Health & Welfare
Notices
Notice to Plan Members
Effective March 1, 2024 – Self-Payments
The Self-Payment rates as of March 1, 2024 are as follows:
| All Other Residents | Ontario Residents | Quebec Residents | |
| Active Age 16 – 64 | $383.00 | $413.64 | $385.44 |
| Active Age 65 & Over | $306.00 | $330.48 | $308.44 |
| Active on LTD | $191.50 | $206.82 | $193.94 |
| Retired on LTD | $176.50 | $190.62 | $178.94 |
| Retirees Age 50-54 | $383.00 | $413.64 | $385.44 |
| Retirees Age 55-64 | $353.00 | $381.24 | $355.44 |
| Retirees Age 65 & Over | $281.00 | $303.48 | $283.44 |
Effective January 1, 2024
Dental Benefits have been updated to provide reimbursement at 90% in accordance with the 2024 Schedule of Fees.
Effective October 1, 2022
Psychological services provided by a provisional psychologist are now eligible.
Effective May 1, 2022
A referral for paramedical services can be obtained from a Nurse Practitioner.
Effective April 1, 2022
Schedule of Dental Fees is increased to the current year’s fee schedule.A maximum purchase exemption may be granted for a travel supply of prescription drugs up to 200 days.
Effective January 1, 2022
The Freestyle Libre System Readers and Sensors will be covered under the Prescription Drug benefit.
Effective March 1, 2022 – Self-Payments
The Self-Payment rates as of March 1, 2022 are as follows:
| All Other Residents | Ontario Residents | Quebec Residents | |
| Active Age 16 – 64 | $338.00 | $365.04 | $346.00 |
| Active Age 65 & Over | $259.00 | $279.72 | $267.00 |
| Active on LTD | $169.00 | $182.52 | $177.00 |
| Retired on LTD | $158.00 | $170.64 | $166.00 |
| Retirees Age 50-54 | $338.00 | $365.04 | $346.00 |
| Retirees Age 55-64 | $316.00 | $341.28 | $324.00 |
| Retirees Age 65 & Over | $243.00 | $262.44 | $251.00 |
Effective November 1, 2021
Plan Members will no longer require a physician’s referral to purchase an Epipen.
Effective September 1, 2021
Virtual and telehealth services will be covered under the Plan.
Effective April 1, 2021
Dental Benefits have been updated to provide reimbursement at 90% in accordance with the 2021 Schedule of Fees.
Effective March 1, 2021
The Plan’s drug claim provider changed from NexgenRx to ClaimSecure Inc. All prescription drug claims must be sent to the new provider, even those dated prior to March 1, 2021. Eligible Plan Members were issued a new drug card. The Group Number for prescription drug claims is 37217. A Certificate Number is required on manual submissions. Refer to the January 2021 Bulletin for complete details.
ClaimSecure Inc. P.O. Box 6500 Station A Sudbury, ON P3A 5N5
Effective March 1, 2021
The following prescription drug Benefit changes took place.
• EpiPens – are covered up to a maximum of $250 per person per calendar year. A doctor’s referral for the Plan Member or Dependent must be submitted along with the receipt for the first Epipen.
• Fertility Drugs – will be payable up to a lifetime maximum of $15,000 per person.
• Special Authorization Drugs – pre-approval of certain drugs will be required in order to purchase a Special Authorization drug from the Plan.
Effective March 1, 2021 – Self-Payments
The Self-Payment rates as of March 1, 2021 are as follows:
| All Other Residents | Ontario Residents | Quebec Residents | |
| Active Age 16 – 64 | $337.00 | $363.96 | $351.00 |
| Active Age 65 & Over | $258.00 | $278.64 | $272.00 |
| Active on LTD | $169.00 | $182.52 | $183.00 |
| Retired on LTD | $158.00 | $170.64 | $172.00 |
| Retirees Age 55-64 | $315.00 | $340.20 | $329.00 |
| Retirees Age 65 & Over | $242.00 | $261.36 | $256.00 |
Effective April 1, 2020
Dental Benefits have been updated to provide reimbursement at 90% in accordance with the 2020 Schedule of Fees.
Effective March 1, 2020
Virtual and telehealth services are not covered under the Plan. Services rendered must be attended "in person" in order to be considered for payment.
Effective March 1, 2020 – Self-Payments
The Self-Payment rates as of March 1, 2020 are as follows:
| All Other Residents | Ontario Residents | |
| Active Age 16 – 64 | $320.00 | $345.60 |
| Active Age 65 & Over | $241.00 | $260.28 |
| Active on LTD | $160.00 | $172.80 |
| Retired on LTD | $149.00 | $160.92 |
| Retirees Age 55-64 | $298.00 | $321.84 |
| Retirees Age 65 & Over | $224.00 | $241.92 |
Effective April 1, 2019
Dental Benefits have been updated to provide reimbursement at 90% in accordance with the 2019 Schedule of Fees.
Effective March 1, 2019 – Self-Payments
The Self-Payment rates as of March 1, 2019 are as follows:
| All Other Residents | Ontario Residents | |
| Active Age 16 – 64 | $312.00 | $336.96 |
| Active Over 65 | $234.00 | $252.72 |
| Active on LTD | $156.00 | $168.48 |
| Retired on LTD | $145.00 | $156.60 |
| Retirees Age 50-54 | $312.00 | $336.96 |
| Retirees Age 55-64 | $289.00 | $312.12 |
| Retirees Age 65 & Over | $217.00 | $234.36 |
Effective July 1, 2018
The Board of Trustees confirmed that medicinal marijuana is not a covered expense under the Plan.
Effective June 7, 2018
The Plan is not considering payment of Libre Diabetic Testing Kits (or other such kits) at this time.
Effective March 1, 2018
All Self-Payments must be made using the Preauthorized Debit Plan. When making your first Self-Payment, your Application and PAD Agreement must be received in the Fund Office prior to losing your Hour Bank.
Effective January 1, 2017
The waiting period for Weekly Disability benefits has been reduced from 2 weeks to 1 week. The maximum payment duration for Weekly Disability benefits increased to 51 weeks, combined with E.I. Sickness and Accident Benefits.
Effective January 1, 2017
The following changes were introduced for the prescription drug benefit:
Lower Cost Alternative (LCA) Pricing – The Plan covers 90% of the LCA price for drug categories in which there is a LCA drug. Plan Members who choose the higher cost drug will be responsible for the amounts in excess of the LCA drug cost.
Prior Authorization – Drugs categorized as Prior Authorization drugs require prior approval based on medical diagnosis and form of treatment.
Dispensing Fee Limit – The Plan limits dispensing fees to $13.00.
Fertility Drug Maximum – Fertility drugs are limited to $5,000 per calendar year and $15,000 per lifetime.
Prescription Drug Benefit - The Plan’s maximum remains at $10,000 per person per calendar year. Prescription drugs are administered by NexgenRx.
Effective June 1, 2015
In the event of a Plan Member’s death, and provided the Plan Member is eligible, the Life Insurance benefit increased to $150,000.
Accidental Death benefits increased from $125,000 to $150,000. Accidental Dismemberment benefits also increased. Details can be found in the Plan booklet.
Weekly Disability benefits are $524.00 per week and the Long-Term Disability benefit increased to $2,269 per month.
The Vision Care benefit increased to $500 every two calendar years per person over 18. For Dependents under 18, the benefit increased to $500 each calendar year if required due to a prescription change.
Eye exams increased to a maximum of $90 for one eye exam in a two calendar year period.
Effective January 1, 2013
Paramedical expenses will only be covered if medically necessary and must be prescribed by a physician or specialist once per year. Physician referrals are required for services provided by a qualified osteopath, chiropractor, podiatrist, chiropodist, physiotherapist, registered massage therapist, registered acupuncturist, naturopath and Christian Science practitioner. The Plan will also accept Chiropractic referrals from a Chiropractor.
Effective October 1, 2012
Massage therapy expenses must be performed by an accredited provider. A massage therapist must have 2200 hours /2 years of schooling program in order to be an accredited provider in Alberta.
MISCELLANEOUS
Employee Assistance Program (EAP) - Lifeworks
Voluntary and confidential short-term counselling and advisory service that is available 24 hours a day, 7 days a week, 365 days a year.
Call Toll Free:
English: 1-877-207-8833
French: 1-877-371-9978
Hearing Impaired: 1-877-370-1080
Dependent Update Forms
With each school term, Plan Members who have Dependents aged 21 to 24 will be required to update their Dependent’s information by completing a Dependent Update Form.
Once a Dependent turns 21, they must meet the requirements listed below in order to maintain their Coverage:
1) rely on the Member for financial support,
2) are not employed on a regular full-time basis,
3) are not married, and
4) are enrolled in a full-time program at an accredited school, college, or university. Evidence will be required from the school confirming the Dependent meets the definition of a full-time student and that upon completion the student will receive a diploma, degree, or designation/certification.
Incapacitated Children
Plan Members who are registering a functionally impaired Dependent child must provide proof of incapacity within 31 days following the Dependent’s 21st birthday. The Dependent child must also meet the requirements for a Dependent child, under the Plan rules.
