PEA Benefits 101 Suzanne Helston Manager, Benefits May 2015 [PDF]

SLIDE 1

Suzanne Helston Manager, Benefits May 2015

PEA Benefits 101

SLIDE 2

Benefits Office
PEA benefits package
Group Plan Coverage
Claim reimbursement
Q & A

Session Outline

SLIDE 3

Located in Sedgewick B wing
Administers enrolment & determines

eligibility for all faculty and staff in the University’s Group Plans

Life events/transitions
Leave management for CUPE

members

Liaison with service providers and

carriers

Benefits Office

SLIDE 4

BC Medical Services Plan
Extended Healthcare Plan
Dental Plan
Pension Plan
Basic Group Life Insurance
Long Term Disability Plan
Employee & Family Wellness

Program

Benefit Package for Regular PEA Members

SLIDE 5

MSP covers:

Services of Physicians and Specialists
Maternity care
X-ray and lab services
Inpatient hospital accommodation and

services

Outpatient services including

emergency, casting, daycare surgery, renal dialysis, cancer therapy, diabetic counselling etc.

Emergency out-of province Physician’s

charges

Access to Fair PharmaCare

Medical Services Plan

f BC

SLIDE 6

Administered by Pacific Blue Cross

(PBC)

PBC is a not for profit entity
We pay PBC for adjudication and

administration of claim reimbursement

nly
Premiums paid by employees and the

University cover the cost of each claim

www.pac.bluecross.ca

Extended Healthcare Plan

SLIDE 7

Special Authority designation.

– small number of prescription drugs are eligible for Special Authority designation. – ensures that the Provincial PharmaCare program will be the first payor once your family deductible has been met. – Physician or pharmacist will advise if your prescription is eligible for Special Authority.

Regardless of the decision by PharmaCare to

accept or deny Special Authority coverage, the plan covers the drug when you provide proof of PharmaCare’s decision prior to or with your first claim submission.

Prescription Drug Coverage

SLIDE 8

Generic Pricing

– only applied when there is a generic drug available – If there is not a generic alternative, a brand name drug is provided.

You may request the brand name and pay

the difference between the brand and the lowest cost generic drug.

Your physician can transcribe “no

substitutions” on the prescription.

Cost of generic drug is approx 35% of

brand name

Prescription Drug Coverage cont’d

SLIDE 9

Free on-line tool
List of pharmacy names, locations

and per-pill prices for the drug, as well as dispensing fees

Access by computer, smartphone or

tablet

Comparison shop for prescription

medications at B.C. pharmacies

www.pharmacycompass.ca

PBC Pharmacy Compass

SLIDE 10

Therapy Limit

Massage $30 per visit for first 12/ annual maximum $500 Chiropractor $30 per visit for first 12/ annual maximum $500 Physiotherapy $30 per visit for first 12/ annual maximum $500 Naturopath $20 per visit for first 12/ annual maximum $500 Acupuncture $500 per year Podiatrist $20 per visit for first 12/ annual maximum $500

Paramedical Coverage

SLIDE 11

Emergency coverage only
For business or pleasure
Covers hospital charges, Physicians &

Surgeons, prescription drugs, and ambulance services in an EMERGENCY

nly
(Emergency is a sudden unexpected

injury or an acute episode of disease that requires immediate treatment or surgery and it is not possible to return to BC before treatment)

Lifetime maximum applies
Discounted rates available to University

employees for additional travel insurance bought through Pacific Blue Cross

Travel Coverage

SLIDE 12

– provides assistance while travelling

utside of your province of residence.

– 24/7 medical travel assistance line – Helps locate medical care, provide advisory services, refer you to interpreters, assist with transportation, contact relatives and more.

Medi-Assist

SLIDE 13

Call Medi-Assist within 24 hours of an

emergency

Available 24/7
Have a pen and paper ready
Know your PBC Group # (40704) and ID#
How to connect to Medi-Assist:

In Canada and the US: 1 888 699-9333 (toll-free)

Outside of Canada/US: Contact an international operator and request a collect call to: 604 419-4487

When and How to Contact Medi-Assist

SLIDE 14

Direct Billing: pharmacist or practitioner

directly submits expense on your behalf to PBC

Online claims through CaresNet

www.pac.bluecross.ca

Complete paper claim form, attach

receipts and mail

Reimbursement for eligible health care claims

SLIDE 15

Health Care:

chiropractor naturopath physio podiatrist massage psychologist acupuncture

Vision Care:

Eye exams & eye wear

Drugs:

Prescription Drugs Diabetic Supplies

Submit eligible claims

n-line for…

SLIDE 16

PEA Dental Care Plan Annual deductible Plan A – covers basic diagnostic and preventative services. This includes examinations, radiographs, basic restorations, root canals, periodontal cleaning, maintenance of dentures, and extractions. 80% Plan B – covers major restorative procedures such as crowns, onlays, veneers, bridgework and dentures. 50% Plan C – covers services related to

rthodontics

50% ($3,000 max per person)

Dental Care

SLIDE 17

Administered by the Pensions &

Investments Office

PEA members participate in either:

– Combination Pension Plan

r

– Money Purchase Pension Plan (for part-time or sessional PEA appointments)

University of Victoria Pension Plans

SLIDE 18

– Basic Life Insurance

2 X annual salary
Term insurance for employee only
Premiums cost-shared with UVic

– Optional Life Insurance

Up to $500,000 for you and/or spouse
Employee pays full premium
Rates based on age and smoking status

– Accidental Death & Dismemberment

Maximum $250,000
Employee pays full premium

BC Life & Casualty Co. Insurance Plans

SLIDE 19

Provides accident insurance while travelling on

approved University business

Coverage up to $100,000 in event of accidental

death or dismemberment

Automatically covered without application
University pays full premium

Travel Life Insurance

SLIDE 20

Administered by BC Life & Casualty Co.
Income replacement plan
Recommended to apply after 3 months

absence for illness or injury

6 month elimination period if applying
Must meet definition of totally disabled and

unable to perform the duties of your job

Long Term Disability benefits are based on

80% of your NET basic salary.

Full pension contributions paid on your behalf

Long Term Disability

SLIDE 21

Optum Canada
Confidential program that includes

professional counselling, information and referral services.

100% paid for by UVic
On-line health and wellness tools
In person, telephonic or e-counselling