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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 80% to a maximum of $250 per occurrence.
(please click Supplemental Health for details)

Prescription Drugs:
Reimbursed at 80% to a maximum of $3,000 per benefit year.
Based on the National Formulary with a generic rider.
(please click Prescription Drug for details)

Vision: 
Reimbursed at 100% to a maximum of $50 for one eye exam and $150 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 of $20 per visit. Each service has an overall plan maximum of $300 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 80%. A physician's prescription is required. Pre-authorization is suggested.
(please click Supplemental Health for details)

Managed Dental Plan Coverage:
Exams covered at 100% limited to once per benefit year. Overall plan maximum of $750 per benefit year.
Coverage is limited to specified Dental centres. Services performed by Dental centres outside of the Managed Plan will not be eligible for reimbursement.
(please click Dental for details)

Dental Accident:
Reimbursed at 80% to a maximum of $1,000 per accident (services must be performed within 12 months of accident; authorization required).
(please click Supplemental Health for details)

Tuition:
$10,000 lifetime maximum.
(please click Other 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




Ambulance
Your plan covers of 80% to a maximum of $250 per occurrence 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 80% for $20 per visit to a maximum of $300 per practitioner, per benefit year.

• physiotherapist*
• registered massage therapist*
• chiropractor, including 1 x-ray examination per benefit year
• speech language pathologist*
• psychologist or social worker*
• osteopath, including 1 x-ray examination per benefit year
• naturopath
• podiatrist or chiropodist, including one x-ray examination per benefit year

*physician’s prescription/referral required for indicated services

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% 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 (lifetime maximum of $250)
• walkers
• hospital beds
• traction kits

Trusses, Crutches, Splints, and Braces
Your plan covers 80% 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% to a maximum of $150 during a 5 year period for blood glucose monitors.

Hearing Aids
Your plan covers 100% to a maximum of $500 during a 5 year period for hearing aids and repairs, excluding batteries.

Prosthesis
Your plan covers 80% of reasonable and customary charges when prescribed by a physician for artificial limbs or other prosthetic appliances.

Orthopaedics*
Your plan covers 80% up to a maximum of $150 per foot, per benefit year for Custom-Made Orthopaedic shoes when they are 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. Modifications, repairs and adjustments to custom-made orthopaedic shoes are covered without a prescription.

*IMPORTANT It is strongly recommended that a pre-determination/estimate be submitted to Great-West Life to ensure that the guidelines set out by Great-West 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% 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 be performed within 12 months of the accident. If a dental accident occurs, the health plan’s dental accident provision will pay benefits before the dental plan.

Treatment must be completed within 12 months of the impact. If treatment is scheduled to occur more than 90 days after the impact, a treatment plan must be submitted to the insurer before the end of the 90 day period.

Prescription Drug

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

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 SU Health and 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 eye examinations by an ophthalmologist or optometrist limited to one examination, in a 24 month period, to a maximum of $50, 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 $150, once during a 24 month period, based on reasonable and customary charges.

Dental

The dental benefits provided under the Managed Dental Plan are provided through a specific network of dental centres. Click here to see a listing of centres. Managed Dental Providers are experienced practitioners who provide quality dental care to students at a preferred rate. Please contact the SU Health and Dental Plan Office or use the "Find a Practitioner" option to access your Managed Dental Provider details. The managed dental program is provided to ensure students can maintain their basic dental health, without having to incur the increasing dental fees associated with dental care.
Claims are submitted automatically through the Managed Dental Centre.

Services performed by Dental Providers outside the Managed network will not be eligible for reimbursement.

Services are covered at rates outlined in the 1997 Alberta Dental Association Fee Guide for General Practitioners, plus inflationary adjustments as determined by the Dental Provider. Should your dentist charge fees in excess of the fee guide, the additional costs are not covered.

Dental Providers
The dental plan requires that you use specified dental centres. All required treatment is carried out or arranged by a Managed Dental Centre. Payment for covered portions of eligible services will be handled by the Dental Provider. If you are coordinating benefits between your student dental plan and another dental plan, you must still use one of the Managed Dental Centres.

Pre-determination/Pre-authorization for dental treatment exceeding $500, the student and Managed Dental Centre will need to discuss treatment plan and/or payment arrangements.

* Please note: the dentist or dental centre listing may be subject to change.

If you need to cancel your dental appointment, 48 business hours notice is expected. If you do not give 48 hours notice, the dental office may charge a fee which is not covered under the plan.

Emergency Dental
If an emergency exam is required by a covered person, who at the time of incident and exam is more than eighty (80) kilometers away from Calgary, payment will be limited to that of an emergency exam and single periapical x-ray. The maximum amount payable will be $75 per covered person.

Partially Covered Services
Partial coverage for restorative, surgery and other dental services (beyond diagnostic & preventative) are eligible under this plan when required for restoring dental health or when medically necessary.

If you have supplemental or existing dental coverage through a third party benefits provider, you may co-ordinate you coverage to increase you total coverage to 100% of actual expense. Your Dental Provider may submit the uncovered portion of your expense directly to your supplemental insurer or third party benefits provider. You are responsible for any portion of the Partially Covered Services that is not actually paid under this Managed Dental Plan or by another benefits provider.

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


Diagnostic & Preventative (Fully Covered)
Your plan covers 100% of the expense for diagnostic and preventative procedures including:
• examination, 1 per benefit year
• complete series of x-rays, 1 in any period of 36 months
• bitewings, not more than 4 films per benefit year
• polishing, 1 unit per benefit year
• scaling, 2 units per benefit year
• fluoride, under 15 years of age, 1 treatment per benefit year
Minor Restorative (Partially Covered)
Your plan covers 80% of the Fee Guide Rate for services associated with dental health restoration, including:
• space maintainers and maintenance, under 15 years of age
• amalgam and tooth coloured fillings, 1 per tooth in any period of 24 months
• stainless steel and plastic full coverage restorations, under 15 years of age, 1 per tooth in any period of 24 months
• pit and fissure sealants, under 16 years of age, 1 replacement per tooth, per lifetime, on permanent molars
Other Restorative (Partially Covered)
Your plan covers 50% of the Fee Guide Rate for services associated with other dental health restoration, including:
• denture adjustments and repairs
• denture relining, rebasing and tissue conditioning, 1 treatment in any period of 36 months
• recementation of fixed prosthesis
Oral Surgery (Partially Covered)
Your plan covers 50% of the Fee Guide Rate for services associated with, medically necessary surgical extractions, including:
• wisdom teeth, limited to 2 teeth per patient, per benefit year
• periapical x-rays
• anaesthesia, eligible when done in conjunction with Oral Surgery
• panoramic, 1 in any period of 36 months
Endodontic (Partially Covered)
Your plan covers 50% for endodontic services including:
• root canal therapy

Periodontic (Partially Covered)
Your plan covers 50% of the Fee Guide Rate for periodontic services including:
• additional scaling and/or root planing, maximum 2 units per benefit year

Major Restorative (Partially Covered)
Your plan covers 15% of the Fee Guide Rate for major restorative services including:
• crowns
• bridges
• dentures

Replacement of an existing crown, bridge or dentures is an eligible expense if the replacement is required to replace an existing crown, bridge or denture which was installed less than 5 years before the replacement.

Other Insurances

Tuition*
Your plan provides coverage for Tuition Insurance and covers a student who has left school and medically cannot continue studies, as a result of death or severe and prolonged disability. The student must be enrolled in the Health Plan and must be under the continuous care of an appropriate specialist for a period of at least 60 days prior to applying for this benefit. The student will receive a benefit up to a lifetime maximum of $10,000 in accordance with any tuition, and ancillary fees paid by said student to cover:
1) Tuition for courses the student was unable to complete
2) Mandatory, non-negotiable/non-refundable fees, which will be amortized to the point of disability
3) Book allowance of up to $1,000 (receipts required)

Tutorial*

Your plan covers 80% up to $15 per hour to a maximum of $2,000 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 Tuition and Tutorial benefits.

Health and Wellness

Health & Wellness offers credible information on diseases, conditions, drugs and treatment options.

Watch a short video about Health & Wellness.

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 for services and products, rendered or prescribed by a person who is ordinarily a resident in the patient's home or who is related to the patient by blood or marriage;
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) out-of-province expenses for medical treatment or surgery;
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);
11) expenses for smoking cessation aids;
12) expenses for drugs if they are used for the treatment of infertility;
13) expenses for the services of a registered nursing assistant (R.N.A.), licensed practical nurse (L.P.N.) or homemaker;
14) expenses for items purchased solely for athletic use;
15) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
16) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
17) 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;
18) immunizations and vaccines (Hepatitis B and Twinrix will be covered, except for Recombivax HB preservative free - DIN 02245976 & DIN 02245977); or
19) any other exclusion identified in the policy contract.

Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) when a covered person receives dental treatment from a dentist not on the Dental Plan Network;
2) any cause for which the insured may apply for and receive protection, exemption or compensation under any Workers' Compensation Act;
3) self-inflicted injuries while sane or insane;
4) war, insurrection or hostilities of any kind, whether or not the insured was a participant in such actions;
5) participation in any riot or civil commotion;
6) committing or attempting to commit a criminal offence or provoking an assault;
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) expenses for crowns placed on a tooth not functionally impaired by incisal angle or cuspal damage;
12) expenses for orthodontic treatment (ie. dental braces);
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) where coverage for services is provided under any government plan;
16) where services would be provided without charge in the absence of this plan; or
17) any other exclusions identified in the policy contract.

Service Members


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