Plan details

What is covered under UHIP?

UHIP covers the medical services and treatments in the list below. You will also find what UHIP doesn’t cover.
UHIP pays the full cost for most services. But some medical professionals may charge more than the UHIP reimbursement rate. In these cases, you will have to pay the difference between the two amounts.

IMPORTANT INFORMATION

  • Some services and treatments need approval from Sun Life before you have the service or treatment.
    • If you think you need this service or treatment, call Sun Life at 1-866-500-8447 first.
    • If you don’t get pre-approval, UHIP may not cover you for these services. You will have to pay the cost yourself.
  • Find providers that will direct bill Sun Life at UHIP rates through the Preferred Provider Network.
  • You always have to show a paper copy of your UHIP coverage card when you visit any type of health care facility.

What’s Covered

UHIP covers these services and treatments
Up to $1,000,000.00 (Canadian dollars) per policy year (September 1 to August 31) for eligible medically necessary1 health services and medical treatments.2

IMPORTANT: You must notify Sun Life within 48 hours of any hospital stay expected to last more than 72 hours.
Inpatient and outpatient services including the emergency room – 100%.3
This includes:

  • Services by any person the hospital pays (this excludes physicians).
  • Standard ward room accommodations including:
    • Meals.
    • Lab and diagnostic tests.
    • Medication during an inpatient stay.
You need Sun Life’s pre-approval for:
  • Elective or non-emergency surgery or treatment (such as dialysis, and cancer treatment).
  • Private room accommodation.

Physician services in the current OHIP Schedule of Benefits are covered up to 125%.

Services include (this is not a complete list):

  • Diagnosis and treatment of illness or injury.
  • Surgery, including the administration of anaesthetics.
  • Care related to pregnancy (prenatal and postnatal), even if pregnancy began before arriving in Ontario.
  • One annual health examination.
A complete list of services may be found in the OHIP Schedule of Benefits

Eligible members are 19 years of age and younger or 65 years of age and older.

Annual eye examination by an Ophthalmologist (a medical doctor who specializes in eye and vision care): 125% of OHIP Schedule of Benefits.

Optometrist (Doctor of Optometry, OD): 100% OHIP rate.

If you are 20 to 64 years old and have any of the following conditions, you may be eligible for eye exams every 12 months. You must get pre-approval from Sun Life by calling 1-866-500-8447.

  • Diabetes
  • Glaucoma
  • Cataract
  • Retinal disease
  • Amblyopia
  • Visual field defects
  • Corneal disease and strabismus
Podiatry (Doctor of Podiatry-DPM): Covered under the same terms as OHIP Schedule of Benefits. Surgery is not covered.

Osteopathy (Doctor of Osteopathy-DO): Coverage under the same terms as OHIP Schedule of Benefits.

Physiotherapy: Same coverage as the Ontario Health Insurance Plan.

Services requiring pre-approval from Sun Life:
Type of injury requiring physiotherapy Age 19 to 64 Age 18 and under or over age 65
Non-complex injury or surgery that did not require inpatient stay (for example, ACL repair, arthroscopy, rotator cuff surgery). Not eligible for physiotherapy. Eligible for private physiotherapy. Maximum coverage: $312.
Complex injury or surgery or neurological injury (for example, knee or hip replacement or stroke) that requires an overnight stay in the hospital. Eligible for hospital physiotherapy and private physiotherapy clinic. Maximum coverage: $312. Eligible for hospital physiotherapy and private physiotherapy clinic. Maximum coverage: $312.

Lab services: Coverage under the same terms as OHIP Schedule of Benefits. Services in an approved laboratory listed within the Preferred Provider Network are eligible when:

  1. Ordered by a physician.
  2. Ordered for diagnostic and treatment purposes.
Covered lab tests include (this is not a complete list):
  1. X-Rays.
  2. Ultrasounds/sonograms.
  3. Bloodwork.
Diagnostic services: 100% when performed at a hospital or at a Preferred Provider.
Services include:
  1. Magnetic resonance imaging (MRI).
  2. Cardiac catheterization.
  3. CAT scans.

Coverage under the same terms as the OHIP Schedule of Benefits.

Ground or in-province air ambulance to the nearest available hospital in Ontario, when a physician or designated hospital official confirms as essential.

There is a fee of $45 for UHIP members.

You need Sun Life’s pre-approval (except in an emergency)

Oral and maxillofacial surgery that is required to be performed in a hospital by an oral/dental surgeon and under the same fees and conditions as OHIP (Ontario Health Insurance Plan). Some examples of eligible surgery include:

  • Corrective jaw surgery.
  • Reconstructive surgery.
  • Cyst removal.
  • Temporomandibular Joint Disorder (TMJD) surgery.
  • Trauma.
  • Bone grafting.
Dental treatment. You may be eligible for coverage only if you have the following conditions and your dental surgery must be performed in a hospital. Wisdom teeth removal is not eligible unless you have any of the following conditions:
  • Are physically and/or mentally challenged.
  • Are immunocompromised.
  • Have a cardiac issue.
  • Are undergoing cancer treatment.
  • Have temporomandibular joint disorder.

You need Sun Life’s pre-approval for:

Only emergency services are eligible for reimbursement when you are outside of Ontario. Reimbursement is at the same level of coverage in Ontario. Note: Ambulance charges are not eligible for reimbursement

  • Emergency means any unexpected sickness or injury first occurring during the coverage period, which requires immediate medical treatment to relieve acute pain and suffering.
Eligible services include:
  • Inpatient hospital services (coverage at 100%).3
  • Outpatient/emergency services (coverage at 100%).
  • Lab and diagnostic services (coverage under the same terms as OHIP Schedule of Benefits).
  • Physician services at the same conditions as coverage in Ontario (covered for 125% of OHIP Schedule of Benefits).

UHIP has minimal coverage for emergency out of country medical treatment. It is at the same level and conditions as OHIP. We strongly recommend that you purchase out of country travel insurance to avoid additional expenses. Check if your University supplemental insurance offers out of country coverage. Note: Ambulance charges are not eligible for reimbursement.

Coverage for medically necessary emergency expenses up to the same level of coverage as OHIP, including:

Doctor services
Maximum: Rates listed in and paid to Ontario physicians in the Ontario Schedule of Benefits for Physicians Services.

Emergency outpatient services (this refers to emergency medical service(s)/treatment(s) received while you are NOT admitted to the hospital)
Maximum: $50 (Canadian) per day.

$210 (Canadian) per day for outpatient dialysis services.

Emergency inpatient (if you are admitted to the hospital) services

Maximums:

  1. $400 (Canadian) per day for services provided in:
    • Operating room.
    • Coronary care unit.
    • Intensive care unit.
    • Neonatal or pediatric special care unit.
  2. $200 (Canadian) per day for lower levels of care (standard ward room).

You need Sun Life’s pre-approval for repatriation service reimbursement.

Terminally ill

  • Maximum: $20,000 for repatriation of a terminally ill member.
  • A terminally ill person is someone with 12 months or less to live and the medical condition is stable. Either Sun Life or the covered person may request repatriation to his/her home country.


Death
  • Contact Sun Life as soon as it’s reasonably possible to request repatriation.
  • Maximum: $20,000 coverage for one of the following services:
    • Repatriation (return to home country): coverage is for reasonable and customary cost of preparing and transporting the deceased to their home country, the cost of transportation and a standard shipping container. Expenses incurred in the home country and expenses related to special traditional funeral rituals or ceremonies are not covered, or
    • Cremation: coverage is for reasonable and customary costs of eligible expenses that relate to the preparation of the body for cremation in Ontario. Expenses incurred in the home country and expenses related to special traditional funeral rituals or ceremonies are not covered, or
    • Funeral in Ontario: coverage is for the reasonable and customary costs of eligible expenses (in Ontario) that relate to the preparation of the body for burial, the cemetery plot, and cost of a casket. Expenses related to special traditional funeral rituals or ceremonies are not covered.

What’s not covered by UHIP?

Sun Life will not pay for the cost of any of the following:

  • Services OHIP doesn’t currently provide unless the UHIP Steering Committee adopts a change.
  • Physicians’ and hospitals’ charges above those the group policy describes.
  • Charges incurred by a covered person for which he/she is entitled to obtain benefits or reimbursement under any other plan, or which would be provided without charge in the absence of coverage.
  • Cosmetic surgery is elective and not covered under OHIP so UHIP does not cover. OHIP/UHIP would cover if it relates to an accident.
  • Medical exams and tests for immigration purposes or for a third party.
  • Travel time or mileage expenses.
  • Advice given by telephone.
  • Court testimony, preparation of records, reports, certificates, or communications.
  • Group exams, immunizations, or inoculations.
  • Physicians’ services or examinations for surveys, research purposes or screenings (except those OHIP covers).
  • Lab services or clinical pathology, unless specifically included as an eligible expense.
  • Acupuncture.
  • Eyeglasses, frames or contact lenses.
  • Private-duty nursing, except under Home Care and with Sun Life’s pre-approval.
  • Hospital visits solely for administering drugs.
  • Drugs, whether prescribed or not (unless administered during a hospital stay), except as set out under the eligible expenses in the group policy.
  • Dental care services, except as set out under Dental Surgery, done in a Hospital and pre-approved by Sun Life.

Supplementary health insurance

In Ontario, most citizens and permanent residents have another health insurance plan, not just OHIP (the Ontario provincial health plan). This gives them coverage for services OHIP or UHIP doesn’t cover (e.g. prescription drugs, dental care).

Many participating Universities offer supplementary health insurance through their student or employee unions. These plans are separate from your UHIP coverage. Contact your University to learn about the supplementary health insurance options available.

Am I covered under UHIP while travelling outside Ontario?

In Canada

UHIP provides the same coverage for emergency medical expenses as OHIP (Ontario’s provincial health plan).
A medical emergency is an acute injury or illness. It poses an immediate risk to a person's life or long-term health.

How it works:

  • Under UHIP, if you need emergency service, you will have to pay the hospital or medical provider directly.
  • Always make sure to complete a claim form and get the original receipts for your medical expenses.
  • You will need to send these documents to Sun Life for reimbursement.

Out of Canada

UHIP provides minimal out-of-country for emergency medical expenses. A medical emergency is an acute injury or illness. It poses an immediate risk to a person's life or long-term health. This may not be enough to cover your medical expenses (see Emergency services outside Ontario or Canada).

We strongly recommend you purchase additional private travel insurance4 to cover significant out-of-pocket expenses.

How it works:

  • Under UHIP, if you need emergency service, you will have to pay the hospital or medical provider directly.
  • Always make sure to complete a claim form and get the original receipts for your medical expenses.
  • You will need to send these documents to Sun Life for reimbursement.


TIP: Your University supplemental health care coverage may have a provision for out of country insurance. Please contact your University Student Union.

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Footnotes:
1This is a treatment, service or supply which is eligible under OHIP. It must also be essential, effective and appropriate, as determined by Sun Life, in the diagnosis, care or treatment of a specific medical condition, sickness or injury.
2Coverage rates based on the OHIP Schedule of Benefits and Fees.
3Inpatient hospitalization at a maximum of 2.5 times the hospital’s inter-provincial rates, except for the first 4 days which are paid at 100%.
4UHIP does not endorse nor advertise any particular private coverage plan. It is your sole responsibility to research a private coverage plan that is right for you.

The information presented on this website summarizes the main aspects of UHIP. Your actual benefits from UHIP will be determined according to the terms and conditions of the insurance contract with the UHIP insurer. No typographical or mechanical error made by a University or any of the parties to the UHIP insurance contract will invalidate insurance otherwise in force, or continue insurance otherwise terminated under the insurance policy's terms and conditions.
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Sun Life Assurance Company of Canada is the insurer and a member of the Sun Life Financial group of companies