest frame styles to choose from plus latest lens and coating technology
professional opticians to assist in selecting products
offer applies to non-disposable contact lenses

To find a Bay Optical store near you, call the toll free store locator at 1-866-BAY-EYES. Or visit our web site at www.greenshield.ca

CLAIMING INFORMATION

Present your Green Shield Identification Card as proof of being a Green Shield subscriber.
The vision provider will apply the appropriate discount(s) to your claim and submit the claim directly to Green Shield for payment. You pay your vision provider any balance not covered under your vision benefit
If no vision benefits exist, you pay your provider the full balance owing after the applicable discounts have been applied.

TRAVEL BENEFITS

Travel Benefits are eligible within the first 90 days per trip while traveling or vacationing outside of the Province/Country.
Canadian residents are covered while temporarily residing outside of the country provided they maintain their government health insurance plan coverage. Note: the 90 day per trip out-of-province/country travel limit would apply.
Your maximum is $1,000,000 per calendar year for Emergency Services; and $50,000 per calendar year for Referral Services.
Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of the services received.
Green Shield must be contacted by phone within 48 hours of commencement of treatment, by dialing 1-800-936-6226 within Canada or USA or call collect 0 519-742-3556. These telephone assistance numbers are also located on the reverse of your Green Shield Identification Card.
Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling.

For complete details on your travel benefits, please refer to the enclosed Deluxe Travel Plan Booklet.

Top of Page

MEMBER BENEFITS TRUST

CLASS – 3

OUTLINE OF BENEFITS

Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact the Member Benefits Trust at (604) 685-1678, or the Green Shield Customer Service Centre toll free at 1-888-711-1119 to determine benefit eligibility and coverage details. Green Shield Canada’s Customer Service Centre is available 5:30 am to 4:30 pm Pacific Standard Time.

BENEFIT YEAR

Your benefit year runs from June 1 to May 31 each year. Where applicable, your deductible, co-pay and/or maximums will be calculated for this 12 month period each year.

DRUG

A co-payment of 25% of the drug cost plus the dispensing fee applies to each prescription.
Your overall Drug maximum is $5,000 per participant, per calendar year.
Drugs are eligible only if the drug is a benefit of your current provincial medical plan.
Drugs may be submitted on a Pay Direct basis at your pharmacy.
Benefits include drugs legally requiring a prescription by law, diabetic needles and syringes.
Benefits do not include medication for the treatment of anti-obesity, erectile dysfunction, and fertility. Serums and vitamins are also ineligible unless injected and medically necessary.
Smoking cessation products are covered with a $200 lifetime maximum per person. Products available over the counter are ineligible.
If you are a resident of Ontario, The Ontario Drug Benefit co-pay for seniors is not a benefit.
In the province of Quebec, legislation states that Green Shield Canada is obligated to follow RAMQ reimbursement guidelines for all residents of Quebec. For those 65 years of age and under, Green Shield Canada is primary payor.

HEALTH SERVICES

Your overall Health deductible is Nil.
Your co-payment for Health Services is 5%.
Co-payments do not apply to Accommodations, Vision, Audio and Travel Benefits.
Co-payments apply to Emergency Transportation, Medical Items, Paramedical Services, Dental Accident, and Eye Exams.

EMERGENCY TRANSPORTATION

Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment.

ACCIDENTAL DENTAL BENEFITS

Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident.

ACCOMMODATION

SEMI-PRIVATE

Semi-Private Room in a public general hospital

AUDIO

Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a maximum of $750 once every 5 years.
Batteries are not eligible.

MEDICAL ITEMS

Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit.

OPTOMETRIST EYE EXAMS

Optometrist eye examinations performed by a licensed Optometrist limited to one exam up to a maximum of $65 per 24 months. Applicable co-payment will be applied. Note: the Provincial Health Care Plan must be used first (where applicable).

PARAMEDICAL SERVICES

Physiotherapist, Registered Clinical Psychologist, Registered Clinical Counselor, Registered Social Worker, Chiropractor, Osteopath, Podiatrist/Chiropodist, Naturopath, Registered Massage Therapist (medical referral required), Speech Therapist, Acupuncturist (physician/surgeon or anyone licensed through the Acupuncture Foundation of Canada to perform acupuncture) up to a $500 maximum per paramedical discipline per benefit year (June 1 to May 31)

NOTE:

The above listed paramedicals are subject to a combined overall maximum of $900, per participant, per benefit year (June 1 to May 31).
All paramedical services, excluding Psychologist benefits, are subject to a maximum reimbursement of $30 per visit (June 1 to May 31). Applicable co-payment will apply.
Paramedical services are only eligible when the practitioner rendering the service is licensed by their provincial association and that association is recognized by Green Shield Canada. Please contact the Green Shield Customer Service Centre to confirm eligibility when in doubt.
Private Duty Nursing Benefits carry a maximum of $15,000 per benefit year (June 1 to May 31) for the services of a registered nurse (R.N.) or registered nurses assistant (R.N.A.) in the home on a full or part shift basis.

VISION

Your Vision Benefit carries a maximum of $250 every 24 months (or $250 every 12 months if a change in prescription occurs) for prescription eye glasses (including prescription sunglasses) and/or contact lenses and/or towards laser eye surgery provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist.

Commencement of your benefit period is based on the initial date you receive vision benefits. This service date is the actual pick-up date of the eyewear.

As a Green Shield subscriber, you have access to our national preferred provider vision network arrangement with “The Bay Optical” and “Zellers Vision Centre” stores.

All Green Shield subscribers are eligible to receive a discount of 33% off the regular prices available at “The Bay Optical” and “Zellers Vision Centres”. This offer applies to all extra coatings and upgrades. (Excludes disposable contact lenses).

Features of this great value-added service include:

offer applies to any Green Shield subscriber, regardless of whether you have Green Shield vision benefits or not
direct billing to Green Shield by the provider; the subscriber just pays any portion not covered
trustworthy retail chains with convenient locations
discount offer applies to everything such as coatings, upgrades and accessories
hundreds of the latest frame styles to choose from plus latest lens and coating technology
professional opticians to assist in selecting products
offer applies to non-disposable contact lenses

To find a Bay Optical store near you, call the toll free store locator at 1-866-BAY-EYES. Or visit our web site at www.greenshield.ca

CLAIMING INFORMATION

Present your Green Shield Identification Card as proof of being a Green Shield subscriber.
The vision provider will apply the appropriate discount(s) to your claim and submit the claim directly to Green Shield for payment. You pay your vision provider any balance not covered under your vision benefit
If no vision benefits exist, you pay your provider the full balance owing after the applicable discounts have been applied.

DENTAL

Your deductible is nil.
Your overall Dental maximum is $500 per person, per benefit year (June 1 to May 31).
Stated maximums are based on paid claims.
Your co-insurance which is applied to the eligible allowed amount is 50% for Basic Services and 50% for Comprehensive Basic Services.
Beginning on the date of the first paid claim, recalls are covered every 6 months, other exams and full mouth x-rays every 3 years.
Comprehensive Basic Services cover denture relines 1 every 3 years.
Applicable lab, drug and other expenses are eligible to a maximum of 40% (50% cap on dentures) of the allowable professional fee. Any applicable co-payment is then applied.
Your eligible claims are reimbursed at the level stated above and in accordance with the current Provincial Dental Association Fee Guide for General Practitioners. In provinces with more than one fee guide, Green Shield will reimburse according to the least expensive standard fee (or fee range).

BASIC SERVICES

Recalls include exams, bitewing X-rays, preventive cleanings and fluoride treatments.
Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays.
Basic restorations, fillings and inlays.
Extractions and surgical services. General anesthetics and intravenous sedation only when done in conjunction with eligible extraction(s) and/or oral surgery. Sleep dentistry is not eligible.

COMPREHENSIVE BASIC SERVICES

Endodontic treatment including standard root canal therapy, excluding retreatments.
Periodontal treatment including scaling and/or root planing.
Standard denture services including relining and rebasing of dentures plus denture adjustments after 3 months from installation

TRAVEL BENEFITS

Travel Benefits are eligible within the first 90 days per trip while traveling or vacationing outside of the Province/Country.
Canadian residents are covered while temporarily residing outside of the country provided they maintain their government health insurance plan coverage. Note: the 90 day per trip out-of-province/country travel limit would apply.
Your maximum is $1,000,000 per calendar year for Emergency Services; and $50,000 per calendar year for Referral Services.
Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of the services received.
Green Shield must be contacted by phone within 48 hours of commencement of treatment, by dialing 1-800-936-6226 within Canada or USA or call collect 0 519-742-3556. These telephone assistance numbers are also located on the reverse of your Green Shield Identification Card.
Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling.

For complete details on your travel benefits, please refer to the enclosed Deluxe Travel Plan Booklet.

Top of Page

MEMBER BENEFITS TRUST

CLASS - 4

OUTLINE OF BENEFITS

Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact the Member Benefits Trust at (604) 685-1678, or the Green Shield Customer Service Centre toll free at 1-888-711-1119 to determine benefit eligibility and coverage details. Green Shield Canada’s Customer Service Centre is available 5:30 am to 4:30 pm Pacific Standard Time.

BENEFIT YEAR

Your benefit year runs from June 1 to May 31 each year. Where applicable, your deductible, co-pay and/or maximums will be calculated for this 12 month period each year.

DRUG

A co-payment of 25% of the drug cost plus the dispensing fee applies to each prescription.
Your overall Drug maximum is $5,000 per participant, per calendar year.
Drugs are eligible only if the drug is a benefit of your current provincial medical plan.
Drugs may be submitted on a Pay Direct basis at your pharmacy.
Benefits include drugs legally requiring a prescription by law, diabetic needles and syringes.
Benefits do not include medication for the treatment of anti-obesity, erectile dysfunction, and fertility. Serums and vitamins are also ineligible unless injected and medically necessary.
Smoking cessation products are covered with a $200 lifetime maximum per person. Products available over the counter are ineligible.
If you are a resident of Ontario, The Ontario Drug Benefit co-pay for seniors is not a benefit.
In the province of Quebec, legislation states that Green Shield Canada is obligated to follow RAMQ reimbursement guidelines for all residents of Quebec. For those 65 years of age and under, Green Shield Canada is primary payor.

HEALTH SERVICES

Your overall Health deductible is Nil.
Your co-payment for Health Services is 5%.
Co-payments do not apply to Accommodations, Vision, Audio and Travel Benefits.
Co-payments apply to Emergency Transportation, Medical Items, Paramedical Services, Dental Accident, and Eye Exams.

EMERGENCY TRANSPORTATION

Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment.

ACCIDENTAL DENTAL BENEFITS

Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident.

ACCOMMODATION

SEMI-PRIVATE

Semi-Private Room in a public general hospital

AUDIO

Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a maximum of $750 once every 5 years.
Batteries are not eligible.

MEDICAL ITEMS

Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit.

OPTOMETRIST EYE EXAMS

Optometrist eye examinations performed by a licensed Optometrist limited to one exam up to a maximum of $65 per 24 months. Applicable co-payment will be applied. Note: the Provincial Health Care Plan must be used first (where applicable).

PARAMEDICAL SERVICES

Physiotherapist, Registered Clinical Psychologist, Registered Clinical Counselor, Registered Social Worker, Chiropractor, Osteopath, Podiatrist/Chiropodist, Naturopath, Registered Massage Therapist (medical referral required), Speech Therapist, Acupuncturist (physician/surgeon or anyone licensed through the Acupuncture Foundation of Canada to perform acupuncture) up to a $500 maximum per paramedical discipline per benefit year ( June 1 to May 31)

NOTE:

The above listed paramedicals are subject to a combined overall maximum of $900, per participant, per benefit year (June 1 to May 31).
All paramedical services, excluding Psychologist benefits, are subject to a maximum reimbursement of $40 per visit (June 1 to May 31). Applicable co-payment will apply.
Paramedical services are only eligible when the practitioner rendering the service is licensed by their provincial association and that association is recognized by Green Shield Canada. Please contact the Green Shield Customer Service Centre to confirm eligibility when in doubt.
Private Duty Nursing Benefits carry a maximum of $15,000 per benefit year (June 1 to May 31) for the services of a registered nurse (R.N.) or registered nurses assistant (R.N.A.) in the home on a full or part shift basis.

VISION

Your Vision Benefit carries a maximum of $250 every 24 months (or $250 every 12 months if a change in prescription occurs) for prescription eye glasses (including prescription sunglasses) and/or contact lenses and/or towards laser eye surgery provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist.

Commencement of your benefit period is based on the initial date you receive vision benefits. This service date is the actual pick-up date of the eyewear.

As a Green Shield subscriber, you have access to our national preferred provider vision network arrangement with “The Bay Optical” and “Zellers Vision Centre” stores.

All Green Shield subscribers are eligible to receive a discount of 33% off the regular prices available at “The Bay Optical” and “Zellers Vision Centres”. This offer applies to all extra coatings and upgrades. (Excludes disposable contact lenses).

Features of this great value-added service include:

offer applies to any Green Shield subscriber, regardless of whether you have Green Shield vision benefits or not
direct billing to Green Shield by the provider; the subscriber just pays any portion not covered
trustworthy retail chains with convenient locations
discount offer applies to everything such as coatings, upgrades and accessories
hundreds of the latest frame styles to choose from plus latest lens and coating technology
professional opticians to assist in selecting products
offer applies to non-disposable contact lenses

To find a Bay Optical store near you, call the toll free store locator at 1-866-BAY-EYES. Or visit our web site at www.greenshield.ca

CLAIMING INFORMATION

Present your Green Shield Identification Card as proof of being a Green Shield subscriber.
The vision provider will apply the appropriate discount(s) to your claim and submit the claim directly to Green Shield for payment. You pay your vision provider any balance not covered under your vision benefit
If no vision benefits exist, you pay your provider the full balance owing after the applicable discounts have been applied.

DENTAL

Your deductible is $50 Single or $50 Family per benefit year (June 1 to May 31).
Your overall Dental maximum is $1,000 per person, per benefit year (June 1 to May 31).
Stated maximums are based on paid claims.
Your co-insurance which is applied to the eligible allowed amount is 20% for Basic Services, 20% for Comprehensive Basic Services and 50% for Major Restorative services.
Beginning on the date of the first paid claim, recalls are covered every 6 months, other exams and full mouth x-rays every 3 years.
Comprehensive Basic Services cover denture relines 1 every 3 years.
Major Restorative Services cover standard dentures, crowns and bridges once every 5 years.
Applicable lab, drug and other expenses are eligible to a maximum of 40% (50% cap on dentures) of the allowable professional fee. Any applicable co-payment is then applied.
Your eligible claims are reimbursed at the level stated above and in accordance with the current Provincial Dental Association Fee Guide for General Practitioners. In provinces with more than one fee guide, Green Shield will reimburse according to the least expensive standard fee (or fee range).

BASIC SERVICES

Recalls include exams, bitewing X-rays, preventive cleanings and fluoride treatments.
Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays.
Basic restorations, fillings and inlays.
Extractions and surgical services. General anaesthetics and intravenous sedation only when done in conjunction with eligible extraction(s) and/or oral surgery. Sleep dentistry is not eligible.

COMPREHENSIVE BASIC SERVICES

Endodontic treatment including standard root canal therapy, excluding retreatments.
Periodontal treatment including scaling and/or root planing.
Standard denture services including relining and rebasing of dentures plus denture adjustments after 3 months from installation

MAJOR RESTORATIVE SERVICES

Standard dentures, complete, immediate and partial.
Standard crown restorations or onlays on natural teeth.
Repair or recementing of crowns, onlays and bridgework on natural teeth.
Standard bridges, including pontics, abutment retainers/crowns on natural teeth.

TRAVEL BENEFITS

Travel Benefits are eligible within the first 90 days per trip while traveling or vacationing outside of the Province/Country.
Canadian residents are covered while temporarily residing outside of the country provided they maintain their government health insurance plan coverage. Note: the 90 day per trip out-of-province/country travel limit would apply.
Your maximum is $1,000,000 per calendar year for Emergency Services; and $50,000 per calendar year for Referral Services.
Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of the services received.
Green Shield must be contacted by phone within 48 hours of commencement of treatment, by dialing 1-800-936-6226 within Canada or USA or call collect 0 519-742-3556. These telephone assistance numbers are also located on the reverse of your Green Shield Identification Card.
Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling.

For complete details on your travel benefits, please refer to the enclosed Deluxe Travel Plan Booklet.

Top of Page

MEMBER BENEFITS TRUST

CLASS – 5

OUTLINE OF BENEFITS

Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact the Member Benefits Trust at (604) 685-1678, or the Green Shield Customer Service Centre toll free at 1-888-711-1119 to determine benefit eligibility and coverage details. Green Shield Canada’s Customer Service Centre is available 5:30 am to 4:30 pm Pacific Standard Time.

BENEFIT YEAR

Your benefit year runs from June 1 to May 31 each year. Where applicable, your deductible, co-pay and/or maximums will be calculated for this 12 month period each year.

DRUG

A co-payment of 25% of the drug cost plus the dispensing fee applies to each prescription.
Your overall Drug maximum is $5,000 per participant, per calendar year.
Drugs are eligible only if the drug is a benefit of your current provincial medical plan.
Drugs may be submitted on a Pay Direct basis at your pharmacy.
Benefits include drugs legally requiring a prescription by law, diabetic needles and syringes.
Benefits do not include medication for the treatment of anti-obesity, erectile dysfunction, and fertility. Serums and vitamins are also ineligible unless injected and medically necessary.
Smoking cessation products are covered with a $200 lifetime maximum per person. Products available over the counter are ineligible.
If you are a resident of Ontario, The Ontario Drug Benefit co-pay for seniors is not a benefit.
In the province of Quebec, legislation states that Green Shield Canada is obligated to follow RAMQ reimbursement guidelines for all residents of Quebec. For those 65 years of age and under, Green Shield Canada is primary payor.

HEALTH SERVICES

Your overall Health deductible is Nil.
Your co-payment for Health Services is 5%.
Co-payments do not apply to Accommodations, Vision, Audio and Travel Benefits.
Co-payments apply to Emergency Transportation, Medical Items, Paramedical Services, Dental Accident, and Eye Exams.

EMERGENCY TRANSPORTATION

Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment.

ACCIDENTAL DENTAL BENEFITS

Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident.

ACCOMMODATION

SEMI-PRIVATE

Semi-Private Room in a public general hospital

AUDIO

Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a maximum of $750 once every 5 years.
Batteries are not eligible.

MEDICAL ITEMS

Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit.

OPTOMETRIST EYE EXAMS

Optometrist eye examinations performed by a licensed Optometrist limited to one exam up to a maximum of $65 per 24 months. Applicable co-payment will be applied. Note: the Provincial Health Care Plan must be used first (where applicable).

PARAMEDICAL SERVICES

Physiotherapist, Registered Clinical Psychologist, Registered Clinical Counselor, Registered Social Worker, Chiropractor, Osteopath, Podiatrist/Chiropodist, Naturopath, Registered Massage Therapist (medical referral required), Speech Therapist, Acupuncturist (physician/surgeon or anyone licensed through the Acupuncture Foundation of Canada to perform acupuncture) up to a $500 maximum per paramedical discipline per benefit year (June 1 to May 31)

NOTE:

The above listed paramedicals are subject to a combined overall maximum of $900, per participant, per benefit year (June 1 to May 31).
All paramedical services, excluding Psychologist benefits, are subject to a maximum reimbursement of $50 per visit (June 1 to May 31). Applicable co-payment will apply.
Paramedical services are only eligible when the practitioner rendering the service is licensed by their provincial association and that association is recognized by Green Shield Canada. Please contact the Green Shield Customer Service Centre to confirm eligibility when in doubt.
Private Duty Nursing Benefits carry a maximum of $15,000 per benefit year (June 1 to May 31) for the services of a registered nurse (R.N.) or registered nurses assistant (R.N.A.) in the home on a full or part shift basis.

VISION

Your Vision Benefit carries a maximum of $250 every 24 months (or $250 every 12 months if a change in prescription occurs) for prescription eye glasses (including prescription sunglasses) and/or contact lenses and/or towards laser eye surgery provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist.

Commencement of your benefit period is based on the initial date you receive vision benefits. This service date is the actual pick-up date of the eyewear.

As a Green Shield subscriber, you have access to our national preferred provider vision network arrangement with “The Bay Optical” and “Zellers Vision Centre” stores.

All Green Shield subscribers are eligible to receive a discount of 33% off the regular prices available at “The Bay Optical” and “Zellers Vision Centres”. This offer applies to all extra coatings and upgrades. (Excludes disposable contact lenses).

Features of this great value-added service include:

offer applies to any Green Shield subscriber, regardless of whether you have Green Shield vision benefits or not
direct billing to Green Shield by the provider; the subscriber just pays any portion not covered
trustworthy retail chains with convenient locations
discount offer applies to everything such as coatings, upgrades and accessories
hundreds of the latest frame styles to choose from plus latest lens and coating technology
professional opticians to assist in selecting products
offer applies to non-disposable contact lenses

To find a Bay Optical store near you, call the toll free store locator at 1-866-BAY-EYES. Or visit our web site at www.greenshield.ca

CLAIMING INFORMATION

Present your Green Shield Identification Card as proof of being a Green Shield subscriber.
The vision provider will apply the appropriate discount(s) to your claim and submit the claim directly to Green Shield for payment. You pay your vision provider any balance not covered under your vision benefit
If no vision benefits exist, you pay your provider the full balance owing after the applicable discounts have been applied.

DENTAL

Your deductible is nil.
Your overall Dental maximum is $2,500 per person, per benefit year (June 1 to May 31), excluding Orthodontics.
Your lifetime maximum for Orthodontic benefits is $1,000.
Stated maximums are based on paid claims.
Your reimbursement which is applied to the eligible allowed amount is 100% for Basic Services, 100% for Comprehensive Basic Services, 80% for Major Restorative Services and 50% for Orthodontics.
Beginning on the date of the first paid claim, recalls are covered once every 6 months, other exams and full mouth x-rays every 3 years.
Comprehensive Basic Services cover denture relines 1 every 3 years, based on the date of the first paid claim.
Major Restorative Services cover standard dentures, crowns and bridges once every 5 years.
Applicable lab, drug and other expenses are eligible to a maximum of 40% (50% cap on dentures) of the allowable professional fee. Any applicable co-payment is then applied.
Your eligible claims are reimbursed at the level stated above and in accordance with the current Provincial Dental Association Fee Guide for General Practitioners. In provinces with more than one fee guide, Green Shield will reimburse according to the least expensive standard fee (or fee range).

BASIC SERVICES

Recalls include exams, bitewing X-rays, preventive cleanings and fluoride treatments.
Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays.
Basic restorations, fillings and inlays.
Extractions and surgical services. General anaesthetics and intravenous sedation only when done in conjunction with eligible extraction(s) and/or oral surgery. Sleep dentistry is not eligible.

COMPREHENSIVE BASIC SERVICES

Endodontic treatment including standard root canal therapy, excluding retreatments.
Periodontal treatment including scaling and/or root planing.
Standard denture services including relining and rebasing of dentures plus denture adjustments after 3 months from installation

MAJOR RESTORATIVE SERVICES

Standard dentures, complete, immediate and partial.
Standard crown restorations or onlays on natural teeth.
Repair or recementing of crowns, onlays and bridgework on natural teeth.
Standard bridges, including pontics, abutment retainers/crowns on natural teeth.

ORTHODONTIC SERVICES

Orthodontic treatment to straighten teeth and correct the bite.
Subject to a usual and customary monthly cap as established by Green Shield.

TRAVEL BENEFITS

Travel Benefits are eligible within the first 90 days per trip while traveling or vacationing outside of the Province/Country.
Canadian residents are covered while temporarily residing outside of the country provided they maintain their government health insurance plan coverage. Note: the 90 day per trip out-of-province/country travel limit would apply.
Your maximum is $1,000,000 per calendar year for Emergency Services; and $50,000 per calendar year for Referral Services.
Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of the services received.
Green Shield must be contacted by phone within 48 hours of commencement of treatment, by dialing 1-800-936-6226 within Canada or USA or call collect 0 519-742-3556. These telephone assistance numbers are also located on the reverse of your Green Shield Identification Card.
Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling.

For complete details on your travel benefits, please refer to the enclosed Deluxe Travel Plan Booklet.

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MEMBER BENEFITS TRUST

CLASS 6 AND 7

OUTLINE OF BENEFITS

Services shown below will be eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury. Please contact the Member Benefits Trust at (604) 685-1678, or the Green Shield Customer Service Centre toll free at 1-888-711-1119 to determine benefit eligibility and coverage details. Green Shield Canada’s Customer Service Centre is available 5:30 am to 4:30 pm Pacific Standard Time.

BENEFIT YEAR

Your benefit year runs from June 1 to May 31 each year. Where applicable, your deductible, co-pay and/or maximums will be calculated for this 12 month period each year.

DRUG

A co-payment of 5% of the drug cost plus the dispensing fee applies to each prescription.
Your overall Drug maximum is $5,000 per participant, per calendar year.
Drugs are eligible only if the drug is a benefit of your current provincial medical plan.
Drugs may be submitted on a Pay Direct basis at your pharmacy.
Benefits include drugs legally requiring a prescription by law, diabetic needles and syringes.
Benefits do not include medication for the treatment of anti-obesity, erectile dysfunction, and fertility. Serums and vitamins are also ineligible unless injected and medically necessary.
Smoking cessation products are covered with a $200 lifetime maximum per person. Products available over the counter are ineligible.
If you are a resident of Ontario, The Ontario Drug Benefit co-pay for seniors is not a benefit.
In the province of Quebec, legislation states that Green Shield Canada is obligated to follow RAMQ reimbursement guidelines for all residents of Quebec. For those 65 years of age and under, Green Shield Canada is primary payor.

HEALTH SERVICES

Your overall Health deductible is Nil.
Your co-payment for Health Services is 5%.
Co-payments do not apply to Accommodations, Vision, Audio and Travel Benefits.
Co-payments apply to Emergency Transportation, Medical Items, Paramedical Services, Dental Accident, and Eye Exams.

EMERGENCY TRANSPORTATION

Ambulance Transportation, for land or air ambulance to the nearest hospital equipped to provide the required treatment.

ACCIDENTAL DENTAL BENEFITS

Accidental Dental benefits for treatment by a dentist. A dental accident report form must be submitted immediately following the accident.

ACCOMMODATION

SEMI-PRIVATE

Semi-Private Room in a public general hospital

AUDIO

Reimbursement will be made for standard hearing aids, repairs or replacement parts up to a maximum of $750 once every 5 years.
Batteries are not eligible.

MEDICAL ITEMS

Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices. Contact the Customer Service Centre to verify eligibility of a particular benefit.

OPTOMETRIST EYE EXAMS

Optometrist eye examinations performed by a licensed Optometrist limited to one exam up to a maximum of $65 per 24 months. Applicable co-payment will be applied. Note: the Provincial Health Care Plan must be used first (where applicable).

PARAMEDICAL SERVICES

Physiotherapist, Registered Clinical Psychologist, Registered Clinical Counselor, Registered Social Worker, Chiropractor, Osteopath, Podiatrist/Chiropodist, Naturopath, Registered Massage Therapist (medical referral required), Speech Therapist, Acupuncturist (physician/surgeon or anyone licensed through the Acupuncture Foundation of Canada to perform acupuncture) up to a $800 maximum per paramedical discipline per benefit year (June 1 to May 31)

NOTE:

The above listed paramedicals are subject to a combined overall maximum of $2,000 per participant, per benefit year (June 1 to May 31).
All paramedical services, excluding Psychologist benefits, are subject to a maximum reimbursement of $50 per visit (June 1 to May 31). Applicable co-payment will apply.
Paramedical services are only eligible when the practitioner rendering the service is licensed by their provincial association and that association is recognized by Green Shield Canada. Please contact the Green Shield Customer Service Centre to confirm eligibility when in doubt.
Private Duty Nursing Benefits carry a maximum of $15,000 per benefit year (June 1 to May 31) for the services of a registered nurse (R.N.) or registered nurses assistant (R.N.A.) in the home on a full or part shift basis.

VISION

Your Vision Benefit carries a maximum of $300 every 24 months (or $300 every 12 months if a change in prescription occurs) for prescription eye glasses (including prescription sunglasses) and/or contact lenses and/or towards laser eye surgery provided they are dispensed by an Optometrist, an Optician or an Ophthalmologist.

Commencement of your benefit period is based on the initial date you receive vision benefits. This service date is the actual pick-up date of the eyewear.

As a Green Shield subscriber, you have access to our national preferred provider vision network arrangement with “The Bay Optical” and “Zellers Vision Centre” stores.

All Green Shield subscribers are eligible to receive a discount of 33% off the regular prices available at “The Bay Optical” and “Zellers Vision Centres”. This offer applies to all extra coatings and upgrades. (Excludes disposable contact lenses).

Features of this great value-added service include

offer applies to any Green Shield subscriber, regardless of whether you have Green Shield vision benefits or not
direct billing to Green Shield by the provider; the subscriber just pays any portion not covered
trustworthy retail chains with convenient locations
discount offer applies to everything such as coatings, upgrades and accessories
hundreds of the latest frame styles to choose from plus latest lens and coating technology
professional opticians to assist in selecting products
offer applies to non-disposable contact lenses

To find a Bay Optical store near you, call the toll free store locator at 1-866-BAY-EYES. Or visit our web site at www.greenshield.ca

CLAIMING INFORMATION

Present your Green Shield Identification Card as proof of being a Green Shield subscriber.
The vision provider will apply the appropriate discount(s) to your claim and submit the claim directly to Green Shield for payment. You pay your vision provider any balance not covered under your vision benefit
If no vision benefits exist, you pay your provider the full balance owing after the applicable discounts have been applied.

DENTAL

Your deductible is nil.
Your combined maximum for Basic and Comprehensive Basic Services is $2500.
Your maximum for Major Restorative Services is $2,500 per person, per benefit year (June 1 to May 31).
Your overall Dental maximum is $4,000 per person, per benefit year (June 1 to May 31), excluding Orthodontics.
Your lifetime maximum for Orthodontic benefits is $2,500 per participant.
Stated maximums are based on paid claims.
Your reimbursement which is applied to the eligible allowed amount is 100% for Basic Services, 100% for Comprehensive Basic Services, 100% for Major Restorative Services and 50% for Orthodontics.
Your maximum for teeth whitening is $600 every 2 years.
Beginning on the date of the first paid claim, recalls are covered once every 6 months, other exams and full mouth x-rays once every 3 years.
Comprehensive Basic Services cover denture relines 1 every 3 years, based on the date of the first paid claim.
Major Restorative Services cover standard dentures, crowns and bridges once every 5 years.
Applicable lab, drug and other expenses are eligible to a maximum of 40% (50% cap on dentures) of the allowable professional fee. Any applicable co-payment is then applied.
Your eligible claims are reimbursed at the level stated above and in accordance with the current Provincial Dental Association Fee Guide for General Practitioners. In provinces with more than one fee guide, Green Shield will reimburse according to the least expensive standard fee (or fee range).

BASIC SERVICES

Recalls include exams, bitewing X-rays, preventive cleanings and fluoride treatments.
Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays.
Basic restorations, fillings and inlays.
Extractions and surgical services. General anaesthetics and intravenous sedation only when done in conjunction with eligible extraction(s) and/or oral surgery. Sleep dentistry is not eligible.

COMPREHENSIVE BASIC SERVICES

Endodontic treatment including standard root canal therapy, excluding retreatments.
Periodontal treatment including scaling and/or root planing.
Standard denture services including relining and rebasing of dentures plus denture adjustments after 3 months from installation

MAJOR RESTORATIVE SERVICES

Standard dentures, complete, immediate and partial.
Standard crown restorations or onlays on natural teeth.
Repair or recementing of crowns, onlays and bridgework on natural teeth.
Standard bridges, including pontics, abutment retainers/crowns on natural teeth.

ORTHODONTIC SERVICES

Orthodontic treatment to straighten teeth and correct the bite.
Subject to a usual and customary monthly cap as established by Green Shield.

TRAVEL BENEFITS

Travel Benefits are eligible within the first 90 days per trip while traveling or vacationing outside of the Province/Country.
Canadian residents are covered while temporarily residing outside of the country provided they maintain their government health insurance plan coverage. Note: the 90 day per trip out-of-province/country travel limit would apply.
Your maximum is $1,000,000 per calendar year for Emergency Services; and $50,000 per calendar year for Referral Services.
Hospital and medical services are eligible only if your provincial government health plan provides payment toward the cost of the services received.
Green Shield must be contacted by phone within 48 hours of commencement of treatment, by dialing 1-800-936-6226 within Canada or USA or call collect 0 519-742-3556. These telephone assistance numbers are also located on the reverse of your Green Shield Identification Card.
Green Shield, through consultation with the Assistance Medical Team, reserves the right to repatriate the patient for treatment upon medical verification of the tolerance for travel. Carry your Green Shield identification card with you when traveling.

For complete details on your travel benefits, please refer to the enclosed Deluxe Travel Plan Booklet.

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UBCP Retirement Benefits Society

Retirement Plan Booklet

b_w MBT_UBCP_logo

Investing in your Future
The UBCP Retirement Benefits Society
Retirement Savings Program

DIRECTORS

Joe Doserro Ken Kirzinger Rob Morton Terrance Leigh
David Jacox Lori Stewart Duane Dickinson

PLAN ADMINISTRATOR

Sarah E. King

LEGAL COUNSEL

Margaret H. Mason - Bull, Housser & Tupper LLP

CONSULTANT

William J. Watt - TRG BENEFITS AND PENSIONS

PLAN SPONSOR

The UBCP Retirement Benefits Society

SUITE 320—1155 WEST PENDER STREET
VANCOUVER, BC V6E 2P4
TELEPHONE: 604-689- 0727 EXT.2261
FAX: 604-685-1478
E-MAIL: sarah.king@ubcp.com
WEBSITE: www.mbt.ca

Plan Anniversary Date: January 1st of each year.

Policy Number - 37957

The information provided in this booklet is for informational purposes only. If there are any discrepancies between this booklet and the Contract, the Contract will apply without exception.

INTRODUCTION

Have you thought about what you would like to do once you retire? Spend more time with friends and family? Travel? Devote more time to a favorite hobby? Have you thought about where the money will come from?

While you may not be ready to plan your retirement calendar, it’s never too early to start securing your financial future. With the right combination of commitment, good judgment and careful planning, your dreams could come true. It is all about making informed choices, today and in the coming years.

Fortunately, you are not alone. You, together with the UBCP Retirement Benefits Society Program and the Government, share the responsibility of building your retirement income.

Most financial advisors agree that you will need 50 per cent to 70 per cent of your pre-retirement income to continue your standard of living into retirement. If you take advantage of the UBCP Retirement Benefits Society Program, it can help make this goal possible.

PLAN DESIGN

The Plan is administered by Group Retirement Services (GRS), the group retirement products and services division of Great West Life, London Life and Canada Life. The Retirement Plan with GRS consists of two parts, a Group Non-Registered Savings Plan (NRSP) and a Group Registered Retirement Savings Plan (RRSP).

The Group NRSP serves as an entry point for your contributions (producer and member required) into the plan. Contributions to this part of the Plan are not tax deductible and any earnings on these contributions are taxable to you.This portion of the Plan is simply a temporary depository for your contributions.

Once a year, when the Plan Administrator receives the information on your available RRSP contribution room, these funds will be transferred to the Registered Plan.

The Group RRSP is a tax-deferred retirement plan. It allows you to make tax-deductible contributions towards savings, within limits set by the Canada Revenue Agency (CRA), up to the end of the year in which you turn 71.

Alternatively, you may request to have your funds (both Producer, and where applicable, Member) deposited directly to the Registered Plan each year by providing the UBCP Plan Administrator with a letter or direction and authorization.

Your retirement income will come from the monies you have accumulated under both the Registered and Non-Registered Plans.

HOW TO JOIN

To enroll in the Retirement Plan, you need to complete application forms for both the Registered and Non-Registered plans and submit the forms to the Plan Administrator.

You are also required to sign the Authorization Form to Obtain Proof of Available Contribution Room from the Canada Revenue Agency and then return it to the Plan Administrator.

Note: All information regarding your Retirement Plan will be kept in strict confidence by the Plan Administrator.

CONTRIBUTIONS

By the Producers:

As a participant of this plan, there are restrictions on withdrawals of contributions made by Producers on your behalf. These contributions will depend on the terms of your collective agreement.

By the Members:

Member contributions, through payroll, or in a lump sum; and amounts transferred in from other plans will go into a Voluntary Account in your name.

Required member contributions to the Plan are made through regular payroll deductions following the terms of the collective agreement under which you are working.

Transfers-in from other RRSP’s are permitted. All RRSP funds transferred to the Group RRSP from any financial institution are considered to be voluntary contributions.

The CRA sets the amount that each individual taxpayer can contribute to an RRSP each year. To obtain your available contribution room, refer to the most recent Notice of Assessment sent to you by the CRA. Transfers in from other plans do not affect the amount of contribution room available.

The Plan Administrator and Plan design will help prevent over-contributions and tax penalties by only allowing contributions to be deposited into the RRSP when proof of available RRSP room has been obtained.

Note: If you make any contributions to another plan, it is essential that you advise the Plan Administrator in order to ensure you do not over-contribute.

IN - SERVICE WITHDRAWALS

Voluntary contributions made to the RRSP and the NRSP can be withdrawn at any time. Withholding tax will be deducted from the amounts withdrawn from the RRSP.

It is important for you to clearly understand that withdrawing your retirement savings prematurely will significantly reduce your chances of having an adequate income at retirement.

There are restrictions on withdrawals for members under the age of 50, on contributions that have been made by Producers. These restrictions will ensure that the contributions made to the Plan and the investment earnings on these contributions will be available for you at retirement. If you terminate your membership, your funds are available for you to withdraw 60 days after termination.

Withdrawals from the contributions made by Producers are permitted in the following circumstances:

RRSP Withdrawals:

The Home Buyers’ Plan (HBP);
The Lifelong Learning Plan (LLP);
Financial Hardship Policy;
Disability Policy;
Resignation of Membership with UBCP; and
Attainment of age 50.

Under 1 and 2 contributions must be deposited in your account for 90 days before they can be withdrawn for these government programs. If they are withdrawn prior to 90 days you will be subject to applicable withholding taxes.

NRSP Withdrawals:

Financial Hardship Policy;
Disability Policy;
Resignation of Membership with UBCP; and
Attainment of age 50.

Requests submitted to GRS for these programs are processed in 5-7 business days.

PLAN COSTS

The first withdrawal of contributions, in a calendar year, from either the NRSP or the RRSP is subject to a $35 administration fee. Each subsequent withdrawal in that year is subject to a $50 administration fee.

Withdrawals from the RRSP for the Lifelong Learning and Home Buyers’ Plan are not subject to an administration fee.

Investment Management Fee (IMF’s) are outlined in the following section. Each fund offered by GRS is also subject to a Fund Operating Expense (FOE). Refer to the Glossary for definitions.

INVESTMENT FUND OPTIONS

The investment options available under the Plan are as follows:

Non-Registered Plan

With the exception of minor UBCP members, all contributions to the Non-Registered Plan are directed to a Daily Interest Account. These investments pay the investor a predetermined guaranteed rate of interest on money invested for a fixed amount of time. It is a short-term investment fund used to invest funds temporarily. It is not intended for long term investing.

Contributions made to the Plan by minor members are invested in 5 year Compound Interest Accounts (CIAs).

Registered Plan

Contributions to the Registered Plan can be directed to any of the investment options described below:

a) Money Market Fund

This fund invests primarily in government securities and high quality corporate money market instruments maturing within one year. It is short-term investment fund used to invest funds temporarily. It is not intended for long-term investing.

The investment management fee and expense for this Fund is 0.030% per annum.

b) Group Retirement Services Portfolio Funds

There are 5 Continuum Funds to choose from. (See “Continuum Funds” brochure in Enrolment Package for more detailed information.)

The five Continuum Funds are listed (from lowest risk to highest risk) and their target asset mixes are as follows:

Conservative (75% fixed income and 25% equities)
Moderate (60% fixed income and 40% equities)
Balanced (40% fixed income and 60% equities)
Advanced (20% fixed income and 80% equities)
Aggressive (100% equities)

To determine which fund is appropriate for you, you need to complete the Investment Personality Questionnaire included in your Enrollment Package. Additional copies are available from the Plan Administrator.

The Investment Personality Questionnaire looks at the length of time that you are investing, your current financial status and your expectations for future growth. It will also help you assess both your willingness to take risks and your understanding of the consequences of your choices. Your responses will help you determine the Portfolio Fund tailored to best suit your personal investment objectives.

The investment management fee and expense for each of the Portfolio Funds is 1.297% to 1.298% per annum.

c) The Socially Responsible Balanced Fund

This fund invests in socially responsible equity funds and fixed income funds. The fund’s objective is to achieve long-term capital appreciation through socially responsible investing with conservative risk.

The investment management fee and expense for this fund is 1.787% per annum.

d) The Socially Responsible Canadian Equity Fund

This fund invests in socially responsible companies that do not engage in the manufacture of tobacco, alcohol, military, gaming, and pornography products. This fund invests in the Canadian companies that comprise the Jantzi Social Index.

The investment management fee and expense for this fund is 1.786% per annum.

e) The Socially Responsible Bond Fund

This fund’s strategy uses a combination of interest rate appreciation, foreign exchange rate anticipation and security selection while ensuring that the insuring corporations meet the standards set for socially responsible investing.

The investment management fee and expense for this fund is 1.638% per annum.

f) The Socially Responsible Us Equities Fund

This fund invests in socially responsible companies that do not engage in the manufacture of tobacco, alcohol, military, gaming, and pornography products. This fund invests primarily in large capitalization US based companies.

The investment management fee and expense for this fund is 1.944% per annum.

g) 5 Year Compound Interest Accounts (CIAs)

These investments pay a guaranteed rate of interest - specified on the date of your deposit. Interest on each CIA compounds annually and the original interest rate applies to both the principal and the reinvested interest. The rate will not change over the term, even if interest rates change. Remember that if you cash out your account prematurely, you could be subject to a market value adjustment.

Contributions in the Compound Interest Account will be credited with interest at a rate equal to the GRS standard published rates plus 0.25%.

ANNUAL STATEMENTS

Members that have completed applications and are enrolled in the plan will receive annual statements (December 31) by mail. These statements will provide you with your account balance, current investment instructions, contribution information and personalized net rate of return on your account.

Enrolled members are also able to print statements at any time by visiting the GRS web site at www.grsaccess.com.

GETTING INFORMATION

For information on any aspect of the Retirement Plan or for answers to questions that cannot be dealt with by the GRS Customer Call Centre you can also contact the Plan Administrator at 604-689-0727 ext. 2261 or via email at sarah.king@ubcp.com.

You can also visit the GRS web site at www.grsaccess.com and obtain information on your account at any time. You will also be able to view and make changes to your investment instructions as well as update your contact information.

GRS ACCESS LINE is an automated voice response telephone line. This line gives you easy access to your Retirement Plan information 24 hours a day, 7 days a week by calling 1-800-724-3402.

To speak directly with a Customer Service Specialist at the GRS Customer Call Centre, dial the number above and press “0”. The hours are weekdays from 5:00AM to 5:00PM PST. If you call after hours your call will be returned the next business day.

RECEIVING ACCESS TO THESE SERVICES

For security purposes, you will be mailed a LOGON ID letter and then a few days later, a second letter containing your password. With these two pieces of information, you can access both the GRS web site and Access Line.

ENROLLING IN THE PLAN

Your Enrollment Package contains the following material:

Information Booklet for the new Plan
Frequently Asked Questions
Glossary of Terms
Investment Personality Questionnaire
Continuum Funds Brochure and Fund Details Sheets
Current gross annualized rates of return for the investment funds
Application forms for both the Registered and Non-Registered Plans
Authorization Form to Obtain Proof of Available Contribution Room from the CRA
Return Envelope

Remember, long-term financial planning for retirement is important to you and your family.

We encourage you to take advantage of the Union of BC Performers Retirement Plan to help you achieve your retirement goals.

GLOSSARY OF TERMS

Default Fund - This is a fund to which any contributions to the Registered Plan will be invested if Group Retirement Services receives no other investment instructions from a member. The default fund for this Plan is the Moderate Continuum Fund.

Ethical Fund - This kind of fund invests primarily in the shares of publicly traded companies (both Canadian and international) that conduct their business operations in a socially responsible manner. In addition to their social values, these funds are still managed with the hopes of creating the prospect of good long-term growth.

Fiduciary Responsibility - Arises when the relationship between two parties implies that a necessary element of the relationship is one of confidence and trust on the one part and a high degree of good faith on the other. A fiduciary must act in “scrupulous goo d faith and candor”.

Fund Operating Expense (FOE) - These fees are charged directly to the fund to cover costs including audit and custodial fees, fund transaction costs, taxes paid by the fund, bank fees, fund valuation and reporting. The total amount of the fund operating expense is calculated at the end of each year. This fee does not include GST which is charged separately.

These additional expenses are subject to change annually, but currently range from 0.029% to 0.073%, depending on the fund.

Group RRSP - A group retirement plan, through which the bundling of administrative services and investments, offer individuals the opportunity to save on a group basis with significantly lower fees and often far better contractual term than would be available to an individual investor.

Guaranteed Investment Fund (GIF) - These investment vehicles pay you a predetermined rate of interest on money invested for a five-year term. The rate is guaranteed and is determined at the time of purchase by market conditions. The rate will not change over time, even if rates change.

Investment Management Fees (IMF) - Represent fees paid to the investment manager for their professional services including the daily management of the fund. It also includes the fee to Group Retirement Services for the cost of administering the plan and providing services such as service personnel, statements, web sites, and call centre support. IMFs are based on the asset value of each fund and are paid directly from the fund each day.

Money Market Fund - These funds invest primarily in short-term government securities and high quality corporate money market investment instruments that mature within one year. It is a short—term investment tool used to invest money temporarily, and is not intended for long-term investing.

Non-Registered Retirement Savings Plan (NRSP) - Provides an easy way to accumulate savings. However, contributions to this part of the plan are not tax deductible and any earnings on these contributions are taxable to you.

Registered Retirement Savings Plan (RRSP) - Is a tax-sheltered plan that allows Members to make tax-deductible contributions towards savings - within the limits set by the Canada Revenue Agency (CRA) - up to the end of the year in which the member turns 71.

Restricted Withdrawals - As a condition of participation in the Plan, there are restrictions on the withdrawals of all Producer contributions made on your behalf. For example, funds cannot be withdrawn until you become 50 years of age or your membership with UBCP terminates.

FREQUENTLY ASKED QUESTIONS

Q: I understand the UBCP RBS Retirement Plan consists of two parts?

A: Yes, the Retirement Plan consists of two parts, a Group Non-Registered Retirement Savings Plan and a Group Registered Retirement Savings Plan.

The Non-Registered Savings Plan (NRSP) serves as an entry point for your contributions (producer and member) into the Plan. Contributions to this plan are not tax deductible and any earnings on these contributions are taxable to you. This portion of the Plan is simply a temporary depository for your contributions.

The Group Retirement Savings Plan (RRSP) is a tax-deferred retirement plan. It allows you to make tax-deductible contributions towards savings, within limits set by the Canada Revenue Agency (CRA), up to the end of the year in which you turn 71.

Q: What is the difference between a Group RRSP and an individual RRSP?

A: An employer or organization can sponsor a Group RRSP that offers you specific benefits that otherwise would be unavailable to you under an individual plan. Some of these benefits include:

Access to a wide variety of institutional investment funds which are normally unavailable to individual investors.

A substantial reduction in fees you will pay. The average equity mutual fund in Canada has a Management Expense Ratio (MER) of 2.51%*. Currently, the highest Investment Management Fee charged under the Retirement Plan is 1.97% (See IMF definition in the Glossary for more information).

*Taken from the Globe and Mail Newspaper July 19, 2001

Q: What exactly is the Investment Management Fee (IMF)?

A: The IMF, like the MER, is the most important fee for you to understand in assessing your different retirement plan investments under the UBCP Retirement Benefits Society Retirement Plan.

IMFs represent fees paid to the investment manager for their professional services including the daily management of each fund. It also includes the fee to GRS for the cost of administering the Plan and providing services such as service personnel, statements, web sites and call centre support.

IMFs are based on the asset value of each fund and are paid directly from the fund each day. The IMFs are unique to this Plan and do not include GST, which is also charged.

FOEs are fees charged directly to the fund to cover costs including audit and custodial fees, fund transaction costs, taxes paid by the fund, bank fees, fund valuation and reporting. Charged as they occur, the total amount of fund operating expense is calculated at the end of each year. Therefore, the amount GRS reports to you will usually be the previous year end charges calculated as a percentage of the fund. This does not include GST, which is also charged.

Q: Why are lower fees so important?

A: Lower fees will allow your retirement savings to grow faster. For example, let us consider two identical funds, except Fund A has a 1.2% fee and Fund B has a 2.5% fee.

If you invested $10,000 at age 30 with no further deposits in each of these funds (with interest compounded annually) and obtained an average rate of return before fees of 6%, the difference in the capital accumulated under each fund at age 65 is dramatic.

Fund A has a net rate of return of 4.8% per year (6% gross return minus 1.2% fees). Fund B has a net return of 3.5% (6% gross return minus 2.5% fees).

Assuming identical $10,000 investments, at age 65, if you invested in Fund A (lower fees) you will save $51,599, however if you invested in Fund B (higher fees) you will only save $33,336. The lower fees of Fund A provide $18,263 (or 55%) more in overall savings.

Q: Why is 6% consistently used as the average rate or return on investments in all the Q & A examples?

A: Savings for your retirement is a long-term process. We believe it is better to use conservative estimates to project a return on investment. Your willingness to take risks and the growth of future markets means you may earn more. However, given the volatility of the economy, you may earn less; therefore we feel 6% is a reasonable expectation.

Q: How did the UBCP Retirement Benefits Society obtain such low fees?

A: The collective bargaining power of the members’ money enabled the UBCP Retirement Benefits Society to negotiate the lower fees with GRS.

Q: What are my investment choices under the NRSP?

A: With the exception of minor members, there is only one choice under the Non-Registered Plan - the Money Market Fund. This fund is set up as a temporary depository in which to accumulate contributions to the Retirement Plan until you can provide the Plan Administrator with proof of available room in your RRSP.

Contributions made to the Plan by minor members are invested in 5 year Compound Interest Accounts (CIAs).

Q: Why is the Money Market Fund used?

A: Until you provide the Plan Administrator with your eligible RRSP contribution room, the objective of the Non-Registered account is to ensure the contributions do not depreciate in value. In fact, these contributions will grow while they are held in the Non-Registered part of the Plan awaiting transfer.

Q: What are my investment choices under the Registered part of the Retirement Plan?

A: The five Continuum funds listed (from lowest risk to highest risk) and their target asset mixes are as follows:

Conservative (75% fixed income and 25% equities)
Moderate (60% fixed income and 40% equities)
Balanced (40% fixed income and 60% equities)
Advanced (20% fixed income and 80% equities)
Aggressive (100% equities)

A Money Market Fund, a Socially Responsible Balanced Fund, and a 5-year Guaranteed Investment Fund are also included under the UBCP Retirement Society Retirement Plan.

These investments represent a broad range of diversified choices that best fits the needs of the membership according to their age, risk tolerance and their personal retirement savings goals.

Q: Why did the UBCP Retirement Benefits Society make these particular investment selections for the Registered part of the plan?

A: The UBCP Retirement Benefits Society, as the sponsor of this Group Retirement Savings Plan, carries a fiduciary responsibility to consistently monitor the performance of the funds that its members invest in. In an effort to make this monitoring feasible, the UBCP Retirement Benefits Society needed to stipulate the number of fund choices in which its members invest.

Q: How does the plan work so that I do not make excess RRSP contributions?

A: You are required to sign and return the Authorization Form to Obtain Proof of Available Contribution Room from Canada Revenue Agency to the Plan Administrator. The information received from the CRA will ensure that each participating member has available RRSP contribution room.

Q: Am I able to transfer in funds from my other RRSPs to benefit from the lower fees?

A: Yes, you can. You will receive information on how to do that in your UBCP Retirement Society Retirement Plan Information Booklet and Enrollment Package.

Q: Can GRS track which of my contributions are my own and those that are transfers from other plans?

A: Yes, the GRS system is able to track Employer and Member contributions, including transfers into the plan.

Q: I understand that there are restrictions on the withdrawal of the Employer Contributions. What are the ways I can withdraw these funds?

A: You can withdraw your Employer contributions from the Retirement Plan to take advantage of the following government Plans:

The Home Buyers’ Plan (HBP)
The Lifelong Learning Plan (LLP)

You can also withdraw these funds if you meet the following criteria:

Terminate membership with UBCP; or
When you turn age 50; or
Financial Hardship Policy; or
Disability Policy

Q: I am 30 years old and earning $30,000 a year. My contributions average about $125 per month or $1,500 per year. Will this make a difference in the amount I will accumulate by the time I retire at age 65?

A: Yes, it most certainly will. By saving $125 at the end of every month over the next 35 years and assuming you can earn 6% per year on your investment, you will have accumulated $171,700 in you Registered Account by age 65.

Q: I feel like I can only save an extra $50 per month for retirement; is it worth it?

A: Absolutely. If you voluntarily contribute an extra $50 at the end of every month, or $600 per year (in addition to the Employer contributions) and earn 6% per year on these monies you will accumulate an additional $65,680 in you Member Account by age 65. By doing this you will accumulate a total of $240,380 in retirement savings by age 65!

Q: How does the UBCP Retirement Benefits Society protect the privacy of my financial information?

A: The UBCP Retirement Benefits Society has taken all reasonable precautions to protect your privacy under its Retirement Plan.

Q: How can I obtain information about the UBCP Retirement Benefits Society Retirement Plan?

A: There are several ways you can find out about your account under the Plan:

Contact the UBCP RBS Plan Administrator directly at 604-689-0727 ext. 2261.
Call the GRS Access Line. This is an automated voice response telephone line which gives you easy access to your Retirement Plan information 24 hours a day, 7 days a week by calling 1-800-724-3402. To speak directly with a Customer Service Specialist at the GRS Customer Call Centre, call the number above and press”0”. The hours are weekdays from5:00 A.M. to 5:00P.M .PST. If you call after hours your call will be returned the next business day.
Visit the GRS web site at www.grsaccess.com.

Q: Am I able to obtain information about my individual account from GRS at any time?

A: Yes. For security purposes, you will be mailed a LOGON ID, and then a few days later, a second letter containing your password. With these two pieces of information, you can access both the GRS web site and GRS Access Line.

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COVERAGE

CLASS 1

($500.00- $4,499)

CLASS 2

($4,500-$7,499)

CLASS 3

($7,500- $11,999)

CLASS 4

($12,000-$24,999)

CLASS 5

($25,000-$69,999)

CLASS 6

($70,000-$99,999)

CLASS 7

($100,000
and up)

LIFE AND A D&D COVERAGE¹

(UNDER AGE 65)

$10,000

$15,000

$60,000

$100,000

$250,000

$400,000

PRESCRIPTION DRUGS

(%OF INGREDIENT COST)

N/A

75%

95%

PARMEDICAL COVERAGE

95% REIMBURSEMENT

N/A

$30/VISIT²

$40/VISIT²

$50/VISIT²

$50/VISIT³

ORTHOTICS

95% REIMBURSEMENT

N/A

$300.00

TRAVEL INSURANCE

(OUT OF COUNTRY/

PROVINCE)

N/A

90 DAYS PER TRIP⁴

90 DAYS PER TRIP

EYE EXAMS

95% REIMBURSEMENT

N/A

$65 PER 24 MONTHS

VISION

100% REIMBURSEMENT

N/A

$250 PER 24 MONTHS⁵

$300 PER 24 MONTHS⁵

DENTAL

- DEDUCTABLE

- BASIC
%ANNUAL MAX

- MAJOR
%ANNUAL MAX

- COMBINED LIMITS

- ORTHO
%LIFETIME MAX

N/A

50%/$500

N/A

80%/$1000

50%/$1000

$1000

N/A

100%/$2500

80%/$2500

$2500

50%/$1000

N/A

100%/$2500

$4000

50%/$2500

N/A

100%/$2500

$4000

50%/$2500

¹  Amount of coverage in force prior to age 65 reduces by 50% at age 65 and further reduces by 10% each subsequent year on Member's birthday.
  Please contact the MBT office for confirmation of coverage if you are over age 65.
²  $500 maximum per Paramedical discipline and $900 combined maximum per benefit year.
³  $800 maximum per Paramedical discipline and $2000 combined maximum per benefit year.
⁴  Not available over age 70 for Class 2 & 3.
⁵  Coverage is per 24 months unless there is a change in prescription in which case coverage is per 12 months.

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Coverage	Eligibility	Benefit
Short Term Disability	Minimum average of $17,500 in earnings over the past 3 calendar years prior to the current benefit year.	66.7% of the first $400 of weekly earnings plus 55% of the remainder to a maximum benefit of $1000 per week.
Long Term Disability	Minimum average of $35,000 in earnings over the past 3 calendar years prior to the current benefit year.	66.7% of the first $3000 of weekly earnings plus 50% of the remainder to a maximum benefit of:
		One year of Eligibility	$2500 per month
		Two or more years of Eligibility	$5000 per month
Critical Illness (Enrollment form is required)	$17,000 in earnings in previous calendar year.	$10,000 Policy
	$70,000 in earnings in previous calendar year.	$50,000 Policy for Stunt Performers/$100,000 Policy for Performers
	$100,000 in earnings in previous calendar year.	$100,000 Policy Stunt Performers and Performers
Employee and Family Assistance Program	All MBT Members resident in Canada.	Short term counseling including: - Family/Relationship Matters - Financial Matters - Legal Matters

Claim Submissions:

Health and Dental Claims:

Receipts can be directly submitted to Green Shield. Claim forms are available for download Here or sign up for online services at Green Shield Canada for access to personalized claim forms, benefit eligibility and direct deposit. Please note that receipts over 12 months old will not be accepted.

Disability Claims:

Claim forms are available for download Here. Please ensure that notification of claim is submitted within 10 days of onset of injury or illness. Great West Life is not liable for claims submitted after 90 days of onset of injury or illness.

Critical Illness:

Please contact the MBT office for information on submitting a claim for Critical Illness.

Employee and Family Assistance Program:

To access this program please contact Shepell-FGI at 1-800-387-4765

Employee and Family Assistance Program Booklet

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MBT BENEFITS

GENERAL INFORMATION

MEMBER BENEFITS TRUST

CLASS – 2

OUTLINE OF BENEFITS

BENEFIT YEAR

DRUG

HEALTH SERVICES

EMERGENCY TRANSPORTATION

ACCIDENTAL DENTAL BENEFITS

ACCOMMODATION

SEMI-PRIVATE

AUDIO

MEDICAL ITEMS

OPTOMETRIST EYE EXAMS

PARAMEDICAL SERVICES

VISION

CLAIMING INFORMATION

TRAVEL BENEFITS

MEMBER BENEFITS TRUST

CLASS – 3

OUTLINE OF BENEFITS

BENEFIT YEAR

DRUG

HEALTH SERVICES

EMERGENCY TRANSPORTATION

ACCIDENTAL DENTAL BENEFITS

ACCOMMODATION

SEMI-PRIVATE

AUDIO

MEDICAL ITEMS

OPTOMETRIST EYE EXAMS

PARAMEDICAL SERVICES

VISION

CLAIMING INFORMATION

DENTAL

BASIC SERVICES

COMPREHENSIVE BASIC SERVICES

TRAVEL BENEFITS

MEMBER BENEFITS TRUST

CLASS - 4

OUTLINE OF BENEFITS

BENEFIT YEAR

DRUG

HEALTH SERVICES

EMERGENCY TRANSPORTATION

ACCIDENTAL DENTAL BENEFITS

ACCOMMODATION

SEMI-PRIVATE

AUDIO

MEDICAL ITEMS

OPTOMETRIST EYE EXAMS

PARAMEDICAL SERVICES

VISION

CLAIMING INFORMATION

DENTAL

BASIC SERVICES

COMPREHENSIVE BASIC SERVICES

MAJOR RESTORATIVE SERVICES

TRAVEL BENEFITS

MEMBER BENEFITS TRUST

CLASS – 5

OUTLINE OF BENEFITS

BENEFIT YEAR

DRUG

HEALTH SERVICES

EMERGENCY TRANSPORTATION

ACCIDENTAL DENTAL BENEFITS

ACCOMMODATION

SEMI-PRIVATE

AUDIO

MEDICAL ITEMS

OPTOMETRIST EYE EXAMS

PARAMEDICAL SERVICES

VISION

CLAIMING INFORMATION

DENTAL

BASIC SERVICES

COMPREHENSIVE BASIC SERVICES

MAJOR RESTORATIVE SERVICES