Medical Member Benefit
The following medical benefits are provided to help eligible members with unexpected health care expenses, so that they can focus on what matters the most – their recuperation.
Eligibility requirements and limitations
The following apply to each of the Medical member benefits. The additional eligibility requirements and limitations that apply to a specific Medical member benefit are listed under the Benefit Description for that benefit.
- If eligibility for this benefit is based on the holding of a Foresters life insurance certificate, for the holder’s spouse and child(ren) to be considered for this grant, that life insurance protection on the holder is not less than $6,000 or the annual premium is not less than $150.
- When eligibility is based on a Social Fraternal Membership, it must have been
inforce for a continuous period of two years immediately prior to the date
of the diagnosis.
- An application for the benefit must be accompanied by a Foresters claim form, completed by the attending physician, indicating a complete medical history of the diagnosis, date of onset, and date of total disability, if applicable.
- An application for this grant must be received by Foresters within six (6) months of the date of diagnosis (or the date of total disability where the grant is based on total disability). Consideration may be given to a late application if the required information can be provided.
- The diagnosis must be made by a duly licensed physician qualified to make the diagnosis.
- Where the grant is based on total disability, Foresters may, at its discretion, require medical evidence of continued total disability.
- Total disability and totally disabled mean the inability to engage in gainful occupation for which the person is reasonably fitted by education, training or experience except:
- In the case of a homemaker, it will mean the inability to perform normal household duties.
- For a person aged up to and including 18 or 65 or over, will mean confinement to a hospital confirmed by a statement from the hospital, or under active treatment supervised by a licensed physician either as an outpatient (requiring daily or weekly treatment), or in the case of terminal illness, at home.
- For claims with a diagnosis date before September 1, 2010, this benefit will be paid as either monthly installments or reimbursement for out-of-pocket expenses.
- For new claims with a diagnosis date on or after September 1, 2010, this benefit will be paid as a lump sum.
- This benefit will be paid in the currency of the country where the certificate was purchased.
Multiple Sclerosis Member Benefit
This benefit may provide a grant when an eligible member is diagnosed with multiple sclerosis.
If the country of eligibility is the United States:
For a diagnosis made before September 1, 2010:
- The grant is for reimbursement of out-of-pocket medical expenses, up to the lifetime maximum, incurred for the treatment of multiple sclerosis
A medical expense covered by another agency or a plan will not be reimbursed. The application must disclose the amount(s) billed to, paid or payable by another agency or plan
- Payment for medicine will be considered only if Foresters receives the doctor's prescription and pharmacist's voucher, each identifying the name of the patient, medication and cost
- A grant for medical supply items not covered by medical insurance will be considered if Foresters receives the doctor's statement confirming the need is directly related to the diagnosis of multiple sclerosis. Unless a paid bill is received, a grant provided will be made jointly payable to the applicant and the service provider
- The cost for registered or licensed nursing care, and convalescent or rest homes, will be considered upon the recommendation of the attending physician
- The cost for transportation other than by ambulance will not be considered as a medical expense. The maximum allowance for ambulance service will be $1,000
The lifetime maximum is: -
$1,200 for a diagnosis made between January 1, 1970 (benefit introduction date) and November 30, 1974
-
$2,400 for a diagnosis made between December 1, 1974 and January 31, 1976
- $5,000 for a diagnosis made between February 1, 1976 and July 31, 1993
- $6,000 for a diagnosis made between August 1, 1993 and August 31, 2010
For a diagnosis made on or after September 1, 2010:
- The grant is a lump sum payment up to a lifetime maximum of $6,000
If the country of eligibility is Canada:
For a diagnosis made before September 1, 2010, the grant is one (but not both) of the following:
- $200 per month while totally disabled due to multiple sclerosis, up to the lifetime maximum, if the eligible member is over 17 years old when diagnosed, or
- A one-time $500 grant if the eligible member is under age 18 when diagnosed
The lifetime maximum is: -
$1,200 for a diagnosis made between January 1, 1970 (benefit introduction date) and November 30, 1974
-
$2,400 for a diagnosis made between December 1, 1974 and January 31, 1976
-
$5,000 for a diagnosis made between February 1, 1976 and July 31, 1993
-
$6,000 for a diagnosis made between August 1, 1993 and August 31, 2010
For a diagnosis made on or after September 1, 2010:
- The grant is a lump sum payment up to a lifetime maximum of $6,000
Cancer Member Benefit
This benefit may provide a grant when an eligible member is diagnosed with almost any form of cancer, including leukemia and Hodgkin's disease. Note, however, that the only type of skin cancer covered by this member benefit is malignant melanoma.
If the country of eligibility is the United States:
For a diagnosis made before September 1, 2010:
- The grant is for reimbursement of out-of-pocket medical expenses incurred for the treatment of cancer
- A medical expense covered by another agency or a plan will not be reimbursed. The application must disclose the amount(s) billed to, paid or payable by another agency or plan
- Payment for medicine will be considered only if Foresters receives the doctor's prescription and pharmacist's voucher, each identifying the patient name, medication and cost
- A grant for medical supply items, including prosthetic equipment, not covered by medical insurance will be considered if Foresters receives the doctor's statement confirming the need is directly related to the diagnosis of cancer. Unless a paid bill is received, a grant provided will be made jointly payable to the applicant and the service provider
- The cost for transportation other than by ambulance will not be considered as a medical expense. The maximum allowance for ambulance service will be $1,000
- The cost for registered or licensed nursing care, and convalescent or rest homes, will be considered upon the recommendation of the attending physician
The lifetime maximum is: -
$2,000 for a diagnosis made between July 1, 1989 and July 31, 1993
-
$2,400 for a diagnosis made between August 1, 1993 and April 30, 2005
- $4,000 for a diagnosis made between March 1, 2005 and August 31, 2010
For a diagnosis made on or after September 1, 2010:
- The grant is a lump sum payment up to a lifetime maximum of $4,000
If the country of eligibility is Canada:
For a diagnosis made before September 1, 2010, the grant is one (but not both) of the following:
- $400 per month while totally disabled due to cancer, up to the lifetime maximum, if the eligible member is over 17 years old when diagnosed, or
- A one-time $500 grant if the eligible member is under age 18 when diagnosed
The lifetime maximum is: -
$2,000 for a diagnosis made between July 1, 1989 and July 31, 1993
-
$2,400 for a diagnosis made between August 1, 1993 and April 30, 2005
-
$4,000 for a diagnosis made between March 1, 2005 and August 31, 2010
For a diagnosis made on or after September 1, 2010:
- The grant is a lump sum payment up to a lifetime maximum of $4,000
Tuberculosis Member Benefit
This benefit may provide a grant while an eligible member is totally disabled due to active tuberculosis.
For a diagnosis made before September 1, 2010, the grant is one (but not both) of the following:
- $300 per month for the first six (6) months of the total disability and $200 per month thereafter while totally disabled, up to the lifetime maximum, if the eligible member is over 17 years old when diagnosed with active tuberculosis, or
- $200 per month while totally disabled, up to the lifetime maximum, if the eligible member is under 18 when diagnosed with active tuberculosis
The lifetime maximum is: -
$5,000 for a diagnosis made between January 1, 1963 and July 31, 1993
-
$6,000 for a diagnosis made between August 1, 1993 and August 31, 2010
For a diagnosis made on or after September 1, 2010:
- The grant is a lump sum payment up to a lifetime maximum of $6,000
Infectious Diseases Member Benefit
This benefit may provide a grant when an eligible member is undergoing treatment for and is totally disabled due to one of the following infectious diseases: encephalitis, meningitis, Reyes syndrome, Guillain-Barre syndrome, or hepatitis B or C.
For a diagnosis made before September 1, 2010:
The grant, while undergoing treatment for, and total disability due to, an infectious disease or diseases is one (but not both) of the following
- $300 per month for the first six (6) months of the total disability and $200 per month thereafter while totally disabled, up to the lifetime maximum, if the eligible member is over 17 years old when diagnosed, or
- $200 per month while totally disabled, up to the lifetime maximum, if the eligible member is under 18 when diagnosed
This benefit may also provide a grant to cover the payment of medicines and vaccinations for preventative treatment of rabies on an attending physician's prescription only. We will require, within six (6) months of that treatment, the doctor's prescription and pharmacist's voucher(s), each identifying the name of the patient, medication and cost. The application must disclose the amount(s) billed to, paid or payable by another agency or plan.
A grant may be based on more than one infectious disease, and combined with the grant for the treatment of rabies. Regardless of the number of infectious diseases, the total grant for an eligible member cannot exceed the monthly amount or the lifetime maximum of $6,000. If already receiving a grant due to an infectious disease, another grant does not begin for another infectious disease.
For a diagnosis made on or after September 1, 2010:
- The grant is a lump sum payment up to a lifetime maximum of $6,000
Eligibility for Foresters Member Benefits
Definition of Terms
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