Volume 2022.22 Benefit Changes Q&A for Menno Home HEU Members
Menno Home employees have recently certified with the Hospital Employees’ Union (HEU) under the Facilities Agreement. As a result, employees who are now members of HEU will be covered for benefits provided by the Joint Facilities Benefits Trust (JFBT).
Effective November 1, 2022, your new benefits provider will be the Joint Facilities Benefits Trust (JFBT). Acting as third-party administrator on behalf of the JFBT is the Healthcare Benefit Trust (HBT). HBT will administer benefits on behalf of the Joint Trust.
JFBTs partners – Pacific Blue Cross and Canada Life
For Extended Health and Dental Claims, JFBT partners with Pacific Blue Cross (PBC). PBC is a contracted service provider who provides the following services:
- Extended Health and Dental claims adjudication
- Extended Health and Dental claims payment
- Enrollment and billing services
For Life and Long Term Disability Claims, JFBT partners with Canada Life (CL). CL is a contracted service provider who provides:
- Claims adjudication
- Disability Management (LTD)
- Early Referral Services (LTD)
- Rehabilitation Services (LTD)
- Claims payment
Please see below for important information regarding this transition.
Will my benefits coverage change?
Your Group Life, Accidental Death & Dismemberment (AD&D), Long Term Disability (LTD), Dental and Extended Health Care (EHC) benefits will be in accordance with the current plan design in effect for all members of the JFBT on November 1, 2022.
To learn more about the Joint Facilities Benefits Trust, please visit their website: www.jfbt.ca.
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Frequently Asked Questions
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Q1. What is the effective date of coverage?
A1. Coverage under the JFBT plan will take effect on November 1, 2022 if you are actively at work on that date. This includes if you are on regularly scheduled day off, vacation, maternity/parental leave, paid leave or unpaid leave other than for sickness.
Q2. Do I need to fill out new forms?
A2. You will be required to complete a new enrolment form and a new appointment of beneficiary form.
Q3. How do I know I have been enrolled for coverage?
A3. You will receive a Member ID card from Pacific Blue Cross that confirms your Dental and Extended Health coverage. It will contain your new policy number and your new Benefits Identification (BID) number. The card will be mailed to your home address. Your card will also be available online to download effective November 1, 2022. Enrolment for Group Life, Dependent Life, AD&D and LTD coverage is done by the Human Resource Department.
Q4. Will I need to provide a new policy/plan number to my healthcare providers?
A4. Yes, you will need to update your information with your dentist, pharmacist, and any paramedical practitioners who offer direct billing. Please provide them with the information available on your PBC Member ID card.
Q5. What is the deadline to submit Dental and Extended Health claims to Manulife?
A5. Dental and Extended Health claims with a purchase or service date up to October 31, 2022 must be submitted by November 30, 2022. So that you do not miss the deadline, we encourage you to submit your claims to Manulife as soon as possible and online if you can.
Q6. When do I submit Dental and Extended Health claims to Pacific Blue Cross?
A6. You can submit dental and extended health claims to Pacific Blue Cross for purchase or service dates starting November 1, 2022.
Q7. Will I get a new benefits booklet?
A7. You may access your Benefits Booklet and Benefits-at-a-Glance Summary through JFBT’s website (www.jfbt.ca).
Q8. Do I need to re-satisfy my annual deductible?
A8. Effective January 1, 2022 under the JFBT plan the deductible was eliminated so you are no longer required to pay a deductible moving forward.
Q9. What are reasonable and customary limits?
A9. Reasonable and customary (R&C) is the term used to describe the dollar amount a benefits plan covers for a given product or service. PBC applies R&C limits (like all carriers) to ensure the plan pays for services that are medically necessary for health care and maintenance. PBC establishes and applies R&C pricing to ensure the plan is paying the reasonable and customary pricing for a service given the circumstances (e.g. severity and nature of medical condition).
Fees charged by health providers can vary a great deal, for the same product or service, in the same region. For those health care professional groups that do not have a fee guide, PBC uses an approach common in the industry which includes reviewing trends, pricing in the geographical area, actuarial reports, and association data which includes suggested pricing. The suggested pricing established by the colleges/associations serve as a guideline and are taken into consideration, along with all other data points noted above. PBC’s R&C limits may differ from other carriers within each paramedical category but overall, their limits are comparable across the industry.
R&C pricing is a standard used throughout the insurance industry to help manage the rising cost of benefits. They play an important role to help ensure a sustainable benefits plan and they also help reduce the likelihood of benefits fraud or abuse.
Q10. What if I have an ongoing dental treatment plan?
A10. If you have an ongoing treatment plan where a pre-authorization was approved by Manulife, advise your dentist to submit a copy of the Manulife approval or re-submit a new pre-authorization to Pacific Blue Cross.
Q11. Does Pacific Blue Cross have online access for Dental and Extended Health claims and coverage information?
A11. Attached is information to help familiarize you with Pacific Blue Cross. Member features include:
- Member Profile – log in to manage your coverage, submit claims, view claim status and history, download Member ID card or claim forms, sign up for Member Communication from PBC
- Mobile App – sign in using fingerprint touch ID to submit claims, check coverage balance, find Insta-Claim Providers for direct billing
- Preferred Pharmacy Network – Pacific Blue Cross has partnered with leading pharmacy retailers to offer guaranteed low prices and dispensing fees
- Pharmacy Compass – lookup tool to compare pill prices and dispensing fees at pharmacies in BC
Q12. Can I still use my favourite pharmacy if it is not in the Preferred Pharmacy Network?
A12. Yes, you can still use your favourite pharmacy.
Q13. Who can I contact for more information?
A13. If you have any questions about your benefit coverage, you may address it to your employer or to JFBT (contact@jfbt.ca).
Thank you,
Jeanette Lee
Director, Human Resources
