Health & Dental Plan Referendum

The University of Toronto Graduate Students’ Union Health Plan was introduced by a student referendum in March 1987. The student referendum passed resulting in mandatory participation for all full-time graduate students in a UTGSU Health Plan. Part-time graduate students chose not to participate in the Health Plan at this time. Students were entitled to opt-out only if they have comparable coverage.

• In 2006, a Dental Plan referendum passed for both full-time and part-time students.
• In 2016, a Health Plan referendum passed for the part-time students.

There are three main parties that facilitate the UTGSU Health & Dental Plan:

1. Greenshield Canada is the plan provider. The insurance provider navigates the claims process and works to ensure a fair and timely resolution. 
2. Studentcare is the plan broker. The broker negotiates, monitors and administers the plan.
3. The UTGSU is the plan sponsor. The sponsor makes the strategic and operational decisions relating to the scope of the plan, and employs an Administrator to liaise with the provider and broker to ensure the highest standards of service and coverage.

As the plan Administrator, the UTGSU makes important decisions in the maintenance and the funding of the health and dental plan. The UTGSU employs a full-time Health & Dental Plan Administrator who coordinates the interests of the UTGSU and its members in maximizing the use, coverage and capacity of the plan to meet members’ needs. 

The UTGSU Board of Directors makes a decision every year to modify the Health & Dental Plan fee based on recommendations and user reports by the Administrator, Greenshield and Studentcare. This decision is historically made based on plan use and inflationary pressures but has also been increased to provide expanded coverage, such as increases to mental health coverage in 2022-23.

Benefit Changes 2012-2014  

• The physiotherapy coverage was increased from $15 to $30 per visit to an annual maximum of 20 visits. For physiotherapy the requirement for accident-only coverage was removed.  
• Mental Health: Psychology coverage was increased to an annual maximum of $400 per policy year.  
• Mental Health: The practitioner list was expanded to include services provided by Master of Social Work.  
• Prescription Drugs: Prescription Drugs are the largest claimed category on student plans in Canada. Prior to 2012, graduate students did not have access to a pay-direct drug card; all drug claims until this time were reimbursement only. The pay-direct card [for adjudication at point-of-sale] was implemented in September 2012. 
• Prescription Drugs: Gardasil coverage as part of the prescription drug category was extended to all genders with no age restrictions. 
• Speech therapy coverage was increased to an annual maximum of $1,000. 
• Dental Coverage: The dental coverage annual maximum was increased to $550 

Benefit Change 2014-2015 

• Mirena Copper IUD added to drug plan formulary 

Benefit Change 2018-2019 

• Psychotherapy was added to the existing list of eligible Mental Health Practitioners Psychologists/Social Worker/Councillor. Coverage to remain 100% up to a combined annual maximum of $500. 

Benefit Change 2021-2022 

• Occupational therapists: Addition of $30 per visit up to 20 visits

Benefit Change 2022-2023 

• Mental Health: Increased annual maximum to $750 from $500 for mental health practitioners’ category (Psychotherapy/Psychologists/Social Worker/Counsellor). Coverage was maintained at 100%.

The “Health Industry Index” currently does not exist.

In 2022-23, in the absence of the definition for the “Health Industry Index” and “Dental Industry Index”, the UTGSU Board of Directors was able to increase health fees by 16.8% and dental fees by 10.9% without a membership referendum. This increase was primarily due to the increase of mental health coverage.

The UTGSU is looking to prevent that from happening again without directly consulting with its membership through a referendum first.

This referendum is a procedural requirement only that any increase above 10% must be approved by a membership referendum.

Claims generally tend to increase over time, leading to increases in Plan premiums. Various factors contribute to this trend including benefit changes to the Plan.

The UTGSU enhanced the insured benefit in the recent policy year for mental health practitioners to 100% per visit, up to an annual maximum of $750. The implementation of the increase to the mental health benefit simply accelerated what was already a substantial pace [prior to the executed benefit changes], and further enhancement would further elevate that trend. 

If the majority of graduate students vote no in this referendum, then the status quo continues to exist. This means that the UTGSU Board of Directors would be able to increase health and dental fees beyond 10% if the plan usage and inflation justify the increase.

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As a reminder, graduate students in the Toronto School of Theology and all undergraduate students are not eligible to vote in UTGSU referendums.