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Student Health & Wellness!mystudentplan is a benefits plan for students and can provide coverage for prescription drugs, vision care, dental care, mental health counseling, and more. The plan is designed to supplement provincial health insurance and provide additional access to medical services.

 

Plan Details

The Student Plan covers prescription drugs, vision, dental care, paramedical practitioners, ambulance, and medical equipment & supplies, among others.

Extended Health Coverage

Your extended health coverage runs for as long as you remain an enrolled and eligible student at Toronto Metropolitan University. For more information about enrollment and eligibility, please visit the Plan Enrollment section.

Plan Leaflet

Get a summary of eligible expenses and maximum reimbursements of your Health and Dental Plan.

Plan Card

Your Plan Card allows you direct billing with pharmacies and dental offices.

Select Savings

Get a student discount and save money on certain eligible services by visiting one of our members.

The following is the coverage for your Health Plan:

Health Benefits Coverage
Prescription Drugs 80%

Maximum of $5000 per benefit year. The maximum amount payable to an eligible brand name drug will be limited to the lowest priced item in the appropriate generic category.

HPV Vaccines are covered at 65%.

Birth control is covered at 100% and the Cooper IUD is covered to a maximum of $75 per benefit year and are included in the total drug maximum for the year.

Vision 100%
  • $75 for one eye examination. The exam must be by an ophthalmologist or optometrist.
  • $150 for eyeglasses or contact lenses.

The vision coverage renews every 24 months from the initial date of service. Coverage is based on reasonable and customary charges.

Prescription sunglasses are not covered by the plan.

Paramedical Practitioners 100%

Student benefits are payable after any Provincial Health Care benefits have been exhausted. This plan does not cover user fees.

Practitioners must be registered and licensed in their field of practice.

Mental Health Practitioners 100%

The services of a psychologist, counsellor/social Worker, master of social work or psychotherapist are covered to a maximum of $1000 based on reasonable and customary charges per benefit year.

Practitioners must be registered and licensed in their field of practice.

Holistic Nutritional Consultant Included in the overall combined maximum of $1,000 per benefit year for Psychologist, Social Worker/Counsellor, Master of Social Work or Psychotherapist.

Ambulance 100%

To a maximum of $100 per occurrence. This coverage is applied after the provincial deduction.

The plan covers a licensed ground ambulance or emergency air service that transports the patient (student) 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.

Private Duty Nursing in the Home 100%

To a maximum of $25,000 per benefit year. Reimbursement for the services of a Registered Nurse (R.N.) or Registered Practical Nurse/Licensed Practical Nurse (R.P.N./L.P.N.) in the home on a visit or shift basis.

No amount will be paid for services which are custodial and/or services which do not require the skill level of a Registered Nurse (R.N.) or Registered Practical Nurse/Licensed Practical Nurse (R.P.N./L.P.N.)

A Pre-Authorization Form for Private Duty Nursing must be completed by the attending physician.

Medical Equipment & Supplies 100%

The plan covers reasonable and customary charges for eligible equipment when prescribed by a physician, podiatrist, chiropodist, or chiropractor.

Prescription and pre-authorization may be required.

Custom-Made Shoes - Orthopaedics 80%

Your plan covers 80% of 1 pair, once every 3 benefit years, up to a maximum of $750 for custom made orthopaedic shoes.

Your plan also covers 80% of 1 pair, once every 3 benefit years, up to a maximum of $300 for custom made foot orthotics.

Footwear, when prescribed by your attending physician, podiatrist or chiropodist and dispensed by your podiatrist, chiropodist, chiropractor, orthotist or pedorthist.

Emergency Travel Assistance - Emergency Out of Province Medical and Accidental Death and Dismemberment Coverage 100%

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.

Policy Number: SRG 9429070

Classes of Eligible Persons:

A Class of Eligible Participants who are individuals:

  • who are covered by a Government Health Insurance Plan (GHIP) of a Canadian province or territory or equivalent;
  • who are under the age of seventy (70);
  • who are members of one (1) of the following classes of Participants:
    • Class I: Domestic Undergraduate Students; and
    • Class II: Foreign Undergraduate Students

Spouse and Dependent Children of a person within a Class of Eligible Participants who are covered by a Government Health Insurance Plan (GHIP) of a Canadian province or territory or equivalent, are eligible if additional family health coverage was purchased for the current benefit period.

Other Insurance -

The student plan also offers the following complementary insurances:

These insurances are only applicable to the Student. Family members added to the plan are not eligible.

Limitations and Exclusions to Health Benefits

An exclusion is a condition or instance that is not covered by the Health Plan. it's important to review and understand exclusions to the plan before using your benefits.

Dental Coverage

Your dental coverage runs for as long as you remain an enrolled and eligible student at Toronto Metropolitan University. For more information about enrollment and eligibility, please visit the Plan Enrollment section.

Plan Leaflet

Get a summary of eligible expenses and maximum reimbursements of your Health and Dental Plan.

Plan Card

Your Plan Card allows you direct billing with pharmacies and dental offices.

Select Savings

Get a student discount and save money on certain eligible services by visiting one of our members.

The following is the coverage for your Dental Plan:

The Dental Plan covers up a maximum of $750 per benefit year. Please submit an estimate/pre-authorization prior to any dental treatment plan exceeding $500.

Dental Benefits Coverage
Basic Diagnostic and Preventive Services 80%
  • Complete oral examinations once every 3 benefit years
  • Emergency and specific oral examinations
  • Full series X-rays and panoramic X-rays once every 3 benefit years
  • Bitewing X-rays once per benefit year
  • Recall examinations once per benefit year
  • Cleaning of teeth (up to 1 unit of polishing plus up to 1 unit of scaling) once per recall period
  • Topical application of fluoride twice per benefit year for covered persons 19 years of age andunder
  • Oral hygiene instruction once per lifetime
  • Denture cleaning once per recall period
  • Pit and fissure sealants on molars only
  • Space maintainers
  • Protective mouth guards once per benefit year
Comprehensive oral surgery 10%
  • Surgical exposure, repositioning, transplantation or enucleation of teeth.
  • Remodeling and recontouring - shaping or restructuring of bone or gum.
  • Excision - removal of cysts and tumors.
  • Incision - drainage and/or exploration of soft or hard tissue.
  • Fractures including the treatment of the dislocation and/or fracture of the lower or upper jaw and repair of soft tissue lacerations.
  • Maxilofacial deformities - frenectomy - surgery on the fold of the tissue connecting the lip to the gum or the tongue to the floor of the mouth.
other basic services 75%
  1. Basic Restorative Services:
    • Amalgam, tooth coloured filling restorations, and temporary sedative fillings.
    • Inlay restorations - these are considered basic restorations and will be paid to the equivalent nonbonded amalgam.
  2. Basic oral surgery:
    • Extractions of teeth and/or residual roots.
  3. General anaesthesia, deep sedation, and intravenous sedation in conjunction with eligible oral surgery only.
  4. Standard denture services:
    • Denture repairs and/or tooth/teeth additions.
    • Standard relining and rebasing of dentures, once every 3 benefit years, only after 6 months have elapsed from the installation of a denture.
    • Denture adjustments and remount and equilibration procedures, only after 3 months have elapsed from the installation of a denture.
    • Soft tissue conditioning linings for the gums to promote healing.
    • Remake of a partial denture using existing framework, once every 5 benefit years.
Comprehensive Basic Services 10%
  1. Endodontic treatment including:
    • Root canal therapy.
    • Pulpotomy (removal of the pulp from the crown portion of the tooth).
    • Pulpectomy (removal of the pulp from the crown and root portion of the tooth).
    • Apexification (assistance of root tip closure).
    • Apical curettage, root resections and retrograde fillings (cleaning and removing diseased tissue of the root tip).
    • Root amputation and hemisection.
    • Bleaching of non-vital tooth/teeth.
    • Emergency procedures including opening or draining of the gum/tooth.
  2. Periodontal treatment of diseased bone and gums including:
    • Occlusal equilibration - selective grinding of tooth surfaces to adjust a bite 4 time units per benefit year.
    • Bruxism appliance once every 2 benefit years.

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.

Periodontal scaling and/or root planing 80%

periodontal scaling and/or root planing 1-time unit per benefit year.

Major Services 10%
  • Standard onlays or crown restorations to restore diseased or accidentally injured natural teeth, once every 5 benefit years.
  • Standard bridges, including pontics, abutment retainers/crowns on natural teeth, once every 5 benefit years.
  • Standard dentures including complete, immediate, transitional, and partial dentures, once every 5 benefit years.
  • Standard repair or recementing of crowns, onlays and bridge work on natural teeth.
Orthodontic Services 10%

Reimbursement for in-person orthodontic treatment to straighten teeth and/or correct the bite. This plan does not provide coverage for any virtual/tele-orthodontics.

Receipts for payment must be received by Green Shield Canada no later than 12 months from the date the service is incurred while treatment is in progress, not at the end of the treatment.

Dental Accident 100%

Reimbursement for the services of a licensed dental practitioner for dental care to natural teeth when necessitated by a direct blow to the mouth and not by an object wittingly or unwittingly placed in the mouth. The accident must occur while the coverage is in force. When natural teeth have been damaged eligible services are limited to one set of artificial teeth. You must notify Green Shield Canada immediately following the accident and the treatment must commence within 180 days of the accident.

Green Shield Canada will not be liable for any services performed after the earlier of

  • 365 days following the accident; or
  • the date you or your dependent cease to be covered under this plan.

No amount will be paid for periodontia or orthodontia treatments or the repair or replacement of artificial teeth.

Charges will be based on the current Provincial Dental Association Fee Guide for General Practitioners in the province where services are rendered. Approval will be based on the current status and/or benefit level of the covered person at the time that we are notified of the accident.

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

Pre-authorization required. An estimate for all dental accident services MUST be submitted to Green Shield Canada. If you go ahead with treatment without a pre-determination being approved, you are doing so at the risk of the expenses being yours.

This coverage is under the Health Plan. You must be enrolled in the Health Plan to claim the dental accident.

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.

Limitations and Exclusions to Dental Benefits

An exclusion is a condition or instance that is not covered by the Health Plan. it's important to review and understand exclusions to the plan before using your benefits.

myBenefits Booklet

This booklet provides a summary of your benefits under your benefit plan. It includes:

  • A Table of Contents, to allow easy and quick access to the information you are looking for
  • A Schedule of Benefits, listing all the deductibles, co-pays and maximums that may impact the amount paid to you
  • A Definitions section, to explain common terms used throughout the booklet
  • Detailed benefit descriptions for each benefit in your group benefits plan
  • Information you need to submit a claim
  • You are encouraged to read this booklet carefully; please keep it in a safe place so that you may refer to it when submitting claims.

    Your Identification Card showing your GSC Identification Number is to be used on all claims and correspondence.

    Your unique GSC Identification Number is your student identification number with the prefix “RSU” and ends with -00. Example: RSU123456789-00. If you have any eligible dependents, they share the same number as you except their number ends with their own unique dependent code.

TMSU Benefits Plan Office

Email: tmsu@mystudentplan.ca
Phone: 416-979-5000 Extension 552358
Address: Student Centre (SCC)
lobby, 55 Gould Street
Toronto, ON. M5B 1E9

General Inquiries Line

Monday to Friday from 8:00am to 7:00pm EST

Phone: 1-877-746-5566 Ext. 7249