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YOUR COVERAGE Please see your coverage listed below


Policy Year: September 1, 2017 - August 31, 2018
 

The details below are a summary of benefits, full benefit details can be found in the Benefit Brochure for the current policy year.

In the event of a discrepancy between the website and the Benefit Brochure, the Benefit Brochure will be taken as true.



  • Drug Coverage
  • Extended Health Coverage
  • Vision Coverage
  • Dental Coverage
  • Travel Coverage
  • Accident Coverage

Coverage valid IN CANADA only.

Annual EHC Maximum $5,000 per year, per insured

Drug Coverage – 50% - 100% Coverage

 

100% Coverage

80% Coverage

Generic Drugs

Brand Drugs


All Other Pharmacies

80% Coverage

50% Coverage

Generic Drugs

Brand Drugs


Mandatory Generic Product Selection:

(does not apply to Direct2U Prescriptions)

  • Only those drugs which legally require a prescription and are eligible under the plan will be covered.
  • When a doctor writes "no substitution" on the prescription, students will have the option of having the brand name drug dispensed and pay the difference between the brand and generic price.  Brand name drugs whose patents have not expired will continue to be covered.

Want to know if your drug is eligible for coverage? Login to the Blue Cross Member Portal to find out!


Drug Plan Also Includes:

  • Non-Oral Contraceptives (incl IUDs, IUSs)
  • Some Travel Immunizations* (see listing HERE)
  • Diabetic Supplies (test strips & needles, glucometers may be covered under Extended Health)
  • CNS Stimulants** ($600/benefit year)
  • Smoking Cessation aids/remedies (98 patches/benefit year, $500/lifetime)
  • Hepatitis C Medications ($1,500/lifetime)
  • Biologic Agents ($1,000/benefit year)


Drug Plan Does NOT Include:

  • Oral Contraceptives (Please visit WLU Health Services for oral contraceptives)
  • Fertility Drugs/Treatment
  • Anti-Obesity Drugs/Products
  • Erectile Dysfunction Drugs
  • Gardasil Vaccine

* Vaccines are on a cost-reimbursement basis. Students pay upfront & submit a Health Claim Form for reimbursement. Not all vaccines listed may be covered, this list is not exhaustive but merely a sample.
** CNS Stimulants are medications used to increase physical activity, mental alertness and attention span. They are often used in the treatment of Attention Deficit Disorder and/or Hyperactivity Disorders (i.e. Adderall, Concerta, Vyvanse, Ritalin and their generic versions).

Coverage valid IN CANADA only.

Annual EHC Maximum $5,000 per year, per insured

Practitioner Coverage – 80% Coverage

Max $500 per practitioner per benefit year, unless otherwise stated:

  • Physiotherapist
  • Chiropodist
  • Podiatrist
  • Acupuncturist
  • Osteopath
  • Chiropractor
  • Speech Therapist
  • Naturopath
  • Psychologist/Social Worker ($800/benefit year)
  • Registered Massage Therapist* ($30/visit maximum)
    Physician's prescription required for first RMT claim each policy year, if a prescription is less than 12 months from date of issue, it can be used.

 

Other Medical Coverage – 80% Coverage

Coverage is to maximum indicated, unless otherwise stated:

  • Orthotic Appliances & Orthopedic Shoes ($200/benefit year)*
  • Medical Equipment & Supplies ($500/benefit year)*** **
  • Hearing Aids ($500/5 years)
  • Ambulance to Nearest Treating Hospital (Reasonable & Customary)

*Prescribed by a medical doctor, an orthopedic surgeon or podiatrist
**Physician's prescription required 
***For a full listing of eligible expenses, please see the Brochure

Coverage valid IN CANADA only.

Annual EHC Maximum $5,000 per year, per insured

Vision Coverage – 100% Coverage

Eye Examinations, Frames, Lenses & Contact Lenses - $80 per benefit year

LASIK or Laser Eye Surgery is NOT covered under the plan.


Vision Pros

Coverage Valid IN CANADA Only

Dental Coverage – 30% - 80% Coverage

Pre-Authorization: It is strongly recommended to obtain a pre-authorization for extensive dental procedures to prevent unexpected costs. Have your dentist send a quote/predetermination along with your name and Student ID to Medavie Blue Cross™ at fax: 506-867-4651.

Students can check to see if the dental code on their pre-determination is eligible on the Plan. Login to the Blue Cross Member Portal to find out!  Note that this does not say how much is eligible, just if the code itself is eligible on your plan.

 

If your claim is the result of a Dental Accident please go to the Accident Coverage section for more information.


Annual combined maximum of $750.00/year/insured       Reimbursement based on current Dental Fee Guide

 

Examinations (80%)
Complete oral examination (once every 5 years) / Limited/recall examination (once every 12 months)

 

Radiographs (80%)
Complete series Periapical or Panoramic (once every 5 years)  / Bitewing (once every 12 months)

 

Preventative Services (80%)
Dental polishing (1-15 minute unit every 12 months) / Scaling (2-15 minute units every 12 months)

 

Minor Restorative (70%)
Fillings

 

Extractions (50%)
Includes wisdom tooth extractions

 

Anesthesia (50%)
When in conjunction with surgical services

 

Other Dental Coverage (30%)
Endodontic / Periodontic 


Limitations and Exclusions may apply.
Please see the BROCHURE for full details.

365 days per trip up to $2,000,000 incident

Full details can be found in the Travel Brochure

Keep In Mind

  • Travel coverage cannot be extended past August 31 each policy year. If your travel duration exceeds August 31, please contact your health plan office or Student VIP for more information.
  • 365 days of coverage may not be valid for international students. Please contact the health plan office or Student VIP for confirmation before you leave the province.
  • Travel coverage offered through the plan is only valid if your provincial health care is in force for the entire duration of your travel. Please contact your provincial Ministry of Health office or download the appropriate travel flyer HERE for more information.

Visa & Travel Letter Requests

  • Students requiring proof of coverage for their Visa application may complete the Visa Request Form, your request will be reviewed and the letter e-mailed to you in 3-5 business days.
  • Student only require a travel letter if the country they are travelling to requires a letter for entry into the country, or if they have to apply for a travel visa.
  • Domestic Students travelling to Cuba do not require a travel letter, your provincial health coverage should be sufficient for entry into Cuba.

Using your Coverage:

In the event of a medical emergency, please contact the appropriate number below to ensure that your expenses are eligible:

  • In Canada (not your home province) & the USA: 1-800-563-4444

  • Anywhere else in the world Call Collect: 1-506-854-2222

If you have a claim that you must submit, please call 1-800-563-4444 once you return to Canada to have the proper claim form sent to you.

 

Coverage Includes, but is not limited to:

  • Emergency medical assistance
  • Repatriation of mortal remains (maximum $7,500)
  • Airfare in the event of:
    • Missed return flight due to illness of you or travelling companion
    • Medically required attendant to accompany insured home
    • Cost of airfare for spouse or close relative if confined outside province for at least 7 days plus $150/day for meals & accommodation for up to 5 days
    • Cost of airfare to return unsupervised children under the age of 15 home when only available supervising guardian is hospitalized
  • Cost of return of patients vehicle when patient or family is unable to do so (maximum $1,000)
  • Costs incurred by family (when patient is detained in hospital) for meals and accommodation (maximum $150/days up to 10 days)
  • Trip cancellation ($5,000 Maximum)
  • Lost luggage coverage ($500 Maximum)
  • International students will have coverage in their home country for emergency services if provincial or equivalent coverage is extended as well.

Travel Advisories
Students planning to travel to counties with travel advisories issued to them should check to ensure coverage will be enforced while abroad, even if not planning to travel to an affected area. To see a listing of travel advisories, please visit the Government of Canada Travel Website.


Provincial Coverage & Travel

Those with a valid provincial health plan card may still have partial coverage for some emergency services while travelling abroad. For more information please visit the Ministry of Health website for the province your coverage is with.


Exclusions
Expenses incurred for injuries and/or illness as a result of the insured’s reckless behavior while on a trip, including international non-compliance with a prescribed treatment or therapy, or intentional misuse of medication or reckless disregard for their own health or safety while engaging in activities or treatment thereof, or accidents relating thereto.

 

Coverage valid IN CANADA only.

What is an Accident?

An accident means an occurrence due to external, violent, sudden, fortuitous causes beyond the insured’s control, which must occur while the student is insured under this policy. 


What is Covered?

Accidental Death & Dismemberment      Maximum $5,000 

Payment of a stipulated sum for loss of life or limb through accidental means, provided such loss occurs within 365 days after the date of accident causing such loss

 

Accidental Dental      Maximum $1,000 

Injury to whole and sound teeth, and within 30 days from the day of the accident obtains treatment in Canada from a qualified dentist. Reimbursement will only be provided on expenses which are: incurred in Canada, incurred within 52 weeks of the date of the accident causing injury, incurred only for therapeutic and not elective or aesthetic treatment, and supported by an original standard dental claim form.

 

Accidental Medical      Maximum $10,000 

If within 30 days from the accident causing injury, the insured obtains medical treatment in Canada may be reimbursed for the following reasonable and necessary expenses to the specified maximum per Insured for all injuries resulting from any one accident: 

  • Duty nurse ($50/hour, $5,000 maximum)

  • Ambulance ($5,000)

  • Semi-private hospital room ($5,000)

  • Wheelchair rental (Reasonable & Customary)

  • Fee for services of a licensed physiotherapist ($500), chiropractor ($300)

  • Hearing aids, crutches, splints, casts, trusses and braces, excluding replacement (Reasonable & Customary)

Expenses must be incurred in Canada, within 52 weeks of the date of the accident causing injury, incurred for only therapeutic and not elective treatment, and supported by original receipts.

 

Tutorial Expense      Maximum $20/hour up to $2,000

If insured suffers injury resulting in hospital or medically necessary bed rest and is confined for at least 15 consecutive school days, as determined by a Physician, the insurer will pay for the private tutorial services of a qualified teacher.

 

Repatriation      Maximum $10,000 

If injury causing loss of life occurs more than 50 kilometers from insured’s permanent city of residence and within 365 days of the date of the accident causing injury, the insurer shall pay the actual expenses incurred for preparing the deceased insured for burial or cremation and shipment of the body to the city of residence of the deceased insured.

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