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Supplementary Medical Plan (including prescription drugs)

The website describes the principal features of the group benefit plan sponsored by Queen’s University, but Group Policy No. 139046 issued by Great-West Life is the governing document. If there are variations between the information on this site and the provisions of the policy, the policy will prevail.

The Supplementary Medical Plan (Healthcare) is a non-taxable benefit that helps cover the cost of necessary health care expenses which are not covered by OHIP.

This optional benefit provides for reimbursement of expenses which are incurred by you or your insured dependents and which, during any one calendar year, exceed the deductible amount of $25. "Calendar year" means the period from any January 1st to the following December 31st.

Monthly premiums are based on the level of coverage required (i.e. single or family).

To submit a claim, please visit Claims Submission.


Covered Expenses

Reimbursement will be made for the following expenses as long as they are reasonable, deemed medically necessary and authorized by a physician or another person entitled by law to practice medicine:

1. Charges for:

  1. drugs and serums that can only be obtained through a written prescription and certain life-supporting, non-prescription drugs, approved by Great-West Life
  2. vaccines used to prevent disease
  3. The maximum amount payable for drugs used to treat erectile dysfunction is $1,000 in a calendar year. Benefits for fertility drugs are limited to 6 menstrual cycles in a person’s lifetime

Exceptions (under 1 (a) above):

Charges for the following items are not covered whether or not they have been prescribed for medical reasons:

  • any drug that does not have a drug identification number as defined by the Food and Drugs Act, Canada; food products, vitamins, minerals, other dietary supplements or weight loss products
  • skin and hair products, eye lubricants, contact lens care products, dental or oral hygiene products or personal hygiene products
  • medication for colds, coughs, fever, inflammation or allergies, for relief of pain or for prevention or treatment of infection
  • for the treatment of acne or warts
  • remedies for stomach upsets, bowel complaints, or parasites
  • drugs administered during treatment in an emergency room of a hospital or as an in-patient in a hospital
  • homeopathic preparations, unless federal or provincial legislation requires a prescription for their sale
  • smoking cessation products
  • any single purchase of a drug that would not reasonably be consumed or used within 6 months

2. Charges equal to 80% of expenses for the services of a registered nurse or registered nursing assistant at your residence provided that such person does not normally live in your residence, up to a maximum of $10,000 per insured person per calendar year. However, the lifetime maximum will be $25,000 during the period from the first day of a calendar year coinciding with or next following your 65th birthday until your death.

The services that will not be considered as eligible charges under this provision:

  • while you (or your insured dependent) are residing in a nursing home, home for the aged, rest home or any other facility providing similar care
  • if in Great-West Life's opinion they are for custodial care and do not require the skill of a registered nurse, or
  • while you (or your insured dependent) are confined in a licensed hospital

3. Charges for services furnished by a licensed hospital and supplies prescribed by a physician or surgeon which are obtained from an out-patient department of a licensed hospital or a surgical supply company, while you (or your insured dependent) are not confined to a hospital.


4. Charges for licensed ambulance service, including air ambulance services, for transportation to the nearest centre where essential treatment is available. Local ambulance services for the return trip are also covered. If transportation is to a further centre, Great-West Life will provide alternative benefits based on coverage for transportation to the nearest centre where essential treatment is available.

This coverage applies only to emergency services required in Canada.


5. Charges for the following aids, services and supplies when prescribed by a physician:

  • purchase of braces, crutches, artificial limbs or eyes and prosthetic devices approved by Great-West Life, maximum amount payable for each prosthesis is $10,000. Repair charges do not apply to this maximum
  • external breast prostheses once every 2 calendar years and 2 surgical brassieres per calendar year
  • rental of a wheelchair, hospital bed or other approved durable equipment for temporary therapeutic use (This equipment may be purchased subject to Great-West Life's approval prior to the purchase. If such approval is not obtained, Great-West Life will pay only the equivalent of the rental cost of the equipment)
  • oxygen and blood serum
  • reasonable and customary charges for either custom-made orthopaedic shoes including modifications to orthopedic footwear or inserts, as prescribed by a podiatrist or physician. Coverage for all shoes and inserts combined is limited to a maximum of one pair in any one calendar year
  • surgical stockings, to a maximum of 4 pairs per calendar year
  • wigs up to a lifetime maximum of $100 if necessary as a result of chemotherapy, or up to a lifetime maximum of $250 if necessary as a result of total hair loss from alopecia totalis
  • chronic care provided during confinement in a hospital or nursing home in Canada with a $25.00 daily maximum

6. Charges by a legally licensed dentist, oral surgeon or denturist for dental treatment of injuries to natural teeth and the replacement of natural teeth for accidents suffered by you or your insured dependent while you are insured under this provision. The charge will be subject to all of the following conditions:

  • the treatment is necessitated by a direct accidental blow to your (or your insured dependent(s)) mouth and not by an object or food placed knowingly or unknowingly in the mouth
  • the accidental blow occurs while you are insured under this provision
  • the treatment is the least expensive that will provide professionally adequate treatment, and
  • treatment is received within 12 months after the accidental blow. If treatment is to be received more than 180 days after the accidental blow, a treatment plan must be submitted to Great-West Life within 180 days of the accident

7. Charges for the services of a qualified speech therapist, up to a maximum of $1,000 per calendar year per person.


8. Charges for the purchase of hearing aids, up to a maximum of $500 in each period of 4 consecutive years per insured person.


9. Charges for diabetic supplies including: insulin and insulin syringes; Novolin-Pens or similar insulin injection devices using a needle; test strips; blood letting devices


10. Charges for the services of a qualified physiotherapist provided that such person does not normally reside in your home.  The maximum amount payable for any one condition:

 

Private Clinics

OHIP Approved

Initial visit

$55.00

$40.00

Subsequent visits

$35.00

$20.00*

*for assessment or re-assessment only, not for treatment


11. The following paramedical services are covered when provided out-of-hospital: legally licensed chiropractor, chiropodist, osteopath, podiatrist or naturopath. Great-West Life will pay an amount equal to 50% of such medical expenses up to a maximum of $300 per practitioner per year. Where applicable, no payment can be made until the provincial plans have paid their yearly maximum.


12. Chronic Care: Chronic care is management of a condition where significant improvement or deterioration is unlikely within the next 12 months. Chronic care is covered if it starts while the person is insured under this benefit provision and it is provided in Canada. Great-West life will pay a maximum of $25 per day while being confined in a hospital or nursing home.


13. Vision Care: Only active employees who participate in the Supplementary Medical benefit are eligible for vision care expenses.

Coverage:

  • eye examinations, including refractions, when they are performed by a licensed ophthalmologist or optometrist, and are not available under the person’s provincial government plan
  • glasses and contact lenses required to correct vision when provided by a licensed ophthalmologist, optometrist or optician 
  • laser eye surgery required to correct vision when performed by a licensed ophthalmologist
  • visual training and remedial therapy performed by a licensed ophthalmologist or optometrist

Limits:

The maximum amount payable is:

  • up to $75 every 24 months for faculty association members, QUFA department employees, or other clinical (non-QUFA) faculty, and $65 every 24 months for any other employee for eye examinations performed by a licensed ophthalmologist, optometrist or medical doctor
  • up to $250 every 24 months for glasses, contact lenses, laser eye surgery
  • lifetime maximum of $150 in a person's lifetime for visual training and remedial therapy performed by a licensed ophthalmologist or optometrist

No benefits will be paid for vision care services or supplies required by an employer as a condition of employment.

For information on available discounts on eyewear and vision care services, refer to Preferred Vision Services.

Preferred Vision Services (PVS) entitles you to a discount on a wide selection of quality eyewear and lens extras (scratch guarding, tints, etc.) when you purchase these items from a PVS network optician or optometrist. You are eligible to receive the PVS discount through the network whether or not you are enrolled in the Queen's University supplementary medical coverage. You can use the PVS network as often as you wish to purchase eyewear for yourself and your dependents at a reduced cost.

Questions? Contact the PVS Information Hotline at 1-800-668-6444 or visit the PVS web site for information about PVS locations and the program:


Exclusions

No amount of benefit will be payable under this provision for any charge that resulted either directly or indirectly from, or was in any manner or degree associated with, or occasioned by, any one or more of:

  • any cause for which you may apply and receive indemnity or compensation under the Workplace Safety and Insurance Act or any such Act,
  • war, insurrection or hostilities of any kind, whether or not you were a participant in such actions,
  • participating in any riot or civil commotion,
  • committing or attempting to commit a criminal offence or provoking an assault,
  • an examination by, or the services of, a physician or surgeon if required solely for the use of a third party,
  • any treatment that has as its purpose the correction of temporomandibular joint dysfunction,
  • any service or treatment which you (or your insured dependent) would receive without being charged if you were not insured under this provision, and
  • cosmetic surgery

Termination

Insurance ceases immediately upon termination of employment.

Coverage at Retirement under the Retiree Benefits Plan

Please see Retiree Benefits to access the Retiree Benefits Booklet.