*UPDATE, OCTOBER 2018* Please note: The Dental Spending Account has closed as of August 31, 2018.
Over the past few years, CUPE 3906 has been in the process of negotiating and establishing a premium-based dental plan for our Unit 2 Members.
We are pleased to announce that we are finally launching the dental coverage for our members this fall.
To make a claim, here’s what you need to know:
Provider: Equitable Life of Canada
Group Policy Number: 97528
Division: 203 for Sessional Faculty
Personal certificate/ID number: (your employee number)
CLICK HERE for a dental claim form.
The coverage provides 100% for most standard basic services up to $1,000 per calendar year. Access to the benefit is subject to current eligibility, which is determined by Unit 2 employment within the current academic year. The member cost for single dental coverage is $170.00 for the current academic year (i.e., September 1, 2018-August 31, 2019). (Please note: you should only be charged the dental premium once per academic year. The initial, one-time premium deduction provides you with single coverage for the full academic year, September 1 to August 31. For family coverage information, please see below.)
Members will be automatically enrolled in single coverage (unless they are otherwise covered by our Unit 1 or Unit 3 plan). Participation in the plan is mandatory for Unit 2 members, unless members can provide proof of alternate coverage in another dental plan. Members can elect to enroll in family coverage [which provides up to $2,000 in coverage per family per calendar year subject to the enrollment period. The cost of family coverage is $853.72 for the current academic year (i.e., September 1, 2018-August 31, 2019)].
To view the details of what the plan will cover, please see our dental benefits booklet, available here.
For Frequently Asked Questions (FAQs) about the plan once it is set up, please scroll down.
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 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 firstname.lastname@example.org or drop in to the CUPE office in KTH B111 and speak to Mary Ellen Campbell. 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.
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 email@example.com 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.)
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.
- 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 firstname.lastname@example.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 email@example.com 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 October 1st?
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 firstname.lastname@example.org. Members are encouraged to make decisions about their dental coverage needs for the academic year in September.
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. We currently have no Employer premium contributions for Family coverage. This right was won in our other Collective Agreements, and we will have to win this language for Sessional Faculty during Collective Bargaining. 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 email@example.com 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.equitablehealth.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 firstname.lastname@example.org or drop by the CUPE office KTH B111 and speak to Mary Ellen Campbell. Also, please see our information on “eligibility” above.
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 email@example.com or firstname.lastname@example.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 email@example.com or firstname.lastname@example.org to find out about your options while on leave.
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 provider 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.