Suzanne Helston Manager, Benefits

May 2015

PEA Benefits 101

•  Benefits Office •  PEA benefits package •  Group Plan Coverage

•  Claim reimbursement

•  Q & A

Session Outline

•  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

•  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

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 of BC

•  Administered by Pacific Blue Cross (PBC)

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

administration of claim reimbursement only

•  Premiums paid by employees and the University cover the cost of each claim

•  www.pac.bluecross.ca

Extended Healthcare Plan

•  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

•  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

•  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

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

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

Surgeons, prescription drugs, and ambulance services in an EMERGENCY only

•  (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

–  provides assistance while travelling outside 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

•  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

•  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

•  Health Care: chiropractor naturopath physio podiatrist massage psychologist acupuncture

•  Vision Care:

Eye exams & eye wear

•  Drugs: Prescription Drugs Diabetic Supplies

Submit eligible claims on-line for…

PEA Dental Care Plan Annual deductible 0 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 orthodontics

50% ($3,000 max per

person)

Dental Care

•  Administered by the Pensions & Investments Office

•  PEA members participate in either: –  Combination Pension Plan or –  Money Purchase Pension Plan (for

part-time or sessional PEA appointments)

University of Victoria Pension Plans

–  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

•  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

•  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

•  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

services

Employee & Family Wellness Program

•  dietary concerns •  elder care •  financial planning •  health coaching •  parenting •  relationship challenges Every month a free webinar, covering a variety of topics, is available to employees.

Employee & Family Wellness Program cont’d

•  Benefits Handbooks/guides/FAQ http://www.uvic.ca/hr/services/home/compensation/benefits/handbooks/index.php

•  Pacific Blue Cross CaresNet https://service.pac.bluecross.ca/ACESWeb/Pages/Authentication/SignIn.aspx?userType=1

•  Optum Canada LiveWell (username = healthy)

https://www.livewell.optum.com/public/welcome.asp

Resources

Q & A