myBenefits

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%, limited to $250 per occurrence.
(please click Supplemental Health for details.)

Prescription Drugs:
Reimbursed at 80% to a maximum of $1,500 per benefit year.
Based on the National Formulary with a generic rider.
(please click Prescription Drug for details.)

Vision:
Reimbursed at 100%, Combined maximum of $150 for one eye exam, glasses or contact lenses every 24 months.
(please click Vision for details)

Health Practitioners:
The services of paramedical practitioners are reimbursed at 100% to a maximum of $300 based on reasonable and customary charges, per benefit year. Practitioners must be registered and licensed in their field of practice.
(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 Coverage:
Exams covered at 80% once per benefit year. Overall plan maximum of $750 per benefit year.
(please click Dental 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.

Please select an option to see details Ambulance Practitioners Medical Equipment Orthopaedics Trusses, Crutches, Splints, and Braces Prosthesis Dental Accident

Your drug plan covers 80% of the cost of most medications legally requiring a prescription to a maximum of $1,500 per benefit year.

Your drug plan includes coverage at 80% for smoking cessation products that legally require a prescription to a lifetime maximum of $500.

Your drug plan includes $100 for vaccines every benefit year (included in overall prescription drug maximum of $1,500).

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

IMPORTANT! Advise your doctor and pharmacist that you are on the National Formulary.

The National Formulary is a specific list of drugs that are eligible for reimbursement under your drug benefit. Formularies are developed to ensure that prescription drugs are available on a cost-effective basis. It covers approximately 85% of the most frequently prescribed drugs. Formularies are reviewed regularly and as a result, updates are made on an ongoing basis.

Exception Process: In the event that the drugs covered by the Formulary are not effective in treating the condition, an exception process is in place. To be eligible for an exception, you must have tried one alternative drug listed on the Formulary. An exception drug request form is available below or from your Benefits Plan Office and must be completed by your physician. Completed forms may be returned to SANC Student Benefits Plan Office or can be faxed directly to the insurance company.

Request for Coverage of Exception Status Drug form

Your plan covers 100% of the cost of an eye examination, glasses or contact lenses by an ophthalmologist or optometrist to a combined maximum of $150 in a 24 month period.

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 $500.

Your plan covers up to a maximum of $750 per benefit year.
Please select an option to see details Diagnostic & Preventative Minor Restorative Endodontic and Oral Surgery Periodontic and Other Oral Surgery

Tutorial*
Your plan covers 80% up to $15 per hour to a maximum of $1,000 per benefit year 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 Tutorial benefits.

Emergency Out of Country Travel Insurance
Your plan covers 100% up to a maximum of $2,000,000 per lifetime 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. For additional details on this benefit download your Global Medical Assistance Brochure.

The Personal Health Risk Assessment can be used to create a health profile, build an action plan to support your health and wellness needs and track progress.
Watch a short video about Personal Health Risk Assessment.

Limitations and Exclusions to Extended Health Benefits
No benefit is payable for:
1) expenses for which benefits are payable under a Workers' Compensation Act or a similar statute;
2) expenses incurred due to intentionally self-inflicted injuries;
3) expenses incurred due to civil disorder or war, whether or not war was declared;
4) expenses incurred due to committing a criminal offense or provoking an assault;
5) expenses for which benefits are payable under a government plan;
6) expenses for benefits which are legally prohibited by the government from coverage;
7) expenses for drugs which, in the insurer's opinion, are experimental;
8) expenses for dietary supplements, vitamins and infant foods;
9) expenses for contraceptives (other than oral);
10) expenses for drugs if they are used for the treatment of infertility;
11) expenses for "in vitro" or "in vivo" procedures, or any other infertility procedures;
12) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
13) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
14) expenses for the regular treatment of an injury or disease which existed before the member's or dependant';s departure from his/her province of residence; or
15) any other exclusion identified in the policy contract.

Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) any cause for which the insured may apply for and receive protection, exemption or compensation under any Worker' Compensation Act;
2) self-inflicted injuries while sane or insane;
3) war, insurrection or hostilities of any kind, whether or not the insured was a participant in such actions;
4) participation in any riot or civil commotion;
5) committing or attempting to commit a criminal offence or provoking an assault;
6) any group or policyholder sponsored dental care or treatment;
7) any dental care, treatment or supplies primarily for cosmetic purposes;
8) failing to keep scheduled appointments;
9) file transfers, the completion of claim forms or other documentation;
10) any dental treatment for the correction of temporomandibular joint dysfunction;
11) replacement of mislaid, lost or stolen appliances;
12) expenses for full mouth reconstructions for vertical dimension correction or to repair or restore teeth damaged or worn due to attrition or vertical wear or to restore occlusion;
13) any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants;
14) any dental procedure which is not listed in the descriptions of dental benefits indicated herein;
15) charges that are in excess of the fees stated in the Dental Association General Dentist Fee Guide applicable to this benefit;
16) where coverage for services is provided under any government plan;
17) where services would be provided without charge in the absence of this policy; or
18) any other exclusions identified in the policy contract.