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Benefits Plan Details

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The Plan Details in this section reflect the policy for the September 1, 2020 - August 31, 2021 Benefits Year.
Click here to download the purplecare Health & Dental Plan coverage leaflet for the 2020-2021 Benefit Year.


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 80% to a daily maximum of $100.
( please click Supplemental Health for details)

Prescription Drugs:
Reimbursed at 80% to a maximum of $3,000 per benefit year and a maximum Dispensing Fee of $9.45.
Reimbursement will be made for the cost of the lowest priced equivalent drug.
( please click Prescription Drugs for details)

Vision:
Reimbursed at 100% to a maximum of $70, for one eye exam based on reasonable and customary charges every 24 months from the date of service. Glasses or contact lenses, maximum of $100 every 24 months from the first date of purchase.
(please click Vision for details.)

Health Practitioners:
The services of paramedical practitioners must be registered and licensed in their field of practice.

( please click Supplemental Health for details)

Medical Equipment & Supplies:
Reimbursed at 80% to a maximum of $1,000 per benefit year. 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)

Dental Accident:
Reimbursed at 80% to a maximum of $1,500 per benefit year.
(services must be performed within 12 months of accident; authorization required)
( please click Supplemental Health for details)

Travel Insurance:
$5 million of coverage for emergencies and illnesses while traveling.

( please click Travel Insurance for complete 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 80% 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. If the patient requires the services of a registered nurse during the flight, the services and return airfare for a registered nurse are covered.

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 $40 per visit, $500 maximum per benefit year for all practitioners combined:

• Acupuncturist
• Chiropractor**
• Dietitian - No per visit maximum
• Registered massage therapist*
• Naturopath
• Osteopath**
• Occupational therapist
• Physiotherapist*
• Chiropodist, Podiatrist
• Speech therapist
*physician’s prescription/referral required for indicated services. If a referral is required it must be current and will be valid for one year.
** If an X-Ray is recommended, up to $25 is covered towards this expense within the overall $500 Health Practitioner maximum.

Counselling covered up to $750 per benefit year combined for the following providers:
• Licensed Psychologist
• Social Worker or
• Psychotherapist

For Online Video Counselling you can submit your receipts online or with our paper form for reimbursement.
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 80% to a maximum of $1,000 per benefit year 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:

• Hearing Aids (1 pair every 60 months);
• Wheelchairs (repairs, $250 per lifetime);
• Respiratory equipment, including oxygen ($1,000 per benefit year);
• Contact lenses/glasses following cataract surgery (1 pair per lifetime);
• Canes, crutches, walkers, casts, splints catheters;
• Compression stockings (2 pairs per benefit year);
• Blood glucose monitor ($500 per benefit year);
• Insulin pump ($500 per lifetime);
• Aero chamber (1 per benefit year);
• Custom-made rigid or semi-rigid braces (not for athletic use)($1,000 per lifetime, per condition);
• Wigs and hairpieces for patients with temporary hair loss as a result of medical treatment;
• Non-dental prosthesis such as artificial limbs and eyes; including replacement if required because of a change in physical condition.

Excluded are items required for athletic use, personal comfort, or items which may also be used for non-medical reasons, such as, but not limited to heating pads or light therapy devices, communication aids, air conditioners or cleaners and whirlpool baths or saunas.
Orthopaedics*
Orthopaedic Shoes and Custom-Made Orthotics: Your plan covers 50% up to $200 per plan year combined for Orthopaedic Shoes and Custom-Made Orthotics

*IMPORTANT It is strongly recommended that a pre-determination/estimate be submitted to Canada Life to ensure that the guidelines set out by Canada Life 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 80% to a maximum of $1,500 per accident for of the cost of the services of treatment of injury to sound natural teeth (treatment must commence within 30 days of the accident and be completed within 12 months of accident; authorization required). Treatment must start within 30 days after the accident unless delayed by a medical condition. A sound tooth is any tooth that did not require restorative treatment immediately before the accident. A natural tooth is any tooth that has not been artificially replaced.

No benefits are paid for:
• accidental damage to dentures
• dental treatment completed more than 12 months after the accident
• orthodontic diagnostic services or treatment

In the event of a dental accident, you must complete a Standard Dental Association claim form. When making a claim, be sure to attach all original receipts to the claim form. The claim form can be mailed directly to the insurance company.

BC Fair Pharmacare

PLEASE NOTE: International students or out of province students do not need to apply for BC Fair Pharmacare.  Please register directly for your myBenfits Card.  On this form instead of the BC Fair Pharmacare number, please indicate the country or province you are from.  Register for your myBenefits Card HERE.    

The Fair PharmaCare program in British Columbia is intended to provide greater financial assistance to British Columbian's 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 Columbian's 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!


To register you will need to have your:
• BC Care Card number
• Net income from 2 years ago (line 236 on your tax return)
• Social insurance number
• Date of birth

You will receive your registration number immediately.

Click here for a PDF on the step-by-step process needed to completed your card registration.  

Register online HERE
Please note this link above works best using Safari or Internet Explorer. 

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.


Once you have your BC Fair PharmaCare number, register for your myBenefits Card HERE




Vision

Your plan covers 100% of the cost of one eye examinations, to a maximum of $70, by an ophthalmologist or optometrist in a 24 month period from the date of service. 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 $100, once during a 24 month period from the first date of purchase. Based on reasonable and customary charges.

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 and a maximum Dispensing Fee of $9.45.

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 NASA Formulary.

The NASA 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 USC Health & Dental Plan Administrator and must be completed by your physician. Completed forms can be e-mailed directly to the insurance company, cldrug.services@canadalife.com.

Request for Coverage of Exception Status Drug form

vision

Your plan covers 70% the cost of one eye examination every 24 months. Eyeglasses or contact lenses by an ophthalmologist or optometrist, limited to a combined maximum of $100 in a 24 month period for a cost that is considered reasonable and customary.

Dental

MBA'S DO NOT QUALIFY FOR THE DENTAL COVERAGE.

Payment of dental benefits is based on the General Practitioners Dental Association suggested fee minus 1 year 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 minus 1 year.

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.



Oral Surgery
Your plan covers 50% for services associated with surgical extractions, including:
• extractions of impacted teeth and/or residual roots

Your plan covers 10% for services of minor surgical procedures, simple extractions and post surgical care.
Diagnostic & Preventative
Your plan covers 80% of diagnostic and preventative procedures including:
• complete oral examinations once every benefit year
• emergency and specific oral examinations
• full series X-rays and panoramic X-rays once every 3 years
• bitewing X-rays once per benefit year
• recall examinations once per benefit year
• Cleaning of teeth (up to 1 unit of polishing per benefit year, and 2 units of scaling twice per benefit year)
• fluoride once per benefit year for covered dependants 16 years of age and under
• oral hygiene instruction once per lifetime
• pit and fissure sealants once in a 36 month period for covered dependants 16 years of age and under
• space maintainer once per space for covered dependants 14 years of age and under
Minor Restorative
Your plan covers 80% for services associated with dental health restoration, including:
• amalgam, silicate and composite fillings;
• tooth-coloured fillings
Anesthesia
Your plan covers 80% for Anesthesia.
Endodontic
Your plan covers 10% for endodontic services including:
• root canal therapy
Periodontic
Your plan covers 10% for periodontic services (excluding light scaling for 80% coverage) including:
• periodontal scaling and/or root planing 16 units per benefit year
• occlusal equilibration - selective grinding of tooth surfaces to adjust a bite 8 units per benefit year
The fees for periodontal treatment are based on units of time (15 minutes per unit) and/or number of teeth in a surgical site in accordance with the General Practitioners Fee Guide.

Travel Insurance

Group Out-of-Province/Canada Travel Medical Emergency Insurance 

Provides coverage of up to a maximum of $5 million per insured person per coverage period for certain expenses incurred as a result of an emergency while travelling on trips that originated from your Canadian province or territory of residence. It is important to remind you that this coverage is not available in the province where you attend school or in your country of origin. Your coverage period is 180 days per trip. When travel is required to complete a course of study, coverage can be extended to 365 days, following confirmation from your academic supervisor. Please check with your campus administrator for details. Coverage is subject to the terms and conditions provided in the Benefits Booklet.

In addition, this insurance provides coverage for the following benefits:
• Up to $5,000 per insured person, per trip for trip cancellation 
• Up to $2,000 per insured person, per trip, for trip interruption; and
• Up to $1,000 per insured person, per trip, for baggage insurance. 

Information you will need along with your Travel Assist card when opening a claim:
Group Policy Number: 1170790
Certificate Number: Your University Students’ Council of Western University Student ID

This insurance product is underwritten by Royal & Sun Alliance Insurance Company of Canada. Coverage is subject to the terms and conditions in the Benefits Booklet. For benefit complete details regarding this coverage download your Benefits Booklet and travel medical assistance card.

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 $6,000. Please contact the USC Health & Dental Plan Administrator for a complete schedule of losses.

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.

Personal Health Risk Assessment

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.

Exclusions

Limitations and Exclusions to Prescription Drug Benefits
No benefits are paid for:
1) over-the-counter products, or medicines available without a prescription;
2) fertility drugs;
3) anti-smoking remedies (e.g. nicorette gum, patches or similar prescribed remedies);
4) injectable vitamins that are non-prescription;
5) patented medicines and G.P. products;
6) first-aid and surgical supplies;
7) atomizers, vaporizers;
8) salt and sugar substitutes;
9) infant formula, dietary foods and aids;
10) contact lens care products;
11) diagnostic aids and laboratory tests;
12) contraceptives, other than oral and the IUD Mirena;
13) lozenges, mouthwash, toothpastes and cosmetics;
14) oral vitamins;
15) items deemed cosmetic, even if a prescription is legally required;
16) male baldness treatments;
17) drugs which in whole or in part a government health plan prohibits from being paid, except to the extent that it permits excess reimbursement;
18) drugs which the Insured Person received without charge;
19) drugs which are experimental in nature;
20) drugs, hormones, products and injections for the treatment of obesity;
21) erectile dysfunction drugs;
22) Accutane or other acne preparations containing the same medicinal ingredient as Accutane;
23) anabolic steroids; or
24) sclerosing agents.

Limitations and Exclusions to Extended Health Benefits
No benefit is payable for:
1) expenses as a result of any injury or sickness caused by declared or undeclared war or any act thereof;
2) expenses of any kind which would not normally be charged to you if the policy were not in effect;
3) expenses incurred from any injury or sickness sustained as a result of employment when you are covered or eligible to receive benefits under the applicable Workplace Safety and Insurance Board's legislation or similar law;
4) expenses as a result of suicide or any attempt thereat or intentionally self-inflicted injury, while sane or insane;
5) cosmetic medical or surgical care, other than due to an accidental bodily injury sustained while you are insured under this benefit;
6) medical treatment which is experimental or investigational in nature;
7) periodic health examinations, broken appointments, physician's costs for traveling or providing telephone advice, third party examinations, completion of forms or medical reports, travel for health purposes;
8) services, treatment or supplies not included in this benefit;
9) expenses incurred from any injury or sickness as the result of active full-time service in the armed forces of any country;
10) expenses incurred by you if you are not covered under any Federal or Provincial Hospital or Medical Plan or its equivalent;
11) expenses which are not medically required;
12) services or supplies associated with exercise, weight loss, physical fitness or sports, environmental or atmospheric control in the home or workplace;
13) expenses which are prohibited by law from being covered by a private insurance plan; or
14) services, treatments or supplies which the Insured Person received without charge.

Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) Services not included in the list of defined eligible services (e.g. temporary fillings);
2) Completion of claim forms, advice by phone, or charges for missed or cancelled appointments;
3) Cosmetic surgery or treatment when classified as such by the Company;
4) Any dental treatment not yet approved by the Canadian Dental Association or which is clearly experimental in nature.
5) implants and any dental service associated with implants;
6) replacement of fixed bridge pontics, retainers, abutments, crowns, or removable complete or partial dentures unless:
(a) made necessary by the extraction of a natural tooth while insured hereunder,
(b) the crown is at least five years old,
(c) the existing appliance is at least five years old and cannot be made serviceable, or
(d) the existing appliance is temporary and is replaced with a permanent bridge pontic or denture within 12 months of the date on which the temporary appliance was installed;
7) services not included in the list of defined eligible services;
8) cosmetic surgery or treatment when classified as such by Canada Life;
9) expenses recoverable from other benefit sections of this policy;
10) expenses which are provided for by any Federal, Provincial, or Municipal government plan, or which would have been provided for if the Insured Person had applied for coverage under such plan;
11) expenses of any kind which would not normally be charged to the Insured Person if the insurance provide by this policy were not in effect;
12) completion of claim forms, advice by phone, or charges for missed or cancelled appointments;
13) replacement of lost, misplaced or stolen appliances or dentures;
14) initial crowns, bridges, retainers, abutments or complete or partial dentures required to replace a tooth or teeth missing prior to coverage becoming effective;
15) nutritional counseling, oral hygiene and dental plaque control programs; or
16) any dental treatment which is not yet approved by the Canadian Dental Association or which is clearly experimental in nature.

myBenefits Booklet

Service Members


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