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Group Insurance for Small Business
BENEFIT COVERAGE & PREMIUM SUMMARY - ONTARIO |
| BENEFIT |
PLAN 1 |
PLAN 2 |
PLAN 3 |
PLAN 4 |
| COVERAGE: |
(P2) |
(O5) |
(O6) |
(O8) |
| (80% co-insurance) |
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| DRUG MAXIMUM |
$15,000 per |
$15,000 per |
$15,000 per |
$15,000 per |
| (Generic & Brand) |
participant, per |
participant, per |
participant, per |
participant, per |
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calendar year |
calendar year |
calendar year |
calendar year |
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| EHS |
INCLUDED |
INCLUDED |
INCLUDED |
INCLUDED |
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| VISION |
Not a benefit |
Not a benefit |
Not a benefit |
$300/24 months |
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| SEMI-PRIVATE |
Not a benefit |
Not a benefit |
Not a benefit |
INCLUDED |
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| DENTAL |
$800 per benefit |
$1,000 per benefit |
Not a benefit |
$1,000 per benefit |
| MAXIMUM |
year |
year |
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year |
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| TRAVEL |
INCLUDED |
INCLUDED |
INCLUDED |
INCLUDED |
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| NOTE: PST IS APPLICABLE - 8% |
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| MONTHLY PREMIUM |
PLAN 1 |
PLAN 2 |
PLAN 3 |
PLAN 4 |
| SUMMARY: |
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| SINGLE |
$ 102.12 |
$ 108.39 |
$ 64.15 |
$ 122.08 |
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| COUPLE |
$ 204.23 |
$ 216.97 |
$ 128.30 |
$ 244.15 |
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| FAMILY |
$ 269.60 |
$ 286.22 |
$ 175.64 |
$ 322.63 |
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5+* No Medical |
5+* Deluxe Plan |
5+* No Medical |
5+* No Medical |
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Underwriting or |
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Underwriting or |
Underwriting or |
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1-4 With Medical |
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1-4 with Medical |
1-4 with Medical |
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Underwriting |
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Underwriting |
Underwriting |
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| APPLICATION(S) |
Employee Application |
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| TO COMPLETE: |
Group Benefits Application |
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| *Life, AD&D and LTD Coverage can also be added to 5+ person plans |
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| RATES ARE EFFECTIVE FROM JULY 1ST 2011 to JUNE 30TH 2012 |
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| NOTE: Remember Membership Application and Fee(You can choose $2.50 a month or pay annually $28.25) |
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