UCR means the charge or fee determined by the Company to be the general rate charged by others who render or furnish such treatments, services or supplies to persons whose injuries or illnesses are comparable in nature and severity.
The Company will consider such factors as; complexity; degree of skill needed, type of specialist required, and the range of services or supplies provided by the facility. For example, if a doctor charges $3,000 for a surgical procedure and the usual fee for the procedure is $2000 then the plan will reimburse you based on the charge of $2000 and applicable co-insurance will apply.

Exclusions and Limitations refer to services, equipment, procedures and types of treatment that are not covered under the plan. These are listed in the policy contract.

A letter from the treating Physician or Medical facility with an itemization of the charges and the type of treatment/procedure recommended or scheduled must be sent to your TTPCU plan administrator, who in turn will send to GENESIS.

Pre-certification is a notification of anticipated or schedule medical services that is required in advance of the actual medical treatment. Before you actually receive treatment or incur the medical expenses, BEACON upon request by the Provider, issues a pre-approval letter stating whether the anticipated service is eligible for coverage and the level of charges that would be reimbursed from the health plan.

When an individual is covered under more than one health plan and is able to claim for the expenses incurred from both plans, the benefits under this policy will be reduced to an amount which when added to the benefit of the other plan will equal 100% of medical expenses incurred.
The following will determine which plan will pay first:
• The plan covering the insured as an employee;
• The plan covering the insured as a Dependent of a Male employee; and
• If the above do not establish an order of priority, the plan which has covered the insured for the longer period of time pays the benefits first.

This is the annual dollar amount of covered expenses for which the Insured is responsible before benefits can be payable under the Policy.

Coverage is only applicable to your spouse (common-law included) and children (step, legally adopted + incapacitated over the age of 25 years included). Children are covered without exception up to age 19. Between the ages of 19 and 25 children can continue coverage; however, they must be in school full-time as evidenced by a letter from the respective institution at the start of each academic year.

A pre-existing condition is a condition resulting from illness or injury for which a Covered Insured has received a diagnosis, consultation, medical treatment, or drug prescription prior to the effective date of the policy or date cover was effective; OR for which a symptom and/or sign of illness, if presented to a physician prior to the effective date of the policy would have resulted in the diagnosis of an illness or medical condition whether or not the patient was aware of the condition.

This plan will not carry a swipe card option and will be a reimbursement plan as opposed to a network provider plan. Members will receive a membership card which can be presented at any SUPERPHARM location when purchasing eligible prescriptions where they will only pay 20% of the cost.

New members wanting to join the new GENMed plan will need to complete the Enrolment, ACH and Medical Questionnaire forms which are available at your closest AGRICOLA office.

It is intended to have a one (1) month open enrolment period where anyone can sign up to the plan with no Medical Underwriting. There will be conditions for new persons who are now signing up with Pre-Existing conditions. This open enrollment will be decided upon by your Credit Union.