HEALTH/DENTAL PLANS 2010/11

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.

Opt-in/Opt-out
The opt-in/opt-out process for the new academic year will start on August 31st until October 8th, 2010.

GSU Premium Receipts for TAs
The GSU Health and Dental Office will ONLY be issuing receipts for the family plans. Receipts are ready for pick at the HDI Office ONLY Tuesdays & Thursdays, Noon-2pm (these days and times are strictly enforced).

For information on obtaining your receipt, see: www.cupe3902.org, "Benefits", "How to combine your GSU & CUPE Benefits" and follow the steps.


HDI NEWSLETTERS

Spring 2010

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 2010-2011 single Health Plan for one year is $213.74 The Dental Plan is $133.78

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

Students enrolled in the Fall 2010 term: August 31st - October 8th, 2010.

New students enrolled in the Winter 2011 term: January 3rd - February 4th, 2011.

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

https://studentplans.ca/UTG

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HOW MUCH DOES THE PLAN COST?

The Health Plan costs $213.74 and the Dental Plan costs $133.78 for full-year coverage (September 1, 2010 – August 31, 2011).

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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 welcomes you to the Student Centre website www.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. When does my coverage begin?
Coverage begins September 1, 2010 until August 31, 2011. 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 1st to be reimbursed.  
 
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. Is dependent coverage available?
Yes. However, you must pay an additional fee. You can enrol your spouse and dependent children. Family coverage forms are available in the GSU Office and online during the below application periods only. The deadlines for adding family coverage are:

• for students enrolled in the Fall Term: August 31st - October 8th, 2010
• for new students enrolling in the Winter Term: January 3rd - February 4th, 2011
 
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. What if I already have health and dental care coverage?
You can opt-out provided you do so within the required time frame. Opt-out can only be done online or through ROSI during the below application periods only. 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: August 31st - October 8th, 2010
• for new students enrolled in the Winter term: January 3rd - February 4th, 2011
           
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.

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. Co-ordination of Benefit
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. 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 also a TA – What are my benefits?
Please refer all questions regarding TA benefits directly to CUPE 3902: 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”. Forms are available in the GSU Office and online during the below application periods only. The deadlines to purchase the “12 Month Extended Insurance” coverage are:

• for students completing their program in the summer: August 31st - October 8th, 2010
• for students completing their program in December: January 3rd - February 4th, 2011