Frequently Asked Questions

Transcription

1 Frequently Asked Questions What is the SACB-HDP?... 2 Who and what is Cigna?... 2 Who is eligible under the SACB-HDP?... 2 Are my Dependents covered?... 2 Who qualifies as an Accompanying Person?... 2 When will I and/or my family receive certificate card(s)?... 3 How many certificate cards will I receive?... 3 How does the SACB-HDP plan work?... 3 What is GHIP?... 3 Does everyone qualify for GHIP?... 3 What does GHIP cover?... 4 Do all provincial GHIP plans provide the same level of coverage?... 4 What if I am covered by GHIP in the province where I reside?... 4 What is BCMSP?... 4 Do I enrol as an individual or under the group plan?... 5 What if I already purchased other private health insurance coverage?... 5 How do I use my SACB-HDP certificate card?... 5 What is covered by the SACB-HDP?... 6 Am I covered for Orthopedic shoes and Orthotics?... 6 Am I covered while travelling outside of Canada?... 6 What do I do if I encounter a medical emergency outside Canada?... 6 What is SAICO and what do they cover?... 7 What is not covered by the SACB-HDP?... 7 How do I submit a claim?... 7 Where do I obtain additional SACB-HDP claim forms?... 7 When does SACB-HDP coverage end?... 8 How do I submit a comment or question?... 8

2 What is the SACB-HDP? The SACB-HDP provides insurance to pay the cost of hospital, medical and dental services which Saudi Arabian Government-sponsored students, trainees and their accompanying dependents may require to maintain their health while in Canada. The SACB-HDP is a group health and dental benefit program which includes basic health (GHIP replacement coverage), supplemental health (including prescription medications) and dental care. Who and what is Cigna? Cigna is our Insurance partner who insurers the SACB-HDP plan, thus the reason there logo appears on most SACB-HDP communications. Who is eligible under the SACB-HDP? A member is eligible if he/she is: A sponsored student; A spouse (husband or wife) of a sponsored student; A dependent son of a sponsored student under the age of 25 and registered in the Bureau; A dependent daughter of a sponsored student and registered in the Bureau; A person accompanying a sponsored student and registered in the Bureau. Are my Dependents covered? The following dependents of approved students or trainees are eligible: your legal spouse; your unmarried children under age 18; your unmarried children under age 25 if they are full-time students (annual proof of registration required); your unmarried children incapable of supporting themselves because of physical or mental disorder are covered without age limit if the disorder begins before they turn 18, or while they are students under age 25 and the disorder has been continuous since that time; A person accompanying a sponsored student and registered in the Bureau. Who qualifies as an Accompanying Person? A student or trainee s family member who accompanies the student or trainee on scholarship and is approved by the Cultural Bureau is eligible.

3 When will I and/or my family receive certificate card(s)? You will receive an from the SACB-HDP Administrator requesting you to provide your current mailing address before certificate cards can be mailed out. Once the SACB-HDP Administrator receives your current address details, a personalized card for each eligible family member will be mailed to your home address. How many certificate cards will I receive? Each approved eligible member will receive one personalized certificate card. For example, 4 insured members will receive 4 certificate cards. a family of How does the SACB-HDP plan work? The SACB-HDP program will provide you and your accompanying family members with a comprehensive health and dental insurance plan which will either provide: a) full coverage to those of you who do not hold any other form of health insurance coverage [such as provincial health (GHIP) or other insurance plan]; or b) be complementary to any coverage you currently hold [such as provincial health (GHIP) or other insurance plan]. What is GHIP? Each province in Canada runs a Government Health Insurance Plan (GHIP) which is offered to residents who meet the province s eligibility criteria. Does everyone qualify for GHIP? The eligibility criteria for non-residents of Canada who are studying or working differ by province or territory. Your respective provincial Ministry of Health determines eligibility based on the study or work permit you hold from Citizenship and Immigration Canada (CIC). In order to provide assistance to you in determining whether you qualify for GHIP we have posted a summary of which provinces will allow coverage to non-residents studying or working in Canada on the SACB-HDP Portal which can be found at: This summary is intended to be used as a guideline only; final decision of eligibility rests with the respective Ministry of Health. To offer you a general overview: If you reside in the following provinces you may qualify for GHIP depending of the type of study/work permit you hold: British Columbia, Alberta, Manitoba, Saskatchewan, Nova Scotia or Newfoundland. Ontario, Quebec, New Brunswick and P.E.I. do not offer provincial health care (GHIP) to international students holding a study permit or their accompanying family members. However, they may grant GHIP to post-doctorate fellows and trainees who hold work permits.

4 What does GHIP cover? Government-run health insurance plans primarily provide essential, basic health care services such as hospital, physician, diagnostic services (lab, x-rays) and certain other medical services. Do all provincial GHIP plans provide the same level of coverage? All provincial or territorial GHIP plans provide standard ward hospitalization, physician and diagnostic services. Other health care services vary by province. For example, the majority of provinces do not include coverage for prescription medications, dental care, ambulance services, etc. What if I am covered by GHIP in the province where I reside? You are to continue to utilize your provincial health insurance plan card. Any expenses which are not eligible under your GHIP plan can be submitted to the SACB-HDP for processing. What is BCMSP? BCMSP is a government program that covers the cost of essential medical care within Canada, such as: Hospital care Physician visits Laboratory and diagnostic services I currently have coverage under the SACB-HDP program, why should I have to enrol in BCMSP? All residents of British Columbia are required to enrol with MSP. If you do not enrol into BCMSP, your other health benefits such as prescriptions drugs, vision care, and dental benefits will be suspended and no claims will be paid. Once you have enrolled in BCMSP your health benefits will be in effect with the SACB-HDP.

5 Do I enrol as an individual or under the group plan? All SACB-HDP members residing in British Columbia should enrol under the Group Plan as you will not have to pay the BCMSP premium. The monthly invoices will be sent directly to the SACB-HDP administrator and the premium will be paid by the SACB-HDP. To enrol you must print and complete the Group Application Form provided in the link below. Once this form is completed you must return it and include copies of your and your dependents immigration documents (study/work permit) to the SACB- HDP administrator by mail at the address provided below: SACB-HDP Blair Place Ottawa, Ontario K1J 9L8 HDP%20BC%20MSP%20Group%20Application%20Form.pdf Please note scanned or faxed copies will not be accepted. For more information in regards to BCMSP please refer to the BCMSP page of the SACB-HDP Portal. What if I already purchased other private health insurance coverage? You are to continue to utilize the coverage you have in place until the expiry date of your plan. Any expenses which are not fully covered by your private health plan can be submitted to the SACB-HDP for processing. Once your private health insurance plan expires, you will only be required to hold coverage under the SACB-HDP. How do I use my SACB-HDP certificate card? If you currently hold no other form of health coverage, you would simply present your SACB-HDP certificate card along with your photo identification to the health service provider. All claims should then be submitted to the SACB-HDP Administrator for processing. The SACB-HDP will reimburse either the provider directly or, in cases where you are required to pay, the SACB-HDP will reimburse you. If you currently have coverage under a provincial health insurance plan (GHIP), you should present your provincial health card along with your SACB-HDP certificate card to the health service provider. The provider will know to charge services eligible under the provincial plan to the respective provincial Ministry of Health. If certain expenses are not eligible under your GHIP plan, they should be submitted to the SACB-HDP. If you are currently covered under a private health insurance plan, you must: 1. Present your private health insurance plan card to the service provider; your claim must be sent to your private insurer first. 2. If your private insurance company does not pay the service in full, you should submit your claim including the statement of payment from the other insurance carrier along with copies of your receipts to the SACB-HDP for processing. Make sure to keep photocopies of your claims and receipts.

6 What is covered by the SACB-HDP? The SACB-HDP is a comprehensive benefit plan which includes but is not limited to: in-patient and outpatient hospital care; physician services including surgical, anesthetic charges and consultations by specialists; diagnostic (lab and x-ray) services; ambulance transportation; medically necessary equipment and supplies (e.g., wheelchairs, hospital beds); and emergency out-of-country travel insurance. The plan also includes supplementary services such as prescription medications, paramedical services, vision care and dental care. Your Group Benefit Booklet provides a full description of eligible benefits. You may view or download your booklet after February 1, 2012 by visiting the SACB-HDP Portal at Am I covered for Orthopedic shoes and Orthotics? Yes you are covered for Orthopedic shoes, however you are limited to 2 pairs per calendar year and/or up to a $500 maximum per calendar year. You are also covered for custom made foot orthotics, however you have a $500 maximum. Please note that an Insurer approval must be obtained prior to the purchase of any Orthopedic/Orthotic footwear. A Doctor s diagnosis and estimate for cost of shoes must be submitted/approved PRIOR to any purchases. Am I covered while travelling outside of Canada? Yes, coverage is offered to members while travelling outside of Canada, provided the reason for departure is: work-related to the student or trainee s on-going studies; or travel for personal reasons while the student or trainee is still actively studying in Canada; or a temporary visit to Saudi Arabia. The plan covers medical expenses incurred as a result of a medical emergency arising while outside of Canada for vacation, business or education purposes. A medical emergency is a sudden, unexpected injury or acute episode of disease. What do I do if I encounter a medical emergency outside Canada? Should you encounter a medical emergency outside of Canada you are to contact Cigna at the following telephone number, or collect to Please note that in the event of an emergency the above mentioned telephone numbers for Cigna can be located on the back of your SACB-HDP card along with any relevant information.

7 What is SAICO and what do they cover? SAICO is one of the Insurance partners located in the Kingdom of Saudi Arabia. SAICO provides coverage only when services are rendered in the KSA and coverage mirrors the Canadian insurance benefits. What is not covered by the SACB-HDP? Please note, details of the plan s limits and exclusions can be found in your SACB-HDP Group Benefit Booklet. Please visit the SACB-HDP portal at to view or download your booklet. You should make sure to read this information carefully as it is important that you are well informed on what the plan does and does not cover. The following is a sample of expenses for which no benefits are paid for: expenses private insurers are not permitted to cover by law; services or supplies that do not represent reasonable treatment; treatment performed only for cosmetic purposes; contraception, other than oral contraceptives; services or supplies not listed as covered expenses; Teeth whitening extra medical supplies that are spares or alternates; rest cures, spas and health monitoring; expenses arising from war, insurrection, or voluntary participation in a riot; any drug or item which does not have a drug identification number as defined by the Food and Drugs Act, Canada (e.g., over the counter medications); drugs used to treat erectile dysfunction; orthodontic treatment; massage therapy; missed appointments. How do I submit a claim? Routinely, health care service providers will send the request for payment on your behalf. In these cases, the provider may use their standard invoice to submit their expense to us or they may ask you to supply a claim form. You should always remember to bring a claim form with you to your scheduled appointments. If a claim form is required, you must complete Sections 1, 2 and 3 and the health care provider is to complete Sections 4 and 5. In situations where you are required to pay the provider, you will need to send your claim form to us. Please ensure that the form is fully completed and attach all original itemized statements and/or receipts. Eligible claims will be reimbursed directly to your bank account within a period of 14 days from the date we receive all supporting documentation necessary to assess your claim. Once your claim is processed an Explanation of Benefits will be mailed to you. Where do I obtain additional SACB-HDP claim forms? Additional claim forms can be downloaded and printed through the SACB-HDP Web Portal at

8 When does SACB-HDP coverage end? Students and trainees coverage terminates on the earliest of the following: the date they are no longer eligible, as determined by the Cultural Bureau in Ottawa; the date the policy terminates; or the date the student or trainee leaves Canada, unless the reason for departure is work-related to on-going studies, travel for personal reasons while still actively studying in Canada, or a temporary visit to Saudi Arabia. Dependents coverage terminates when the student or trainee s insurance terminates or the dependent no longer qualifies as a dependent, whichever is earlier. How do I submit a comment or question? Your feedback is valuable to us. Our FAQ s will be updated based on your comments and questions. Please send us any of your questions by to clients@sacb-hdp.com.