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Benefits Plan

For an overview of all the kinds of benefits, funds and leaves click here. There are also health funds available (services not covered by the plan, services you may need despite having reached the Benefits Plan maximum allocation) through the Extended Health Benefit Fund (click here) that is administered by CUPE 3903. 

Benefits Plan
Administered through Sun Life, it covers 
- Vision Care
- Dental Care
- Prescription Drugs and
- Paramedical Services (six services including naturopaths and chiropractors)
 

Who is eligible
All CUPE 3903 members and their dependents (spouses, common- law and same-sex partners, and children; parents are ineligible) are eligible from the first day of your contract until four months after the end of your contract. There is no wait period and you have coverage in the summer whether you are working or not. The Employer pays this for and there is no cost to you as a member.
 

How do I enroll
Current 3903 members are already enrolled (Members who have had a contract within the past four months are already enrolled PROVIDING you enrolled when you started that contract. If you've never enrolled then you are not now and won't be until you do enroll). New members must opt-in for benefits coverage. The enrollment form is available at the 3903 office, from the employer (in new employee packages that you receive in September), or online (see directions below).

NEW MEMBERS MUST ENROLL

• Print the CUPE 3903 Benefits Enrolment Form: we would love to post the form or even make this URL a hyperlink, but the form turns to jibberish when we try. Go to York University's benefits page, click on "Forms", then click on "CUPE 3903 Benefit Enrolment Form"
• Complete the form. You are asked to include your employee number. It starts with “102” and appears on the upper corner of your pay stub.  If you haven't got a pay stub yet, or if you haven't got one handy, don't worry; Human Resources can process your form without it
• Take the form to the university’s Pension & Benefits Office (in the East Office Building per the address on the bottom of it) or fax it to 416-736-5703 
• Once you submit the form to it will take approximately four weeks for you to be enrolled in the plan (although in past years, members have said this may take longer than four weeks)
• You will receive a drug card approximately four to six weeks after you submit your form. You will receive the drug card in the mailbox in your teaching/work hiring unit or at your home address
• You will be enrolled before you receive your drug card, as receiving your benefits card is the last step in this process
• Once you are enrolled you may send in your claims to Sun Life (more about this below) if they are not billed directly to Sun Life by the health care provider
• You will need to confirm your enrollment with Sun Life before submitting claims
• ALERT: if your contract begins in September and you submit your form before the end of the month, benefits are retroactive to September 1 (meaning you can get your teeth cleaned on September 12, drop off the form on September 19, and upon enrollment claim a reimbursement). If you wait until after the end of September, your benefits begin when the form is processed (there is not reach back to September 1, the day your contract starts)

How do I enroll dependents  

Fill out the Benefit Enrolment and Change Form, add in the dependant's information, and submit the form to the Pension and Benefits office. You can get the form here: 

http://www.yorku.ca/hr/documents/CUPE3903_Benefit_Enrolment_Form.pdf

When is coverage active
If your contract starts in September and you enroll in benefits before the end of the month, your coverage is retroactive to September 1. Otherwise, your benefits will begin as soon as your enrolment form is processed--a few weeks after it is submitted. You can check with the insurance company about two weeks after submitting the enrollment form to see if the insurance company has enrolled you. You can start making claims as soon as you confirm eligibility; you do not have to wait for the card. If you have had a contract within the past four months you are already enrolled.

How long does coverage last
Coverage continues until four months after the completion of your most recent contract. While the benefits period is January to December, some of the coverage is allocated on a “rolling month” basis. This means that just because a new year starts it doesn’t mean you can access all services immediately. For example, if you get glasses on October 1, 2011, you are not eligible for glasses-coverage again until October 1, 2013. The same kind of “rolling basis” applies for various aspects of dental care, such as oral exams, X-rays and cleanings & scalings.

What is covered
Sun Life is the insurer. The full information of what is covered is available here. It includes information on things like what is not covered, so might be worth your reviewing it. Otherwise, in short, what is covered is as follows.

VISION CARE 

• $400 every two years (from date of purchase), on a 24 “rolling” month basis
• Includes frames and lenses, contacts, and one eye exam every two years
• This amount may also be put toward laser eye surgery
• Most vision centres will accept the drug card that you receive after enrolling. Note that you do not actually have to have a drug card on you: all you need to know is your employee number and the policy number (14098)
• If the service provider requires you to pay up front, click here aaf for the ways to get reimbursed

DENTAL CARE 

• $3,000 every calendar year (Jan 1 - Dec 31). 
• 100% of oral examinations, cleaning, scaling, fillings, removals, and most x-rays. The exams, recall visits and cleaning & scalings are done on a “rolling” month basis what does that mean, not a calendar year
• 100% of root canal therapy
• 85% of bridges, crowns
• 80% of periodentic (gums and jaw) surgical services
• Note the CUPE 3903 covers dental fees laid out in the Canadian Dental Association fee guide. It is advised that you confirm that your dentist’s fees are no greater than those in the fee guide. If your dentist charges more than the fee guide you will be responsible for paying the difference
• Some dentists will bill the insurance company directly; others will ask you to pay up front. If you pay out of pocket, click here aaf for the ways to get reimbursed

PRESCRIPTION DRUGS 

• 100% of the cost of prescription drugs dispensed by a registered pharmacist, subject to a $3.00 deductible per prescription (CIMS Pharmacy, located in York Lanes, waives this fee)
• The plan covers the lowest cost generic drug, unless the doctor indicates no substitutions on the prescription
• Most pharmacists will accept the drug card that you receive after enrolling. Note that you do not actually have to have a drug card on you: all you need to know is your employee number and the policy number (14098)
• If the pharmacy does not automatically bill the insurer then you will have to pay up front. If you pay out of  pocket, click here aaf for the ways to get reimbursed

PARAMEDICAL SERVICES

• In the 2011-12 bargaining round, the Union won increases to the paramedical coverage. The maximum amount that you can spend on any one paramedical service has been raised to $2000, while the total amount you can spend on paramedical services in a year remains at $3000. 
   
• To clarify, eligible expenses under the Paramedical coverage include Chiropracty, Physiotherapy, Massage Therapy, Counselling, Podiatry, and Naturopathy. You can spend up to a maximum of $2000 on any one of these services. If you did this, you would then have another $1000 left to spend on the other five services, for a total of $3000. If you have dependants (children and/or spouse), each of them also has their own allotment of $3000 for Paramedical services.
   
  Eligible practitioners under Counselling services include: Social Worker, Psychotherapist, Psychoanalyst, Family Therapist, Psychologist and Psychiatrist.

Do I get a drug card? 
You'll get a card sent to you in the mail, but it's for information purposes only.  As long as you have your employee number and the policy number (14098), that is all you need.

When do I pay, when do I not (making claims)
There is no universal right answer to this. For instance, the York Lanes dental office requires you pay for your first visit, regardless of activation of the benefits plan, then charges the insurer directly after that. Other dentists may require you to pay each time. This process will vary by eye-doctor, pharmacist, naturopath etc.

There are two ways to get reimbursed should the insurance not have covered costs at the time of getting the service: completing and mailing forms or submitting online.

Submitting a Dental claim form: click here for the form
Submitting the form for Vision, Prescription Drugs, or Paramedical Services: one form for any of these, click here for the form
- Complete the form and attach necessary paperwork (ie receipts)
- Mail to the address on the form
- Sun Life will send a cheque to you

Online: Go to the Sun Life website. On the right-hand side of the page you will see a log in where you can register for an Access ID. You will need your Plan Number (14098) [there is no division number] and your employee number to register (it is on your paystub and drug card – nine digits beginning with 102). Once registered, you may log onto the secure Sun Life website to review your coverage, file new claims, verify the status of current claims, and get information about past claims. The benefit of filing claims online is that you receive compensation more quickly than by using the paper form – claims are processed in about 48 hours and are directly deposited to your bank account.

What do I do if I exhaust my coverage? Incur other expenses? 
If you exhaust your coverage you can apply to the Extended Health Benefits Fund. Depending on the number of applications, you may receive partial reimbursement for additional expenses--usually between 25% and 50%. Some additional health expenses may be covered by the Extended Health Benefits Fund too. Note that the Extended Health Benefits Fund does not cover expenses incurred by or related to care for dependents.

Notes for international students
What is the difference between this plan and UHIP? The latter is for International students only. It is designed to pay the cost of the hospital and medical services which members and their family members may need to maintain their health while in Canada. The plan provides coverage comparable to that of OHIP for Ontario residents. The CUPE 3903 Health Benefits plan are in addition to, and separate from, UHIP; if you have a contract and are a member of CUPE3903 then you are eligible for these benefits.
Information about UHIP is available on the York International website
Note that you need to go to York International to pick up your UHIP Card.
 

Numbers you might need
Employee Number: it starts with “102” and appears on the upper corner of your pay stub
Policy Number: 14098
Sun Life’s number: 1-877-SUN-LIFE (1-877-786-5433) or online

Other questions  

When you have questions, the first person to contact is a Benefits Counsellor at the York Pension and Benefits Office. You can reach them at:

Phone: 416-736-2100 ext. 27572
Email: askpb@yorku.ca

If they are not able to address your problem, then contact CUPE 3903 staff: 416-736-5154 x1 or 416-736-2100 x66314