Annual benefit maxima


         extended health care Dental Disability Life Insurance


The benefits maxima are subject to an annual review, the following maxima are effective January 1, 2019:

Extended health care benefit

Predetermination is highly recommended for all high cost expenses prior to incurring expense.

Benefit type Coverage Coverage maxima
Ambulance
  • Ambulance charges
Covered at 100%
Chiropractor
  • 80% of $12.00 per visit for the first 15 visits.
  • After 15 visits, 80% of reasonable and customary per visit charges applies (100% if out-of-pocket limit is reached)

$704 per covered person per calendar year

Hearing aids
  • As authorized by the Assistive Devices Program (ADP)

Covered at 80%

$704 per ear, per covered person, every 5 years

Medical supplies and equipment
  • 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%

Orthopedic appliances

Covered at 80%

$704 per covered person per calendar year

Reasonable and customary charges will apply per pair

Orthopedic footwear

Covered at 80%

Reasonable and customary charges for three pairs every 2 years

Out of country coverage
  • Plan pays the difference between provincial plan payment and reasonable and customary charges for emergency medical treatment
  • Don’t leave home without your Great-West Life AssureTM card
  • Refer to the out of country section for further details

100% for all eligible dependents

$1,000,000 per covered person per lifetime

Paramedical services
  • Chiropractor see section above
  • Counsellor (must be registered psychologist or, with written authorization of a physician, a registered social worker holding a Master’s degree in Social Work)
  • Dietician, registered (On written recommendation of a physician)
  • Massage Therapist, registered  (On written recommendation of a physician)
  • Naturopath, registered
  • Osteopath, registered
  • Physiotherapist or Occupational Therapist, registered
  • Podiatrist or Chiropodist (After Ontario health insurance (OHIP) maximum has been reached)
  • Speech Therapist (On written recommendation of a physician)

Covered at 80%

$704 per paramedical service covered, per person, per calendar year.

Prescription drugs
  • Prescriptions that have “no substitutions” or no generic drug equivalent available will be reimbursed at the cost of brand name
  • Excludes weight loss and smoking cessation
  • Trial prescription program available for employees taking any new maintenance drug or change in dosage of current maintenance drug

Dispensing fee cap is $7.00

80% of generic drug paid by the benefit plan

Fertility drugs limited to $3000 lifetime maximum

Private duty nursing
  • Medical documentation will be required
  • Must be provided in the home by registered nurse or restorative nurse assistant (not a relative) with a physician’s written referral
  • Does not apply to rehabilitation or long-term care facilities, or services deemed custodial by insurance carrier; single/family cap does not apply to this benefit
  • Please contact Great-West Life for assistance

Covered at 80%  for the - first 10 days in each calendar year, thereafter 100% to an annual maximum of $21,344

Semi-private hospital
  • 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; single/family cap does not apply to this benefit

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

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

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Dental benefit

 Predetermination is highly recommended for all high cost expenses prior to incurring expense.

Benefit types Coverage Coverage maxima
Basic dental
  • 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 $2,234 per year per covered person

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

50% of the fee guide in effect to a maximum of $3,367 per year per covered person

Orthodontic services
  • 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 $3,367 per covered person

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Disability benefit

Benefit type Employee group Coverage details
Sick leave
  • 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)
Long term disability (LTD)
  • All employee groups
  • 85% of prescribed pre-LTD net salary to a maximum insured salary of $175,487 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

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Life insurance

Benefit type Coverage Coverage maximums
Basic life
  • One (1) times your annual base salary

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

Additional basic life
  • 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

Optional life

  • one (1) to three (3) times annual base salary
  • Medical evidence is required
Optional spousal life
  • 1 times to 6 times annual salary
  • Medical evidence is required

$200,000

Business travel accident insurance
  • For accidental death that occurs while travelling on University business (refer to Policy 31 for more information)
$100,000

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