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What is Covered?

IMPORTANT: You must notify Cowan within 48 hours of your admission to hospital. Some services and treatments need to be approved by Cowan before they happen.

UHIP covers:

  • Emergency hospitalization in a standard ward room (100% coverage for the first four days, and limited to 2.5 times the interprovincial rate for residents of Canada).
    • Semi-private or private room must be medically necessary and pre-approved by Cowan.
  • Operating and delivery room usage.
  • Radiotherapy facilities and respiratory equipment.
  • Supplies and medications provided by the hospital during your stay.
  • Physician services or services of any other provider paid by the hospital.

You need Cowan’s pre-approval for:

  • Surgery or treatment that is not for a medical emergency (such as dialysis and cancer treatment).
  • Semi-private or private room accommodation.

UHIP covers:

  • The services of a physician (covered up to 125% of what the physician charges for Ontario residents to the same overall maximum and terms as under OHIP), including:
    • Diagnosis and treatment of illness or injury.
    • Surgery, including the administration of anaesthetics.
    • Care related to pregnancy (prenatal and postnatal)
    • One annual health exam
  • Services of a nurse practitioner are also eligible (covered up to 80% of what UHIP will pay for physicians).

A complete list of OHIP services and fees for Ontario residents can be found in the OHIP Schedule of Benefits.

UHIP covers:

  • For those who are age 19 and under or 65 and over, one annual eye examination by either an:
    • Ophthalmologist (covered up to 125% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP).
    • Optometrist (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP).
  • If you are age 20 to 64 and have any of the following conditions, you may be eligible for eye exams every 12 months, when pre-approved by Cowan.
    • Diabetes
    • Glaucoma
    • Cataracts
    • Retinal disease
    • Amblyopia
    • Visual field defects
    • Corneal disease and strabismus

A complete list of OHIP services and fees for Ontario residents can be found in the OHIP Schedule of Benefits.

UHIP covers:

  • The services of a registered podiatrist (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP). Surgery is not covered.
  • The services of a registered physiotherapist (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP), when pre-approved by Cowan.
Injury requiring physiotherapyAge 20 to 64All other ages
Non-complex injury or surgery that did not require inpatient stay (such as ACL repair, arthroscopy, rotator cuff surgery).Not eligible.Eligible for private physiotherapy (overall maximum $312).
Complex injury or surgery or neurological injury (such as knee or hip replacement or stroke) that requires an overnight stay in the hospital.Eligible in hospital and private clinics (overall maximum $312).Eligible in hospital and private clinics (overall maximum $312).

UHIP covers these services when ordered by a physician or a nurse practitioner for diagnostic and treatment purposes:

  • Lab services such as X-rays, ultrasounds and blood work (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP). Services in an approved laboratory listed within the Preferred Provider Network are eligible.
  • Diagnostic services such as MRI and CAT scans (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP). Services at a hospital or at a provider within the Preferred Provider Network are eligible.

A complete list of OHIP services and fees for Ontario residents can be found in the OHIP Schedule of Benefits.

UHIP covers:

  • Ground or air ambulance within Ontario to the nearest available hospital in the province, when a physician or designated hospital official confirms as essential (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP, less the same $45 fee applicable to all residents).

A complete list of OHIP services and fees for Ontario residents can be found in the OHIP Schedule of Benefits.

UHIP covers:

  • Oral and maxillofacial surgery such as corrective or reconstructive jaw surgery that can only be performed in hospital (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as under OHIP), when pre-approved by Cowan.

UHIP covers:

  • The services of a medical professional to provide home care (covered at 100% of what the provider charges for Ontario residents to the same overall maximum and terms as the Ontario government), when pre-approved by Cowan.

UHIP covers:

  • Specialized medical devices and aids such as home oxygen, and respiratory equipment and supplies (covered to the same overall maximum and terms as the Ontario Assistive Devices Program), when pre-approved by Cowan.

A complete list of devices can be found at Ontario’s Assistive Devices Program.

UHIP covers:

  • Outside of Ontario, UHIP limits coverage to medical emergencies (not applicable to those who live and receive services in Gatineau/Hull). This means that your condition requires immediate medical attention to relieve acute pain and suffering (covered at 100% of what a provider charges in Ontario to the same overall maximum and terms as under OHIP, and excludes ambulance).

You must notify Cowan within 48 hours of your admission to hospital. Some services and treatments need to be approved by Cowan before they happen.

UHIP covers:

  • Outside of Canada, UHIP limits coverage to medical emergencies. This means that your condition requires immediate medical attention to relieve acute pain and suffering (coverage is limited to the same overall maximum and conditions as under OHIP, and excludes ambulance). Example:
    • Emergency outpatient services (maximum $50 CAD per day).
    • Emergency inpatient services (maximum $400 CAD per day for coronary care or intensive care units, maximum $200 CAD per day for lower-level care).

UHIP reimbursement outside of Canada is severely limited. We strongly advise that you buy travel insurance to avoid significant out-of-pocket expenses. Check if your University supplemental insurance offers out of country coverage.

You must notify Cowan within 48 hours of your admission to hospital. Some services and treatments need to be approved by Cowan before they happen.

UHIP covers:

  • The services to transport to your home country once you are stable, when Cowan pre-approves and arranges these services:
    • During the automatic extension for hospitalization
    • If you are diagnosed as terminally ill.
  • The services to transport your remains to your home country (maximum $20,000) upon your death, when Cowan pre-approves and arranges these services, or.
    • The services to cremate or bury (maximum $10,000) in the place where death occurs.

Including:

  • Treatment or surgery in Canada, where travel to Canada is undertaken specifically for the purpose of obtaining medical treatment or hospital services, even if the visit is taken on the advice of a physician.
  • Medical examinations and tests for immigration or for a third party.
  • Cosmetic surgery (unless required because of injury caused by an accident occurring while the Covered Person’s coverage is in force and would be covered by OHIP).
  • Out-of-hospital food or accommodation.
  • Charges that are eligible under another plan, or would have been provided without cost in the absence of insurance.
  • Court testimony, preparation of records, reports, certificates, or communications.
  • Dental care services, except noted in the coverage details.
  • Supplemental health and dental services, e.g. prescription drugs, dental cleanings, eyeglasses, acupuncture.
  • Drugs, unless administered during a hospital stay.
  • Hospital visits solely for drug administration.
  • Expenses for travel time, mileage, or telephone advice.
  • Lab services or clinical pathology, unless specifically included.
  • Travel emergency medical services during an approved leave of absence if you have exceeded the maximum trip duration.
  • Charges in excess of UHIP limits, or in the absence of limits, reasonable and customary.
  • Physician services or examinations for screenings, survey, or research processes, except those covered by OHIP.
  • Private duty nursing, except under home care benefit.
  • Services not currently covered by OHIP unless otherwise noted. Changes to OHIP will not be automatically adopted by UHIP.