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FREQUENTLY ASKED QUESTIONS

Please see below some commonly asked questions about your coverage with Student VIP.



  • Glossary of Terms
  • How do I know if I am covered by the extended health and dental plan?
  • What is my Group Policy Number and Identification Number?
  • Who is eligible for coverage?
  • How much does the plan cost?
  • If I already have coverage, can I opt-out of the WLU Students' Union Plan?
  • How does OHIP+ affect my coverage?
  • Can I add family to the plan?
  • How long do I have to submit a claim?
  • How do I check on the status of my claim?
  • What is the Opt-Out process?
  • What if the only medication that works is not covered?
  • Do I need to submit a prescription with my claim?
  • Coordination of benefits (COB)
  • Why are oral contraceptives not covered?
  • Is there a maximum age cap on my student plan?
  • What is the turn-around time for Special Authorization Drug Requests?
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

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%.

 

CO-PAY

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

 

BENEFICIARY

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.

 

DEDUCTIBLE

A deductible is an amount you pay for health care services before your health policy begins to pay.

 
BENEFIT YEAR

For students, this is the 12 month period spanning from Sept 1st - Aug 31st, providing coverage for the full school year.

 

CALENDAR 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.

 

REPATRIATION

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.

 

DRUG TERMS  


MONITORED MEDICATION

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.

 

DISPENSING FEES

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.

 


DENTAL TERMS 


ENDODONTIC

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.

 

PERIODONTIC

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

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

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. 

 

PREDETERMINATION

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

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.

 

RADIOGRAPHS

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.

 

ANESTHESIA

Dental Anesthesia is a field of anesthesia that includes not only local anesthetics but sedation and general anesthesia.

 


COMPLETE VS. RECALL EXAM 


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.

 

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 


VIP PRACTITIONERS

Discounted practitioners near your school or home! Click HERE to find out more.

 

MEDAVIE BLUE CROSS PRACTITIONERS

Practitioners that direct bill near your school or home! Click HERE to find out more. 

Check the breakdown of your annual general fees; if they include the health and dental fees, you are automatically enrolled in the plan.  In order to confirm that your coverage has been activated and to confirm the period of coverage, you need to contact us at: 1-888-918-5056.  If your annual general fees do not include the health and dental fees, you can enrol yourself during the month of your annual registration.

This information is on your plan card:

Group Policy #: 0091944000
Identification #: Your 9-digit Student Number +00 
(Example: If your student number is 123456789, your ID number would be: 12345678900)

All full-time or part-time undergraduate students, including co-op, work term & study abroad students, registered in the Fall term are automatically covered under this plan, provided you have provincial coverage (i.e. OHIP) or equivalent coverage (i.e. UHIP for international students).

2018 - 2019 Fees 

Policy Period: September - August

Single: Health $119.33 / Dental $112.00

Family (1 Dependent)*: Health $238.66 /  Dental: $224.00

Family (2 or more Dependents)*: Health $357.99 / Dental $336.00


*Family rates do NOT include single rates.

 

Yes, if you have comparable alternative coverage you may opt-out of the Student VIP plan during the opt-out period.


You should be aware that your WLU Students' Union Plan offers benefits specifically designed for students.  You may find it advantageous to remain enrolled on this plan and coordinate your benefits with your existing coverage.

As of April 1, 2019, the government is changing OHIP+ by providing benefits to only those without private insurance plans. You can find more information regarding OHIP+ and how this affects your coverage here.

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).

All claims must be submitted to Medavie Blue Cross™ no later than 12 months from the date the expense was incurred.  In the event of termination of coverage, claims incurred prior to the termination date must be submitted to Medavie Blue Cross™ within 3 months of the termination date.

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.

 

Additional Questions:

Any outstanding questions regarding claim status/history can be directed to Medavie Blue Cross via the contact information listed below:

If you choose to request an opt-out from the WLU Students' Union Plan, you must provide comparable coverage online during the opt-out period.


Note: There are no exceptions or extensions to the opt-out deadline.  If you submit a claim during the opt-out period and have requested to opt-out of the plan your opt-out request will be declined and your fee will not be reversed.

In the event that the therapeutic alternatives, which are eligible under the plan, prove to be ineffective for treating your particular condition, it is possible to have a special care approval for your medication.  These approvals are done on a case-by-case basis.  You must complete the Exception Request Form.  You will be notified in writing if your application has been approved or not.

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.
 

Hearing Aids 

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 laurier@medavie.bluecross.ca 

Students with plans through their parents or spouse can coordinate their benefits for increased coverage.  To do this, submit first to Student VIP.  Once you get your Explanation of Benefits (EOB) and your reimbursement,  you can submit that along with your receipts and claim form from your parents' plan for further reimbursement.


Students with plans through their employer must submit to the provider they have had the longest first,  then submit to their other plan second.

The Students' Union Health & Dental plan does not cover oral contraceptives because the WLU Health & Wellness Centre offers discounted oral contraceptives in the office on a cost-recovery basis.

Visit the Health & Wellness Centre for more information.

Yes. Insurance companies everywhere will have a maximum age cap for Health, Dental, Accident, Travel etc.
The current age cap on your student plan is age 70.

 

Your request will be confidentially reviewed by a health care professional according to the payment criteria established.  When all the required information is received by Blue Cross, the standard turn-around time for Special Authorization decisions is 7 to 10 working days.

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