Skip to main content - Skip to contact information

Benefit Plans

Dental and Extended Health Care Group Plans

ELIGIBLE DEPENDENTS UNDER Vancouver Island University HEALTH BENEFITS PLANS

Spouse:

  • legally married husband or wife
  • opposite sex person to whom you are not married but with whom you have lived and publicly represented as your spouse* for at least one year (no waiting period/MSP; 1 year/EHB & Dental)
  • same sex person to whom you are not married but with whom you have lived and publicly represented as your spouse* for at least one year (no waiting period/MSP; 1 year/EHB & Dental)

*Employee must sign "Declaration of Common Law Spouse" form.

Dependent Children:

  • any natural child, legally adopted child, stepchild or legal ward (including a sister, brother, niece or nephew if you stand in place of a parent) who is:
    • unmarried
    • mainly supported by you
    • under the age of 19 (MSP) / 21 (EHB/Dental)
    • 19 (MSP) / 21 (EHB/Dental) years of age or older but less than 25 years of age and in full-time attendance at an accredited school or university.

Not Eligible:

  • children under the age of 19 (MSP) / 21(EHB/Dental) who become employed on a full-time basis
  • divorced spouses
  • parents/grandparents

Note:


You and your dependents must be covered by a provincial medical/hospital plan in order to be eligible for Extended Health Benefits coverage.

MONTHLY PREMIUM COST FOR BENEFIT COVERAGE

Premiums effective April 1, 2012 for benefit coverage effective April 1, 2012

  EMPLOYEE EMPLOYER
MEDICAL Single ADMIN, BCGEU, CUPE, VIUFA 0.00 64.00
Couple ADMIN, BCGEU, CUPE, VIUFA 0.00 116.00
Family ADMIN, BCGEU, CUPE, VIUFA 0.00 128.00
DENTAL Single BCGEU 0.00 53.83
ADMIN, VIUFA 0.00 47.65
CUPE 0.00 46.32
Couple BCGEU 0.00 104.97
ADMIN, VIUFA 0.00 92.92
CUPE 0.00 90.32
Family BCGEU 0.00 156.11
ADMIN, VIUFA 0.00 138.19
CUPE 0.00 134.33
EHB Single BCGEU 0.00 50.53
ADMIN, VIUFA 0.00 47.37
CUPE 0.00 32.90
Family BCGEU 0.00 135.25
ADMIN, VIUFA 0.00 126.71
CUPE 0.00 87.65
DISABILITY INSURANCE
(100% employer paid) STD LTD
CUPE Not applicable $3.023/$100 of monthly benefit*
VIUFA\BCGEU $0.360/$10 of weekly benefit** $3.685/$100 of monthly benefit**
ADMIN $0.179/$10 of weekly benefit** $2.995/$100 of monthly benefit**

* Benefit for claims approved by carrier based on 60% of monthly earnings immediately prior to last regular day worked to a maximum monthly benefit of $12,000.00

** Benefit for claims approved by carrier based on 70% of insurable earnings, determined from hours normally worked per week (STD) or month (LTD) averaged over the 52 week period immediately preceding date of disability

AD&D IS .015/$1,000 AND GROUP LIFE IS .173/$1,000 COVERAGE

March 1, 2012

DENTAL

The Dental plan will reimburse you up to the amounts specified in the fee guide established for the B.C. Colleges/Universitys, as follows: 100% for Basic Services; 60% (BCGEU/CUPE/VIUFA/ADMIN) for Major Restorative Services; and 50% for Orthodontic treatment of dependent children.

You should ask your dentist for a verbal estimate of the cost of your proposed course of treatment; if the estimate is in excess of $300, request the dentist to complete a Manulife Financial claim application, or a standard provincial claim form, outlining the proposed work and estimated cost. This completed form should be forwarded to Manulife Financial who will confirm the amount that will be reimbursed for each procedure. You can then decide whether or not to proceed with the treatment knowing your share of the cost, if any.

Covered Expenses

Basic Services (Plan A)—100%

  • Oral examinations: once every nine months for employees, spouses and dependents age 19 and over, once every six months if dependent under age 19.
  • Fluoride treatment: once every nine months for employees, spouses and dependents age 19 and over, once every six months if dependent under age 19.
  • Polishing: one unit every nine months for employees, spouses and dependents age 19 and over, once every six months if dependent under age 19.
  • Scaling (16 units per year).
  • Consultations (as a separate appointment, two per year).
  • Xrays (limited to the equivalent of one full mouth series per year).
  • Complete mouth Xrays (once every three years).
  • Fixed band and loop space maintainers.
  • Basic procedures necessary for the extraction of teeth, and other basic surgical procedures normally performed by a dentist.
  • Amalgam fillings.
  • Composite fillings on anterior or bicuspid teeth only.
  • Stainless steel crowns (limited to once per tooth per five year period).
  • Gold inlays or onlays (once per tooth per five year period) but only when there are three or more surfaces of the tooth to be restored, decay is evident on pretreatment Xrays and one or more cusps are involved. If fewer than three surfaces are treated, the amalgam equivalent for the restoration will be paid. Xrays and study models are required for approval by Manulife Financial prior to commencement of treatment when a series of onlays or inlays is planned.
  • Gold foil, but only in cases of repair to existing gold restorations.
  • Relining or repairing of bridgework and dentures (not remaking).
  • Endodontic treatment, including root canal therapy (once per tooth).
  • Periodontic treatment of gums and bones surrounding and supporting the teeth (but not bone or tissue grafts).
  • Emergency Basic Services treatment which occurred while travelling or on vacation outside your province of residence or Canada.

Major Restorative Services (Plan B)— 60% (BCGEU/VIUFA/CUPE/ADMIN)

  • Crowns and/or bridges.
  • Onlays and/or inlays involved in bridgework.
  • Partial dentures.
  • Complete upper and lower dentures.
  • Implants (covered to the price of a denture).

No benefit will be paid for replacement of the above unless it is at least five years old and cannot be made serviceable. No benefit will be paid for replacement of lost, stolen or broken dentures.

Orthodontia for Dependent Children Only (Plan C)—50%

  • Orthodontic treatment covered under this plan shall include only charges for those necessary services which have as their objective the correction of malocclusion of the teeth. The lifetime maximum benefit payable for each covered child is $2,000 (BCGEU/VIUFA/CUPE/ADMIN).

No benefit will be paid for replacement of lost, stolen or broken appliances.

Exclusions

No benefit will be payable for the initial installation (or addition) of prosthetic devices unless such installation (or addition) is required primarily due to teeth that were missing, extracted or fractured after becoming insured under this plan for prosthetic devices.

The following expenses are not covered.

  • Broken dental appointments, completion of forms, written reports or communication costs.
  • Dental care which is cosmetic.
  • Self-inflicted injuries.
  • War, riot, insurrection or civil commotion.
  • Dental care which is the result of committing or attempting to commit an assault or criminal offence.
  • Items not listed in the Fee Schedule.
  • Services which are payable by any government plan.
  • Services or supplies provided by an employer’s medical or dental department.
  • Services or supplies for which no charge would normally be made in the absence of group benefit coverage.
  • Laboratory fees which exceed reasonable and customary charges.
  • Services and supplies for a full mouth reconstruction, a vertical dimension correction, or correction of a temporomandibular joint (jaw structure) dysfunction.
  • Charges for drugs, pantographic tracings, osseous or tissue grafts, implants and/or services performed in conjunction with implants.

EXTENDED HEALTH CARE

The Extended Health Care plan will reimburse you for necessary medical and hospital expenses which are reasonable and customary and are not covered by your provincial medical/hospital plans.

Prescription Card (Script Card)

You will be reimbursed at the rate of 80% (CUPE); 95% (ADMIN/BCGEU/VIUFA) for all covered expenses in excess of a $25 deductible per calendar year, whether you are single or have dependents. After $1,000 has been paid out for an individual in a calendar year, further eligible expenses incurred within that year will be reimbursed at 100%. Reimbursement at 100% is also provided for eligible emergency expenses incurred while travelling outside your province of residence, or outside of Canada.

If in any calendar year your covered expenses do not exceed the deductible, the covered expenses incurred during the last three months of that calendar year may be applied against the deductible for the next calendar year.

The maximum lifetime benefit payable is unlimited.

Covered Expenses

  • Charges made by a public general hospital, or by its extended care unit, in excess of ward accommodation for semiprivate or private accommodation.
  • Charges for drugs and medicines obtainable only by a dentist’s or physician’s prescription. Drugs and medicines prescribed for contraceptive or fertility purposes, and vaccines and medication used to treat an addiction or habituation including smoking are not covered.
  • Maintenance drugs are limited to a supply which is reasonably used within 100 days; other drugs are limited to a 34-day supply.
  • Fees of licensed chiropractors and naturopaths (excluding Xray service). The maximum benefit payable in any calendar year is $200 per person or $500 per family.
  • Fees of licensed physiotherapists.
  • Fees of licensed massage practitioners.
  • Fees of licensed podiatrists (excluding Xray service or appliances).
  • Charges for oxygen, blood and blood plasma.
  • Charges for permanent prosthetic appliances (artificial limbs and eyes, but excluding myoelectric limbs), crutches, splints, casts, trusses and braces, when prescribed by the attending physician.
  • Stump socks to a maximum of $200 per year, mastectomy brassieres to a maximum of $150 per year, and wigs and hair pieces when required due to temporary hair loss as a result of a medical condition, up to $500 per lifetime per person.
  • Charges for insulin, syringes and diabetic testing supplies when prescribed by the attending physician.
  • Charges for wheel chair, hospital bed, or iron lung when ordered by the attending physician.
  • Fees for services of a registered nurse when recommended by the attending physician in the management of an acutely ill patient. For in-home nursing care, there is a $25,000 lifetime maximum.
  • Necessary dental treatment by a qualified dentist required as the result of an accident and performed within 52 weeks after the accident for the repair of natural teeth.
  • Orthopedic shoes and foot orthodics when prescribed by a physician or podiatrist due to congenital or post-traumatic foot problems (arch supports excluded).
  • In an emergency, transportation by ambulance, railroad, boat or scheduled aircraft to and from the nearest hospital where adequate facilities are available.
  • Hearing aids when prescribed by the attending certified ear, nose and throat specialist (excluding payment for repairs, maintenance and batteries). The maximum benefit payable during a five year period is $600 per person.

Exclusions

The plan does not provide coverage for the following items.

  • Dental treatment, dentures or hearing aids (except as outlined).
  • Expenses which are eligible for payment under your provincial government Pharmacare/medical/hospital plans, any other government authority such as Worker’s Compensation, or any other group or individual insurance policy.
  • Expenses incurred prior to the effective date of coverage or incurred by an employee or dependent (other than a newborn infant) hospitalized on their effective date of coverage.
  • Expenses for which a third party is liable or expenses related to or as a result of war, riot, insurrection or civil commotion.
  • Procedures for purely cosmetic reasons.
  • Elastic stockings, air humidifiers and purifiers, arch supports, foot orthotics, rest cures, travel for health or health examinations of any kind.
  • Drugs and medicines not approved under the Food and Drug Act for sale in Canada, vitamin preparations (except Vitamin B12 used for the treatment of pernicious anemia), food and mineral supplements and medications commonly available without a written prescription.
  • Charges for completion of claim forms or written reports.
  • Hospital coinsurance, or public ward accommodation.
  • Out-of-province expenses incurred due to elective treatment and/or diagnostic procedures, or complications related to such treatment.
  • Acupuncture.
  • Psychological counselling.

VISION CARE

The Vision Care plan will reimburse you for necessary expenses for eyeglasses, contact lenses, or laser eye surgery. CUPE will be reimbursed at a rate of 100% to a maximum benefit payment of $250 per person during any 24 consecutive months. VIUFA, BCGEU and ADMIN will be reimbursed at a rate of 100% to a maximum benefit of $500 per person during any 24 consecutive months.

Eye Vision Exams shall be reimbursed to a maximum of $75 during any 24 consecutive months for ADMIN, BCGEU, CUPE, and VIUFA.

EMERGENCY TRAVEL ASSISTANCE (ManuAssist)

This plan will assist you and your family during a medical emergency occurring almost anywhere in the world. The plan provides 24 hour a day access to a communications network which can assist you to locate medical care and to arrange medical transportation. The plan also provides assistance to replace necessary travel documents or tickets in the event of theft or loss; however, the cost of replacement is not covered. Qualified physicians provide advisory and consultative services. Contact will be made with your family, employer or insurance company if requested. To obtain service, call the toll free number on your Emergency Travel Assistance card. You will be asked for the ID number and the group policy number which appear on the card, as well as for your provincial medical insurance number from your BC Health CareCard.

There are some countries in which Manulife Financial can not guarantee assistance. An up-to-date list of known countries where emergency travel assistance may be a problem can be obtained from Mondial Assistance. by calling one of the telephone numbers on the back of your Emergency Travel Assistance card.

Important: This webpage summarizes the provisions of the benefits provided by VIU’s group plans. It does not create or confer any contractual or other rights. The insurance policies issued to Vancouver Island University by Manulife Financial, together with applicable government legislation, will prevail if there is any conflict in information. Contact Carol Tisdale at Vancouver Island University, 250-740-6237, if you require additional information concerning benefits or claims and any matters not covered in this summary.