Brief Overview of Benefits
The following list is intended to be a brief summary of the benefits available to you under this group insurance program. The Master Contract is the governing document for determining coverage. To view the entire booklet, drop by the MISU office. Any questions about health and dental plan coverage that is not outlined in this summary can be directed to the Office Finance Manager or the toll free number listed on the MISU Health and Dental Plan brochure.
Drugs that legally require a prescription (including oral contraceptives) and diabetic supplies (include needles, syringes, swabs, test tapes, and lancets) – 100% coverage with a personalized Marine Institute Students’ ID card.
Contact lenses or lenses and frames for eyeglasses and their replacement, provided there is an actual need for a change in their magnifying strength (maximum $250 every 24 months). Services of an Ophthalmologist or a licensed Optometrist for eye exams (maximum $80 every 24 months).
Services of a registered Massage Therapist limited to 20 visits and an overall dollar maximum of $350 per calendar year. Charges for a treatment by a registered Chiropractor, Physiotherapist, Osteopath or Chiropodist/Podiatrist up to a maximum of 20 visits per calendar year. Charges for the services of a qualified Speech Therapist to a maximum of $200 per person every 24 months. Service providers may not be related to you or a member of your family by blood or marriage. Physician’s prescription required for massage therapy.
Accidental Dental Benefit
Charges for dental treatment when natural teeth have been damaged by a direct accidental blow to the mouth or jaw. Eligible expenses will be the dentist’s usual and customary fee up to the “Dental Fee Guide” for general practitioners in effect where services are rendered, to a maximum of $300 per tooth.
Medical Equipment & Appliances
Charges for the initial remedial prosthetic appliances up to a maximum of $1,000. Includes artificial limbs, breasts, eyes, splints, casts, trusses, crutches and braces, provided they are needed as a result of bodily injury or disease that occurred or commenced while covered by this plan. Charges for rental of a wheelchair, hospital-type bed (including mattress and safety side rails), equipment for the administration of oxygen, braces, crutches, iron lung and other approved durable equipment for temporary therapeutic use.
Emergency transportation to the doctor or to the hospital. Ambulances must be medically necessary. Taxis will be paid at regular fares. (Private automobiles will be reimbursed at $0.20 per kilometer to a maximum of $80). Taxis and private automobiles are limited to $80 per incident.
Semi-Private Room Accommodation
Charges for the difference in cost between standard room rate and semi-private room accommodation in a licensed general hospital, if determined to be medically necessary.
Private Duty Nurse
Services of a registered Nurse, necessitated by injury or illness, on the written authorization of the attending Doctor. The nurse must be currently registered with the appropriate nurses’ association and cannot be an employee of the hospital, a resident at the participant’s home or related to a member of the participant’s family by blood or marriage. The expense is limited to $10,000 per benefit year.
Plan only covers a FM System at a maximum lifetime cost of $1000.
Charges for dental services are reimbursed at 80% up to an annual maximum of $500. Includes a recall exam every calendar year, basic diagnostics, preventive services, basic restorative services, endodontic services, periodontic services, prosthodontic services, oral surgery and adjunctive general services.
Tel: 709 778 0595