UPDATES, REMINDERS AND HOW-TO’S FOR 2014 March 1, 2014 is the annual renewal of the Members’ Insurance Program and your coverage may have changed. To learn if this is the case for you, please review your Insurance Statement. If you wish to exercise an option shown on your Statement, please submit your completed Form 01, or login at afbs.ca and use Quick Pay. The deadline to act is midnight (EDT) March 31, 2014. For help reading your statement, please see the guide included in your package and posted to afbs.ca. If you have any questions at all, don’t hesitate to contact us in Toronto at [email protected] or 1-800-387-8897, or in Vancouver at [email protected] or 1-866-801-6550. WHY ARE MARCH 1ST AND MARCH 31ST SO IMPORTANT? The Members’ Insurance Program renews each year on March 1. This means that leading up to March 1, AFBS re-calculates your coverage for the March 2014 - February 2015 Benefit Year. Your coverage can change from year to year, and it’s important that you check your insurance statement each year. Your combination of benefits is referred to as your Benefit Level, and both your Benefit Level and the corresponding benefits are shown on the first page of your insurance statement. Your Benefit Level will be Gold, Silver, Bronze, Base or None, and will indicate whether you are the only person insured (Member only), or whether you and your eligible dependants have access to these benefits (Member and Dependants). If your coverage has been renewed at a lower level, you have the option to maintain your previous year’s higher Benefit Level. This option is noted on the second page of your insurance statement, and there is a direct cost to you if you wish to maintain your previous Benefit Level. If you wish to do this, you must advise AFBS no later than March 31. Members registered on afbs.ca can do this online using Quick-Pay; otherwise complete and send Form 01: Option and Payment Form to AFBS. Form 01 is included as part of your insurance statement package and is also available at afbs.ca. If you have questions about your statement or the option to maintain coverage, please contact us ASAP and in advance of the March 31 deadline at: [email protected] or 1-800-387-8897 (Toronto), or at [email protected] or 1-866-801-6550 (Vancouver). CHANGES THAT HAVE OCCURRED SINCE MARCH 1ST, 2013 Increase in Manitoba RST - On July 1, 2013 the Manitoba government increased the retail sales tax (RST) percentage from 7% to 8%. Manitoba residents will see 8% RST reflected on their statements for those benefits where AFBS is required to collect and remit RST to the provincial government. Mail-Order Pharmacy - Relevant to Members outside of Québec, Rexall Direct’s mail-order pharmacy service is reverting back to their old name, MediTrust. Contact information is www.MediTrust.com or 1-888-792-3667. Rexall Pharmacy Network Retail Discount - The Rexall group of pharmacies is no longer providing a retail discount. Rexall Network cards will not be re-issued. Note: Information about mail-order pharmacy is provided as a Member service. AFBS does not endorse Rexall or Meditrust. Recent Additions to our Affinity Programs - AFBS provides Members with access to additional insurance products for which they can voluntarily apply. These benefits are not a part of the Members’ Insurance Program, and require dealing directly with the provider. This group of options is referred to as AFBS’ Affinity Programs. We are pleased to announce two additional offerings: 1.Voluntary Travel/Travel Medical Insurance, provided by Ingle International; 2.Dependant coverage is now available for the voluntary Critical Illness benefits, provided by Industrial Alliance Insurance and Financial Services Inc. Information about all AFBS Affinity programs can be found at afbs.ca. WGC Policy Change: Guild Subsidy - Due to a recent WGC council decision, the application of the Guild subsidy has been changed effective immediately. • For active Members: While any Guild subsidy will continue to reduce the cost of coverage for the Benefit Level at which you’re renewed, it will no longer be available to offset out-of-pocket costs as part of the maintain option. • For Members on honourary withdrawal: Previously, any Guild subsidy was available for the first year you were on withdrawal. As a result of the change, Guild subsidy is no longer available to WGC Members while on withdrawal status. For WGC Members this change replaces the Premium Subsidy information on page 11 of the Insurance Benefits Guide. If you require additional details about the change please contact WGC. HOW TO SUBMIT CLAIMS – A HELPFUL SUMMARY In order to provide you with the best possible program, AFBS partners with a number of provider organizations. Unfortunately, when claim submissions are sent to the wrong organization, processing delays occur and the receipt of your reimbursement can be delayed. Complete details about claim submission can be found in the Insurance Benefits Guide, pages 23-26. If you ever have questions, please contact AFBS in Toronto at [email protected] or 1-800-387-8897, or in Vancouver at [email protected] or 1-866-801-6550. PLEASE NOTE: You may not be eligible for all of the benefits listed below. Review your current Insurance Statement to confirm the benefits that apply to you. EXTENDED HEALTH CARE: 1.Complete and sign Form 07 – Extended Health Care Claim Form, which is available at afbs.ca or by contacting AFBS; 2.Submit your original extended health care receipts to AFBS with your signed Form 07; 3.Reimbursement cheques are issued by AFBS. Hospital Room Charge Expenses: Do not provide your AFBS electronic claim submission information. If you are hospitalized and the hospital wants to bill the insurance company directly, please make sure the invoice is sent directly to AFBS. The hospital will require: 1.The policy number under which you are insured: 1000 for ACTRA or 3000 for WGC; 2.Your identification number: either your ACTRA/WGC number or preferably your AFBS Account Number (shown on your insurance statement); 3.AFBS’ address: • Toronto: 1000 Yonge Street, Toronto ON, M4W 2K2 • Vancouver: 320-1155 Pender St. West, Vancouver BC, V6E 2P4 The hospital room charge benefit is only available to Members residing in Canada and when hospitalization occurs within your province of residence. Please check your insurance statement to confirm the coverage available to you. For complete information, see the Insurance Benefits Guide, pages 31-41. DENTAL CARE: Electronic Submission by your dental office: 1.Provide the information on your AFBS Electronic Claim Submission card to the dental office (shown on your statement); 2.Make sure you receive the transmittal confirmation before you leave the office. This will be from Claimsecure, and it will indicate if the claim has been accepted, including the reimbursement amount or if a paper claim needs to be provided. Paper submission: 1.Your dental office will complete the provincial dental association standard dental claim form. Be sure to sign this form; 2.This form must be submitted to AFBS (not Claimsecure, which is for electronic submission only). Your dentist may give you the completed form to send to AFBS, or they may send it themselves; 3.Dental reimbursement cheques are issued by Claimsecure (though the paper claim submission is processed by AFBS). Please direct all dental claims inquiries to AFBS, or see the Insurance Benefits Guide, pages 50-54. Note for Québec Residents: For electronic claims submission and adjudication, your dental office must use procedure codes recognized by the Canadian Dental Association (CDA). Electronic claim submission and adjudication is not possible when Québec Dental Association codes are used. To avoid reimbursement delays: 1.Ask your dentist if they are able to submit the procedure codes used by the CDA; 2.Obtain a copy of the transmittal confirmation. It will indicate whether the electronic submission has been accepted along with the reimbursement amount; 3.If your dentist does not use the CDA codes, or if the electronic transmittal is unsuccessful, please request a completed Standard Dental Claim form from your dental office and mail it to AFBS; 4.If an expected reimbursement is not received, please let us know. We can research the possible cause. Note: If this is due to the use of incompatible electronic codes, we will require a completed paper Standard Dental Claim form from your dental office. PRESCRIPTION DRUG: Electronic Submission at the pharmacy: • Provide the information on your AFBS Electronic Claim Submission card to the pharmacy (shown on your statement). Paper submission: 1.If your claim cannot be processed electronically, complete and sign Form 09 - Prescription Drug Claim Form which is available at afbs.ca or by contacting AFBS; 2.Submit Form 09 to AFBS with your original Official Receipt from the pharmacy; 3.Reimbursement cheques are issued from Claimsecure (though the paper claim submission is processed by AFBS). Please direct all prescription drug inquiries to AFBS, or see the Insurance Benefits Guide, pages 42-48. MAY 31 2014 THE DEADLINE TO SUBMIT EXTENDED HEALTH CARE, PRESCRIPTION DRUG, OR DENTAL CARE CLAIMS FOR THE PERIOD MARCH 1, 2013 – FEBRUARY 28, 2014. TRAVEL EMERGENCY MEDICAL: This benefit is provided by Industrial Alliance Insurance and Financial Services Inc (IA). 1.Carry with you the Industrial Alliance Emergency Assistance card (found on your statement), and consider keeping your Travel Emergency Medical Coverage Summary (included with this mail package) with your travel documents, as it includes claim submission details and your policy number (100009655); 2.If you have any eligible out-of-pocket expenses, obtain claim forms at solutionsinsurance.com or, within Canada, by calling 1-800-549-7227. Completed claim forms must be sent directly to IA; 3.Reimbursement cheques are issued by IA. See the Insurance Benefits Guide, pages 58-62, or your Travel Emergency Medical Summary for additional details. WEEKLY TOTAL DISABILITY: BASIC CRITICAL ILLNESS: If you are totally disabled and unable to work, contact AFBS for the necessary claim forms in Toronto at [email protected] or 1-800-387-8897, or in Vancouver at [email protected] or 1-866-801-6550. We will review the claim filing process with you at that time. This benefit is provided by Industrial Alliance Insurance and Financial Services Inc (IA). 1.Contact IA at 1-800-266-5667, option 1 to alert them to your claim; 2.IA will require confirmation of the policy under which you are insured, which is 100006095, as well as the covered condition for which you are claiming; 3.Claim forms will be provided by IA and completed forms must be returned directly to them; 4.Any claim payment will be issued by IA. For more information about this benefit please see the Insurance Benefits Guide, pages 70-80. LIFE INSURANCE AND AD&D INSURANCE: 1.If a loss occurs that is covered by the AD&D Insurance Benefit, contact AFBS. Otherwise; 2.Your beneficiary, executor or lawyer should contact AFBS and we will review the claim filing process at that time. See the Insurance Benefits Guide, pages 66-69, for additional details. YOUR BENEFICIARY AND YOUR DEPENDANTS Your beneficiary is the individual or individual(s) who would receive the proceeds of your Life Insurance, and possibly Accidental Death and Dismemberment Insurance, if anything were to happen to you. Life events such as marriage, the birth of children, separation or divorce, or the loss of a loved one could have unintended consequences for your beneficiary designation and/or will. Please keep your beneficiary designation up to date. Form 04 - Beneficiary Designation/Change Form is available online at afbs.ca or by contacting AFBS. Your eligible dependants are individuals, such as family members, that may have access to AFBS insurance benefits through you. As with beneficiaries, life events may also impact whether a change is required to add or remove a dependant’s access to benefits. Please be sure to review pages 12-14 of the Insurance Benefits Guide (available at afbs.ca), as there are specific rules in place that dictate when AFBS must be notified of requests regarding dependants, and when coverage begins and ceases.