Health & Dental Plan
The Students’ General Association Benefit Plan covers all full-time SGA/AGÉ students attending Laurentian University. These benefits were specifically designed for students. The Campus Trust has worked with the SGA/AGÉ of Laurentian University in order to create a plan that meets and exceeds your needs. The SGA Benefit Plan provides coverage for many important services. Get to know your benefits so you are able to get the most from your SGA Benefit Plan.
If you choose to opt-out of the Health Plan, you have from August 1 – September 18th, every year, to do so.
How To Claim
How long do I have to 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.
Where do I get my benefits card?
Your personalized Benefits Card can be printed from www.studentbenefits.ca under the Download Centre, once you have completed the online registration. The card should be presented to your pharmacist (along with your prescription) and/or dental office, in order to access the Pay-direct system. Your claim is processed immediately without the need for you to mail in a claim form.
You and your eligible dependents can purchase prescription drugs and dental services using Pay-direct.
Remember that all benefits have limits and some pharmacists and dental offices do not submit claims electronically.
How do I submit a claim without a benefits card?
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.
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.
What if I have more than one plan?
In the case of a claim for you, the student, this plan is the first payer and the dependent coverage available through your other plan is the second payer. In the case of your spouse’s claim, our 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 other plan so that the balance can be considered for payment.
What if my practitioner does not accept my benefits card?
If your health care practitioner does not accept your benefits card you are required to pay upfront and submit your receipt for reimbursement at studentbenefits.ca.
Health Benefits
Prescription Drugs
80%, up to $1,000 per student year, Max dispensing fee of $6.99 per visit
—
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.
Eye Exam
100% up to $100 every 24 months.
—
One eye examination, by an ophthalmologist or optometrist, registered and legally practicing within the scope of his or her license is covered. No amount will be paid for contact lens fitting fee.
Health Practitioners
$500 per student year, combined, Max of 50$ per visit.
—
Acupuncturist, Chiropractor, Counselling by a Psychologist or Registered Social Worker, Dietitian/Nutritionist, Massage Therapist, Naturopath Consultations, Osteopath, Occupational Therapist, Physiotherapist, Podiatrist/Chiropodist, Speech Therapist
Tutorial Benefits
$15 per hour, up to $1, 000 per disability
—
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, by the Students’ Council.
Accidental Dental
$1,000 per injury
—
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.
Foot Care
50%, up to $200 per student year (Referral Required)
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 doctor (M.D.).
Eye Wear
$150 every 24 months
—
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, anti-reflective coatings or for tints.
Ambulance
100%
—
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.
Counselling
100% up to $500 per student year
—
Medical Equipment
$3,000 per student year
—
Dental Care Benefits
*Percentages are only covered until the total claims reach $1,000 per student year in total dental claims.*
Diagnostic & Preventative
75%
—
Oral Surgery
75%
—
Procedures include local anesthesia, appropriate x-rays, surgery and follow-up care.
—
Minor: Extractions, Erupted Teeth, Residual Root Removal
Major: Extractions, Surgical, Alveoloplasty, Gingivoplasty, Stomatoplasty, Vestibuloplasty Surgical Excision/Incision, Fractures, Frenectomy, Post Surgical Care
Restorative
75%
—
Procedures include local anesthesia, removal of decay, pulp protection and bite adjustment.
—
Fillings: Sedative, Silver and White Fillings Retentive Pins
Anesthesia
75%
—
Includes General Anesthesia, Deep Sedation, Inhalation Technique, Intravenous Sedation
Endodontics & Periodontics
75%
—
Procedures include root canals, root planing and management of oral disease.
—
Endodontic: Pulpotomy, Root Canal
(1 time per tooth)
Periodontic: Oral Disease, Desensitization, Gingival Curettage, Gingivectomy, Flap Surgery, Tissue Graft, Root Planing
NO AMOUNT WILL BE REIMBURSED FOR THE FOLLOWING EXPENSES:
-
crowns
-
bridges
-
dentures
-
bite plates
-
major restorative
-
orthodontic services
-
any anesthesia administered in a hospital
-
dental charges that could be claimed under Workers’ Compensation
-
dental charges not included in the current provincial Fee Guide
-
cosmetic procedures, experimental treatment or testing
-
charges for appointments that are not kept
-
charges for the completion of claim forms
-
treatment to correct temporomandibular joint dysfunction (Jaw)
-
endodontic treatment that started before the effective date of coverage dental appliances
-
any orthognathic surgery (remodeling or reconstruction of your jaw)
-
procedures or supplies used in vertical dimension corrections (changing the height of the teeth) or to correct attrition problems (worn down teeth)
-
implanting fabricated teeth or any major surgery resulting from implanting fabricated teeth.