Health Plan

Participation in the Health plan is voluntary for all eligible active employees. You may choose coverage for yourself only (single coverage), or for your spouse and/or dependent children (family coverage).

Note: If you opt out of this plan for reasons other than spousal coverage, you will need to provide medical evidence if you want to join the plan later.

Your Health plan (including Emergency Travel) covers many medical expenses that are not covered by MSI.

  • The Health Association Nova Scotia Health Plan is administered by Manulife.
  • The Emergency Travel plan protects you from the financial burden that could result from an emergency illness or injury while travelling out of province or out of Canada. Travel outside of your province of residence is covered first by MSI and second by our Emergency Travel Plan (currently insured by SSQ Insurance Company in collaboration with AXA Assistance).

Who is eligible?

You are eligible if you are an active employee and you are either...

  • A permanent employee hired to work at least 40% of a regular work week, or
  • A term employee hired to work at least 40% of a regular work week for a guaranteed term of one year or more.

Your family members are eligible if they meet the following definitions:

Your spouse is defined as someone to whom you are married legally or married by common law and have lived together for at least one year. This includes spouses of the same sex.

Your dependent children are defined as those who are under 21 or under 26 if attending a full-time, accredited learning institute, unmarried, unemployed.  A child who is incapable of employment due to a mental or physical condition that occurred before age 21 is considered a dependent child. The child must be primarily dependent upon you for maintenance and support. To enrol your disabled dependent in the program for the first time, you must complete and submit the Application for Over-Age Disabled Dependent Coverage - Form #55.


What happens if I apply after 60 days of becoming eligible?

If you apply for coverage more than 60 days after becoming eligible, you will need to provide medical evidence and be approved for coverage before it takes effect. Any family members who apply for coverage after 60 days of becoming eligible will also need to provide medical evidence.

 

What coverage is available?

Here is a summary of the coverage available under the Health plan. For more detailed information about a particular item, select the applicable link to the right.


PRESCRIPTION DRUGS

100% coverage of eligible prescription drug expenses.

Please check out the Prescription drugs link for further details on Drug Covereage, Managed Drug Formulary, Mandatory Drug substitution, Step Therapy, Drug Maximums, etc.

You pay dispensing fee.

An electronic drug look-up tool is available through the Manulife Plan Member Secure Website.

Your plan has mandatory generic substitution. This means your plan will reimburse up to the cost of the generic drug.

Please contact the Manulife Client Service line toll free at 1-855-626-4267 if you have questions regarding specific drugs.


VISION CARE

Reasonable and customary reimbursement for lenses or contacts when there is a reasonable prescription change. If not coverage is limited to the reasonable and customary costs of prescribed lenses or contact lenses every 4 years (every 2 years for children under 21).

$150 for frames every 4 years (every 2 years for children under 21).


PARAMEDICAL PRACTIONERS

$1,800 annual max for all practitioners combined.


HOSPITAL

100% Pay-Direct for semi-private or private room.


PRIVATE DUTY NURSING

100% coverage of eligible expenses, to maximum of $10,000 per calendar year.


SUPPLIES AND SERVICES

100% coverage of eligible expenses. Some supplies and equipment may be governed by annual and/or lifetime maximums or other limits.


EMERGENCY TRAVEL

100% coverage of eligible expenses due to emergency illness or injury while travelling. 60-day maximum per trip.
*Retired members do not have this coverage.

 

When does my coverage become effective?

If you are hired on the first day of the month, your coverage is effective immediately; otherwise, your coverage starts on the first day of the month after the date your employment begins or when you become eligible whichever is later. For example, if you are hired or become eligible on July 7, your coverage is effective on August 1.


How do I submit a Health claim?

You typically do not have to submit claims for drugs. You will present your pharmacist with your benefit card to pay your "co-pay" amount at the pharmacy. The pharmacy submits for the remainder of the claim.

For some health supplies and services, you will need to submit a claim form along with your original paid-in-full receipts to Manulife.

Claim forms are necessary to be reimbursed for these services:

Many paramedical practitioners and providers (chiropractor, massage therapist, physiotherapist) are set up with Provider eClaims.  With this process, providers are able to submit claims directly to Manulife on behalf of plan members. The plan member only pays the provider what the plan doesn’t cover.

Plan members must be registered on the Manulife Plan Member Secure Website and signed up for direct deposit and electronic claims statements.

Not registered yet?

· Go to www.manulife.ca/planmember click on “Login/register” (right-side) and you’ll be directed to the site access page

· On the site access page, click on “register” and provide the required information (If you’re not sure of your plan and certificate numbers, check your group coverage ID card or find the numbers on a previous claims statement)

· Submit the completed information and follow the directions on the page.

Once you’ve received your personal login information, you’ll have access to all online information available to your plan.

For those providers not set-up with Provider eClaims:

Mail your Health claim form to Manulife along with your receipts within 12 months. Write your name, policy number and plan member certificate number on the receipts. Mail to the address on the claim form.

For online submission, you must be registered on the Manulife Plan Member Secure Site and set up for direct deposit.  When you login at www.manulife.ca/planmember you select Claims from the top navigation and then Online claims.  Enter the details of your claim found on your receipt from your provider, along with details on your provider’s name, address and their contact information.

For your convenience, you can also contact the Manulife Customer Service Centre toll-free at 1-855-626-4267 with questions about your health claims. Please have your benefits card as you will need to provide them your policy and certification number. 

For plan members in Halifax, you may drop-off your claim at the Manulife drop-off box located at the Manulife Security Desk, 2727 Joseph Howe Drive, Halifax, NS.

 

What if my spouse also has coverage?

Canadian insurance companies follow a process called Coordination of Benefits (CoB) when a plan member is covered under more than one health and/or dental plan. CoB ensures you receive the maximum benefit available from your health and dental policies. In fact, two policies can be combined to give you up to 100% reimbursement of eligible claims.

Here's how Coordination of Benefits works when both the employee and their spouse has family coverage:

  1. Submit your health and/or dental expenses first to your Health Association benefits program. You can then submit any unpaid portion of your claim to your spouse’s plan.
  2. Submit your spouse’s health and/or dental expenses first to your spouse’s benefits program. You can then submit any unpaid portion of your spouse’s claim to your Health Association benefits program.
  3. If your dependent children are covered under your and your spouse’s benefit programs, you must submit their health and/or dental expenses first to the benefit program of the parent whose birth date falls earliest in the calendar year (the month, then day). Any remaining balance can then be reimbursed from the other plan. When parents are separated or divorced, the custodial parent claims under his or her plan first, then their spouse’s plan, and then the plan of the parent without custody.
  4. When you submit a claim for an unpaid balance from another insurance company, Manulife will need a copy of the receipt and a copy of the statement showing the portion of the claim paid by the other company. Although you have 12 months to claim any remaining balances, your receipts should be submitted as soon as possible.

If you need help determining the order in which your claims should be submitted, call the Manulife Customer Service Centre toll-free at 1-855-626-4267.

For further information, please check out our Benefits Information Coordination of Benefits document available on our Benefits Communication page.


What happens to my coverage during a leave of absence?

During a leave of absence, your Health coverage (including Emergency Travel) can be continued for up to 12 months.

See your Benefits Administrator to complete the:

  • Application for Continuation of Group Benefits During an Approved Unpaid Leave of Absence form; or
  • Application for Continuation of Group Benefits During an Unpaid Leave of Absence due to an Injury or Sickness form.

What happens when I reach age 70?

If you are actively at work, your Prescription Drug plan ends when you turn 70, and you may be eligible for coverage under MSI's Senior's Pharmacare program.


What happens to my Health coverage when I retire?

If you retire with 10 years of service and you are a member of the Nova Scotia Health Employers’ Pension Plan (NSHEPP) or any other pension plan sponsored by a member organization, you are eligible for Health coverage, except Emergency Travel Benefits. If you are over age 65 when you retire, you may become eligible for Pharmacare as there is no prescription drug coverage.

If you wish to continue your Health Insurance at retirement, fill in the Application for Continuation of Group Benefits - Retired Members form. Your Benefits Administrator will send it to the Health Association.

Please note that premium rates for the Retiree Plan differ from the Active Member plan and there are some other plan design differences.


When does my Health coverage end?

Your coverage ends at the end of the month in which you are no longer considered an employee, or when the Plan is terminated, whichever comes first.

Your family's coverage also ends at the end of the month in which you are no longer considered an employee, when they no longer meet the eligibility requirements, or when the Plan is terminated, whichever comes first.


Do I have any options when my Health coverage ends?

Yes, you have the option to convert your and your spouse's Health coverage to an individual plan. This conversion option is also available to your dependent children once they no longer meet the eligibility requirements.

All applications for conversion must be made within 60 days of the end of Health Association Health coverage.


What is a conversion privilege?

The conversion privilege is your right to "convert" your group coverage to individual coverage in the event of retirement, or termination of your employment, or the Group Contract itself. Typically, you can convert from group to individual without providing medical evidence. Your individual rates will be based primarily on your age and smoking status at that time.

You must apply to convert your health policy within 60 days of your retirement, termination and so on. Talk to your Benefits Administrator about this conversion option or call toll-free 1-877-COVERME (1-877-268-3763).

 

If I die, can my Health coverage continue for my dependents?

Yes, your spouse and dependent children can continue their Health coverage for up to two years after your death. No premiums are required for this coverage.