Unless specifically stated otherwise, definitions for these terms are available in the Definitions of Benefit Terms section.
There are several Green Shield Benefit Plans available to University of Toronto employees. Each of these Plans is prepaid by one month, with coverage normally effective the first of the month following the month of your appointment.
To be eligible for coverage, you must be:
- a) a plan member who is a resident of Canada;
- b) covered under your provincial health insurance plan or UHIP; and
- c) appointed on a continuing or term basis and with a total percentage of appointment equal to 25% or more.
For Your Dependents
To be eligible for coverage you must be:
- a) covered under this plan; and;
- b) each dependent must be covered under a provincial health insurance plan.
Coverage Effective Date
Your coverage begins on the date the University certifies that you are eligible for coverage, and have satisfied the eligibility requirements and are enrolled under the plan.
Your dependent coverage will begin on the same date as your coverage.
If you have waived eligibility due to having coverage through your spouse’s benefit plan, you must request coverage from the University within 31 days after termination of the coverage under your spouse’s plan.
Your plan sponsor is solely responsible for submitting all required forms to Green Shield as of the Effective Date of this plan or as of the first date that you become eligible.
Life Event Changes
If you experience an eligible life event, you may elect to change your coverage with 31 days of your life event change. Qualifying life events include:
- a) marriage;
- b) change in your marital status – divorce, legal separation, or the end of a common-law relationship;
- c) birth or adoption of a first child;
- d) change in dependent child eligibility; or
- e) the death of a spouse or dependent child.
Your coverage will end on the earliest of the following dates:
- a) the date your employment ends;
- b) the date you are no longer actively working, or your approved leave expires;
- c) the end of the period for which rates have been paid to Green Shield for your coverage;
- d) the date the group contract terminates.
Dependent coverage will end on the earliest of the following dates:
- a) the date your coverage terminates;
- b) the date your dependent is no longer an eligible dependent;
- c) the end of the month in which your dependent child attains the specified age limit;
- d) the end of the period for which rates have been paid for dependent coverage;
- e) the date the group contract terminates.
Dependent Children Continuation of Coverage
Any child whose coverage would end because they have reached the specified age limit may qualify for continued coverage, subject to the following conditions:
- a) your child became dependent upon you by reason of a mental or physical disability prior to reaching this age; and
- b) your child has been continuously so disabled since that time.
Survivor Continuation of Coverage
Single coverage may continue for the surviving spouse of a deceased pensioner, or plan member provided the spouse is in receipt of a survivor pension and the required rates are paid. The surviving spouse must be the person named as your spouse on this group plan at the time of your retirement. Coverage for the surviving spouse continues even if the surviving spouse remarries. After your retirement, if your spouse dies and you remarry, you are entitled to family/single coverage until your death. Coverage for your surviving spouse terminates at your death. All coverage for your surviving spouse will terminate when the Group Contract terminates, or the spouse becomes eligible for coverage under any other group policy.
Group Conversion – PRISM CONTINUUM® Program
The PRISM CONTINUUM® Program offers three plans that are focused on providing coverage for you if you are leaving a company group plan.
This program may be your solution if you, your spouse or dependent children are losing, or have lost company group health benefits within the last 60 days and are looking for guaranteed coverage.
Call 416.601.0429 in the Toronto area or toll-free at 1.800.667.0429 for an information package or visit our website at greenshield.ca. Coverage is guaranteed if you apply within 60 days of losing your Green Shield group benefits.