EXPLORING GROUP HEALTH INSURANCE
FOR STUDENTS IN CANADIAN POST-SECONDARY INSTITUTIONS

by
Robert Chavarie

B.Mgt, University of British Columbia, 2010

PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ARTS
IN
INTERNATIONAL STUDIES

UNIVERSITY OF NORTHERN BRITISH COLUMBIA
JANUARY 2016
©Robert Chavarie, 2016

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Abstract
Across Canadian post-secondary institutions, students experience varying levels of
fees and coverage for private health insurance. These plans are mandatory, while
democratically and autonomously governed by students as part of their membership in
student societies. This market is of a sizeable scale with an estimated total of 153
different group-plans insuring 1.58 million students across the country. Given the
complexities of how benefits are described and how the premiums are set, it is difficult to
compare all plans benefits in a standardized way. This creates a challenge for elected
student leaders and their staff to ensure the best value for dollar for their plan's coverage.
This project provides a benchmark of who's who in the post secondary student health
insurance market in Canada. It identifies and compiles information from the six main
providers of this form of private health insurance. This .includes a comparison of the
current state of plans, based on annual plan costs, and an overview of the types of
coverage provided to students in each group. A descriptive and empirical analysis is
applied in order to give a more comprehensive understanding of the current landscape of
the market, with a focus on the annual plan costs across providers, provinces and student
groups.
The results show that there are differences in annual plan costs depending on
undergraduate or graduate level of study. There are also differences across provider
networks and across the provinces. With all student groups, cost is expected (though not
shown in this project) to be at least in part, a reflection of the level of benefits provided.
In terms of benefits, with some exceptions, most plans cover all three categories of
vision, dental and extended health benefits. Nevertheless, without regulated minimums
or maximums, there is a lack of uniformity in the range of benefits provided.

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TABLE OF CONTENTS
Abstract

ii

Table of Contents

iii

List of Tables

V

List of Figures

vi

Chapter 1: Introduction

1

1.1 An International Overview

1

1.2 A Brief History of HealthCare Insurance in Canada

5

1.3 Student Health Insurance in Canadian Universities and Colleges

10

1.4 Providers of Health Insurance to Students in Canada

15

1.5 Previous Work

19

1.6 Objectives of this Study

21

Chapter 2: Data and Methodology

23

Chapter 3: Empirical Results and Analysis

27

3.1 Providers' Market Share

32

3.2 Distribution of Health Insurance Plan Costs

39

3.3 Distribution of Health Insurance Plan Benefits

49

Chapter 4: Discussion and Conclusion

54

References

60

Appendix: Overview of the Six Main Providers

63

Provider 1 ASEQ/Student Care

63

Provider 2 CFS-Services Student Health Network

65

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Provider 3 Gallivan & Associates

68

Provider 4 ACL Benefits

70

Provider 5 Campbell & Company

71

Provider 6 PBAS Group

73

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List of Tables
Table 3.1: Institutional Coverage by the Six Main Providers

28

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List of Figures
Figure 1.1: Conceptual Map of Stakeholder Relationships

17

Figure 3.2: Number of Student Group Plans Served by each of the Six Main
Companies

33

Figure 3.3: Distribution of Market Share by Number of Plans

34

Figure 3.4: Distribution of Market Share by Annual Number of Students

35

Figure 3.5: Distribution of Market Share by Type of Institution

36

Figure 3.6: Distribution of Market Share by the Number of Students

37

Figure 3. 7: The Provincial Presence of Providers

39

Figure 3.8: Box-plot of the Annual Cost of Student Health Insurance Plans for
Canada

41

Figure 3.9: Box-Plots of the Annual Cost of Student Health Insurance Plans by
Province

41

Figure 3.10: Box-plots of the Annual Cost of Student Health Insurance Plans by
Provider

45

Figure 3.11: Box-plots of the Annual Cost of Student Health Insurance Plans by
Category of Student Group

46

Figure 3.12: Average Annual per Student Plan Cost for Each Province

48

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Chapter 1: Introduction
1.1 An International Overview
Around the world, post-secondary students experience a wide range of valueadded services, such as health insurance, when they attend school. Depending on the
country of study, privately coordinated health insurance plans vary depending on the
makeup of the encompassing healthcare system. This project's focus is on the Canadian
landscape, partially due to the lack of comparable data or information across other
countries on the specific category of group health insurance for post-secondary students.
Still, understanding the global environment is increasingly important with a growing
community of international students either visiting the country or going internationally
abroad. The entire reason we see extended health insurance plans in Canada is due to
inadequacies and shortcomings of how the public healthcare system is presently
structured. If the public system were more comprehensive, there would be no need for
student organizations to implement these programs for private health and dental
msurance.
Overseas, the experiences differ in many ways. For example, private systems
exist in some countries such as the United Kingdom and France, parallel to their preexisting public systems, yet their public systems are much more comprehensive than the
Canadian patchwork. As for the United States, they experience even more variance in
their patchwork system of private insurance with a public system only for seniors of a
certain income and veterans and poor households. As for Asia and Africa, encompassing
healthcare systems and coverage for healthcare related services are in most cases, non-

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existent or inadequate. All in all, there isn't an environment where group health insurance
for post-secondary students exists in a directly comparable way to that of Canada.
Historical reasons for this are based in global discussions on healthcare reform,
which began taking shape in multi-national forums, most prominently following the
conclusion of World War II in 1945. One year later, the World Health Organization
(WHO) adopted a preamble to their constitution defining health as "a state of complete
physical, mental, and social well being and not merely the absence of disease or
infirmity" (World Health Organization, 2013). This was a broad definition adopted by
many nations who moved to establish integrated systems for social and healthcare
services. The evolution of healthcare systems in various countries has been varied.
However, this has been recognized by the WHO, which indicates that, the way in which
government services (including healthcare) are organized and delivered are different
across nations (Boslaugh, 2013).
In 1948, the United Nations constitution was fully adopted and the United
Nations General Assembly established the Universal Declaration of Human Rights.
Article 25, of the declaration proclaiming that:
"Everyone has the right to a standard of adequate health and well-being of

himself and of his family, including food, clothing, housing, medical services and
necessary social services and the right to security in the event of unemployment,
sickness, disability, widowhood, old age or other lack of livelihood in
circumstances beyond his control" (United Nations, 2015).

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Although this global definition for health and a proclamation of global rights to
social services was established more than 60 years ago, establishing global uniformity in
healthcare systems and integration with social services has not been achieved. This
makes it a challenging task to make direct comparisons about the experiences of postsecondary students between countries with fundamentally different models for
healthcare. Every nation has developed in different ways due to a wide array of
characteristics. For instance, the level of development, the geographic location, the
climate, and the political history and social values, all influence the model in different
ways, which over time created the unique systems we experience today. Some
governments include the right to health in their constitutions, but this does not ensure that
healthcare services are explicitly ensured for all citizens (Boslaugh, 2013).
Despite many distinct differences, the most direct environmental contrast with
Canada in terms of Post Secondary student health insurance is to that of the United
States. In addition to the domestic students, there is also a considerably large population
of international students that should also be accounted for. Both Canada and the United
States have a considerably sizeable population of international students enrolled in postsecondary education whom, in tum, engage with other integrated social services for both
public and private healthcare. International student enrolment in American colleges and
universities is about 514,000 visiting students compared to 129, 000 American students
studying abroad (NAFSA Association of International Educators, 2002). The most recent
available figures for Canada show an international student population of 174, 030 in
2010. Of the total number reported, 20,240 were visiting international students studying
in trades, 116, 890 were studying in university programs and 36, 900 were studying in

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other post-secondary programs. This illustrates that nearly 67% of international students
are studying at the university level and approximately 33% are in college or other
institutes. The level of cost and coverage for services is shown to be greater for university
students having a great impact for this population (Government of Canada, 2014). For the
2011 /2012 academic-year, a total of 45,409 Canadians were reported to be studying
abroad in a variety of countries (Institute of International Education, 2015). In both
Canada and the United States there is a large and growing population of international
students. International students add to the diversity of perspectives and experiences not
only in the classroom, but they add to and enhance the overall cultural diversity of
campus communities. The experience of international students and how they access both
basic and extended health and dental health services also comes with unique challenges
and advantages where coverage would have not otherwise been attainable or comparable
in a student's country of origin.
Lastly, the key difference in American model from that of Canada, is that it is the
university or college that negotiates the premium cost and coverage provisions instead of
this being a service of autonomous, representative and democratically governed student
organizations. In the United States there are a sizeable amount of post-secondary
institutions that require students to demonstrate proof of healthcare coverage in order to
be able to enrol in the first place. When sufficient pre-existing coverage cannot be
demonstrated, they are required to take on a school-based option for health insurance.
The cost is much higher as the coverage requirements are greater in the absence of a core
public package for the majority of basic medically necessary services. There are about
ten times as many plans in the United States with an estimated 1, 500 to 2, 000 private

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health insurance plans in place, with about 57% of all schools requiring health insurance
as a condition of enrolment (McIntosh, 2012).
1.2 A Brief History of HealthCare Insurance in Canada
Setting the stage for the current state of group health insurance for postsecondary students in Canada is the long history of Canadian Medicare, the
encompassing national public healthcare system, which has shaped the present day
environment for all other health services and programs in the country. Early
developments for this system go back as far as the late eighteenth century when the
regulation and public funding of healthcare systems was first initiated by individual
provincial governments.
Pre-dating the establishment of Canadian Medicare, one of the most
significant events to be noted, was the creation of the Charity Act of 1874, wherein the
Ontario Government laid out the framework for non-profit faith based (mainly Catholic,
but also Protestant and Jewish) hospitals to receive public funding in exchange for a
degree of government regulation and oversight. This was the basis for further
developments in workers compensation law and what would eventually become the first
province-wide medical services plan for all citizens on social assistance (Machildon,
2013, p. 23). As other governments progressed in this matter, it is of note that the Alberta
provincial government held two commissions of inquiry in 193 5 and approved a Health
Insurance Act. Still, due to a change in government, this Act was never implemented in
Alberta leaving it up to the Ontario provincial government to again lead the way at this
time. That same year, a Medical Welfare Board was established in partnership with the

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Ontario Medical Association. This was the first fully public medical care-plan of its kind,
later to be adopted as a template for other provinces (Taylor, 1987, p. 6).
Further to this initial and provincial introduction of plans, the governments of
Alberta, British Columbia and Newfoundland continued to develop their systems leading
up to the Dominion-Provincial Reconstruction Conference of 1945-46. At this
conference, a nationalized system involving 60% federal cost sharing was proposed in
order to provide a better balance of uniformity across the provinces. The proposal was
first rejected over concerns with the administrc;1tive and tax arrangements involved which
in tum lead to what can be described as a more piecemeal approach to the early
introduction of universal health coverage (Machildon, 2013, p. 25). The key turning point
occurred in the year 1944 when the Co-operative Commonwealth Federation (CCF)- a
Canadian political party that would later become the New Democratic Party of Canada in
1961 - won the Saskatchewan provincial election and formed the first democratic
socialist government elected in North America. By 1947, the CCF took the lead in
establishing a universal hospital services plan that eliminated possibilities for a second
tier of private hospital insurance. The CCF was financially aided in doing so through
grants from the federal government.
The momentum gained for universal health insurance in Canada can be attributed
to the presence of the CCF social democratic party as both a provincial and federal party.
Having a third main party at the federal level especially raised the national profile for
universal health insurance for it to be considered as a viable health reform alternative.
This of course was a political crossroads eventually striking the difference between
Canadian and the United States healthcare systems. Historically, it has been shown that

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the difference seen in the United States was that political debate and agendas have been
stifled by the two-party system where there is less opportunity to build coalitions for
legislative reform of this kind (Maioni, 1997, p. 414). The failure to establish a strong
labour-based third party in the United States pandered to the country's culture ofliberal
individualism and had a wide range of consequences in how systems for social security
and economic development would be created. This history of divergence between the
Canadian and American systems goes as far back go back as the American Federation of
Labour's annual convention o.f 1894 where delegates delivered a strong mandate that
party politics would not have a place in their national labour organization. This nonpartisan mandate was reaffirmed time and time again and became a firmly entrenched
principle for how labour would engage in American politics (Archer, 2007, p. 1).
By 1962, the New Democratic Party of Canada and its newly-elected leader of the
day, Tommy Douglas, made Medicare a central component of the political party's
platform and achieved consensus with the Liberal Party of Canada on working to ensure
a future for national health insurance was securely in place (Taylor, 1987, p. 334). As has
been shown, the significant distinction, when comparing Canada with the United States
on this matter, is this presence of a third main party based on social democratic principles
and the broader influence that this has had on other political parties. This dynamic
ensured a positive trajectory of health reform and the continued development of a system
ofuniversal health insurance (Maioni, 1997, p. 412).
Both hospital and medical insurance were first initiated in Saskatchewan before
later being adopted by the Canadian federal government. Between the years of 1962 and
1966, the CCF, as the Saskatchewan provincial government, led the way on these two

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forms of publically provided insurance for access to Canadian healthcare. This was not
without challenges. In 1962, following the introduction of province-wide hospital
insurance based on a fee for service model, they proceeded to implement prepaid medical
care insurance with the financial support of the federal government. In opposition to this,
Saskatchewan doctors went on a strike that lasted 23 days. Nevertheless, Tommy
Douglas and the CCF did not back down on moving forward on implementation of this
policy. An agreement was eventually reached wherein the contractual autonomy of
physicians wa,s emphasized and re-enforced as a part of fee for service payment by
government. This agreement came to be known as the Saskatoon agreement. Two years
later, by 1964, the Hall commission delivered its report to the federal government
recommending countrywide adoption of the provincial partnership model that had been
implemented in Saskatchewan (Machildon, 2013, p. 26).
In 1966, to move forward on the Hall Commission's report, the Federal
government introduced the Medical Care Act to cost-share single payer universal medical
care insurance with provincial governments. This was motivated and supported through
federal transfers, which were delivered to the provinces and were sent by 1968. As this
continued into the 1970s, public coverage and subsidy of health services continued to
expand well beyond hospital and medical care to include prescription drug plans and
support for long-term care. Despite this progress, there remained a lack of structure and
equality across the country. Without nationally prescribed principles, coverage continued
to be inconsistent across the provinces depending on the fiscal capacity and policy
aspirations of each provincial government.

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In 1977, Established Programs Financing (EPF), with block transfers, replaced
federal cost sharing with provinces for Medicare and by 1984 the Federal government
introduced the Canada Health Act. The Act took steps to discourage extra billing and
user fees for physician and hospital services and re-instating the four founding principles
of public administration, comprehensiveness, universality and portability with the added
fifth principle of accessibility. Since the implementation of the Act, the Federal
government has made no changes; however, in the face of budget cuts they have allowed
for flexibility in how the provinces administer and apply their funding. This has, in its
own way, eroded the coverage provisions of the public package now experienced by
Canadian residents (Machildon, 2013 , pp. 27-29).
Over the years, the terms themselves outlined in the Canada Health Act of
1984 have not changed, yet there has been a shift in the interpretation and application of
the five founding principles. This has been further impacted by federal cuts in spending
on healthcare. With fewer resources provided and in order to cut costs, the provinces
have had to limit their interpretations of how they provide medically necessary services
on a universal basis (comprehensiveness). In this system where all residents are supposed
to be provided with access to public healthcare insurance on equal terms and conditions
(universality), the provincial governments have still been given a great deal of
discretionary power and aren' t legislated to insure a specific list of services. In tum, there
is a wide range of services insured by each of the provinces and territories (Mikkonen &
Raphael, 2010, p. 38). Due to reductions in federal funding, further impacted by
discretionary practices and the changing interpretation and application of the term
'medically necessary', there now exists a system where extended health benefits are

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largely covered in a second tier of privately obtained individual and group health
insurance. Such developments underlie the theme of this study where the provision of
health benefits outside of the universal and public insurance plan fall to other organized
groups as is seen in the case of student societies in Canadian post-secondary.
1.3 Student Health Insurance in Canadian Universities and Colleges
Student driven organizations have come forward to privately coordinate
supplemental coverage of health and other services as part of their ability to implement
mandatory fees for the members they represent. In British Columbia (BC), the University
Act as well as the Colleges and Institute Act include language permitting student
organizations the right to organize and set membership dues and fees for value-added
programs through the democratic choices of members. To ensure this, an annual notice
letter outlining those mandatory fees, must be submitted to their respective institution's
Board of Governors (Legislature of British Columbia, 1996). The mechanisms for
democratic choice in these matters consist of annual general meetings, referenda and
board of directors meetings wherein binding decisions are made by a vote, typically of
three quarters or at least by a majority vote of membership present in a general meeting
or participating in a referendum voting process. These requirements are determined by
the bylaws of each organization and the province's governing Society Act. In all cases, a
democratic choice needs to be made by the students in order to move forward on any
form of fee implementation. Once this occurs, the college or university they operate
within becomes a partner for implementation. Colleges and universities are required to
collect and remit all respective membership and additional value added fees, which have

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been voted on by the student body through these democratic decision-making
mechanisms. As part of this arrangement and to ensure accountability and transparency,
an annual audit of all financials is required in order to ensure fair and transparent
operation. This is done in accordance with Canadian generally accepted accounting
regulations (Legislature of British Columbia, 1996). These regulations act as a safeguard
to ensure that student societies act in a fiscally responsible manner as a requirement of
their good standing and society status. Pending the annual audit and confirmation that a
student society remains in good standing, the respective college or university is required
to remit the membership and associated fees. Fees are assessed based on the student
societies working definition of a member and are outlined in their bylaws and
constitution. These fees are collected at the same time as tuition and as a mandatory part
of attending post-secondary education.
Compared to BC, the Quebec model is more extensive in that it more closely
parallels the certification structure of trade unions. It establishes the right of students'
unions to have fees collected and protects students' union autonomy in all matters
relating to student issues and student representation. In the other Canadian provinces,
legislation of this nature does not exist to ensure and enshrine the right to organize and
collect fees as a mechanism for student representation and autonomy (Canadian
Federation of Students -Ontario, 2005, p. 3). Where these functions are not legislated,
student societies still operate in the same way, although this is based on working
relationships hinged on agreements and memorandums of understanding with each
college or university's administration. These post-secondary institutions still recognize
and collect the membership and associated fees, which have been implemented by

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student societies yet this action is not legally required. This is important to note, so that it
can be understood that there may be additional challenges that student organizations face
in provinces where the institutions are not legally obligated to collect membership dues
and other associated fees. This could compromise the long-term stability of group health
insurance plans for students.
Across Canada, there is a wide range of programs offered through public postsecondary institutions including, but not limited to, programs for domestic and
international students. These include adult basic education (high school equivalent
upgrading); English language learning, undergraduate and graduate programs as well as
technical, trades and apprenticeship training. Within these groups there is a range of
factors, which may impact health and health outcomes and influence demand for direct
health and health related services. As a result, the benefits packages offered through
group health insurance plans for students in each case are unique, dependent on the
democratic decisions and demands of members and how students' society representatives
and staff negotiate a health benefits package based on those demands. Democratic choice,
in the form of referendum votes of a society's membership, set the parameters for the
allowable cost as well as the priorities of the coverage provided.
The key point to understand about post-secondary students in Canada is that their
membership in student societies is mandatory across the majority of colleges and
universities and it should be noted that this is not legislated in each case. It is through the
structure of student societies that mandatory fees have been implemented for group
health insurance to address needs for healthcare and healthcare related services beyond
the public package for Canadian healthcare.

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Moreover, there are various extended health and dental benefits that are not
covered by national public healthcare (Medicare) in Canada, which can be quite costly to
obtain on an individual basis. As a result, there is a demand and a viable market for
privately provided extended health, dental and other benefits. In response to this unmet
need for health coverage, various populations have formed group plans wherein
collective action helps to lower the cost of premiums for the individual. The individual
per person cost is adjusted, from time to time, based on the claim history of the given
group. Through this group, they are able to achieve an economy of scale while also
engaging in the pooling of risk in order to reduce premiums. Although a majority of the
costs for developing and selling health insurance are constant across small and large
groups, these groups benefit from adverse selection being eliminated through this form of
cost pooling. Students, when compared to the general population, are a relatively healthy
demographic, assembled for a main reason other than the purpose of purchasing health
insurance and, though they experience their fair share of good and bad health risks, they
generally balance to make them a favourable group. Through this pooling of risks by
establishing mandatory plans for full-time students enrolled in a variety of programs, "the
insurance company can sell insurance without having to go through the trouble of
examining people, taking histories and so on, which is common with individual insurance
policies" (Phelps, 2010, p. 349). Over time, Canadian's unmet need for extended health
and other benefits has led to increased numbers of groups pursuing extended health
insurance in this way. These groups of people range from employers to labour unions,
student societies and other non-profit or membership-driven organizations working to
coordinate extended health and dental plans for their specific populations. These

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organizations have pursued extended group health insurance due to the perceived and
expressed demand of their members, wanting to benefit from the lower premiums
afforded by group health insurance.
More commonly known than student plans, are employer-based plans that
initially paved the way for group insurance in Canada. These plans are leveraged through
the added benefit of being classified by the government as non-taxable benefits. The
purpose is to encourage employers to better the compensation package in a way that

.

helps them to promote and produce healthy employees. Without government provisions
to provide tax exemptions for extended health insurance, employers would be less likely
to provide benefits as a part of the compensation package and the market would be
significantly less profitable for insurance companies. As for students, the transaction of
obtaining coverage through student society fees is exempt from taxation, which also
makes it more appealing. Since these fees are administered as an additional and valueadded part of membership in a students' society, extended health plan fees are also
covered by government student loan programs. This means that they qualify for interest
free status while in full time study and for interest rates of about 5% afterwards
depending on a student's province of study and provincially coordinated loan program
(Government of Canada, 2014).
It is important to understand that the demand for group health insurance is not

only coming from students and their respective societies' , but that colleges and
universities themselves may also contribute as demand drivers as they look for ways to
continually improve on recruitment and retention for their programs. In the same way
that employers enhance their compensation package through supplemental health

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coverage, student societies contribute to the benefits of the overall enrolment package.
1.4 Providers of Health Insurance to Students in Canada
There is no available, well-documented history of the developments and evolution
of this form of group health insurance for students in Canada. Still, through informal
interviews, many industry contacts confirmed that the market began to first establish
itself in the early 1980's. In support of these anecdotes, the 'about us' section on the
Canadian Federation of Students (CFS) Services Heal\h Network website states its
formal establishment in 1985 (CFS-Services, 2014) and Adam C. Lewis (ACL) Benefits
states they have been in business for over 20 years (ACL Benefits, 2013). Nevertheless,
the other providers, institutions and their respective students' societies do not list their
plans history, what year the plan was first established and how they have developed yearto-year. Each plan has developed and continues to develop in autonomous and
independent ways at their own stages of evolution. As each institution's plan has
developed uniquely based on the political and social climate of each student body and
there is a range of costs and benefits coverage experienced by each group. Although
providing a more in depth history of the evolution of plans is not possible, this project
attempts to better document its current state as a benchmark study.
Student health insurance plans have established themselves within the last 30
years and the student health insurance market in now firmly established. This has taken
place through the actions of students working collectively through their respective
student societies to address their unmet needs for coverage. Through these plans, students
have supplemented the universal health insurance program provided under the Canada

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Health Act in addition to the pharmaceutical plans within each province. These

developments have led to the implementation of a mandatory extended health and dental
benefits insurance program at almost every post-secondary institution across the country.
This section describes the current system for health insurance provision to
students wherein; student societies solicit either a broker or the National Student Health
Network established by the Canadian Federation of Students-Services, to act on their
behalf as agents to negotiate appropriate levels of coverage at a level of cost that has been
democratically approved by the members they represent. Figure 1.1 below is the
conceptual map of institution-student society-provider relationships, which outlines the
relationships between the stakeholders involved in providing this form of service to
students.

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Figure 1.1: Conceptual Map of Stakeholder Relationships

Students' Society

The key feature to point out is that the broker described along with the insurance
company, to make up the "provider", acts as the students' society's agent in coordinating
the extended heath and dental insurance package. How this occurs is stipulated by the
societies members and managed by the representative board of directors and their support
staff. General cost and coverage parameters are set by the society's membership through

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democratic process and referendum voting as was previously mentioned.
In this current system, students and student societies do have a unique ability to
create discount networks and to solicit lower co-payment. Cost saving discounts can be
achieved for student groups through the establishment of preferred providers for health
services (Student Care, 2013). Discounts on drug dispensing fees , and on the cost of
prescriptions allow students to add value to their benefits plans. A dispensing fee can be
arbitrarily set by any given pharmacy based on their company policy but this is still a
way for students to reduce the costs they experience in accessing their extended health
benefits. Coordinated by Canada' s largest student led organization, Canadian Federation
of Students-Services (CFS-S) operates and markets its National Student Health Network,
as part of its various member services available to its members of the CFS . CFS-Services
are optional to member student societies and as a result, not all members coordinate their
plan through the National Student Health Network. CFS-Services has in tum been
working on a number of initiatives to solicit these discounts in ways that will ensure the
discount benefits the student. For instance, CFS-Services advocates for the provision of
manufacturer list prices plus a set percentage as marginal revenue for the pharmacy. This
ensures that there is not a floating rate of marginal revenue and ensures that there are in
fact savings in the discount provided. In addition to CFS-Services, there are a handful of
other networks, developed by other providers, made up of brokers and the insurance
companies they cooperate with. They specialize their support and tailor their benefit
plans to the unique needs of students and student societies. Brokers are also found, by
this study, to generally solicit further discounts to reduce costs for students when it
comes to accessing their benefits to reduce the costs of co-payments.

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The review of the available plans across the country identified a total of 153
comparable group health insurance plans for students, currently coordinated by six main
providers. These plans have been implemented at almost all campuses as an ad hoc
reaction to gaps in what health services are publically available for students in each
province. There is a wide range of plans and number of students insured by these
independently established student society programs. The market for post-secondary
student health insurance is now well established across Canadian campuses, which is
partly why it is worthy of further attention and investigation. The current status of this
system is that plans are self-selected based on differing circumstances facing differently
composed student groups at each campus and institution. To further tailor benefits, there
are even sometimes instances of multiple plans in operation at one institution.

1.5 Previous Work
In initial preparation for this study, an extensive search was conducted to see if
any previous academic articles had been published on the topic of group health insurance
in Canadian post-secondary educational institutions. After completing multiple Boolean
searches in multiple available databases through the University of Northern British
Columbia (UNBC) and University of British Columbia (UBC) library and online
resources using multiple key terms and synonyms, it was determined that there is a lack
of previous study or research specific to the situation of group health insurance for
students within Canadian post-secondary. There is only one exception, and that is the
study by Nunes et al, published in 2014, which specifically addressed unmet needs for
plan coverage of mental health services while also noting the wide range of coverage and

STUDENT HEALTH INSURANCE IN CANADA

20

cost between plans. This paper has a narrow scope of assessing mental health coverage of
each plan.
More specifically, Nunes et al collected data on the variance of mental health
coverage at 210 not-for profit post-secondary institutions and arranged this information
by type of institution (college or university) and by province. One limitation of this
study mentioned was that the authors were not able to include institutions from Quebec in
the study. This was due to how the Quebec system differs from the rest of Canada with
its 48 publically funded pre-university colleges (CEGEPS), 25 provincially funded
colleges, and 24 private colleges which are not provincially funded, and a greater level of
coverage by other means resulting in a reduced need in that province (Nunes, et al.,
2014). Although some institutions from Quebec were included in this project, they
should still be noted as outliers given the increased number of public health services and
a more comprehensive multi-level system of post-secondary than is currently in place
throughout the rest of the Canadian provinces.
Furthermore, Nunes et al specifically looked into the limited prescription
coverage and support for mental health issues. The authors identified students as a
demographic group in need of coverage for programs, services and medications relating
to mental health issues and noted the compounding factors and stressors of student life.
Their findings identified a varied level of coverage experience across plans stating that
"plans usually covered other health services such as ambulance, physiotherapy, vision
care, and dental care [yet] the coverage of these other services is quite variable among the
plans" (Nunes, et al., 2014). They also went on to state that neither the other areas of
coverage, nor the variance of plan cost were further looked into since the focus of the

STUDENT HEALTH INSURANCE IN CANADA

21

study was specific to the coverage of mental health services. This reinforces the need for
further investigation to help fill the gaps and establish a more comprehensive body of
knowledge around health insurance for post-secondary students in Canada. In doing so,
this project will help to inform students who find themselves elected to their students'
society board of directors, and assist them in upholding their fiduciary duties in the
oversight of group health insurance plan costs, scope and benefits. It will also help
insurance provider networks and governments base their policies on factual grounds.
1.6 Objectives of this Study
The market for group health insurance for students in Canada is not well known
or documented despite its importance. This is an important gap to fill given the large
number of students impacted, and the effects of supporting and insuring the Canadian
student population. The purpose of this study is to assemble relevant information to
provide a foundational understanding of the scene for student health insurance in
Canadian post-secondary institutions. To do so, it identifies the key players - insurance
providers, networks, brokers and students' societies, and documents how they interact.
The study also describes the variety of insurance plans in terms of costs and benefits
coverage. Beyond this, it outlines the main providers and the student bodies they serve at
various post-secondary institutions across the various provinces of Canada.
This project expands on previous research (Nunes, et al., 2014), taking a broader
look at the main components of benefits coverage with a deeper look into the cost of each
plan across the providers, within each province, and with respect to the level of study of
the insured student groups. Although the lack of prior research on this topic created

STUDENT HEALTH INSURANCE IN CANADA

22

some challenges and limitations for approaching and completing research in this area, it
clearly demonstrates the need for original research of this nature. This project will help to
better understand the plans currently in place with regards to the annual coverage costs in
relation to the level of study (whether, college, university, graduate or undergraduate),
the provider coordinating each plan, and the province of study. As such, this project
provides a foundational understanding of the environment for student health insurance in
Canadian post-secondary institutions.
In order to better understand the range of plans, annual cost and benefits coverage
information was compiled for a total of 153 extended health and dental plans run by
student societies. Chapter Two describes the compilation of data and the methodology
used in collecting information across plans. Chapter Three analyzes the cost of plans
across the six main providers, the number of plans and the number of students insured
across undergraduate and graduate populations. In that chapter, graphical depictions were
used to show the variance in plan cost across these attributes. Chapter Four discusses the
main results and concludes the paper.
A key limitation of this study is that corresponding graphical depictions could
not be created to analyze the value and distribution of benefits in a comparable way, and
be able to relate plan costs to benefits. This limitation was partly due to a lack of
standardization in how benefits are provided in addition to the fact that claims data is not
publically available across plans.

STUDENT HEALTH INSURANCE IN CANADA

23

Chapter 2: Data and Methodology
2.1 Data
The sources for data used in the original research component of this study consist
of a number of online resources and varied for each student health plan. For each plan, a
mix of sources was reviewed including the website for the institution, the provider's
website, and the website of each respective student society. When information was not
available online, informal telephone interviews were conducted and annecdota~
information was gathered. There were a number of challenges in compiling this data
given that for each plan, information was not consistantly kept in the same place and that
providers and student societies detail their benefits covered in different ways, with
different terminology depending on the provider and province. This could also be
partially attributed to variances in the publically provided plan for coverage in each
province. All of these factors contributed to it taking a great amount of time to compile
comparable information for each student health plan. As previously stated, there were
various limitations which limited the scope of the comparisons that could be made.
The annual plan costs and benefits coverage data was taken during the 2013-2014
academic year running from September 2013 to August 2014. As such, the reliability of
the data is based on the accuracy of these websites and may be subject to change after
August 2014. The representative institution and student society population data was
obtained largely from estimates on each institution' s website in order to provide a
comparison of the number of students covered by each plan, in each province and by
each provider.

STUDENT HEALTH INSURANCE IN CANADA

24

By compiling the most recently available data taken from provider and postsecondary websites and by organizing and summarizing this information across different
attributes, This study contributes to better understanding of health insurance for postsecondary students in Canada.
2.2 Methodology
The methodology for this project is descriptive and empirical. Charts are used to
depict the distributions of plans across the providers, province~ and student groups. Boxplots are used to present the detailed distributions of per-student annual costs for the
same categories of providers, provinces and student groups. The data is first organized by
the six main providers in the Canadian marketplace. Following a comparison of providers
the data is reorganized by province, and finally by level of study of the students in each
covered group as either undergraduate or graduate students only, or undergraduate and
graduate students together.
Although information was also compiled detailing the benefits of each plan, a
cost-based approach is used to narrow the scope and make it more manageable. All
information compiled is from various publically available online sources and was
gathered in a comparable way in order to outline the varied range of cost and coverage
for plans providing extended health coverage. Typically coverage is found to be in place
in the three main areas of extended healthcare, extended dental, and vision coverage.
Extended healthcare, dental, and vision coverage are the most common themes
and plan features driving the cost of these plans. These categories are broadly defined in
the Canadian public healthcare system with extended private health coverage referring to

STUDENT HEALTH INSURANCE IN CANADA

25

prescription drug provisions, extended dental coverage referring to preventative and
restorative dental work, and vision coverage referring to medical vision exams,
eyeglasses, corrective contact lenses and sometimes limited coverage to subsidize laser
eye surgery procedures. Coverage of these main benefits appears to be a common theme
and guiding principles for the majority of the plans now in place across Canada although
paramedical and travel benefits are sometimes also included. This project identifies and
evaluates the trends to determine whether there are inconsistencies and variances in the
per-student annual cost of plans and benefits. fi.s previously stated, this study takes a
closer look at the provider, province, institution, as well as the level of study of students
insured in each group. It is with a better understanding of this current landscape that a
better assessment can be made of the situation for group health insurance in the Canadian
post-secondary system. This study provides a basis for further analysis and for
developments in order to address potential issues and to inform the best way forward for
this evidentially large and potentially growing area of private health insurance in Canada.
Through a comparison of the various student-health insurance providers and the
plans that these providers coordinate, we can better understand to what end, and at what
costs students have established these value added insurance programs. Through a
Canada-wide overview, a further understanding and a clearer picture of the costs and
coverage distributions for various combinations of extended health, dental, and vision
benefits can be established. These plans are more or less unique, given that they are
administered by non-profit organizations (student societies) through the solicitation of
brokers working on behalf of student societies as their agents to negotiate benefits with
both for-profit and not-for-profit insurance providers in Canada's two-tiered system of

STUDENT HEALTH INSURANCE IN CANADA

26

healthcare.
By assessing whether variance exists between plans through an empirical
approach, a better analysis of student health insurance and understanding of the range and
trends for the costs and distribution of plans can be determined. Is there variance, and if
so, what is the level of this variance? Is there a large difference between solely
undergraduate or graduate and mixed undergraduate and graduate student groups? What
is the variance between plans depending on the provider and the province of study?
There are a number of questions still to be answered in order to fully assess the
current state of this system with regards to how the system may be improved and whether
the system should be changed. Although the scope of this project is somewhat limited, it
will contribute to the dialogue on whether healthcare policy should better regulate private
insurance or whether there should be greater public coverage for extended healthcare,
dental, and vision benefits for students in order to create more consistency in the level of
coverage and cost of these plans.
Although the Canadian model may seem favourable when compared with the
current state of student health insurance in many other countries, there is a need for
Canadians to hold this system to the highest standard. As federal and provincial
governments cut healthcare funding, coverage is decreasing by an erosion of what is
considered to be medically necessary within the public package. As shown in this study,
when government provides less, groups of citizens such as post-secondary students, for
better or for worse, react in order to meet their healthcare needs that extend beyond this
public package.

STUDENT HEALTH INSURANCE IN CANADA

27

Chapter 3: Empirical Results and Analysis
Taking a closer look at the current Canadian marketplace for student health
insurance, there are six main providers whom have created network pools. The network
pools, also known as buying consortiums, are coordinated by a combination of brokers
working in cooperation with insurance companies to serve this niche market of group
health insurance plans for students.
Thes~ include, Student Care, the CFS-Services Health Network, Gallivan &
Associates, Adam C. Lewis (ACL) Benefits, Campbell & Company and Prudent Benefits
Administration Services (PBAS) Group. Student Care, first forming as the Quebec
Student Health Alliance (ASEQ), now serves 40 post-secondary school health plans
translating to about 26% of the number of total plans in the Canadian market for group
health insurance. The CFS-Services Health Network coordinates with a for-profit broker,
yet nearly exclusively purchases coverage with Greenshield Canada, Canada' s only
cross-country non-profit insurance company. This CFS-Services National Student Health
Network consists of 3 7 post-secondary school health plans, which represents
approximately 24% of the total number of plans in the market (Greenshield Canada
Student Centre, 2013). Gallivan & Associates currently administers health insurance
plans to a network consisting of 33 student groups, constituting 22% of the total number
of plans in the market. ACL Benefits serves a network consisting of 21 student groups
and about 14% of the total number of plans in the market. Campbell & Co. serves a
customer base of 12 student groups and 8% of the total number of plans in the market.
Lastly, the PBAS Group serves a network consisting of the 10 student groups, covering
the remaining 7% of the total number of plans in the niche market for group health

28

STUDENT HEALTH INSURANCE IN CANADA
insurance plans of this nature.

Table 3.1 presents a comprehensive list of which institutions are covered by each
of the six main providers going left to right from largest to smallest:
Table 3.1 Institutional Coverage by the Six Main Providers

Provider 1:
Provider 2:
CFSStudentCare
Services
University of Brandon
Manitoba
University
University of Carleton
Toronto University Graduate
Graduate
Students
Students
UBC
College of
Okanagan
New
Caledonia
Carleton
College of
University North
Undergradua Atlantic
te Students

Provider 3:
Gallivan &
Associates
BCIT

Durham
Emily Carr
College and
University
UOIT
University of George
Western
Brown
Ontario College
Graduate
Students
Capilano
Laurentin
University
University
University of Laurentian
Victoria
University Graduate
Students

Provider 5:
Campbell&
Co.
Algoma
University
Athabasca
University Graduate
Students
Brock
University

Provider 6:
PBAS
Group
Acadia
University
University of
Calgary Graduate
Students
Holland
College

Confederati
on College

Brock Graduate
Students

Mount St.
Vincent

Conestoga

Fanshawe
College

Dalhousie

Mount
Allison

Dalhousie
University Truro
Campus

Fleming
College

Lakehead
University

Douglas
College

Humber
College

University of
Lethbridge

Ontario
College of
Art and
Design
University
Medicine
Hat College

Georgian
College

Lamb ton
College

Trent Central

The St. FX

Camosun
College
Cape
Breton
University
Concordia
University

Provider 4:
ACL
Benefits
Algonquin
College
Cambrian
College
Can adore
College

29

STUDENT HEALTH INSURANCE IN CANADA

Provider 1:
Provider 2:
StudentCare CFSServices
Royal Roads Laurentian
University University
Barrie
Campus

Provider 3:
Gallivan &
Associates
Great Plains
College

Provider 4:
ACL
Benefits
Laurentian
University

Provider 5:
Campbell&
Co.
Saint Mary's
University

Provider 6:
PBAS
Group
University of
Prince
Edward
Island

Mohawk
College

Kwantlen

Loyalist
College

Lakeland
College

McMaster
University

Wilfrid
Lauri er
University
University of
Windsor

University of
Western
Ontario

Lethbridge
College

Niagara
College

Universite
de SaintBoniface
Marine
Institute

University of
Alberta Undergradua
te Students
Simon Fraser Grenfell
University
College
undergraduat
e Students
Simon Fraser
University Graduate
students

NAIT
Ni pissing
Memorial
University
University
of
Newfoundla
nd Graduate
Students
Sault College Memorial
New
Northern
University
Brunswick
College
of
Community
Newfoundla College
nd
UBCNS CAD
Nova Scotia Seneca
Vancouver
University
Community College
College
Langara
Okanagan
Parkland
St. Clair
College
College
College
College
University of Queens
Red River
St.
the Fraser
University - College
Lawrence
Valley
College
Graduate
and
Professional
Students

University of
New
BrunswickGraduate
Students

STUDENT HEALTH INSURANCE IN CANADA

Pr-0vider 2:
Provider 1:
StudentCare CFS,;g/¥
Services
UNBC Ryerson
Undergradua
te Students

Provider 3:
Gallivan&
Associates
SAIT

UNBCGraduate
Students

CESARContinuing
Education
Students

University of
Alberta Graduate
Students
ACAD Alberta
College of
Art & Design
University of
Saskatchewa
nUndergradua
te Students
University of
Saskatchewa
n -Graduate
Students

Selkirk
College

Saskatchew
an Institute
of Applied
Science and
Tech
Bow Valley
College

University of
Regina &
First Nations
University
University of
Waterloo Undergradua
te Students
University of
Waterloo Graduate
Students

Thompson
Rivers
University
Trent Graduate
Students

Grande
Prairie
Regional
College
Keyano
College

l 'Universite MacEwan
Sainte-Anne University

University
of Kings
College

Mount
Royal
University

University
of Ottawa Graduate
Students'
University
of Ottawa

Olds
College
Red Deer
College

Provider 4:
ACL
Benefits
The
Michener
Institute for
Applied
Health
Sciences
Trent Oshawa

University
of New
Brunswick

30

Provider 5:
Campbell&
Co.

Provider 6: ,
PBAS
Group

STUDENT HEALTH INSURANCE IN CANADA

Provider 1:
Provider 2: ,,, ProviderJ:
Gallivan&
StudentCare CFS ..
Associates
Services
CCNMUniversity
Norquest
of Toronto
College
Canadian
College of
Naturopathic
Medicine
McMaster
University

CMCCCanadian
Memorial
Chiropractic
College
Sheridan
College

Queen's
University

University
of Toronto Part-Time
Undergradu
ate Students
University
of Windsor
-Graduate
Students
University
of Windsor
-Part-time
University
Students
University
of
Winnipeg

WLUUniversity
Wilfrid
of
Lauri er
WinnipegUniversity Aboriginal
Graduate
Students
students
University of University
Toronto, of
Scarborough Winnipeg
Campus
Part-Time
Students
McGill
Vancouver
University Community
Undergradua College
te Students

The
University
of Calgary
Universite
de GuelphCampus
d' Alfred
University
of GuelphMain
Campus
University
of Guelph Kemptville
Campus
University
of GuelphRidgetown
Campus
Okanagan
CollegeVernon
Campus

Provider 4: Provider 5:
Campbell&
ACL
Benefits " ,r,?1 Co.

31

Provider 6:
PBAS
Grout>

STUDENT HEALTH INSURANCE IN CANADA

Provider 2:
Provider 1:
StudentCare CFSServices
McGill
University,
Macdonald
Campus
(MCSS)
McGill
University Graduate
Students
McGill
University Residents

Concordia
University U ndergradua
te Students
Concordia
University Graduate
Students
HEC
Montreal

Vancouver
Island
University
Students'
Union
Glendon
College

Provider 3:
Gallivan&
Associates

Provider 4:
ACL
Benefits

32

Provider 5: ,
C~mpbell&
Co.

Provider 6:
PBAS
Group "'

York
University Graduate
Students

3.1 Providers' Market Share
Figure 3.2 below, depicts the number of health insurance plans currently
administered by each of the six main providers dominating the market for student group
health insurance in Canada. Student Care provides the largest number of plans, followed
by the CFS-Services Health Network and Gallivan & Associates. The remaining
providers offer less than 30% of the plans.

33

STUDENT HEALTH INSURANCE IN CANADA

Figure 3.2 Number of Student Group Plans Served by each of the Six Main
Companies

40

# of
group
plans
10

Provider 1:
Student Care

Provider 2:
CFS Health
Network

Provider 3:
Gallivan &
Associates

Provider 4:
ACL Benefits

Provider 5:
Campbell &
Co

Provider 6:
PBAS Group

'--------···----------------------------------'

Figure 3.3 below, shows the percentage of market share for each of these six main
insurance companies serving this niche market, based on the number of student society
group plans in each buying consortium.

STUDENT HEALTH INSURANCE IN CANADA

34

Figure 3.3 Distribution of Market share by Number of Plans
6%

II Provider 1: Student Care

8 Provider 2: CFS Health Network

14%

IZI Provider 3: Gallivan & Associates

• Provider 4: ACL Benefits
.Eil Provider 5: Campbell & Co

D Provider 6: PBAS Group

Since the number of plans served does not provide the clearest picture of the size
of market share, Figure 3 .4 reports the number of students served by each provider.

35

STUDENT HEALTH INSURANCE IN CANADA

Figure 3.4 Distribution of Market Share by Number of Students

588170

# of

students
covered

360,317

- ~- ' --

Provider 1:
Student Care

Provider 2:
CFS Health
Network

Provider 3:
Gallivan &
Associates

Provider 4:
ACL Benefits

Provider 5:
Campbell &
Co

.....- - ,

Provider 6:
PBAS Group

Note: Student populations are approximate and based on the most recent figures available
through the institutions of study between the years 2010 to 2014.
In total, this study estimates 1,580,887 students studying across 97 universities,
55 colleges and 1 university-college. Group health insurance for Canadian postsecondary students is a market of considerable scale with the majority of students
covered studying in universities as further portrayed in Figure 3.5.

36

STUDENT HEALTH INSURANCE IN CANADA

Figure 3.5 Distribution of Market Share by Type of Institution

1,090,461

Studen t
Population

488,812

1,600

universities

colleges

university colleges

There is already documented evidence of variance between the health coverage
experience between students studying at colleges and universities. According to the study
by Nunes et al, college students experience 27% less coverage than their counterparts in
universities. The study states that just 41 % of colleges have provisions of extended health
insurance for prescription medication in comparison with universities where prescription
coverage of this kind is provided at 68% of institutions (Nunes, et al., 2014).
As shown by this project and above in Figure 3.4, Student Care is currently
serving the lion's share of the market by providing group health insurance benefits for
almost 600,000 post-secondary students in Canada, this is in part due to their coverage of
some of the much larger university student societies. Universities are also clearly shown

STUDENT HEALTH INSURANCE IN CANADA

37

to make up the majority of the insured student population as shown above in Figure 3.5.
The CFS-Services Health Network and Gallivan & Associates are the other large players
although they serve at least 200,000 less students according to estimates based on
institutionally available student body head counts. It should also be taken into account
that there is some attrition to these numbers due to opt-out procedures and in some cases,
non-assessment of coverage for part-time students or shorter running programs.
Figure 3.6 below shows the distribution ofrelative market share for each of the
six niain providers based on the estimated number of students they serve.

Figure 3.6 Distribution of Market Share by the Number of Students

4%

ID Provider 1: Student Care
Cl Provider 2: CFS Health

Network

~ Provider 3: Gallivan &

Associates

• Provider 4: ACL Benefits
1!11 Provider 5: Campbell &

Co

D Provider 6: PBAS Group

23%

Figure 3.6 re-affirms Student Care as the largest provider of coverage, which can
be attributed to serving some of the largest universities in the country such as the
University of British Columbia (UBC) and McGill University. In support of this finding,

STUDENT HEALTH INSURANCE IN CANADA

38

Figure 3.6 shows an 11 % increase in market share when compared to the number of plans
coordinated by this provider in Figure 3.3 .
Also of interest is the number of providers acting and the number of plans they
each coordinate by province; this is presented below in Figure 3.7. As expected, given
that Ontario is the largest market for group health insurance in Canada, it is the only
province where all six providers currently coordinate plans. Other interesting
observations of this distribution are that Gallivan & Associates finds most of its market
in Alberta, while Student Care is the sole plan provider in Quebec, and the CFS-Services
National Student Health Network is the sole provider in Newfoundland. Also, the three
largest providers, Student Care, Gallivan & Associates and the CFS-Services National
Student Health Network are the only providers currently active in British Columbia and
Manitoba.

39

STUDENT HEALTH INSURANCE IN CANADA

Figure 3. 7 The Provincial Presence of Providers

20
18
16
14
12

# of 10
group 8
plans 6

=

4
2
0

~
~

~

~

~

II"

~I =

AB

BC

l=rl

~

MB

NB

Ill~
NL

'1-

NS

~

;
;

;

ON

1

~

I

S1

11

PE

QC

SK

Provinces of Canada
IJ Provider 1: CFS-S Health Network

la Provider 2: Student Care

IZI Provider 3: Gallivan & Associates

• Provider 4: ACL Benefits

Provider 5: Campbell and Co.

D Provider 6: PBAS Group

111!1

As demonstrated in Figure 3.7 above, providers show a significant amount of
variation in the number of plans they offer across different provinces. Given the sheer
number of plans, and the amount of business currently conducted in this area of group
health insurance, it is evident that the market is significant.

3.2 Distribution of Health Insurance Plan Costs
This section describes the plan costs across providers, provinces, and student
groups. These health insurance plans are offered at various costs, which are made up of
both premiums and administration fees. The least costly plan in Canada is at Sault
College in Sault St. Marie, Ontario where per student cost assessed just is $50 annually.
The most expensive plan documented in this study is at the University of Windsor in

STUDENT HEALTH INSURANCE IN CANADA

40

Windsor, Ontario, where the Graduate Students' Society operates a plan for its members
at an annual cost of $606.87 per student. In addition to the 153 comparable plans
documented in this study, there was one additional student society providing their plan in
a different way, the Athabasca Graduate Student Association (AU GSA) is an outlier that
operates uniquely in two ways. Firstly, AU GSA coordinates plans in multiple provinces
and secondly, they do so with a monthly opt-in rate for their members. All other 153
plans list an annual per student cost, which is assessed up-front as a mandatory fee, along
with student society fees and tuition. Across the country, the average plan cost is $262.68
the median is $248, and the standard deviation is $100.65 suggesting a relatively
symmetric but wide distribution of the costs. When looking at the per-student annual plan
cost in each province, with each provider, and across solely undergraduate or graduate, or
undergraduate and graduate combined, we observe significant variations. To summarize
these variations more precisely, I use the Box-plot displays that provide us with the
median, interquartile range, and the overall range of the distribution from the minimum
to the maximum. The variance in plan cost across Canada is depicted in the Box-plot
shown in Figure 3.8 below.

STUDENT HEALTH INSURANCE IN CANADA

41

Figure 3.8 Box-plot of the Distribution of the Annual Cost of Student Health
Insurance Plans for Canada
$700
Maximum

$600
$500
$400

Q3

$300

Median

,$200

Ql

$100
Minimum

$0

Canada (All Plans)

The distribution of plan costs for individual provinces are presented in Figure 3 .9.

Figure 3.9 Box plots of the Annual Cost of Student Health Insurance Plans by
Province

$700
$600
$500

1O

$400
$300
$200
$100
$0

AB

BC

MB

NB

NL

NS

ON

PEJ

QC

SK

Note: Since there are only two plans for the province of Prince Edward Island, no Boxplot is provided for PEI.

STUDENT HEALTH INSURANCE IN CANADA

42

The Box-plots show the first and third-quartile, Ql and Q3, respectively; the
inter-quartile range (QI to Q3, or the height of the Box) and the overall range of the
annual cost. The smaller the interquartile range, the less variance there is in the annual
cost between plans in the middle of the distribution. The Box-plots show that there is
significant variation in the overall range of costs across the provinces. The raise in plan
cost is about $150 in Saskatchewan. In contrast, the cost range is over $550 in Ontario.
Due to outliers, a more reliable measure of variation is the inter-quartile range (IQR),
which gives the variation for 50% of the data occurring in the middle of the di~tribution.
New Brunswick shows least amount of variance in plan cost with an interquartile
range of $15, Saskatchewan's is $34, British Columbia's is $68.69, Alberta's is $92.50,
Manitoba's is $101.75, Nova Scotia is $119.17, and Newfoundland is $134.92. The
highest amount of variance in plan costs across student groups is seen in Ontario where
the inter-quartile range is $139.50. Based on these findings, one can observe that Ontario
likely experiences the highest rate of variance due to the tailoring of plans, having the
highest number of plans, compounded by the fact that all six main providers currently
coordinate plans in the province as previously depicted in Figure 3. 7. In comparison,
British Columbia has only three of the main providers coordinating less than a third as
many plans as Ontario and experiences less than half the variance as shown by its interquartile range and provincial distribution of plans. Interestingly, Newfoundland
experiences the second highest amount of plan variance across only five plans as shown
by its inter-quartile range being just $4.58 less than that of Ontario at $134.92. This could
be due to a higher than average rate of customization of plans for the province of
Newfoundland.

STUDENT HEALTH INSURANCE IN CANADA

43

Also, as depicted above in Figure 3.9, for all of the provinces that Box-plots could
be created, they are positively skewed. Specifically, taking a closer look at Alberta, half
of the plan costs in the middle vary within an $84 range (from $257 to less than $341).
Outside the interquartile range, the most expensive plan in Alberta has an annual fee of
$515 .16 assessed by the Graduate Students' Association of the University of Calgary.
This outlier plan is coordinated by the PBAS Group. As a rather large graduate student
population it is understandable that they would have a higher fee as a graduate students
are shown to be a more risk averse population with more dema!}d and ability to pay for
health services. Graduate students typically have higher fees for higher rates of coverage
than undergraduate student or mixed student groups. In further support of this finding,
the least expensive plan in Alberta is $221.96 assessed by University of Alberta
Undergraduate Students Union, they coordinate this plan with Student Care as their
provider.
Half the plan costs in the middle in Manitoba vary within a range of a little over
$100. Outside this interquartile range, Manitoba's least expensive plan is $148.67 and is
assessed by the University of Winnipeg Aboriginal Students' Association. The most
expensive plan in Manitoba is $439.67 assessed by the University of Winnipeg's Parttime Students' Society. In Saskatchewan there are six student health plans, where half the
middle plans costs vary within a range of roughly $32. Outside of the interquartile range,
the least expensive plan costs $196.40 annually assessed by the University of Regina
First Nations University and the most expensive plan is the University of Saskatchewan
Graduate Students Association at $350.51 annually. It is observed that first nations
student group members in both Manitoba and Saskatchewan typically receive

STUDENT HEALTH INSURANCE IN CANADA

44

phannaceutical coverage through Federal Government plans are in tum reduced in cost
without having to provide as broad a range of coverage. This further supports the thesis
that student plans are reactive to what is publically available as a supplement to fulfill
unmet needs.
Additionally, the two provinces shown to have the most group health insurance
plans in place are British Columbia and Ontario. In British Columbia, there are 23 plans,
the least expensive plan of which costs $159 .92 annually assessed by the University of
the Fraser Valley Students' Society and the most expensive plan costs $420 annually
assessed by the Graduate Student Society at Simon Fraser University.
Ontario has more than triple the number of group plans in place in British
Columbia with 68 with the widest distribution of cost. The least expensive plan in
Ontario previously mentioned in this study is the least expensive in all of Canada at $50
assessed by the undergraduate student society at Sault College. As previously mentioned,
Ontario has the most expensive group plan in the country at a cost of $606.87 assessed by
the University of Windsor Graduate Student Society. The findings in Ontario and in
British Columbia further reinforce findings that graduate students are a more risk averse
population with a higher willingness and ability to pay for these kinds of group benefit
plans.
To assess the level of variance from a different angle, Figure 3.10 provides Boxplots for the six main provider networks.

45

STUDENT HEALTH INSURANCE IN CANADA
Figure 3.10 Box-plots of the Annual Cost of Student Health Insurance Plans by
Provider

700
600
500
400
300
200
100
0
Provider l:
Student Care

Provider 2:
CFS-Services
Health Network

Provider 3:
Gallivan and
Associates

Provider 4 :
ACL Benefits

Provider 5:
Campbell and
Co.

Provider 6:
PBAS Group

Across the providers, Gallivan & Associates is shown to have the least amount of
variance with an interquartile range of $32, this is partially due to their push for more
standardization across the plans they provide as noted in the appendix. In ascending
order, ACL Benefits has an almost three times as much variance with an inter-quartile
range of $91 and Campbell & Co. is about the same with an interquartile range of $92.94.
Interestingly, the other two largest actors in the market: the CFS-Services Health
Network has a high interquartile range of $118.76 and Student Care has a higher
interquartile range of $129 .13. Nonetheless, if going purely by the interquartile range,
then PBAS Group has the most variance with an inter-quartile range of $151 for its 11
plans. This could be because of the high overall average annual cost for plans

STUDENT HEALTH INSURANCE IN CANADA

46

coordinated by PBAS Group of $335.92 and the fact that they coordinate plans across
distinctly different provinces such as Alberta, New Brunswick Nova Scotia, Ontario and
Prince Edward Island. PBAS Group has a wider range of provinces, and a higher average
annual plan cost than that of the other three smaller providers as is further noted and
explained in the appendix. Student Care and Campbell & Co. have the largest overall
variation with Gallivan & Associates showing the smallest overall variation in cost.
Figure 3 .11 below, shows the distribution of plan costs for different student
groups. It is clear that the plan costs are higher for the Graduate students as a separate
group.
Figure 3.11 Box-plots of the Annual Cost of Student Health Insurance Plans by
Category of Student Group
$700
$600
$500
$400
$300
$200
$100
$0
Undergraduates Only

Undergraduates & Graduates

Graduates Only

As Figure 3.11 shows, the interquartile range for undergraduates across both
college and university students is less than graduates. The undergraduate interquartile

STUDENT HEALTH INSURANCE IN CANADA

47

range is $63.60, in comparison to $80.69 for undergraduate and graduate combined
group. The graduate only groups experience the highest degree of variance with an interquartile range of $154.03 accompanied by higher average plan costs. By and large,
graduate student plans are amongst the most expensive group health insurance plans for
students in the Canadian post-secondary system. This could be due to a number of
contributing factors such as smaller pool size, older demographics and a more informed
and potentially more risk-averse population but it is also due to the fact that they are
richer plans with more coverage.
In order to provide a further overview of where the plans are concentrated, the
number of plans as well as the average plan cost within each province has been
identified. The majority of these plans (in accordance with the majority of educational
institutions) shown in Figure 3.7 are in the province of Ontario. In Ontario, there are 68
student group health plans in operation at an average annual per student cost of $242.94.
British Columbia has the second highest concentration of student group health plans in
operation, with 23 plans in place at an average annual per student cost of $256.94.
Alberta has the third largest concentration of plans with 20 student group health plans in
operation at a slightly higher average annual per student cost of $293.73. The national
average annual plan cost is $262.68, which reflects the higher average costs for the
Maritime Provinces. With a different provincially coordinated public healthcare
environment in each province, it makes sense that there would be cost differences. The
provincial average plan costs are presented in Figure 3 .12 in ascending order of costs.

STUDENT HEALTH INSURANCE IN CANADA

48

Figure 3.12 Average Annual per Student Plan Cost for Each Province
$400
$350
$300
$250
$200
$150
$100
$50
$-

MB

ON

SK

BC

QC

AB

NB

NS

PEI

NL

An in depth overview of the six main providers acting in each province and a

more complete description of each main provider network is available in the appendix to
expand on the overview and the distribution of the health insurance plan benefits.

STUDENT HEALTH INSURANCE IN CANADA

49

3.3 Distribution of Health Insurance Plan Benefits
The terms and extent of benefits range from plan to plan, and there is no standard
way of comparing benefits. Despite some exclusions of key areas for benefits, the
majority of plans offer coverage in the three main identifiable areas of extended health,
extended dental and vision coverage. Further to this, some schools have made the
decision to omit vision or dental benefits coverage as a way of limiting plan expenses.
Where the group of students insured have access to supplemental government coverage
of pharmaceuticals, extended health benefits have been taken out of the insured package
of benefits.
Vision coverage is a benefit that a certain portion of the population is almost always
guaranteed to use and is therefore a certain cost driver for plans. Due to this, it is the
benefit most often to be exempted from coverage provisions as a premium cost-saving
measure. One example of a student group omitting this benefit is the seen at Okanagan
College, where the Okanagan College Students' Union has excluded vision coverage
from the plan as a way to ensure adequate coverage in extended health and dental without
having to increase the premium beyond the current annual per student cost of $249.06.
Through informal interviews with staff at the Okanagan College Students' Union, further
context was given that this benefit was at one point covered by the plan, but that over
time, it was determined that it was not a vital benefit to provide for their members and
that it had become too costly to insure vision benefits along with extended health and
extended dental which were determined to be the main pillars of the health plan they
coordinate for their students. With similar reasoning, two other group plans that have

STUDENT HEALTH INSURANCE IN CANADA

50

made the decision to remove vision coverage benefits from their package are both at
Ryerson University in Toronto, where the student societies in operation there have
excluded vision benefits to keep the annual cost from rising.
Another interesting case, reinforcing the findings of this study, is at the University
of Winnipeg where the University of Winnipeg Aboriginal Students' Association
coordinates a plan that excludes extended health benefits. The reasoning for this is
actually quite simple, as the majority of these students have been targeted by additional
governmental benefits for Canadian First Nations and Inuit peoples. This is a targeted
approach of the Canadian government to support First Nations and Inuit peoples in
reaching an overall health status that is comparable with other Canadians, this program is
titled, Non-Insured Health Benefits (NIHB), and the general experience is that NIHB
provides adequate extended health benefits coverage for its members, however there is
still an expressed need for extended dental and vision coverage which are still expressed
as in need by this group as they are not adequately covered by NIHB (Health Canada,
2014). In tum, it is through the University of Winnipeg Aboriginal Students' Association
at an annual per student cost of $148 that these gaps in coverage are looked after.
Because the plan excludes coverage of extended health benefits as a reflection of the preexisting available public services for this population, the Winnipeg Aboriginal Students'
Association is able to save on costs and coordinate this plan well below the national
average for annual plan costs for an extended health benefits program. The University of
Winnipeg Aboriginal Students' Association's group health plan is currently one of the
least expensive plans coordinated by the CFS-Services' National Student Health Network
(Greenshield Canada, 2013).

STUDENT HEALTH INSURANCE IN CANADA

51

Additionally, the student group health plans in place at the Okanagan College's
Vernon campus in British Columbia, the University of Guelph Kempt Ville campus in
Ontario, the Grand Prairie Regional College in Alberta, the New Brunswick Community
College in New Brunswick, and Dalhousie University in Nova Scotia, are the only five
plans in the Gallivan & Associates network which exclude vision coverage provisions.
For the Gallivan & Associates network, removing vision coverage from the benefits
package seems to be a common recommendation made to student societies as a way of
keeping premiums from increasing, as the costs of health and dental services can, on th~ir
own, already be major cost and demand driver for plans at their current levels of
premmm.
The "WeSpeakStudent," ACL Benefits network coordinates four plans, which
have made dental and/or vision plan exclusions in order to maintain a lower per student
annual cost but all of their plans currently cover extended health benefits. The group
student plan at Cambrian College in Ontario is able to maintain its plan at a reasonably
low per student annual cost of $126 by excluding dental benefits coverage from their
plan, while still providing strong provisions for extended health (at 80% coverage to a
$5,000 maximum) and full cost coverage for vision exams and eyewear coverage ofup to
$80 per 24 months. At Candore College in Ontario, the group student plan has excluded
vision coverage, to maintain a very low annual per student cost of $60. Other cost saving
measures in place for the plan at Candore College of note, are that they limit dental
coverage to accidental dental only to a maximum coverage amount of $2,000 per policy
year, and although they do provide 80% coverage for extended health, this is also
curtailed by a per policy year maximum plan coverage of $2,000. Comparable to the plan

STUDENT HEALTH INSURANCE IN CANADA

52

in place at Candore College, the group student plan at Loyalist College, Ontario,
maintains a low per-student annual cost of $60 by excluding benefits coverage for vision
and limiting dental coverage to accidental dental at a maximum coverage amount of
$2,000 per policy year. Similarly, the group student plan at Nippising University
maintains a low per student annual cost of $60 by excluding dental coverage and limiting
vision coverage to just $30 per 24 months for exams and $30 per 24 months for
eyeglasses or contact lenses, a much lower rate of coverage than is customary with other
plans.
"Student VIP," Campbell & Company administers health insurance to a network
consisting of 12 groups spread across the country, but not in all provinces. Of the six
provider networks in Canada, Campbell & Co. is the only company providing coverage
in the three main areas for all of their group student health plans and the benefits that
they provide in these areas are consistent with what is customary across other providers.
Although Campbell & Co. is among the smaller brokers for student health insurance,
they are among most interesting, having made special arrangements to accommodate for
a growing online education market through Athabasca University Graduate Students
'Association (AUGSA). Unique from other providers, and in partnership with the
AU GSA, Campbell & Co. coordinates benefits across all of Canada on a voluntary, optin basis, with a monthly fee for coverage. This arrangement does not allow for the same
economies of scale that is achieved through other plans, however, it still proves to be a
viable service for those members of the AUGSA who would like to opt into extended
health and dental benefits. Due to its uniqueness, this plan was not included in the
graphical comparisons used to demonstrate trends across the 153 other plans. When

STUDENT HEALTH INSURANCE IN CANADA

53

referenced to the typical annual rate for 12 months of coverage, the AU GSA plan is the
most expensive plan in the country at a 12 month cost of $1278.48 in British Columbia,
$1478 .88 in Alberta, $1101.60 in Manitoba or Saskatchewan, $1236.72 in
Newfoundland, $1506 in Ontario, $1377.84 in Nova Scotia and $1478 .88 for the North
West Territories, the Yukon and Nunavut (Campbell & Co., 2013).
In summary, the group plan at Sault College, in Sault St. Marie, Ontario, has the

lowest annual plan cost in the country, attributed at least in part, to the exclusion of
extended dental coverage, which enables them to maintain the lowest annual per student
cost in the Country at only $50 per year. Further steps are taken in order to maintain such
a low annual cost in that the plan at Sault College. Their plan also limits vision benefits
to just $50 per two policy years for exams and $100 per 24 months for eyeglasses or
contacts and $150 per 24 months for laser eye surgery. Customary coverage for the other
group plans usually insure and cover higher amounts of the cost for vision without as
many restrictions in terms of which policy year and time period for claims. At the other
end of the spectrum, the plan with the highest annual cost in Canada is at the University
of Windsor where the plan insuring all graduate students costs $606.87 annually with a
fairly generous benefits package of 80% extended health coverage with a $1000
maximum per benefit year, a 100% coverage of basic and preventative dental services to
a maximum of $750 per policy year, $65 every 24 months for medical eye exams and
$17 5 every 24 months of eye glasses or corrective lenses. In review of this range in
annual cost for plans and the variance in benefits provided at each end of this spectrum, it
can be concluded that this is, at least in part, a reflection of a range in coverage of
benefits compounded by the claims history of an older student population.

STUDENT HEALTH INSURANCE IN CANADA

54

Chapter 4: Discussion and Conclusion

Besides the variations across plan providers, there are differences found between
student group health insurance plans. This is the result of a number of compounding
factors such as each health plan's different governance and business model, the different
experiences across the provinces and the different experiences in student pool size. Pool
size can range from as small as about four hundred graduate students at the Trent
University to as large as about 75,000 undergraduate students at George Brown College.
This, of course, is further compounded by the fact that each school experiences different
demographics as well as demands from the student groups they serve. Such complexity
could not be fully examined by this study.
For this project, a comprehensive understanding of plans was gained through the
composition of a data matrix of plan cost and coverage information for all the 153 plans
included in this study. This has been summarized for further reading and information in
the appendices. Annual per student plan cost was selected as the main variable that could
be effectively compared as a higher-level indicator given that it is also generally expected
to be correlated with a higher level of benefits coverage. In order to further identify
trends and commonalities, the mean and median costs were compared across provinces,
providers and student groups. Variations in the cost were summarized by constructing
Box-plots to make comparisons across the provinces, the six main providers and across
undergraduate or graduate groups or groups made up of both undergraduate and graduate
students. By making comparisons across these domains, a clearer and more high-level
picture of the distribution of the costs was provided.

STUDENT HEALTH INSURANCE IN CANADA

55

In terms of the benefits, and looking at the three largest purchasing networks, the
CFS-Services National Student Health Network covers all categories with the exception
of gaps in three plans that exclude vision coverage as a cost saving measure and one plan
that excludes extended health coverage due to the student population consisting
exclusively of aboriginal learners who already have access to increased extended health
coverage through the Federal Government. Gallivan & Associates excludes vision from
five plans as a standard practice for saving costs. Lastly, ASEQ/Student Care has a more
varied range of plan e?(clusions with one plan excluding extended dental, two plans
excluding vision, one plan excluding extended health, and one plan that excludes both
vision and extended dental coverage. This and other unique arrangements are likely made
at the request or in advisement to the students' societies they serve to meet the overall
goals of their coverage package and cost parameters.
Of the three smaller purchasing networks, ACL Benefits has just two plans that
have excluded coverage for extended dental benefits, one plan that excludes vision
benefits coverage and one plan that excludes both vision and extended dental coverage.
This plan exists primarily to provide students extended health and other supporting health
services. Otherwise, Campbell & Co. is the only purchasing network that has some level
of coverage provisions in all three areas identified by this project although this might be
due to the small scale of the business they conduct, and PBAS group has two plans which
exclude vision and two plans which exclude both vision and extended health coverage.
These plans are in place with a narrowed approach to provide extended dental as the
primary coverage provisions beyond that of other services not assessed.

STUDENT HEALTH INSURANCE IN CANADA

56

The market overview shows the range of student group health plans currently
available to students in Canada across six main providers. Some of the limitations for this
project were due to the lack of current enrolment and other post-secondary institution
data. Without publically available information from by Statistics Canada, enrolment
numbers had to be taken from institutional information reports, which varied in content,
detail and terminology. Based on the approximate and most recent figures available, the
market of a sizeable scale with about 153 group plans in place at almost all postsecondary institutions in Canada insuring an estimated 1.58 million students across the
country.
Additionally, although a higher-level comparison linking cost and coverage
variance was made for the purposes of this study, it must be noted that the annual per
student cost for each plan documented may vary for any number of reasons not
considered herein. These could include the uniqueness of each institutions plan and
benefits package, the demographic and claims history of the group at each institution, as
well as varying rates of administration fees. In many cases, part of the fee collected is
redirected to help fund internal student society staffing and other administrative costs
associated with the plan, this could not be documented as part of this study but could
contribute to overall plan costs. More in depth research is necessary to further and more
fully explore the nuances of this market. With profit motive at hand, providers could also
be in a position to misrepresent and exaggerate the complexities of the system. A degree
of caution must be exercised in negotiating these large contracts given the asymmetry of
information that exists between providers and the student organizations.
The structures for public healthcare and related services in Canada have created

STUDENT HEALTH INSURANCE IN CANADA

57

an environment for these plans to exist without consistent government intervention and
regulation to create uniformity in how providers describe and promote benefits.
Currently, post-secondary students in Canada experience a wide range of per student
annual costs and there are no controls set on the maximum allowable cost for a minimum
required level of benefits or service for each plan.
Moreover, the system for group health insurance in Canadian post-secondary
system has been defined by the willingness of students to pay and the demands for
benefits at each individual school. Within these structures, student societies make almost
entirely autonomous decisions on what these plans should look like. For example, when a
students' society engages in the process of obtaining quotes for and reviewing the cost
and coverage provided through these plans, there is no consistent and standardized
process by which they are required to engage in beyond their constitutional and
legislative requirements. Choosing a plan most suited to the needs of the student
demographics at each campus is a challenging task for student leaders and the staff that
advise and support them. If this is not done with the upmost attention to detail as well as
consultation of members, the process can result in students not always getting the best
deal or the most suited package in terms of cost, comprehensiveness and coverage.
Following this review and comparison of various extended health insurance plans
for students in the Canadian post-secondary, it is clear that there is a high demand and a
flourishing market for student health insurance in the Canadian post-secondary system.
Its role in health production, promotion and restoration is crucial. Public provision for the
most marginalized and less well-off students could enhance the existing student health
plans.

STUDENT HEALTH INSURANCE IN CANADA

58

The current state of unmet need for extended health and other benefits in Canada
has led to the high prevalence of student groups pursuing extended health insurance.
These student membership driven organizations work to coordinate extended health and
dental plans with additional benefits for their specific populations. In turn, these groups
are able to access increased efficiency and lower premiums. Such economies of scale
allow student groups to decrease long-run average cost by forming larger enrolment
groups to pool risk and create a balance for comprehensive service provision (Folland et
al, 1997, p. 599). Through the act of providing this supplemental form of health
coverage, these plans have a tangible impact as a safety net to help students manage
health issues that may arise while successfully maintaining their studies.

It is clear that there is a reasonably high level of variance in the annual cost to
students for these customized plans. It was also determined that the three most common
identified areas for this form of group health insurance are extended dental, extended
health, and at a lower but still a priority is vision coverage which is most often excluded,
as a cost saving measure for plans. The variance in cost can be assumed to be, at least in
part, a reflection of the variance in the level of benefits provided. This foundational
understanding of the current landscape of health insurance at post-secondary institutions
provides a basis for further dialogue and for potential policy development in this unique
category of health insurance.
The market for group health insurance in Canadian post-secondary is continuing
to evolve and expand. With a lack of previous academic study on this category, this
project helps to fill the gaps and provide a benchmark of who's who, identifying and
compiling information on the six main providers, including comparisons of the current

STUDENT HEALTH INSURANCE IN CANADA

59

state of plans based on annual plan costs and an overview of the types of coverage
provided to students in each group.
Admittedly this study delivers a descriptive analysis, which does not allow us to
make solid claims or conclusions beyond providing the current landscape. Future studies
might want to look at finding a way to adjust cost in a comparable way based on the
benefits package provided by each students' society. Still, the intricacy of plans and the
current state of highly customized plans would make this a challenging task. With so
many variables and factors at play, future studies may want to isolate one particular plan
benefit such as drug claims coverage, for example, and compare this with corresponding
provincial programs for extended health coverage. An isolated comparison may help to
draw out a better understanding to better test whether these plans are, in fact, reactionary
to unmet needs from the public package for healthcare. With a narrowed scope, more
solid claims and conclusions may be achievable.
To conclude, this study confirms that group health insurance plans are
prevalent in the Canadian post-secondary system. There are differences in annual plan
costs depending on the provider network and province of study. This has also shown to
be impacted by whether the insured group is made up of undergraduate and graduate
students combined or in separately insured groups. This study has determined that
graduate students experience (on average) higher annual plan costs than their
undergraduate counterparts. The variance seen in the annual plan cost at each institution
is significant and, at least in part, a reflection of the variance in the distribution of the
benefits provided while other variables and factors are yet to be further explored.

STUDENT HEALTH INSURANCE IN CANADA

60

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STUDENT HEALTH INSURANCE IN CANADA

63

Appendix: Overview of the Six Main Providers
Provider 1 ASEQ/Student Care
ASEQ, known outside of Quebec, as Student Care, is a for-profit provider who
currently administers health insurance plans to one of Canada's largest networks. The
three basic principles from the Student Care website are: equitability, accessibility and
sustainability. Student Care defines itself as a start-up company, founded more than 15
years ago to serve these three principles and now promotes itself as an industry leader
that coordinates plans, which are fair to students while limiting the impact that they make
on the environment. By being more accessible through increased use of electronic
communication, and in their goals for sustainability, they also plan to be carbon-neutral
by 2013 (Student Care, 2013). Student Care boasts strengths in value added areas such as
online communications and sustainability measures to attract student groups as clients.
Student Care's current network consists of 40 student groups and they have the
second highest average annual per student plan cost at $277 .12. Student Care also
experiences the largest variance in plan cost with a median cost of $247.52. At the low
end of their range, they coordinate the lowest cost plan in the country with an annual per
student plan cost of $50 at Sault College in Sault St. Marie. This is in contrast with a
number of plans currently operating at an annual cost of over $300. Their most expensive
plan is at the Canadian College ofNaturopathic Medicine in Toronto, Ontario, where the
annual plan cost is $525 for a basic benefits package covering 70% for extended health
and dental services and a lower level of coverage than is common for vision, with $50
per two policy years for eye exams, and $100 per 24 months for eyeglasses or contact

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lenses (typically eye exams cost around $100, so this benefit is reduced by about 50% of
what is customary for many other student group health plans that Student Care and the
other providers currently offer.
When taking a closer look at the group plan at Sault College, in Sault St. Marie
Ontario, we can see that the low cost of this plan can be attributed, at least in part, to the
exclusion of extended dental coverage, which enables them to maintain the lowest annual
per student cost in the Country at only $50 per year. In order to maintain such a low
annual cost, the plan at Sault College also limits vision benefits to just $50 per two policy
years for exams, $100 per 24 months for eye glasses or contacts and $150 per 24 months
for laser eye surgery. Customary coverage for the other group plans usually insure and
cover higher amounts of the cost for vision without as many restrictions in terms of
which policy year and time period for claims.
Additionally, the group plan at McMaster University in Hamilton Ontario,
coordinated by the McMaster University Graduate Student Association, runs at an annual
per student cost of $352 and has excluded vision benefits as a cost saving measure. Three
more of the Student Care network's student group plans, all in Montreal Quebec, have
exclusions in key areas for coverage. The group plan currently coordinated by the student
society at McGill University's Macdonald campus maintains an annual per student cost
of $206.67 and excludes vision coverage for similar reasoning as at McMaster. In
addition to the Macdonald Campus Student Society Plan, The McGill University
Association of Residents coordinates a plan without health or vision coverage primarily
for the purpose of providing dental and other benefits as they have access to other
services through their program of study. The Student Association of the HEC Montreal

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Business School also excludes some of the more common benefits, as it coordinates its
plan without vision coverage for an annual per student cost of $286, a more standard cost
saving measure. Despite the exclusions of some of the key areas for benefits, it can be
concluded that the Student Care network does consistently offer comprehensive coverage
in the three main identifiable areas of extended health, extended dental and vision
coverage (Student Care, 2013).

Provider 2 CFS-Services Student Health Network
Marketed to student groups through the Canadian Federation of Students-Services
National Student Health Network, Moumeau Sheppel (a for-profit broker) coordinates
with Greenshield Canada, Canada's only nationally coordinated not-for-profit insurance
provider. The CFS-Services National Student Health Network' s main principles from
their website are as follows:
"Each year, the cost of prescription drugs and basic health and dental services, not
covered by Provincial health plans take increasingly larger portions out of the
limited budgets of many students. To address this problem, the Canadian
Federation of Students-Services created the National Student Health Network.
Established in 1985, the Federation's health, dental and vision plan assists students'
associations with the design, negotiation, promotion, and administration of campus
health and dental plans. Through negotiations with Canada's only non-profit
insurance provider, Greenshield, the Federation offers the most comprehensive set
of benefits available through a campus health plan:
•

Prescription drugs with or without a pay-direct drug card;

STUDENT HEALTH INSURANCE IN CANADA
•

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Paramedical services: physiotherapist, speech pathologist, massage
therapist, chiropractor, naturopath, and psychologist;

•

Dental accident costs;

•

Medical equipment/appliances;

•

Accident or sickness related tutorial costs;

•

Ambulance costs;

•

Semi-private hospital rooms;

•

Out of province emergency services;

•

Accidental death and dismemberment insurance;
Vision care/prescription glasses; and

•

Managed dental care.

These benefits are available in component parts, which allows a students'
association the opportunity to design a customized plan for its members, thus
maintaining the principle of meeting students' needs first and foremost" (CFSServices, 2014).
Through the CFS-Services National Student Health Network, Greenshield currently
administers health insurance plans to a network consisting of 3 7 student groups. Almost
all 37 of the student group plans coordinated by this network provide comprehensive
coverage, with three group plans that do not provide vision benefits coverage and one
group plan that that does not provide extended health coverage. At Okanagan College,
the Okanagan College Students' Union has excluded vision coverage from the plan as a
way to ensure adequate coverage in extended health and dental without having to
increase the premium beyond the current annual per student cost of $249.06. Through

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informal interviews with the staff for the Okanagan College Students' Union, an
explanation was provided that vision benefits were at one point covered by the plan, but
that it was determined that it was not a vital benefit to provide for their members and that
it had been too costly maintain an adequately insure vision benefits along with extended
health and extended dental which are the main pillars of the health plan they coordinate.
The other two group plans in the network that have made the decision to remove the
benefit from the package are both at Ryerson University in Toronto, where two of the
student societies in operation there have excluded the benefit with similar reasoning.
Another interesting case is at the University of Winnipeg where the University of
Winnipeg Aboriginal Students' Association coordinates the only plan in the network that
excludes extended health benefits. The reasoning for this is actually quite simple, as the
majority of these students have been targeted by additional governmental benefits for
Canadian First Nations and Inuit peoples. This is a targeted approach of the Canadian
government to support First Nations and Inuit peoples in reaching an overall health status
that is comparable with other Canadians, this program is titled, Non-Insured Health
Benefits (NIHB), and the general experience is that NIHB provides adequate extended
health benefits coverage for its members, however there is still an expressed need for
extended dental and vision coverage which are in need as they are not adequately covered
by NIHB (Health Canada, 2013). In tum, it is through the University of Winnipeg
Aboriginal Students' Association at an annual per student cost of $148 that these gaps are
looked after. Because, the plan excludes coverage of extended health benefits as a
reflection of the pre-existing available public services for this population, the Winnipeg
Aboriginal Students' Association is able to coordinate this plan well below the national

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average for annual plan costs for an extended health benefits program. The University of
Winnipeg Aboriginal Students' Association's group health plan is currently one of the
least expensive plans coordinated by the (CFS-Services, 2014)' Student Health Network
(Greenshield Canada Student Centre, 2013).
In review of all of the plans on the CFS-Services Student Health Network, the cost to
students in each school's specific purchasing group ranges from as low as $130 to as high
as $606.87 annually. The average annual cost is $280.20 and the median cost is $250.
Across the provinces, the National Student Health Network maintains seven group plans
in British Columbia with an average annual plan cost of $147.49, five group plans in
Manitoba with an average annual plan cost of $197.49, five group plans in
Newfoundland with an average plan cost of $240.76, and 18 plans (the majority of its
plans) across Ontario with an average plan cost of $369 .22. It is apparent that although
the CFS-Services National Health Network does operate some higher cost plans,
however, the majority of plans coordinated by the them, fall below the national average
annual per student cost and they still continue to provide comprehensive benefits through
the majority of their plans (Greenshield Canada Student Centre, 2013).
Provider 3 Gallivan & Associates
Currently marketed to student groups as "MyStudentPlan," Gallivan & Associates
currently administers health insurance plans to a network consisting of the 33 student
groups. The cost to students in each group ranges from as low as $155 to as high as
$364.47 annually. The average annual cost for these plans is $252.95 and the Median
cost is $252. Across the provinces, Gallivan & Associates maintains 14 group plans in

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Alberta with an average annual plan cost of $220.22; five group plans in British
Columbia with an average annual per student plan cost of $251.80, one plan in Manitoba
with an annual cost of $155, one plan in New Brunswick at an annual cost of $245, three
plans in Nova Scotia at an average annual cost of $258, six plans in Ontario at an average
annual cost of $279.96 and three plans in Saskatchewan at an average annual cost of
$348.86. With an average plan cost below that of the national average, Gallivan &
Associates coordinates the majority of their plans in Alberta, with a growing presence in
both British Columbia and in Ontario (Gallivan & Associates Student Network, 2013).
In review of the 33 group plans in the Gallivan & Associates student network, there
are only five student groups which exclude some of the basic benefits typically covered
within our three identifiable areas. The student group health plans in place at the
Okanagan College's Vernon campus in British Columbia, at the University of Guelph
Kempt Ville campus in Ontario, at the Grand Prairie Regional College in Alberta, at the
New Brunswick Community College in New Brunswick, and at Dalhousie University in
Nova Scotia, are the only five plans in the Gallivan & Associates Network which exclude
vision coverage provisions. For this network, removing vision coverage from the benefits
package is a common theme for student societies to keep premiums from increasing, as
the costs of extended health and dental services can be the major cost and demand drivers
for plans. In review of this information, one can come to the conclusion that vision is of
lower importance to student groups when assessing their hierarchy of needs for what can
be covered for their members at a reasonable per student annual cost.

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Provider 4 ACL Benefits
Marketed to student groups as "WeSpeakStudent," ACL Benefits describes itself
on its website as being dedicated and experienced in the field of health and dental plan
consulting, with a 25 year history and an over 15 year commitment to students in
Canadian colleges and universities, and as a leader for providing affordable and flexible
health and dental programs. In the "about us" section of their website, ACL boasts a
"track record of providing exceptional service to many colleges and universities [that]
has resulted in unprecedented growth in the industry since 1987" (ACL Benefits, 2013).
ACL currently administers health insurance to a network consisting of 21 student
groups almost entirely in the province of Ontario, where they coordinate 19 plans at an
average annual cost of $202.34, well below the national average. Of note, Nova Scotia is
the only other province they serve, where ACL Benefits coordinates two plans for the
University of New Brunswick in Fredericton as well as at the University of New
Brunswick in St. John, at the same annual cost of $260.
In review of the available data, it can be confirmed that seventeen of ACL's 21
plans provide comprehensive coverage in the three identified key, most commonly
included areas of coverage for extended health, extended dental and vision benefits.
Otherwise, there are four plans, which have made dental and/or vision plan exclusions in
order to maintain a lower per student annual cost but all plans currently cover extended
health benefits.
The group student plan at Cambrian College in Ontario is able to maintain its plan
at a reasonably low per student annual cost of $126 by excluding dental benefits coverage

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from their plan, while still providing strong provisions for extended health ( at 80%
coverage to a $5,000 maximum) and full cost coverage for vision exams and eyewear
coverage ofup to $80 per 24 months. At Candore College, Ontario, the group student
plan has excluded vision coverage, to maintain a very low annual per student cost of $60.
Other cost saving measures in place for the plan at Candore College are that they limit
dental coverage to accidental dental only to a maximum coverage amount of $2,000 per
policy year and although they do provide 80% coverage for extended health, this is
curtailed by a per policy year maximum plan coverage of $2,000. Comparable, to the
plan in place at Candore College, the group student plan at Loyalist College, Ontario,
maintains a low per student annual cost of $60 by excluding benefits coverage for vision
and limiting dental coverage to accidental dental, to a maximum coverage amount of
$2,000 per policy year.
Similarly, the group student plan at Nippising University maintains a low per
student annual cost of $60 by excluding dental coverage and limiting vision coverage to
just $30 per 24 months for exams and $30 per 24 months for eyeglasses or contact lenses,
which is a much lower rate of coverage than is customary with other plans. The group
student plan at St. Clair College is primarily in place for the purpose of providing
extended health coverage, excluding both dental and vision coverage, while maintaining
80% full coverage to a maximum of $5,000 (ACL Benefits, 2013).
Provider 5 Campbell & Company
Marketed to student groups as "Student VIP," Campbell & Company currently
administers health insurance to a network consisting of 12 groups spread across the

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country, but not in all provinces. Of the six provider networks in Canada, Campbell &
Co. is the only company providing coverage in the three main areas for all of their group
student health plans and the benefits that they provide in these areas are consistent with
what is customary across other providers.
The majority of Campbell & Company' s plans exist in Ontario, where they
coordinate seven plans at an average annual cost of $196.44. In addition to this they
coordinate one plan in Alberta at an annual cost of $245, one plan in New Brunswick at
an annual cost of $465 and two plans in Halifax, Nova Scotia at an average annual cost of
$244. Although Campbell & Co. is among the smaller buying consortiums for student
health insurance, they are among most interesting, having made special arrangements to
accommodate for a growing online education market through Athabasca University
Graduate Students 'Association (AUGSA). Unique from other providers, and in
partnership with the AU GSA, Campbell & Co. coordinates benefits across all of Canada
on a voluntary, opt-in basis, with a monthly fee for coverage. This arrangement does not
allow for the same economies of scale that is achieved through other plans, however, it
still proves to be a viable service for those members of the AUGSA who would like to
opt into extended health and dental benefits. When referenced to the typical annual rate
for 12 months of coverage, the AU GSA plan is the most expensive plan in the country at
a 12 month cost of$1278.48 in British Columbia, $1478.88 in Alberta, $1101.60 in
Manitoba or Saskatchewan, $1236.72 in Newfoundland, $1506 in Ontario, $1377.84 in
Nova Scotia and $1478.88 for the North West Territories, the Yukon and Nunavut
(Campbell & Co., 2013).

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Provider 6 PBAS Group
Lastly, marketed to student groups as "The Campus Trust," PBAS administers a
network consisting of the 10 student groups. Five of the plans provided by this network
exclude the coverage of vision benefits, and two plans have also excluded extended
health coverage along with the exclusion of vision benefits coverage. The student group
plan at Holland College in Prince Edward Island, provides coverage for extended health
and dental at an annual per student cost of $340 and the student group plan at the Ontario
College of Art and Design excludes vision coverage and operates at an annual per student
cost of $183. The student group plan at the University of Western in Ontario also
excludes vision coverage and still operates at an annual per student plan cost of $227.75.
There is no reason to see this information as significant beyond the reasons of controlling
plan costs by limiting coverage to extended health and extended dental within the key
and most common areas of coverage identified.
Further to this, the group student plan at Medicine Hat College in Alberta, excludes
both extended health and vision coverage and still has a higher than average annual per
student cost of $284, and the student group plan at St. FX University in Nova Scotia also
excludes both extended health and vision and operates at an even higher annual per
student cost of $320. This could be attributed to them still offering a full 100% coverage
for dental services making it the primary offering and service coverage for the plan.
The overall average annual cost for plans coordinated by PBAS Group is $335.92.
PBAS group manages less plans than the other main providers in the Canadian student
market coordinating two plans in Alberta at an average annual cost of $205 .38, one plan

STUDENT HEALTH INSURANCE IN CANADA
in New Brunswick at a cost of $254, three plans in Nova Scotia at an average cost of
$314.67, three plans in the province of Ontario at $375.06 and two plans on Prince
Edward Island at significantly higher average annual cost of $480.71 (PBAS Group,
2013).

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