Are we really getting good health coverage?

By in Features

The health and dental plans offered by the University of Saskatchewan Students’ Union provide basic coverage to students — but is it enough? Many health services that students need and use aren’t covered by the government, and it can be difficult to choose whether or not the USSU plan and its advantages are right for you.

I’ve definitely had my fair share of injuries over the years. I’m only 23 years old, but after having a few concussions, a nasty case of whiplash after getting into a car accident, injuring my rotator cuff after a hard body check, rupturing the anterior cruciate ligament in my knee playing hockey — and then going through reconstructive surgery and quite a bit of physiotherapy to get back up to full speed — I’m no stranger to rehabilitation and taking time off to recover.

But hey, it could be worse — way worse. Thanks to some luck, good doctors, naturopaths, chiropractors, physiotherapists and massage therapists, I’m fortunate enough to still be walking around and enjoying the sports and activities that I always have. I still have to do a bit of maintenance work in order to stay healthy, and I don’t plan on giving up sports anytime soon.

Aside from the injuries, like everyone else I also need to get my teeth cleaned every year, have a wisdom tooth that needs to get pulled, have a prescription for glasses that I never wear and could probably use a good massage once a month. None of this stuff is free, either, and on a student budget health care costs are definitely much scarier. I imagine that I’m not the only who thinks so.

The Basics

All students enrolled in a minimum of nine credit units in term one and who are undergraduate students are automatically enrolled in the plan. The cost of full coverage per policy year — which starts on Sept. 1, 2016 and ends Aug. 31, 2017 — is $247.69, which is split between health and dental coverage at $136.85 and $110.84, respectively.

In order to opt out of the plan, students need to provide proof that they are covered under an insurance plan with equal or greater benefits before the opt out date, which was Sept. 30. Students can also choose to permanently opt out provided that they already have adequate coverage but may re-enrol under the USSU plan in the future if need be, although they will be required to pay a fee in order to so.

So what kind of basic coverage do students get?

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Health Coverage

– Coverage of up to 80 per cent of most drugs legally requiring a prescription.

– 80 per cent coverage for appointments with psychologists, to a maximum of $750 per policy year.

– For massage therapists, chiropractors, physiotherapists, naturopaths, osteopaths, registered dieticians, podiatrists/chiropodists, speech therapists and athletic therapists: coverage up to a maximum of $20 per appointment and up to $400 per year.

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Vision Coverage

– A maximum of $100 per 24 months for glasses and contacts.

– Up to $50 per year for an eye exam performed by a licensed optometrist.

– Laser eye surgery is covered to a maximum of $150 per policy year.

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Dental Coverage

– Coverage up to $500 for dental visits per policy year.

– 70 per cent coverage for recalls, cleanings, extraction of impacted teeth and fillings.

– 50 per cent coverage for oral surgery, root canals and gum treatment.

Is It Worth It?

According to Colten Yamagishi, the program manager with Studentcare, the administrator of the USSU Health & Dental Plan, the current plan offers excellent coverage at an affordable price because of its group payment structure and does not discriminate against students that already have pre-existing medical conditions.

“A lot of other plans will look to see if you have other medical issues and if you do, then you’ll have to pay more up front for that, but this plan doesn’t discriminate,” Yamagishi said. “So say you had Crohn’s disease, for example — something that requires really powerful prescription drugs, then you might have to pay more. Same thing with heart disease. Or say that you require a wheelchair. They’re very expensive.”

Other benefits include improved coverage for mental health services, that was previously only covered up to a $400 limit with a maximum reimbursement of $20 per appointment.

“One big push that the USSU had last year was to change the coverage for psychologists. That used to cover $20 per policy visit up to $400 per policy year. That’s just not enough. Psychology appointments are pretty expensive and students really need the support,” he said.

Yamagishi added that travel coverage provided by the plan is exceptional and valued at a price that is higher than what students currently pay.

“It covers you for 150 days per year, during exchange or if [students] want to go on extended vacations after they convocate. Compared to other private plans the cost is very low and because there are so many students enrolled in the plan it keeps costs low,” Yamagishi said. 

He also points out that having the USSU plan can be complementary to an existing plan as well.

“A lot of students do opt out because they do have other coverage, either through their parents or their employers, but the nice thing though is that if you do have double coverage through your parents and the health and dental plan, then the coverage will compliment each other. So say you get $1,000 in dental work done in one year, you could use coverage from each of the plans to cover it,” he said. “There’s nothing wrong with opting out, but the fact that it’s a group plan really decreases the price and this is probably the best deal that you’re going to get for a plan at any point in your life.”

Despite the travel and mental health coverage, the student plan does have its drawbacks. Under the current plan, students are only reimbursed $20 per visit for appointments with most health care providers — excluding psychologists and Studentcare Network physiotherapists, massage therapists and dentists — instead of a flat rate across all services.

For a $45 chiropractic appointment, students would only end up paying $25 under the student plan after being reimbursed — this equals roughly 45 per cent coverage for one appointment up to maximum of $400 in coverage per year.

However, if a student visited a naturopath for one appointment under the current plan at a cost of $100 per appointment, the total cost would come to $80 per appointment with only $20 being covered, or a coverage rate of 20 per cent.

Furthermore, if students already have a better plan, which, for example, offers a flat rate of 80 per cent coverage that is provided for all health care services up to a maximum of $500 for most healthcare practitioners, then students would only end up only paying a mere $9 per appointment until the reimbursement limit is reached. And they would probably save more money by opting out of the program than reclaiming the out-of-pocket expense with the money they are paying for the student health and dental plan.

It’s also important to consider how the USSU plan differs from other university plans across Canada. At the University of Regina, students pay a total of $196.40 per year for the complete health and dental plan and get minimum coverage of 80 per cent on preventative services and 70 per cent on basic services for dental. By choosing to visit dental care providers under the Studentcare network they receive an additional 20 per cent discount, increasing their coverage to 100 per cent and 90 per cent — and they have a $750 reimbursement limit.

At MacEwan University in Edmonton, students pay a total of approximately $232 per year and can get up to 100 per cent coverage on basic services, and a minimum of 15 per cent for major restorative work.

Students at the University of Toronto pay upwards of $300 per year, but they also are reimbursed $100 per psychologist appointment up to a maximum of 20 appointments per year and they are reimbursed $30 per appointment with most healthcare practitioners up to a $600 limit.

Looking at the plans of other universities in Canada, it seems the U of S sits somewhere in the middle when it comes to coverage, cost and services. The way our plan works might not be suitable for everyone, but it does offer decent coverage in certain areas, especially when used in conjunction with a secondary health plan.

The question is, should students be more concerned with how their student unions negotiate coverage plans, and what those plans include? Furthermore, are students informed enough about the extent of the coverage they are getting and are they being properly informed about their options to opt out of the plan?

Brenden Palmer / Sports & Health Editor

Infographics and graphics: Lesia Karalash / Graphics Editor