Maximum of $5,000 per benefit year. The maximum amount payable to an eligible brand name drug will be limited to the lowest priced item in the appropriate generic category.

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

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

• Drugs which require the written prescription of a physician or dentist
• Injectable drugs including allergy serums and insulin
• Extemporaneous preparations or compounds if one of the ingredients is a covered drug
• 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
• Hepatitis B vaccine, subject to a maximum of $100 per insured, per benefit year. All other vaccines are payable at 80%.
• Nuva Ring (contraceptive), subject to a maximum of $178 per insured, per benefit year
• Oral contraceptives and the patch (birth control)
• All acne preparations excluding Accutane or other acne preparations containing the same medicinal ingredient as Accutane

The following diabetic supplies are covered:

• Insulin syringes.
• Disposable needles for use with non-disposable insulin injection devices.
• Test strips.
• Sensors for flash glucose monitoring machines.
• Lancets.
• Glucose monitoring machines.
• Alcohol swabs.

Vaccinations are covered at 80% based on reasonable and customary charges. Administration costs associated with providing the injection are not covered.

Drug Exception Process

If the medications covered by your insurance do not work for your condition, or if an effective drug is not covered, there is a special process to handle exceptions.

Download the form and print it, ask your doctor to complete the physician information section and submit your request to be considered for a drug exception.

To be considered for a drug exception, you must have tried at least one medication on your student health plan.

Prior-Authorization Drug Claims

Some prescription drugs require prior authorization before reimbursement is considered. You must submit a form to get prior authorization. Once prior authorization has been confirmed by the prescription search tool, you must work with your doctor to complete and submit a Drug Prior Authorization Form.