HEALTH/DENTAL PLANS 2011/12

Welcome to your Health & Dental Plans. This year, please get familiar with the coverage details in the Benefits Booklet available through the Greenshield Website (see below for link).

HDI NEWS & UPDATES

Office Hours
Monday-Friday 10am – 4pm.
Please see the list of summer closures here.

GSU Health Insurance Travel Benefit
The GSU Health Plan provides a travel benefit – emergency sickness and accident coverage of $5 million dollars for the first 60 days away. It starts each time you leave the province. All GSU benefits remain in effect when you travel, for any purpose, out-of-country. If you will be away for more than 60 days, call ETFS at 1-800-680-3837 and request a Top-Up for the remainder of your stay. Visit greenshield.ca/studentcentre.ca for the detailed Travel Benefits Guide. You MUST contact the insurer below as quickly as possible when you have a medical emergency out of the province. Give them your policy # 28556323 followed by your id (student #). They are available 24 hrs/7 days a week. You can arrange direct payment if expenses are over $200 Canadian. In Canada or USA call 1-866-870-1898. Elsewhere call collect 0-819-566-1898

GSU Health Insurance For Summer Students
Students starting in May are charged incidental fees which also include health and dental, however, the health and dental coverage does not become effective until September 1st. Students can opt-out if they have comparable coverage and can also opt-in family members in the Fall of 2011 for the upcoming academic year. Please check back at the end of August
for more information.

Opt-out Cheques
If you haven't yet received your cheque we will be happy to take the following steps:

1. We will put a "stop payment" on that cheque;
2. Request that you sign a "cheque declaration" form;
3. Process a new cheque, and;
4. We will request that you come and pick it up from the GSU HDI office.
Please note that there will be a $15 charge by the bank to put a stop payment.

Receipts for Teaching Assistants (TA)If you are a TA and would like to get your GSU premium receipt (i.e. if you did not opt-out), please check the CUPE website: www.cupe3902.org and follow the instructions under the Benefits section.

The GSU Health and Dental Office will ONLY be issuing receipts for the family plans. Family premium receipts can be picked up from the GSU Health and Dental office on Tuesdays & Thursdays (ONLY), between Noon-2pm (these days and times are strictly enforced).

HDI NEWSLETTERS

Summer 2011

Winter 2010/11

Fall 2010

Summer 2010

Spring 2010

Winter 2009/10

Fall 2009

--------------------------------------------------------------------------------------
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 - WHAT IS THE BLACKOUT PERIOD?

7 - FAQ

----------------------------------------------------------------------------------------------

GENERAL INFORMATION

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

The Graduate Students 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.

----------------------------------------------------------------------------------------------

WHO IS COVERED?

The cost of the 2011-2012 single Health Plan for one year is $213.60. The Dental Plan is $146.88.

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 leave 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.

----------------------------------------------------------------------------------------------

OPTING- OUT

NOTE: OHIP does not provide coverage equivalent to the Graduate Students Health and Dental Plan; therefore, you cannot opt-out if you are 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 can not 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:

Students charged Fall 2011 fees:  September 1st – October 7th, 2011
Students charged Winter 2012 fees:  January 3rd – February 3rd, 2012

SORRY.  NO EXCEPTIONS WILL BE MADE IF YOU MISS THESE DEADLINES.

To Opt-Out (during the above opt-out periods only):

https://studentplans.ca/UTG

----------------------------------------------------------------------------------------------

HOW MUCH DOES THE PLAN COST?

The Health Plan costs $213.60 and the Dental Plan costs $146.88 for full-year coverage (September 1, 2011 – August 31, 2012). Students beginning in January 2012 will be assessed $106.80 for the Health Plan and $73.44 for the Dental Plan coverage from January 1, 2012 to August 31, 2012.

----------------------------------------------------------------------------------------------

HOW DO I CLAIM MY BENEFITS?

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

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. You can also sign up for on line services after this period,  and provide your banking information for your claim to be deposited directly into your account.

----------------------------------------------------------------------------------------------

WHAT IS THE BLACKOUT PERIOD?

Claims processing is delayed for students during the first two months of the Fall and Winter semester, while the broker waits for complete enrolment lists (after opt-outs and enrolments have been processed). During this time, you can use your coverage, but claims should not be sent to Greenshield until November 15th (for students enrolled in the Fall Session) and March 15th (for students enrolled in the Winter Session). Claims will be processed and reimbursement cheques will only be mailed once the Blackout Period ends.  You can also sign up for on line services after this period,  and provide your banking information for your claim to be deposited directly into your account.

----------------------------------------------------------------------------------------------

FAQ

Green Shield Canada welcomes you to the Student Centre website (greenshield.ca/studentcentre) created especially for students who are covered by benefits provided by the GSU. For more specific information regarding eligibility/coverage, please call the Green Shield Customer Service Centre at 1-888-711-1119. Register for Plan Member Online Services to obtain access to all the services, including, direct deposit for your claims.
 
Q. Why do I have to pay incidental fees?
All tuition-paying students, including those engaged in academic work away from the campuses of the University, are charged compulsory non-academic incidental fees. These include fees for student societies and for campus based services (e.g., Student Services, Student Life, Health Services, Hart House and the Athletics Centre). The GSU fees include designated amounts for student health plans.
 
Q. Why is GSU allowed to charge a health plan fee?
The health plan fees were established in the late '80s through a referendum in which students were asked to support collection of the compulsory fee. Increases to the fee and the establishment of the dental plan fee were approved by student referenda in subsequent years.
 
Q. Why do previous students have the power to set my incidental fees?
As in any democracy, a current voting population makes decisions that affect the future. Current students will likely be asked to make similar decisions for future students.

Q. How do I pay for my coverage?
Your coverage is paid through your ROSI account, and is listed under incidentals. Payment is divided in half, between the fall and winter sessions. For students starting their programme in September, half of the premiums are charged in the fall, and the other half in winter. For students starting their programme in January, their full premiums are charged in January.

Q. What is the benefit period?
For students that start in September, their coverage beings September 1, 2011 and for students that start in January, it begins January 1, 2012.
 
Coverage terminates August 31, 2012, except for students that graduate after the first semester or leave their program after the first semester. In this case, you are not charged winter fees, and therefore your coverage is terminated December 31, 2011. For students finishing their programs in April, you have paid winter fees, and therefore your coverage expires August 31, 2012.
 
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 can 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 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”. Forms are available in the GSU Health Insurance Office and here.  

The deadlines to purchase the “12 Month Extended Insurance” coverage are:
• for students completing their program in the summer – September 1, - October 7, 2011
• for students completing their program in December – January 3, 2012 – February 3, 2012
 
 
Q. Is dependent coverage available?
Yes. However, you must pay an additional fee. You can enroll your spouse and dependent children. Family coverage forms are available in the GSU Office and here.
 
Q. When should I enroll my dependant?
You must enroll your dependant at the start of each academic year that you are a registered student. If you are a registered student in September, you must enroll them in September, by October 7, 2011. If you start your program in January, then you can enroll them in January, by February 3, 2012. Students that start in September cannot opt dependants in January unless:
 
1.  A child being born outside the opt-in periods (must be opted in by 30 days of date of birth)
2.  Change in marital status (must be opted in by 30 days of date of change in status)
3.  Spouse/Partner moving to Canada (must be opted in by 30 days of move)

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 can I make claims?
Please note that due to the time it takes to update the Green Shield files following student registration and the opt-out period, your information will not be in the Green Shield System.  The list of students is sent by the University and used by the insurance company to verify eligibility.   If you require a prescription or need to see a dentist between September 1st and October 31st, you can make the payment for the prescription or dentist fees and submit a claim form to Green Shield after November 15th to be reimbursed.  For students starting in January, please wait till after March 15th.
 
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 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. 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. 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 have two benefit plans. How Do I coordinate them?
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  “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. I have another insurance plan. How Do I Opt out of the GSU insurance plan?
You can opt-out provided you do so within the required time frame. Opt out can only be done on line 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. The deadlines for opting out are:

• for students enrolled in the Fall term – September 1, 2011 – October 7, 2011
• for new students enrolled in the Winter term - January 3-February 3, 2012

Your opt out will not carry over to the next academic year, and therefore you must opt-out every year to cancel your GSU benefits.         
           
Q. Why can't my refund be credited back to my student account?
Student society fees are collected in trust by the University and paid directly to the student society. The student societies, therefore, receive your fees in trust and must issue the refund directly. In addition, ROSI currently cannot handle this transaction on behalf of student societies.