Insurance terms can be difficult to understand, but that's why we're here to break them down for you.
COMMON INSURANCE TERMS
Co-Insurance means you’re going to pay a little bit, and the carriers are going to pay the rest. For example, if you know your plan has an 80/20 co-insurance, it means that the carrier will pay 80 percent and you’ll pay the 20 percent remainder.
COORDINATION OF BENEFITS
If you are covered by another extended plan in addition to your Student Plan (e.g. through a parent's or spouse's employer, or your own employer), you may coordinate the benefits in order to increase your overall coverage, up to 100%.
You pay a portion of the cost of your prescriptions by paying either the same amount each time (e.g. $5) or a percentage of the total cost (e.g. 20%). If you’re paying a percentage, then you’re encouraged to shop around for the best available dispensing fees and ingredient costs
A person who receives benefits under health care insurance through the Health Care Plan. A person eligible for benefits under a dental plan.
EXPLANATION OF BENEFITS (EOB)
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. The EOB is not a bill. It simply explains how your benefits were applied to that particular claim. It includes the date you received the service, the amount billed, the amount covered, the amount that the insurance company paid, and any balance you’re responsible for paying the provider.
A deductible is an amount you pay for health care services before your health policy begins to pay.
For students, this is the 12 month period spanning from Sept 1st - Aug 31st, providing coverage for the full school year.
The 12-consecutive-month period that begins on January 1 and ends on December 31.
REASONABLE & CUSTOMARY
Reasonable & Customary limits are the range of usual fees for comparable medical services in a geographical area. Like other benefit providers, Medavie Blue Cross uses these limits to determine the maximum eligible amounts for health care services and supplies covered by your plan. We review reasonable and customary limits on a continual basis and make changes periodically to ensure our allowed amounts are representative of the current standard charges in the health care environment.
The term repatriation is not familiar to most travelers, so we felt as though it was important to include. Repatriation coverage means that the insurance company arranges for and handles the transportation necessary to return a covered person’s body to his or her home country, should they pass away during their time out of the country. This benefit will arrange and pay for reasonable and necessary expenses, including, but not limited to, expenses for embalming, an appropriate container for transportation, and shipping costs to transport your remains via the most direct and economical route.
MANDATORY PRODUCT SELECTION
MPS, quite simply, pays for the cost of a prescription up to the equivalent generic price.
A Monitored Medication, or controlled substance, is generally a drug or chemical whose manufacture, possession, or use is regulated by a government, such as illicitly used drugs or prescription medications that are designated a Controlled Drug by the Controlled Drug and Substance Act. Examples include Dilaudid, Methadone, Demerol, OxyContin, Percocet, Morphine, Opium, Codeine, Amphetamine (Dexedrine, Adderall), and Methamphetamine. Schedule III – These are substances that can still lead to moderate or low physical dependence and high psychological dependence.
A dispensing fee represents the charge for the professional services provided by a pharmacist when dispensing a prescription. The dispensing fee differs from pharmacy to pharmacy. Student VIP is able to offer you student-friendly dispensing fees through some of our partners!
BRAND VS. GENERIC
Brand - A medication sold by a pharmaceutical company under a trademark-protected name. Brand Name are typically more expensive than generic drugs.
Generic - Generic drugs contain the same active medicinal ingredients as the brand name alternative, and are therefore considered therapeutic equivalents. However, the ingredients that actually combine the active ingredients may differ. For the most part, generic products will perform the same as their brand name counterparts, cost less and can reduce the costs of your health plan. It is recommended that you ask your health care professional to prescribe the generic drug whenever possible.
DRUG IDENTIFICATION NUMBER (DIN)
A DIN is an eight-digit number that tells you if the product has been approved for use and can legally be manufactured and sold in Canada.
An Endodontist is a dentist who specializes in maintaining teeth through endodontic therapy – procedures, involving the soft inner tissue of the teeth, called the pulp. Endodontists perform a variety of procedures including root canal therapy, endodontic retreatment, treating cracked teeth, and treating dental trauma. Root canal therapy is one of the most common procedures performed by Endodontists.
Periodontal insurance refers to dental plans that include benefits for periodontal care. This care ranges from routine treatment of gums to assisting those diagnosed with gum disease, and can include the removal of calcium deposits (plaque, tartar, calculus, and stone) from around the tooth above and below the gum.
Minor Restorative Dental Services typically include types of treatments and procedures that are relatively straightforward in nature. Minor Restorative Services can include Composite Fillings, Recementing Dental Crowns, Stainless Steel Crowns, etc.
Major Restorative Dental Services typically include procedures and treatments that are relatively more complex in nature. Major Restorative Services can include Dental Crowns, Dentures, Bridges, etc.
A dental predetermination is an estimate of what your dental plan will cover and what you will be responsible for. Your dental office can submit an outline of the proposed treatment to Medavie Blue Cross prior to proceeding with treatment. The predetermination is only an estimate, and does not guarantee the final costs you will be responsible for paying.
Scaling teeth is part of a routine professional cleaning, and it involves scaling teeth and the gum line to remove plaque and tartar. This is done to keep your teeth and gums healthy.
A radiograph (x-ray) helps dentists diagnose and treat dental problems, including cavities, gum disease, infections, and more. Radiographs allow dentists to see inside a tooth and beneath the gums to assess the health of the bone and supporting tissues that hold teeth in place.
Dental Anesthesia is a field of anesthesia that includes not only local anesthetics but sedation and general anesthesia.
COMPLETE VS. RECALL EXAM
A Complete Exam consists of the dentist looking inside your mouth for things that can affect your oral – and overall – health. The complete exam can catch problems early before you see or feel them and when they are easier and less expensive to treat. Some of the problems that dentists can identify include deteriorating fillings, early signs of gum disease or oral cancer, etc.
A Recall Exam is a maintenance exam performed once a year following the initial oral examination. This exam helps to prevent tooth decay, gum disease, and other dental disorders that may have developed during the year. A recall visit typically includes an exam, as well and polishing and scaling.
STUDENT VIP & YOUR PLAN -- SIMPLIFIED
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MEDAVIE BLUE CROSS PRACTITIONERS
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Yes, students may enroll their spouse and/or dependent children onto the plan for an additional fee during the opt-in period in which they begin their studies.
The following are considered eligible dependents:
Spouse/Common-Law: The legal spouse of the insured student provided there is no legal separation in effect, or an individual of the same or opposite sex who has been residing with the insured student for a period of at least one (1) year and who has been designated as the spouse/common-law partner of the insured student in the policyholders records for insurance purposes, and is a resident of Canada and has provincial health coverage (or equivalent coverage).
Dependent Child(ren): Any natural child, step-child or legally adopted child of the insured student, who is under 21 years of age, unmarried and receives full support and maintenance from the insured student, or those over 21, but under 25 years of age, unmarried and receives full support and maintenance from the insured student for reason of full-time attendance at an accredited institute, college, or university in Canada, or receives full support and maintenance from the insured student by reason of mental or physical infirmity, and is a resident of Canada and has provincial health coverage (or equivalent coverage).
You can check the status of your claim via the Medavie Blue Cross Portal or Mobile App.
Medavie Blue Cross Portal:
Using the Portal, you can check your claim status by clicking the "Statements" top menu bar. Then select a date range, insured member, line of benefit, and hit "Search". If your claim has already been processed you will also be able to see the explanation of benefits.
Medavie Blue Cross Mobile App:
While using the Mobile App, you can check your claim status by simply clicking the "View my claims" top menu bar.
Any outstanding questions regarding claim status/history can be directed to Medavie Blue Cross via the contact information listed below:
For some benefits you will need to submit a prescription alongside your claim for it to be eligible.
These are as follows:
Drug Claims & Vision Appliances
Always require a prescription.
Registered Massage Therapy (RMT)
Requires a physician's prescription on your first claim submission, each policy year.
Orthotics & Orthopedics
Must be prescribed by an attending physician, orthopedic surgeon, physiatrist, rheumatologist or chiropodist/podiatrist.
Must be prescribed by an otorhinolaryngologist or otologist, or recommended by an audiologist.
Some travel expenses will also require a receipt.
For more information on this please contact Blue Cross directly at 1-833-867-3468 or firstname.lastname@example.org