Benefit Changes are a Comin'!
Every year, we review our benefit offerings to ensure they continue to meet the needs of our covered members (that’s you!), while also ensuring the financial stability of the plan. Our main goal is to support the health and wellness of you and your family, now and in the future. Through consultation with our Health Benefits Advisory Panel, newly formed Oral Health Advisory Panel (OHAP) and the prudent leadership of the ASEBP Trustees, a number of benefit changes designed to help us continue to meet this goal will take effect on January 1, 2019.
We encourage you to use this as an opportunity to review your benefits and become familiar with what each one does and does not cover (webpages for the applicable benefits will be updated with the outlined changes on January 1).
DENTAL PLAN CHANGES
With the help of our OHAP, which includes working dentists and hygienists from across the province, we reviewed the design of our preventative and related diagnostic treatment coverage and the following changes will be made to the dental plan:
- Dental exams (recall and specific) – will be covered every six months for anyone under 19 and every 12 months for anyone 19 and older
- Fluoride applications – will be covered once every six months for anyone under 19
- Polishing – one half unit will be covered every six months for anyone under 19. Polishing will no longer be covered for anyone 19 and older as the benefit of this service is supported by clinical evidence for young children and is of limited value for adults, where scaling may be used as an alternative
- X-rays (bitewing) – will be covered once every six months for anyone under 19 and once every 12 months for anyone 19 and older
- Panoramic and full mouth X-rays – will be covered once every five years as these X-rays are not required frequently and technology allows for easier transfer of X-rays between dental offices
- Introduction of an oral health exception process—on a pilot basis—to support the oral health of individuals with certain health conditions
- Smoking cessation – lifetime maximum will be increasing to $1,500. This new maximum will help further the support we offer covered members in their efforts to quit smoking.
MEDICAL SERVICES AND SUPPLIES CHANGES
- To better reflect the range of service charges in the marketplace and as a result of covered member feedback, the combined maximum of $1,600 will be removed for acupuncture, massage therapy, physiotherapy and chiropractic and the following changes will be made to per visit maximums:
- Acupuncture – per visit maximum will be increasing to $65; the yearly $700 maximum remains the same
- Massage therapy – per visit maximum will be increasing to $75; the yearly $700 maximum remains the same
- Physiotherapy – per visit maximum will be increasing to $75; the yearly $700 maximum remains the same
Please note that there will be no change to the $50 chiropractic per visit maximum or the $700 yearly maximum.
- Compression garments and support/surgical stockings - the two-pair maximum will be removed. The two-pair maximum was instituted based on manufacturer warranties (six months per pair); however, we recognize that you may need more than two pairs per year. This change allows for additional pairs to be purchased, encouraging you to compare offerings from different providers, while preserving the overall maximum which remains at $250
- Endovenous therapy for varicose veins – coverage for treatment with medical adhesives will be added
- Respiratory equipment and respiratory equipment accessories and repairs – will become separate categories with their own maximums:
- $1,500 every five years for the purchase or rental of equipment
- $200 per year for accessories and repairs
- New eligibility criteria will also be added as a result of a recommendation made by the Canadian Agency for Drugs and Technologies in Health, which states that treatment with continuous positive airway pressure (CPAP) is appropriate for patients with moderate to severe disease, meaning they measure a 15 or higher on the apnea-hypopnea index (AHI).
- Moving forward, covered members 18 and older must have an AHI of at least 15, as determined by a sleep study, to qualify for coverage for the purchase or rental of respiratory equipment (this includes CPAP machines as well as dental appliances). Dependants under 18 are eligible for coverage if they have an AHI of 1 or greater, supported by a sleep study.
VISION PLAN CHANGES
- Vision Plan 1 will be ending due to low enrolment. We will contact affected individuals about their benefit options prior to January 1
- Vision Plan 2 – rolling two-year maximum will be increasing to $300 as a result of covered member feedback
- Vision Plan 3 – rolling two-year maximum will be increasing to $400 as a result of covered member feedback
- Coverage for prescription safety glasses will be added to each plan
- The maximum salary covered under Life Insurance, Accidental Death & Dismemberment Insurance and Extended Disability Benefits is increasing to $400,000 to ensure full income replacement coverage for all employees within the public education sector
- Consolidation of Substitute Teachers and Casual Staff (STACS) and Part-time Employee benefits into a new benefit package—Supplemental Package—with simplified and expanded eligibility. This new package will provide coverage for a larger pool of people who are not eligible for regular group employer benefits (i.e. STACS, part-time employees, working retirees under 70, and employees serving a waiting period for benefits). If you’re currently enrolled in our STACS or Part-time Employee benefits, no action is required on your part.
- The Employee and Family Assistance Program (EFAP) will be included as part of the benefits offered through this package. It will be included at no cost to those who enrol. The ASEBP Trustees see this as an investment in the health of the public education sector
If you have questions about any of these changes, please contact us.