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BALANCED HEALTH & DENTAL PLAN Your Plan. Your Choice.

Starting in September 2016, You will be given the option of choosing the plan that is right for you.  There are 4 options:


Balanced Plan: This plan is you are automatically enrolled in. This plan offers a balanced coverage between your Health & Dental Plans.


Enhanced Drug Plan: This plan offers you enhanced Drug Coverage increasing the overall drug maximum and the coverage amount and decreases coverage for all other Health & Dental expenses.  


Enhanced Health Plan: This plan offers you enhanced Health coverage increasing coverage for items like practitioners and vision, but decreases coverage for Drug & Dental expenses.


Enhanced Dental Plan: This plan offers you increased coverage for Dental expenses, but decreases the coverage for Drugs & Health coverage.


All plans include the same Travel & Accident Coverage. Full Coverage Details can be found in the Benefit Brochure

See Coverage Information for the Balanced Plan in the tabs below:



  • Drug Coverage
  • Extended Health Coverage
  • Vision Coverage
  • Dental Coverage
  • Travel Coverage
  • Accident Coverage

Coverage valid IN CANADA only

Overall Drug, Extended Health & Vision Maximum: $10,000/benefit year

Drug Coverage - 80% - 100% Coverage

100% Coverage

80% Coverage

Generic Drugs

Brand Drugs

$7 Dispensing Fee

All Other Pharmacies

80% Coverage

80% Coverage

Generic Drugs

Brand Drugs

$7 Dispensing Fee


Mandatory Product Selection

(Mandatory Product Selection does not apply to Direct2U Prescriptions

  • Drugs which legally require a prescription and are identified as eligible under the plan are covered.
  • The Plan will cover the cost up to the cost of the lowest priced generic equivalent
  • When a doctor writes "no substitutions" on the prescription, students will have the option of having the brand name drug dispensed and pay the difference between the brand and generic price
  • Brand name drugs whose patents have not expired will continue to be covered.

Drug Plan Also Includes:

  • Standard Preventative Vaccines
  • Contraceptives (Oral, IUD, Injectable)
  • Diabetic Supplies (Test strips & needles) (Glucometers covered under "Extended Health" coverage)
  • Erectile Dysfunction Drugs (50% coverage, $600/benefit year)*
  • Fertility Drugs/Treatment (50%, $1,500/lifetime)*
  • Smoking Cessation Aids/Remedies with prescription ($300/lifetime)*
  • Biologic Agents ($1,000/benefit year)**
  • Hepatitis C Medications ($1,500/lifetime)
  • Gardasil Vaccine (men to age 26, women to age 45)
  • CNS Stimulants ($500/benefit year)***  If you require assistance with coverage for CNS Stimulants and/or you have received and error message at the pharmacy, please contact the LUSU Heatlh Plan Office in Thunder Bay or Orillia

Drug Plan Does Not Include:

  • Anti-Obesity Drugs/Products

*These drugs are dispensed on a cost-reimbursement basis

**Biologic Agents may include drugs used to treat severe arthritis, MS, Crohn's Disease, etc., such as Humira.

***CNS Stimulants are medications used to increase physical activity, mental alertness & attention span.  They are used in treatment of ADD, and/or ADHD disorders (i.e. Adderall, Concerta, Vyvanse, Ritalin and their generic forms.)

Coverage valid IN CANADA only

Overall Drug, Extended Health & Vision Maximum: $10,000/benefit year

Practitioner Coverage - 90% Coverage

Maximum $20 per visit, $300 per benefit year per practitioner, unless otherwise indicated:

  • Chiropractor
  • Podiatrist
  • Speech Therapist
  • Acupunturist
  • Naturopath
  • Osteopath
  • Chiropodist
  • Psychologist/Social Worker (MSW) (combined)
  • Physiotherapist*
  • Registered Massage Therapist ($25 per visit maximum)*

*Physician's Prescription required for first claim

 

Other Health Coverage - 90% Coverage

  • Orthopedic Shoes & Orthotic Appliances ($300/benefit year combined)*
  • Medical Equipment, Services & Supplies ($500/benefit year)**
  • Ambulance to nearest treating hospital
  • Psycho-Educational Assessment ($1,000/lifetime)

*Prescribed by medical doctor, orthopedic surgion or podiatrist

**Physician's prescription required, reasonable & customary charges apply)

Coverage valid IN CANADA only

Overall Drug, Extended Health & Vision Maximum: $10,000/benefit year

Vision Coverage - 90% Coverage


Eye Exams, Frames, Lenses & Contact Lenses  $200/benefit year


Lasik & Laser Eye Surgery is not covered.


Vision Pros

Coverage valid IN CANADA only

Overall Dental Maximum: $750/benefit year

Dental Coverage - 25%-80% Coverage

Pre-Authorization: It is strongly recommended to obtain a pre-authorization for extensive dental procedures to prevent unexpected costs. Have your dentist send a quote/predetermination along with your name and Student ID to RWAM at fax: 519-669-1923.

 

If your claim is the result of a Dental Accident please go to the Accident Coverage section for more information.


Examinations (80%)

Complete oral examination (once every 5 years) / Limited/recall examination (once every 9 months)

 

Radiographs (80%)

Complete series Periapical or Panoramic (once every 5 years)  / Bitewing (once every 12 months)

 

Preventative Services (80%)

Dental polishing (1-15 minute unit every 12 months) / Scaling (2-15 minute units every 12 months)

 

Minor Restorative (80%)

Fillings

 

Major Restorative (80%)

Crowns, Bridgework & Dentures Subject to Limitations & Exclusions

 

Extractions (50%)

Includes Wisdom Tooth extractions

 

Anesthesia (25%)

When in conjunction with surgical services

 

Other Dental Coverage (50%)

Endodontic / Periodontic 


Limitations and Exclusions may apply.
Please see the
BROCHURE for full details.

365 days per trip up to $5,000,000 maximum

Full Details can be found in the Travel Brochure

Keep In Mind

  • Travel coverage cannot be extended past August 31 each policy year. If your travel duration exceeds August 31, please contact your health plan office or Student VIP for more information.
  • 365 Days of coverage may not be valid for International students. Please contact the health plan office or Student VIP for confirmation before you leave the province.
  • Travel coverage offered through the plan is only valid if your provincial health care is in force for the entire duration of your travel. Please contact your provincial Ministry of Health office or download the appropriate travel flyer HERE for more information.

Absences & Visa Requests

  • Students participating in a school sanctioned study or work term outside of their province of residence 1 full academic term or longer OR students who are travelling for longer than 120 days, must record their absence by completing the Travel Absence Form.
  • Students requiring proof of coverage for their Visa application may complete the Visa Request Form, your request will be reviewed and the letter e-mailed to you in 3-5 business days.

Using your Coverage:

  • In the event of a medical emergency, please contact the appropriate number below to ensure that your expenses are eligible:
    • In Canada (not your home province) & the USA: 1-866-520-8829
    • Anywhere else in the world Call Collect: 519-742-4196
  • If you have a claim that you must submit, please submit the Travel Claim Form to Allianz using the instructions on the form.

Coverage Includes, but is not limited to:

  • Emergency Medical Assistance
  • Repatriation of mortal remains (maximum $7,500)
  • Airfare in the event of:
    • Missed return flight due to illness of you or travelling companion
    • Medically required attendant to accompany insured home
    • Cost of airfare for spouse or close relative if confined outside
    • province for at least 7 days plus $150/day for meals & accommodation for up to 5 days
    • Cost of airfare to return unsupervised children under the age of 15 home when only available supervising guardian is hospitalized
  • Cost of return of patients vehicle when patient or family is unable to do so (maximum $1,000)
  • Costs incurred by family (when patient is detained in hospital) for meals and accommodation (maximum $150/days up to 10 days)
  • Trip Cancellation ($1,000 Maximum) 
  • Lost Luggage Coverage ($250 Maximum)
  • International Students will have coverage in their home country for emergency services if provincial or equivalent coverage is extended as well.

Travel Advisories
Students planning to travel to counties with travel advisories issued to them should check to ensure coverage will be enforced while abroad, even if not planning to travel to an affected area.  To see a listing of travel advisories, please visit the Government of Canada Travel Website.


Provincial Coverage & Travel

Those with a valid provincial health plan card may still have partial coverage for some emergency services while travelling abroad. For more information please visit the Ministry of Health website for the province your coverage is with.


Exclusions
Expenses incurred for injuries and/or illness as a result of the insured’s reckless behavior while on a trip, including international non-compliance with a prescribed treatment or therapy, or intentional misuse of medication or reckless disregard for their own health or safety while engaging in activities or treatment thereof, or accidents relating thereto.  Additional Exclusions and Limitations can be found HERE.

 

Coverage valid IN CANADA only.

What is an Accident?

An Accident means an occurrence due to external, violent, sudden, fortuitous causes beyond the insured’s control, which must occur while the student is insured under this policy. 


What is Covered?

Accidental Death & Dismemberment      Maximum $8,000 

Payment of a stipulated sum for loss of life or limb through accidental means, provided such loss occurs within 365 days after the date of accident causing such loss

 

Accidental Dental      Maximum $1,000 

Injury to whole and sound teeth, and within 30 days from the day of the accident obtains treatment in Canada from a qualified dentist. Reimbursement will only be provided on expenses which are: incurred in Canada, incurred within 52 weeks of the date of the accident causing injury, incurred only for therapeutic and not elective or aesthetic treatment, and supported by an original standard dental claim form.

 

Accidental Medical      Maximum $10,000 

If within 30 days from the accident causing injury, the insured obtains medical treatment in Canada may be reimbursed for the following reasonable and necessary expenses to the specified maximum per Insured for all injuries resulting from any one accident: 

  • Duty Nurse ($50/hour, $5,000 maximum)

  • Ambulance ($5,000)

  • Semi-Private Hospital Room ($5,000)

  • Wheelchair Rental (Reasonable & Customary)

  • Fee for services of a licensed physiotherapist ($500), chiropractor ($300)

  • Hearing aids, crutches, splints, casts, trusses and braces, excluding replacement (Reasonable & Customary)

Expenses must be incurred in Canada, within 52 weeks of the date of the accident causing injury, incurred for only therapeutic and not elective treatment, and supported by original receipts.

 

Tutorial Expense      Maximum $20/hour up to $2,000

If insured suffers injury resulting in hospital or medically necessary bed rest and is confined for at least 15 consecutive school days, as determined by a Physician, the insurer will pay for the private tutorial services of a qualified teacher.

 

Repatriation      Maximum $10,000 

If injury causing loss of life occurs more than 50 kilometers from insured’s permanent city of residence and within 365 days of the date of the accident causing injury, the insurer shall pay the actual expenses incurred for preparing the deceased insured for burial or cremation and shipment of the body to the city of residence of the deceased insured.

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