Unit 2 Dental Coverage

FORMS

CLICK HERE for a standard dental claim form.

Please note that we require supporting documentation (i.e., proof of alternate dental coverage with your name on it) to opt-out of the plan. The deadline for winter opt outs is Jan 30, 2023. Opt outs will not be accepted after this date.

To obtain a copy of the UNIT 2 Family Dental Enrollment Form, PLEASE CLICK HERE.

For Frequently Asked Questions (FAQs) about the plan once it is set up, please scroll down.

COVERAGE BOOKLET

To view the details of what the plan will cover, please see our dental benefits booklet, available here.

FAQs for Sessional Faculty Dental Coverage:

****PLEASE NOTE: The following will apply once the the dental premium deductions and enrollments/opt-outs for Sessional Faculty Members are settled.****

How do I get in touch with the insurer?

Equitable Life of Canada can be reached at 1-800-265-4556. Remember to have the group policy number (97528), division (203) and your personal certificate number (your employee number) on hand. You can also check the status of your claim online by going to the plan member website at www.equitable.ca

How much coverage do I have?

Members are entitled to $1000 per calendar year for basic dental services such as cleanings and fillings.  Members enrolled in family coverage are entitled to $2000 per calendar year. See our dental booklet for a full list of procedures covered.  (Please note that the eligibility year follows the academic year–September 1st to August 31st.   See the “Eligibility” section for more information on this.  If your eligibility for the coverage expires, you are not eligible for reimbursement regardless of how much money you did not claim when you were eligible.)

I am not sure if my dental coverage is current. How do I find out?
Contact administrator@cupe3906.org or drop in to the CUPE office in KTH B111 and speak to our Administrative Coordinator. You can also contact Equitable Life of Canada at 1-800-265-4556. Remember to have the group policy number (97528), division number (203) and your personal certificate number (employee number) on hand.

How do I sign up for direct deposit and/or create an online profile?

To view updates of your claims, to sign up for direct deposit, and to view/update your personal information with Equitable Life, you need to create a user profile at www.equitable.ca.  Go to the top left corner, click “log in” and select “plan member.”  This should take you to a page where you can select “active account” as on the right-hand side of the page.  Select “plan member”.  You will require your name, date of birth, Group Policy number (97528) and certificate number (your student/employee number).  Please note! You cannot create a user profile online until your information and premiums have been remitted to the insurance company.  If you have questions about the timing of this, please contact administrator@cupe3906.org.  Also, you must provide Equitable with your direct deposit information through your online profile if you wish to sign up for direct deposit.  Equitable has no way of paying your claims through the McMaster payroll system.  *Tip! If you are having trouble logging on, try using your first and middle name as your “first name.”

Equitable Life has my incorrect address.  How can I change it?

For a helpful video on updating your person information, please visit: https://www.equitable.ca/en/our-products/group-benefits/how-to-review-and-update-your-information-for-group-benefits/

If you do not have an online profile, you will need to fill out the relevant parts of the following form (i.e., “Plan Member Information”, Part 7, and Part 10) and drop it off a the CUPE 3906 Office (KTH B111): https://cdn.equitable.ca/forms/unsecured/group/438.pdf

*Tip! Equitable receives your address from the Employer.  It’s a good idea to make sure that you update your address on MOSAIC.

I am sure that I qualify for the CUPE 3906 dental plan, but my dental office informed me that I do not have dental coverage.

Dental offices often contact the wrong insurer, especially if they have other patients from McMaster.  (Other groups of employees have different insurers.) Your first step should be to confirm the insurance information that your dental office has on file. Our insurer is Equitable Life of Canada. The group policy number is 97528. Unit 2 members are part of Division 203.  Your personal certificate number is your employee number.

If your insurance information is correct but you are still having trouble making a claim, contact administrator@cupe3906.org or drop in to the CUPE office in the basement of KTH (room B111) and speak to our Administrative Coordinator.

I was employed last academic year/term as a TA at McMaster in my Master’s/PhD program but this year/term I am employed as Sessional Faculty.  Does this mean that the reimbursement money that is available to me gets “reset” since I’ve started a new program/job classification?

No.  You receive these benefits as an employee, not as a student, so a change in your student status does not “reset” your plan/eligibility amount.  Similarly, a change between your employment status between units (e.g., from TA to Sessional) does not “reset” your plan/reimbursement eligibility.  As of September 1, 2018, all of our Units are enrolled in the same plan, which is in part why we can offer single coverage at a relatively low premium cost to members.  These kinds of restrictions are typical of premium-based plans and coverage in many workplaces.

I have another, non-CUPE 3906 job at McMaster University with dental coverage.  Will I automatically be opted out of the CUPE 3906 dental plan?

No.  For privacy reasons, we only have coverage information for our own members enrolled in our Equitable Life of Canada 97528 policy.  If you are covered by another dental plan by virtue of your employment at McMaster University, you can either coordinate your benefits (i.e., keep both plans) or opt-out of our coverage according to the opt-out policy and procedure (using your non-CUPE 3906 coverage documents as proof of alternate coverage).

Can I coordinate my CUPE 3906 Unit 2 benefits with my spouse/parent’s dental benefits?

Yes.  The CUPE 3906 Unit 2 dental coverage is premium-based employee coverage, so if you are enrolled in the coverage it might be considered your primary coverage according to your spouse/parent’s plan.  This might mean that you have to claim with our CUPE 3906 Unit 2 coverage before you submit claims to your spouse/parent’s coverage.  (Check your spouse/parent’s coverage for primary and secondary coverage restrictions.)

If you have enrolled in CUPE 3906 family coverage, and your spouse/dependents are covered by another premium-based dental plan, you should submit your spouse/dependents’ claims to their primary insurer first.  [If you have enrolled your spouse/dependents in CUPE 3906 family dental coverage, and your spouse/dependents are not enrolled in any other premium-based dental coverage of their own, you may submit claims to Equitable (as long as you, your spouse, and/or dependents are active on the plan).]

Why am I seeing premium deductions over multiple pay statements?

You should only have the single dental premium deducted once per academic year.  When the deduction is made, it will show up in the “current deduction” column of your pay statement.  Your premium deduction will likely show in the “year-to-date” column of your pay statement until the end of the calendar year, but no further current “CUPE Dental” deductions should appear in the current deduction column.  (If this happens, please contact our Staff.)

Can I get my dental work done internationally and have the claims paid by this plan?

No.  Equitable will not pay dental claims for expenses incurred outside of Canada.  Also, they only pay procedures at the Ontario rate, so if you get dental work done in another province and that province charges for procedures at a higher rate than Ontario dentists charge, you must pay the difference.  If possible, get your dental work done in Ontario, and only visit registered practitioners.

Change of Coverage & Family Coverage

Can I opt out of the dental plan after October 1st?

• Members must opt out of the dental plan by October 1st, unless you only begin work in the Winter or Spring/Summer terms (see: the special notice at the top of the page)
• Members seeking to opt out of the plan outside of these “change of coverage” periods should contact the benefits officer about their individual circumstances.
• Please note that exceptions are rarely permitted by the insurer

I am a Graduate Student and a Sessional Faculty Member, but I don’t work as a TA or RA (in lieu of TA).  If I opt out of the CUPE 3906 dental plan, will I still have coverage through the GSA?

You should have coverage through the GSA plan unless you opt-out of the GSA using proof of your coverage as a Sessional Faculty Member.  To obtain proof of alternate coverage as a Sessional Faculty Member, please contact administrator@cupe3906.org.  Please include your employee number and department of employment in your correspondence.

I opted out of the dental plan in September, but have since aged out of my parent’s alternate coverage or I lost coverage through my spouse’s plan. Can I opt back into the CUPE 3906 plan?

Yes, you can “opt into” the CUPE 3906 plan, but you may have to pay back premiums to bring your coverage up to date. Also, the insurance company will only consider this exceptional change of coverage within 30 days of when you became ineligible for your parents’ or spouse’s plan.  Please contact administrator@cupe3906.org for more information on restarting your coverage.

My family member needs dental work done but I missed the opt-in deadline. Can I enroll my family member in the CUPE 3906 dental plan after the 30-day change of coverage period?
Exceptions to the change of coverage period can only be made in exceptional circumstances.  Members can opt-in to family coverage outside of the change of coverage period ONLY if there has been a change in their family status (e.g. they got married or their spouse’s alternate coverage was terminated).  To see if your particular circumstances qualify, please contact administrator@cupe3906.org. Members are encouraged to make decisions about their dental coverage needs for the academic year in September (or, in January, if they are hired mid-academic year).

Why is the CUPE 3906 family plan so much more expensive than single coverage?

The CUPE 3906 dental plan for Sessional Faculty is a relatively new benefit in our Collective Agreement.  Over the past two rounds of negotiations, we have been able to establish a small fund that subsidizes part of the cost of family dental coverage for members.  The family plan provides 100% coverage for basic procedures (outlined in the “schedule of benefits” in the benefits booklet) to a maximum of $2000 per calendar year, subject to member eligibility for the plan.

Denied Dental Claims

My dental claim was denied. What can I do?

• Contact the Administrative Coordinator at administrator@cupe3906.org or drop by the CUPE office in KTH B111 and speak to one of our staff.
• The staff will be able to serve you better if you know why the claim was denied. If you received an explanation of benefits in the mail, it should state a reason why the claim was not paid out. If you are unsure why the claim was denied call Equitable at 1-800-265-4556.
• Remember to have the group policy number (97528), division (203 for Sessional Faculty) and your personal certificate number (your employee number) on hand

How can I find out if the dental plan covered my dental work? 

• Check on the status of your claim by going to the plan member website at www.equitable.ca or by calling Equitable at 1-800-265-4556.    Remember to have the group policy number (97528), division (203) and your personal certificate number (your employee number) on hand.

My dental claim was denied because my coverage was terminated. What should I do?

• Contact administrator@cupe3906.org or drop by the CUPE office KTH B111 and speak to our Administrative Coordinator.  Also, please see our information on “eligibility” above.

Leaves

Do I remain eligible for the CUPE 3906 dental plan while on pregnancy and/or parental leave?

• Yes, you remain eligible for dental benefits while on pregnancy leave.
• Please contact administrator@cupe3906.org or bwalchuk@cupe3906.org to find out about your options while on pregnancy/parental leave(s).

Do I remain eligible for the CUPE 3906 dental plan while on sick leave, bereavement leave, jury leave or reservist leave?

• Yes, members remain entitled to dental benefits while on these temporary leaves
• Please contact administrator@cupe3906.org or bwalchuk@cupe3906.org to find out about your options while on leave.

Coverage Questions

How often can I go for check-ups?  There is a 9-month recall limitation on regular check-ups.  If you are uncertain if your check-up will be covered, please confirm with the Equitable Life of Canada group claims department (1-800-265-4556)  prior to having your check-up performed.

Will the dental plan cover work done in another province?
You can you use your dental benefit in any province within Canada, but the benefit coverage only pays out on Ontario rates. This means that if a procedure costs $200.00 in Ontario, but $250. 00 in BC, the insurance company would only pay $200.00. More information is available in our single coverage or family coverage booklets.

Does the dental plan cover crowns?
No, the CUPE 3906 dental plan covers basic dental care. Crowns are considered “major restorative” work excluded by the plan. More information is available in our single coverage or family coverage booklets.

Does the dental plan cover bridges?
No, the CUPE 3906 dental plan covers basic dental care. Bridges are considered “major restorative” work excluded by the plan. More information is available in our single coverage or family coverage booklets.

Please remember that your insurance coverage can be complicated!  When in doubt, ask your dentist to submit an estimate to Equitable Life in advance of any procedures to make sure that something is covered.  The insurance company can require detailed and specialized information about tooth surfaces, procedural codes, etc., to confirm coverage.