Health & Dental
Plan Guide

Your benefits, as described below, come into effect after any Provincial Health Care annual maximums have been exhausted. 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 100%, up to $1,000 per benefit year, 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 New Brunswick Dental Society Suggested 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.

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 100%, up to one trip per benefit year.

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 air ambulance, or for expenses outside of Canada.

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 100%, 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.

Charges for an Eye examination, by an Ophthalmologist or Optometrist, registered and legally practicing within the scope of their license, are covered at 100%, once every 12 months. 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 $200 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 at 100%, up to $50 per visit, up to $300 per practitioner per benefit year, provided the practitioner is licensed by the appropriate provincial or federal organization to practice their profession in accordance with the rules of their profession;

• Acupuncturist
• Chiropractor
• Dietitian
• Massage Therapist (referral required)
• Naturopath Consultations
• Osteopath
• Physiotherapist (referral required)
• Podiatrist/Chiropodist consultations
• Speech Therapist

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 for hearing aids, purchase or repairs, (excluding batteries), are covered at 100%, up to $500 evert 60 months, when recommended by a certified, clinical audiologist.

Charges are covered for the rental or purchase of medical equipment based on the nature and severity of the covered person’s medical needs at 100%, up to $1,000 per benefit year, 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 or rental, $1,000 per lifetime; repairs, $250 per lifetime);
• Respiratory Equipment including oxygen, CPAP/BPAP machines and supplies ($1,000 per lifetime);
• Contact lenses/glasses following cataract surgery (one pair per lifetime);
• Canes, crutches, walkers, casts, splints, catheters, colostomy supplies;
• Compression stockings or garments (excluding athletic or general-use apparel) (2 items or pairs per benefit year);
• Insulin pump and diabetic supplies not covered under the prescription drug benefit (infusions sets, cartridges, and continuous glucose monitors) ($1,000 per benefit year);
• Intra-uterine devices with no medicinal content (one per benefit year);
• Custom-made rigid or semi-rigid braces (not for athletic use) for back, neck, arm or leg ($1,000 per lifetime, per type of brace);
• 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);
• 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 $500 per benefit year, 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 at 80%, up to $1,000 per benefit year. The “Student Managed Drug Formulary” is designed to help reduce the cost of the plan while maintaining comprehensive quality care and benefits. Access to the drug formulary can be found at studentbenefits.ca, or your Plan Member portal nbccdsa.drawbridge.ca.

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

• Eligible drugs that, 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/serums (only if course requirement, authorization by school required);
• 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);
• Vaccinations, unless required for course of study.

The Wellness Benefit, up to $350 per benefit year, is a flexible benefit that can be used towards approved health or dental-related expenses that are outside your plan's coverage, or when you have reached your maximum of a covered benefit.

Covered expenses include items and services that contribute to your wellness, whether through physical activity, mental health, or overall lifestyle improvement.

Fitness & Physical Activity

• Gym and fitness memberships;
• Exercise classes (e.g., yoga, Pilates, spin, martial arts);
• Personal training services;
• Cosmetic Surgeon (medical or dental);
• Expenses from a specialist not covered by your - Provincial coverage;
• Health related items such as vitamins, menstrual products, supplements, etc.

Wellness Technology & Equipment

• Wearable fitness devices (e.g., smartwatches, activity trackers);
• Fitness and exercise equipment (e.g., weights, treadmills, bikes);
• Gaming systems and accessories that encourage movement, activity, or stress relief.

Mental Health & Well-being

• Counseling or therapy services (where not covered elsewhere);
• Meditation or mindfulness programs and apps;
• Stress management programs.

Recreation & Lifestyle

• Organized sports or league fees;
• Recreation programs or memberships;
• Hobby or activity-based purchases that support relaxation, creativity, or mental wellness.

A detailed receipt is required when submitting a claim. Cash or debit receipts are not accepted. The receipt must include:

• the claimants name;
• the date of service or purchase; and,
• a description of the items purchased.

Ineligible Expenses
While this benefit is flexible, some expenses are not eligible:

• Items without a clear wellness purpose or intended use;
• Primarily cosmetic or aesthetic services (unless otherwise noted);
• General day-to-day living expenses (e.g., groceries, rent, utilities);
• Fees not tied to participation (e.g., late fees, penalties);
• Expenses that have already been covered under another benefit plan;
• Fees charged by your school (gym, benefit plan fees, etc);
• Administrative, processing, shipping, or convenience fees;
• Expenses that do not clearly indicate that they were purchased for personal use.

When using this toward expenses that are not normally covered under your plan, we recommend that you contact the administrator to ensure that the expense is an approved expense. When dependants have been added to the Plan, this benefit is limited to $350 per family.

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, learning disabilities; or,
• 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
• 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.

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 New Brunswick Dental Society Suggested Fee Guide for Dental Services provided by General Practitioners, 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.

There is an overall dental maximum of $1,000 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.

The Plan provides coverage for eligible diagnostic and preventative services, at  100%, included in the overall maximum.

Examinations

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

X-rays

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

Cavity Prevention

• Polishing or cleaning teeth (two units per benefit year)
• Recall scaling (two units per benefit year at 100%, additional six units covered at 80%)
• Fluoride (once every 6 months for dependants age 16 or younger)
• Oral hygiene instruction (covered once only)
• Pit and fissure sealants (once every three years for dependants age 16 or younger)
• Space Maintainers (once per space in a benefit year)

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 50%, included in the overall maximum.

• Pulpotomy
• Root Canal (once per tooth)

The Plan provides coverage for eligible periodontic services at 50%, included in the overall maximum.

• Oral Disease
• Desensitization
• Gingival Curettage
• Gingivectomy
• Flap Surgery
• Tissue Graft
• Root Planing (four units per student year, combined with scaling)

The Plan provides coverage for eligible oral surgery services at 50%, 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 anesthesia services at 50%, included in the overall maximum.

• Local anesthesia
• Deep sedation
• Inhalation technique
• Intravenous sedation

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