120. (1) Subject to subsection (2), the Supplementary Health and Hospital Insurance Plan shall provide to every employee who joins the Plan, (a) reimbursement for 90 per cent of the cost of drugs and medicine listed in the Canadian Pharmaceutical Association Compendium of Pharmaceuticals and Specialities
and dispensed by a legally qualified medical practitioner or by a pharmacist as defined in subsection 117 (1) of the Drug and Pharmacies Regulation Act on the written prescription of a legally qualified medical practitioner; (b) reimbursement for charges for private or semi-private room hospital care made by a hospital within the meaning of the Public Hospitals Act or by a hospital that is licensed or approved by the governing body in the jurisdiction in which the hospital is located not exceeding, (i) $75 more than the charge by the hospital for standard ward room hospital care, for private or semi-private hospital room care received on or after January 19, 2004 but before April 1, 2004, and (ii) $130 more than the charge by the hospital for standard ward room hospital care, for private or semi-private hospital room care received on and after April 1, 2004; and (c) such other health and hospital expenses as result from treatment and services recommended or approved by a legally qualified medical practitioner as may be provided by the Plan.  O. Reg. 1/04, s. 32. (2) The following conditions and restrictions apply with respect to the benefits described in subsection (1): 1. The maximum amount of the reimbursement for a drug or medicine (excluding the dispensing fee) is the reasonable and customary cost of the generic form of the drug or medicine. 2. The maximum amount of the reimbursement for the dispensing fee for drugs and medicine is $8 for each prescription. 3. The employee is not entitled to be reimbursed for drugs or medicine that is available without a prescription. 4. No benefits are payable for expenses incurred outside Canada. 5. The employee is not entitled to be reimbursed for more than one pair of orthotics per person in a calendar year and the maximum amount of the reimbursement for a pair of orthotics is $500. 6. The employee is not entitled to be reimbursed for more than 75 per cent of the cost of one pair of orthopaedic shoes per person in a calendar year and the maximum amount of the reimbursement for a pair of orthopaedic shoes is $500.  O. Reg. 1/04, s. 32. (3) The employer shall pay, (a) the premiums for every full-time employee who joins the Supplementary Health and Hospital Insurance Plan; and (b) 40, 50, 60, 70 or 80 per cent of the premiums for every part-time employee who joins the Supplementary Health and Hospital Insurance Plan, whichever percentage is closest to the relation that the employee’s regularly scheduled hours of work bear to full employment, and the employee shall pay the balance of the premium through payroll deduction.  O. Reg. 1/04, s. 32. (4) An employee who has made the election described in subsection 112 (3) may elect to participate in the Supplementary Health and Hospital Insurance Plan, (a) when he or she makes the election described in subsection 112 (3); (b) in December of any year, for coverage commencing on January 1 next following, if the employee has satisfied the waiting period of the Plan and the employee, (i) did not join the Plan on appointment, or (ii) previously opted out of the Plan; or (c) on providing evidence that similar coverage available to the employee under the plan of another person has been terminated, for coverage commencing on the 1st day of the month coinciding with or following the presentation of the evidence.  O. Reg. 1/04, s. 32. (5) An employee may elect in December of any year to opt out of the Supplementary Health and Hospital Insurance Plan and coverage shall cease at the end of that month.  O. Reg. 1/04, s. 32. (6) The Supplementary Health and Hospital Insurance Plan shall provide the cost of vision care to a maximum of the following amount, to every employee who elects to participate in the Plan’s additional coverage for vision care and hearing aids: 1. $200 per person every 24 months for vision care provided on or after January 19, 2004 but before April 1, 2004. 2. $300 per person every 24 months for vision care provided on and after April 1, 2004.  O. Reg. 1/04, s. 32. (7) The Supplementary Health and Hospital Insurance Plan shall provide the cost of the purchase and repair of a hearing aid (other than the replacement of a battery) to the following maximum to every employee who elects to participate in the Plan’s additional coverage for vision care and hearing aids: 1. A lifetime maximum of $200 per person for the cost of purchasing or repairing a hearing aid incurred on or after January 19, 2004 but before April 1, 2004. 2. A maximum of $2,500 per person every five years for the cost of purchasing or repairing a hearing aid incurred on or after April 1, 2004.  O. Reg. 1/04, s. 32. (8) The additional coverage described in subsections (6) and (7) is subject to the following deductible amount: 1. $10 for each calendar year for an employee with single coverage. 2. $10 per person for each calendar year to a maximum of $20 for an employee with family coverage.  O. Reg. 1/04, s. 32. (9) For the additional coverage described in subsection (6), the employer shall pay the following percentage of the premiums for each participating employee and the employee shall pay the balance of the premium costs through payroll deduction: 1. For premiums payable on or after January 19, 2004 but before April 1, 2004, 60 per cent. 2. For premiums payable on or after April 1, 2004, 80 per cent.  O. Reg. 1/04, s. 32. (10) For the additional coverage described in subsection (7), the employer shall pay 60 per cent of the premiums for each participating employee and the employee shall pay the balance of the premium costs through payroll deduction.  O. Reg. 1/04, s. 32. (11) In this section, “optometrist” means a member of the College of Optometrists of Ontario; “physician” means a member of the College of Physicians and Surgeons of Ontario; “vision care” means eyeglasses, frames and lenses for eyeglasses and contact lenses prescribed by a physician or an optometrist, and includes the fitting of such eyeglasses, frames, lenses and contact lenses, but does not include eyeglasses for cosmetic purposes or sunglasses.  O. Reg. 1/04, s. 32.