GTA Health and Dental Plan

Basic services:

• fillings
• oral surgery
• endodontics (root canal)
• periodontics (gum treatment)
• scaling

70% covered

• Student care network is available which covers an additional 20% of cost.
• Recall exams once every 12 months.
• Scaling is 2 units per policy year.
• Complete or new patient exam covered once every 36 months.
• Fillings in amalgam (metal) are covered for all teeth. Composite (white) fillings are covered for front teeth and pre-molars only.
• If you choose to have your back (posterior) teeth filled in composite, claims will be reimbursed according to the amalgam fee.

Preventive services:

• recall exams
• cleanings
• extraction of impacted teeth

70% covered

Student care network is available which covers and additional 30% of cost (extractions are 20%).

Major restorative:

• crowns
• bridges
• posts

Not covered

Student care network is available which covers 20% of cost.

Prescription drugs

80% covered to a maximum of $3,000 per policy year

• $8 deductible applies for every prescription/refill.
• Lowest price drug is covered (mandatory generic).
• Contraceptive medications are covered.
• Student care network (discounted service provider) for pharmacy available.

Paramedical services:

• Psychologists
• Massage Therapists Acupuncturists
• Chiropractors
• Physiotherapists
• Naturopaths Osteopaths
• Podiatrists/Chiropodists Speech Therapists

$30 per visit to a maximum of $500 per policy year for each type of service

Student care network (discounted service providers) for psychology, naturopathy, chiropractic, physiotherapy, massage therapy, mental health resources available.

Vaccinations

100% covered to a maximum $150 per policy year

$8 deductible applies for each vaccination.

Vision: eyeglasses and contacts 

$75 per 24 months

Student care network available 30% off prescription eyeglasses (independent specialists), and 10% off contact lenses (Clearly).

Vision: eye exams

$50 per 2 policy years for eye exams

N/A

Vision: laser eye surgery

$150 per policy year

Student care network available up to $200 off laser eye surgery (LASIK MD).

Diagnostic services (lab tests)

100% covered

Only covered when used to diagnose illness and performed in a commercial lab.

Home care nurse

100% covered

A home nurse is covered when certified in writing as medically necessary by the attending physician and when approved by Sun Life.

Home care tutorial

Up to a maximum $10/hour to a maximum of $300 per accident/illness

Private tutorial service by a qualified teacher if an accident or illness causes disability and confinement to a home or hospital for more than 7 consecutive days.

Medical equipment:

• hearing aids
• crutches
• wheelchair rental
• hospital-type bed
• rigid and semi-rigid braces (not for athletic use)
• permanent prosthesis

100% covered

N/A

Orthotics

100% covered to a maximum of $350 per policy year

N/A

Orthopedic shoes and modifications

100% Covered to a maximum of $350 per policy year

A prescription is required from a physician, podiatrist, chiropodist for these claims.

Ambulance

100% covered

The plan covers the reasonable and customary charges for air or land ambulance service to the nearest hospital when an emergency requires immediate medical attention.

Dental accident (covered under health plan)

100% covered (within 12 months of accident)

The repair/replacement of natural teeth damaged through an external accidental blow to the mouth according to the Provincial Dental Fee Guide for General Practitioners (the province where the service was performed).

Travel accident

120 days per trip (unlimited trips)

$5,000,000 lifetime maximum applies

Includes hospital, physician, and other services for emergency treatment of an injury or illness while travelling outside of the province in which you reside (including international travel). Reasonable and customary charges apply which are in excess of the provincial health-care allowance. International students (including US students) who are not permanent Canadian residents may not use their travel health coverage when traveling to their country of origin.

Trip cancellation

$1,500 per trip

Only covers pre-paid, non-refundable trip expenses in case of a medical emergency.

Trip interruption

$1,500 per trip

For trips taken during policy year in case of a medical emergency.

Accidental death and dismemberment insurance

N/A

For the loss of life or limb, and for paralysis caused by an accident.