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GRADUATE STUDENTS' UNION HEALTH PLAN BROCHURE
Hard copies of the 2007/2008 Green Shield brochure will soon be available in all graduate departments, and in the GSU lounge.
Click here for the Green Shield 2007/2008 benefits brochure (PDF) Effective Sept. 1st, 2007
Green Shield 2007/2008 Health Benefits
TABLE OF CONTENTS
1) Welcome To Your Student Health & Dental Plans2) General Information3) Rates & Coverage4) Opting-Out or Opting-In
15) Contact Information
Dear Student,
Welcome to your students’ union health and dental plan.
Graduate students (Masters & PhD) here at the University of Toronto have come together to protect ourselves and each other by collectively contributing to health and dental benefits plans that provide benefits to us all.
Your health and dental plans were established democratically by the graduate students at the University of Toronto through referenda and, every year, your representatives and staff work to negotiate the best value possible. Students who already have coverage are allowed to withdraw from the plan, so that this service can be focused on those who need it.
Your health and dental plans are services of your students’ union and are underwritten by Green Shield Canada, the only national non-profit benefits provider in the country, so you can be assured that students’ interests are the only priority.
In creating universal health and dental plans, U of T graduate students have recognised that when we work together, we can save money and provide important services. If any individual student were to seek private and independent health coverage, the cost would be too great and the benefits too limited. However, by pooling our resources, we are able to realise incredible savings and service enhancements through economies of scale.
These benefits plans represent much more! In deciding to offer ourselves health and dental protection, students are working to ensure that no student suffers academically or has to drop out of school because of unexpected and unmanageable health related costs. Some students with chronic illnesses would never be able to see the inside of a classroom without access to affordable treatment and therapies. That is why it is important to work collectively to provide protection for each other in the most cost-effective way possible.
While we hope that this year will be worry free, if your health does falter, we are glad that your health and dental plans will be there to support you. Many of your plan benefits support health promotion and illness prevention, such as annual dental cleaning and maintenance medication. Being proactive about your health and dental needs is as much a worthwhile investment in your future as your education is.
This year, please get familiar with the coverage detailed in this brochure and take advantage of the benefits provided by your students’ union health and dental plans. After all, we can all benefit from having the peace of mind that this coverage brings.
If you have any questions or suggestions, there are a team of people waiting to assist you.
Have a healthy and successful year!
The GSU Executive
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The Graduate Students’ Union of the University of Toronto is pleased to provide all members with a group Dental Plan (for part-time and full-time Masters and PhD students), and a group Health Plan for full-time members only. This brochure provides a summary of the benefits available to you. It is not the official benefits policy, but an informal explanation of the coverage found in the plan. If there are any discrepancies between benefits provider contracts and this brochure, the group master policies issued by the benefits provider will take priority.
Your health plan is student-run and tailored to student needs. It offers coverage beyond that provided by the provincial plans like Ontario Health Insurance Plan (OHIP), and the University Health Insurance Plan (UHIP) for international students.
Please note that by law this policy can only cover medical expenses that are NOT COVERED by your provincial health care (eg. OHIP), or equivalent coverage, like UHIP. It is not a substitute for OHIP or UHIP. Moreover, it does not cover all non-OHIP medical expenses.
Ontario Residents: Permanent residents of Ontario must apply for their own Ontario Health Insurance Plan (OHIP) card (416-314-7444). This is free coverage that covers doctor and hospital visits. Coverage ends if you leave the country for more than 3 months, and during that time pays benefits at a reduced rate, such as $400 per day for hospital. Purchase alternate coverage for OHIP if you will be away for longer than 60 days (see your Travel Benefits on page 19 for the first 60 days away). If you travel to another province to study, your OHIP coverage remains in effect if you notify OHIP and get approval.
Out-Of-Province Students: Students from other Canadian provinces must maintain their home province coverage. You must arrange this with your home province health coverage. You do not qualify for OHIP, as a student is deemed to be a “temporary resident” when studying in Ontario.
International Students: International students receive basic health coverage through the University Health Insurance Plan “UHIP”. Contact the UHIP Office immediately at the International Students Centre, 33 St. George St., 416-978-0290, for information about your coverage. Coverage for family members must be purchased with 30 days of their arrival.
The Health and Dental benefits are provided by Green Shield Canada. The Accidental Death & Dismemberment Benefits are insured by ACE INA.
GSU MEMBERS
Your identification number at Green Shield is:
‘UTG’ + your UofT student number - ‘00’
For example, a plan member’s Identification number would appear as; UTG111222333-00.
The ‘00’ indicates a plan member. ‘01’ is for a spouse, ‘02’, ‘03’ etc. for dependent children.
(see your Family Application Form)
When submitting claim information, there are some important details you need to know. Your benefits plan combines coverage from more than one insurance company in order to provide you with the most comprehensive coverage at the most affordable rates. Each insurance company has their own policy numbers and distinct claims procedures.
Because it is a reimbursement plan, there is no membership card. We receive regular lists of students from ROSI and these are used by the benefits company to verify eligibility when receiving claims. TA’s will receive a Green Shield Spending Account Card from CUPE 3902 but this card should not be confused with the GSU benefits plans.
Mail original receipts along with a completed GSU claim form to Green Shield (keep a photocopy for your records). Their address is on the claim form. You will receive a cheque within 3 weeks. Please delay submitting your claims for 2 months from the date your coverage begins, when the opt-in and opt-out periods ends and Green Shield receives the list of eligible students.
Health and Dental Claims Must:
- Include your student identification number (UTG + your student number - 00)
- Include original receipts
- Be submitted to Green Shield within 12 months of the service being rendered.
We do not provide Green Shield with your birthdate. Please use 1/1/60, the generic date they have given our students, when asked by GS for your birthdate.
You will need to submit a standard Dental Claim Form (available at any dental office). Have your dentist complete the appropriate section of the dental claim form, attach the standard claim form to a GSU claim form and mail it to Green Shield. Payment can be made directly to the dentist, ask your dentist about “assignment of benefits” and/or electronic claims submission. Also, students should ask their dentist to participate in the Green Shield Canada Dental Discount Network, which offers students further reductions of 20-30% on their dental service.
Green Shield may require you to provide the dentist’s statement of the treatment received, pre-treatment x-rays and any additional information that Green Shield considers necessary.
The completed forms, receipts and documentation should be sent to:
Green Shield Canada
P.O. Box 1699, Windsor, Ontario N9A 7G6
IT IS YOUR RESPONSIBILITY TO KEEP COPIES OF EVERYTHING SUBMITTED.
If you need help making a claim, or have questions about your benefits, contact Green Shield @ 1-888-711-1119.
Claim Forms:
Students can use Green Shield Canada’s electronic claim forms and view the status of their claims online. Hard copies of benefits guides and claim forms were mailed to each Graduate Administrator in September, so check in your dept. student lounge.
Claim forms are available at:
- GSU website: http://www.gsu.utoronto.ca/insurance/claimforms.html
- Graduate Students’ Union basement lounge, 16 Bancroft Ave. (open weekdays 9 am - 11 pm)
- Ontario Institute for Studies in Education (OISE) Graduate Student Association, 252 Bloor Street West, 8th Floor (in hallway by room 8-105)
- Health Services at all three campuses
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Your Health and Dental Plan premiums are INCLUDED IN YOUR GSU INCIDENTAL FEE.
Full-time Students (Single)
Health Plan
Full year: $189.36 (including 8% tax)
One term: $94.68 (including 8% tax)
Full And Part-time Students (Single)
Dental Plan
Full year: $136.80 (including 8% tax)
One term: $68.40 (including 8% tax)
Full-time students are covered by both the Health and Dental Plans; part-time students are covered by the Dental Plan only. You are automatically covered if you are registered as a graduate student (Masters or PhD) at the University of Toronto. For exceptions, please see below.
Who Is Not Covered?
- Undergraduate Students: Full-Time (St. George & Mississauga Campuses)
Full-time undergraduate students on the St. George and Mississauga campuses are covered by the University of Toronto Students’ Union (UTSU): 416-978-4911 x 227.
- Undergraduate Students: Full-Time (Scarborough Campus)
Full-time undergraduate students on the Scarborough campus are covered by Scarborough Campus Students Union (SCSU): 416-287-7005.
- Undergraduate Students: Part-Time
Part-time undergraduate students on all three campuses are covered by the Association of Part-time Undergraduate Students (APUS): 416-978-3993.
- Toronto School Of Theology
Toronto School of Theology students joined the University of Toronto Students’ Union (UTSU): 416-978-4911 x 227.
- Students On Leave - Purchasing the Prism ContinuumTM Individual Plan
Students on leave are not charged fees and therefore are not covered by this benefits coverage. Your coverage ends on the last day of the last term you were registered in (December 31 or August 31). You have the option of purchasing the Green Shield Prism ContinuumTM Individual plan within 60 days of leaving the GSU plan. Pre-existing conditions are accepted.
A dependent child who is no longer eligible for benefits under your Green Shield group benefits program may also enrol in the Green Shield Prism ContinuumTM Individual plan. Call toll free 1-800-667-0429 or 416-601-0429 (local) for an information package.
- Are You Completing a PhD?
If you are a PhD student in your final year, you will be charged monthly tuition fees and non-refundable one-term ancillary fees, which include this coverage. You will be insured from September to December. You can purchase one-term family coverage, and the “12 Month Extended Coverage” in January (see below).
If you don’t complete by January, you will be charged monthly tuition fees and non-refundable one-term ancillary fees, which include this coverage. In this case you will be insured until August 31, and can purchase an extension of your family coverage in January, and the “12 Month Extended Coverage” in September.
- Students Starting In May
You have no summer coverage. You are charged tuition and incidental fees in the summer, which are applied to the upcoming academic year. Your insurance is effective from September 1 to August 31.
If you are charged the full year fee, you are covered from September 1 to August 31. If you are charged a one term fee you are insured either for September to December, January to August, depending on the term you are registered in. Coverage remains in force until the end of the term you were charged for, provided you have not been refunded your fees.
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(Available in Sept, Jan, and May only)
You must apply to opt-out, or purchase family coverage or the “12-Month Extension Upon Graduation,” within the dates below. Normally you can apply only in the first term you are eligible for (see opting-out for TA’s below). It is normally not possible to opt-out or opt-in after the deadline has passed. For exceptions contact the GSU.
Students starting in September 2007: Monday, August 27 to Friday, October 5
Students starting in January 2008: Tuesday, January 7 to Friday, February 8
Forms
All application forms, including electronic opt-out, and our benefits guide and claim form, are available at:
-
GSU website: www.gsu.utoronto.ca/insurance
- Graduate Students’ Union basement lounge, 16 Bancroft Ave. (open weekdays 9 am - 11 pm)
- Ontario Institute for Studies in Education (OISE) Graduate Student Association, 252 Bloor Street West, 8th Floor (in hallway by room 8-105)
-
Health Services at all three campuses
You may opt-out and receive a refund of the premiums charged to you, if you are covered by another comparable benefits plan. You must apply during the periods noted above. You can only apply at the beginning of the first term you are eligible for (eg. if you start in January you can apply in January, but if you started in Sept. you can’t apply in January, unless you recently acquired equivalent coverage). Complete an electronic opt-out form on the GSU website, www.heath.ca/students, or a form available in the offices above. You will receive a cheque by mail within 3 months of opting-out. If you do not receive your cheque contact the National Student Health Network. If leaving a message spell your name and give your student number.
Electronic Opt-Outs: You may be required to provide proof of alternative coverage at a later date (e.g., a current policy or membership card clearly showing your name, the name of the benefits provider, and your policy number), under a plan other than OHIP or UHIP.
Important Note: Check the expiry date of your equivalent benefits coverage. Once you have left the plan(s), you cannot rejoin until September of the next academic year. For exceptions contact the GSU.
Aboriginal Students: Many aboriginal students have coverage through Federal Government funding. Those who do must apply for an opt-out refund. See above.
International Students: Like domestic students, international students are covered by the GSU plans. They pay for things not covered by your basic coverage, UHIP. Get your UHIP card and information immediately at the International Student Centre: 416-978-0290
TAs are eligible for dental and health benefits through their union, CUPE 3902. Call them at 416-593-7057 for details, or see www.cupe 3902.org.
Your CUPE health coverage is not equivalent to the GSU Health Plan and cannot be used to opt out of the GSU Health Plan. You can get a receipt from the GSU for any premium you paid (including family premiums), and claim it as a CUPE HCSA medical expense. The Green Shield Card you receive in the mail is for the CUPE HCSA and not the GSU Health Plan.
You can combine your $500 CUPE Dental Rebate with the GSU Dental Benefit of $500, for a total of $1000 in dental benefits in your policy year. Or you may opt out of the GSU Dental Plan by completing an online opt out form (see below).
Opt Out Online from the GSU Dental Plan
You must opt out of the GSU Dental Plan in the same term your are registered, refer to the opt out deadlines section. You will receive a refund for those months that you are not insured, regardless of whether you have made dental claims. However, we will face large premium increases next year if TA’s claim benefits on the plan and later opt out.
A special opt out form has been created for TA’s who wish to opt out of the GSU Dental Plan. When completing this online form, please use the following information:
Name of Insurance Company: Green Shield Canada
Name of Policy Holder: CUPE 3902
Policy Number: 30131
Claiming from GSU and CUPE Dental Plans
To claim from both Dental Plans, first submit your claim to the GSU Dental Plan. When your claim is paid, use the letter your received with your benefits cheque, that details your claim and the reimbursement you were entitled to under the GSU Dental Plan. This letter will function as your receipt for submitting a claim to the CUPE Dental Rebate. The CUPE Dental Rebate will pay for services the GSU Dental Plan did not reimburse you for.
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If you are already covered by equivalent benefits coverage, you may not wish to opt-out of your student plan. You can co-ordinate your benefits coverage, which means using both plans to receive up to 100% coverage on different items. In such circumstances, you are required to first submit your claim where you are covered as a plan member, and then submit a claim for the outstanding portion to the plan where you are covered as a dependent. For example, this plan covers 80% of prescription drug costs, while you could use your other plan for coverage of the remaining 20%. Simply send the letter (called Explanation of Benefits) you receive from the first company you claimed from, showing what has not been paid, to your secondary benefits provider for payment, attached to a completed claim form.
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You may enrol your spouse (including a common law or same sex partner) and / or children on your plans at the beginning of your first eligible term.
Health Plan (Full-time Students): Sept. 2007 To Aug. 2008
Family of 2:
$189.36 Single (in your GSU fee)
$191.40 Spouse OR child (additional charge)
= $380.80 TOTAL (including 8% tax)
Family of 3 or more:
$189.36 Single (in your GSU fee)
$304.70 Spouse and/or children (additional charge)
= $494.04 TOTAL (including 8% tax)
Dental Plan (Full And Part-time Students): Sept. 2007 To Aug. 2008
Family of 2:
$136.80 Single (in your GSU fee)
$136.80 Spouse OR child (additional charge)
= $273.60 TOTAL (including 8% tax)
Family of 3 or more:
$136.80 Single (in your GSU fee)
$222.41 Spouse and/or children (additional charge)
= $359.21 TOTAL (including 8% tax)
Dependent Children include your unmarried children, stepchildren and legally adopted children who reside with you and are dependent upon you for support and are:
a) Younger than age 22;
b) Age 22 and up to 26 years of age and in full-time attendance at an accredited institute of learning and dependent on you for support; or
c) Twenty-two (22) years or older and mentally or physically disabled and incapable of self-sustaining employment who was insured under this policy as a Dependent on the day prior to his or her 22nd birthday and remains dependent on you for support.
A dependent child who is no longer eligible for benefits under your Green Shield Group Benefits Program may also enrol in the Green Shield Group Conversion Program (see “Who Is Not Covered - Students On Leave”).
If you are graduating, your insurance and most student services are in effect until the end of the last term in which you are charged fees (Dec. 31 or Aug. 31). At the end of this term you may purchase this extension. Students who opted out are also eligible. Pre-existing conditions are also accepted.
Your 12-month Extended Coverage Cost Is:
| |
Health |
Dental |
Combined |
| Single: |
$ 283.32 |
$ 203.88 |
$ 487.20 |
| Family of 2: |
$ 567.14 |
$ 404.88 |
$ 972.02 |
| Family of 3 or more: |
$ 736.66 |
$ 533.19 |
$ 1, 269.85 |
(All rates include 8% tax)
In order to add family members to your plan(s) or purchase the 12-Month Extension, you must:
1. Fill out a GSU application form, available on the GSU web site and in the GSU basement lounge within the period above that you qualify for. For exceptions (a spouse or child joins you from away, or a child is born) contact the GSU within 30 days of their arrival.
2. Send the completed application forms and a cheque or money order (made out to the “Graduate Students’ Union”) to 16 Bancroft Avenue, Toronto, Ontario, M5S 1C1. Please do not send cash.
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Services are eligible if they are usual, reasonable and customary, and are medically necessary for the treatment of an illness or injury unless otherwise noted. Please contact the Green Shield Customer Service Centre at 1-888-711-1119 or the National Student Health Network at 1-800-468-0668 to determine benefit eligibility and coverage details. Inquiries can also be emailed to Green Shield at cservice@greenshield.ca
Predetermination
If the cost of any proposed treatment is expected to exceed $300.00 submit to Green Shield a detailed treatment plan from your provider before your 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, taking into account alternate procedures, services or course of treatment, based on accepted standards of medical/dental practice.
BENEFIT |
REIMBURSEMENT |
BENEFIT YEAR* MAXIMUM |
Acupuncturist
|
|
$15 per visit up to 20 visits (See Medical Practitioners below) |
Chiropractor |
|
$15 per visit up to 20 visits (See Medical Practitioners below) |
Homeopath |
|
$50 per visit (See Medical Practitioners below) |
Naturopath |
|
$15 per visit up to 20 visits (See Medical Practitioners below) |
Oral Contraceptives |
80% |
(See Prescription Drugs Below) |
| Orthotic: Custom Made Inserts |
|
$350/benefit year
(Doctor’s authorization required) |
Prescription Drugs (Generics unless doctor indicates no substitution) |
80% |
$5, 000 (See below) |
Podiatrist/Chiropodist (medical referral required) |
|
Reasonable & Customary Limit (See Medical Practitioners Below) |
Psychologist |
|
$300 per benefit year (See Medical Practitioners below) |
Speech Therapist (medical referral required) |
|
Reasonable & Customary limit (See Medical Practitioners below) |
Travel Coverage (provided by ETFS Insurance) |
100% |
$5 million for emergency accident or illness within first 60 days per trip (see travel insurance section) |
Tutorial Benefit |
100% |
(Plan member only) private tutorial services of a qualified teacher up to $15/hr up to $1, 000/disability (See below) |
Vision - Prescription Eyewear
|
|
$125/24 months (See below) |
Vision - Eye Exams
|
|
$75/24 months (every 12 months for dependent children) (See below) |
For coverage of the services of the following paramedical practitioners, see chart above:
Acupuncturist
Chiropractor
Homeopath
Massage Therapist*
Naturopath
Podiatrist/chiropodist*
Psychologist
Speech Therapist*
* Medical referral required
All paramedical practitioners must be licensed by the appropriate licensing body of the province in which they are practicing. OHIP or your basic health coverage plan must be exhausted first, as we will not pay the difference between what is charged by the practitioner and funded by basic coverage. Our plan will start reimbursement after your basic coverage maximum is reached. Attach a referral note from your Dr. (when required) the first time you claim. Please check with GS to see if a special claim form is required.
Prescription Drugs
Under this benefit you will be reimbursed eighty percent (80%) of the cost of eligible expenses. There is no deductible. There is a $5,000 per year maximum, and a limit of 3 months drug supply per claim.
Eligible benefits include drugs legally requiring a prescription by law, needles, syringes, vaccines, serums and injectable drugs. The generic equivalent drug substitution applies. Vaccines are eligible – call Green Shield to verify, as some vaccines are covered by the provincial health plan. Insulin, including needles, syringes, pump supplies, and blood glucose testing strips are eligible. Colostomy supplies, and life sustaining drugs that may not require a prescription, such as anti-parkinson agents, tuberculosis therapy, glaucoma therapy, etc. are eligible. If purchasing a large supply to prepare for travelling, the receipt needs to state”vacation supply”.
Long-Term Medication
Pharmex Direct: If you are on long-term (maintenance) medication, you can lower the cost of your prescription medications by using this service. Save yourself and your plan money. https://www.pharmexdirect.com/presmed.html
Ineligible Drugs
Benefits do not include “Over the Counter” drugs that require a Dr.’s note but not a prescription, anti-obesity, smoking cessation products, erectile dysfunction, acne (unless severe, requires Dr.’s note), hair loss/replacement, and fertility. Contract Green Shield for details.
Oral Contraceptives
You can be reimbursed 80% for oral contraceptives receipts dated after Aug. 31, 2007. For oral contraceptives at significant savings, contact Health Services at 416-978-8030. If your spouse is not a UofT student they can use the Health Services and be eligible for these savings. They are also available at cost at the Bay Centre for Birth Control, 416-351-3700 or Pharmex (above). Save yourself money and help reduce premium increases.
Travel Benefits (Accident or Illness Coverage)
Most health plan benefits remain in effect when you are away. Additionally, you have Travel Coverage offered by ETFS Insurance Services for trips for any purpose (pleasure, work, study etc.). Travel coverage up to $5 million is available for the first 60 days, per trip.
Hospital and medical services are eligible only if your basic health coverage (OHIP, UHIP, etc.) provides payment toward the cost of the services received.
If You Are Traveling For Academic Purposes
OHIP/UHIP eliminated coverage for the doctor’s appointment required for travelling (for vaccines, etc.). If you are traveling for academic purposes the University of Toronto Health Services will not charge you for this appointment. You must bring in a letter from a professor stating that the trip is for academic purposes. Book early. Note: this appointment is not covered by this coverage.
Tutorial Benefit
- Your coverage for Tutorial Services is 100%
- Your maximum is $1,000.00 per benefit year
- Private tutorial service of a qualified teacher up to $15.00 per hour, if an accident or • illness causes you to be disabled and confined to home or hospital for 15 consecutive days within 100 days following the date of the illness or accident. Note: your dependents are not eligible for this benefit.
Vision – Prescription Eyewear and Eye Exams
Vision receipts must be dated at least 24 months apart. If a receipt is dated March 1, 2007, your next eligible receipt must be dated after March 1, 2009. Laser eye surgery is covered. Green Shield Canada has an exclusive arrangement with several prominent eyewear retailers and stores offering significant discounts for students. For even more businesses offering student discounts see the Student Saver Guide in the back of the GSU handbook, or www.studentsaver.ca
Definition: a bodily injury that occurs solely as a direct result of a violent, sudden and unexpected action (sports injury, fall, etc). Your GSU accident plan offers several options to you in the event of an accident. Please contact the GSU Health Plan Administrator if you are unsure of what to do if you are in a serious accident.
BENEFIT |
REIMBURSEMENT |
BENEFIT YEAR* MAXIMUM |
Accidental Death & Dismemberment |
|
$5,000 member, spouse, child
(See below) |
Accidental Dental |
|
(See below) |
Ambulance Transportation |
|
(See below) |
Durable Medical Equipment |
|
(See below) |
Hospital Room, Semi-Private |
|
(See below) |
Nursing, Private Duty
(Pre-authorisation is required) |
|
$25,000 per 3 consecutive benefit years (See below) |
Other Extended Health Benefits |
100% |
(See below) |
| Physiotherapist |
|
$15 per visit up to 20 visits |
Repatriation |
100% |
Maximum of $15,000 (from US only and visa req'd) |
Accidental Death and Dismemberment (A, D & D)
ACE INA COVERAGE
POLICY SGC (10-30-35-01)
The Basic Accidental Death and Dismemberment plan covers you 24 hours a day, anywhere in the world, for specified accidental losses. If you suffer any of the eligible losses listed in the policy as the result of an accidental injury which results directly and independently of all other causes and the loss occurs within 365 days of the date of the accident, the benefits indicated in the policy will be paid.
The insurer will pay a stipulated sum for the loss of life or limb. The maximum benefit for accidental death is $5,000 and $15,000 for dismemberment.
Accidental Dental
Charges for dental treatment required as a result of an accident to natural teeth. The treatment must commence within six (6) months and be completed within one (1) year of the date of the accident. Reimbursement will be made for reasonable and customary expenses as set out in the General Practitioners Fee Guide in effect on the date of treatment. Ask your dentist about “assignment of benefits” to arrange direct payment to your dentist. No payment will be made if injury is the result of an accident caused by an object wittingly or unwitting placed in your mouth.
For expenses under $300, get a completed ‘standard dental claim form’ from your dentist, and attach it to the GSU claim form. Or print the GS dental claim form from their website. Your dentist will complete it. Write “dental accident” on both forms. Submit immediately.
Predetermination
If the cost of any proposed treatment is expected to exceed $300 submit to Green Shield a “Dental Pre-Treatment Form” before your 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, taking into account alternate procedures, services or course of treatment, based on accepted standards of medical/dental practice. With this information GS can tell you what is covered, and how much you may have to pay.
See “Dental Plan” below for non-accident claims.
Teaching assistants have dental benefits.
Call CUPE 3902 at 416-593-7057 for details or visit www.cupe3902.org
Ambulance Transportation
For land or air ambulance to the nearest hospital equipped to provide required treatment.
Durable Medical Equipment
Prosthetic Appliances and Durable Medical Equipment as well as replacements, repairs, fittings and adjustments of such devices (including: splints, trusses, braces, casts, or crutches). Contact the Customer Service Centre to verify eligibility of a particular benefit.
- Wheelchairs, Walkers, Hospital Beds, Traction Kits – Reasonable & customary maximum for repair to wheelchairs.
- Artificial Limbs and Eyes – Reasonable & customary maximums.
Notes to remember:
- Confirm eligibility prior to purchasing or renting equipment by submitting a Pre- Authorisation Form to Green Shield. In this way you will know what is covered and the extent to which you are covered.
- In Ontario, some of the above may be covered under the Assistive Devices Program (ADP). If an item is ADP eligible you must apply for ADP funding first.
Hospital Room, Semi-private
Semi-Private Room in a public general hospital. The plan does not cover specialty hospitals – contact GS for details.
Other Extended Health Benefits (Covered at 100%)
- Laboratory Tests – Lab tests conducted in a commercial laboratory. Tests conducted in a doctor’s office or in a pharmacy are not covered.
- Radiotherapy, coagulatotherapy, oxygen, plasma, and blood transfusions
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Members can see the dentist of their choice, and there are specific dentists who provide 20-30% discount (See below). You may opt-out, purchase family coverage, or a 12-month extension – see above. Full-time grads also have dental accident benefits in their Health Plan – see above.
BENEFIT |
% REIMBURSED (on current Dental Association Fee Guide for General Practitioners) |
BENEFIT YEAR* MAXIMUM |
Basic Preventative Services:
Complete, general or comprehensive oral exams, full mouth x-rays & panoramic x-rays
|
70% |
One annual exam |
Recall visit:
Including exams, bitewing x-rays, cleanings, and flouride treatments
|
70% |
One recall visit |
Basic Restorative Services:
Basic restorations, metal fillings, & inlays (porcelain is not covered) |
70% |
|
Extractions and Surgical Services (sleep dentistry is not eligible) |
70% |
|
Endodontics:
Standard root canal therapy |
70% |
|
Periodontic (gum treatment):
Scaling, root planing |
70% |
|
Standard Denture Services:
Relining and rebasing of dentures after 6 months from installation |
70% |
|
In an effort to help students have a greater portion of their dental claims covered by Green Shield, a Network of dentists who are willing to charge lower fees for students has been created. Students are not required to use a Network dentist, but doing so can save you more money.
The Dental discount works according to the following chart.
DENTAL SERVICE |
Discount (Participating Dentists) |
Preventive Services:
Recall exams, bitewing x-rays, extraction of impacted teeth, oral hygiene instruction
|
30% |
Other Preventive Services:
Polishing, scaling, and root planing
|
30% |
Basic Services:
Fillings, oral surgery |
20% |
Periodontic & Endodontic treatments |
20% |
The discount formula is (below is an illustration):
Total cost of procedure (i.e. for a filling) $100.00
Minus discount: 20% $20.00
Minus Green Shield co-payment: 70% $70.00
You pay $10.00
Without the discount, you would pay $30.00
You are also eligible for a discount on services not covered by your student plan, such as 20% off of major restorative services (crowns, bridges, posts, etc.).
To Receive Your Dental Discount
- Choose a dentist from the list of dentists here (PDF)
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Prior to having your dental work done inform your dentist that you have a dental plan with Green Shield and wish to receive a student discount.
- It is a good idea to request a Green Shield Predetermination in the event that your dentist estimates a claim exceeding $300
- The dentist will submit the claim on your behalf.
To make a dental claim, please see the Making A Claim section.
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Eligible Services do not include and reimbursement will not be made for:
Services or supplies received as a result of disease, illness or injury due to:
• intentionally self-inflicted injury while sane or insane;
• an act of war, declared or undeclared;
• participation in a riot or civil commotion; or
• committing a criminal offence;
Services or supplies provided while serving in the armed forces of any country;
Failure to keep a scheduled appointment with a legally qualified medical or dental practitioner;
The completion of any claim forms and/or insurance reports;
Any specific treatment or drug which:
• does not meet accepted standards of medical, dental or ophthalmic practice, including charges for services or supplies which are experimental in nature, or is not considered to be effective (either medically or from a cost perspective, based on Health Canada’s approved indication for use);
• is an adjunctive drug prescribed in connection with any treatment or drug that is not an eligible service;
• will be administered in a hospital;
• is not dispensed by the pharmacist in accordance with the payment method used for Drugs;
• is not being used and/or administered in accordance with Health Canada’s approved indication for use, even though such drug or procedure may customarily be used in the treatment of other illnesses or injuries;
Services or supplies that:
• are not recommended, provided by or approved by the attending legally qualified (in the opinion of Green Shield) medical practitioner or dental practitioner as permitted by law;
• are legally prohibited by the government from coverage;
• you are not obligated to pay for or for which no charge would be made in the absence of benefit coverage or for which payment is made on your behalf by a not-for-profit prepayment association, insurance carrier, third party administrator, like agency or a party other than Green Shield, or you;
• are provided by a health practitioner whose license by the relevant provincial regulatory and/or professional association has been suspended or revoked;
• are not provided by a designated provider of service in response to a prescription issued by a legally qualified health practitioner;
• are primarily for cosmetic or aesthetic purposes, or are to correct congenital malformations;
• are provided by an immediate family member related to you by birth, adoption, or by marriage and/or a practitioner who normally resides in your home. An immediate family member includes a parent, spouse, child or sibling;
• are a replacement of lost, missing or stolen items, or items that are damaged due to negligence.
• are from any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipal or other governmental body;
• would normally be paid through any Provincial Government Health Plan, Workplace Safety & Insurance Board, or tribunal, the Assistive Devices Program or any other government agency, or which would have been payable under such a plan had proper application for coverage been made, or had proper and timely claims submission been made;
• were previously provided or paid for by any governmental body or agency, but which have been modified, suspended or discontinued as result of changes in Provincial Government Health Plan legislation or de-listing of any Provincial Government Health Plan services or supplies;
• may include but are not limited to, drugs, laboratory services, diagnostic testing or any other service which is provided by and/or administered in any public or private health care clinic or like facility, medical practitioner’s office or residence, where the treatment or drug does not meet the accepted standards or is not considered to be effective (either medically or from a cost perspective, based on Health Canada’s approved indication for use);
• are provided by a medical practitioner who has opted out of any Provincial Government Health Plan and the Provincial Government Health Plan would have otherwise paid for such eligible service;
• relates to treatment of injuries arising out of a motor vehicle accident;
• are cognitive or administrative services or other fees charged by a provider of service for services other than those directly relating to the delivery of the service or supply
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The Travel Benefits portion of your insurance plan offered by the GSU is provided by ETFS Insurance Services Canada.
You can extend your travel insurance beyond the 60 day period allowed under the GSU Travel Benefit Plan. The GSU has secured a significant discount for all GSU members who wish to purchase travel insurance beyond the GSU plan.
For more information contact ETFS Insurance Services Toll Free at: 1 877 832-6025.
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Green Shield retains the right to subrogation if benefits have or should have been paid or provided by a third party. In cases of third party liability, you must advise your lawyer of these rights.
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See Contact Information section.
If you are told by the Green Shield staff that you or a family member are not covered, or you are denied benefits you believe are eligible, please contact the Graduate Students’ Union Health Insurance Office.
If you didn’t receive your opt-out refund cheque within 3 months, call or write the National Student Health Network. When leaving a message spell your name and leave your students’ union name and student #.
You can claim GSU Health and Dental Plan premiums, and the amount not covered by your coverage (the co-payment) under medical expenses on your income tax form. To calculate what you paid see premiums above. If you would like a receipt please contact us.
For free income tax submission, please visit the Canadian Federation of Students website for access to the FREE student U-File service: www.cfs-fcee.ca
See the “Getting There” student handbook for more details. Some University of Toronto students services are:
Health Services: 416-978-8030
Psychiatric Services: 416-978-8070
Counselling Services: 416-978-7970
If you have any questions about the information in this brochure, or if you need additional information, please contact the GSU Health Insurance Office or Green Shield Canada.
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The Green Shield Canada Privacy Code balances the privacy rights of our group and benefit plan participants, and our employees, with the legitimate information requirements to provide customer service and to meet our human resource requirements. It consists of the following key principles:
1. We Ask For Your Personal Information For The Following Purposes:
To establish your identification
To provide you and/or your dependants with the applicable benefit coverage
To protect you and us from error and fraud
To provide ongoing services
2. Consent
When you enrolled in your group benefit plan as a plan participant, your personal information was obtained and used only with your consent. We obtained your consent before we:
Provided benefit coverage
Offered you other Green Shield Canada services
Obtained, used or disclosed to other persons, information about you unless we were obliged to do so by law or to protect our interests
Used your personal information in any way we did not tell you about previously
Your consent can be either express or implied. Express consent can be verbal or written.
Consent can be implied or inferred from certain actions. For our existing group and benefit plan participants, we will continue to use and disclose your personal information previously collected in accordance with our current privacy code, unless you inform us otherwise and will infer that consent has been obtained by your continued use.
3. Withdrawal of Consent
You can withdraw your consent any time after you’ve given it to us, provided there are no legal or regulatory requirements to prevent this.
If you don’t consent to certain uses of personal information, or if you withdraw your consent, we will no longer be able to administer your benefit coverage. If so, we will explain the situation to you to help you with your decision.
For further information on our privacy policies and procedures, please refer to the Green Shield Canada web site at www.greenshield.ca
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Your Health and Dental Provider is: Green Shield Canada
Your Subscriber Number is: ‘UTG’ + your UofT student number + ‘00’
Your Accidental Death and Dismemberment Provider is: ACE INA
Your Policy Number for this plan is: 10-30-35-01
Your Travel Benefits Provider is: ETFS Insurance Services
Your policy number is for this plan is: 28556323
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Questions About Benefit Eligibility and Coverage Details?
Contact Green Shield Customer Service Centre:
1-888-711-1119 cservice@greenshield.ca
Health Plan Administrator, Graduate Students’ Union
Tel: 416-978-8465
Fax: 416-971-2362
Email: health.gsu@utoronto.ca or dental.gsu@utoronto.ca
University of Toronto, 16 Bancroft Avenue, Toronto ON M5S 1C1
National Student Health Network
Toll Free: 1-877-241-8881
Tel: 416-922-2381
Fax: 416-925-6774
Email: ontario@studentsbenefit.ca
180 Bloor Street West, Suite 900 Toronto, ON V6H 3V9
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