2 minute read
“Be informed: Read the Fine Print!”
Pat Bowslaugh, Chair, Benefits Committee
Experiences shared by our members become a “gold mine” to the rest of us.
“How is that?” you might be asking. Read on.
One of our members moved to BC and although he did not have medical coverage from RTAM, we have discovered that his experiences are not uncommon. Reading the “fine print” in your insurance documents is essential and may be fundamental to avoiding unfortunate “concerns”.
Concern # 1:
If you take up residence in another province, check how much your coverage will be in your new province. For example, Health Care Coverage may be based on the exact amount for which you would be covered in Manitoba. Thus, if the cost of your intervention in your new province happens to be higher, your coverage might only be the amount you would have received in Manitoba. You then become responsible for the difference in cost between Manitoba and that of your new province.
Concern # 2:
Each province has lists called a Formulary which identifies all of the medications that may be covered by the Health Care System of that province. Provinces do not have identical lists. In the event of you moving to a different province, you are advised to research to see if your medications are covered in your new place of residence.
Concern # 3:
Oftentimes, individuals are prescribed a new medication that is not yet on the Formulary List and thus not covered by insurance. Ask your doctor to prepare an “Exception Drug Status” form which is a communication stating that the medication is essential for your particular health situation. Your doctor must then forward your drug Status form to your province’s Health Authority for review and possible acceptance. Upon acceptance, you must then communicate the approval to your Health Care Provider. (This would be the company/organization through which you obtained your insurance coverage. ) Based on such a process you may be sufficiently fortunate to receive approval for coverage through your health insurance policy. (You have the right to appeal if unsuccessful.) Please remember that provinces differ. Your research with your doctor is essential.
Once approved, it is “future” prescriptions that are covered; there is no retroactive support. Contact Johnson, Inc. for further information. (See contact information below. )
Concern # 4:
Another member alerted us to concerns about dental interventions.
When seeking dental care ask for a cost appraisal of what interventions your dentist is suggesting. Then ask questions to clarify the specifics of what you are getting.
Note that there are different methods of filling a cavity. There are also different methods of replacing a tooth.
Please know in advance of the work being proposed that costs may vary from one method to another and from one practitioner to another. It is your right to ask and your responsibility to choose so there are no surprises when you receive your bill.
Protect your smile!
Appreciation note # 1:
If you have any questions and/or you cannot find answers in your RTAM sponsored benefit plan materials, you are welcome to seek clarification from Johnson at 1-877-989-2600.
