Menumenu button

myBenefits

For Flex benefits information, please click the button "myBenefits at a Glance" for details.



myBenefits at a Glance

The Student Benefits Flex Plan allows you to choose coverage to suit your needs. Below is a summary of the coverage options available. You have one opportunity each year during your enrolment period or on the anniversary of your first enrolment period to Flex your benefits however please note certain restrictions apply. Please see the Terms and Conditions section.

Please scroll the table if the content can not be seen


Balanced
Plan
FLEXible Drug & Parameds FLEXible Vision & Parameds FLEXible Dental 
Prescription Drugs 80% coverage
$3,000/benefit year
90% coverage
$3,000/benefit year
70% coverage
$3,000 / benefit year
70% coverage
$3,000/benefit year
Vision 100% coverage
Eye Exams $60 / 24 months
Glasses / Contacts $100 / 24 months no coverage $150 / 24 months no coverage
Parameds 80% coverage
$300 / benefit year
80% coverage
$400 / benefit year 
 80% coverage
$500 / benefit year
 80% coverage
$300 / benefit year
Psychologist or Social Worker $500 / benefit year
Dental $750 / benefit year $500 / benefit year $750 / benefit year $1,000/benefit year
Diagnostic & Preventative 12 month recall 6 month recall
Select Dentists 100% coverage
Alternative Dentists 70% coverage 80% coverage
Minor Restorative 80% coverage 50% coverage 60% coverage 80% coverage
Oral Surgery 50% coverage 30% coverage 30% coverage 80% coverage
Periodontic 50% coverage
Endodontic 50% coverage
Major Restorative 15% coverage
Included in All Options
Supplemental Health 80% coverage
Ambulance $250 per trip
Dental Accident $1,000 per accident
Medical Service & Supplies Based on reasonable and customary
Emergency Travel $2,000,000 lifetime maximum
AD&D $5,000 for loss of life
Critical Illness $5,000 upon diagnosis of a covered illness or injury
Tuition $10,000 per lifetime
Tutorial $15 / hour up to $2,000 / benefit year

Supplemental Health




Diabetic Supplies
Your plan covers 80% to a maximum of $150 during a 5 year period for blood glucose monitors.
Hearing Aids
Your plan covers 80% to a maximum of $500 during a 5 year period for hearing aids and repairs, excluding batteries.
Ambulance
Your plan covers 80% 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.

Coverage for services of the following practitioners is dependent on your plan option, to an overall maximum of $300-$500 per practitioner, per benefit year (depending on your plan option).

• physiotherapist* or athletic therapist*
• registered massage therapist*
• speech language pathologist*
• chiropractor, including 1 x-ray examination per benefit year
• osteopath, including 1 x-ray examination per benefit year
• naturopath
• podiatrist/chiropodist, including 1 x-ray examination per benefit year
• acupuncture

*physician’s prescription/referral required for indicated services

The services of the following practitioners are covered at 80% regardless of your plan option, to an overall maximum of $500 based on reasonable and customary charges, per practitioner, per benefit year.

• psychologist or social worker
Medical Equipment & Supplies
It is recommended that an application for pre-approval be submitted to the insurer for any item that would be claimed under the Medical Services & Supplies benefit.

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
Trusses, Crutches, Splints, and Braces
Your plan covers 80% of reasonable and customary charges when prescribed by a physician and are not solely for athletic use for braces, crutches, splints, and trusses.
Prosthesis
Your plan covers 80% of reasonable and customary charges when prescribed by a physician for artificial limbs or other prosthetic appliances.
Orthopaedics*
Your plan covers 80% up to a maximum of $150 per benefit year for Custom-Made Orthopaedic shoes when they are required for the correction of deformity of the bones and muscles and provided they are not solely for athletic use and are prescribed by a physician, podiatrist, chiropodist or chiropractor. Modifications, repairs and adjustments to custom-made orthopaedic shoes are covered without a prescription.

*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.
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 80% of the cost of the services of a dental surgeon, limited to the fees provided in the current General Practitioners fee guide, including dental prosthesis, required for the treatment of a fractured jaw or accidental injuries to natural teeth or jaw if caused by external, violent and accidental means. Services must be performed within 12 months of the accident. If a dental accident occurs, the health plan’s dental accident provision will pay benefits before the dental plan.

Treatment must be completed within 12 months of the impact. If treatment is scheduled to occur more than 90 days after the impact, a treatment plan must be submitted to the insurer before the end of the 90 day period.

Prescription Drug

Coverage for your drug plan is dependent on your plan option and covers the cost of most medications legally requiring a prescription, to a maximum of $3,000 per benefit year.

Your drug plan includes coverage Smoking Cessation Products that legally require a prescription. Reimbursed at 80% to a lifetime maximum of $500.

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

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

The NASA 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 SA MacEwan 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 examination by an ophthalmologist or optometrist to a maximum of $60 once during a 24 month period, based on reasonable and customary charges.

Your plan may cover up to 100% of the cost for the purchase of eyeglasses and/or contact lenses to a maximum of $100, once during a 24 month period, based on reasonable and customary charges. Coverage is dependent on your plan option.

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.

Select and Alternate Dental Providers

The dental benefits provided under the Select Dental Provider option are provided through a specific network of dental centres. If you choose one of the Select Dental Providers, your diagnostic & preventive dental benefits will be reimbursed at the level indicated below. Please contact the SA MacEwan Student Benefits Plan Office or use the "Find a Practitioner" option for a list of Select Dental Providers* where services can be received.

If you choose an Alternate Dental Provider (a dentist or dental centre not on the Select Dental Provider list) your diagnostic & preventive dental benefits will be reimbursed at the level indicated below.

*Please note: the list of Select Dental Providers may be subject to change.

If you need to cancel your dental appointment, 24 hours notice is expected. If you do not give 24 hours notice, the dental office may charge a fee which is not covered under the plan.

IMPORTANT! Please submit a pre-determination/pre-authorization to the insurance carrier prior to treatment of specialist services and any treatment plan exceeding $500.

Maximum yearly coverage is dependent on your plan option. Please click myBenefits at a Glance button to check your plan coverage.


Diagnostic & Preventative
Your plan covers 100% for Select Dentists or 70%-80% for Alternate Dentists for diagnostic and preventative procedures, depending on your plan option, including:
• recall examination, 1 per benefit year
• complete series of x-rays, 1 in any period of 36 months
• bitewings, not more than 4 films per benefit year
• polishing, 1 unit per benefit year
• scaling, 2 units per benefit year
• fluoride, under 19 years of age, 1 treatment per benefit year
Minor Restorative
Your plan covers 50%, 60%, or 80% for services associated with dental health restoration, depending on your plan option, including:
• pit and fissure sealants, under 19 years of age, 1 replacement per tooth, per lifetime, on permanent molars only
• space maintainers and maintenance, under 15 years of age
• amalgam and tooth coloured fillings, 1 per tooth in any period of 24 months
• stainless steel and plastic full coverage restorations, under 15 years of age, 1 per tooth in any period of 36 months
• denture adjustments and repairs
• relining, rebasing and tissue conditioning, one treatment in any period of 36 months
• recementation of fixed prosthesis
Major Restorative
Your plan covers 15% for major restorative services including:
• crowns
• bridges
• dentures

Replacement of an existing crown, bridge or dentures is an eligible expense if the replacement is required to replace an existing crown, bridge or denture which was installed 5 years before the replacement.
Oral Surgery
Your plan covers 30%, 50%, or 80% for services associated with surgical extractions, depending on your plan option, including:
• extractions, not more than 2 wisdom teeth per benefit year
• anaesthesia, eligible when done in conjunction with Oral Surgery
• panoramic x-ray, 1 in any period of 36 months
Endodontic
Your plan covers 50% for endodontic services including:
• root canal therapy
Periodontic
Your plan covers 50% for periodontic services including:
• additional scaling and/or root planing, maximum 2 units per benefit year

Other Insurances

Accidental Death & 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 $5,000. Please contact health and dental plan office for a complete schedule of losses.

Critical Illness*
Your plan provides coverage for a Critical Illness benefit of up to $5,000 which is paid upon diagnosis of a covered illness or injury and survival after 30 days, 365 days for paralysis and a 90 day waiting period for Cancer applies. This benefit is limited to students who are under age 65. For further details on this benefit, download your Critical Illness Brochure.

Tuition*
Your plan provides coverage for Tuition Insurance and covers a student who has left school and medically cannot continue studies, as a result of death or severe and prolonged disability. The student must be enrolled in the Health Plan and must be under the continuous care of an appropriate specialist for a period of at least 60 days prior to applying for this benefit. The student will receive a benefit up to a lifetime maximum of $10,000 in accordance with any tuition, and ancillary fees paid by said student to cover:
1) Tuition for courses the student was unable to complete
2) Mandatory, non-negotiable/non-refundable fees, which will be amortized to the point of disability 
3) Book allowance of up to $1,000 (receipts required)

Tutorial*

Your plan covers 80% up to $15 per hour to a maximum of $2,000 per benefit year for private tutorial service if the student is confined to home or hospital for a minimum of 15 consecutive school days.

*Applicable to the Student only. Family members are not eligible for reimbursement of Accidental Death & Dismemberment, Critical Illness, Tuition and Tutorial benefits.

Travel Insurance

Emergency Out of Country Travel Insurance
Your plan covers 100% up to a maximum of $2,000,000 per lifetime of medical expenses incurred as a result of a medical emergency arising while you are traveling outside Canada for vacation, business or education purposes. To qualify for benefits, you must be covered by the government health plan in your home province. For additional details on this benefit download your Travel Assist Brochure.

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 Extended Health Benefits
No benefit is payable for:
1) expenses for which benefits are payable under a Workers' Compensation Act or a similar statute;
2) expenses incurred due to intentionally self-inflicted injuries;
3) expenses incurred due to civil disorder or war, whether or not war was declared;
4) expenses for services and products, rendered or prescribed by a person who is ordinarily a resident in the patient's home or who is related to the patient by blood or marriage;
5) expenses for which benefits are payable under a government plan;
6) expenses for benefits which are legally prohibited by the government from coverage;
7) out-of-province expenses for elective (non-emergency) medical treatment or surgery;
8) expenses for drugs which, in the insurer's opinion, are experimental;
9) expenses for dietary supplements, vitamins and infant foods;
10) expenses for contraceptives (other than oral);
11) expenses for drugs if they are used for the treatment of infertility;
12) expenses for the services of a homemaker;
13) expenses for items purchased solely for athletic use;
14) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
15) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
16) expenses for the regular treatment of an injury or disease which existed before the member's or dependent's departure from his/her province of residence;
17) immunizations and vaccines (Hepatitis B will be covered, except for Recombivax HB preservative free - DIN 02245976 and DIN 02245977); or
18) any other exclusion identified in the policy contract.

Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) any cause for which the insured may apply for and receive protection, exemption or compensation under any Workers' Compensation Act;
2) self-inflicted injuries while sane or insane;
3) war, insurrection or hostilities of any kind, whether or not the insured was a participant in such actions;
4) participation in any riot or civil commotion;
5) committing or attempting to commit a criminal offence or provoking an assault;
6) any dental care, treatment or supplies primarily for cosmetic purposes;
7) failing to keep scheduled appointments;
8) file transfers, the completion of claim forms or other documentation;
9) any dental treatment for the correction of temporomandibular joint dysfunction;
10) expenses for crowns placed on a tooth not functionally impaired by incisal angle or cuspal damage;
11) any dental procedure which is not listed in the descriptions of dental benefits indicated herein;
12) charges that are in excess of the fees stated in the Dental Association General Dentist Fee Guide applicable to this benefit;
13) where coverage for services is provided under any government plan; or
14) where services would be provided without charge in the absence of this plan.

Service Members


Find a Practitioner