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We are the primary insurer for your expenses. Your Spouse's insurer is theprimary carrier for your Spouse's expenses.Dependent children become the primary responsibility of the plan whoinsures the parent who has the earliest birth date in the year (monthand day).If the Plan is the secondary carrier, please remit copies of receipts paid bythe primary carrier along with their statement of payment details.In the event of marital breakup, please see page 6 of this Bookletand/or contact the Plan’s office for further details.PharmacareThe Provincial Fair Pharmacare program provides 70% coverage foreligible prescription medications included under their “formulary” oncetheir annual deductible (based on family income) has been reached. Ifyou have reached the Pharmacare deductible, the Plan will continue topay any portion not covered by Pharmacare provided you have notreached the Plan’s annual limit of 2,500 per person.IMPORTANT --- The Fair Pharmacare program is based on incomeand it is necessary for you to make application to Health InsuranceB.C. for coverage. Proof of registration will be issued by FairPharmacare. It will be necessary for you to provide proof ofregistration to the Plan before your drug card will be activated andbefore any prescription medications will be eligible forreimbursement.11

E.H.B. Eligible Expenses - In Province (reimbursed at 80% with theexception of prescribed medications which are reimbursed at 100%).1.) Medications approved for sale in Canada for the treatment of illness ordisease which are available only by prescription and when prescribed bya physician.a.) Medications determined by the Trustees to be “lifestyle drugs”are excluded from coverage (“lifestyle drugs” are described under“Exclusions and Limitations (EHB)” on page 19 of this Booklet.b.) Unless your doctor specifically requires that no substitutions beused, the Plan will pay for the generic equivalent of name brandmedications.c.) The Plan has a 90 day supply limit on all prescriptionmedications.d.) If it is possible that a prescription medication could be coveredby Pharmacare under its “special authority” provision, we adviseyou have your doctor apply to Pharmacare for Special Authority. IfPharmacare approved, this amount will then be applied to yourPharmacare deductible. Please ask your pharmacist for furtherdetails.12

The following treatment providers must be Registered Practitionersof British Columbia, or similar association in the Province or Territoryin which the Member resides up to the limits set out by the Plan.2.) Chiropractor - customary fees not exceeding 70 initial visit 50subsequent visits of a licensed chiropractor to a maximum benefit of 400per person, 800 per family per calendar year (x-rays excluded).3.) Naturopath - customary fees not exceeding 240 initial visit 180subsequent visits of a licensed naturopath to a maximum benefit of 400per person, 800 per family per calendar year, (testing fees, x-rays andmedication excluded).4.) Physiotherapist, Occupational Therapist or Kinesiologist - customaryfees not exceeding 85 initial visit 75 subsequent visits of a licensedprovider to a combined maximum benefit of 400 per person, 800 perfamily per calendar year.5.) Massage Therapist - customary fee not exceeding 100 for 60 minutevisit, 80 for 45 minute visit, 55 for 30 minute visit of a licensed massagetherapist to a maximum benefit of 400 per person, 800 per family percalendar year.6.) Podiatrist - customary fees not exceeding 175 initial visit, 100subsequent visits of a licensed podiatrist to a maximum benefit of 400 perperson, 800 per family per calendar year (x-rays and appliancesexcluded).7.) Licensed Registered Psychologist, Registered Clinical Counsellor,Canadian Certified Counsellor or Registered Therapeutic Counsellor –customary fees not exceeding 110 per visit to a maximum benefit of 400 per person, 800 per family per calendar year.8.) Speech Therapist – customary fees not exceeding 140 for 60 minutes, 70 for 30 minutes of a licensed speech therapist to a maximum benefit of 400 per person, 800 per family per calendar year.13

9.) Acupuncturist - customary fees not exceeding 135 initial visit, 100subsequent visits of a licensed acupuncturist to a maximum benefit of 400per person, 800 per family per calendar year.10.) Registered Nurse - when referred - customary fees to a maximumbenefit of 10,000 per calendar year. Must not be a relative or a personresiding with you.11.) Crutches, canes and walkers to a maximum of once in any 12consecutive month period. Replacement items are covered only whenoriginal or previously covered equipment is no longer functional.12.) Artificial limbs and artificial eyes to a maximum benefit of once in any36 consecutive month period and only if pre-authorization is obtained fromthe Trustees. Replacement items are covered only when original orpreviously covered equipment is no longer functional.13.) Charges for oxygen and its administration, blood or blood plasma andits administration.14.) Charges for certain ostomy and ileostomy supplies and materials asdetermined by the Trustees from time to time.15.) Splints, casts, air-casts, trusses or braces to a limit of once in any 24consecutive month period for a Member or Spouse and once in any 12consecutive month period for a Dependent Child but only when custommade for daily use and prescribed by a physician. Replacement items arecovered only when original or previously covered equipment is no longerfunctional.16.) Cryocuffs when prescribed by a physician immediately followingsurgery to a maximum benefit of 250 per calendar year.17.) C.P.A.P. machine or Mandibular Repositioning appliance only in thosecases which are determined to be categorized as moderate or severe asdiagnosed by clinical evidence performed by a sleep study and whenprescribed by a physician for the treatment of Sleep Apnea to a combinedmaximum benefit of 1,600 in any consecutive 36 month period. C.P.A.P.masks, hoses and filters once every 12 months.14

18.) Custom made Orthopaedic Shoes - when prescribed by a physician –maximum benefit of 150 per pair per person - limit 2 pair per year.19.) Custom Made Foot Orthotics - when prescribed by a physician,chiropractor or podiatrist for daily use – maximum benefit of 200 perperson in any 24 consecutive month period (for dependent children to amaximum benefit of 200 per person in any consecutive 12 month period).20.) Charges for support hose when prescribed by a physician limited totwo (2) pair per calendar year.21.) Wigs and Hairpieces - when required as a result of medical treatmentor accident - maximum benefit of 500 per person per lifetime.22.) Mastectomy Prostheses - maximum 1 (per side) in any 24 consecutivemonth period.23.) Brassieres - following purchase of initial prostheses to a maximumbenefit of 150 per calendar year.24.) Charges for the rental or, where more economical, the purchase, ofdurable equipment prescribed by a physician for therapeutic treatmentincluding hospital beds and wheelchairs, provided, however, that chargesfor electric wheelchairs or scooters are covered only when pre-approvedby the Trustees. Coverage for electric wheelchairs or scooters mayrequire additional information from the Member’s physician confirmingthat the equipment is medically necessary.25.) Hearing Aids, when prescribed by your physician, to a maximumbenefit of 500 for each ear during any 36 consecutive month period.26.) Assistive Listening Devices to a maximum benefit of 400 limited toone per lifetime.27.) Prescription eyeglasses, prescription contact lenses or fees forcorrective laser eye surgery, when prescribed by a physician to a maximumcombined benefit of 300 per person in any 24 consecutive month period.Please note, the Plan requires submission of the optical prescription,receipt and proof of payment.15

28.) Eye examinations by a licensed optometrist to a maximum benefit of 50 in any 24 consecutive months.29.) Transcutaneous Nerve Stimulation (TNS) Equipment – whenprescribed by a physician to a maximum benefit of 400 per person perlifetime.30.) Glucometers – when prescribed by a physician to a maximum benefitof 200 per person in any 36 consecutive month period.31.) Insulin Pumps when prescribed by an endocrinologist to a maximumbenefit of 1,600 in any 60 consecutive month period.32.) Blood Pressure Monitors – when prescribed by a physician to amaximum benefit of 100 per person in any 36 consecutive month period.33.) Ambulance service in an emergency, and when recommended by aphysician, return fare for transportation of the Member or Dependentrequiring treatment by ambulance, railroad, boat or airplane, and in anacute emergency by air ambulance, from the place where the sickness orinjury occurs to the nearest hospital, including the return fare of 1attending physician, nurse or first aid attendant, or a parent of aDependent child, where such person is necessary to care for the patientduring transport.34.) Dental services included as Covered Procedures under the DentalBenefit portion of the Plan, required as the result of a non-occupationalaccident and performed by a dentist for the restoration, repair orreplacement of natural teeth. To be eligible, treatment must occur withinone year of the date of injury and must not be the result of a motor vehicleaccident in the Province of British Columbia.35.) Hospital charges for out-patient, emergency ward and short stayfacilities.36.) Hospital room differential for private and semi-private accommodation.37.) Pulse monitoring equipment on a once per lifetime basis to a maximumof 150, when prescribed by a physician in conjunction with a prescribedheart therapy program.16

38.) Treatment as recommended by a physician or podiatrist, for lasertreatment for plantar warts that are resistant to the standard therapy.Coverage is limited to 80 per treatment a maximum limit of 350 perperson; 750 per family per calendar year.Treatment for Substance AbuseThe Plan will pay 100% of the fees for “in-patient” substance abusetreatment in a Residential Treatment Centre recognized and licensed bythe Province of British Columbia or the Yukon Territories. The Plan willcover the normal cost for such treatment as recognized by thosegovernments to a maximum benefit of 4,500. Please note, this benefit isavailable once per lifetime and payment will be made directly to theResidential Treatment facility. This benefit is available to Members only not Dependents.Eligible Expenses - Out of Province – 6 Week Maximum per out ofProvince visitEligible expenses shall include reasonable and customary chargesincurred during the first six weeks of absence from the Member’sProvince of residence for the following expenses as the result of anemergency outside the Province while travelling or on vacation, to theextent that such expenses are not payable or provided under or pursuantto Medical Services Plan of B.C., Pharmacare, any other medical plan orplan of insurance, any Hospital Program or Workers' Compensation Act orby any public or tax supported authority or agency:1)Charges of a hospital for services, medical supplies, co-insuranceand short term stay facilities, ward accommodation and anyadditional charge for private or semi-private room actuallyoccupied if ward accommodation is not available or if required bya physician, but not charges for the rental of telephones,televisions, radios or similar equipment.2)Fees of physician and charges for laboratory and x-ray serviceswhen ordered by a physician.17

3)Charges for drugs available only by prescription when prescribedby a physician but only in sufficient quantity to alleviate an acutemedical condition.4)Charges for local ambulance service to provide transportation tothe nearest hospital equipped to provide the required treatment.5)Charges for transportation, including air transportation on a regularscheduled commercial flight from the hospital providing treatmentto a hospital equipped to provide adequate treatment in a patient'scity of residence, subject to written approval by the attendingphysician and, if the total cost of transportation will exceed 1,000,the prior approval of the Trustees.As noted, Out of Province coverage is limited to a maximum period ofabsence from your Province of residence of 6 weeks. If you are outsideyour Province of residence for longer than 6 weeks it will be necessaryfor you to obtain additional coverage from a travel insurance provider.Out of Province coverage is not provided for you or your dependantsif you are travelling outside your Province of residence against theadvice of your physician.All Out of Province claims are facilitated through UnitedHealthcareGlobal.Should you require emergency treatment while travelling, pleasehave the attending physician or hospital call UnitedHealthcareGlobal to verify your coverage and to confirm the guarantee ofpayment by the Plan for the emergency medical expenses.Please ask the physician or hospital to direct any invoicesdirectly to the Plan’s office. The address is on page 3 of thisBooklet.UnitedHealthcare Global can be reached at:Toll free in North America 1-800-527-0218Worldwide 1-410-453-6330UnitedHealthcare Global Identification Number 34752118

Exclusions and Limitations (EHB)Expenses incurred for the following shall not be considered eligibleexpenses:1)Expenses for benefits, care, services or supplies payable by orunder the Medical Services Plan of B.C., Pharmacare, any HospitalProgram, a Workers' Compensation Act, or any GovernmentAuthority.2)Expenses eligible for reimbursement under any other group orindividual plan.3)Expenses for dental services of any kind including services as theresult of automobile accidents in B.C. except as provided under thedental and extended benefit plans in this booklet.4)Any portion of the fee of a physician not allowable under the BasicMedical Plan except as provided under Eligible Expenses - Out ofProvince as outlined in this booklet.5)Any portion of a fee or charge in excess of reasonable charges forthe services performed.6)Expenses incurred outside the Province of residence except asprovided under Eligible Expenses - Out of Province as outlined inthis booklet.7)Expenses for services and supplies for cosmetic purposes or forthe purpose other than the treatment of sickness or injury.8)Expenses incurred in the treatment of any sickness or injury forwhich a person was hospitalized on the effective date of coverage.9)Expenses incurred outside a person's province of residence due totherapeutic abortion or childbirth or for complications of pregnancyoccurring within 2 months of the expected date of confinement.19

10)Charges for contraceptive devices or sterilization procedures thatare not covered under the Medical Services Act of B.C.11)Charges of a Physician or Licensed Practitioner which are: For a medical examination required for the use of a third party. For the completion of forms or reports for any purpose. The Medical Services Plan of BC (MSP) will no longer cover theseexpenses unless you qualify for “premium assistance”. Pleasecontact MSP for further information (see page 56) for contactinfo).12)Charges for any brace, truss or other device prescribed primarilyfor protection against injury while participating in sports activities.13)Charges for any services, supplies, drugs or other productsdetermined by the Trustees not to be an eligible expense includingdrugs described as “lifestyle” drugs which include but are notlimited to treatment for smoking cessation, weight loss, hair growth,erectile dysfunction, vaccines, vitamins, fertility treatment or forcosmetic purposes.14)Expenses for repairs, maintenance, batteries, re-charging devicesor other such accessories for hearing aids, wheelchairs, scootersor other durable equipment.15)Expenses caused, contributed to or necessitated as the result of: War or any act of war or participation in a riot or civil insurrection. Sickness or injury which was intentionally self-inflicted, whethersustained or suffered while sane or insane. The commission by any eligible person of any unlawful actincluding an offence under the Criminal Code of Canada or asimilar offence under the laws of any other country.20

Injuries received due to the operation of a vehicle, if, when theinjuries were received, the claimant’s blood contained more thaneighty (80) milligrams of alcohol per one hundred (100) millilitresof blood.16)Services and supplies the person is entitled to without charge bylaw or for which a charge is made only because the person hasinsurance coverage.17)Services or supplies not listed as covered expenses.18) Services or supplies incurred during any period in which a personhas been absent from his Province of residence in excess of 6consecutive weeks.19) Ambulance Service: Transportation arranged at the patient's convenience. modation for a condition not requiring immediatetransportation to the Hospital. Transportation for the removal of a patient from one Hospital toanother except in cases where the Hospital from which thepatient is removed has inadequate facilities to provide therequired treatment, or as set out under the terms of the Plan. Transportation to a Hospital at which the patient is not admittedfor emergency treatment. Charges for ambulance services where transportation does notactually occur shall be covered to a maximum of once in any 12consecutive month period.21

DENTAL BENEFITThis benefit is divided into three separate services:Basic100% reimbursement of accepted fees for all eligible persons.Major (Pre-authorization required)80% reimbursement of accepted fees for member, Spouse andeligible dependent children over age 21, and 100% for dependentchildren under age 21.Orthodontic (Pre-authorization required)50% reimbursement of accepted fees for all eligible persons.Maximum Benefit The maximum benefit payable for any eligible person for Basicand Major services combined performed in any calendar yearis 3,000. The maximum lifetime benefit payable for Orthodonticservices for any eligible person is 3,000.Pre-authorizationIf the treatment the dentist proposes exceeds 500, involves the useof gold, crowns or bridgework, dentures or involves treatment to beprovided by a specialist, a treatment plan should be submitted to thePlan Administrator for prior review. A Pre-authorization form will besent to both you and your dentist confirming the amount that can bepaid by the Plan.22

Dental Benefit DetailsBenefits are based on fee schedule amounts accepted by theTrustees.The Plan covers mo

TEAMSTERS' NATIONAL BENEFIT PLAN PLAN SUMMARY TEAMSTERS LOCAL 31 DIVISION January 1, 2019 . 2 TEAMSTERS' NATIONAL BENEFIT PLAN . Extended Health Benefit 10 Dental Benefit 22 Group Life Insurance 31 Accidental Death and Dismemberment 33 Weekly Indemnity Benefit 41 Long Term Disability Benefit 47 Miscellaneous 51 -Dual Coverage .