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myBenefits



myBenefits at a Glance

The highlights below are provided as general information. Coverage for eligible costs are based on the contract detail. Reasonable and customary rates will be applied. Select the benefit for additional coverage details.

Ambulance:
Reimbursed at 80% based on reasonable and customary charges.
(please click Supplemental Health for details.)

Prescription Drugs:
Reimbursed at 90% to a maximum of $5,000 per benefit year.
Based on the Ontario Provincial Formulary with a generic rider.
$8 dispensing fee limit.
(please click Prescription Drug for details.)

Vision:
Reimbursed at 100%, for one eye exam based on reasonable and customary charges every 24 months from the date of service. Glasses or contact lenses, maximum of $120 every 24 months from the first date of purchase.
(please click Vision for details.)

Health Practitioners:
The services of paramedical practitioners are reimbursed at 80% to a maximum of $300 per practitioner, per benefit year. Practitioners must be registered and licensed in their field of practice.
(please click Supplemental Health for details.)

Medical Equipment & Supplies:
Reimbursed at 80%. A physician's prescription is required. Pre-authorization is suggested.
(please click Supplemental Health for details.)

Dental Coverage:
Exams covered at 100% once per benefit year. Overall plan maximum of $500 per benefit year.
(please click Dental for details.)

Dental Accident:
Reimbursed at 100% to a maximum of $2,000 per accident (treatment must commence within 30 days of the accident and be completed within 12 months of accident; authorization required).
(please click Supplemental Health for details.)

Accidental Death & Dismemberment:
$25,000 loss of life benefit.
(please click Other Insurances for details.)

Accident Benefits:
Accident benefits are provided to both students covered under the Georgian College SA Student Health & Dental Plan and Apprentice Students of Georgian College of Applied Arts and Technology.
(please click Other Insurances for details.)

NOTE: In the event of any discrepancy between the information herein and our contract with the insurer, the terms of the contract will apply.

Supplemental Health




Ambulance
Your plan covers of 80% based on reasonable and customary charges, for licensed ground ambulance or emergency air service that transports the patient to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation. If the patient requires the services of a registered nurse during the flight, the services and return airfare for a registered nurse are covered.
Practitioners
Student benefits are payable after any Provincial Health Care benefits have been exhausted. This plan does not cover user fees. Student specific rates are available for some of the indicated services, information can be found in Select Savings. Practitioners must be registered and licensed in their field of practice.

The services of the following practitioners are covered at 80% to a maximum of $300 per practitioner, per benefit year.

• physiotherapist*
• speech therapist*
• chiropractor, including 1 x-ray examination per benefit year
• naturopath
• registered massage therapist*
• athletic therapist*
• psychologist or social worker


*physician’s prescription/referral required for indicated services

For Online Video Counselling you can click here to use online (eClaim) or our paper form (Health Claim Form) for reimbursement by submitting your receipts.
Medical Equipment & Supplies
Your plan covers 80% based on reasonable and customary charged for vaccines, compound serums, colostomy supplies, injectable drugs and varicose vein injections, if medically necessary. Such drugs or supplies must be either administered by a physician or dentist or prescribed by a physician or dentist and dispensed by a pharmacist. Any charges for administration are not eligible.

Medical Equipment
Your plan covers 80% of reasonable and customary charges for eligible equipment when prescribed by a physician. Eligible durable equipment includes, but is not limited to, items such as:

• wheel chairs
• wheel chair repairs (lifetime maximum of $250)
• walkers
• hospital beds
• traction kits
Prosthesis
Your plan covers 80% of reasonable and customary charges when prescribed by a physician for Prosthetic Appliances including:

Charges for artificial limbs when the loss of the limb occurs while the individual is insured under this benefit. The cost of repair is also covered. Replacement is covered when required due to physiological change, excluding myoelectric  appliances. It is recommended that an application for pre-approvable submitted to the insurer.

Charges for artificial eyes including one polishing or one re-make each benefit year.

Casts, splints, trusses, braces or crutches, including replacements when medically necessary. It is recommended that  an application for pre-approval be submitted to the insurer.

External breast prosthesis when required due to a total or radical mastectomy that has been performed while you are  insured under this benefit. The purchase of 2 surgical brassieres is included to a maximum of $200 each benefit year.
Orthopaedics*
Your plan covers 80% up to a maximum of $200 per benefit year for custom-made orthopedic shoes, molded arch supports, or orthopedic supplies, when recommended by a physician, podiatrist or chiropodist, provided  they are dispensed by an orthotist, pedorthist, podiatrist, or chiropodist and must be dispensed by a different provider than the prescriber. The prescriber cannot be the Insured Person or a member of their immediate family nor  ordinarily reside in the Insured Person’s Residence. Excluded: orthopedic supplies prescribed or dispensed by a  chiropractor.

*IMPORTANT It is strongly recommended that a pre-determination/estimate be submitted to Great-West Life to ensure that the guidelines set out by Great-West Life for the payment of Orthopaedics are met and to confirm that your claim would be eligible.
Other Eligible Expenses
1) Charges for oxygen, blood or blood products and the equipment required for it’s administration;
2) Charges for treatment of a sickness by the use of radiotherapy or coagulotherapy;
3) Charges for laboratory tests done in a commercial laboratory for diagnosis of a sickness but excluding any tests performed in a physician’s office or a pharmacy.
Dental Accident
IMPORTANT! Dental Accident Pre-determination: An estimate for all dental accident services MUST be submitted to the health plan insurer. If you go ahead with treatment without a pre-determination being approved, you are doing so at the risk of the expenses being yours.

The plan covers 100% to a maximum of $2,000 per accident for of the cost of the services of treatment of injury to sound natural teeth (treatment must commence within 30 days of the accident and be completed within 12 months of accident; authorization required). Treatment must start within 30 days after the accident unless delayed by a medical condition. A sound tooth is any tooth that did not require restorative treatment immediately before the accident. A natural tooth is any tooth that has not been artificially replaced.

No benefits are paid for:
• accidental damage to dentures
• dental treatment completed more than 12 months after the accident
• orthodontic diagnostic services or treatment

In the event of a dental accident, you must complete a Standard Dental Association claim form (available from the Student Benefits Plan Office). When making a claim, be sure to attach all original receipts to the claim form. The claim form can be mailed directly to the insurance company.

Prescription Drug

Attention Out of Country and Out of Province Students!
Starting January 1, 2018, the Ontario government introduced a new program called OHIP+.  This program allows individual’s under 25 years old, covered under the Ontario Health Insurance Plan (OHIP) to receive free prescription medications for more than 4,400 drug products.  If you do not have OHIP, you must contact your benefit plan coordinator to indicate your home province or country.  If you visit a pharmacist before updating your home province/country your drug claims will bedenied.

Your drug plan covers 90% of the cost of most medications legally requiring a prescription to a maximum of $5,000 per benefit year.

Vaccinations are covered at 80% based on reasonable and customary charges. Administration costs associated with providing the injection are not covered. Vaccination benefits are paid through your medical supply benefit and therefore must be submitted via the health claim form. Vaccination claims cannot be submitted using the myBenefits Card.

The maximum amount allowed for a dispensing fee is $8.00. Any amount charged over and above will be payable by the student.

The maximum amount payable to an eligible brand name drug will be limited to the lowest priced item in the appropriate generic category.

The following drugs are covered if they are listed in the Ontario Provincial Formulary and Interchangeable List in effect on the date of purchase:

(a) drugs which require the written prescription of a physician or dentist
(b) injectable drugs including allergy serums and insulin
(c) extemporaneous preparations or compounds if one of the ingredients is a covered drug
(d) certain other drugs that do not require a prescription by law may be covered when prescribed by your physician or dentist. If you have any questions, contact your plan administrator before incurring the expense
(e) hepatitis B vaccine, subject to a maximum of $100 per insured, per benefit year
(f) Nuva Ring (contraceptive), subject to a maximum of $178 per insured, per benefit year
(g) oral contraceptives and the patch (birth control)
(h) all acne preparations excluding Accutane or other acne preparations containing the same medicinal ingredient as Accutane

The following diabetic supplies are covered to a maximum of $200 per benefit year:
(a) insulin syringes
(b) disposable needles for use with non-disposable insulin injection devices
(c) lancets and test strips

IMPORTANT! Advise your doctor and pharmacist that you are on the ON Provincial Formulary.

The ON Provincial Formulary is a specific list of drugs that are eligible for reimbursement under your drug benefit. Formularies are developed to ensure that prescription drugs are available on a cost-effective basis. It covers approximately 85% of the most frequently prescribed drugs. Formularies are reviewed regularly and as a result, updates are made on an ongoing basis.

Exception Process: In the event that the drugs covered by the Formulary are not effective in treating the condition, an exception process is in place. To be eligible for an exception, you must have tried one alternative drug listed on the Formulary. An exception drug request form is available below or from your Benefits Plan Office and must be completed by your physician. Completed forms may be returned to the Student Benefits Plan Office or can be faxed directly to the insurance company.

Request for Coverage of Exception Status Drug form

Vision

Your plan covers 100% of the cost of one eye examinations by an ophthalmologist or optometrist in a 24 month period from the date of service. Based on reasonable and customary charges.

Your plan covers 100% of cost for the purchase of eyeglasses and/or contact lenses to a maximum of $120, once during a 24 month period from the first date of purchase. Based on reasonable and customary charges.

Special contact lenses for severe corneal astigmatism, severe corneal scarring, Keratoconus (Conical Cornea) or Aphakia, when they are prescribed by a licensed ophthalmologist or optometrist, provided that visual acuity can be improved to at least 20/40 level whereas it cannot be improved to that level with standard glasses. The maximum is $200 for one complete set of lenses every 24 months from the first date of purchase.

Note: The following will not be covered sunglasses, safety glasses or eyeglasses provided for cosmetic or aesthetic purposes.

Dental

Payment of dental benefits is based on the General Practitioners Dental Association suggested fee guide or the Insurance Reimbursement Rate set by the Canadian Life and Health Insurance Association Inc. (CLHIA) when a fee guide is not available. For services provided by a dental specialist, payment is based upon the General Practitioners Dental Association suggested fee guide.

Alternate Benefit - When there are two or more courses of treatment available to adequately correct a dental condition, reimbursement may be based on the cost of the least expensive treatment, which provides adequate care to the Insured.

IMPORTANT! Please submit a pre-determination/pre-authorization to the insurance carrier prior to treatment of specialist services and any treatment plan exceeding $300.

Your plan covers up to a maximum of $500 per benefit year. Exams covered at 100% once per benefit year.



Diagnostic & Preventative
Your plan covers 100% for diagnostic and preventative procedures including:
One examination and consultation during each benefit year, including any necessary x-rays and diagnostic services at the time of the examination.

Eligible Exams
• complete oral examinations
• recall oral examinations
• emergency or specific oral examinations
• consultation

Eligible X-rays
• full mouth series, minimum 16 films, including bitewings in any 36 consecutive months
• panorex (one in any 36 consecutive months)
• periapical (no more than 16 films in any 36 consecutive months)
• occlusal (no more that 4 films in 12 consecutive months)
• bitewing (no more than 4 films in 12 consecutive months)
• one cleaning and one unit of polishing, including up to 4 units of scaling (above the gum line).
• fluoride treatments will be limited to one per benefit year
• oral hygiene instruction, 1 treatment per lifetime
Minor Restorative
Your plan covers 75% for services associated with minor restoration, including:

(a) amalgam, silicate and composite fillings;
(b) tooth-coloured fillings, limited to once every two years on the same tooth surfaces.
(c) space maintainers (for a Dependent Child only, up to and including 14 years of age).

Multiple restorations on a common surface placed on the same service date will be considered
a single restoration. The maximum benefit payable will not exceed the fee for a five surface
restoration regarding the same tooth during one sitting.
Extractions and Oral Surgery
Your plan covers 75% for services associated with surgical extractions and root removal, including:
• extractions of teeth and residual root removal, limited to two wisdom teeth in any policy year;
• surgical excision, surgical enucleation and surgical movement of teeth;
• surgical incision and drainage, surgical incision for removal of foreign bodies and antral surgery;
• gingivoplasty, stomatoplasty, vestibuloplasty and all alveoloplastys;
• general anaesthesia;
• remodelling of floor of the mouth, reconstruction of alveolar ridge;
• extensions of mucous folds, bone grafts to the jaw and prosthetic augmentations to the jaw;
• replantation and repositioning of teeth;
• treatment of fractures, repairs of lacerations;
• frenectomy, hemorrhage control, treatment of salivary glands;
• treatment of maxillofacial deformities.
Endodontic
Your plan covers 10% for endodontic services including where applicable, treatment plan, local anaesthesia, tooth isolation, clinical procedures, sutures, appropriate radiographs and follow-up care for:
• pulpotomy (not in conjunction with root canal therapy if rendered within 30 days)
• root canal therapy
• apexification
• periapal sevices
• root amputation
• hemisection
• intentional removal, apical filling and reimplantation
Periodontic & Other Oral Surgery
Your plan covers 10% for periodontic services including:
• non-surgical procedures
• definitive surgical procedures
• adjunctive surgical procedures
• occlusal equilibration
• periodontal appliances including impression and insertion (one appliance per arch in 24 consecutive months)
• periodontal appliance repair, maintenance and adjustment (no more that 4 units in any benefit year)
Major Restorative (crowns/bridges/dentures)
Your plan covers 10% of major restorative services including:
Most of the services listed below will be replaced only if the existing appliance is at least 5 years old. If the appliance is temporary and being replaced with a permanent appliance within 12 months of the installation of the temporary appliance, or if the appliance was necessary due to the extraction of one natural tooth.

• crowns, including treatment plan, occlusal records, local anaesthesia, subgingival preparation of the tooth and supporting structures, removal of decay and old restoration, tooth preparations, pulp protection, impressions, temporary coverage, insertion, occlusal adjustment and cementation, repairs and removal.
• removable prosthodontics will include, where applicable, treatment plan, impressions, jaw relation records, try-in, insertion, occlusal equilibration and 3 months post-insertion care on complete dentures, transitional dentures, acrylic dentures and cast partial dentures.
• fixed prosthodontics will include, where applicable, treatment plan, occlusal records, local anaesthesia, subgingival preparation of the tooth and supporting structures, removal of decay and old restoration, tooth preparation, pulp protection, impressions, temporary coverage, splinting, intraoral indexing for soldering purposes, insertion, occlusal adjustments and cementation on pontic, retainers, abutments and repairs.

Other Insurances

Accidental Death & Dismemberment*
Accident Benefits*
For the purposes of the following benefits, “accident” wherever used means an occurrence due to external, violent,  sudden, fortuitous causes beyond the Insured’s control. This must occur while the insurance is in force.

Accidental Death And Dismemberment *
Your plan provides coverage for the loss of life or limb and for paralysis caused by an accident. The amount of your life benefit is $25,000. For a complete schedule of losses please see the Accident Benefits Brochure.

Accident Benefits are provided to students covered under the Georgian College SA Student Health & Dental Plan and Apprentice Students of Georgian College of Applied Arts and Technology

Information regarding coverages included in the Accident Benefits plan can be found in the Accident Benefits Brochure.


*Applicable to the Student only. Family members are not eligible for reimbursement of Accidental Death &Dismemberment benefits.

Personal Health Risk Assessment

The Personal Health Risk Assessment can be used to create a health profile, build an action plan to support your health and wellness needs and track progress.
Watch a short video about Personal Health Risk Assessment.

Exclusions

Limitations and Exclusions to Prescription Drug Benefits
No benefits are paid for:
1) over-the-counter products, or medicines available without a prescription;
2) fertility drugs;
3) anti-smoking remedies (e.g. nicorette gum, patches or similar prescribed remedies);
4) preventative vaccines;
5) injectable vitamins that are non-prescription;
6) patented medicines and G.P. products;
7) first-aid and surgical supplies;
8) atomizers, vaporizers;
9) salt and sugar substitutes;
10) infant formula, dietary foods and aids;
11) contact lens care products;
12) diagnostic aids and laboratory tests;
13) contraceptives, other than oral, patch and NuvaRing;
14) lozenges, mouthwash, toothpastes and cosmetics;
15) oral vitamins;
16) items deemed cosmetic, even if a prescription is legally required;
17) male baldness treatments;
18) drugs which in whole or in part a government health plan prohibits from being paid, except to the extent that it permits excess reimbursement;
19) drugs which the Insured Person received without charge;
20) drugs which are experimental in nature;
21) drugs, hormones, products and injections for the treatment of obesity;
22) erectile dysfunction drugs;
23) Accutane or other acne preparations containing the same medicinal ingredient as Accutane;
24) anabolic steroids; or
25) sclerosing agents.

Limitations and Exclusions to Extended Health Benefits
No benefit is payable for:
1) expenses as a result of any injury or sickness caused by declared or undeclared war or any act thereof;
2) expenses of any kind which would not normally be charged to you if the policy were not in effect;
3) expenses incurred from any injury or sickness sustained as a result of employment when you are covered or eligible to receive benefits under the applicable Workplace Safety and Insurance Board's legislation or similar law;
4) expenses as a result of suicide or any attempt thereat or intentionally self-inflicted injury, while sane or insane;
5) cosmetic medical or surgical care, other than due to an accidental bodily injury sustained while you are insured under this benefit;
6) medical treatment which is experimental or investigational in nature;
7) periodic health examinations, broken appointments, physician's costs for traveling or providing telephone advice, third party examinations, completion of forms or medical reports, travel for health purposes;
8) services, treatment or supplies not included in this benefit;
9) expenses incurred from any injury or sickness as the result of active full-time service in the armed forces of any country;
10) expenses incurred by you if you are not covered under any Federal or Provincial Hospital or Medical Plan or its equivalent;
11) expenses which are not medically required;
12) services or supplies associated with exercise, weight loss, physical fitness or sports, environmental or atmospheric control in the home or workplace;
13) expenses which are prohibited by law from being covered by a private insurance plan; or
14) services, treatments or supplies which the Insured Person received without charge.

Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) services or supplies required as a result of declared or undeclared war or any act thereof;
2) services or supplies required as a result of suicide or any attempt thereat or intentionally self-inflicted Injury, while sane or insane;
3) professional fees for an anesthetist;
4) protective appliances for athletic purposes;
5) implants and any dental service associated with implants;
6) replacement of fixed bridge pontics, retainers, abutments, crowns, or removable complete or partial dentures unless:
(a) made necessary by the extraction of a natural tooth while insured hereunder,
(b) the crown is at least five years old,
(c) the existing appliance is at least five years old and cannot be made serviceable, or
(d) the existing appliance is temporary and is replaced with a permanent bridge pontic or denture within 12 months of the date on which the temporary appliance was installed;
7) services not included in the list of defined eligible services;
8) cosmetic surgery or treatment when classified as such by Great-West Life;
9) expenses recoverable from other benefit sections of this policy;
10) expenses which are provided for by any Federal, Provincial, or Municipal government plan, or which would have been provided for if the Insured Person had applied for coverage under such plan;
11) expenses of any kind which would not normally be charged to the Insured Person if the insurance provide by this policy were not in effect;
12) completion of claim forms, advice by phone, or charges for missed or cancelled appointments;
13) replacement of lost, misplaced or stolen appliances or dentures;
14) initial crowns, bridges, retainers, abutments or complete or partial dentures required to replace a tooth or teeth missing prior to coverage becoming effective;
15) nutritional counseling, oral hygiene and dental plaque control programs; or
16) any dental treatment which is not yet approved by the Canadian Dental Association or which is clearly experimental in nature.

Service Members


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