HEALTH/DENTAL PLANS 2009/10

NEWS & UPDATES

Opt-out cheques have already been mailed out. If you don't receive your cheque by mid-January, please email health@utgsu.ca with the confirmation number and your student number.

HDI NEWSLETTERS

Winter 2009/10

Fall 2009

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All graduate students are covered by our Dental Plan. Only full-time students are covered by our Health Plan. You can opt-out if you have equivalent coverage. You can also opt-in family members. See details on opt-out/in dates below.

CONTENTS

1 - GENERAL INFORMATION

2 - WHO IS COVERED?

3 - OPTING- OUT

4 - HOW MUCH DOES THE PLAN COST?

5 - HOW DO I CLAIM MY BENEFITS?

6 - FAQ

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GENERAL INFORMATION

THE HEALTH INSURANCE BROCHURE AND ALL COVERAGE DETAILS ARE NOW ONLY AVAILABLE THROUGH THE GREEN SHIELD WEBSITE

The Graduate Students' Union Health Plan provides students with unique health benefits. The Plan was designed to provide many important services and cover expenses not covered by a basic health care plan (i.e. OHIP), or the equivalent (such as UHIP for international students) such as prescription drugs, health practitioners, medical equipment, travel health coverage, and more.
 
In most provinces, only approximately 30%-40% of normal annual health-care expenses are covered by provincial health care for individuals aged 18-35. The balance is paid directly by individuals (out-of-pocket expenses) or through private insurance plans, usually through an employer. These costs can be extremely high and may pose a very real barrier to obtaining necessary health care. Unfortunately, a large number of students do not have access to affordable extended insurance through employers. Student health plans are designed to provide this access and eliminate barriers to affordable health care.
 
Most Plan benefits are effective across Canada and anywhere in the world for the duration of the coverage. Reimbursements are in Canadian funds and are calculated at the exchange rate of the day the claim is processed. Reimbursement is limited to what the service would have cost if done in Canada.

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WHO IS COVERED?

The cost of the 2009-2010 single Health Plan for one year is $216.90. The Dental Plan is $121.00.

All Masters and PhD students (except Toronto School of Theology) are automatically enrolled in the Dental Plan. Only full-time grads are enrolled in the Health Plan. It is paid as part of your GSU fee.

WHO IS NOT COVERED?

1) Students who are not Graduate Students (such as post-degree students, students on leaves of absence, incoming exchange students from another university).

2) Toronto School of Theology - graduate students are covered by UTSU's insurance plan. See www.utsu.utoronto.ca or call 416-978-4911 X 227. * Students starting in the summer session (May to August) - are charged the upcoming academic year fees. Coverage begins in September.

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OPTING- OUT

NOTE: OHIP does not provide coverage equivalent to the GSU Health and Dental Plan; therefore, you cannot opt-out if you're only covered by OHIP. Travel health coverage obtained by international students in their home country may not provide an equivalent level of benefits to this Plan.

If you are a student with equivalent insurance elsewhere, you may opt-out of these plans.  You must opt-out annually, at the beginning of the term you are first registered in. Students who missed the deadline in the Fall cannot opt-out again until the following year. You cannot rejoin the plan after you have opted-out, so check the expiry date on your insurance.

Application Periods

THE FALL 2009 OPT-OUT PERIOD ENDED OCT. 9TH. NO EXCEPTIONS WILL BE MADE.

Students charged Winter 2010 fees: January 5th - February 4th, 2010

To Opt-Out (during the advertised opt-out period only):

https://studentplans.ca/UTG

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HOW MUCH DOES THE PLAN COST?

The Health Plan costs $216.90 and the Dental Plan costs $121.00 for full-year coverage (September 1, 2009 – August 31, 2010).

Students beginning in January 2010 will be assessed $144.60 for the Health Plan and $80.67 for the Dental Plan coverage from January 1, 2010 to August 31, 2010.

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HOW DO I CLAIM MY BENEFITS?

For health claims (including prescription drugs) you will be responsible for payment when the service is rendered.

Claims for physiotherapy, psychology, massage therapist, chiropractor, acupuncturist, homeopath, naturopath, podiatrist/chiropodist and speech therapist treatment must have a physicians referral for reimbursement.

Complete a claim form here and mail it to the address indicated on the form with original receipts.  Photocopied receipts are not acceptable.  Be sure to keep copies of receipts for your records. Claims for physiotherapy, psychology, massage therapy and chiropractic treatment must have a physician's referral for reimbursement.

Claim cheques are mailed to the address provided on the form. Be sure to include your apartment number. Canada Post will not deliver mail without it. Please allow two weeks for your claim to be processed.

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FAQ

Green Shield Canada, in partnership with the Canadian Federation of Students and the National Student Health Network, welcome you to the Student Centre website (www.greenshield.ca/studentcentre) created especially for students who are covered by benefits provided by the GSU.  Register for Plan Member Online Services to obtain access to all the services.

Q. When does my coverage begin?
As an eligible full-time or part-time student coverage begins September 1, 2009 and will continue until August 31, 2010. Time is required to co-ordinate the student enrolment and coverage will not be active until after the opt-out process is complete. You can start submitting claims after November 1st.
 
Q. What is my Green Shield ID Number?
Your Green Shield ID Number is your student number preceded by “UTG”.  Your identification number ends in -00 while each dependent’s number ends with a different number i.e. -01, -02, etc.
 
Q. When will I receive my card?
Your Student Card is your ID card – no other card will be provided.

Q. Is everything I need on the Green Shield Website?
The GSU Student Centre Home page is intended as a guide.  For more specific information regarding eligibility/coverage, please call the Green Shield Customer Service Centre at 1-888-711-1119 or register for Plan Member Online Services.

Q. Is dependent coverage available?
Yes. However, you must pay an additional fee. You can enrol your spouse and dependent children. Dependents include common-law/same sex spouses with whom the student has been cohabitating with for a period of 12 months. Dependent children are eligible up to the date they turn 21 or 25 if enrolled and in full-time attendance at an accredited college or university.

Family coverage forms are available in the GSU Office and here. The deadlines for adding family coverage are:
• for students enrolled in the Fall Term – August 31 - October 9, 2009
• for new students enrolling in the Winter Term – January 4 - February 5, 2010
 
Q. What if I already have health and dental care coverage?
You may be able to opt-out provided you do so within the required time frame. Opt-out can only be done here or through ROSI. In order to opt-out, you must provide proof of alternative health insurance, this is not provincial health, but a privately purchased benefits plan. If approved, you will receive a cheque once the opt-out period is completed.

The deadlines for opting-out are:
• for students enrolled in the Fall term - August 31 - October 9, 2009
• for new students enrolled in the Winter term - January 4 - February 5, 2010
 
Q. What do I need to submit a EHC claim?
All claims should be mailed directly to Green Shield with original receipts at the address (on the top left hand corner of the claim form) as follows:

Green Shield Canada
P. O. Box 1699
Windsor, Ontario, N9A 7G6
 
Q. How do I make a dental claim?
To make a dental claim, obtain a completed Standard Dental Claim Form from your dentist's office and submit it to Greenshield.  All claims submitted to Green Shield require a GSU Claim Form. Your dentist can send your claim electronically to Greenshield using “UTG” as the Group/Policy Number and your student number as your ID.

Q. What if my treatment is going to exceed $300?
If the cost of any proposed treatment is expected to exceed $300, submit to Greenshield a “pre-determination” form from your provider before the treatment begins.  If a description of the procedures to be performed and an estimate of the charges are not submitted in advance, Green Shield reserves the right to make a determination of benefits payable based on accepted standards of medical/dental practice.  For further information call the Customer Service Centre at 1-888-711-1119.
 
Q. How do I know whether a particular item is covered under my plan?
For specific or detailed information regarding eligibility please call the Customer Service Centre at: 1-888-711-1119 or register for Plan Member Online Services.

Q. What if I have multiple claims for different types of benefits?
You can submit multiple claims in one envelope and mail to Green Shield.
 
Q. How long do I have to submit a health or dental claim?
Green Shield must receive all claims within 12 months from the date of service.

Q. Co-ordination of Benefit (COB)
Where you or your dependents have coverage with more than one carrier, you can co-ordinate your benefits, which means you can use both plans to receive up to 100% coverage. Submit first to the GSU plan. Green Shield will send you a statement called EOB “Explanation of Benefits” with your reimbursement.  You than submit the EOB statement to the other insurance company to be reimbursed for the balance of the claim.
 
Q. My program starts in the summer – when does my coverage begin?
You are charged tuition and incidental fees in the summer, which is applied to the upcoming academic year.  Your insurance is effective from September 1st to August 31st. If you already have alternative coverage, you may be able to opt-out provided you do so within the required time frame.  Please visit the Opt-Out section of the Green Shield website for more information and opt-out deadlines.
           
Q. I am also a TA – What are my benefits?
Please refer all questions regarding TA benefits directly to CUPE 3902.  Telephone Number: 416-593-7057.
 
Q. I am in my Final Year of my PhD – how long am I covered?
You will be charged monthly tuition fees and non-refundable one-term incidental fees, which include the fee for insurance.  You will be insured from September to December.  If you don’t complete your studies by January, you will then be charged non-refundable one-term incidental fees, and will be insured until August 31.  At the end of the term for which you were charged fees, you may purchase the “12 Month Extended Insurance”. Please visit the Opt-In section of the Green Shield website for more information and deadlines.