Annual benefit maxima

• Ambulance charges

• As authorized by the Assistive Devices Program (ADP)

Covered at 80%

$768 per ear, per covered person, every 5 years

• The plan covers a number of medical supplies and equipment
• Must be prescribed in writing by a physician
• Predetermination of benefits must be submitted
• Some medical supplies may also be covered in part by government provincial plans under Assistive Device Programs (ADP)
• Examples of commonly covered items include wheelchairs, hospital beds, walkers, and oxygen

Covered at 80%

• Custom made foot orthotics, including repairs
• On written recommendation of a physician
• Refer to Orthotics guideline (PDF)

Covered at 80%

$768 per covered person per calendar year

Reasonable and customary charges will apply per pair

• Custom made
• On written recommendation of a physician
• Refer to Orthotics guideline (PDF)

Covered at 80%

Reasonable and customary charges for three pairs every 2 years

• Plan pays the difference between provincial plan payment and reasonable and customary charges for medically necessary services and supplies as a result of a medical emergency
• Don’t leave home without your benefits ID card
• Refer to the out of country section for further details

100% up to $5,000,000 per covered person per lifetime

• Counsellor (must be a Registered Psychologist, Registered Social Worker holding a Master's degree in Social Work or a Registered Psychotherapist), Dietician, Massage Therapist, Naturopath, Osteopath, Occupational Therapist, Physiotherapist, Athletic Therapist, Podiatrist/ Chiropodist*, Speech Therapist, and Chiropractor**

Covered at 80% per person, per calendar year up to $975 for counselling services and up to $768 for all other paramedical services

*OHIP maximum must be reached prior to claiming

**80% of $12.00 per visit for the first 15 visits; thereafter 80% per person, per calendar year

• Enhanced generic drug substitution
• Trial prescription program available
• Prior authorization process applies for some medications and may be subject to participation in a health case management program
• Excludes weight loss and smoking cessation

Covered at 80%

Dispensing fee cap is $7.00

Fertility drugs limited to $3000 lifetime maximum

• A Nursing Pre-Care Assessment, including a Medical Doctor Referral, must be submitted before home nursing begins
• Must be provided in the home by a registered nurse or registered or licensed practical nurse (not a relative) 
• Does not apply to rehabilitation or long-term care facilities, or services deemed custodial by insurance carrier
• Out of pocket maximum does not apply to this benefit

Covered at 80% for the first 10 days in each calendar year; 100% thereafter up to a maximum of $23,271

• Eye examinations, including refractions, when they are performed by a licensed ophthalmologist or optometrist

100% coverage up to $85 per person every two years

• Continuous glucose monitors (CGM)* and flash glucose monitors (FGM)**, coverage includes the monitors themselves as well as sensors and transmitters

80% coninsurance to a maximum of $4,000 per calendar year per person (maximum applies to CGM and FGM on a combined basis) 

 
* A pre-treatment form (estimate) is required for machines and supplies
patient must be insulin dependent to be eligible

** Prescribed by a physician
Patient must be insulin dependent to be eligible

FGM sensors will need to be paid for up front and then submitted to Canada Life. If purchased through the pharmacy via drug card, it will be declined

• Providing supplemental coverage to provincial care. Coverage available through provincial healthcare programs must be exhausted first.

A $30,000 lifetime maximum per member. Patient age <43.  
 

Eligible expenses: anaesthetist fees; cycle monitoring fee; 1 ultrasound and blood test once the in-vitro procedure has begun; embryo freezing – initial process, preparation, and annual storage limit of 1 year; embryo thawing; in vitro fertilization procedure; sperm thawing; sperm washing; transfer of frozen embryo
 

Ineligible expenses: embryo donation program; donation to a sperm bank; egg freezing; donor’s fee or cost; medical expenses or services incurred by the surrogate mother; surrogate agency fee; surrogate mother’s fee

• Applicable to public hospitals in province of residence
• Does not apply to rehabilitation or long-term care facilities, or services deemed custodial by insurance carrier
• Out of pocket maxmium does not apply to this benefit

Covered at 80% for the first 5 days in each calendar year; 100% thereafter 

Donwood and Homewood are limited to a lifetime maximum of 60 days

• Coverage includes basic preventative dental expenses such as regular oral examinations, x-rays, fillings, extractions, root canals and periodontal scaling 
• Payment for recall examinations (includes examinations, x-rays, cleaning) is limited to once every 9 months with 16 units of scaling per calendar year

95% of the current fee guide in effect to a maximum of $2,466 per year per covered person

• Includes bridges, crowns and onlays, including some denture expenses

50% of the fee guide in effect to a maximum of $3,716 per year per covered person

• Includes braces and teeth straightening including correction, observation and adjustment
• Includes adult orthodontics

50% of the fee guide in effect to a lifetime maximum of $3,716 per covered person

• Faculty, non-union staff university support group (USG) 5 and above (full and part-time)

180 calendar days salary continuance

• All other employees (including  Canadian Union of Public Employees (CUPE) Local 793)

90 calendar days salary continuance

• After 5 years of service, one additional day credited for each complete month worked; maximum credited sick leave is 180 calendar days
• CUPE Local 793 employees limited to maximum of three days during initial probationary period (see Article 19)

• All employee groups

• 85% of prescribed pre-LTD net salary to a maximum insured salary of $190,549 tax-free
• Unable to perform regular duties of own occupation during the qualifying period and the subsequent two years
• Unable to work at any occupation after 2 years 
  • Any occupation is defined as any job for which you are qualified or may reasonably become qualified by training, education or experience

• One (1) times your annual base salary

Maximum coverage is the lesser of 6 times employee annual base salary or $2,000,000

• One (1) to two (2) times your annual basic salary
• Medical evidence is required for coverage in excess of $600,000 (combined with basic life) or for any amount after 31 days from date of hire

• one (1) to three (3) times annual base salary
• Medical evidence is required

• 1 times to 6 times annual salary
• Medical evidence is required

$200,000

• For accidental death that occurs while travelling on University business (refer to Policy 31 for more information)