Prime Health & Dental Insurance
Home > Health & Dental > Prime > Health & Dental

Prime Health & Dental Insurance

Because you shouldn’t have to pay so much out of your own pocket for medical expenses

Overview

Engineers Canada-sponsored Prime Health & Dental Insurance can help reduce your out-of-pocket payments for medical expenses that may not be covered by your government health plan. Regardless of your age, you can get coverage for yourself, your spouse and your eligible children.

With the Prime plan that we’ve offered for years, you can purchase either Extended Health Care or Dental Care, or both. It really just depends on what you may want.

Attention: Members of the Ordre des ingénieurs du Québec (OIQ)
Members of OIQ have access to health and dental insurance plans sponsored by Engineers Canada and underwritten by Manulife. These plans offer prescription drug coverage that is at least equivalent to that offered by the Régie de l’assurance maladie du Québec (RAMQ) under An Act respecting prescription drug insurance (the “Act”). Read more. 
What’s covered > Extended Health Care
Eligible expenses 100% coverage per person
Vision care
  • $80 every 24 months for eye examinations
  • $250 every 24 months for prescription lenses, frames, contact lenses and laser eye surgery
Hospitalization Private or semi-private hospital room in Canada
Eligible expenses 80% coverage per person
Prescription drugs Generic drug coverage (or brand-name drugs if no generic exists)
Medical practitioners $500 per practitioner, per calendar year
  • acupuncturists
  • chiropractors
  • osteopaths
  • chiropodists
  • podiatrists
  • naturopaths
  • psychologists
  • physiotherapists
  • speech therapists
  • massage therapists
  • dietitian
Hospitalization
  • Convalescent care: Semi-private up to 180 days in excess of any amount paid by provincial plan
  • Long-term care facility: Semi-private up to 90 days in excess of any amount paid by provincial plan
Ambulance Cost of land or air ambulance
Nursing care Private duty nursing: $10,000 for any one injury or sickness in any 12 consecutive months
Hearing aids $500 every 5 years
Orthotics and orthopaedic shoes $225 (combined) per calendar year
Diabetic supplies $500 per calendar year for glucometers
Emergency travel assistance Includes medical assistance, emergency medical care, ambulance services, and personal and legal services
Accidental dental $750 per tooth
Miscellaneous Includes artificial limbs and eyes; casts, crutches and braces; oxygen and related equipment; blood and plasma; wheelchairs and hospital beds; diagnostic procedures and x-rays
Deductible: For prescription drugs only: $50 per person, maximum $100 per family, per calendar year
Payable: 80% of eligible expenses, not exceeding $2,500 per family, per calendar year; 100% of eligible expenses in excess of $2,500 per family, per calendar year
Lifetime maximum:

If the insured is under age 65:
- $5 million for eligible expenses for Emergency Out of Province and/or Canada Medical Surgical services
- $1 million for all other eligible expenses

If the insured is age 65 and over:
- $50,000 (in Canada) and $25,000 (out of Canada)

What’s covered > Dental Care
Basic Dental 80% coverage per person
Diagnostic Complete exam every 3 years, diagnostic x-rays every 3 years, 2 bitewing x-rays every 6 months
Preventative Recall exam every 9 months,  prophylaxis every 12 months,  light scaling
Minor restorative Fillings,  pins,  preformed stainless steel and plastic crowns
Endodontic Root canals and retreatment,  pulpectomy, endodontic surgery
Periodontic Curettage and root planing, gingivoplasty, grafts, splinting
Oral surgery Extractions, biopsies, removal of cysts and tumours
Other Anesthesia, denture maintenance (every 24 months)
Major Dental 50% coverage per person
Dentures Denture installation, adjustment and replacement
Crowns Inlays, onlays, gold fillings and crowns
Bridgework Installation or replacement of fixed bridgework
Deductible: $50 per person, maximum $100 per family, per calendar year
Annual maximum: $1,500 per person per calendar year
Special benefits
  • Built-in travel insurance
    The Extended Health Care Plan covers you and your eligible insured dependents for medical emergencies while travelling outside your home province for up to the first 60 consecutive days per trip. Emergency travel assistance is available worldwide, 24 hours a day, 365 days a year.
  • Drug card
    Receive a pay-direct drug card which allows your pharmacist to bill Manulife directly for your covered prescriptions, so you don’t have to pay out of your own pocket for the covered portion of the prescription price.
  • Reinstatement of lifetime maximum
    On January 1st of each year, the Plan automatically reinstates up to $5000 of incurred expenses towards your lifetime maximum — provided that the amount to be added back in shall never cause the overall maximum to exceed the amount you would otherwise be eligible for.
What’s excluded > Extended Health Care

1. General Exclusions
You will not be covered for any loss, or expenses caused or contributed to by:
a) self-inflicted injury; or
b) war or any act of war; or
c) active full-time service in the armed forces of any country or international organization; or
d) for services payable under any Workers’ Compensation Act or Occupational Disease Law, or any Government Plan of Health or Law, or any instrumentality thereof; or
e) travel for health, periodic health examinations or examinations required for the use of a third party; or
f) for any dental treatment, appliance or expense, except as otherwise provided in your Certificate of Insurance; or
g) for cosmetic surgery, except when necessitated by injury; or
h) vitamins (unless injected), birth control devices, anti-impotence drugs, over-the-counter drugs, anabolic steroids, fertility drugs, smoking cessation products and drugs, treatment or supplies which are not approved by Health Canada or are experimental, preventative, or limited in use whether or not so approved; or
i) all types of surgery.

2. Extended Health Care Pre-existing Condition Limitation
Our underwriters base their decision to exclude a condition or conditions on the health information you declare on the application and/or information your doctor provides during the underwriting process. Excluded conditions will not be covered under the contract.

3. Out of Province/Territory and/or Out of Canada Exclusions
You will not be covered for any loss or expenses you incur while outside of your province of residence and/or Canada caused or contributed to by:
a) any treatment or surgery that does not require immediate relief of acute pain or suffering, or which could reasonably be delayed until you return to the province of residence and/or Canada; or
b) treatment you may decide to receive outside of your province of residence and/or Canada following emergency treatment or diagnosis of a medical condition which, based upon medical evidence, would not have prevented you from returning to your province of residence and/or Canada for treatment or surgery; or
c) any medical or hospital services which necessitated travel specifically to obtain them, whether or not on the advice of a physician; or
d) operation of a motorized vehicle while impaired by drugs or other toxic substances or where the level of alcohol exceeds 80 milligrams per 100 millilitres of bodily fluid; or
e) participation in a professional sport, any speed contest, SCUBA diving without a basic SCUBA designation from a certified school or other licensing body, bungee-jumping, parachuting, parasailing, mountaineering, spelunking, or any airborne activity unless you are riding as a passenger on a commercially licensed airline.

4. General Limitation
You will only be reimbursed eligible expenses not covered by a provincial or territorial plan. You will not be reimbursed expenses covered by any government program or other program of health insurance. Manulife will be entitled to the reimbursement of any amounts it pays which are recovered from a third party. In addition, you will not receive benefits for that part of any expense in excess of those considered reasonable and customary.

5. Out of Province and/or Canada Limitation
The coverage period of this insurance for any one trip outside of province of residence and/or Canada is limited to the first 60 consecutive days. The coverage period of this insurance for all trips in any six-month period is limited to the first 75 days in the aggregate. This insurance does not cover any loss or expenses you incur while outside of your province of residence and/or Canada for any period beyond the coverage period.

6. Out of Province and/or Canada Pre-existing Condition Limitation
This insurance does not cover any loss or expenses you incur while outside of your province of residence and/or Canada caused or contributed to by any injury or sickness or related condition for which you received treatment or required the use of medication during the 90 days prior to the date you left your province of residence and/or Canada. However, any condition which has been controlled by the consistent use of medication prescribed by a physician is covered, provided that during the same 90-day period the condition was stable and there had been no change in the medication or dosage.

7. Out of Province and/or Canada Pregnancy and Childbirth Limitation
This insurance does not cover any loss or expenses incurred for the treatment or confinement of mother or child(ren) as a result of pregnancy, miscarriage, childbirth, or complications of any of these occurring within two months of the expected date of birth.

What’s excluded > Dental Care

1. Exclusions
No amount will be paid for charges for:
a) recalls occurring more frequently than once every 9 months;
b) dental services or appliances which were assessed, arranged, ordered or obtained prior to the effective date of your coverage;
c) white fillings on molars;
d) completion of claim forms;
e) dental care which is cosmetic;
f) broken appointments;
g) self-inflicted injury;
h) dental care covered under a medical plan provided by an employer or government;
i) replacement of a lost or stolen prosthesis;
j) expenses for which, in the absence of coverage, there would be no charge;
k) stainless steel crowns on permanent teeth;
l) protective athletic appliances;
m) any expense incurred after termination of coverage;
n) a full mouth reconstruction, for a vertical dimension correction, or for diagnosis or correction of a temporomandibular joint dysfunction.

2. Limitations
The plan will pay for reasonable and customary charges for the expenses charged by a dentist, but not exceeding the limit for that service listed in the Provincial General Practitioners Dental Fee Guide. When two or more covered dental procedures are suitable for the dental care of a specific condition, and both are consistent with good dental care, you will receive benefits for the least expensive service. The plan does not reimburse for expenses covered by any government program or other program of insurance. Manulife is entitled to reimbursement of any amounts recovered from a third party.

Who is eligible?

Note: All applicants must have coverage under a provincial/territorial health care insurance plan in order to be eligible for this insurance product. If anyone on the application does not meet this requirement, please call 1-877-598-2273 for more information.

You must be a Canadian resident  and under age 66 if applying for Extended Health Care, or under age 65 if applying for Dental Care. You must also fall under one of the following:

  • Members (including members in training) of the 12 provincial and territorial engineering licensing associations. Also included are student engineers who are members of a student section (in those associations where a student section exists) and who are within 24 months of expected graduation from a program accredited by the Canadian Engineering Accreditation Board.
  • Members of the 8 participating provincial associations of technicians and technologists.
  • Members of l'Ordre des Géologues du Québec.
  • Members of Geoscientists Nova Scotia.
  • Members of the Association of Professional Geoscientists of Ontario.
  • Members of the Ontario Society of Professional Engineers.
  • Members of the Manitoba Association of Architects.
  • Members of the Architects' Association of New Brunswick.
  • Members of the Nova Scotia Association of Architects.
  • Members of the Architects Association of Prince Edward Island.
  • A full-time employee of Engineers Canada, or of one of Engineers Canada provincial/territorial constituent associations, or of one of the participating organizations, or of The Youth Science Foundation Canada.
  • Limited licensees.
  • Provincial licensees.

If you are applying or are already covered under Extended Health Care and/or Dental Care, you may also apply for your spouse and eligible children who are covered by government health insurance.  Children must be under age 21 at the time of application and, once insured, benefits will be extended to age 25 for full-time students. Covered children who are incapacitated and dependent on you for support will be covered up to any age.

Frequently asked questions

I only see rates to age 65 on the website. Does this mean that Extended Health Care coverage ends at 65?
Coverage under Extended Health Care can be maintained past age 65. Please contact us for the rates that apply to those over 65 years of age.

What is the annual limit per practitioner under medical practitioners (such as chiropractors, massage therapists, psychologists, etc.)?
There is an annual limit of $500 for each practitioner

What are the limits per eligible expense, per person?
Eye exams – $50 every 24 months
Prescription eyewear – $200 every 24 months
Medical practitioner – $500 per practitioner, per calendar year
Private duty nursing – $10,000 for any one injury or sickness every 12 months
Hearing aids – $500 every 5 years
Orthotics and orthopaedic shoes – $225 (combined) per calendar year
Glucometers – $500 per calendar year
Accidental dental – $750 per tooth
Prescribed vaccines (required for out-of-Canada travel) – $250 per calendar year
Repatriation – $15,000 per injury or sickness
Dental care – $1,500 per calendar year

View the complete FAQs.

 

ManulifeCAEmail