University of Toronto Graduate Students’ Union (UTGSU)
Health & Dental Plan
Frequently Asked Questions
Studentcare.net/works welcomes you to visit their website: www.ihaveaplan.ca for information regarding your coverage, for opting in for “12 Month Extended coverage, for Couple coverage and for Family coverage, and, for opt-outing out of the coverage. You can also call the UTGSU dedicated support line at: 1-866-858-4436.
Green Shield Canada is your insurance provider. For specific information regarding eligibility and claims, please call Green Shield 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 UTGSU fees include designated amounts for the student health and dental plans.
Q. WHY IS UTGSU ALLOWED TO CHARGE A HEALTH PLAN FEE?
The health and dental plan fees were established through a referendum in which students were asked to support collection of the compulsory fee. The UTGSU Health and Dental plans are the result of the University-wide full-time graduate student referendum. The UTGSU Dental plan is the result of the University-wide part-time graduate student referendum. In this referendum full-time graduate students voted in favor of a mandatory health and dental plan, and, the part-time students voted in favor of a dental plan only, therefore, it was a democratic decision by the entire full-time and part-time graduate student body. Increases to the fee and the establishment of the health and 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 program in September, half of the premiums are charged in the fall, and the other half in winter. For students starting their program in January, their premiums for a half-year are charged in January.
Q. WHAT IS THE BENEFIT PERIOD?
For students that start in September, their coverage begins September 1, 2014 and for students that start in January, it begins January 1, 2015. Coverage terminates August 31, 2015, 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, 2014. For students finishing their programs in April, you have paid winter fees, and therefore your coverage expires August 31, 2015.
Q. I AM IN MY FINAL YEAR OF MY PHD – HOW LONG AM I COVERED?
You will be charged a one-term incidental fee, which includes the health and dental insurance. You will be insured from September 1st to December 31st. If you don’t complete your studies by January, you will be charged the incidental fee for the winter term and your coverage will end on August 31st. At the end of the term for which you were charged fees, you may purchase the “12 Month Extension”. Forms are available online at www.ihaveaplan.ca. The deadlines to purchase are:
• for students completing their program in the Summer – September 1 – September 30, 2014
• for students completing their program in December – January 3 – January 23, 2015
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 www.ihaveaplan.ca or www.utgsu.ca/health for more information and opt-out deadlines.
Q. IS 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.ihaveaplan.ca or at www.utgsu.ca/insurance. The deadlines to purchase the Couple or Family Insurance coverage are:
• for students completing their program in the Summer/Fall – September 1 – September 30, 2014
• for students completing their program in December – January 3 – January 23, 2015
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, 2014. If you start your program in January, you must enroll them between January 3 and January 23, 2015. Students that start in May or September cannot add dependents in January unless:
1. A child is born outside the opt-in periods (must be opted in by 30 days of date of birth)
2. Marital status changes (must be opted in by 30 days of date of change in status)
3. 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.
Q. I HAVE ANOTHER INSURANCE PLAN. HOW DO I OPT OUT OF THE UTGSU INSURANCE PLAN?
You can opt-out provided you do so within the required time frame. Opting out can only be done on line at www.ihaveaplan.ca, a link from www.utgsu.ca/insurance, or, ROSI. A cheque will be mailed to you in March. In order to opt out, you must provide proof of alternative health insurance. This is not UHIP, OHIP or a provincial health plan, but a benefits plan through an employer plan, etc. The deadlines for opting out are:
• for students starting in the Summer/Fall term – September 1 – September 30, 2014
• for new students starting in the Winter term – January 3 – January 23, 2015
Your opt out will not carry over to the next academic year, therefore you must opt out every year to cancel your UTGSU 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.
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 has a different number, e.g. -01, -02.
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 right away. 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 November 15th, 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 until March 15th.
Q. HOW DO I CLAIM MY BENEFITS?
You can download a Pay-Direct Card here or pick up a card at the Health & Dental Office, 16 Bancroft Avenue, 2nd Floor. Present your card to most pharmacists or dentists in Canada to have your claims automatically processed. 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.
Q. HOW DO I MAKE A DENTAL CLAIM?
To receive reimbursement for out-of-pocket expenses for a dental claim, obtain a completed “Standard Dental Claim Form” from your dentist’s office and submit it to Green shield. All claims submitted to Green Shield require a UTGSU Claim Form. Your dentist can send your claim electronically to Green Shield using “UTG” as the Group/Policy Number and your student number as your ID.
Q. WHAT IF MY TREATMENT IS GOING TO EXCEED $300.00?
If the cost of any proposed dental treatment is expected to exceed $300.00, please ask your dentist to submit to Green Shield a “pre-determination” 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 dental practice. For further information call the Green Shield Customer Service Centre at 1-888-711-1119.
Q. HOW LONG DO I HAVE TO SUBMIT A HEALTH OR DENTAL CLAIM?
To receive reimbursement for out-of-pocket expenses, mail original receipts and appropriate documentation to Green Shield. 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: Green Shield Canada, P. O. Box 1699, Windsor, Ontario, N9A 7G6.
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 UTGSU plan. Green Shield will send you a statement called “Explanation of Benefits” (EOB) 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 AM ALSO 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.