|
|
|
Your Coverage
|
UHIP will pay up to $1,000,000 (Canadian dollars) per policy year (September to August) for the cost of your eligible medically necessary1 health services and medical treatments2.
UHIP provides coverage for basic health care services such as hospital, physician, laboratory, ambulance and some other services generally covered by Ontario resident health insurance (OHIP). In addition to OHIP, there are specific items and programs available to an Ontario resident under special approvals by the Ministry of Health and Long Term Care (e.g. Assisted Devices Program (ADP), Elective Surgical Procedures, Home Care, Nutritional Supplements, Public Health Programs, Addiction and Bridging Programs). These services might be covered by UHIP under some circumstances but they require a pre-approval from Sun Life.
Below you will find an overview of medical services and treatments that are covered under UHIP, along with coverage limitations. Contact Sun Life to help answer any questions or concerns you may have about your UHIP coverage.
1 Medically necessary refers to a treatment, service or supply which is eligible under OHIP and is essential, effective and appropriate, as determined by Sun Life, in the diagnosis, care or treatment of a specific medical condition, sickness or injury.
2 Coverage rates are determined by the OHIP Schedule of Benefits and Fees.
| |
Service or treatment
covered under UHIP |
| Hospital Services in Ontario |
- emergency room services and out-patient charges
- physician services or services provided by any person paid by the hospital
- use of operating and delivery rooms (including anaesthetic and surgical supplies)
- radiotherapy facilities and respiratory equipment
- semi-private or private accommodation, including meals, when medically necessary and certified in writing by the attending physician
Note: elective in-patient and out-patient surgery or treatment requires pre-approval by Sun Life. A pre-determination letter is required from the attending physician or surgeon detailing the medical need. This letter must indicate:
- medical necessity and urgency of the procedure,
- expected duration of hospital stay, and
- billing information
For additional information, contact case.mgmt@sunlife.com.
Note: Sun Life must be notified within 48 hours of any hospital stay expected to exceed 72 hours in duration
|
|
Physician’s Services
(e.g. Family Doctor, General Practitioner, Specialist)
|
- one annual health examination
- services at the physicians’ office, in a hospital or institution, or at home
- diagnosis and treatment of illness and injury
- surgery, including the administration of anaesthetics
- care related to pregnancy (prenatal and postnatal), even if pregnancy began before arrival in Ontario
|
| Services of Other Practitioners |
- treatment by an osteopath or podiatrist
- physiotherapy in an OHIP Designated Physiotherapy Clinic in Ontario, when the criteria set by OHIP is met
|
| Diagnostic Laboratory and X-ray Services |
- Coverage is at the same level and under the same conditions as OHIP coverage.
- Tests should be completed at a location within the Preferred Provider Network.
- x-rays for diagnostic and treatment purposes
- laboratory services, and clinical pathology, ordered by a physician and performed in an approved laboratory
- laboratory fees
|
| Ambulance |
- ground or in-province air ambulance to the nearest available hospital, when confirmed as having been essential by a physician or designated hospital official
- Maximum coverage as specified by OHIP, which includes a fee payable by the covered person.
|
|
Vision Care
(if under age 20 or 65 and over)
|
- one eye examination by a physician, ophthalmologist, or optometrist once in every 12 consecutive months for each covered person under age 20 or 65 and over
- for more frequent exams, preauthorization from Sun Life is required
|
| Drugs Dispensed in Hospital |
- prescription drugs dispensed during a hospital stay for use in the home
|
|
Dental Surgery
(when performed in a hospital)
|
- specified dental surgery, including fractures or medically necessary jaw reconstruction, when hospitalization is judged medically necessary, as determined by a physician or dental surgeon, and the procedures are performed in an approved hospital by a dental surgeon who is a staff member of the hospital
- pre-approval from Sun Life is required, except in the case of emergency. For additional information, contact case.mgmt@sunlife.com.
|
Emergency Services Outside
Ontario or Canada |
→ Outside Ontario (but still in Canada)
- coverage for medical expenses up to the same level of coverage you would receive in Ontario
→ Outside Canada
For additional information, visit the Travel Coverage section of the website or contact case.mgmt@sunlife.com.
|
| Repatriation |
- Sun Life will pay up to $20,000 for eligible expenses for the repatriation of a terminally ill covered person (or the remains) to the covered person’s home country
- in all circumstances, expenses will be eligible for reimbursement only to the extent that such expenses are considered reasonable by Sun Life compared to customary charges for such services. Sun Life must pre-approve all repatriation costs
→ Terminal Illness
- if a covered person is diagnosed as terminally ill (with 12 months or less to live) and the medical condition is stable, either Sun Life or the covered person may request repatriation to his/her home country
- when Sun Life and the covered person mutually agree to repatriation, Sun Life will pay up to $20,000 or the actual cost, whichever is less, for returning the covered person by the most direct route to the air terminal nearest the covered person’s residence in his home country
- if Sun Life or the covered person refuse the request for repatriation, UHIP coverage will continue for as long as the covered person meets the eligibility requirements of UHIP. Until a terminally ill covered person has been repatriated or no longer meets the eligibility requirements of UHIP, Sun Life, in consultation with the attending physician, reserves the right to determine the level of care required in the circumstances, including the right to transfer the person to another hospital or medical facility. In addition, Sun Life may consider alternative procedures, services, and personnel, and to provide benefits on the least costly basis that will result in adequate care, consistent with accepted standards of medical practice
- if a covered person requests repatriation, and Sun Life does not agree that the member meets the criteria for repatriation, Sun Life will obtain an independent medical opinion
→ Death
- if a covered person dies, Sun Life will pay up to $20,000, or the actual cost, whichever is less, of returning the person’s remains by the most direct route to the air terminal nearest the person’s residence in the home country. Eligible expenses within the $20,000 limit will include the reasonable and customary costs for preparation of the body, transportation of the remains, documentation, and shipment container(s); limited to those required by provincial, federal, international or transportation legislation
- Sun Life must be notified as soon as is reasonably possible regarding any request for repatriation
|
Notice: The information presented here summarizes the main aspects of UHIP. Your actual benefits from UHIP will be determined according to the terms and conditions of the insurance contract with the UHIP insurer.
No typographical or mechanical error made by a university of any of the parties to the UHIP insurance contract will invalidate insurance otherwise in force, or continue insurance otherwise terminated under the insurance policy’s terms and conditions.
Supplementary Health Insurance
In Ontario, most citizens and permanent residents have supplementary health insurance in addition to their provincial plan (OHIP). Supplementary health insurance provides additional coverage for services that are not covered under OHIP or UHIP (e.g. prescription drugs, dental care).
Many participating universities offer supplementary health insurance through their student or employee unions. These plans are separate from your UHIP coverage. Contact your university to learn about the supplementary health insurance options available to you.
If you are a student, your UHIP coverage begins on the date you arrive in Canada, but not earlier than the 10th day of the month before your academic term begins.
If you are an employee, your coverage begins on the date you arrive in Canada, but not earlier than 20 days prior to your employment date with the University.
For example:
| Arrival in Canada |
August 05, 2014 |
| Start of academic term |
September 1, 2014 |
| Start of UHIP coverage |
August 10, 2014 |
If you arrive earlier than the 10th day of the month before your academic term begins, you will need to buy private medical insurance until your UHIP coverage takes effect.
For example:
| Arrival in Canada |
December 3 , 2014 |
| Start of academic term |
January 01, 2015 |
| Start of UHIP coverage |
December 10, 2014 |
In this example, private coverage3 is required from December 3rd to December 9th.
If you have any questions about the start date of your coverage, please contact the UHIP Plan Administrator at your university.
3 Please note: UHIP does not endorse nor advertise any particular private coverage plan. It is your sole responsibility to research a private coverage plan that is right for you.
Your UHIP coverage will end on the earliest of the following dates:
- the last day of the month in which you have paid for UHIP;
- the date you are no longer eligible for UHIP;
- the date that your authorization documentation (i.e. student visa, work permit, or temporary resident permit) expires or is no longer good, and you have not been given an extension of coverage (see How do I extend coverage);
- the date it is determined that your proof-of-coverage card has been used fraudulently;
- the date you begin a leave of absence not approved for UHIP coverage (see Approved Leave of Absence);
- the date Sun Life obtains reasonable evidence that medical clearance was fraudulently obtained from Citizenship and Immigration Canada as a result of either non-disclosure or submission of false medical test results;
- the date a student enrolled in a non-accredited program at a university that offers UHIP coverage transfers to a university that does not offer UHIP coverage;
- the first of the month that coincides with or immediately follows the normal retirement date defined by the participating university, if you are an employee; or
- for short-term university visitors, no later than the end of the month when your educational or staffing function ends.
Your dependant’s UHIP coverage will end on the earliest of the following dates:
- the last day of the month in which UHIP has been paid for your dependant(s);
- the termination date of your dependant’s coverage;
- the last day of the month in which your dependent is no longer considered an eligible dependant;
- the date that Sun Life obtains reasonable evidence that medical clearance was fraudulently obtained from Citizenship and Immigration Canada as a result of either non-disclosure or submission of false medical test results
If you have any questions about the end date of your UHIP coverage, please contact the UHIP Plan Administrator at your university.
Your UHIP coverage may only be extended once, for one of the following reasons:
If authorization has been granted to you by Citizenship and Immigration Canada to stay in Ontario until the later of the end of the term in which you graduate or the end of the term in which you convocate, you may be able to extend your UHIP coverage by purchasing it in one month units to a maximum of 4 months.
An extension of coverage is only available if you met the definition of an eligible student on the day you completed your studies. If your extension of coverage is approved, it starts immediately the day after your UHIP coverage would have otherwise terminated.
If you are authorized to stay in Canada for travel purposes, for instance if you have extended your temporary visitor’s permit, you may extend your UHIP coverage to a maximum of 60 days. Coverage must be purchased in one-month units.
- Extension of Authorization Documents
If your student visa or work permit has expired and you have requested an extension of the authorization document, you may extend your UHIP coverage. You must apply for a coverage extension at your university before your UHIP coverage expires, and provide proof that you have applied for an extension of the authorization document.
- Emergency Hospitalization on Coverage End Date
If you or a dependent family member is hospitalized for emergency medical treatment4 on the date your coverage would otherwise end, you may extend your UHIP coverage for a maximum of 31 days. Coverage is for standard ward accommodation only; no other expenses will be covered. You do not have to pay for this extension.
All coverage extensions will need to be approved by your university. To extend your coverage, you must visit your UHIP Plan Administrator and pay the required premium. If you have any additional questions, contact Sun Life.
4 Sun Life will not reimburse the cost of charges relating to elective (non-emergency) surgery or treatment during your extension period.
Approved Leave of Absence
If you need to take a leave of absence from your program of study or employment, you will need to obtain approval from your university in order to continue coverage under UHIP. If approved, UHIP coverage may be continued for a maximum of four months starting from the approved start date of your leave. If you will be taking parental or maternity leave, UHIP coverage may be continued for a maximum of twelve months.
To receive an approved leave of absence, you must:
- Visit the UHIP Plan Administrator at your university. Your leave of absence must be approved at least one month before the start of your leave. (Your university may waive this requirement if, in its opinion, the leave of absence is a result of accident or illness).
- Pay the full required UHIP premium.
- Send documentation of your approved leave of absence to Sun Life at case.mgmt@sunlife.com. Documentation must be sent fifteen days prior to the start date of your approved leave. Approval letter from the university must indicate the reason for the leave, effective date and expected return date.
CONDITIONS
Please note that each approved leave of absence is subject to the following conditions:
- your extension of UHIP coverage must be continuous
- you are covered for medically necessary emergency expenses when travelling outside Canada for a maximum of 90 days beginning on and including the date of departure. Upon expiry of the 90-day period, your UHIP coverage will not resume before your return to Canada. It is recommended that you purchase additional travel insurance coverage as significant out-of-pocket expenses may be incurred (see “Am I covered while traveling outside Ontario?”);
- you must pay all required UHIP premiums in full, in advance, prior to the start of your approved leave of absence. Once you return from your approved leave of absence, you may apply to Sun Life for a premium adjustment that will take into account any period during your approved leave of absence that UHIP coverage was not in effect because of the 90-day limitation, as described above;
- no benefits are payable for expenses incurred on an approved leave outside of Canada as a result of, or in any way associated with:
- suicide, attempted suicide or self-inflicted injury, whether sane or insane;
- committing or attempting to commit a criminal act under legislation in the jurisdiction where the act was attempted or committed;
- a non-recreational or professional sports activity.
Talk to your UHIP Plan Administrator to learn more about an approved leave of absence. If you have any additional questions, contact Sun Life.
Travelling in Canada
If you travel outside Ontario but within Canada, UHIP provides coverage for medical expenses up to the same level of coverage provided in Ontario. Always make sure to complete a claim form and get the original receipts for your medical expenses. Please send all original receipts and invoices to the address listed on the claim form for review.
Travelling Out of Country
If you travel outside of Canada, UHIP provides minimal out-of country coverage which may not be sufficient to cover your medical expenses (see Emergency Services outside Ontario or Canada). It is strongly recommended that you purchase additional private travel insurance5 as significant out of pocket expenses may be incurred.
If you require any emergency service, you will be required to pay the hospital or medical provider directly. Always make sure to complete a claim form and get the original receipts for your medical expenses. You will need to send these documents to Sun Life for reimbursement.
5 UHIP does not endorse nor advertise any particular private coverage plan. It is your sole responsibility to research a private coverage plan that is right for you.
If you have family members who will be moving with you to Canada. UHIP coverage is mandatory for eligible dependant family member(s) residing in Ontario.
Eligible dependants include:
- A spouse (including same-sex spouse)
- A common-law partner (including a same-sex common law partner)
- A child or children
Other family members, such as siblings or parents, are not considered eligible dependants. For more information see “Who is eligible?”
Dependant Enrollment
Dependants are not automatically enrolled in UHIP. To enroll your eligible dependant family member(s), you must contact the UHIP Plan Administrator at your university. Your UHIP administrator will help you by providing enrollment information and details.
Dependants must be enrolled within 30 days after they become eligible for UHIP, otherwise a late fee will apply.
Dependant Premium
The cost of UHIP will depend on the number of eligible dependants you are enrolling. For more information see “How much does UHIP cost?”
If you have any questions, you may contact the UHIP Plan Administrator at your university.
Dependant Coverage
Dependants are provided coverage for the same medically necessary health services and medical treatments that you also receive under UHIP. For more information, see “What is covered?”
Dependant UHIP Renewal
You will need to renew UHIP coverage for your dependant family member(s) each year, as long as your dependant(s) remain eligible UHIP members.
UHIP coverage for dependants must be renewed within 30 days of expiry. To renew coverage, you must contact the UHIP Plan Administrator at your university and pay the required premium.
You may be eligible for a refund of your UHIP premium if one of the following applies to you:
- you withdraw from your academic program voluntarily or at the request of the university
- you complete your academic program
- you are not in regular attendance, as defined for the program in which you are enrolled
- you have dependant family members who have left Canada
- you become eligible for OHIP coverage6
- you are granted a UHIP exemption 6
You are not eligible to receive any refund of your UHIP premium for scheduled breaks between terms, if this is the only period for which you are applying for a refund.
Refund Application & Deadline
To apply for a refund, please contact the UHIP Plan Administrator at your university.
Refund applications are accepted on an on-going basis until March 1st of each academic year.
IMPORTANT! You are strongly encouraged to apply for a refund as early as possible. Timing is very important and may affect the refund amount you receive (see Refund Calculations).
6 Note: If you become eligible for OHIP coverage or are granted a UHIP exemption following the application deadline, you may still be eligible for a partial refund. For more information contact your UHIP Plan Administrator.
Refund Calculations
Refunds are calculated from the first of the following month from when Sun Life receives the completed refund request from your UHIP Administrator.
Refunds are available for complete calendar months and current academic year only.
No refund amount is paid in respect of months in which claims have been paid or for any months prior to the last month for which any claim was paid. These months would be considered covered months. This is applicable to ALL refund requests.
Refund calculation examples
- A member enrolled from September 1 to August 31 receives OHIP on December 15. Sun Life receives the refund request on December 28. The refund amount is calculated from Jan 1 – Aug 31 and UHIP coverage is terminated back to December 14.
- A member enrolled from September 1 to August 31 receives OHIP on January 3. Sun Life receives the refund request on February 22. The refund amount is calculated from March 1 – August 31 and UHIP coverage is terminated back to January 2.
- A member enrolled from September 1 to August 31 will graduate at the end of June and is requesting a refund for July and August. No refund is applicable as refunds are not available for the scheduled breaks between terms.
- A Member enrolled from September 1 to August 31 has been approved for a UHIP exemption. Sun Life receives the refund request on October 16. The member has a UHIP claim incurred on October 8. The refund amount is calculated from November to August and UHIP coverage is terminated as of October 9.
- A member enrolled from September 1 to August 31 withdraws from their program on January 16. Sun Life receives the refund request on March 25. No refund is applicable as the request was received after March 1 and is not eligible.
Refund Appeal
If your refund request is denied or you do not agree with the amount of the refund, you may appeal the decision. To make an appeal, please contact the UHIP Administrator at your university; the UHIP administrator will forward your request to Sun Life. Once Sun Life carefully reviews your case, a response will be sent to your UHIP Administrator, who will forward the decision to you.
|
|