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- Understanding Your Extended Health and Dental Plan
- Smart Shopping Tips… to Help Control Plan Costs
- Know Your Limit and Claim Within It
- Plan Member Tips
- Pension Plan Sustainability Study
- This and That…
Much has changed in the last few years in the way we submit our health and dental plan claims. Reimbursement for claims is now more practical than ever. Many service providers, such as your massage therapist, physiotherapist, chiropractor or optometrist, to name a few, have registered with the TELUS Health eClaims system so that your claim can be conveniently processed at the point of service, similar to the way your dental claims are submitted electronically.
This means that you no longer pay for the cost of the paramedical service up front and then submit either online or by paper claim. Instead, your claim is processed immediately by the service provider via the TELUS Health system and Sun Life immediately pays the service provider for the cost of the service.
Other eClaim Options
You also have other ways to submit claims online
- web (mysunlife.ca)
- iPhone and Blackberry, using the my Sun Life Mobile app (sunlife.ca/mobile)
- android and other smartphone devices (mysunlife.ca/mobile)
Pay Direct Drug Card
By now many of you will have used our new Pay Direct Drug card (PDD) to purchase your prescriptions. The PDD card allows the pharmacist to submit your prescription claim directly to Sun Life for reimbursement. If you are purchasing a generic drug, the only amount that you are responsible for paying is the difference between the plan’s dispensing fee cap and the pharmacist’s dispensing fee.
Be an Informed Health and Dental Plan Member
Although submitting our claims is more convenient and “greener” than ever, understanding the plan’s provisions and limitations will provide you and your family with the best value and help us to manage the overall cost of the plan. Take the time to review your benefits plan. You will find a copy of Your Group Benefits booklet on the Pension and Benefits web page at presbyterian.ca/pensionandbenefits
If you are unclear about any of the services or coverage, you may email Liane Maki or call 1-800-619-7301 ext. 233.
You already know that requesting a lower priced generic drug for a brand name drug will help control rising drug costs in our plan. In fact, this was one of the significant reasons for the decision to implement a “mandatory generic” provision starting in January. Smart shopping means letting your pharmacist know that our plan will only reimburse the cost of an equivalent generic drug. Or, you could continue to accept the brand-name drug and pay the difference out of pocket between the cost of the brand and the generic.
Smart shopping means understanding when it is most cost effective to refill your regularly prescribed medications. For example, one of the easiest ways to control dispensing fees is to purchase a three-month supply of regular maintenance medications, whenever possible. Dispensing fees for a three-month supply is more cost effective to the plan than if you request three separate monthly supplies. Remember, in the long run, these additional fees add significant cost to the benefits plan.
Treatment or Services
You wouldn’t ask your mechanic to repair your car until you knew exactly the cost of the repair and why it is needed. Smart shopping also means speaking to your dentist or health care provider before receiving treatment or services. This is the concept behind the dental “predetermination” provision, which we are already familiar with and use.
A predetermination pre-approves which procedures of the planned treatment will be covered by our dental plan; however, the predetermination process does not take into account the annual limit or any previous charges already applied to the annual limit. It is your responsibility to check with Sun Life to see if any previous charges, plus the pre-approved predetermination charges, exceeds the annual limit. You may even decide to postpone some of the treatment to a later date.
Dentists are free to set their own fees for services. Be sure to ask your dentist to explain what each code means and whether alternative treatments or procedures are available to you. Remember, you will be required to pay the difference between what the dentist charges and what our plan covers.
Here is a list of common services with specific limits.
|Paramedical Service||Annual Coverage||Paramedical Service||Maximum Coverage|
|Speech or massage therapist||$300||Vision care – under age 18||$100 in any 12 month period|
|Psychologist and/or social worker||$300||Vision care – over age 18||$100 in any 24 month period|
|Audiologist, dietician or occupational therapist||$500||Ophthalmologist or optometrist||$50 over 2 benefit years|
|Osteopath, chiropractor||$500||Hearing Aids||$250 over 2 benefit years|
|Podiatrist, chiropodist, naturopath||$500|
|Dental Care||Annual Coverage||Dental Care||Maximum Coverage|
|Maximum amount for all procedures (basic and major restorative)||$2,000 per benefit year||Orthodontic procedures||60% up to a $1,500 lifetime maximum|
|Major restorative procedures||50% of eligible procedures|
- Keep your benefits plan information confidential. Your Pay Direct Drug card, contract number, ID code and any other plan details should be kept private and stored in a secure location.
- Request receipts from your pharmacist, dentist and service provider, and check carefully to ensure they reflect the actual product or service provided.
- Don’t sign blank forms in advance of services provided.
- Don’t substitute products or services. It’s unacceptable to charge for a product or service that is covered by our plan while actually buying another non-eligible product or service.
In the fall of 2013, in response to the needs and requests from the church, the Pension and Benefits Board established a Pension Plan Sustainability Study Group. The Board asked the study group to answer two questions:
- Can we keep the pension promise in a way that allows continuation of the church’s mission and ministry?
- What steps need to be taken to ensure that we can keep the pension promise into the future?
The study group was made up of three members of the board: a retired minister, an active minister and a member of staff. In addition, the Rev. Dr. Peter Coutts and the Rev. Dr. Stuart Macdonald were consulted for their analysis of church statistics regarding future denominational trends. The actuarial firm of Eckler Limited was contracted to conduct a study of the plan’s long-term viability. The study group met with the actuaries on four occasions over a five-month consultation process.
Assessing the Plan
The consultants asked the study group to provide a forecast of the expected growth or decline in the church over the next 15 years. Specifically, the study group was asked to provide details with regard to the
- number of new enrolments; new graduates
- new ministers’ ages, qualifying incomes, full-time or part-time positions
- number of congregational members
- number of congregations and projections on their future dollar base
The study group was also asked to review the modelling assumptions and other baseline methods to be used by the actuaries in their analysis of plan sustainability. Areas of study included
- a stable membership; will the number of future retirees be replaced by new hires; the aging of the active membership
- the cost of pensions already earned by current active members
- the cost of pensions being paid to retirees
- the impact of the assumption used to value future pensions, called the discount rate
Unique Realities of the Plan
The sustainability study evaluated the Presbyterian Church in Canada Pension Plan’s unique realities: the plan is a mature plan with more retirees than active members, few members retire at the 95 factor and many work past age 65, and that we have both congregational and non-congregational employers whose contributions are assessed in different ways. Such a study means that the Pension and Benefits Board can speak with much greater accuracy and certainty about the plan’s sustainability than the more generic “going concern” and “solvency” measurements.
The results of the sustainability study will be presented to the General Assembly in June and will be reported in the October pension and benefits newsletter.
Benefits Booklet Updated
Our Group Benefits Booklet was updated to include the benefit changes that took effect January 1, 2014. Other wording or provincial legislative updates are also included by Sun Life. A copy of the booklet may be sent to you upon request.
The booklet is also available on the Pension and Benefits Board webpage: www.presbyterian.ca/pensionandbenefits
Overage Student Dependents and Travelling Abroad
Reminder… please check that your overage dependent is covered for emergency medical coverage when travelling abroad. Confirmation that your dependent student has coverage for out of country emergency medical assistance should be reviewed annually—don’t assume that it is converted automatically.
Contact the Pension and Benefits Board office each year and arrange to submit proof that your overage dependent is enrolled full-time in an educational institution.
Pay Direct Drug Card
Conversion to the new Pay Direct Drug card was completed in January and we are pleased to report that, for most of you, the conversion occurred without interruption to your usual claim routines.
Some of you, however, reported that claims for your spouse or dependent child were declined by the Pay Direct Drug card because the pharmacy’s TELUS system identified incorrect dates of birth in the Sun Life system. If you have a similar experience, you will be required to submit an electronic claim or a paper claim for that claim. Please contact us—the correction can only be made through our office.
About This Newsletter
This bulletin provides summary information about The Presbyterian Church in Canada’s pension and benefits plans. It is not intended to be complete or comprehensive, or to provide legal or medical advice. If there are any discrepancies between this bulletin and the wording in the legal documents that govern the plans, the legal documents will apply in all cases.
For more information, contact Pension and Benefits by email or call 416-441-1111 or 1-800-619-7301 ext. 287.