Health & Dental
Plan Guide

Your benefits, as described below, come into effect after any Provincial Health Care annual maximums have been exhausted. There is a $5,000 maximum per covered person, per benefit year for health expenses (excluding Gender Affirmation, Hospital, Prescription Drugs and Vision). Unused benefits from a specified time frame cannot be utilized in a future period.

Covered charges are reasonable and customary expenses needed for medical care, services or supplies, and received while the person is eligible, for either an illness or injury that is non-occupational or related to pregnancy. No amount will be payable for taxes and/or shipping and handling fees for any covered service/product(s).

Charges for dental services by a licensed dentist for the repair of sound natural teeth (healthy, non- diseased and not heavily restored) are covered at 80% of the reasonable and customary charges when required for a non-occupational accidental injury, external to the mouth, which occurs while the person is covered. No amount will be payable for injury caused by an object placed in or on the mouth, self-inflicted injury, or damage to existing dentures, crowns, or bridgework. Work performed outside of Canada may be considered, after submitted to any medical or travel insurances of which you are eligible.

Benefits shall be paid in accordance with the Nova Scotia Dental Fee Guide for General Practitioners, in effect at the time of treatment. Treatment must commence within 90 days following the date of the accident, and the care or services must be completed within one year from such date. No amount shall be payable for charges incurred after the termination date, or after the person’s coverage terminates.

When submitting a claim for accidental dental, you are required to submit a letter detailing when and how the accident happened. The attending dentist must confirm that the treatment is the result of an accident.

It is recommended that the dentist submit a predetermination outlining the course of treatment and the resulting cost. Eligible accidental dental claims must first be submitted to the Health Care Plan. Once this benefit is exhausted, remaining expenses can then be considered under the Dental Care Plan.

This benefit is underwritten by Chubb Life Insurance Company of Canada under Policy Number SG102526.

This coverage applies to the insured student only. The amount of the benefit is limited to the percentage shown in the Schedule of Losses. To see complete details of coverage, or to download your copy of the Accidental Death and Dismemberment Policy, please visit your plan member portal ksu.drawbridge.ca.

When you register an account on your Plan Member Portal, you can visit the Document Centre to fill out the form. Send a scanned copy, or the original signed copy, to The PBAS Group. If a beneficiary is not designated, any payments will be made to your estate.

Charges for licensed ambulance services within Canada, in excess of the amount payable under the covered person’s provincial health care plan, are covered at 80% up to $1,100 per trip.

The coverage includes the transport of the covered person from the place of debilitation to the nearest hospital where treatment is available, or from the first hospital to another for specialized treatment not available at the first hospital, or to a convalescent/rehabilitation hospital. No amount will be paid for expenses outside of Canada. Air ambulance is covered up to $200 per trip.

Daily charges in excess of the ward rate up to the Room and Board Limit plus user fees, but not beyond $3 per day, up to 120 days. Confinement must begin within 14 days of hospital discharge. A new maximum stay will apply if the covered person has not been confined in a convalescent/rehabilitation hospital for at least 90 days. A convalescent/ rehabilitation hospital is a place that:

• has a transfer arrangement with hospitals;
• provides in-patient nursing care (that meets minimum Provincial regulations) for the convalescent/ rehabilitation stage of an injury or illness; and,
• is approved as a convalescent/rehabilitation hospital for payment of the ward rate under the Provincial Health Plan.

Counselling services provided by a:

• Licensed psychologist;
• Registered social worker/master of social work;
• Licensed professional counsellor;
• Licensed counselling therapist; or,
• Psychotherapist;

are covered at 80%, up to $1,000 per benefit year, provided the counsellor is licensed under the appropriate provincial or federal organization to practice their profession, in accordance with the rules of their profession. No amount will be paid for group counselling, testing/assessments, or reports under this benefit (see Educational Assessments).

A, Educational Assessment is eligible for coverage under your Plan at 80%, up to $1,000 per benefit year when it is conducted by a licensed professional acting within the scope of their license and in accordance with the standards of their profession.

These assessments may address, but are not limited to, the following areas:

• Learning disorders: difficulties related to reading, writing, or mathematics.
• Attention-Deficit/Hyperactivity Disorder (ADHD): issues with focus, impulsivity, and hyperactivity.
• Cognitive or intellectual disabilities: limitations in intellectual functioning.
• Other conditions: mental health concerns such as anxiety, depression, behavioural disorders, and cognitive difficulties.

A referral from a Medical Doctor or licensed counsellor is required when submitting a claim for an Educational Assessment.

One eye examination, by an ophthalmologist or optometrist, registered and legally practicing within the scope of their license, is covered up to 80% of the reasonable and customary charges every 24 months (or 12 months if under age 17). No amounts will be paid for contact lens fitting fees or retinal photos.

Lenses and frames or contact lenses are covered at 100%, up to $150 every 24 months, when prescribed by an Ophthalmologist or Optometrist. Itemized invoices are required. Laser eye surgery in lieu of lenses and frames will also be covered, up to the benefit maximum. No amount will be paid for electronic components for smart glasses or non-prescription glasses, such as safety or sunglasses,

When purchasing glasses or contact lenses online, you are required to submit a copy of your current prescription with your claim.

Services provided by the following health practitioners are covered, provided the practitioner is licensed by the appropriate provincial or federal organization to practice their profession, in accordance with the rules of their profession.

The following practitioners are covered up to $20 per visit, up to $300 per benefit year, per practitioner:

• Acupuncturist
• Chiropractor
• Dietitian
• Massage therapist (referral required)
• Occupational therapist
• Osteopath
• Podiatrist/chiropodist (consultations)
• Speech therapist

The following practitioners are covered as follows:

• Naturopath (consultations) are covered up to $300 per benefit year
• Physiotherapist (referral required) are covered up to $1,000 per benefit year.

If a referral is required, it must be current, and will be valid for one year after the date of issue.

If an x-ray is recommended by any of the above health practitioners, an additional $25 is covered towards this expense. No amount will be paid for any visit for which any amount is payable under the covered person’s provincial health care plan, unless permitted by law.

Charges are covered at 100% of reasonable and customary charges for semi-private accommodation in a hospital within your home province, limited to the difference between the charges for public ward and semi-private accommodation for each day of hospitalization.

Charges are covered at 100%, up to $1,500 per benefit year for the rental or purchase of medical equipment based on the nature and severity of the covered person’s medical needs, when recommended by a licensed medical doctor (M.D.). Before incurring any major expenses, it is recommended you submit details to The PBAS Group to determine to what extent benefits are payable.

Covered items include, but are not limited to:

• Wheelchairs (purchase, $1,000 per lifetime; repairs, $250 per lifetime);
• Respiratory equipment, including oxygen ($1,500 per lifetime);
• Contact lenses/glasses following cataract surgery (one pair per lifetime);
• Canes, crutches, walkers, casts, splints;
• Catheters, and colostomy supplies;
• Compression stockings (two pairs per benefit year);
• Intra-uterine devices (IUDs) with no medicinal content (one per benefit year);
• Aero chamber (one per student year);
• Custom-made rigid or semi-rigid braces (not for athletic use) for back, neck, arm or leg ($1,000 per lifetime, per condition);
• Non-dental prosthesis such as artificial limbs and eyes, including replacement if required because of a change in physical condition ($1,000 per lifetime, per condition) (excluding myoelectric appliances);
• Artificial eyes, and the cost of one polishing or one remaking of the artificial eye each policy year;
• Surgical brassieres ($200 per benefit year);
• Wigs for a diagnosed medical condition or medical treatment resulting in full or partial hair loss ($1,000 per lifetime).

Gender Affirmation: The following services (not covered by your provincial/territorial health plan) will be considered eligible for coverage up to a $10,000 per lifetime maximum when a diagnosis of gender dysphoria from a legally qualified physician (M.D.), or nurse practitioner is provided. Reimbursement will be limited to reasonable and customary charges.

• Foundation (core) – Transition-related genital and chest/breast surgeries not covered by your provincial/territorial health plan, as well as vocal surgery, tracheal shave, chest contouring/breast construction, vaginal dilators, laser hair removal and facial feminization surgery.
• Focused – Non-genital, non-breast/chest enhancement surgeries as follows: nose surgery, liposuction/lipofilling, face/eyelid lift, lip/cheek fillers, hair transplant/implants, and gluteal lifts/implants.

To qualify for reimbursement, medical equipment must be obtained through a licensed medical equipment supplier or a recognized, reputable retailer specializing in medical or healthcare products. Items purchased through third-party online marketplaces or non-verified vendors are not eligible.

Excluded items include those intended for athletic use; personal comfort or convenience items; fitness or wellness equipment; safety or environmental modifications; cosmetic, self-care or hygiene items; self-help or environmental control items; over-the-counter or non-prescription items; experimental or non-approved devices; duplicates or upgrades. Items with both medical and non-medical uses are not covered, such as, but not limited to: heating pads or light therapy devices, communication aids, air conditioners or cleaners, and whirlpool baths or saunas. Not all exclusions are listed. Medical supplies not listed in this booklet are subject to prior approval from the administrator.

In order to submit a claim for medical equipment, a letter (referral) will be required from a licensed medical doctor (M.D.) describing the nature of the disability, the type of equipment, medical need and estimated duration required.

The plan covers a list of Health Canada approved prescription drugs, professionally compiled to address the needs of students. The KSU Plan uses “The Student Managed Drug Formulary” to help reduce the cost of the plan while maintaining comprehensive quality care and benefits. Access to the drug formulary can be found below or at ksu.drawbridge.ca.

Eligible drugs include those approved by Health Canada, and are within the following general categories:

• Eligible drugs which by law require a prescription for purchase; and,
• Compound mixtures where one of the ingredients is an eligible item.

Coverage is limited to the cost of the lowest priced equivalent item in the applicable generic category that can be legally used to fill your prescription. The plan covers up to a 34-day supply of therapeutic (acute) drugs, and up to a 100-day supply for maintenance drugs, unless prior approval is obtained from The PBAS Group.

The plan is limited to one intra-uterine device (IUD) per benefit year. IUDs that do not contain medicinal content may be eligible for coverage under the medical equipment benefit.

It should be noted that drugs are only considered eligible if they were prescribed by a licensed medical doctor (M.D.), licensed dentist or another professional authorized by provincial legislation to prescribe drugs, and dispensed by a registered pharmacist or licensed medical doctor (M.D.).

The only drugs not legally requiring a prescription that will be reimbursed if accompanied by an official prescription receipt from the pharmacist, are:

• Vaccines, including HPV vaccines Gardasil and Ceravix;
• Diabetic supplies such as insulin, syringes, needles, diagnostic reagents for the diagnosis and monitoring of diabetes, lancets, sensors and readers. Diabetic supplies not listed may be eligible for coverage under the Medical Equipment benefit.

Additionally, the Plan covers the following, without a prescription, up to the benefit maximum:

• Digital contraception apps (such as Natural Cycles);
• Rapid at-home STI testing kits (such as trusti).

Information about these providers can be found in the Plan Member Portal under Preferred Providers. A detailed invoice is required.

Specifically excluded from coverage, whether legally requiring a prescription or not, are:

• Allergy testing and all forms of allergen immunotherapy, including but not limited to allergy serums, extracts, injections, and sublingual tablets or drops;
• viscosupplementation, including all hyaluronic acid derivatives and similar intra-articular viscosupplement products;
• Cannabis and psychedelics;
• Dietary foods and supplements;
• Fertility drugs;
• Hair loss and hair growth agents;
• Household products such as, but not limited to, soap and toothpaste, prescription mouthwash;
• Oral drugs for the treatment of erectile dysfunction;
• Smoking cessation products;
• Anti-obesity drugs;
• Vitamins (other than injectable).

This benefit is underwritten by Chubb Life Insurance Company of Canada under Policy Number SG102526.

This benefit applies to the insured student only. If you become disabled while covered, and are confined at home or in a hospital for a minimum of 15 consecutive school days, you are eligible for the private tutorial services by a qualified teacher, up $15 per hour, up to $1,000 per disability. The teacher must be approved in advance by the KSU. Disabilities due to the same or related cause will be treated as one disability.

If the disability is the result of an accident, confinement must occur no later than 100 days after the accident. Disabled means that you cannot, because of illness or injury, engage in most of the standard activities a person of the same age or demographic.

No amount will be paid for care, services or supplies:

• if the payment is prohibited by law;
• if the benefit is covered under any government plan or law;
• where no charge would have occurred in the absence of this coverage;
• for care, supplies, or treatment which is not medically required;
• for dental work, excluding Accidental Dental;
• for testing including, but not limited to, allergies, sleep studies;
• for care or treatment that exceeds the normal care or treatment that is recognized as customary and common practice for an illness or injury, in accordance with current therapeutic practice; or,
• medical supplies, services, or treatments not listed in this booklet, unless with pre-approval from the Administrator.

No amount will be paid for any charge incurred as a result of:

• war, whether declared or not;
• insurrection, rebellion or participation in a riot or civil commotion;
• purposely self-inflicted injury; or,
• the covered person’s commission of, or attempt to commit, an assault or a criminal offence.

There is an overall dental maximum of $850 per benefit year, however certain items are specifically excluded and limits exist. Unused benefits from a specified time frame cannot be utilized in a future period. It is recommended to submit a predetermination to ensure you are covered for your procedure.

Eligible dental expenses are covered when they are incurred while the person is insured and service is provided by a licensed dentist, dental hygienist, anesthetist, or specialist. The term “dentist” in this provision intends to include all of the above. If treatment is given by a specialist, the amount paid will be limited to the amount stated for that treatment in the Nova Scotia Dental Association Suggested Fee Guide for General Practitioners in effect at the time of treatment, as described below. Treatment by a specialist will only be covered if a comparable dental code exists in the General Practitioner Fee guide of the province of the Plan.

The Plan provides coverage for eligible diagnostic and preventive services, at 80%, included in the overall maximum.

Exams

• Initial or complete examinations (once every 24 months)
• Recall examinations (once per benefit year)
• Specific examinations
• Emergency examinations

X-rays

• Full mouth series x-rays (once every two years)
• Periapical x-rays (up to 16 films every two years)
• Bitewing x-rays (up to four films per benefit year)
• Occlusal x-rays (up to four films per benefit year)
• Panoramic x-rays (once every two years)

Cavity Prevention

• Polishing or cleaning teeth (one unit per benefit year)
• Recall scaling (four units per student year, combined with root planing)
• Fluoride treatments (once per benefit year)
• Space Maintainers (once per space for primary teeth, dependants age 14 or younger)
• Pit and fissure sealants for ages 14 or younger

The Plan provides coverage for eligible restorative services, at 80%, included in the overall maximum.

Fillings

• Sedative, silver or white fillings
• Retentive Pins

The Plan provides coverage for eligible endodontic services, at 80%, included in the overall maximum.

• Pulpotomy
• Root canal (once per tooth)
• Apexification
• Periapical services
• Root amputation
• Hemisection
• Intentional removal, apical filling, and reimplantation

The Plan provides coverage for eligible periodontic services, at 80%, included in the overall maximum.

• Oral disease
• Desensitization
• Gingival curettage
• Gingivectomy
• Flap surgery
• Tissue graft
• Occlusal equilibration
• Root planing (four units per student year, combined with scaling)
• Periodontal appliances once every 12 months

The Plan provides coverage for eligible oral surgery services, at 80%, included in the overall maximum.

Minor

• Extractions, erupted teeth
• Residual root removal

Major

• Extractions surgical
• Alveoloplasty, gingivoplasty, stomatoplasty, vestibuloplasty
• Surgical excision
• Surgical incision
• Fractures
• Frenectomy
• Post surgical care

The Plan provides coverage for eligible denture maintenance services, at 80%, included in the overall maximum.

• Denture cleaning once per benefit year
• Relining and rebasing of existing dentures (once every 36 months)
• Tissue Conditioning (once every 36 months)
• denture repairs and/or tooth/teeth additions
• denture adjustments and remount and equilibration procedures, only after 3 months have elapsed from the installation of a denture
• remake of a partial denture using existing framework, once every 5 years based on first paid claim

The Plan provides 80% of the cost of anesthesia included in the overall maximum.

• Local Anesthesia
• Deep Sedation
• Inhalation Technique
• Intravenous Sedation

No amount will be reimbursed for the following expenses:

• bite plates, bridges, major restorative (unless listed), bleaching, orthodontic services;
• any anesthesia administered in a hospital;
• dental charges that could be claimed under Workers’ Compensation;
• dental charges not included in the current provincial fee guide for General Practitioners;
• cosmetic procedures, experimental treatment or testing;
• charges for appointments that are not kept;
• charges for the completion of claim forms;
• treatment to correct temporomandibular joint dysfunction of the jaw; -endodontic treatment that started before the effective date of coverage;
• dental appliances (unless listed);
• any orthognathic surgery (remodeling or reconstruction of your jaw);
• procedures or supplies used in vertical dimension corrections (changing the height of the teeth) or to correct attrition problems (worn down teeth); or,
• implanting fabricated teeth or any major surgery resulting from implanting fabricated teeth.

This benefit is provided by Orion, under group policy number SBA10001.

As part of the health plan, you and your eligible dependants are covered for hospital services, physicians, and other services for emergency treatment of an injury or illness while traveling outside of the province of Nova Scotia, including international travel. The travel plan covers reasonable and customary charges, which are in excess of the provincial health-care allowance.

You’re covered for up to 90 days per trip, for an unlimited number of trips taken during the time you’re covered. The maximum coverage is $5,000,000 per trip.

When travel is required to complete a course of study, coverage can be extended to 365 days, following confirmation from your academic supervisor. Please contact the Students’ Association or The PBAS Group to obtain a 365-day Medical Assistance Travel Card. For complete details of coverage and/or to print your 90- day Medical Assistance Travel Card, visit ksu.drawbridge.ca.

From Canada and the US, call toll free: 1-888-997-0152
From anywhere else in the world, call collect: +1-519-251-0152
If calling is not possible, contact us via Chat:

SMS: 1-450-234-8044
WhatsApp: 1-888-657-7611
Webchat: orion.xodus.ca/assistance
Email: orionassistance@xodus.ca

If you have an emergency while traveling, you must contact Orion immediately before seeking medical treatment. If you are unable to contact Orion due to the nature of your emergency, you must have someone else call on your behalf, or you must call as soon as medically possible. Orion is available to take your call 24 hours a day, 7 days a week.
In a life threatening emergency situation, call 911 or the local emergency number.

The Maple Assistance Program gives you access to mental health and wellness support directly through your Maple account. When you are dealing with stress, anxiety, relationship issues, financial concerns, legal questions, or just need someone to talk through what is going on, you can connect with trained counsellors, well-being coaches, legal consultants, and financial experts through phone, video, or in-person appointments with a large national network of providers, with services available in both English and French.

Here's what's included

• Counselling — issue-based sessions with trained counsellors to address the challenges that matter most to you
• Legal consultations (LegalConnect) — phone-based legal information, plus an optional referral to a local lawyer that includes one free 30-minute consultation and a 25% discount on standard fees where applicable
• Financial guidance (FinancialConnect) — telephonic support covering personal finance questions and planning topics
• Work-life resources (FamilySource) — digital resource lists for childcare, elder care, pet services, relocation, housing, and everyday life needs
• Digital self-care tools (CCBT) — interactive cognitive behavioural therapy programs for depression, anxiety, stress, chronic pain, sleep, and overall wellbeing
• Well-being coaching — sessions focused on nutrition, sleep, weight management, stress management, burnout, and resilience
• Crisis support — 24/7 crisis assessment and triage when you need immediate help