Thank you for visiting the UTGSU Health and Dental Insurance (HDI) FAQs. UTGSU Health and Dental Insurance Office encourages you to visit www.studentcare.ca for your go-to HDI information. If you need assistance regarding coverage, opt-outs, and enrolments, please call UTGSU Studentcare at 1-866-358-4436 (Monday to Friday 9-5 PM) or visit www.studentcare.ca. If you need assistance with claims inquiries, please contact Green Shield at 1-888-711-1119.
1. 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 has a different number, e.g. -01, -02.
2. Is Family/Dependent Coverage Available?
Yes. However, you must pay an additional fee. You can enroll your spouse and dependent children. Couple and Family coverage forms are available online at www.studentcare.ca. You must enroll your dependent at the start of each academic year that you are a registered student. If you are a registered student in May or September, you must enroll them between September 1 and September 30, 2016. If you start your program in January, you must enroll them between January 1 and January 30, 2017. Students that start in May or September cannot add dependents in January unless:
- A child is born outside the opt-in periods (must be opted in by 30 days of date of birth)
- Marital status changes (must be opted in by 30 days of date of change in status)
- Spouse/partner moves to Canada (must be opted in by 30 days of move)
Note that there are reasonable limits on adding dependents toward the end of the benefit year.
3. How do I Opt-Out?
You can opt-out provided you do so within the required time frame and provided you have proof of an alternative insurance policy (not just OHIP). Opting out can only be done on line at www.studentcare.ca. Visit UTGSU Opting-Out for details. Your opt out will not carry over to the next academic year; therefore, you must opt-out every year to cancel your UTGSU benefits.
4. What are my benefits?
Visit UTGSU Benefits for information on your benefits coverage.
5. What is pay-direct?
Pharmacy claims can be processed immediately by using a Pay-Direct card. Once processed, you will only be required to pay the “co-pay” and you will not have to pay the full amount of your bill.
6. How long do I have to submit my 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
7. I have two insurance plans. How do I co-ordinate and maximize my benefits?
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 UTGSU plan. Green Shield will send you a statement called “Explanation of Benefits” (EOB) with your reimbursement. You then submit the EOB statement to the other insurance company to be reimbursed for the balance of the claim.
8. I am graduating in fall. Can I keep my coverage for a full academic year?
No. This Plan is an academic year Plan. Students are only able to enroll dependents on the Plan if they will be a registered and active student for the full academic year. Dependent coverage is only active if you remain an active student.
9. I am a TA. What are my benefits?
Please refer all questions regarding TA benefits directly to CUPE 3902 Unit 1: 416-593-7057,www.cupe3902.org/unit-1/
See this page for information on the top-up plan for CUPE 3902 Unit 1 members
10. What if I miss the opt-out period?
Unfortunately, if you miss the opt-out period, you cannot opt-out. All opt-out/opt-in periods are announced in the weekly UTGSU Digest and stated on our website at https://www.utgsu.ca/insurance/opting-out. No exceptions will be made.
11. Does OHIP or UHIP count as proof of alternative coverage for opting-out?
12. Where do I send my claims forms?
Do not send your claim forms to UTGSU. Each claim form has a specific address written directly on the form itself. Claim Forms are accessible online via www.studentcare.ca
13. When is the black out period?
There are two black out periods. If you start in fall, the black out period is from September 1 to October 15. If you start in winter, the black out period is from January 1-February 15. During the black out period, you will have to pay for your prescription in full and then submit receipts for reimbursement.
14. 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 www.studentcare.ca for more information and opt-out deadlines.
15. Do I need to opt-in to 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 premiums for a half-year are charged in January.
16. What is the benefit period?
For students that start in September, their coverage begins September 1, 2016 and for students that start in January, it begins January 1, 2017. Coverage terminates August 31, 2017, 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, 2016. For students finishing their programs in April, you have paid winter fees, and therefore your coverage expires August 31, 2017.
17. Is travel insurance covered?
Travel insurance is included with your UTGSU insurance plan. The Travel Benefits portion of your insurance plan coverage is for 120 days of each trip. Students who are leaving on a recognized academic exchange are also covered for the duration of their exchange and for another 120 days before and after their approved exchange. They must remain members of the UTGSU, pay fees to University of Toronto including the Health Plan fee and keep their provincial health-care coverage. We recommend that you review your detailed explanation of coverage prior to travelling. Details are available at www.studentcare.ca.