MAKING YOUR HEALTH A PRIORITY
Your Health and Dental Benefits
UA Local 67 Benefits is dedicated to providing our members and their families one of the most competitive and sustainable group benefits plans available among the Plumbing and Pipefitters unions. When you are considered eligible on the Welfare Plan, you will have access to the following benefits as long as your eligibility continues. Health and Dental benefits are also extended to your eligible dependents.
Your Health & Dental Coverage Overview
Health & Dental at a Glance
Prescription Drugs
GreenShield
There is a $15,000 overall annual maximum per insured, for Prescription Drugs and Extended Health combined.
- 100% reimbursement of the drug cost for:
- Non-maintenance drugs on the provincial formulary – purchased at any pharmacy
- Maintenance drugs on the provincial formulary – purchased through TELUS Health Virtual Pharmacy
- 80% reimbursement of the drug cost for:
- Drugs not listed on the provincial formulary (maintenance or non-maintenance) – purchased at any pharmacy
- Maintenance drugs on the provincial formulary – purchased at any local pharmacy
- Mandatory Generic Substitution
- The Member pays the full cost of the pharmacy dispensing fee. Members can use their Health Care Spending Account to cover the cost of dispensing fees.
Extended Health
GreenShield
There is a $15,000 overall annual maximum per insured, for Prescription Drugs and Extended Health combined.
- 100% for eligible Extended Health expenses not covered by a Provincial Plan or another group benefit plan
- Hearing aids: $500 every 5 calendar years
- Private duty nursing: $10,000 lifetime maximum (requires GreenShield’s prior approval)
- Vision care: $300 for prescription eyewear and eye exams combined
- Every calendar year for Active members
- Every 2 calendar years for dependents and Retired members
- Custom foot orthotics: $300 every 2 calendar years
- Physiotherapy: $55 per visit ($85 for the initial assessment), up to 20 visits per calendar year
- Eligible mental health practitioners: $800 combined per calendar year
- Other eligible paramedical practitioners: $400 combined maximum per calendar year
Group Travel Medical
AIG Insurance Company of Canada
- $2 million maximum, per member or dependent per trip, for emergency medical treatment and services outside of your province or country.
- 90–day maximum trip duration for Active Members and their eligible dependents
- 60–day maximum trip duration for Retired Members (under age 85) and their eligible dependents
- There is no coverage once the member turns 85.
Health Care Spending Account (HCSA)
GreenShield
- $750 credit per family per calendar year, for expenses deemed eligible by the Canada Revenue Agency (CRA) including medical/dental expenses, or for self-paid medical/dental premiums.
- Credits must be used in the year assigned, and do not carry-forward.
- Claims must be received by GreenShield (including all supporting documents) no later than 31 days after the calendar year ends.
Dental
GreenShield
There is a $1,500 maximum per calendar year, for ALL dental services combined (basic, comprehensive basic, major, and orthodontics)
- Eligible basic or comprehensive basic dental services: 100% reimbursement
- Eligible major dental services: 50% reimbursement
- Eligible orthodontic services: 100% reimbursement
- Claims are paid based on the prior year’s Ontario Dental Association fee guide. Members are responsible for any additional amounts charged by the dentist.
How to Check What’s Covered
Want to know what your benefits cover?
- Sign into your GreenShield+ account (greenshieldplus.ca), or log into the GreenShield+ App.
- Click on Check Your Coverage, then enter or select the type of service you want to learn about.
- Fill in the details and hit Continue.
- You’ll see an overview of what your plan covers!
Clicking on View Details will show you how much the plan covers, what you might need to pay out of pocket, and plan details or restrictions like how close you are to the benefit’s maximum or frequency limits.
Keep in mind that not everything can be found in GreenShield’s Coverage tool. If you can’t find what you’re looking for, don’t hesitate to contact GreenShield.
Reasonable & Customary Limits
A Reasonable & Customary (R&C) limit is a set maximum dollar amount that an insurance carrier will reimburse for a specific product or service.
GreenShield regularly reviews the typical fees charged by practitioners (chiropractor, physiotherapist, psychologist, etc.) in your province. GreenShield then uses this information to create and update their R&C list as a guide when they pay claims.
If your claim is above GreenShield’s R&C limit, Green Shield will limit your reimbursement to their listed reasonable & customary maximum for that service.
How Do I Submit A Claim?
Submitting your claims has never been easier, using your GreenShield+ online account or with the GreenShield+ App. Here you can quickly submit your Health, Dental, and Health Care Spending Account (HCSA) claims online for faster reimbursement.
For more details on the claims process and how to submit your claims, please visit our Claims Page.
Do You Need Your Benefits Card?
On the Web
Go to greenshieldplus.ca and login to your account. Click on your name at the top right corner on the screen and choose the option Plan Member ID card.
On the App
Open the GreenShield+ App and click on the wallet icon. Your insurance ID card will be ready for you to use.
Sign up for GreenShield+!
Set up your GreenShield+ online account to easily submit your claims and receive reimbursement directly to your bank account.
Visit greenshieldplus.ca to setup your online account today.
Find a Healthcare Provider
GreenShield partners with providerConnect®, who keeps a national database—called the Provider Registry—of health service providers across Canada. You can get reimbursed for services if they’re covered by the UA Local 67 Benefits Plan and the provider is either licensed by their province’s regulatory body or is a registered member of a professional association that providerConnect® recognizes.
It is your responsibility to verify a provider’s eligibility before purchasing items or paying for services. Services or products purchased from providers/locations that are not recognized by GreenShield/providerConnect® will not be reimbursed.
You can check for delisted providers by logging into your GreenShield+ account or using the GreenShield+App. Select Find a Health Provider and filter your search by Delisted Providers.
Have Any Questions?
Refer to your Benefits Booklet for more information, or contact us at UA Local 67 Benefits.