About Saint Mary's
Health & Dental Care
Medavie Blue Cross is the University's insurer for Extended Health and Dental Care Benefits.
The Blue Advantage program offered through Medavie Blue Cross provides members access to a wealth of savings on medical, vision care and many other products and services. Simply present your Blue Cross identification card to the participating provider and mention the Blue Advantage program. Visit www.blueadvantage.ca, for more details.
Health care benefits are designed to help pay for most medical and hospital expenses that an employee and/or their family may incur.
Health Care Program.
Dental Care Program
Blue Cross Coverage Details
- Effective Date
- Dependent Registration
- Evidence of Insurability
- Coordination of Benefits
- How to Claim
- When Insurance Terminates
- Medavie Blue Cross Contact Information
- Cardholder Site
- Mobile App
Effective April 1, 2017 if an employee participates in the health care program, health care coverage becomes effective on the first day of the month following the date of employment by the University, or if evidence of insurability is required, the date it is approved by the insurer.
Effective April 1, 2017, the Health & Dental Care benefit is mandatory unless proof of other coverage is provided. “Employee" shall mean a person who is employed on the full-time staff of the employer and is a resident in Canada, excluding Faculty and Professional Librarians as well as Post Doctoral Fellows hired on a contract basis.. An employee shall be deemed to be on the full-time staff of the employer if customary employment with the employer is for 30 or more hours per week, excluding any eligible employee not covered on or prior to March 1, 1981. With respect to part-time employees, employee shall mean a person who is employed for a minimum of 17.5 hours per week.
Contract employees who have completed 24 Consecutive Months of contract employment are eligible for group health and dental benefits as defined under the full-time employees' contract. Employees must meet the minimum required hours stated in the contract to be eligible for coverage.
Click here to access the Dependent Registration Form.
If your dependent child who is unmarried, unemployed and is greater than 20 years of age and less than 26 years of age and is attending University/College on a full-time basis for the upcoming academic year, please complete the Registration Card available through Human Resources and forward to Human Resources. The student's name, date of birth, and name of the school, college or university attended will be required.
If you have more than one dependent to register, please complete a separate form for each student dependent.
The term "spouse" shall mean a person of the opposite or same sex who is legally married to the employee, or has continuously resided with the employee for not less than one full year having been represented as members of a conjugal relationship (common law). In the event of divorce, legal separation, or discontinuance of cohabitation (“common law” spouse), the employee may elect to continue membership of the former spouse or to provide notice to Medavie Blue Cross to terminate coverage for the Spouse. Medavie Blue Cross will at no time provide coverage for more than one spouse under the same policy.
Unmarried, unemployed children 21 years of age or older qualify, if they are dependent upon the covered employee by reason of a mental or physical disability and became totally disabled prior to attaining age 21, and who have been continuously disabled since that time. Unmarried, unemployed children who became totally disabled while attending an accredited educational institution, college or university on a full-time basis prior to their attaining age 26 and have been continuously so disabled since that time shall also qualify as a Dependent.
Dependent coverage begins for an employee's eligible dependents on the same date as the employee's coverage, or as soon as they become eligible dependents if added later, provided that dependent benefits were applied for within 31 days of their becoming eligible. If coverage is not applied for within this 31-day period, evidence of health on the dependents may have to be submitted and approved before coverage begins.
Where applicable, be sure to report any changes in dependent status to Human Resources within 31 days of the change so that the appropriate coverage may be obtained.
Evidence of insurability is required if:
- An employee is applying for insurance more than 31 days after becoming eligible to apply;
- An employee reapplies after insurance has terminated due to non-payment of premium
Coordination of Benefits Within the Program
If any of the benefits claimed are payable under more than one section of an employee's health care programs, an employee's claim will be assessed under the program that will provide the employee with the greatest benefit.
Coordination of Benefits With Another Program
Benefits under this program are co-ordinated with similar benefits, which may be available to an employee under another benefit program.
Claims for services an employee has received:
- should first be submitted to the University program for payment
- any unpaid balance may be submitted for payment to an employee's spouse's program
Claims for services an employee's spouse has received:
- should first be submitted to his or her employer's program for payment;
- any unpaid balance may be submitted for payment to the employee's University program.
Claims for services a dependent has received:
- should first be submitted to the program of the parent whose birthday occurs earliest in the year, e.g., if the employee's birthday is February 1 and the employee's spouse's is June 30, the claim should be first submitted to the employee's University program
- any remaining balance may be submitted for payment to the employee's spouse's employer's program
Total reimbursement from all programs will not exceed the actual expense incurred.
For more details on Coordination of Benefits contact Medavie Blue Cross.
In order to quickly process claims, send receipt of payment along with the following information:
- employee's full name and address;
- the name of the University;
- employee's individual Medavie Blue Cross identification number (located on drug card)
- University's Group Policy Number (04841-000).
The following procedures should be followed in the event of a health claim:
All Health benefits are on a reimbursement basis unless otherwise specified. Claims must be submitted within four months of receiving services or supplies.
For claims, on a direct payment basis, the subscriber or dependent should first determine if the "provider of services" is a participating or non-participating member under the program. After this, one of the procedures below should be followed:
(a) Participating Provider: the subscriber's identification card should be shown and the provider will arrange to bill the insurer directly,
(b) Non-Participating Provider: the subscriber must pay the provider, obtain an official receipt and submit this to the insurer for payment. The subscriber should also arrange for the completion of the appropriate claim forms, which are available from the employee's employer or the provider of services, or by contacting Blue Cross. For drug claims on a reimbursement basis, receipts must indicate the following information for each prescription item:
- patient's name
- prescription number and date dispensed
- D.I.N. (Drug Identification Number) or drug name, strength and quantity.
Claim Reimbursement Options
Mail Claim: Submit claims through the mail. Cheques are mailed to the address indicated below. Once processed reimbursed claims are mailed to an employee's home address.
Medavie Blue Cross
P.O. Box 2200
Quick Pay Offices: Go to the QuickPay customer service centres.
230 Brownlow Avenue (Burnside)
1894 Barrington Street (Scotia Square)
Direct Deposit: Direct deposit provides employees with a quick and convenient option for claims reimbursement. With this option, claims are submitted through the mail, once processed claims will be reimbursed directly to an employee's bank account within (2) bank days. A follow-up explanation of benefits will be mailed to an employee's home address, advising that payment has been deposited into their respective bank account.
Insurance terminates in the event of:
- non-payment of premium;
- a change in an employee's classification to one not insured;
- termination of an employee's employment;
- termination or amendment of the insurance program by the University;
- an employee commencing active duty in any armed forces;
- an employee attaining age 65;
- an employee retiring;
- with respect to employees, the June 30th next following attainment of age 65 (July 31st for employees with a June birthday). Contact Human Resources for additional detail if working beyond this date.
Note : In the event an employee is absent from work due to sickness, injury, layoff or approved leave of absence, insurance coverage may continue, subject to payment of premiums. Additional details are available at Human Resources.
The Cardholder Site provides cardholders (employees) with ease and convenience on accessing pertinent benefit plan information.
To access the cardholder site, please click here
There are a variety of options available on the Cardholder Site:
First-time Access to the Cardholder Site For cardholders who want access to detailed information relating to their benefits plan design.
Coverage Inquiry Detailed information about your current Blue Cross benefit plan.
- Claims history for you and your dependents
- Record of payments issued to you and/or your service provider
Forms: Printable versions of many generic Medavie Blue Cross claims forms
Glossary: Definitions of common insurance industry terminology
First-time Access to the Cardholder Site
- Log on to the Medavie Blue Cross Web site at www.medavie.bluecross.ca
- Select “For Cardholders” from the left hand menu bar
- Select “First Time, Register Now”
- Complete the online registration form
- Medavie Blue Cross immediately emails you a temporary password
- Access your email account to receive your temporary password
- Repeat steps 1 and 2
- Enter your selected user ID and your temporary password
- You are prompted to change your password
- You are in the Cardholder Site
Take us with you! You have our card in your wallet—now you can take us with you on your smartphone, too. Our new mobile app ensures you have fast and reliable access to your benefit information – anytime, anywhere.
Our mobile app gives you access to all of your benefit information at your fingertips and services to make accessing those benefits easier.
Top five uses for the app:
- My Member Card – an electronic version of your ID card displays before you even login to the app. Simply show this electronic version to your health professional as proof of coverage—no more digging in your wallet.
- My Coverage – Not sure which services and products you’re covered for? Now you can search your coverage to find out which are eligible benefits. You can even search by prescription drug name.
- My Claims – Look up past claims you’ve submitted and family claims history in one convenient location.
- Submit a Claim – Filing a claim has never been quicker or easier. Submit your claims through the app and have your reimbursement deposited directly to your bank account.
- Find a Health Professional – Using GPS navigation, find a health professional near you – whether you’re close to home or travelling. Once you’ve found your health professional, you can save their details to your favourites and add them to your contacts list.
You can find the Medavie Blue Cross mobile app in the Apple App store, the Android Google Play store and BlackBerry World.