|This page discusses the health care plans available to LGCU members. Information about the ongoing COVID-19 pandemic (LGCU and Linguistics Department policy, as well as resources) can be found on the COVID-19 page of this website.|
On This Page
- Insurance Plans
- Using Your Benefits
- Canadian Students from Outside Ontario
- International Students
- Partners and Families
- Health Services and Resources
- Miscellaneous Issues
Our insurance coverage period runs for the academic year (September 1 to August 31). There are three levels of health insurance:
Basic: All graduate students must have some form of basic provincial health care (OHIP if from Ontario; equivalent provincial/territorial coverage if from elsewhere in Canada; UHIP for international students). This covers basic doctor’s appointments and hospital visits.
GSU supplement: Additional health and dental benefits are provided by the U of T Graduate Students’ Union for all full-time and part-time graduate students. The premium is part of the cost of tuition and fees that you pay each year. Your insurance number for the GSU supplement is: UTG[your student number]-00
CUPE top-up: Each year, all students with a CUPE 3902, Unit 1 appointment of at least 30 hours receive a top-up insurance plan to further supplement their GSU insurance (CUPE refers to this as “Top-up Plan A”). This comes with the HCSA for additional healthcare costs. If your contract in the first term is for fewer than 30 hours, coverage is not available to you until you begin a contract that increases your total. However, regardless of when the coverage kicks in, it is retroactive to September 1 of that year. If you are not enrolled in the GSU plan, you will only have access to the HCSA spending account (CUPE refers to this as “Top-up Plan B”). Your insurance number for the CUPE top-up is: UOT[your employee number]-00
Both the GSU plan and the CUPE top-up plan are through the same company: Green Shield Canada. The GSU plan is considered your ‘primary’ plan, and the top-up plan is used to cover costs that aren’t fully covered by the GSU plan. For example: If both plans cover prescription drugs at 80%, the GSU plan would cover 80% of the total, and the top-up plan would cover the remaining 20% (since it’s 80% of the total, not 80% of the remaining amount).
Expenses must be incurred between September 1 and August 31 for the academic year that you are enrolled in the plan. Expenses for the past year should ideally be submitted for reimbursement before your plan ends on August 31. There is a 30-day ‘grace period’ (i.e. until the end of September after your plan year ends), when you can still submit outstanding expenses1.
The UTGSU plan can be used right away; the CUPE top-up plan, however, is under ‘blackout’ for the first few months. Because you’re not eligible for the top-up plan until after you’ve worked 30 hours in your contract, Green Shield considers your top-up plan ‘inactive’ until it’s confirmed that you’re eligible. The ‘blackout’ period usually lasts from September until early November for LGCU members. Once it kicks in, the top-up plan then retrospectively covers you from September 1, and you can send in expenses you’ve already paid for and get reimbursed.
Notice how the ‘grace period’ from last year will overlap with the ‘blackout’ period from this year? That can make things complicated (since Green Shield considers the plan you’re submitting older receipts for to be inactive). Best course of action: submit whatever expenses you can before August 31, and only send claims in during the grace period if you have to. See Claiming During the ‘Blackout’ Period for more information.
The GSU plan and the CUPE top-up plan together cover a wide variety of health care services. For a full list of benefits, you can review these summaries:
Unfortunately, the descriptions of benefits can sometimes be vague. If you’re not certain whether a particular service will be covered, or what amount will be covered, it’s a good idea to contact Green Shield Canada directly to verify before paying out of pocket. The phone number for Green Shield Canada is 1-888-711-1119; be sure to have the insurance numbers for both your plans at hand when you call.
What Kinds of Things are Covered?
Here are some examples of benefits included in our plans (remember to always check the details of coverage before paying out-of-pocket):
Psychotherapy and counselling
Custom foot orthotics
Prescription glasses or contacts
Laser eye surgery
Preventative, restorative and emergency dental services
Registered massage therapy
Many students under-use their health care coverage; this only benefits the insurance company. Make sure you’re getting the most out of the benefits you’re paying for, and don’t put off medical care for financial reasons when you don’t have to!
Which Providers are Covered?
You can pick your own health care provider, they don’t have to be registered with Green Shield or ‘in-network’. However, Green Shield does put limits on what qualifications providers need to have in order for their services to be covered. This is mostly an issue with professional services (e.g. massage therapy, counselling); your provider might need to have a particular degree, certificate, or be a member of a professional organization for you to get reimbursed.
If you’re not sure if the provider you want to see will be covered by your plan, you can check the GSU benefit booklet, or contact Green Shield directly through their support centre, online form or at 1-888-711-1119. Remember to check both the GSU and CUPE plan requirements, as they’re sometimes different.
Green Shield has agreements with healthcare providers in the city (and around the country) that will lower the cost of some services for plan members. You can look through the complete list of in-network providers, or check details of the discounts and providers for each network on the Studentcare website (on the right-hand side, under “Studentcare Networks”). You do not have to use an in-network provider to get reimbursed; your coverage applies equally to all qualified providers, being “in the network” just means a provider will offer discounts on some services to plan members.
Using Your Benefits
Some healthcare providers are able to apply insurance benefits on the spot so you never have to pay the full cost. Discuss this directly with your healthcare provider(s), and see whether they will coordinate benefits with both your GSU and CUPE plans, or with only one (always apply the GSU benefits first). Take your insurance numbers with you to every medical appointment in order to increase the likelihood of using your benefits as you go.
You can also print your own insurance card to carry around. Write your GSU plan number in the box and CUPE plan number below or on the other side. Consider laminating the card, printing it out on cardboard, or using tape.
If you have paid for some kind of health service or prescription without accessing your insurance up front, you can likely receive reimbursement for some of the expense. This is done by filing an insurance claim. You can file a joint claim to both supplementary health plans simultaneously, or file independent claims to each plan. If you file the claims separately, always apply to the GSU plan first (since this is the primary plan). If your medical expense is not fully covered by the combined supplementary and top-up plans, you can also access your health care spending account (HCSA) which may cover the remainder.
Filing a Paper Claim
If you prefer to stick with analogue, you can print and fill in a paper claim form and mail it in. The Health and Vision form can be used for most claims. There’s a separate form for Dental claims which you should take with you to your dentist so that they can fill it out for you. Travel Insurance and Accidental Death and Dismemberment claims are both submitted differently, so it’s best to check the Studentcare website for details.
In order to get a claim processed by both health plans at the same time, fill in section 1 of the form with your UTGSU plan ID (UTG[yourstudentnumber]-00) and put down your top-up plan ID (UOT[youremployeenumber]-00) in section 2 (the “mandatory declaration”). Make sure you tick the box in section 2 indicating that you want to coordinate this claim with your other Green Shield coverage, and you should be reimbursed from both plans at once.
Even if the expense being claimed is for a family member, the plan member (i.e. the grad student) will have to sign the form. You’ll need to include original receipts along with the form, and sometimes a referral or prescription as well. The second page of the Health and Vision form has some guidelines on what to include. It’s a good idea to keep copies of your receipts, referrals, and submitted forms until after you’ve gotten successfully reimbursed. Mail the completed form to one of the addresses at the bottom, whichever one best suits the type of claim you’re sending in.
Filing a Claim Online
Another way to file a claim is through the Green Shield online portal. Claims submitted online are often processed faster. You’ll need to get a registration key and then register your plan before being able to sign in to the portal. The two plans will have two different online accounts.
Once you’re signed in, you can submit new claims, or check the details of claims that have already been processed. The process for submitting a claim online is usually pretty simple: 1) Select the type of medical service, 2) Fill out the requested information, 3) Attach any documentation (such as receipts or referrals) and submit. If the claim is for a professional service, you’ll be asked to fill out some information about your provider. Some providers will show up in the search function when you enter their info, but you can still submit a claim for a qualified provider even if Green Shield doesn’t have their information already.
Some types of claims don’t require you to submit your full documentation. Even when this happens, however, some proportion of claims submitted will be ‘audited’. This doesn’t mean you’ve submitted the claim incorrectly, it’s just a random check. When you get the audit notification, it will include information on what supporting documentation they want to see, and how to upload it.
Claiming During the ‘Blackout’ Period
If your top-up plan is under blackout you can still submit claims to be reimbursed. In theory, these will be reimbursed through your UTGSU plan right away, and then through your top-up plan once it is ‘active’ again. In practice, there seems to be a higher rate of errors when doing things this way.
If you can afford to wait on reimbursement, it’s often easier to hold on to your receipts and send in everything once the blackout period has ended. If you can’t wait, submit as you normally would, and just double-check after the blackout ends that everything got reimbursed that should have been. Remember that health care providers also can’t submit to your top-up plan while it’s inactive, so if you’re paying direct you’ll have to pay the amount that would normally be covered by the top-up plan out of pocket, and request reimbursement later.
Very annoyingly, the ‘grace period’ (i.e. the one month after the end of the policy year where you can still submit claims from that year) overlaps with the ‘blackout’ period. This complicates the process of submitting, because the system considers you ‘inactive’, even though you’re submitting costs from a time when your plan was ‘active’. For instance: A 2nd year PhD on September 5th is still able to get reimbursed for an expense incurred last month on August 10th (during her 1st year), but since she has not yet fulfilled the requirements to be on the top-up plan for her 2nd year, the insurer considers that plan ‘inactive’, and makes it harder to get reimbursed from it.
You can still get reimbursed! The most reliable way seems to be: 1) Submit online through your UTGSU plan account, 2) Choose the option to ‘coordinate’ with your other plan, and 3) Submit your claim ‘manually’2 if there is an option to do so. “Submitting the claim manually” means that when you submit a claim, and you select the type of service you’re submitting, you need to choose the “Not Listed” option. For instance: if you were submitting a claim for physiotherapy, you would go under the heading “Professional Services”, but instead of clicking “Physiotherapy Treatment” you need to choose “Professional Services - Not Listed”.
The issue seems to be that while your plan is ‘inactive’, you need to include more documentation (i.e. all related receipts/referrals/prescriptions). But since you need to send the claim through your UTGSU plan (which is still ‘active’), by default it will not give you the option of including the extra documentation. Choosing “Not Listed” prompts the system to ask for documentation. So this weird quirk doesn’t apply for claims that always require documentation (e.g. Prescription Drugs).
Claims Being Rejected
In theory: submitting a claim for a service you have coverage for should get you reimbursed. In practice: the employees at the insurance company are fallible, we are fallible, and the system is designed to make it hard to get your money back. It’s not uncommon for something to go wrong.
Your best defence is good record-keeping and follow-up. Always photograph/screenshot/scan your form and receipts before submitting them. Keep track of what you’ve submitted, so you notice if things get lost. Green Shield will send you an email notification when a claim is processed (for each plan separately); you’ll find the details on the Green Shield online portal, under “My Claim Statements”. It’s a good idea to verify that your claim was approved, and that you’ve been reimbursed for the amount you expected.
If things look off, ask! Green Shield has an online support centre, but the best way to get things resolved remains talking to an actual human by phone (1-888-711-1119, Mon-Fri 8:30am-8:30pm EST). There are a whole bunch of reasons your claim might have been turned down, and many of them are fixable.
If you sign up for direct deposit (you can do this through the Green Shield online portal), your refund will be deposited right into your account. Otherwise, you’ll receive a cheque in the mail.
If you’re having trouble with filing a claim, you could always ask your fellow grad students for help. You’re probably not the first person to run into a particular problem.
Canadian Students from Outside Ontario
Canadian students from out of province can continue to use their other provincial health coverage (e.g. MSP for students from British Columbia) instead of OHIP. This has no effect on UTGSU or top-up plan coverage. Provincial health care plans sometimes have different coverage, however, so it’s a good idea to get familiar with how your provincial coverage differs from OHIP.
If you continue to use another province’s health coverage, you should inform your home province that you are attending an educational institution in Ontario. This is so that when you go to a doctor in Ontario, your claim won’t be denied.
You can also switch your provincial health coverage to OHIP if you want. There’s a three-month waiting period for enrolment, so make sure to co-ordinate the dates with your home province’s coverage; you don’t want to be left with a gap in coverage!3 If you move back to your previous province after graduation, you can switch your coverage back too (once again, with a 3-month wait). For most students, it’s a good idea to switch if you’re planning to stay in Ontario after graduation, but easier to keep the same coverage if you’re planning to go back to your home province after graduating.
Note: As of March 2020, the 3-month waiting period for applying to OHIP has been waived due to COVID-19.
International students need to register for a special form of basic health coverage (UHIP). The pool of health providers that take UHIP coverage is more limited than those who take OHIP; when finding a health care provider or trying to get a referral, always check whether or not the provider takes UHIP. While OHIP is paid for through your provincial taxes, UHIP is not. Fees for UHIP are part of the cost of tuition and fees, and should be covered by the department if you are currently funded. If you are not currently funded and have to pay for UHIP out of pocket, you can apply for CUPE 3902’s UHIP reimbursement fund.
Partners and Families
You can enrol family members on your health insurance plans as well! Up to one spouse and any dependent children can be covered. Common-law and same-sex partners are considered valid spouses. You can verify eligibility on the Studentcare page on couple and family enrolment eligibility.
To enrol family members, sign up for family coverage on the GSU insurance plan and pay the additional fee(s). Health and dental are dealt with separately. You must opt-in by the deadline, usually the end of September.
The CUPE plan is linked to the GSU plan. So if you are eligible for the CUPE top-up plan, this top-up will be extended to all your family members who also have GSU insurance. All dependents added under your plan will have their own separate limits on funds (e.g. the amount of coverage for prescription drugs is per person not per family). The exception is the health care spending account, which is one amount shared between all members of the family; if you enrol at least one dependent on your plan, the amount of money in the HCSA is larger (but it doesn’t increase again if you add more than one dependent).
Any family members on your plan will have their own individual ID number. This number is the same as the UTG[student number] and UOT[employee number] IDs that you have as an individual, but instead of -00, your family members’ numbers will end in -01, -02, etc. When submitting a claim, make sure the ID number reflects the family member who received the medical care.4
If you enrol family members on your health plan, you may be able to get a percentage of their premiums reimbursed through the U of T Family Plan Assistance Fund. Applications for this fund are usually open in February, check the website to see if you’re eligible.
You can also optionally authorize up to four people to contact Green Shield on your behalf to inquire or update about the details of the benefits plan (do so when signed in to the Green Shield online portal, under “My Profile”). Individuals do not have to be enrolled on your plan as family members to be authorized this way. You will still have to authorize and/or sign submitted claims as the primary plan holder, however.
Health Services and Resources
The U of T offers a variety of on-campus health services, including general family doctor-type services, sexual and reproductive health support, mental health care, disability documentation, immunizations, and many more.
University of Toronto Health Resources
Health and Wellness Centre
214 College Street; entrance on St. George
t: 416-978-8030 e: firstname.lastname@example.org
U of T Health Services allows online booking and lab results through a platform called Medeo. You’ll need to contact Health and Wellness (and have your U of T email address in hand) in order to set it up (more information on booking through Medeo). It can take a few days for your registration to go through, and Health and Wellness are currently running most doctor’s appointments remotely through Medeo right now, so don’t put it off until the last minute.
Student Mental Health Webportal is a newly launched site that aims to help students find mental health supports at U of T. It has search and filter functions to help you find what you need, and an emergency page for if you need to get urgent help.
Sexual Education Centre
21 Sussex Ave. 6th Floor, Unit 612
t: 416-978-8732 e: email@example.com
Sport Medicine Clinic
Goldring Centre for High Performance Sport, 4th floor; entrance on North side of building
t: 416-978-4678 (press “0” for reception)
My SSP provides free, confidential 24-hour helpline for U of T students. 146 languages supported.
School of Graduate Studies Wellness FAQs has answers to a variety of wellness-related questions for graduate students.
Off-campus Health Resources
iamsick.ca will help you find a health care provider near you
Telehealth Ontario will allow you to confidentially talk to a registered nurse 24/7
Health Care Connect will help you find a doctor or nurse practitioner near you who is accepting new patients (requires OHIP)
Ontario Virtual Care Clinic will let you talk to an on-call doctor (requires OHIP)
Walk-in counselling services across Toronto can help you without an appointment or fees
Good2Talk is a free, confidential 24-hour helpline for post-secondary students’ mental health and well-being.
Talk4Healing is a free, confidential 24-hour helpline for Indigenous women, by Indigenous women. 14 Indigenous languages supported, as well as English and French.
t: 1-855-554-HEAL (4325) (talk or text)
The GSU’s Grad Minds promotes mental health awareness among grad students at U of T. Check out their workshops and events, or consider volunteering.
If you need help with coverage, opt-outs, or enrolling, you can talk to UTGSU directly.
UTGSU Health and Dental Insurance Office: 16 Bancroft Ave.
t: 1-866-358-4436 e: firstname.lastname@example.org
Your fellow grad students can be a great source of advice and support (even if it’s just about what dentist they go to). To get in touch in the age of social distancing, you can: email the LGCU listserv (LGCU-L@listserv.utoronto.ca); contact to be added to the LGCUers facebook page; or contact to be added to the LGCU virtual lounge on Zulip.
The LGCU’s own Mindsweepers Wellness Committee does not provide direct support to students, but may be able to point you in the direction of some good resources. You can send them suggestions or get involved yourself.
If you have an alternative source of equivalent (or better) coverage from your partner or family that you prefer to use rather than this insurance system, you can opt-out of the GSU plan. You will be opted out of the CUPE plan by extension (though you will still have access to the health care spending account, if you are eligible for it). Opting-out is done online, through the links on the studentcare page. You must opt-out by the deadline, usually the end of September.
If you are graduating in the Fall semester (i.e. before January), you will not be charged winter fees and your coverage will automatically end on December 31st. If you are graduating in the Winter or Summer semester (i.e. in or after January), you will already have paid winter fees, so your coverage will end on August 31st.
You do have the option to extend your coverage, however. At the end of the last term you pay fees for, you can purchase a 12-month extension. You have to apply for this extended coverage within 30 days of the termination of your UTGSU insurance (i.e. the end of the last term you paid fees for). Fill out the application form and submit the fees by cheque or money order by the deadline.
Other things to note:
The 12-month extended coverage is typically more expensive than the fees charged to graduate students for the plan (for 2020-21, it was approximately 50% more expensive)
Partners and dependents can also be enrolled for 12-month extended coverage
If you keep working as a TA after graduating, you’ll be eligible for the CUPE top-up plan. If you sign up for the 12-month extension of the UTGSU plan, this will be top-up Plan A (health and dental); if you don’t get the extension, this will be top-up Plan B (HCSA only).
If you get the 12-month extension and are eligible for the CUPE top-up plan, you can use the HCSA account to claim against the premium (see HCSA details)
Former LGCU members who used the extension have strongly recommended purchasing it
Going on Leave
By default, students on a leave of absence lose UTGSU health coverage. On leave, students don’t pay tuition and incidental fees, which includes health and dental premiums. Without paying the premiums, students are not enrolled in the plan.
If you have been accessing medical or psychiatric care through U of T Health and Wellness before going on leave, you can still access treatment this way. This also applies to access to the David L. MacIntosh Sports Medicine Clinic, for those with sport or exercise-related injuries.
However, it may be possible to continue your UTGSU health and dental plan coverage during your leave of absence. Extending coverage throughout your leave is something you have to specifically request, and it seems to be done on a case-by-case basis. If you want to do this, contact the GSU Health Plan administrator by emailing email@example.com. You will need to provide: 1) A request to have the coverage while on leave, 2) An indication of exit and return dates, and 3) An approved Leave of Absence form from SGS.
Once the Health Plan Administrator receives your materials, they advocate on your behalf for you to be enrolled in the health and dental plans while you are on leave. After this gets approved, you’ll have to complete an enrolment form, and pay the fees directly to the Broker. Leave of absence coverage continuation has to be applied for during the Change of Coverage period (e.g. for the Fall semester, this would be September 1-30), with no exceptions. The UTGSU Health Plan administrator can help you figure out the details of your own situation.
If you have secured and signed a contract before going on approved leave, you can also be covered by the CUPE top-up plan. As well as your having gotten a contract, your top-up plan coverage also depends on whether you have a GSU plan or not (i.e. CUPE top-up plan coverage will apply while you are enrolled in the UTGSU plan and have a contract, but if you are not enrolled in the UTGSU plan, you will only ever have HCSA coverage through CUPE).
For instance: Say you have completed the 30 hours of TA-ing required to qualify for the CUPE top-up plan. You pay fees for the UTGSU plan in the Fall, but not in the Winter. You would be covered by Top-up Plan A (full health and dental) from September to December, since you’ve 1) completed 30 hours, and 2) enrolled in the UTGSU health plan during that term. You would be covered by Top-up Plan B (HCSA only) from January to August, since you’ve 1) completed 30 hours, and 2) not enrolled in the UTGSU plan during that term. Taking leave during the Summer would not affect your coverage.
For more information on taking a leave of absence, check out:
Before going on any international travel related to your work, the university requires you to have travel insurance. The GSU plan includes full travel insurance for trips of up to 120 days that can cover you for conferences, research trips, many other reasons.
Due to COVID-19, however, travel advisories and insurance coverage can change quickly. For this reason, we are strongly recommending that you verify your coverage before travelling outside of Canada. Check with the Green Shield COVID-19 FAQ, as well as the Government of Canada official travel advisories and COVID-19 travel restrictions and advice for up-to-date information.
The HCSA is a undifferentiated pool of funds associated with your CUPE top-up plan. It can be used to pay for health care not otherwise covered by provincial health care or your plans’ benefits. A wide variety of expenses can be paid for using the HCSA. Like the rest of your health care benefits, this fund does not roll over into the following year; any amount not used by August 31st of the plan year is lost.
You can set your plan to automatically have any unpaid health and dental expenses paid for out of the HCSA. This can be done by logging in to your Green Shield portal top-up plan account and looking under “My Spending Accounts”. While this is quite convenient, there are potential downsides. You may not notice if the insurance provider wrongly rejects your valid expense claim, and then takes the money to reimburse you out of the HCSA account instead. Automation may also make it appear to some health care providers running a pre-authorization that you have more coverage than you actually do! If you choose to set up automation, make sure to keep an eye on how those funds are being disbursed.
You can also directly submit claims for reimbursement to the HCSA. Eligible claims include the cost of you or your family’s GSU health care premiums! Your own premium will be listed among your fees on ROSI/Acorn, enrolled family member fees can be found in the email confirmation sent to you when you pay. The HCSA alone will not cover the full cost of premiums, but this is a useful way to make use of any remaining HCSA funds when the end of the year approaches. Remember not to submit any family member’s premium costs to the HCSA if you’re going to be applying for the U of T Family Plan Assistance Fund (application usually open in February).
Useful Forms and Sign-in Pages
Self-Enrolment Form (Regular Students) \ Note: Most students will be enrolled automatically, this form is for new students starting in the Winter session
Coverage Manager Online Form \ This is where you go to change your coverage, enrol a family member, or opt-out
CUPE Member Portal \ The forms to apply for the U of T Family Plan Assistance Fund (UFPAF) and the International Health Plan Assistance Fund (IHPAF) will be available here when applications open
This does not seem to apply to the HCSA, unused amounts of which expire on August 31st of the plan year. ↩
This is the insurer’s name for it. No idea why. ↩
You also want to avoid an overlap in coverage. If your home province thinks you’re still on their health care, they might continue to charge you. More than one student has gotten a nasty bill from MSP years later over a misunderstanding. ↩
If you submit a paper claim, sections 1 and 2 get filled out with the primary plan holder’s ID number (the one ending in -00), and in section 3 each line gets filled out with the ID number of whichever plan member received the medical care (-00, -01, -02, etc., depending). ↩