The Journal

Solid Group Plans Made Simple

Student Benefits Coverage

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Student in your family?  Verification Time!

It’s that time of year! Employees whose dependent child is currently identified as a full-time student, 21 years and older, will receive a verification letter from us in early September to re-certify the student’s status. Dependent children who are students are eligible for coverage until age 25, or age 26 in Quebec.  Verification of continuation of coverage must be received by our office by September 30th; otherwise benefits for your overage dependent will terminate.

Student Studying Out-of-Province?

If your dependent child is studying in another province or country, it’s important to understand how the insurer of your group benefits plan will view the student. They may not consider them to be “travelling” for purposes of coverage, but rather as having taken residence in the new location. While it can complicate coverage eligibility, most insurers will extend coverage for students, although some may apply an additional premium.

We suggest you check with our office prior to the student leaving for school to ensure existing coverage can be extended or to review other options. Depending on the overall maximum included in your extended health policy, it may be wise to consider additional travel insurance. See below for additional information on studying in another country.

Maintaining Provincial Health Coverage

To continue eligibility for extended health, the student MUST maintain their provincial health coverage. Each province has established guidelines for continuation of provincial health coverage for students outside of their normal province of residence. This information can be found on provincial government websites.

Provincial health will only cover the services of physicians and hospitals while outside the student’s normal province of residence.

Most provinces will allow students to retain eligibility for coverage for the period of their studies. The following conditions typically apply:

  • The student must be a Canadian citizen or permanent resident
  • The student makes their home in the specifically named province
  • The student must be physically present in Canada for six of the 12 months immediately preceding their departure for the out-of-province school
  • The student must be in full-time attendance at an educational facility recognized by the provincial health commission.
  • The student is required to return to their normal province of residence by the last day of the month following the completion of their studies or complete a wait period upon their return to regain provincial health coverage.

Student in Another Province?

The Canada Health Act requires provinces and territories to extend medically necessary hospital and physician coverage to their eligible residents during temporary absences. This “portability” provision (generally implemented through a series of bilateral reciprocal billing agreements between the provinces and territories, with the exception of Quebec) means that your health card will be accepted when you receive hospital or physician services in another province or territory. Sometimes, however, there is a requirement for patients to pay “up front” and claim reimbursement from their home provincial or territorial health insurance plan.

Additional benefits that provinces and territories may include under their respective health insurance plans are generally not portable outside one’s home province/territory (e.g. drug plans). Most group extended health plans provide coverage for such “additional benefits” (such as ambulance services and prescription drugs) in case of a medical emergency while studying in another province or territory.

Student in Another Country?

A medical emergency outside of Canada could use up $1,000,000 very quickly. We recommend adequacy of coverage be reviewed with each person studying outside of Canada.

Depending on the lifetime maximum in the group plan, as well as other personal factors, employees can purchase additional protection for their dependent child while they are studying out-of-country. Both the group plan and individual travel plan cover ambulance, physician, in-hospital nursing, testing and drugs in a medical emergency although there may be differences in the amount of coverage provided by each. In most cases, individual travel plans offer more protection (ie. higher limits, more eligible expenses) than out-of-country coverage through your group health plan. In case of a claim, the individual travel plan will pay first, protecting the group plan’s lifetime maximum.

In preparing when a dependent child is planning to study out of Canada, employees should check the fine print – plan limitations and exclusions, plan maximums, need for things like trip cancellation, baggage return, trip interruption, etc. (items typically not covered in group plans).