HEALTH & DENTAL PLAN
The Students’ General Association Benefit Plan covers all full-time SGA/AGÉ students attending Laurentian University. As of 2023-2024 online and part-time students can now choose to opt-into the plan. These benefits were specifically designed with students in mind. Campus Trust has worked with the SGA/AGÉ in order to create a plan that exceeds your needs. Get to know the benefits so you can use them to the maximum!
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For the 2023-2024 academic year the health plan fee is $299.99 for full-time students and $400.00 for online and part-time students who chose to opt-in.
*Please note that the opt-out and opt-in period for the 2023-2024 academic year has now ended.*
Health Benefits Overview
Prescription Drugs
80%, up to $1,000 per student year, Max dispensing fee of $6.99 per visit
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Coverage is limited to the cost of the lowest priced equivalent item in the applicable generic category that can be legally used to fill your prescription. Our plan covers up to a 34-day supply of therapeutic (acute) drugs, and up to a 100-day supply for maintenance drugs unless prior approval is obtained from The Campus Trust.
Tutorial Benefits
$15 per hour, up to $1, 000 per disability
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If you become disabled while covered and are confined at home or in a hospital for a minimum of 15 consecutive school days, you are eligible for the private tutorial services by a qualified teacher, up to the benefit maximum. The teacher must be approved, in advance.
Eye Exam
100% up to $100 every 24 months.
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One eye examination, by an Ophthalmologist or Optometrist, registered and legally practicing within the scope of their license is covered. No amount will be paid for contact lens fitting fee or retinal photos.
Eye Wear
100% up to $200 every 24 months
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Lenses and frames or contact lenses, when prescribed by an Ophthalmologist or Optometrist, are covered. Laser eye surgery; in lieu of lenses and frames, will also be covered, up to the benefit maximum. No amount will be paid for non-prescription glasses, such as safety or sunglasses.
Accidental Dental
100% up to $1,000 per injury
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Charges for dental services by a licensed dentist for the repair of sound natural teeth (healthy, non-diseased and not heavily restored) are covered when required for a non-occupational accidental injury, external to the mouth, which occurs while the person is covered. No amount will be payable for injury caused by an object placed in or on the mouth, self-inflicted or to existing dentures, crowns, or bridgework.
Ambulance
100%
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Charges for licensed ambulance service are covered in excess of the amount payable under the covered person’s Provincial Health Care Plan. The coverage includes the transport of the covered person from the place of debilitation to the nearest hospital where treatment is available, or from the first hospital to another for specialized treatment not available at the first hospital, or to a convalescent/rehabilitation hospital.
Health Practitioners
$50 per visit up to $500 per student year, combined.
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Services provided by the following health practitioners are covered, provided they are licensed by the appropriate organization to practice their profession: Acupuncturist, Athletic Therapist, Chiropractor, Dietitian, Massage Therapist, Naturopath, Occupational Therapist, Osteopath, Physiotherapist, Podiatrist/Chiropodist, Speech Therapist. Referral is required for some health practitioners.
Orthodontics
50%, up to $200 per student year (Referral Required)
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Charges for custom-made orthopaedic shoes (including repairs), arch supports, moulds and orthotics, which have been specially designed and moulded for the covered person, are covered when required to correct a diagnosed physical impairment and when recommended by a licensed medical doctor or Podiatrist/Chiropodist.
Counselling
100% up to $800 per student year
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Provided that the counselling services are provided by a: Licensed Psychologist, Registered Social Worker/Master of SocialWork,
Licensed Professional Counsellor,
Licensed Counselling Therapist, or
Psychotherapist.
Medical Equipment
100% up to $3,000 per student year
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Charges are covered for the rental or purchase of some medical equipment, based on the nature and severity of the covered person’s medical needs, when recommended by a licensed medical doctor (M.D.)
Wellness Benefit
$100 per student year
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The Wellness Benefit is a flexible benefit that can be used towards approved health or dental-related expenses that are outside your plan's coverage, or when you have reached your maximum of a covered benefit.
Dental Benefits Overview
*Percentages are only covered until the total claims reach $1,000 per student year in total dental claims.*
Diagnostic & Preventative
90%
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Regular and emergency examinations, x-rays, and cavity prevention such as teeth cleanings and polishing
Restorative
75%
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Fillings
Endodontics & Periodontics
75%
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Procedures including root canals, root planing, tissue grafts, and management of oral disease.
Oral Surgery
75%
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Minor and major including: extractions, residual root removal, fractures, and surgical excision/Incision
Anesthesia
75%
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Includes general anesthesia, deep sedation, inhalation technique, intravenous sedation
NO AMOUNT WILL BE REIMBURSED FOR THE FOLLOWING EXPENSES:
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Fluoride, oral hygiene instruction
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Crowns, bridges, dentures, bite plates, major restorative, orthodontic services
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Any anesthesia administered in a hospital
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Dental charges that could be claimed under Workers’ Compensation
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Dental charges not included in the current provincial fee guide for General Practitioners
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Cosmetic procedures, experimental treatment or testing
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Charges for appointments that are not kept
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Charges for the completion of claim forms
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Treatment to correct temporomandibular joint dysfunction of the jaw
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Endodontic treatment that started before the effective date of coverage
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Dental appliances;
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Any orthognathic surgery (remodeling or reconstruction of your jaw)
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Procedures or supplies used in vertical dimension corrections (changing the height of the teeth) or to correct attrition problems (worn down teeth)
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Implanting fabricated teeth or any major surgery resulting from implanting fabricated teeth
Adding Dependents
You can add dependents to your plan during the specified time at the beginning of each school year. If you wish to add dependents to your plan there is a fee associated with each dependent you add.
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Please note that adding dependents can only be done during during the change of coverage period.
1st Dependent Added
Additional $225.00
2nd Dependent Added
Additional $150.00
Any Further Dependents
Additional $75.00 per dependent
Example as to how your total fee would be calculated if you are a full time student who wishes to add 2 dependents:
$299.99 (full time student fee) + $225.00 (1st dependent) + $150.00 (2nd dependent) = $674.99
How To Claim
Where do I get my benefits cards?
Head to www.studentbenefits.ca. Once you have completed your registration and logged in, your personalized benefits cards can be printed from the 'Download Centre'. Two cards will be available Health and Drug. The appropriate card should be presented to your health provider (dental office, pharmacist, etc.) in order to access the Pay-direct system whenever it is available. This way your claim is processed immediately without the need for you to make a claim online. Remember that all benefits have limits and some pharmacists and dental offices do not submit claims electronically.
What if I have more than one plan?
If you are making a claim for yourself this plan is the first payer and the coverage available through your other plan is the second payer. In the case you are making a claim for a spouse this plan is the second payer if they have their own plan. For dependent children, claims are submitted first to the benefit plan for the parent whose birthday (month and day) occurs earlier in the calendar year, regardless of age. Following the reimbursement from the first payer, copies of the receipts and the Explanation of Benefits must be submitted to the secondary plan so that the remaining balance can be considered for payment.
Can I assign my benefits to a provider?
Your plan allows you to assign your benefits to a provider. When you assign your benefits, the Explanation of Benefits (EOB) is mailed to the provider only. When a provider is submitting a claim on your behalf, the claim must include an Assignment of Benefits form, found on studentbenefits.ca under the Download Centre, an invoice, and a Doctor’s referral (if applicable). You must review and sign the Assignment of Benefits form to ensure accuracy before the claim is submitted, on your behalf, by your service provider.
How do I make a claim online?
Online Claim Submission is an easy and practical way to submit for reimbursement. You must log in to Member Registration in order to access the Online Claim Submission form. For more details, visit www.studentbenefits.ca.
How long do I have to make a claim?
Claims must be submitted within 6 months of the date of loss. If the Plan terminates, claims must be submitted within 3 months from the termination date. Legal action to recover benefits must begin within 2 years of the date of loss.
What if my practitioner does not accept my benefits card?
If your health care practitioner does not accept your benefits card (does not offer a pay-direct service) you are required to pay upfront and submit your receipt for reimbursement at studentbenefits.ca.