Please contact us if you have any questions about the correctness of this post!
Got questions about your Student Benefits Plan? Is that question “what the heck is a Student Benefits Plan”? You’ve come to the right place.
How does it work?
Your SAMRU benefits plan covers a bunch of services, including prescription drugs, vision and dental care, practitioners like physiotherapists and naturopaths, and some medical equipment like wheelchairs or crutches.
If you’re using those services, there’s a good chance at least some of it will be paid for by your plan! The process can vary depending which service you’re using, but if you’re not sure how it works, just pull out your myBenefits card and ask. (No myBenefits card? No problem: you can print one online!)
You won’t always get 100% coverage for everything. Some things are only covered up to 80% – you’re expected to pay the remaining cost. Coverage also depends on “reasonable and customary charges”, which means you may not be covered if you go somewhere that’s way more expensive than usual. And most things have a limit to how many times you can access a service, or how much money you can spend – for example, you’re only covered for one eye exam every 24 months, and dental coverage has a maximum of $1000 per year.
For the nitty gritty details about services covered by your SAMRU Student Benefits Plan, please click here.
Why am I paying these fees?
We’re glad you asked! In the 1990s, two separate student referenda introduced mandatory health and dental plans for Mount Royal students. We asked and students answered: providing health care is important to students. (In fact, the health benefits plan is SAMRU’s second-largest service!)
We’ve done our very best to design a plan that offers good coverage for a reasonable price. That’s especially important considering the high cost for health and dental services – for example, did you know that dental fees in Alberta have increased by 56% over the last ten years? And health spending in Canada has been on the rise, too.
Our benefits plan is mandatory so that the insurance risk can be spread out over a larger number of individuals – it’s a model that actually lowers the cost per student. It’s similar to why you pay a U-Pass fee, even if you don’t take the bus. An individual health and dental plan could cost up to five times more!
The good news is that if you’re covered by another plan – for example, through your parents, your spouse, or your employer – you can opt out of SAMRU’s benefits. You’ll still have to pay the fee upfront, but you will be reimbursed with a cheque later in the semester. You don’t have to opt out, though, and if you’re covered by more than one plan you can coordinate your benefits – meaning that you can use your two plans to get 100% coverage. You can learn more about coordinating your benefits here.
Can’t I just use my Alberta (or provincial) health care?
Your basic provincial health care plan covers basic services like doctor examinations and medically necessary procedures. But that’s it: you’re not covered for things like prescription drugs, ambulance services, dental work or eye exams.
That means if you need a new pair of glasses, a cavity filled, to renew your prescription, or an ambulance ride, you’ll have to pay for those things out of your own pocket. Whether you’re working part-time, relying on student loans, or are otherwise on a fixed income, the unexpected cost of an accident or dental work can be a real blow to your budget. And putting off a necessary procedure can have even scarier consequences if it means you get sick and start missing classes or can’t finish your schoolwork. Having a mandatory plan not only saves money – it’s also good for your health.
Is there anything else I should know about using my health and dental benefits?
Yes! Sometimes health care providers offer direct billing, which means their office will fill in the paperwork and submit the claim for you, and you only pay any outstanding amount if the cost isn’t completely covered by your benefits. Other times you will have to pay first then submit the claim yourself, and then receive reimbursement after the claim has been approved. So even if something is 100% covered, you may still need to pay first and then be reimbursed later.
If you’re not sure whether or not something will be covered – like, say, extensive dental work – it’s a good idea to get a quote first and ask about a pre-determination. A pre-determination is sent from your medical provider to the benefits provider so that the benefits provider can assess whether or not the services will be covered, or what portion of a given service will be covered. Sometimes health benefits won’t cover things you expect them to, or they refuse coverage based on other factors, so a pre-determination is a good way to find out what you’ll be expected to pay.
Wait! I have more questions!
No problem – we’ve actually got someone right on campus to answer all your questions or clarify anything you don’t understand about your benefits plan. Contact the Student Benefits Plan Office and we’ll be happy to speak with you about your plan.
SAMRU Student Benefits Plan Office
Room Z001, Wyckham House