Eligible drug expenses are shared between the plan and the employee. The plan covers 80% of the eligible expenses until the employee’s 20% cost reaches the out-of-packet cap, after which point the plan covers 100% of eligible expenses, subject to the benefit maxima. Until you have reached the out-of-pocket maximum, you will have to pay a portion of the costs. For more information, please visit the Extended Health Care Benefit page.
Please visit the Benefit Eligibility and Eligible Dependents page.
When two or more plans are involved, one plan is considered to be the primary plan. The primary carrier pays its eligible amount first. The secondary carrier then reduces its payment by the amount in which total payments would exceed eligible expenses available through both plans. Eligible expenses are as defined in each carrier's contract before limitations like deductibles, co-insurance, fee guides, and maximums are applied.
As a plan member, your claims should be processed through your benefit plan first. Claims for your spouse must be processed through your spouse's plan first. Any remaining balance can then be processed through the other insurance plan.
When a child is covered under both parents' plans, the plan of the parent whose birthday (month and day) falls earlier in the calendar year is billed first.
Our chiropractic coverage includes 80% of $12.00 for the first 15 visits within the year. After 15 visits, 80% of reasonable and customary per visit charges (100% if out-of-pocket limit is reached) applies. All chiropractor expenses apply to the 2021 annual maximum of $743 per covered person per calendar year.
For more information, please refer to Annual Benefit Maximums.
Our plan includes a dispensing fee cap for prescription drugs, which is currently $7.00. If this fee (charged by the pharmacy) exceeds the dispensing fee cap, the difference is the responsibility of the employee and the fee is not applied to the employee’s out-of-pocket amount.
Cards are issued only under the name of the plan member and spouse. The pharmacy will ask your dependent to confirm his/her relationship to you to verify that he/she is an eligible dependent.
An important and valued feature of the extended health benefit is the Green Shield Canada out of country travel benefit, which covers 100% of medically necessary services, or supplies required, as a result of a medical emergency, up to $5,000,000 (Canadian) per lifetime per covered person. Please visit the Out-Of-Country Benefit page for more information.
The plan does not cover transportation costs if you are unable to leave home at the start of a trip due to emergencies. This type of coverage is provided by flight cancellation insurance.
If you miss prearranged and prepaid return transportation to Canada because you are in a hospital, the assistance company will arrange and pay the cost of comparable return transportation for you.
Currently, the only country that requires proof of coverage is Cuba. Employees who will be travelling to Cuba are advised to contact hrhelp@uwaterloo.ca for a letter indicating the type of coverage and any covered dependents.
The toll-free out-of-country/travel contact information for GSC is 1-800-936-6226 (also, collect with operator assistance at 519-742-3556). GSC Travel Assistance is available 24/7/365 (including holidays). When contacting GSC Travel Assistance, quote your ID number on your GSC card.
If you require a travel coverage letter, employees can contact GSC directly with this request.
Please contact us at hrhelp@uwaterloo.ca with any questions or comments.
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The University of Waterloo acknowledges that much of our work takes place on the traditional territory of the Neutral, Anishinaabeg and Haudenosaunee peoples. Our main campus is situated on the Haldimand Tract, the land granted to the Six Nations that includes six miles on each side of the Grand River. Our active work toward reconciliation takes place across our campuses through research, learning, teaching, and community building, and is co-ordinated within our Office of Indigenous Relations.
