Effective April 1, 2019, OHIP+ will no longer provide drug coverage for individuals under the age of 25 who have access to private insurance. Therefore, prescription drug claims for children and youth 24 years of age and younger with private plan coverage will have to be submitted directly to their private plan. Click here for details!

Coverd Illnesses

Alzheimer’s Disease: means the diagnosis that you have Alzheimer’s Disease, which is a progressive degenerative disease of the brain. The diagnosis must be supported by medical evidence that you exhibit the loss of intellectual capacity resulting in impairment of your memory and judgment, which results in a significant reduction in your mental and social functioning, such that you are require permanent daily personal supervision for the Activities of Daily Living. All other dementing organic brain disorders and psychiatric illnesses are excluded from this Insured Condition definition. A physician who is certified as either a neurologist or a psychiatrist must confirm diagnosis in writing.
 
Amyotrophic Lateral Sclerosis: (ALS) means unequivocal diagnosis of ALS resulting in the inability to perform three of the six Activities of Daily Living without assistance. A physician who is certified as a neurologist must confirm diagnosis in writing.
 
Aorta Surgery: means surgery to the aorta that is medically required to treat disease of the aorta and that involves the excision and surgical replacement of the diseased aorta with a graft. The Aortic Surgery must be performed on the prior written advice of a physician certified as a cardiovascular surgeon. Aorta includes the thoracic and abdominal aorta but does not include any of the branches of the aorta.

Benign Brain Tumour: means a benign neoplasm in the brain or meninges with histologic confirmation. Cysts granulomas, malformations of intracranial arteries or veins, and tumours or lesions of the pituitary are specifically excluded. The diagnosis must be confirmed neuro-radiologically by a specialist trained in the interpretation of radiological investigations.

Blindness: means the total and irrecoverable loss of sight in both eyes due to Injury or sickness. Corrected visual acuity must be 20/200 or less in both eyes and the field of vision must be less than 20 degrees in both eyes. A physician certified in ophthalmology, must clinically confirm the diagnosis in writing.

Cancer: means a malignant tumour characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue. This includes Leukemia, Hodgkin’s Disease and invasive melanoma but does not include:

  • Carcinoma in situ
  • Kaposi's Sarcoma (or other AIDS related cancers) and  cancer in the presence of human immunodeficiency virus  (HIV)
  • Skin cancer or melanoma that is not invasive and has not  exceeded .75 millimetres in depth.
  • Prostate cancer diagnosed as T1N0M0 or equivalent staging.

A physician certified as an oncologist must confirm diagnosis in writing.

Coma: means you have been in a state of unconsciousness for a continuous period of at least 96 hours, during which external stimulation produced no more than primitive avoidance reflexes. A physician who is certified as a Neurologist must confirm diagnosis in writing.

Coronary Artery Bypass Surgery: means surgery performed by a physician who is certified as a cardiovascular surgeon to correct narrowing or blockage of one or more coronary arteries with bypass grafts. Non-surgical techniques such as balloon angioplasty, laser relief of an obstruction, or other intra-arterial techniques will not be considered to be a covered Critical Illness.

Deafness: means the diagnosis of permanent loss of hearing in both of your ears, with an auditory threshold of more than 90 decibels in each ear. A physician, who is certified as an otolaryngologist must confirm diagnosis in writing.

Heart Attack: means the death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. Diagnosis must be confirmed in writing by a physician who is a certified specialist in internal medicine or cardiologist and should be based on new electrocardiograph changes consistent with heart attack and at least one of the following: elevation of cardiac biochemical markers or elevation in cardiac enzyme, to levels consistent with heart attack.

Heart Attack does not include elevation of cardiac biochemical markers or elevation of cardiac enzymes due to coronary angioplasty unless accompanied by diagnostic changes of a new Q wave infarction on the ECG.

Loss of Independence: means the definitive diagnosis by a licensed physicians of either ;

  • Being totally and permanently unable to perform, by oneself, at least two of the six activities of daily living or,
  • Cognitive impairment

A mental or nervous disorder without a demonstrable organic cause is not covered. Loss of independence must persist for at least 90 days from the date of the diagnosis.
Major Organ Failure: means the irreversible failure of the entire heart, entire liver, both lungs, both kidneys or bone marrow, in which the affected organ is unresponsive to any treatment and for which you medically required to become enrolled in a recognized Canadian transplant program to become the recipient of a heart, a liver, a lung, or a kidney or to receive a bone marrow transplant.

Multiple Sclerosis: means the unequivocal written diagnosis by a physician who is certified as a neurologist confirming at least moderate persisting neurological abnormalities, with impairment of function, but not necessarily confining you to a wheelchair or bed.

Paralysis: means the total and irrecoverable loss of function of two (2) or more limbs through neurological damage due to Injury or sickness, provided such loss of function continually lasts for 180 consecutive days and such loss of function is thereafter determined on evidence satisfactory to AIG Insurance Company of Canada to be permanent. A physician certified as a neurologist must confirm diagnosis in writing.

Parkinson’s Disease: means unequivocal diagnosis of primary idiopathic Parkinson’s Disease resulting in the inability to perform three of the six Activities of Daily Living without assistance. Diagnosis should show signs of progressive impairment and must be confirmed in writing by a physician who is certified as a neurologist.
Severe Burns: means third degree burns covering at least 20% of the surface area of the body. A physician who is certified as a plastic surgeon must confirm diagnosis of this condition in writing.

Stroke: means that you have suffered a cerebrovascular incident, excluding transient ischemic attack (TIA), producing infarction of brain tissue due to thrombosis, haemorrhage from an intracranial vessel or embolization caused by an extra cranial source. There must be evidence of permanent neurological deficit persisting for 30 consecutive days, supported by evidence that the deficit is resulting from the Stroke, confirmed in writing by a physician who is certified as a neurologist.

The Activities of Daily Living means the activities that a person would normally perform without assistance: bathing, dressing, toileting, bladder and bowel continence, transferring or feeding.

Claim Forms

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Teamster Local Union 230 Members' Benefit Fund c/o Benefit Plan Administrators
90 Burnhamthorpe Road West, Suite 300 Mississauga, Ontario L5B 3C3