Extended health insurance
Summary
The Extended Health Insurance Plan covers certain medical expenses not covered by the Ontario and Quebec health insurance plans. To be eligible for coverage, products and services must be prescribed by a physician and be required to treat an injury or illness.
Examples:
- Prescription drugs
- Paramedical expenses
- Medical supplies and equipment
- Vision care
- Hospital rooms
- Emergency medical expenses in Canada and abroad
The University pays 100% of the premiums.
Eligibility
- A permanent employee
- regardless of age
You can select either individual or family coverage. Family coverage includes your eligible Spouse and/or Dependent child.
Opt-out option
During the re-enrolment period, you may choose to opt out of the Extended Health Insurance Plan if you are covered under another health plan, such as your spouse’s health plan.
If you opt out, you can opt back in at the next re-enrolment period. To opt back in before the next re-enrolment period, you must:
- experience an eligible life event, or
- provide evidence of insurability.
When you opt out, you receive 1,044 benefit dollars each year in your Health Care Spending Account.
Premiums
Eligible medical expenses
The Extended Health Insurance Plan reimburses 100% of the eligible medical expenses with the exception of prescription drugs, reimbursed at 80%. Supplies and services must be medically necessary for treatment of an injury or illness, and performed or prescribed by a doctor. The eligible medical expenses are the following:
Ambulance
Licensed ground or air ambulance service to and from the nearest hospital for immediate treatment.
Prescription drugs
Prescription drugs are the only medical expenses that can be paid with your pay-direct card.
- Drugs that legally require a prescription and are prescribed from a doctor or dentist and dispensed by a pharmacist, doctor or dentist,
- Automatic generic drug substitution unless otherwise prescribed by the treating physician. The maximum amount reimbursed is the price of the lowest cost generic equivalent product that can legally be used to fill the prescription, as listed in the Provincial Drug Benefit Formulary. If the treating physician specifies no substitution, or there is no generic equivalent product for the prescribed drug or medicine, the amount covered is the cost of the prescribed product.
- Life-sustaining drugs that do not legally require a prescription but are required for
continuous treatment of a chronic condition that:
- is permanent,
- leaves residual disability,
- is caused by non-reversible pathological alteration, or
- requires special rehabilitation training of the patient.
- The employee will pay 20% of the cost of eligible prescription drugs, up to the drug out-of-pocket annual family maximum of $3,000. If an employee reaches the maximum, eligible prescription drugs will be reimbursed at 100% for the balance of the calendar year.
In Ontario
- The plan will reimburse 80% of the cost of the prescription and a maximum dispensing fee of $6.11. If the dispensing fee is above the maximum reimbursed, you will be responsible for covering the difference.
In Quebec
- The plan will reimburse 80% of the cost of the prescription after you pay a deductible of $1.39 per prescription filled.
- If your doctor is licensed to practice in Ontario, you could have your prescription filled in Ontario and at one of the Preferred Provider Network pharmacies.
The plan will reimburse the cost of the prescription, based on reasonable and customary charges for the area where the drug was dispensed.
Outside Ontario and Quebec
The plan will only reimburse the cost for prescriptions bought in Canada; the reimbursement is based on the reasonable and customary charges for the area where the drug was dispensed.
Preferred Provider Network of pharmacies
- The University has a special agreement with the Pharmacie Campus Pharmacy (100 Marie Curie) for you and your covered dependents.
- The University has arranged a Preferred Provider Network of pharmacies of local area pharmacies in Ontario.
If you shop at a pharmacy with a dispensing fee under $6.11, you can receive an 80% reimbursement of your eligible prescription costs. If you shop at a pharmacy with a dispensing fee over $6.11, you will be responsible for paying the difference.
When you need a prescription filled, present your Canada Life card to the pharmacist before the prescription is filled. If you are at a participating Preferred Provider Network pharmacy, the pharmacist will automatically charge the Preferred Provider Network dispensing fee and all eligible expenses will be charged electronically to Canada Life.
Support information
Accidental dental treatment
Services required as the result of an accidental injury to sound natural teeth that occurred while the person was covered under this plan, provided the treatment is completed within six months of the accident.
Medical supplies and services
- Oxygen and equipment for its administration
- Blood transfusions, including cost of the blood
- Laboratory, routine surgical supplies, x-rays, and other diagnostic procedures
- Splints, trusses, braces, crutches, casts, artificial limbs or eyes, prosthetic devices, orthopedic back supports
- Orthopedic shoes which are attached to and form part of a brace, to a maximum of $250 for each covered person in any one calendar year; if the shoes do not form part of a brace, eligible expenses will be restricted to two pairs for a lifetime maximum of $250 for each covered person
- Orthotics, limited to one pair every three years to a maximum of $400 per eligible person,
- Hearing aids, to a maximum of $2,000 for each covered person every five years
- Support hose, to a maximum of four pairs per calendar year for each covered person
- Insulin infusion pumps, including repair and replacement at least five years after the most recent purchase
- Colostomy and ileostomy supplies
- Rental or, at Canada Life’s option, purchase of durable items required for therapeutic use, such as wheelchairs, hospital-style beds, or iron lungs
Private or semi-private hospital room
The plan will pay 100% of the charges for hospital accommodations in Canada over and above any amount covered by provincial health care plans.
Nursing home
Room and board in a licensed nursing home, and normal nursing care (excluding custodial care) by a registered nurse or nursing assistant or licensed practical nurse to a maximum of $25 a day for each covered person.
Paramedical expenses
- Chiropractor, naturopath, osteopath and podiatrist to a maximum of
$400 per practitioner for each covered
person per calendar year,
- One x-ray examination by each practitioner per year
- Physiotherapist, speech therapist and massage therapist to a maximum of $400 per practitioner for each covered person per calendar year
- Psychologist, Psychotherapist, Psychoanalyst, Marriage/Family Therapist, Clinical Counselor and Clinical Social Worker: 50% per visit up to a combined maximum of $3,000 for each covered person per calendar year
Private-duty nursing
When referred by a physician, home-delivered services of a registered nurse or a registered nursing assistant (or equivalent designation), to a lifetime maximum of $25,000 for each covered person,
If part of the benefit amount is used, the balance will be topped up annually by $1,000, in order to gradually restore the original maximum. You may have the full maximum reinstated provided evidence of insurability is submitted and approved by Canada Life.
Vision
Vision examination
To a maximum of $110 for each covered person every two years
Vision care (prescription glasses and contact lenses)
To a maximum of $475 for each covered person every two years
Out-of-country medical coverage
When you are traveling or studying outside Canada (when studying, you need to obtain the approval of Canada Life), the plan covers medical supplies or services that would be eligible for reimbursement in Canada up to the amount that Canada Life considers reasonable compared with prices generally charged in the area where expenses are incurred.
In case of emergency hospitalization, the plan will reimburse the cost of hospital accommodation above the amount payable by the provincial health care plan in your province of residence.
All expenses for hospitalization and medical expenses are subject to a CA$5,000,000 lifetime maximum for each covered person. Always get approval before incurring any expense by phoning the Global Medical Assistance emergency travel assistance hotline (listed on your Canada Life card.)
Global Medical Assistance Program
The University also provides emergency travel assistance under the Global Medical Assistance Program for travel outside your normal province of residence. Your Canada Life card is your proof of coverage while you are traveling for business or pleasure. You are issued one Canada Life card for yourself. If you have family coverage, you get additional cards for your Spouse, as well as for your Dependent child who are age 21 or over. This card includes the emergency hotline telephone numbers.
Global Medical Assistance Program enhances the coverage you already have, for periods of travel. This plan provides medical and non-medical services as outlined below:
- Multilingual telephone assistance: You have access to a 24-hour-a-day hotline that you can call toll free or collect, linking you with a qualified network of professionals who can help with medical, legal, or other travel-related emergencies.
- Emergency advance hospital/medical payments: The plan will provide advances for medical expenses exceeding CA$200 and coordinate claims on behalf of the covered person.
- Medical evacuation: If medically required, the plan will arrange for the transfer of the patient to a medical facility better equipped to treat the emergency, either in the country where it occurred or, on recommendation of Canada Life, in Canada or any other country.
- Transportation home following hospitalization: If a covered person is hospitalized and misses prearranged and prepaid transportation, the plan will provide return transportation to Canada. Any valid, open, return ticket held by the covered person will be utilized.
- Return travel expenses for travelling companions: If a covered person is hospitalized, the plan will provide return transportation to Canada for other covered persons who missed prearranged and prepaid transportation as a result of the hospitalization. This will include a qualified escort for unattended covered children under age 16.
- Meals and accommodation: Following pre-authorization by Canada Life, the plan will pay meal and accommodation costs to a combined maximum of CA$2,000 per medical emergency for a covered person who is unable to travel due to medical reasons following discharge from the hospital and/or their covered travelling companion.
- Visit of a family member: If a covered person is traveling alone and is expected to be hospitalized for more than seven days, the plan will pay round-trip economy airfare for an immediate family member to come to the place of hospitalization outside Canada. This benefit is also provided if a family member must identify the deceased before the body is released.
- Repatriation (up to CA$5,000 maximum): If a covered person dies while travelling, the plan pays the cost of returning the remains to their normal province of residence, including the cost of post-mortem treatment, government authorization, and a coffin required for international transportation. Expense related to the burial will not be paid.
- Return of vehicle (up to CA$1,000 maximum): If a covered person is not able to operate a vehicle (owned or rented) because of injury, illness, or death, the plan will pay for the vehicle to be returned home, or to the nearest rental agency.
Exclusions
The Extended Health Insurance Plan does not reimburse expenses for broken appointments, completion of claim forms or supplies and services that are:
- Received before the plan was in effect;
- Required as a result of self-inflicted injuries (while the person was sane or insane), or resulting directly or indirectly from insurrection, war, service in the armed forces of any country, or participation in a riot;
- Eligible for reimbursement under any government plan, or for which a government or government agency prohibits payment of benefits;
- Related to periodic health examinations, examinations required by a third party, or travel for health;
- Provided for cosmetic reasons unless required to correct damage caused by accidental injury sustained while the person was covered by the plan;
- Provided by an immediate family member or a person who lives with the covered person;
- Normally rendered without charge or for which the covered person receives benefits as a result of legal action or settlement;
- Required as a result of injury or illness sustained during commission or attempted commission of a criminal offence (not including impaired driving);
- Vitamins other than injectable and dietary supplements (whether or not prescribed for a medical reason);
- Medicines bearing a General Public (G.P.) number on their label and
- Services, drugs or supplies that are judged experimental in terms of generally accepted medical standards;
- Hospitalization because of a disability for which the person is not under the continuing care of a doctor.
Global Medical Assistance Program emergency travel assistance coverage is not responsible for:
- The availability, quality or results of any medical treatment or the failure of a covered person to obtain medical treatment for any reason.
Services may not be available in all countries due to conditions such as war, political unrest or other circumstances.
Insurance forms
To initiate a claim or modify your policy, log into the Canada Life Secure Site - You will then need the following information:
- Your contract number, which is 177714
- Your certificate number, which is your 9 digit uOttawa employee number, and
- Your password (if you do not have a password, you must first sign up online)
Help lines
- Via the Canada Life website or
- By phoning the Canada Life customer service hotline at 1-833-794-0225
If you encounter any problems or issues, contact Human Resources at hrinfo@uottawa.ca or 613-562-5832