UTGSU Health and Dental Insurance

As a graduate student, you automatically pay a premium to the University of Toronto Graduate Students’ Union (UTGSU) to receive health and dental insurance. You can choose to opt out of the UTGSU plan to be refunded this premium, but only if you have equivalent or better coverage elsewhere. Note that OHIP does not cover many of the items covered by the UTGSU plan, including prescription drugs, dental care, vision care, and mental health services.

Note that the coverage provided through this plan is not total: for many items, you will be reimbursed or covered for a certain percentage of the cost (e.g., for prescription drugs, 80% of the total) or a specific dollar amount (e.g., for a physiotherapist, $30 per visit). There are also annual limits on either the total amount you can receive for a given service (e.g., for mental health services, $500) or the number of visits covered (e.g., for a chiropractor, 20 visits). Coverage runs annually from September 1st to August 31st, so be strategic about scheduling services to get the most bang for your buck. See the benefits pamphlet for a summary of coverage or the plan booklet for full details.

For more information about the plan, including general information, family coverage, and instructions for opting-out, visit the UTGSU website.

Submitting Claims

Note: UTGSU coverage will typically be unavailable during the change-of-coverage period, September 1st to 30th; claims submitted during this period will be denied. For expenses incurred during this period, hold on to your receipts and submit the claims in October.

The UTGSU’s health and dental plan is managed through Green Shield Canada; you can submit and review claims through their online portal. To register your account, you will need your member ID (UTG followed by your student number) as well as your date of birth.

To submit a claim, you will need to select the type of service or item you wish to claim and look up the provider using their name and/or phone number. You will then need to say who this claim is for (see “Dependents/Family Coverage” below) and answer a few questions; this allows you to coordinate an additional claim through your CUPE insurance, if applicable (see our CUPE Plan page for details).

Next, you’ll need to provide some basic information about the service, such as the date it occurred and the total cost, and after confirming that all of the information you’ve entered is true and accurate, you can submit your claim. Note that your claim may be “audited,” requiring you to submit documentation to substantiate your claim, so be sure to save a copy of any receipts for your service or item. As well, prescription drug claims will always require that you submit your receipt.

Once you’ve submitted your claim (and/or any requested documentation), it will usually be approved and funds deposited within 1-3 business days.

You can also submit claims by mail, but online submission is strongly recommended if at all possible.

Dependents/Family Coverage

Students may choose to enroll their spouse (including common-law partners) and/or dependent children in the UTGSU plan, entitling them to the same coverage. Dependents must be enrolled during the change-of-coverage period, September 1st to 30th, to be covered for that academic year. The annual fee for enrolment in the full plan is $640.58 for one dependent and $1,236.93 for two or more dependents, though you can also choose to only enroll your dependent(s) in either the health or dental portions of the plan for a lower fee. For more information or to enroll a dependent, visit the UTGSU’s StudentCare page.

Claims for your dependents are submitted in the same manner as your own, and you can use the same online account. Individuals are distinguished through a suffix to your member ID: -00 for you, and -01, -02, etc. for dependents.

Note that if you are also covered under the CUPE 3902 Top-Up Plan, any enrolled dependents are automatically enrolled in that plan as well. See the CUPE 3902 Top-Up Plan page for more details.

Travel Insurance

The UTGSU plan also includes substantial travel insurance to cover emergency medical treatments for injuries or illnesses occurring while outside of your home province, including international travel, up to a maximum of $5,000,000 CAD per incident. Repatriation costs are also covered up to $7,500 CAD. These benefits also apply to any dependents you have enrolled as described above. See the UTGSU website for more details.