[summer]

The MSU Health and Dental Plans: You’re covered!

By MAVIS VAZ, MACINSIDERS

As the time comes for all of us to complete our Payment Agreements and fork over tuition money, that list of supplementary fees can seem a little daunting. If you are a full-time undergraduate student (you are considered full-time by the McMaster Students Union if you are enrolled in 18 credits or more), you will notice that with your supplementary fees, you will have paid for a Health Plan ($45.00) and a Dental Plan ($95.00). These are insurance plans that entitle you to certain benefits over the course of the year (September 1, 2008 to August 31, 2009).

First, this is a common practice at universities, to enroll students automatically into insurance plans with their yearly fees (I was, when I attended UBC). If students wish to opt out of the plans, they have to provide proof that they have comparable coverage; but more on that later. The MSU initiated the application of these fees a few years ago to ensure that ALL students that they represent are covered at least in part for health and dental costs. The purpose is to help relieve students of these sometimes very costly expenses.

The MSU website (www.msu.mcmaster.ca/health) offers complete details of both plans, but here is a basic outline of the major details of the plans:

Health Plan
The most important part of this plan is that it covers 80% of all prescription drugs. That means you only pay 20%! If you fill your prescription at the pharmacy in the Student Centre, or certain pharmacies around McMaster, all you have to do is give them your student card. They will use it to confirm that you are enrolled in the plan, and then only charge you the 20%. If you fill your prescription elsewhere, you will need to pay the full 100% up front, fill out a HEALTH claim form, attach your original receipts to the form, and mail it in to the insurance company, whose address is on the form. They will mail you a reimbursement cheque. Just keep in mind that using the claim form method takes about 6-8 weeks to process before you get your reimbursement cheque.

Need an eye exam? No problem! This plan also covers 50% of an eye exam, up to $50.00. In addition, if you break or damage a pair of glasses or rip a contact lens, you are covered for the repair or a replacement pair up to $100.00. Keep in mind that you are not covered for a completely new pair of glasses or lenses (ie. if you just found out you needed eyewear).

The plan also allows females to get contraceptives at a cheaper price, if they get their prescriptions from the Campus Health Clinic (MUSC B101).

Please check the website for further details and more information about what you are covered for.

Dental Plan
Under the dental plan, you are covered for one full cleaning and consultation per year, including any x-rays taken at the time. In addition, you are covered for two wisdom teeth extractions per year.

You are covered for certain percentages of any other work you get done. For example, you are covered for 10% of root canals. For all this ‘extra work’, you are covered for up to $750.

An important point to keep in mind is that what the insurance company pays for is the Canadian Dental Association’s (CDA) set price for dental work. For example, hypothetically, a wisdom tooth extraction costs $260 according to the CDA. Dentists can then place their own charge on top of the CDA price, making the cost of the wisdom tooth extraction much higher than the CDA’s price of $260. Since the MSU dental plan covers the cost of the extraction at the CDA price, you will be reimbursed for the hypothetical $260 cost of the extraction, but NOT any extra charge your dentist has placed. Your best bet before getting work done is to check with the insurance company exactly what the amount they cover is, and then check how much your dentist is charging you, since not all dentists will place this extra charge on top of the CDA price.

Like the health plan, you have the option of making claims either electronically or manually, depending on your dentist. Some dentists bill electronically. This means that they will take your student card, use that to find what you are covered for, and you will just have to pay the balance.

If the dentist does NOT bill electronically, you will need to send the insurance company a claim form and they will send you a reimbursement cheque in the mail. You can print the DENTAL claim form, also found at the website, and take it with you to the dentist. They will fill out most of the form and return it to you to mail to the insurance company. Alternatively, the dentist may give you a form that looks similar to the claim form linked above with all the necessary info already filled out. Just mail it in to the address found at the bottom of the MSU claim form.

If you plan on making a claim through the MSU dental plan, it’s a good idea to take the following information in with you to the dentist:

Insurance provider: ClaimSecure
Group Number: 515324
ID #: 00_ _ _ _ _ _ _M (Your 7 digit student number goes in those spaces)

Please check the website for further details and more information about what you are covered for.

Opting out
As mentioned earlier, if you are covered by another comparable plan, either through a job or through your parents, you can opt out of the MSU plan. The opt-out period is between September 1 and September 30, NO EXCEPTIONS. All opt-outs are done online through the MSU website (www.msu.mcmaster.ca/health). Follow the links on the main page. You will have to fill out some personal information and provide proof of your other plan. You will be told to enter the name of the Primary Subscriber (whose plan you are already covered under), the name of the insurance company that the other plan is under, and the policy number. You will then be sent an email telling you how you can get your reimbursement for the insurance plan(s) you have opted out of.

If you have any questions at all regarding the Health or Dental Plan, here are some contacts you may find helpful:

At the MSU:
Victoria Scott (Insurance Plan Administrator)
905-525-9140 ext. 23251

For the Health Plan:
Trothen & McConkey
519-672-3222

For the Dental Plan:
ClaimSecure
1-888-513-4464

Any idea why we have to tell them who else we're insured with? Are they just being nosy?

Probably to check that you are actually insured and not just trying to opt out.

Is there any reason why it should matter to them? Seems to me if I want to opt out and don't have insurance, it should still be my choice.

It's not that they're being nosy, its that you have to provide proof that you are covered by a comparable plan. THis means, if you are covered by a different insurance plan already (through your parents or work) but it is not as 'good' as the MSU one, you cannot opt out of the MSU plan.

Danny, I see what you mean about it being your choice, and as student, I understand where you are coming from, seeing as to how students are always short of cash. On the other hand, this is a situation you are going to run into for the rest of your life. It is your choice to get home/life/travel insurance. But if you don't, you always run the risk of getting screwed over when your house gets robbed or your luggage gets stolen. But see it from this perspective...if you are NOT covered by another plan, and you are 'forced' to stay in the MSU plan (and it is not your choice), you still have the opportunity to go and reap the benefits of this plan...go get your teeth cleaned, or get a new eye prescription. The University and the MSU KNOW that as a student you are short of cash, and having these insurance plans will, over the course of the year, save you money, if you choose to avail of some of the benefits it provides you.

On a sidenote, providing proof that you are covered by another insurance policy that is equal or better to the one the MSU provides is not unique to McMaster. I had to go through the same thing when I went to UBC and the process was MUCH lengthier. I had to get a letter from my insurance company, saying that I was covered, and then stand in a 2 hour line to get my letter and opt-out processed.

Like mentioned in the article, this insurance plan system is by no means unique to McMaster and the MSU has streamlined the opt-out system as much as they can.

It seems like a waste of money now, as you are paying for tuition, books etc, but like any insurance plan, you learn the value of it when the time comes that you need to make a claim.