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 AD&D COVERAGE1 (UNDER AGE 65) $10,000 $10,000 $15,000 $60,000 $100,000 $250,000 $400,000
PRESCRIPTION DRUGS
(%OF INGREDIENT COST)		 N/A 75% 75% 75% 75% 95% 95%
PARMEDICAL COVERAGE
(i.e. Massage, Physio, Chiro)
95% REIMBURSEMENT		 N/A $30/VISIT2 $30/VISIT2 $40/VISIT2 $50/VISIT2 $50/VISIT3 $50/VISIT3
ORTHOTICS
95% REIMBURSEMENT		 N/A $300.00 $300.00 $300.00 $300.00 $300.00 $300.00
TRAVEL INSURANCE - per trip
(Out of country/province)		 N/A 90 DAYS 4 90 DAYS 4 90 DAYS 90 DAYS 90 DAYS 90 DAYS
EYE EXAMS - Per 24 Months
95% REIMBURSEMENT		 N/A $65 $65 $65 $65 $65 $65
VISION - Per 24 Months5
(glasses,contacts,laser,presc. sun glasses)
100% REIMBURSEMENT		 N/A $250 $250 $250 $250 $300 $300
DENTAL
  - DEDUCTABLE
  - BASIC
   %ANNUAL MAX
  - MAJOR
   %ANNUAL MAX
  - COMBINED    LIMITS
   - ORTHO
   %LIFETIME MAX
 
N/A
N/A
 
N/A
 
N/A
N/A
 
 
N/A
N/A
 
N/A
 
N/A
N/A
 
 
N/A
50%/$500
N/A
 
N/A
N/A
 
 
$50.00
80%/$1000
50%/$1000
$1000
N/A
 
 
N/A
100%/$2500
80%/$2500
$2500
50%/$1000
 
N/A
100%/$2500
100%/$2500
$4000
50%/$2500
 
N/A
100%/$2500
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  For prescription changes, 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 monthly 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
(Completed Enrollment form is required)		 $17,500 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
Retirement Savings
Program		 All MBT Members
- Favourable, lower investment management fees
- No fees for annual service, set-up, transfers between funds, or    redemption
- 12 investment options to choose from including socially    responsible funds
- Non-registered (NRSP) and Registered (RRSP) accounts to help    ensure you don’t over contribute to an RRSP
- A wide variety of world-class investment managers
- Retirement planning software to help you achieve your retirement    goals

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 Ceridian at 1-877-207-8833

Employee and Family Assistance Program Booklet

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