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MUNPA. Group Health Benefits 15 October 2009. Agenda. Introductions & Comments Current Benefit Program Hospital Drugs Extended Health Benefits Dental Retiree Survivor Coverage Worldwide Travel Benefit Travel Product Evolution Travel Benefit Overview Review of Eligible Items

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MUNPA

Group Health Benefits

15 October 2009


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Agenda

Introductions & Comments

Current Benefit Program

  • Hospital

  • Drugs

  • Extended Health Benefits

  • Dental

  • Retiree Survivor Coverage

    Worldwide Travel Benefit

  • Travel Product Evolution

  • Travel Benefit Overview

  • Review of Eligible Items

  • Making Claims

    Obtaining Information

    Questions


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Introductions

Susan King

Client Services Representative, Corporate Accounts

Jerry Mercer

Director Corporate Accounts, Newfoundland & Labrador


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Comments

  • Intent of this session is to provide an overview of current benefit program highlighting recent revisions to the Insurance program at MUN and to review the details of the Worldwide Travel program

  • The unit rates for the MUN program are the same for Active and Retirees


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Current Benefit Program

Health

  • Hospital

  • Drugs

  • Extended Health Benefits

  • Worldwide Travel

    Dental

    Retiree Survivor Coverage


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Current Benefit Program

Health Eligibility

  • Retiree can choose Single or Dependent coverage

  • Common law spouse covered after 12 months

  • Spouse or common law can be same sex

  • If retiree chooses single (when they have dependents) and later applies for dependent coverage then medical evidence must be provided

  • Dependent child covered if under the age of 21

  • Dependent child age 21 to 24 are covered if attending post secondary school and depending upon the retiree for support


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Current Benefit Program

Hospital

  • Coverage provides for the difference between the ward and the semi-private room

  • Semi-private is paid at 100%

  • Payment is direct to the hospital when you present you Blue Cross Identification card

  • This benefit is eligible in any province in Canada


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Current Benefit Program

Drugs

  • Includes Prescription drugs approved by Medavie Blue Cross that require a prescription from a physician

  • Some over the counter (OTC) products are also available for example, Insulin

  • Diabetic Supplies can now be submitted directly by the pharmacy and co-pay is 20%


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Current Benefit Program

Drugs

  • Adjudication details

    • Amount eligible is paid directly to the pharmacy

    • Ingredient cost paid by the program

    • Co-pay is the markup plus the dispensing fee charged by the pharmacy

    • Drug falls in one of three possible categories:

      • Eligible

      • Not Eligible

      • Covered if approved by Special Authorization process


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Current Benefit Program

Extended Health Benefits

  • Program covers 80% eligible expense

  • $25 deductible per calendar year per single/family

  • Most claims are on a reimbursement basis


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Current Benefit Program

Extended Health Benefits

  • Effective 01 April 2008

    • Orthopedic Footwear & Supplies

      • Maximum reimbursement increased to $200 per calendar year

    • Private Duty Nursing

      • Revised to a managed benefit which involves pre-approval by Blue Cross and includes services of a Personal Care Worker. Maximum reimbursement is $10,000 per calendar year.


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Current Benefit Program

Extended Health Benefits

  • Vision Care

    • Eye Exams: One every 24 months, 12 months for dependent children

    • Frames, Lenses/Contact Lenses, Laser Corrective Surgery: Maximum payable of $250 in 24 months, 12 months for dependent children


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Current Benefit Program

Extended Health Benefits

  • Effective 01 April 2009

    • Hearing Aids

      • Increased to provide 80% reimbursement of the cost of hearing aids to a maximum of $1,000 per ear per participant in any 24 consecutive months


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Current Benefit Program

Extended Health Benefits

Ambulance Services Oxygen

Prosthetic Appliances Massage Therapist

Glucometers Psychologist

Acupuncturist Durable Equipment

Burn Pressure Garments Psychiatrist

Paramedical Practitioners Accidental Dental

Chiropractor Podiatrist

Surgical Stockings


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Current Benefit Program

Dental

  • Effective 01 April 2009

    • Dental expenses reimbursed based on 2008 Newfoundland Dental Society Fee Guide

    • Basic Benefits paid at 80%

    • Major Restorative Dental Services

      • Reimbursed at 70% of the eligible expense to a maximum of $1,000 per participant per calendar year

      • Eligible items includes inlays/onlays, crowns, dentures and bridges


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Current Benefits Program

Retiree Survivor Coverage

  • If in receipt of survivor pension the spouse may continue coverage

  • Coverage is eligible until the death of the spouse

  • Applies to both Health and Dental


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Current Benefit Program

Worldwide Travel Benefit


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Travel Product Evolution

  • The product was introduced as an add on to group benefits about 35 years ago

  • Provide coverage for active employees and their families traveling on vacation outside their province of residence

  • Trips were usually short duration of 2 to 4 weeks

  • The same product was extended to retirees


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Travel Product Evolution

  • Group Product – Active and Retiree’s

    • In the beginning any medical condition you had must have been stable and you were not expected to require any treatment during the trip


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Travel Product Evolution

  • Travel trips began to fall into one of three types

    • Active employee trips began to get longer in duration 3 to 5 weeks

    • Dependents of active employees (students) were attending post secondary facilities outside their province. Trips were commonly 12 to 14 weeks

    • Retirees were now traveling more, some up to six months


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Travel Product Evolution

  • Group Product – Retiree’s

    • Wording was revised to: Medavie Blue Cross will not pay any benefit or accept any liability for claims relating to a medical condition/illness/injury or related medical condition/illness/injury which has:

      • deteriorated; or

      • been diagnosed; or

      • required medical consultation; or

      • required hospitalization; or

      • required a change in medication;

        at any time within the six month period immediately prior to the date of departure from the Participant’s province of residence


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Travel Benefit Overview

  • Worldwide Travel

    • This benefit provides coverage for both accident and or unexpected illness outside the province of residence

    • You must have coverage under a provincial medical care program

    • Benefits are 100% over and above your provincial medical care program


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Travel Benefit Overview

  • Worldwide Travel

    • Maximum of $2 million dollars per covered participant per incident outside the province of residence

    • Payment on large claims can be made directly to the provider if assigned by the employee

    • Provides medical as well as assistance benefits


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Eligible Items Medical

  • Hospital Accommodation

  • Physicians and Surgeons

  • Wheelchairs, Crutches, Canes

  • Nurse

  • Ambulance

  • Diagnostic Services

  • Paramedical Services

  • Drugs

  • Dental Services – Accidental


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Eligible Items Other

  • Coming Home

  • Vehicle Return

  • Return of Deceased

  • Meals and Accommodations

  • Transportation to Visit the Covered Person

  • Emergency and Payment Assistance


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Making a Claim

Toll free Numbers

  • Toll free assistance numbers while on vacation

    • USA and Canada

      1-800-563-4444

    • Anywhere else in the world 1-506-854-2222 (call collect)


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Obtaining Information

Information regarding your benefit program:

  • Medavie Blue Cross cardholder website details benefits and claims history

  • Contact the Medavie Blue Cross toll free number to speak with a Customer Service Representative at 1-800-667-4511

  • MUN website contains Group Benefits Guide for Retirees


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Contact Us

If you require any further information please feel free to contact us.

Susan King

  • Tel: 758-3050

  • Fax: 726-4719

  • Email: susan.king@medavie.bluecross.ca

    Jerry Mercer

  • Tel: 758-2999

  • Cell: 682-4676

  • Fax: 726-4719

  • Email: jerry.mercer@medavie.bluecross.ca


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Questions

Thank You!


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