Frequently Asked Questions General

Transcription

1 Frequently Asked Questions General 1. Who is eligible to participate in the SCM eflex Benefits plan? If you are a regular full-time or part-time Canadian employee and you work a minimum of 20 hours per week, you are eligible to participate in the eflex benefits plan. 2. Who qualifies as an eligible dependent under the plan? Under the eflex plan, an eligible dependent is: your spouse, if you are legally married or if not legally married, you have lived in a common-law relationship for more than 1 year. Only one spouse will be considered at any time as being covered under the group contract; your unmarried child under age 21; your unmarried child under age 26, if enrolled and in full-time attendance at an accredited college, university or educational institute; your unmarried child any age, if totally disabled by reason of mental or physical disability and remains continuously so disabled and is considered a dependent as defined under the Income Tax Act. If your child meets the eligibility criteria as a student, proof of attendance at school must be provided annually. 3. What is a Qualifying Life Event? A Qualifying Life Event is an event that happens in your life which would cause you to need to make changes to your benefit coverage. The Qualifying Life Events are: birth or adoption of a child; marriage; divorce/separation; spouse/dependent loses their coverage; spouse/dependent gains coverage You have a maximum of 30 days to make changes to your benefit selections from the date the Qualifying Life Event occurred.

2 Enrolling / Re-Enrolling 4. Why has the company moved to a Biennial Re-enrollment cycle? Results from our last re-enrollment showed only 1 in 5 eligible employees took the opportunity to make changes to their benefit options. With such a low number of employees making changes to their plans on an annual basis, we decided to move to a biennial re-enrollment cycle. This change will allow us to redirect resources to employee wellness and other benefit related initiatives. 5. When will I be able to change my benefit selections? At the next biennial re-enrollment period which is scheduled to be held in November of 2014, or earlier if you experience a Qualifying Life Event. If this is the case, you will have 30 days from the date the Qualifying Life Event occurred to make changes to your benefit selections. 6. What happens if I don't enroll in the plan when I am first eligible? If you miss the initial enrollment period, your coverage will default to Health Option 2 and Dental Option 2. You will be enrolled without dependents, except in Quebec where you will be enrolled based on your current family status (your eligible dependents must be covered under this plan if they are not covered elsewhere). Excess Flex Credits will automatically be allocated to your Health Care Spending Account. Your coverage cannot be changed until the next biennial re-enrollment cycle or unless you experience a Qualifying Life Event. 7. What happens if I don't re-enroll in the plan during the re-enrollment period? If you do not re-enroll during the biennial re-enrollment period, your current elections will remain in place, as will any Optional benefits you elected. You will not be able to change your elections again until the next biennial re-enrollment period, or earlier if you experience a Qualifying Life Event. Excess Flex Credits will automatically be allocated to your Health Care Spending Account. NOTE: if you currently allocate Excess Flex Credits to both your HCSA and your TSA, you must re-enroll to maintain this same allocation. Otherwise, 100% of your Excess Flex Credits will be allocated to your HCSA. 8. How do I enroll/re-enroll? Start by familiarizing yourself with the eflex Benefits Plan by visiting and reviewing the Benefits Guide. Then go to the eflex Online Enrollment Tool at Your Access ID is your address. Passwords New hires - you will be sent your password from AON Hewitt. Employees who are re-enrolling if you do not remember your password, click on the Forgot Password link to be given a new one.

3 Flex Credits and Excess Flex Credits 9. What are Flex Credits? Flex Credits are an allocation of Company money that is used to help pay the cost of Health and Dental coverage. Each Health and Dental option has a price tag. If the options you choose cost more than your annual allocation of Flex Credits, you will pay the remaining costs through payroll deductions. If the options you choose cost less than your annual allocation of Flex credits, you will have Excess Flex Credits remaining. Excess Flex Credits that remain after you have chosen your Health and Dental options can then be allocated to a Health Care Spending Account and/or Taxable Spending Account. 10. What are Excess Flex Credits? Excess Flex Credits are any Flex Credits remaining in your account after you have purchased the Health and Dental coverage you desire. These can then be allocated to your HCSA and/or TSA. 11. What is the Per Pay Deduction amount that shows on the Flex Credit grid? If you have selected a benefits combination which has a higher cost than the amount of Flex Credits provided to you, you will be responsible to pay for the difference in the cost. In this case, the Per Pay Deduction amount is the cost that will be deducted from your paycheque on each pay. 12. Can Excess Flex Credits be used to pay the cost of Optional Benefits? No. Flex Credits are first used to pay the cost of your Health and Dental coverages. Any Excess Flex Credits can then only be allocated to the HCSA and/or TSA. 13. Why do employees with dependents get more Flex Credits than employees without dependents? The group benefits industry has traditionally recognized that employees with dependents have greater insurance needs than those without, and SCM Insurance Services is no exception. Our philosophy is to ensure that comprehensive coverage is available for all employees and their dependents. Since the insurance needs are greater, the cost of providing coverage for employees with dependents is also greater than those without. Therefore, the contribution required from SCM is also greater. That being said, we also recognize that employees without dependents require as much flexibility as those with dependents. Employees without dependents may not have alternative means of coverage, as for example, through a spouse's plan. We have ensured that the level of Excess Flex Credits available to each employee coupled with the various coverage levels available, should be adequate to meet each of our employees' needs, whether they have dependents or not. 14. Will the amount of Flex Credits provided to employees increase each year? At each re-enrollment, our total claims and plan costs will be reviewed. As a result, Flex Credits may or may not be adjusted depending on this review, along with our business realities.

4 15. Will costs go up each year? The premium rates for Health and Dental coverage are set based on a number of factors, which include the trending of claims submitted by SCM employees; demographics (age, gender, etc) of SCM employees; legislative changes that impact benefits coverage; and many other considerations. As a result, SCM continues to pay a portion of the cost, and is making a significant contribution to the plan for 2013 and 2014 by increasing the annual allocation of Flex Credits to fully offset the cost increase. This is to ensure that the premium costs for coverage remain within acceptable margins for our employees, as well as ensuring the sustainability of our plan moving forward. Health and Dental costs will stay the same until the next biennial re-enrollment. At that time, Flex Credits and premium costs will be analyzed and may go up or down based on the plan claims experience and other factors. Health and Dental 16. Why can't I choose the coverage I want from within each Option? The eligible expenses under each Option are bundled. For example, if you choose Option 2, that selection includes only those expenses shown under Option 2, as a bundle. You cannot mix and match eligible expenses between the Options. The eflex Benefits Plan gives you the choice of three different Options to help ensure that each of you finds a level of coverage to meet your own specific needs. Allowing you to choose a different Option for Health than for Dental further increases flexibility under the Plan to address your unique circumstances. An à la carte approach to benefit selection would not only be extremely difficult to administer but would also be more risky and could eventually become prohibitive from a cost-perspective. The structure of the eflex plan takes both affordability and sustainability into account. We intend to continue to offer our employees exceptional, comprehensive levels of both Mandatory Core Insured Benefits, and Optional Benefits coverage, to meet your individual needs. 17. Why can't I opt-out of Health and Dental if I don't have dependents or if I'm not covered under a spouse's plan? SCM wants to make certain you have at least a basic level of Health and Dental coverage to protect you against expenses associated with an unexpected illness. In electing the lowest levels of coverage under the plan, you will still have Excess Flex Credits to allocate to either your HCSA and/or TSA, to reimburse eligible expenses not otherwise covered under the plan, and provide you with added flexibility in tailoring your coverage. 18. Can I check how much of my expense will be covered before I have any procedures done, or make any purchases? Yes, and we strongly recommend that you do this. You can contact Manulife at to pre-authorize any large expense before incurring it.

5 19. Why does the pharmacist give me the "generic drug equivalent" when I have a prescription filled? Coverage under the prescription drug plan depends on the formulary established under your group benefits plan. SCM's is a mandatory generic drug plan. As such, reimbursement of the cost of prescription drugs will be made for the cost of the lowest priced equivalent drug based on specific provincial regulations. If your medical or dental practitioner has written that there is to be no substitution of the prescribed drug or medicine, the plan will reimburse up to the cost of the generic equivalent; you will be responsible for paying the balance. Manulife Financial can provide you with the information you need regarding specific drug coverage. Keep in mind that Excess Flex Credits you direct to your Health Care Spending Account can be used to pay the portion of this cost not otherwise covered under the Plan. Therefore, as you consider which Health Option is best for you and your family, take into consideration an allocation to your HCSA to cover expenses perhaps not otherwise covered under the eflex Benefits Plan. 20. What kind of coverage do I have under the plan if I accidently injure my teeth and require dental care as a result of this accident? Accidental Dental coverage is available under Health Options 2 and 3; it does not form part of Dental coverage under any of the Dental Options. Accidental Dental coverage is not available under Health Option 1. If you choose to Opt-out of Health coverage, or choose the Option 1 of Health coverage, you will not have Accidental Dental coverage. Only prescription drugs and Emergency Travel coverage are available under Health Option 1. In the event of an accidental dental injury, unless you have elected Health Option 2 or Option 3, dental care required as a result of the accident would have to be covered under the Dental Option you chose. This could seriously impact any remaining amount you would have to cover regular preventive Dental expenses you or your family might incur during the year. You should consider this carefully as you select both your Health and Dental Options. 21. Is there a special form that must be completed and/or submitted to Manulife as a pre-authorization of Dental services? Manulife Financial accepts dental transmissions in a real-time environment, where instant adjudication of dental claims and immediate feedback to the provider of dental services occurs. Both pre-treatment plans and dental claims may be submitted in real-time and a response generated in 5 seconds. For the paper submission of Dental pre-authorizations, most dental offices have a form that can be used. If they do not, they use a standard claim form and write or include comments that the form has been completed for pre-authorization purposes only. If needed, forms such as these are available on the Manulife Financial website at However, your dentist should have everything you need. 22. How long am I covered under the Out-of-country emergency travel benefit? Under this benefit, you are covered for a maximum of 60 days while travelling abroad. More detailed information is available from Manulife Financial at

6 Health Care Spending Account (HCSA) and Taxable Spending Account (TSA) 23. What is a Health Care Spending Account (HCSA)? A HCSA is an account in to which you can allocate Excess Flex Credits that remain after you have chosen your Health and Dental options. You can use the HCSA to pay for eligible health and dental expenses not reimbursed under the eflex Benefits Plan, your spouse s plan or your provincial plan. Expenses paid from your HCSA are a non-taxable benefit to you, except in Quebec. 24. What is a Taxable Spending Account (TSA)? A TSA is an account in to which you can allocate Excess Flex Credits that remain after you have chosen your Health and Dental options. You can use the TSA to help pay for eligible fitness-related items. For a detailed list of eligible TSA expenses, refer to the Benefits Guide. Expenses paid from your TSA are a taxable benefit to you. 25. What is the benefit of allocating my Excess Flex Credits to a HCSA? The HCSA will result in savings for you. If you did not have the HCSA, you would be required to pay for any out-of-pocket expenses with after-tax dollars. By using the HCSA, you would benefit by using pre-tax dollars to pay for any eligible expenses. If you had to pay a $500 expense out-of-pocket and you were in a 40% tax bracket, you would have to earn $833 in pre-tax dollars to pay the $500 bill. Using the HCSA saves you $333 in taxes. In Quebec: You would be required to pay provincial tax on any amount reimbursed from the account. Even so, you would save the Federal tax payable. The $500 paid through the HCSA effectively creates a taxable benefit of $600 assuming fees and taxes of 20%. At a provincial income tax bracket of 20%, the income tax payable by the Quebec employee is $120, thereby reducing the savings from $333 to $ Can I contribute part of my salary to the HCSA? No, you cannot. The HCSA is a tax-effective way to pay for eligible health and dental expenses not otherwise covered under the plan. Only Excess Flex Credits can be allocated to the HCSA. This ensures that the funds in the account are tax-free, except in Quebec. If you contributed your own salary, you would be contributing after-tax dollars and therefore lose the savings, thereby eliminating the advantage of the HCSA. Quebec Employees Provincial tax is paid on the amounts reimbursed from the Health Care Spending Account, not on the total Flex Credits allocated. The amount reimbursed is federal tax exempt.

7 27. How can I check the balances of my HCSA and/or TSA? You can view your HCSA and/or TSA balances via the Manulife Financial website at can also call Manulife at How does the carry-over of Excess Flex Credits work? If you do not use all of your Excess Flex Credits in the year they are allocated, they may be carried over into the next Benefit Year. This applies to both the HCSA and the TSA The Canada Revenue Agency (CRA) does not allow the same Excess Flex Credits to be carried over indefinitely so you must use them or lose them in the second year. This means that you have two Benefit Years to spend each allocation made to your HCSA and/or to your TSA. HCSA CARRY-OVER EXAMPLE* You allocate $500 in Flex Credits to your HCSA account You use $300 from your HCSA during the year You are left with $200 that can be carried over into the second year $500 -$300 =$200 YEAR ONE You begin the new Benefit Year with $200 in your HCSA account You decide to allocate $500 in excess Flex Credits again this year, for a total of $700 in Year Two If you don t spend at least the $200 you carried forward, any amount less than $200 left unused will be forfeited in Year Three. $200 +$500 =$700 YEAR TWO Carry-over balances are used first when paying claims *This Carry-Over Example works identically when applied to your TSA

8 29. What happens if I don't use the Excess Flex Credits I have allocated? Excess Flex Credits that were allocated to the HCSA and/or TSA account in Expire December 2012 Expire December 2013 Expire December 2014 Expire December 2015 May 2011 X January 2012 X January 2013 X January 2014 X Any Excess Flex Credits not used by the end of the second year will be forfeited. The HCSA and TSA both use a "first in, first out" rule. Therefore, any Excess Flex Credits you have that are carried forward from a previous year will always be used first when reimbursing eligible expenses. Note that you cannot re-allocate unused Excess Flex Credits to a different account at any time during the year. Once you allocate your Excess Flex Credits regardless of whether you have opportunity to use them, they are locked into the account(s) you chose. 30. How can I find a list of eligible covered expenses for the HCSA? You can access the Canada Revenue Agency site directly for a full list. Search for publication IT519R2 (Medical Expense and Disability Tax Credits and Attendant Care Expense Deduction). 31. How can I find a list of eligible covered expenses for the TSA? The full list of eligible expenses is included in the Benefits Guide.

9 Mandatory Core Insured Benefits 32. Many of my mandatory core insured benefits are based on my earnings. How are my earnings calculated? Salaried Employees: Annual salary is your base annual pay, not including overtime or bonuses. Adjusters: Annual salary is your annual salary (if salaried) or commission reconciled with applicable draw (if commissioned) plus over threshold bonuses generated by production activities, not including overtime. Part-time employees (minimum 20 hours worked per week to qualify for benefits): Annual salary is calculated using hourly rate of pay and hours worked per week, not including overtime or bonuses. 33. Why is the Short-Term Disability premium rate increasing? STD premiums are determined based on activity of the plan over the last year. As a result, our number of STD claims has meant an increase of $0.05 was warranted. Therefore, rates will be going from 0.57/$10 of benefit to $0.62/$10 of benefit effective January 1, See adjacent box for an example of increased employee costs. Employee with earnings of $50,000 Old payroll deduction: $36.54/month + applicable tax New payroll deduction: $39.75/month + applicable tax Difference: $3.21/month + applicable tax 34. Will the Long-Term Disability premium rate be increasing as well? Yes, but only in January of This forecasted increase is due to our rate guarantee with Manulife ending as of December 31, 2013, as well as, projected usage on the plan. Optional Benefits 35. Are Optional Life Insurance rates increasing for the 2013/2014 Benefit Years? The Optional Life Insurance rates negotiated with Manulife Financial are not increasing for 2013 but will be for The rate increases for 2014 will be communicated once received from Manulife. Please remember that under the eflex Benefits Plan the calculation of premium rates is based exclusively on your gender, age and smoker status, or on your spouse's gender, age and smoker status. The premium rate information is therefore accurately based on the specifics to the person electing the coverage.

10 36. How are Spouse's Optional Life Insurance rates calculated? Optional Life Insurance rates are based on the age, gender and smoker status of your spouse. Refer to the Benefits Guide for premium rate information. 37. If I leave SCM's employment, can my Optional Life Insurance be converted to a private plan? Yes. However, the amount being converted cannot exceed the amount of insurance you have while employed at SCM. As well, the amount of Life Insurance you convert to a private plan is subject to a combined maximum of $200,000, including both Basic and Optional Life Insurance coverage you may have under the policy. This means, for example, if you have $50,000 of Basic Life Insurance coverage and $300,000 of Optional Life Insurance coverage, the maximum you can convert to an individual policy is $200, What is medical evidence of insurability (EOI)? This is a medical questionnaire that Manulife requires to be completed by the applicant. They review this document and then determine based on the current health status of the applicant if they will approve or deny the application for optional life insurance. The completion of this form is mandatory if you wish to obtain optional life insurance. 39. Why do I have to submit evidence of good health when I increase or apply for Optional Life Insurance? All amounts of Optional Life Insurance are subject to approval of evidence of good health if, during re-enrollment, you elect Optional Life Insurance coverage for the first time or increase your current coverage amount. Evidence-free Optional Life Insurance coverage up to $30,000 is available only for new hires and their spouse at initial enrollment, provided they apply for this coverage within 31 days of becoming eligible for benefits. You can submit medical evidence of insurability directly to Manulife Financial, at the address on the form. 40. I already have Optional Life Insurance. Can I increase my current coverage without having to provide medical evidence of insurability? No. If you already have Optional Life Insurance coverage, and are increasing your current level, you must provide medical evidence of insurability directly to Manulife Financial before you are approved for the extra amount you are requesting.

11 Utilizing the Plan 41. What Contract numbers do I use when submitting a claim? The Contract numbers are as follows: Health and Dental Claims HCSA TSA Your certificate number is your payroll number, which can be found on your Manulife id card and/or in the upper left hand corner of your pay stub. 42. How do I submit my claims online? Many claims can be submitted online through Manulife's website. Go to and click on Plan Member. The first time you log in you will require your plan contract number (# 83260) and certificate number (payroll number) to register. Once logged-in, toggle over claims in the navigation bar and then click on online claims where you can: Select the type of claim to submit. Select the patient for the claim from a list of family members. Select the practitioner(s) from a list Once you have setup your own personal practitioner s in the system they are saved for future use. Pay the balance of the claim from your HCSA (if you have one). The site includes sample receipts for every type of claim to help you find the right information fast, and includes an easy step-by-step process that is the same for every claim type once you've done one, you can do them all. You can download, save and print the statement for the claims you've submitted online. Easy, online claims history you can view a list of your most recent online claims submissions, check the status of an online claim, look up the claims details or obtain the confirmation number. Be sure to keep and file your receipts in case you are audited and subsequently required to provide them as proof for payment of the eligible claim. The best part? If you request direct deposit to your bank account, you could receive your reimbursement up to 70% faster than by cheque!

12 43. How do I submit claims by mail to Manulife Financial? Visit and use the claim forms posted under Forms. The instructions and mailing address are indicated on the claim form. 44. Who do I contact for claims status and information? You can view all of your claims information online at Click on Plan Member, log in to the site and access your claims information. It's that easy! Or, call the Manulife team at , available Monday through Friday, 8 a.m. to 8 p.m. ET to answer your questions. You will be required to provide your certificate number (payroll number) and plan contract number (# 83260) to gain access to your account information. 45. Why do I need a Drug Card with Manulife Financial? With your Manulife Financial ID Card, your pharmacist (and most dentists) can electronically submit your eligible expenses directly to Manulife Financial for reimbursement. Your Manulife ID Card is a fast and easy way to cover your eligible prescription drugs no claim forms to complete no waiting for a cheque in the mail. All you do is present your card, and your pharmacist (or dentist, and even some paramedical practitioners) will send Manulife your claim information electronically. The ID Card will facilitate the transfer of information the pharmacist requires for Manulife to pay the covered amount directly to your pharmacy so you only have to pay the balance based on the Option you have selected under the plan. Manulife Financial can even coordinate payment directly from your HCSA for amounts above the eligible maximums, or not otherwise covered under the plan, minimizing your out-of-pocket expenses. 46. When will I receive my Manulife Financial ID Card? You will receive your Manulife Financial ID Card not long after enrolling in the plan for the first time. If, for some reason, you do not have your ID Card within a reasonable amount of time after enrolling, you can always provide our plan policy number, # 83260, and your unique employee ID number (your payroll number) to your pharmacist or your dentist, who can electronically submit your eligible expenses to Manulife Financial for reimbursement. Please contact Manulife Financial directly at for more information.

13 Help and Resources 47. Who do I call if I have more questions? You can call the Benefits Centre Hotline at Aon Hewitt has trained benefit specialists to help you with any questions related to: using the Online Benefits Centre enrollment tool and related navigation queries your dependents (adding a dependent and confirming eligibility) Flex Credits eflex Options premium rates applying for Optional benefits Contact Manulife Financial directly at for any questions related to: eligible Health and Dental expenses covered under the plan HCSA or TSA balances Questions about your claims status or re-imbursement