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myBenefits



myBenefits at a Glance

The highlights below are provided as general information. Coverage for eligible costs are based on the contract detail. Reasonable and customary rates will be applied. Select the benefit for additional coverage details.

Ambulance:
Reimbursed at 100% based on reasonable and customary charges.
(please click Supplemental Health for details.)

Prescription Drugs:
Reimbursed at 80% to a maximum of $3,000 per benefit year.
Generic equivalent drug substitution applies.
(please click Prescription Drugs for details.)

Vision:
Reimbursed at 100%, $100 for one eye exam, $125 for glasses or contact lenses every 24 months.
(please click Vision for details.)

Health Practitioners:
The services of paramedical practitioners are reimbursed at 80% to a maximum $300 based on reasonable and customary charges, per person, per type of practitioner, per benefit year.
Physician's referral may be required.
(please click Supplemental Health for details.)


Private Duty Nurse:
Reimbursed at 100% to a maximum of $10,000 per benefit year.
(please click Supplemental Health for details.)

Medical Equipment & Supplies:
Reimbursed at 100%. A physician's prescription is required. Pre-authorization is suggested.
(please click Supplemental Health for details.)

Dental Accident:
Reimbursed at 100% based on reasonable and customary charges; authorization required.
Treatment must commence within 180 days of the accident.
Treatment must be completed within 365 days of the accident.
(please click Supplemental Health for details.)

Dental Coverage:
Exams covered at 80% once per benefit year. Overall plan maximum of $600 per benefit year.
(please click Dental for details.)

Accidental Death & Dismemberment:
$7,000 loss of life benefit.
(please click Other Insurances for details.)

Travel Insurance:
$5 million of coverage for emergencies and illnesses while traveling. Maximum number of days per trip is 180 days.
Looking to travel for more days than this plan covers? Call GreenShield customer service centre at 1-888-711-1119 for more information.
(please click Travel Insurance for details.)

Tutorial:
After 15 days of confinement due to illness or injury.
(please click Other Insurances for details.)

NOTE: In the event of any discrepancy between the information herein and our contract with the insurer, the terms of the contract will apply.

Supplemental Health

All benefits payable through the Student Plan are based on reasonable and customary charges.



Ambulance
Your plan covers 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.


Private Duty Nursing
Your plans covers 100% to a maximum of $10,000 per benefit year 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 Carrier.
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.

The services of the following practitioners are covered at 80% up to $300 based on reasonable and customary charges, per person, per type of practitioner, per benefit year.

• chiropractor 
• physiotherapist 
• registered massage therapist*
• speech therapist*
• podiatrist/chiropodist*, including 1 x-ray examination per benefit year

*physician’s prescription/referral required.

The services of the following practitioners are covered at 80% up to $450 based on reasonable and customary charges, per person, per type of practitioner, per benefit year.

 • psychologist, social worker or registered clinical counselor.
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 100% 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
• walkers
• hospital beds
• traction kits
Braces, Crutches, Splints, Trusses
Your plan covers 100% of reasonable and customary charges when prescribed by a physician and are not solely for athletic use for braces, crutches, splints, and trusses.
Diabetic Supplies
Your plan covers 100% of diabetic equipment, such as blood glucose monitors and lancets.
Prosthesis
Your plan covers 100% of reasonable and customary charges when prescribed by a physician for artificial limbs or other prosthetic appliances.
Orthopaedics*
Your plan covers 100% up to a combined maximum of $300 per benefit year for custom-made foot orthotics and/or orthopaedic shoes, repairs and modifications when required for the correction of deformity of the bones and muscles. Provided the orthopaedics are not solely for athletic use and are prescribed by a physician, podiatrist, or chiropodist.

*IMPORTANT It is strongly recommended that a pre-determination/estimate be submitted to Green Shield to ensure that the guidelines set out by Green Shield 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 100% 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 commence within 180 days of the accident and be completed within 365 days of the accident. Dental Accident benefits are payable through the Health plan and based on reasonable and customary amounts. Authorization required.

BC Fair Pharmacare

The Fair PharmaCare program in British Columbia is intended to provide greater financial assistance to British Columbians for eligible prescription drugs and designated medical supplies. You must be a resident of the Province of British Columbia with an MSP number. The new approach focuses PharmaCare financial assistance to British Columbians who need it most - the lower your income, the more assistance the government will provide for your prescription drugs.

By coordinating the benefits from BC Fair PharmaCare and the Student Health Plan, many enrolled students will enjoy lower out-of-pocket charges for their eligible prescription drugs.

Students with net income less than $15,000 in the previous taxation year, who have registered for BC Medical Services Plan (MSP) on their own, not under their family, will enjoy the greatest benefit. PharmaCare will pay 70% of eligible prescription drug charges from the first dollar charged to the student and the Student Benefits Plan will pay up to 80% of the remainder!

FOLLOW THESE EASY STEPS TO REGISTER:

Have ready your:
• BC Care Card number
• net income from 2 years ago
• social insurance number
• birthdate

You will receive your registration number immediately.

Register online HERE

If you experience difficulty registering, or it states that you are already registered, or if you prefer to register over the phone please call: 604-683-7151 or 1-800-663-7100 for assistance.

Please note: if you are not a permanent resident of BC you must still fill out the registration form providing your home province or country in place of the Fair Pharmacare registration number.

Once your registration is completed and your have received your registration number you must complete the myBenefits Card Registration Form.

Prescription Drugs

Your drug plan covers 80% of the cost of most medications legally requiring a prescription to a maximum of $3,000 per benefit year.

Coverage for Preventative Vaccines is included in the prescription drug benefit.

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

Eligible benefits do not include and no amount will be paid for:
a) Smoking cessation products, and medication for the treatment of hair loss/replacement, obesity, erectile dysfunction and infertility.
b) Products which may lawfully be sold or offered for sale other than through retail pharmacies, and which are not normally considered by practitioners as medicines for which a prescription is necessary or required.
c) Ingredients or products which have not been approved by Health Canada for the treatment of a medical condition or disease and are deemed to be experimental in nature and/or may be in the testing stage.
d) Mixtures, compounded by a pharmacist, that do not conform to the insurer's current Compound Policy.

vision

Your plan covers 100% of the cost of eye examinations by an ophthalmologist or optometrist limited to one examination, in a 24 month period to a maximum of $100, based on reasonable and customary charges.

Your plan covers 100% of cost for the purchase of eyeglasses and/or contact lenses to a maximum of $125, once during a 24 month period, based on reasonable and customary charges.

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.

IMPORTANT! Please submit a pre-determination/pre-authorization to the insurance carrier prior to treatment of specialist services and any treatment plan exceeding $300.

Reimbursement is at 80% up to a maximum of $600 per benefit year.



Basic Services
• Recalls include exams, bitewing X-rays, fluoride treatments and cleanings once every 12 months, based on first paid claim.
• Complete, general or comprehensive oral exams, full mouth x-rays and panoramic x-rays, once every 3 years based on first paid claim.
• Basic restorations, fillings and inlays.
• Extractions and surgical services. General anaesthetics and intravenous sedation only when done in conjunction with eligible extraction(s) and/or oral surgery. Sleep dentistry is not eligible.
Comprehensive Basic Services
• Endodontic treatment including standard root canal therapy, excluding retreatments.
• Periodontal treatment including scaling and/or root planning, 3 time units every 12 months based on first paid claim.
• Occlusal equilibration - selective grinding of tooth surfaces to adjust a bite, 2 time units every 12 months based on first paid claim.
• Standard denture services once every 3 years based on first paid claim. Including relining and rebasing of dentures plus denture adjustments after 3 months from installation.
Limitations
a) Laboratory charges must be completed in conjunction with other services and will be limited to the Co-pay of such services. Laboratory charges that are in excess of 40% of the dentist's fee in the current General Practitioners Fee Guide will be reduced accordingly; co-insurance is then applied.

b) Reimbursement will be made according to standard and/or basic services, supplies or treatment. Related expenses beyond the standard and/or basic services, supplies or treatment will remain your responsibility.

c) When more than one surgical procedure is performed during the same appointment in the same area of the mouth, only the most comprehensive procedure will be eligible for reimbursement.

d) Reimbursement will be pro-rated and reduced accordingly, when time spent by the dentist is less than the average time assigned to a dental service procedure code in the General Practitioners Fee Guide.

e) Reimbursement for root canal therapy will be limited to payment once. The total fee for root canal includes all pulpotomies and pulpectomies performed on the same tooth.

f) Common surfaces on the same tooth/same day will be assessed as one surface. If individual surfaces are restored on the same tooth/same day, payment will be assessed according to the procedure code representing the combined surface. Payment will be limited to a maximum of 5 surfaces in any 36 month period.

g) The benefits payable for multiple restorative services in the same quadrant performed at one appointment may be reduced by 20% for all but the most costly service in the quadrant.

h) Root planing is not eligible if done at the same time as gingival curettage.

i) In the event of a dental accident, claims should be submitted under the health benefits plan before submitting them under the dental plan.

Travel Insurances

Emergency Out of Country Travel Insurance
Your plan covers 100% up to a maximum of $5,000,000, per incident, 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.
Maximum number of days per trip is 180 days. Looking to travel for more days than this plan covers? Call Green Shield customer service centre at 1-888-711-1119 for more information. 

For details regarding your travel coverage, please click the button myBenefits Booklet.

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 $7,000. For further details on this benefit please see the Accidental Death & Dismemberment brochure.

Tutorial*
Your plan covers 100% up to $15 per hour to a maximum of $1,000 per disability 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 and Tutorial benefits.

Exclusions

Limitations and Exclusions to Extended Health Benefits
Eligible benefits do not include and reimbursement will not be made for:
1) Services or supplies received as a result of disease, illness or injury due to:
(a) intentionally self-inflicted injury while sane or insane;
(b) an act of war, declared or undeclared;
(c) participation in a riot or civil commotion; or
(d) committing a criminal offence;
2) Services or supplies provided while serving in the armed forces of any country;
3) Failure to keep a scheduled appointment with a legally qualified medical or dental practitioner;
4) The completion of any claim forms and/or insurance reports;
5) Any specific treatment or drug which:
(a) does not meet accepted standards of medical, dental or ophthalmic practice, including charges for services or supplies which are experimental in nature, or is not considered to be effective (either medically or from a cost perspective, based on Health Canada's approved indication for use);
(b) is an adjunctive drug prescribed in connection with any treatment or drug that is not an eligible service;
(c) will be administered in a hospital;
(d) is not dispensed by the pharmacist in accordance with the payment method shown under the Prescription Drugs Benefit; or
(e) is not being used and/or administered in accordance with Health Canada's approved indication for use, even though such drug or procedure may customarily be used in the treatment of other illnesses or injuries; or
6) Services or supplies that:
(a) are not recommended, provided by or approved by the attending legally qualified (in the opinion of the insurer) medical practitioner or dental practitioner as permitted by law;
(b) are legally prohibited by the government from coverage;
(c) you are not obligated to pay for or for which no charge would be made in the absence of benefit coverage or for which payment is made on your behalf by a not-for-profit prepayment association, insurance carrier, third party administrator, like agency or a party other than the insurer, your plan sponsor or you;
(d) are provided by a health practitioner whose license by the relevant provincial regulatory and/or professional association has been suspended or revoked;
(e) are not provided by a designated provider of service in response to a prescription issued by a legally qualified health practitioner;
(f) are used solely for recreational or sporting activities and which are not medically necessary for regular activities;
(g) are primarily for cosmetic or aesthetic purposes, or are to correct congenital malformations;
(h) are provided by an immediate family member related to you by birth, adoption, or by marriage and/or a practitioner who normally resides in your home. An immediate family member includes a parent, spouse, child or sibling;
(i) are provided by your plan sponsor and/or a practitioner employed by your plan sponsor, other than as part of an employee assistance plan;
(j) are a replacement of lost, missing or stolen items, or items that are damaged due to negligence (replacements are eligible when required due to natural wear, growth or relevant change in your medical condition but only when the equipment/prostheses cannot be adjusted or repaired at a lesser cost and the item is still medically required);
(k) are video instructional kits, informational manuals or pamphlets;
(l) are for medical or surgical audio and visual treatment;
(m) are special or unusual procedures such as, but not limited to, orthoptics, vision training, subnormal vision aids and aniseikonic lenses;
(n) are delivery and transportation charges;
(o) are for Insulin pumps and supplies (unless otherwise covered under the plan);
(p) are for medical examinations, audiometric examinations or hearing aid evaluation tests;
(q) are batteries, unless specifically included as an eligible benefit;
(r) are a duplicate prosthetic device or appliance;
(s) are from any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipal or other governmental body;
(t) would normally be paid through any provincial health insurance plan, Workplace Safety and Insurance Board or tribunal, the Assistive Devices Program or any other government agency, or which would have been payable under such a plan had proper application for coverage been made, or had proper and timely claims submission been made;
(u) were previously provided or paid for by any governmental body or agency, but which have been modified, suspended or discontinued as a result of changes in provincial health plan legislation or de-listing of any provincial health plan services or supplies;
(v) may include but are not limited to, drugs, laboratory services, diagnostic testing or any other service which is provided by and/or administered in any public or private health care clinic or like facility, medical practitioner's office or residence, where the treatment or drug does not meet the accepted standards or is not considered to be effective (either medically or from a cost perspective, based on Health Canada's approved indication for use);
(w) are provided by a medical practitioner who has opted out of any provincial health insurance plan and the provincial health insurance plan would have otherwise paid for such eligible service;
(x) relate to treatment of injuries arising out of a motor vehicle accident (Ontario);
Note: Payment of benefits for claims relating to automobile accidents for which coverage is available under a motor vehicle liability policy providing no-fault benefits will be considered only if:
i) the service or supplies being claimed is not eligible; or
ii) the financial commitment is complete (a letter from your automobile insurance carrier will be required); or
(y) are cognitive or administrative services or other fees charged by a provider of service for services other than those directly relating to the delivery of the service or supply.

Limitations and Exclusions to Dental Benefits
Eligible benefits do not include and reimbursement will not be made for:
1) Services or supplies received as a result of disease, illness or Injury due to:
(a) intentionally self-inflicted Injury while sane or insane;
(b) an act of war, declared or undeclared;
(c) participation in a riot or civil commotion; or
(d) committing a criminal offence;
2) Services or supplies provided while serving in the armed forces of any country;
3) Failure to keep a scheduled appointment with a legally qualified dental practitioner;
4) The completion of any claim forms and/or insurance reports;
5) Any dental service that is not contained in the procedure codes developed and maintained by the Canadian Dental Association, adopted by the provincial or territorial dental association of the province or territory in which the service is provided (or your province of residence if any dental service is provided outside Canada) and in effect at the time the service is provided;
6) Implants and related services;
7) Restorations necessary for wear, acid erosion, vertical dimension and/or restoring occlusion; 
8) Appliances related to treatment of myofacial pain syndrome including all diagnostic models, 
gnathological determinants, maintenance, adjustments, repairs and relines;
9) Posterior cantilever pontics/teeth and extra pontics/teeth to fill in diastemas/spaces;
10) Service and charges for sleep dentistry;
11) Diagnostic and/or intraoral repositioning appliances including maintenance, adjustments, repairs and relines related to treatment of temporomandibular joint dysfunction;
12) Any specific treatment or drug which:
(a) does not meet accepted standards of medical, dental or ophthalmic practice, including charges for services or supplies which are experimental in nature, or is not considered to be effective (either medically or from a cost perspective, based on Health Canada's approved indication for use);
(b) is an adjunctive drug prescribed in connection with any treatment or drug that is not an eligible service;
(c) will be administered in a hospital;
(d) is not dispensed by the pharmacist in accordance with the payment method shown under the Health Benefit Plan Prescription Drugs; or
(e) is not being used and/or administered in accordance with Health Canada's approved indication for use, even though such drug or procedure may customarily be used in the treatment of other illnesses or injuries; or
13) Services or supplies that:
(a) are not recommended, provided by or approved by the attending legally qualified (in the opinion of Green Shield) medical practitioner or dental practitioner as permitted by law;
(b) are legally prohibited by the government from coverage;
(c) you are not obligated to pay for or for which no charge would be made in the absence of benefit coverage; or for which payment is made on your behalf by a not-for-profit prepayment association, insurance carrier, third party administrator, like agency or a party other than Green Shield, your plan sponsor or you;
(d) are provided by a health practitioner whose license by the relevant provincial regulatory and/or professional association has been suspended or revoked;
(e) are not provided by a designated provider of service in response to a prescription issued by a legally qualified health practitioner;
(f) are used solely for recreational or sporting activities and which are not medically necessary for regular activities;
(g) are primarily for cosmetic or aesthetic purposes, or are to correct congenital malformations;
(h) are provided by an immediate family member related to you by birth, adoption, or by marriage and/or a practitioner who normally resides in your home. An immediate family member includes a parent, spouse, child or sibling;
(i) are provided by your plan sponsor and/or a practitioner employed by your plan sponsor, other than as part of an employee assistance plan;
(j) are a replacement of lost, missing or stolen items, or items that are damaged due to negligence (replacements are eligible when required due to natural wear, growth or relevant change in your medical condition but only when the equipment/prostheses cannot be adjusted or repaired at a lesser cost and the item is still medically required);
(k) are video instructional kits, informational manuals or pamphlets;
(l) are delivery and transportation charges;
(m) are a duplicate prosthetic device or appliance;
(n) are from any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipal or other governmental body;
(o) would normally be paid through any provincial health insurance plan, Workplace Safety and Insurance Board or tribunal, or any other government agency, or which would have been payable under such a plan had proper application for coverage been made, or had proper and timely claims submission been made;
(p) relate to treatment of injuries arising out of a motor vehicle accident (Ontario);
Note: Payment of benefits for claims relating to automobile accidents for which coverage is available under a motor vehicle liability policy providing no-fault benefits will be considered only if:
i) the service or supplies being claimed is not eligible; or
ii) the financial commitment is complete (a letter from your automobile insurance carrier will be required); or
(q) are cognitive or administrative services or other fees charged by a provider of service for services other than those directly relating to the delivery of the service or supply.

myBenefits Booklet

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