Health & Dental

Health & Dental Plans

*** All questions about health and dental should first be directed to http://www.ihaveaplan.ca/rte/en/McMasterUniversity_Home or 1-866-358-4434. If further assistance is still required, please then contact This email address is being protected from spambots. You need JavaScript enabled to view it.. ***

 

Initiated by your student association, the McMaster GSA Health Plan provides students with unique health benefits. The Plan was designed by students for students to provide many important services and cover expenses not covered by a basic health-care plan (i.e. OHIP), or the equivalent (e.g. UHIP for international students) such as prescription drugs, health practitioners, medical equipment, travel health coverage, and more.

 A comprehensive Dental Plan was added to cover those graduate students who were not covered by the CUPE 3906 Plan (except for Divinity and MBA students).

 


 

The following Frequently Asked Questions about the Plans are posted to help you better understand this important service.

These FAQs are for general information purposes only. We recommend that you directly contact http://www.ihaveaplan.ca/ if you have any specific questions about your GSA Plan and http://www.cupe3906.org if you have any specific questions relating to your CUPE Dental Plan.

** IMPORTANT **

The opt out dates are as follows:

  • September 27th (for students beginning in September)
  • January 31th (for students beginning in January or May)

Health FAQ

Frequently Asked Questions


 Q. Why a student health plan?

A. Under the Canada Health Act, most health-care services in Canada are publicly funded and administered. Provincial health-care programs (such as OHIP) cover most medically necessary services and are mandatory for all permanent provincial residents. However, a growing number of other medical services are not covered by OHIP (e.g. prescription drugs, physiotherapists, chiropractors, medical equipment, ambulance, travel health coverage…).

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.

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 Q. Who is covered?

A. All full-time and part-time graduate students who are GSA members* and who pay GSA and McMaster fees are automatically enrolled in the Plan. Full-time Divinity and full-time MBA co-op students are not GSA members, but are automatically enrolled in the Plan.

* GSA members include International students studying at McMaster and paying McMaster fees, as well as students away on exchange.

Part-time Divinity and part-time MBA students, all students who aren't GSA members (such as post-degree students, students on leave of absence, incoming exchange students from another university and auditing students) and new students registering in May are not automatically enrolled and are not eligible for the Plan.

If you're not sure of your eligibility, please contact studentcare.net/works or the GSA.

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 Q. How much does the Plan cost?

A. The Plan costs $163.00 for full-year coverage (September 1, 2007 – August 31, 2008). Students beginning in Jan. 2006 will be assessed $108.67 for coverage from Jan. 1 to Aug. 31, 2008. If you are covered, the cost of the Plan is part of your student fees.

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 Q. What does the Plan cover?

A. The Plan is a comprehensive package of benefits including:

  • Prescription drugs (80%) NEW: including oral contraceptives
  • Physiotherapists and chiropractors (for a max. of $35 a visit, $500 per category of practitioner, per policy year)
  • Other health practitioners such as massage therapists and naturopaths (for a max. of $25 a visit, $300 per category of practitioner, per policy year)
  • NEW: travel health coverage ($5,000,000 coverage per lifetime, 120 days per trip, unlimited number of trips) now including trip cancellation and trip interruption
  • Vaccinations (when prescribed by a physician)
  • Ambulance, medical equipment
  • And more

Consult your Plan Booklet or visit http://ihaveaplan.ca for more coverage details.

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 Q. What are the Studentcare Networks?

A. To offer students more comprehensive coverage, studentcare.net/works has set up networks of health-care professionals. For example, students can benefit from additional coverage when visiting members of the Studentcare Dental Network, the Studentcare Vision Network and the Studentcare Physiotherapy Network.

Network members offer an additional reduction over and above any amount covered by the McMaster GSA Health Plan. If you combine your physiotherapy benefits with the Studentcare Physiotherapy Network reduction, you will pay no more than $5 for the initial assessment and your physiotherapy costs will be fully covered for subsequent visits after reimbursement from the insurance company (until the yearly maximum is reached).

Although vision care and dental care are not included in the McMaster GSA Health Plan, studentcare.net/works has also set up a Studentcare Vision Network and a Studentcare Dental Network in an effort to save students even more money and to help you get the treatment you need – at an affordable cost. For example, some Vision Network members have reduced their fee for an eye exam to $50, and Dental Network members offer 20-30% off the Dental Fee Guide for General Practitioners price of eligible dental services.

As some practice information may change throughout the year, we recommend you visit the Networks section of www.studentcare.net for updated lists of Network members.

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 Q. Do I have to see a Network physiotherapist in order to receive my Health Plan coverage?

A. No. The Studentcare Physiotherapy Network is in place to help students further reduce the overall costs of services, beyond the insured portion of the McMaster GSA Health Plan coverage. You're covered for the insured portion regardless of the health professional you choose. However, by consulting a member of the Studentcare Physiotherapy Network, you will get additional coverage.

For example, Network physiotherapists have reduced their professional fees to $40 for the initial assessment and $30 for subsequent visits. This means that if you combine your physiotherapy benefits with the Studentcare Physiotherapy Network reduction, you will pay no more than $5 for the initial assessment and your physiotherapy costs will be fully covered for subsequent visits after reimbursement from the insurance company (until the yearly maximum is reached).

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 Q. How do I claim my benefits?

A. Students who are automatically enrolled in the Plan should receive their Plan Booklet near the beginning of September (or January for new Winter semester students only). If you have not received a Plan Booklet, please view the Plan information online at ihaveaplan.ca.. Located on the back cover of the Plan Booklet, and also available at ihaveaplan.ca. is a Pay-Direct Card (see Blackout Period below). By presenting the Pay-Direct Card with your valid student ID, you can fill your prescriptions at most Canadian pharmacies and receive 80% off the price cost of prescriptions at the time of purchase. The pharmacist will be able to process the claim immediately, so you won't have to pay the full amount up front and wait to be reimbursed.

For other health claims (including prescription drugs if you don't use the Pay-Direct Card), you will be responsible for payment when the service is rendered. You can then complete and sign an extended Health Claim Form, attach any necessary receipts and/or documents and mail them to the insurance company (Sun Life).

Claim forms are available at http://ihaveaplan.ca.. Photocopies of blank claim forms may also be used. Please allow one to two weeks for your claim to be processed.

Fill out the form and submit it with the original receipts. Photocopied receipts are not acceptable and ORIGINAL pharmacist receipts must be attached. 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. Photocopies of blank claim forms may also be used.

Group Name: GSA Health Plan

Group Number: 20639

Insurance Company: Sun Life Assurance Company of Canada (Sun Life)

Claims can be dropped off at the GSA Office for mailing or sent to:

Sun Life Assurance Company of Canada
Group Claims Department
PO Box 11805, Stn. CV
Montréal, Québec H3C 0H3

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.

For any issues regarding claims rejections, please contact This email address is being protected from spambots. You need JavaScript enabled to view it. or 1 866 358-4434

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 Q. What is the Blackout Period?

A. Claims processing is delayed for new students during the first two months of the Fall and Winter semester, whilestudent care networks waits for complete enrolment lists, after opt outs and enrolments have been processed. During this time, you may submit claims, but reimbursement cheques will only be mailed once the Blackout Period ends. Pharmacists cannot accept Pay Direct during the Blackout Period.

If I'm covered by the Plan, can I enrol my family?

Yes. The McMaster Health Plan gives you the option to enrol your family (spouse and/or dependants) by paying an additional fee, over and above your fee as a member of the GSA. Common law couples are eligible (for a definition of what qualifies as common law: click here).

All enrolments must be completed within the Change-of-Coverage Period (see below for deadlines). Visit  ihaveaplan.ca and follow the on-screen instructions for enrolments.

 


 Q. What is the Change-of-Coverage Period?

A. The Change-of-Coverage Period is the period at the beginning of the semester when you can either opt out or enrol your spouse/dependants in the McMaster GSA Health Plan.

If you start school in September, the Change-of-Coverage Period is from  Sept. 6 – 28, 2007. The January Change-of-Coverage Period, from Jan. 7 – 31, 2008, is only for new Winter semester students who wish to opt out or enrol their spouse/dependants for coverage from Jan. 1 – Aug. 31, 2008.

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 Q. What if I'm already covered by another plan?

A. NOTE: OHIP does not provide coverage equivalent to the McMaster GSA Health 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're covered by another plan (i.e. parent or spouse's employee benefit plan), you can combine this plan with the McMaster GSA Health Plan to maximize your overall coverage and eliminate out-of-pocket costs. By doing so, you may be able to claim deductibles or co-payments that you would otherwise have had to pay.

Alternately, if you wish to opt out of the McMaster GSA Health Plan, you can do so during the Change-of-Coverage Period, and receive a cheque for the amount of the Plan. In order to opt out, you must provide proof of other equivalent health coverage. Visit ihaveaplan.ca and follow the on-screen instructions for opting out.

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 Q. Why do I have to opt out if I don't want coverage? Why can't I just sign up for health insurance on an individual basis?

A. Individual health insurance plans have always been available for purchase. These plans suffer from several drawbacks.

  1. They're very expensive - up to 9 times the cost of the McMaster GSA Health Plan.
  2. They discriminate by sex and age.
  3. They exclude individuals with pre-existing illnesses (people who need a health plan the most).

As a result, individual health plans aren't a real solution. Experience shows that only group health insurance programs can meet students' health needs at a reasonable cost. A student health plan is a collective investment to ensure a minimum standard of health care for the student body.

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 Q. Can I use this plan when I'm away from Canada?

A. Yes, 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.

The Plan also provides you with travel health coverage. You're covered for up to 120 days per trip, for an unlimited number of trips taken during the time you're covered. Students who are away on academic trips, such as a recognized academic exchange, may be eligible to have their travel health benefits extended for the duration of the trip and should contact studentcare.net/works for more information. The maximum coverage is $5,000,000 per lifetime. Please make sure you submit detailed receipts for services performed while outside of the country. Health Plan members are also covered for trip cancellation and trip interruption.

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Click here for more interesting facts about your GSA Health Plan (DOC).

 

Website: http://www.ihaveaplan.ca/rte/en/McMasterUniversity_Home

Toll-free: 1-866-358-4434