The following benefits are included in the Supplementary Health Care portion of your plan.
Ambulance
Practitioners
Braces, Crutches, Splints, Trusses
Dental Accident
Diagnostic Services
Medical Equipment
Orthopaedics
Private Duty Nurse
Prosthesis
Tutorial
AMBULANCE
Reimbursement level of 100% 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.
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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 using the practicioner search tool to the right.
The services of the following practitioners are covered for $20/visit to a maximum of $400 per category per benefit year.
• athletic therapist*
• chiropodist*, including one x-ray exam per benefit year
• chiropractor, including one x-ray examination per benefit year
• dietician*, licensed
• massage therapist*, registered
• naturopath
• osteopath*, including one x-ray examination per benefit year
• podiatrist*, including one x-ray exam per benefit year
• physiotherapist*
• speech therapist*
The services of the following practitioners are covered to a maximum of $300 per category per benefit year.
• clinical counsellor*, registered
• psychologist*
• social worker*
*physician’s prescription/referral required for indicated services.
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SERVICES & SUPPLIES
Braces, Crutches, Splints, Trusses
Reimbursement level of 100% of reasonable and customary charges for braces - provided they are not solely for athletic use, crutches, splints or trusses. It is recommended that an application for preapproval be submitted to the insurer.
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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 eligible amount paid will be based on the least expensive treatment that is adequate to correct the damage, in allowance with the current General Practitioners Dental Association suggested fee guide and the Insurance Reimbursement Rate (CLHIA) when a fee guide is not available, in the province of the student’s residence as indicated on the claim form submitted. These eligible services are also based on reasonable and customary charges as determined by the insurance company. In the event where a specialist performs the services, comparable eligible services will be paid in accordance to the current General Practitioners Dental Association suggested fee guide. The services of a dental surgeon, 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. Provided the services are performed within 12 months of the accident but excluding services required in conjunction with such injuries due to a condition that existed before the accident. If treatment is scheduled to occur more than 90 days after the impact, a treatment plan must be supplied to the insurance company before the end of the 90 day period. Implants and treatment related to implants are not covered. If a dental accident occurs, the health plan’s dental accident provision will pay benefits before the dental plan.
In the event of a dental accident, you must complete a Standard Dental Association claim form. 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.
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Diagnostic Services
Diagnostic laboratory and x-ray procedures, including radiotherapy and coagulotherapy, performed in the student's province of residence are covered when coverage is not available under a government provincial plan.
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Medical Equipment
Reimbursement level of 100% of reasonable and customary charges for eligible equipment. It is recommended that an application for pre-approval be submitted to the insurer for any items that would be claimed under the Medical Equipment Benefit. This is to determine how much of the cost will be covered based on the least expensive device that is medically adequate. Once it is provided the member will be advised on how much will be covered. Eligible durable equipment includes, but is not limited to, items such as:
• hearing aids
• wheel chairs
• wheel chair repairs
• walkers
• hospital beds
• traction kits
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Orthopaedics
Reimbursement level of 100% up to a maximum of $350 per benefit year for custom-made orthopaedic shoes or orthotic inserts, repairs and modifications when required for the correction of deformity of the bones and muscles. Provided the orthopaedics or orthotics are not solely for athletic use and are prescribed by a physician, podiatrist, chiropodist, or chiropractor.
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Private Duty Nursing
Reimbursement level of 100% of reasonable and customary charges for the services of a Private Duty Nurse when certified in writing as medically necessary by the attending physician. To establish the amount of coverage available under this policy, we suggest that prior to initiating home care, the student submit a pre-care assessment to the insurance company.
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Prosthesis Artificial limbs or other prosthetic appliances.
It is recommended that an application for preapproval be submitted to the insurer.
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Tutorial
Reimbursement level of 100% of $10/hour to a maximum of $300 per incident for private tutorial service if the student is confined to home or hospital for a minimum of 7 consecutive school days.
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