Health and Dental Claim Forms

Health and Dental Claim Forms are available in the GSU Office, or can be downloaded from Green Shield's website.

Opt-in/Opt-out Forms

1. Individual Opt-In Form (.pdf format) (Winter 2012)

To add yourself to the plan, you must return this form to the Graduate Students' Union (GSU) by January 26^th, 2012.

2.  Family Opt-In Form (.pdf format) (Winter 2012)

To add your family members to the plan, you must return this form with payment to the Graduate Students' Union (GSU) by January 26^th, 2012 .  Electronic forms of payment are available between 10:00 - 11:00am, Monday-Friday at the GSU office (GH-2007, Feild Hall).

3.  Individual Opt-Out Form (.pdf format) (Winter 2012)

Opt-Out Form, for students with existing spousal, parental or other health insurance coverage: You must return this completed form and documentation (i.e., proof of existing coverage) by January 26^th, 2012 to the Graduate Students’ Union in person or by fax.

Benefit Booklet 2011-2012

Outline of Benefits (link to Green Shield site)

For members of the GSU health and dental insurance plan, this document from Green Shield details your insurance coverage and benefits for 2010-2011)

NOTICE: GSU Health and Dental Plan – Dental Cleaning Coverage

Due to a number of recent concerns brought to our attention, the GSU has decided to clarify the GSU Dental coverage regarding Dental Recalls/ Routine Dental Cleanings.

The GSU Dental plan covers a Dental Cleaning 100% every six months. Please be advised that included in the Cleaning/Dental recall there is only one unit of scaling covered 100% by Green Shield, any units of scaling beyond that are only covered 10%, while 90% is co-paid (paid by the student/member). This is because additional scaling units used during a routine cleaning or during a periodontal cleaning are considered to be a comprehensive basic service and therefore only 10% covered by Green Shield.

We advised students to always double check with Green Shield for eligibility for a dental recall/cleaning. You can do this by either:

1) Visiting the Plan Member Online services and logging in to your member page (on the right corner). You can then check the Eligibility for a Dental Recall Exam in the Benefit Eligibility Menu.

Link: https://onlineservices.greenshield.ca/studentcentre/Home.aspx?bd=25650.

2) Or, by calling the Green Shield Costumer Service number 1.888.711.1119. They will ask you for your membership number to confirm identity and will be able to provide you with the most updated and detailed information regarding your coverage.

Furthermore, we advise students to request a quote from their dentist office for any services for which they are not sure of coverage details, in order to avoid unexpected costs. Your dentist can access this information much quicker and easier than you. In this quote it should be clear what amount is covered by the insurance (Green Shield) and what amount is co-pay (paid by the student/member) for each individual item in a particular service.

If you have any questions please let us know,

GSU

Health and Dental card

Health and Dental card (.PDF format)

For students on either/both the Health and Dental plans. Your card can also be obtained by contacting the GSU Office ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).