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myBenefits

Please try searching by your key words for the benefit or information you want to know.


Click here to download the Saskatchewan Polytechnic Health & Dental Plan coverage leaflet for the 2022-2023 Benefit Year.

New virtual health care service included as part of the health plan, to learn more visit the My Virtual Doctor website.



myBenefits at a Glance

The highlights below are provided as general information. Coverage for eligible costs is based on the contract detail. Select the benefit for additional coverage details.

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

Prescription Drugs:
Reimbursed at 90% to a maximum of $5,000 per benefit year. Based on the SK Provincial Formulary with a generic rider.
(please click Prescription Drugs for details)

Private Duty Nurse:
Reimbursed at 100% to a maximum of $25,000 in 3 consecutive benefit years.
(please click Supplemental Health for details)

Vision:
Reimbursed at 100%, $75 for one eye exam every 2 benefit years, $200 for glasses or contact lenses every 24 months, $150 for laser eye surgery per benefit year.
(please click Vision for details)

Health Practitioners:
The services of paramedical practitioners are reimbursed $40 per visit. Each service has an overall plan maximum of $400 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)

Hospital:
Reimbursed at 100% for the cost of a semi private room.
(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% of eligible expenses and reasonable and customary charges, services must be performed within 12 months of the accident.
(please click Supplemental Health for details)

Dental Coverage:
Exams covered at 90% once per benefit year. Overall plan maximum of $750 per benefit year.
(please click Dental for details)

Accidental Death & Dismemberment:
$5,000 loss of life benefit.
(please click Other Insurances for details)

Travel Insurance:
$5 million of coverage for emergencies and illnesses while traveling.
(please click Travel Insurances 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% of reasonable and customary charges for a licensed ambulance or emergency 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.

Diagnostic Services
Your plan covers 100%, based on reasonable and customary charges for diagnostic laboratory and x-ray procedures, including radiotherapy and coagulotherapy, performed in the student's province of residence are covered when coverage is not available under a government provincial plan.

Hospital
Your plan covers 100% of the cost of an upgrade from a public ward to a semi-private room in the province of Saskatchewan. Other hospital charges incurred during a person's hospital stay are covered to a maximum of $25 per day, for a maximum of 30 days per period of hospitalization.

Custom-Made Orthotics
Your plan covers 100% to a maximum of $350 per benefit year custom-made foot orthotics, when prescribed by a physician, podiatrist, chiropodist or chiropractor.

*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.

Private Duty Nursing
Your plan covers 100% to a maximum of $25,000 every 3 benefit years 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.

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 for $40 per visit to a maximum of $400 based on reasonable and customary charges, per benefit year.

• physiotherapist
• registered massage therapist
• speech therapist
• psychologist or social worker
• chiropractor, including 1 x-ray examination per benefit year
• osteopath, including 1 x-ray examination per benefit year
• naturopath
• licensed dietician
• chiropodist or podiatrist, including one x-ray exam per benefit year
• athletic therapist

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%, based on 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
• walkers
• hospital beds
• iron lung
• respirator
• braces, crutches, splints & trusses
• artificial limbs & eyes
• other approved prosthetic devices
Braces, Crutches, Splints, Trusses
Your plan covers 100% of reasonable and customary charges for braces, provided they are not solely for athletic use. It is recommended that an application for pre-approval be submitted to the insurer.
Prosthesis
Your plan covers 100% of reasonable and customary charges for artificial limbs or other prosthetic appliances. It is recommended that an application for pre-approval be submitted to the insurer.
Orthopaedics*
Your plan covers 100% to a maximum of $500 per benefit year for custom-made orthopaedic shoes, repairs and modifications when required for the correction of deformity of the bones and muscles and provided they are not solely for athletic use and are prescribed by a physician, podiatrist, chiropodist, or chiropractor.
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, 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. Provided the services are performed within 12 months of the accident but excluding services required in conjunction with such injuries due to a condition that existed before the accident. Implants and treatment related to implants are not covered. If a dental accident occurs, the health plan’s dental accident provision will pay benefits before the dental plan.

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, or dropped off at the On Campus Health & Dental Plan Office.

Saskatchewan Special Support Program

Coverage is available to Saskatchewan residents whose drug costs are high in relation to their family income. Saskatchewan residents must apply every year to the province for coverage under the program. Residents will receive a letter from the province approving coverage and confirming the deductible amount and the percentage of formulary drug costs that they are responsible for.

The deductible is the amount residents are required to pay before the Saskatchewan Special Support Program starts paying a portion of their drug claims. Deductible amount depends on family income and drug costs. The student plan will cover the claimant's provincial deductible amount for drugs covered.

Applying for coverage through the Saskatchewan Special Support Program: Students can complete a one time application for coverage through the SSP which they provide consent to allow the Canada Revenue Agency (CRA) to release income data to Saskatchewan Health in order to determine co-payment and deductible amounts. Applications are available online at: Special Support Services and at local Pharmacies.

Saskatchewan Special Support Program & The Student Health Plan: Students will be required to complete the SSP application prior to receiving their myBenefits Card through the Health & Dental Plan Office.

Once the application has been processed students can begin using their myBenefits Card at the pharmacy.
Students within the standard validation period for their semester period of enrollment will be able to access their benefits upon completion of the validation period.
Claims will automatically be assessed first through Saskatchewan Health using the student's health card number and any outstanding portion will then be submitted electronically to Canada Life via the myBenefits Card.

Prescription Drugs

Your drug plan covers 90%, to a maximum of $5,000 per benefit year. Based on the Saskatchewan Provincial Formulary with a generic rider.

Your drug plan also includes additional coverage for smoking cessation products legally requiring a prescription, up to a maximum of $500 per benefit year.

Vaccinations are covered at 100% up to $150 per benefit year. Administration costs associated with providing the injection are not covered.

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 SK Provincial Formulary.

The SK Provincial 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 are not effective in treating your 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 the On Campus Health & Dental Plan Office and must be completed by your physician. Completed forms may be returned to the On Campus Health & Dental Plan Office or can be faxed directly to the insurance company.

Request for Coverage of Exception Status Drug form

Vision

Your plan covers 100% of the cost of the following vision care expenses:

a) one eye examination by an optometrist or ophthalmologist every 2 benefit years to a maximum of $75;

b) standard eye glass lenses and frames (single vision or bifocal as required) and contact lenses when prescribed by an opthalmologist or a licensed optometrist to a maximum of $200 in any consecutive 24 months for any one insured;

c) laser eye surgery performed by an opthalmologist, to a maximum of $150 per benefit year; and

d) one pair of eyeglasses following cataract surgery up to a maximum of $200 per person per surgery.

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 $500.

Your plan covers up to a maximum of $750 per benefit year.




Preventative Services

Your plan covers 90% for preventative services, including:
• recall examination, once every 12 months
• initial or complete exams, once every 36 months
• specific or emergency exams
• complete series of x-rays and periapical, up to 16 films     including bitewings, 1 in any period of 36 months
• bitewings, not more than 4 films every 12 months
• panoramic, 1 in any period of 36 months
• polishing, 1 unit every 12 months
• scaling, 4 units per benefit year
• fluoride, every 12 months
• oral hygiene instruction, once every 12 months
• pit and fissure sealants
• removal of impacted teeth
• anaesthesia, eligible when done in conjunction with a covered dental procedure
• space maintainers and maintenance, under 15 years of age
Basic Services
Your plan covers 80% for basic services, including:
• fillings; amalgam, composite, acrylic or equivalent. You are only covered for composite fillings in front teeth and pre-molars. Amalgam fillings are covered for molars.
Other Basic Services
Your plan covers 80% for basic services, including:
• fillings; amalgam, composite, acrylic or equivalent. You are only covered for composite fillings
in front teeth and pre-molars

Other Basic Services
Your plan covers 80% for other basic services, including:
• extractions, anaesthesia, eligible when done in conjunction with oral surgical procedures.
Except removal of impacted teeth which is covered under Preventative Services.
• prefabricated metal restorations and repairs to prefabricated metal restorations other than in conjunction with the placement of permanent crowns
• root canal therapy
• root planing and occlusal equilibration are each limited to 8 units per benefit year
• oral surgery
Extractions
Your plan covers 50% for services associated extractions, including:
• extractions, not more than 2 wisdom teeth per benefit year
• anaesthesia, eligible when done in conjunction with oral surgical procedures
Endodontic
Your plan covers 50% for endodontic services including:
• root canal therapy
Periodontic
Your plan covers 50% for periodontic services including:
• additional scaling and/or root planing, maximum of 2 units per benefit year
• occlusal equilibration, not more than 4 units per benefit year
• periodontal appliances, not more than 1 appliance per arch in any 24 month period
• periodontal appliance repairs, maintenance and adjustments, 4 adjustments per benefit year
• oral surgical procedures
• anaesthesia, eligible when done in conjunction with oral surgical procedures

Travel Insurances

Emergency Out of Province Medical and Accidental Death and Dismemberment Coverage

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 the school or in your country of origin. Your coverage period is 180 days per trip. Coverage is subject to the terms and conditions provided in the Benefits Booklet.

This insurance product is underwritten by AIG Insurance Company of Canada. If you are travelling, download the Travel Medical Assistance Card.

Eligible students enrolled in the Extended Health Plan have this Emergency Travel Assistance coverage. Students must be covered by a Government Health Insurance Plan (GHIP) of a Canadian province or territory or equivalent.

Students covered under the travel policy are in one of the following two classes; this information may be needed if you are contacting AIG regarding your coverage.

  • Policy Number: SRG 9429061
  • Class I: Domestic Student
  • Class II: Foreign Student

If students add their family members to the Student Health Plan, they are also covered by the Emergency Travel Assistance and must be covered by a Government Health Insurance Plan (GHIP) of a Canadian province or territory or equivalent.

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 $5,000. Please contact health and dental plan office for a complete schedule of losses.

Tutorial*
Your plan covers 100% up to $10 per hour to a maximum of $300 per benefit year for private tutorial service if the student is confined to home or hospital for a minimum of 7 consecutive school days.

*Applicable to the Student only. Family members are not eligible for reimbursement of the tutorial benefit.

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 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) Services or supplies received outside of Canada;
8) expenses for drugs which, in the insurer's opinion, are experimental;
9) expenses for dietary supplements, vitamins and infant foods;
10) expenses for contraceptives (other than oral and intrauterine devices);
11) expenses for drugs if they are used for the treatment of infertility;
12) expenses for "in vitro" or "in vivo" procedures, or any other infertility procedures;
13) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
14) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
15) 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
16) 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 Workers' 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) Services or supplies received outside of Canada;
6) committing or attempting to commit a criminal offence or provoking an assault;
7) any group or policyholder sponsored dental care or treatment;
8) any dental care, treatment or supplies primarily for cosmetic purposes;
9) failing to keep scheduled appointments;
10) file transfers, the completion of claim forms or other documentation;
11) any dental treatment for the correction of temporomandibular joint dysfunction;
12) replacement of mislaid, lost or stolen appliances;
13) 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;
14) any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants;
15) any dental procedure which is not listed in the descriptions of dental benefits indicated herein;
16) charges that are in excess of the fees stated in the Dental Association General Dentist Fee Guide applicable to this benefit;
17) where coverage for services is provided under any government plan;
18) where services would be provided without charge in the absence of this policy; or
19) any other exclusions identified in the policy contract.

Service Members


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