PSAC610 Benefits - Extended Health Plan
What is the EHP?
Postdoctoral Associates: please follow the link here for information about your health benefits.
The Extended Health Plan is a supplement to your existing health insurance (which may include the SOGS supplemental health plan, UHIP, OHIP, or some private plan). Ideally, you have at least one other health plan to rely upon and the EHP simply adds on a few extra benefits that your other insurance doesn't cover fully. The EHP also lets you get reimbursed for services you might otherwise not get covered, it tops up the cost of prescriptions, and it lets you cover, at least a little, family members that might otherwise get coverage on your plan.
The for the 2016-2017 academic year, the EHP grants up to $499 per academic year to all teaching assistants. The EHP covers all and only claims for the academic year in which you have a teaching assistant position. You can file a claim as soon as you have an expense and you have until the end of the next September to file your claim.
The EHP operates as a rebate system. Filing a claim usually takes the following steps:
- Pay for the expense and get a receipt.
- File a claim though a primary insurer (probably through SOGS).
- Fill out the EHP application form.
- Attach your supporting documentation: copies of receipts and insurance information to the application form.
- Early in the academic year, attach a Contract Letter or Duties Specification Letter.
- Drop the form off at the Local's office, mail it to the office, or email in a scanned copy of the documents.
- Wait for us to contact you regarding the claim. (We should have a cheque ready for you in less than three weeks.)
- Pick up your cheque (and fill out your union card if you have not yet done so), or arrange for someone to pick up your cheque, or we will mail you your cheque.
About Supporting Documentation
Your supporting documentation has to establish three things:
- That you have at least one TA position this academic year.
- If you have a TA position any time between September and August, you are covered for that entire academic year. By the end of October and the end of February, we get a list of all the TAs working that semester. So we might already know that you have a TA position. If you have any doubts, or if you are applying early in the academic year, you should attach something to your application that shows your work as a TA for this year.
- Once you have applied once in a year, we keep your information on file so you shouldn't need to provide more information about your employment.
- What your expense was.
- We need to know the exact amount of the expense.
- We don't always need exact details, but we need to know at least the kind of expense you are applying for.
- If something was recommended to you by a health care professional, we need to see that it was recommended.Applying for expenses relating to prescription drugs is usually easy, because the prescription receipt shows your cost exactly and tells us that you had a prescription.
- That you applied to your primary insurance plan.
- We expect that you have applied to your primary insurer for your expenses before you come to us. So we need to see documentation for this or documentation that shows that your insurer will not cover this expense.
- For prescriptions, this again is usually easy; most prescription receipts show the cost after your insurance has covered part of the cost.
- If your primary insurance is through SOGS, then we have a list of what SOGS covers and does not cover.
- If you have reached the maximum that SOGS (or any other insurer) will pay, then you need to show us a statement that shows you reached the maximum. If you send us a receipt for optical expenses, we will assume that you will get $200 of that expense covered by SOGS unless you show us otherwise.
What is Covered
We have a detailed policy on the EHP, but we'll be brief here. Roughly, the EHP will cover any medical, dental, or optical expense that is recommended by a health care professional. Any health care professional operating within their legally proscribed professional limits can recommend a service or product, even an over the counter product, and we will cover it. Purely cosmetic procedures are off the table.
What might we cover that others might not?
- Prescription sunglasses
- Over-the-counter cold and flu medication for children
- Notes from health care professionals
- Medical costs for a gender transition program
- Pregnancy tests
- Medical tests and notes required for legal proceedings and immigration
Frequently Asked Questions
- For how much can I be reimbursed?
Everyone who has a TA in an academic year can draw up to a total $499 from the EHP for that academic year. If you have previously applied to the EHP, you can contact us to find out how much you have left. Usually, if we issue you a cheque, your remaining balance is printed on the stub of the cheque.
- If I got some of this expense covered by someone else, can I get the rest covered by the EHP?
Yes! That's what we're here for.
- Can I cover the expenses of a family member?
Sure. However, these expenses come out of your balance as if these were your own expenses.
- A doctor recommended this supplement, but I don't have a note, will you still cover it?
No. We reed to see some documentation from a health care professional. However, if you have to pay to get a note, we will cover that cost.
- Will you cover alternative medicine?
While we recommend that you only undergo those medical interventions for which there is good evidence, many governments recognize and license professionals from a number of areas outside of science-based medicine. We will cover the costs of any expenses recommended by a licensed health care professional operating within the law.
- How long do I have to wait to hear back on my claim?
In order to process all claims adequately and ensure that the cheques that we issue are are properly authorized, it can take up to three weeks to fully process a claim even if there are no problems with the claim. If there are questions with regard to your claim, we will attempt to contact you for further information.
- Can I submit my claim through email?
Yes and please do. You can email the EHP Administrator directly with an application or any questions.
- What if I have a lot of expenses over $499?
The Local can try to address significant financial need through the Financial Assistance Fund.
- Am I covered after I stopped being a TA, student, or after I have graduated?
Yes, as long TAed for one of the terms this academic year, you are still a member until August 31.