Kwantlen

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 90% to a maximum of $3,000 per benefit year. Based on the BC Provincial Formulary with a generic rider. (please click Prescription Drugs for details.) Vision: Reimbursed at 100%, $60 for one eye exam, $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 $25 per visit to an overall plan maximum of $500 based on reasonable and customary charges, per benefit year. Services may include a per visit and an overall plan benefit year maximum. Practitioners must be registered and licensed in their field of practice. (please click Supplemental Health for details.) Mental Health Practitioners: The services of mental health practitioners are reimbursed at 80%, to an overall plan maximum of $500 based on reasonable and customary charges, 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.) 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.) Dental Coverage: Exams covered at 90% once per benefit year. Overall plan maximum of $750 per benefit year. (please click Dental for details.) Accidental Death & Dismemberment: $5,000 loss of life benefit. (please click Other Insurances for details.) Critical Illness: $5,000 maximum (limited to students under age 65). (please click Other Insurances for details.) Travel Insurance: $5 million of coverage for emergencies and illnesses while traveling. (please click Travel Insurance 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.

Questions about BC Fair PharmaCare Registration? See below for instructions on how to complete your registration. Should you have any issues or require assistance with your registration please contact the KSA Benefit Plan Office. Your Student Service Coordinator is an expert in assisting with Pharmacare registration. BC Fair PharmaCare The Fair PharmaCare program in British Columbia is intended to provide greater financial assistance to British Columbians for eligible prescription drugs and designated medical supplies. You must be a resident of the Province of British Columbia with an MSP number. The new approach focuses PharmaCare financial assistance to British Columbians who need it most - the lower your income, the more assistance the government will provide for your prescription drugs. By coordinating the benefits from BC Fair PharmaCare and the Student Health Plan, many enrolled students will enjoy lower out-of-pocket charges for their eligible prescription drugs. Students with net income less than $15,000 in the previous taxation year, who have registered for BC Medical Services Plan (MSP) on their own, not under their family, will enjoy the greatest benefit. PharmaCare will pay 70% of eligible prescription drug charges from the first dollar charged to the student and the Student Benefits Plan will pay up to 80% of the remainder! FOLLOW THESE EASY STEPS TO REGISTER: Have ready your: • BC Care Card number • net income from 2 years ago • social insurance number • birthdate You will receive your registration number immediately. Register online HERE If you experience difficulty registering, or it states that you are already registered, or if you prefer to register over the phone please call: 604-683-7151 or 1-800-663-7100 for assistance. Please note: if you are not a permanent resident of BC you must still fill out the registration form providing your home province or country in place of the Fair Pharmacare registration number.

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 $60, 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.

Payment of dental benefits is based on the General Practitioners Dental Association suggested fee guide or the Insurance Reimbursement Rate set by the Canadian Life and Health Insurance Association Inc. (CLHIA) when a fee guide is not available. For services provided by a dental specialist, payment is based upon the General Practitioners Dental Association suggested fee guide. Alternate Benefit - When there are two or more courses of treatment available to adequately correct a dental condition, reimbursement may be based on the cost of the least expensive treatment, which provides adequate care to the Insured. IMPORTANT! Please submit a pre-determination/pre-authorization to the insurance carrier prior to treatment of specialist services and any treatment plan exceeding $500. Your plan covers up to a maximum of $750 per benefit year. Exams covered at 90% once per benefit year.

Your drug plan covers 90% of the cost of most medications legally requiring a prescription to a maximum of $3,000 per benefit year. Your drug plan includes $150 for vaccines every benefit year (included in overall prescription drug maximum of $3,000). Oral contraceptives, Evra Patch, NuvaRing & Mirena are covered under the drug plan. Intrauterine Devices (I.U.D) are covered under the Medical Equipment benefit (Supplemental Health button). Your drug plan also includes additional coverage for Smoking Cessation Products legally requiring a prescription, up to a lifetime maximum of $500. 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 BC Provincial Formulary. The BC Provincial 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 are not effective in treating your 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 the Student Benefit Plan Office and must be completed by your physician. Completed forms may be returned to the Student Benefit Plan Office or can be faxed directly to the insurance company.

Accidental Death & Dismemberment* Your plan provides coverage for the loss of life or limb and for paralysis caused by an accident. The amount of your life benefit is $5,000. Please contact health and dental plan office for a complete schedule of losses. Critical Illness* Your plan provides coverage for a Critical Illness benefit of up to $5,000 which is paid upon diagnosis of a covered illness or injury and survival after 30 days, 365 days for paralysis and a 90 day waiting period for Cancer applies. This benefit is limited to students who are under age 65. For further details on this benefit, download your Critical Illness Brochure. The forms necessary for submitting a Critical Illness claim are available from the Benefits Plan Office. 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 Accidental Death & Dismemberment, Critical Illness, and Tutorial benefits.

Group Out-of-Province/Canada Travel Medical Emergency Insurance Provides coverage of up to a maximum of $5 million per insured person per coverage period for certain expenses incurred as a result of an emergency while travelling on trips that originated from your Canadian province or territory of residence. It is important to remind you that this coverage is not available in the province where you attend school or in your country of origin. Your coverage period is 180 days per trip. Coverage is subject to the terms and conditions provided in the Benefits Booklet In addition, this insurance provides coverage for the following benefits: • Up to $5,000 per insured person, per trip for trip cancellation • Up to $2,000 per insured person, per trip, for trip interruption; and • Up to $1,000 per insured person, per trip, for baggage insurance. Information you will need along with your Travel Assist card when opening a claim: Group Policy Number: 1170105 Certificate Number: Your Kwantlen Student ID This insurance product is underwritten by Royal & Sun Alliance Insurance Company of Canada. Coverage is subject to the terms and conditions in the Benefits Booklet. For benefit complete details regarding this coverage download your Benefits Booklet and travel medical assistance card. For information on COVID-specific conditions to your Travel Insurance coverage, please click here.

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 ordinarily resides 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) Any services or supplies received by an insured person in their home country if their home country is not Canada; 8) out-of-province expenses for elective (non-emergency) medical treatment or surgery; 9) expenses for drugs which, in the insurer's opinion, are experimental; 10) expenses for dietary supplements, vitamins and infant foods; 11) expenses for contraceptives (other than oral & intrauterine devices); 12) drugs for the treatment of erectile dysfunction; 13) expenses for drugs if they are used for the treatment of infertility; 14) expenses for the services of a homemaker; 15) expenses for items purchased solely for athletic use; 16) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth; 17) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service; 18) 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; 19) immunizations and vaccines (Hepatitis B will be covered, except for Recombivax HB preservative free - DIN 02245976 and DIN 02245977); or 20) any other exclusion identified in the policy contract. Limitations and Exclusions to Dental Benefits No benefit is payable for: 1) any cause for which the insured may apply for and receive protection, exemption or compensation under any Workers' Compensation Act; 2) self-inflicted injuries while sane or insane; 3) war, insurrection or hostilities of any kind, whether or not the insured was a participant in such actions; 4) participation in any riot or civil commotion; 5) services or supplies received outside of Canada; 6) committing or attempting to commit a criminal offence or provoking an assault; 7) any group or policyholder sponsored dental care or treatment; 8) any dental care or treatment for which the insured is not legally obliged to pay; 9) any dental care, treatment or supplies primarily for cosmetic purposes; 10) failing to keep scheduled appointments; 11) file transfers, the completion of claim forms or other documentation; 12) any dental treatment for the correction of temporomandibular joint dysfunction; 13) expenses for treatment of root canal therapy, inlays, onlays, crowns, veneers, and bridges started prior to becoming an insured member/dependant under this plan; 14) replacement of mislaid, lost or stolen appliances; 15) expenses for crowns, inlays, onlays and veneers placed on a tooth not functionally impaired by incisal angle or cuspal damage; 16) any charges incurred for other than metal only crowns or pontics, posterior to the second bicuspid tooth; 17) expenses for full mouth reconstructions for vertical dimension correction or to repair or restore teeth damaged or worn due to attrition or vertical wear or to restore occlusion; 18) any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants; 19) any dental procedure which is not listed in the descriptions of dental benefits indicated herein; 20) charges that are in excess of the fees stated in the Dental Association General Practitioners' Fee Guide applicable to where the services were rendered; 21) where coverage for services is provided under any government plan; 22) where services would be provided without charge in the absence of this policy; or 23) any other exclusions identified in the policy contract.