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					                     FUNDED BENEFITS FOR
                     ONTARIO PHYSICIANS

                     OMA Priority Insurance Program




                                                      •   OMA Group Extended Health Care Plan
	
            Comparison		                              •   OMA Priority Insurance Program (OPIP) Extended health Care Plan



    When is evidence of insurability required?

    OMA GROUP: Medical evidence of good health is always required to apply for Extended Health Care Coverage.
    Depending on your health history, this may include a report from your physician as well as additional questionnaires
    and test results.

    OPIP: During the open enrolment period until April 30, 2009, no medical evidence of good health is required.
    Acceptance is guaranteed as long as you submit the application form before April 30, 2008. If you miss the open
    enrolment period, medical evidence of good health will be required.

    Is there a deductible and if so, what is the amount?

    OMA GROUP: There is no deductible.

    OPIP:
    Single Coverage
    $1,000 annual deductible for the member
    Couple Coverage
    $1,000 annual deductible for the member
    $1,000 annual deductible for the spouse or dependent child
    These deductibles are mutually exclusive and do not need to reach a combined $2,000 before reimbursement occurs.
    Family Coverage
    $1,000 annual deductible for the member
    $1,000 annual deductible for the spouse and dependent child combined
    These deductibles are mutually exclusive and do not need to reach a combined $2,000 before reimbursement occurs.

    What is the premium cost?

    OMA GROUP: Premiums are determined by your age, and whether you are insured for single, couple or family coverage.

    OPIP: $50 + OMA funded portion which is a taxable benefit to you or to your professional corporation and is based on
    age and the choice of Single, Couple or Family coverage. The actual cost might be lower when it is calculated at the end
    of the year (once the claims-to-premium experience of the plan is known).




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             FUNDED BENEFITS FOR
             ONTARIO PHYSICIANS

             OMA Priority Insurance Program




What are the tax implications?

While members should always consult with their accountants or financial advisors to discuss the specifics of their own
situation, the following information may be a useful reference. Please keep in mind that the list of Income Tax Act
references below is not intended to be exhaustive.

OMA GROUP: Premiums paid could be deductible from your taxable business income if you qualify under section 20.01
of the federal Income Tax Act.

Premiums qualify as a medical expense and could be used to calculate federal and provincial non-refundable tax credits
to the extent they (and other medical expenses) exceed the lesser of 3% of your Net Income and $1,936 (2007) as defined
under section 118.2(2) of the federal Income Tax Act.

OPIP: The funded benefit cost is reportable as taxable income. The funding could be treated like other remuneration
provided from the Ministry for the provision of medical services. A tax slip (T4A) will be issued to you or to your
Professional Corporation depending on the instruction you provide.

Premiums paid could be deductible from your taxable business income if you qualify under section 20.01 of the
federal Income Tax Act.

Your premium and your deductible qualify as medical expenses and may be used to calculate federal and provincial
non-refundable tax credits to the extent they (and other medical expenses) exceed the lesser of 3% of your Net
Income and $1,936 (2007) as defined under section 118.2(2) of the federal Income Tax Act.

Is there an age limitation to apply for the coverage?

OMA GROUP: You are eligible to apply if you are under age 79

OPIP: No age limitation to apply

Can my employee(s) apply for the coverage?

OMA GROUP: Available to office employees (providing they are permanent full-time and working at least 20 hours
per week)

OPIP: Exclusive to physicians only




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             OMA Priority Insurance Program




When can I add my spouse and/or dependents?

OMA GROUP:
Spouse: can apply at any time with medical evidence of good health.

Dependents: can apply at any time with medical evidence of good health, except newborns who can apply without
medical evidence of good health when notification is received within 60 days of the child’s birth.

OPIP:
Spouse: can be covered without evidence of good health during the open enrolment period to April 30, 2008.
Thereafter, evidence of good health will be required unless eligible to be covered as the result of a life-change event.

Dependents: can be covered without evidence of good health during the open enrolment period to April 30, 2008.
Thereafter, evidence of good health will be required unless eligible to be covered as the result of a life-change event
or if a newborn who can be covered as long as notification is received within 90 days of the child’s birth.

Is there a specific amount that can be claimed for prescription drugs?

OMA GROUP: Unlimited; Covers 90% of the cost of generic drugs plus the first $5.00 dispensing fee; Fertility Drugs not
included.

OPIP: Maximum $1 million per lifetime; Covers 100% of the cost of generic drugs plus the first $10.00 dispensing fee
subject to the deductible. Charges in excess of the lowest cost generic product are not covered unless the physician
specifies in writing that no substitution for the prescribed drug may be made; Fertility Drugs ($2,400 lifetime maximum).

Is there a survivor’s benefit?

OMA GROUP: Your spouse (along with any dependent children) can continue coverage on a premium paying basis by
becoming insured as an Independent Person provided a written request is made within 60 days of your death.
Note: Children who no longer qualify as a dependent at any time may also request to continue coverage as an
Independent Person.

OPIP: Your spouse (along with any dependent children) can continue coverage on a premium paying basis provided a
written request is made within 60 days of your death.

If you die without an insured spouse, coverage for your dependent children terminates three months after your death.




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             OMA Priority Insurance Program




When will my coverage end?

OMA GROUP:
r The date you cease to be a member of the OMA or one of the Atlantic Provinces;
r The date you cease to reside in Canada;
r The date you fail to pay the required premium;
r The date you send a written request to cancel your coverage;
r Upon your death;
r Upon termination of the Group Policy.

OPIP:
r The date you are no longer covered by a provincial or federal medicate plan;
r The date you become a Quebec resident;
r The date you cease to reside in Canada;
r The date you fail to pay the required premium;
r The date you send a written request to cancel your coverage;
r Upon your death;
r Upon termination of the Group Policy;
r The last day of the month your Ministry of Health and Long Term Care (MOHLTC) funding ends, except as
   provided under the Continuation of Insurance provision.

When the MOHLTC funding ends, you are entitled to continue your coverage on a premium paying basis if a) your
insurance has been in force for at least 12 consecutive months and b) your written request for continuation of insurance
has been made within 60 days of the date your MOHLTC funding ended.

What types of paramedical services are covered?

OMA GROUP:
r 90% coinsurance applies
r $350 annual maximum per specialty for each insured person
r Licensed psychologists and massage therapists (physician’s referral required);
r Licensed naturopaths, podiatrists, speech therapists and chiropractors (no physician’s referral required);
r Licensed physiotherapist (no annual limit and no physician’s referral is required).

OPIP:
r $350 annual maximum per specialty for each insured person
r Licensed psychologists, speech therapists and massage therapists (physician’s referral required);
r Licensed naturopaths, osteopaths, acupuncturists, podiatrists or chiropractors (no physician’s referral required);
r Licensed physiotherapist - no annual limit (physician’s referral required).




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             OMA Priority Insurance Program




What hospital services are covered?

OMA GROUP:
Semi-Private Hospital; 100% of the room and board plus an additional $40 per day for private room on top of the
semi-private rate per day; no limit on the length of stay.

Convalescent Hospital: 100% up to 180 days for any one disability, if admitted within 24 days of a stay in a regular
hospital.

OPIP:
Hospital: 100% of out-patient services in a hospital and the difference between the cost of a ward and a semi-private
hospital room.

Convalescent Hospital: 100% up to 180 days for any one disability, if admitted within 24 days of a stay in a regular
hospital.

What other types of services are covered?

OMA GROUP:
Private Nursing: 90% to a maximum of $25,000 every 3 years if you are under age 65; to total of $5,000 beyond age 65.

Services & Equipment: Hearing Aids subject to a $500 maximum in any 5 year period; Ambulance Service; Walkers, Canes,
Braces & Crutches at 90%; Electric Wheelchairs (purchase, rental and repairs) at 100%.

OPIP:
Private Nursing: $25,000 maximum every 3 years for insured under age 65 and $5,000 maximum age 65 and over.

Services & Equipment: Hearing Aids up to $500 every 5 years; Ambulance Service; Walkers, Canes & Crutches ($5,000
per plan year maximum); Durable Equipment ($5,000 maximum per covered person in a plan year); Wheelchairs ($5,000
lifetime maximum); Hospital Beds ($5,000 lifetime maximum).

Is there a time limit on making a claim?

OMA GROUP: 180 days after the end of the benefit year (January 1 to December 31) to claim expenses that were
incurred during that benefit year. After the 180 days, you can no longer submit claims for the previous year’s expenses.

OPIP: 90 days after the end of the benefit year (January 1 to December 31) to claim expenses that were incurred during
that benefit year. After the 90 days, you can no longer submit claims for the previous year’s expenses.




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             OMA Priority Insurance Program




What is covered under the Out-of-Province Travel Insurance?

OMA GROUP:
r No restrictions for pre-existing conditions;
r Includes emergency outside country travel coverage for Member, Spouse and dependent children up to $1 million
  per person;
r Services limited to the first 90 days of travel for persons under the age of 70 and to the first 30 days of travel for
  persons aged 70 or older;
r Covers emergency expenses like physician services, ambulance services, inpatient and outpatient hospital care,
  return airfare to your home province, convalescent accommodations and travel, accommodations and meals for
  visiting family members.

OPIP:
r No restrictions for pre-existing conditions;
r Includes emergency outside country travel coverage for Member, Spouse and dependent children up to $1 million
   per person; lifetime limit;
r Services limited to the first 90 days of travel for persons under the age of 70 and to the first 30 days of travel or
   persons aged 70 and older;
r Covers emergency expenses like physician services, ambulance services, inpatient and outpatient hospital care,
   return airfare to your home province, convalescent accommodations and travel, accommodations and meals for
   visiting family members.




Contact Information

Telephone:           1-866-527-9260 or 416-408-8420           Fax:       416-595-9528
Web:                 www.oma.org or www.opip.ca               E-mail:    info@opip.ca



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