2019 claims freeze is on

January 8, 2019

Each January, 3sHealth conducts an annual measure to determine whether certain health system employees are eligible for workplace benefits. All other-than-full-time employees are subject to the annual measure. In other words, the annual measure does not apply to full-time staff.

This year, the annual measure will run on January 10, 2019.

Please note: during the annual measure, plan members will experience a delay in having their 2019 claims processed by Great-West Life.

During the first three weeks of January, health system employees are encouraged to submit any drug claims by paper or online through the GroupNet for Plan Members site. Please do not use your pay direct drug card during this period.

If your dentist submits claims electronically to Great-West Life, your dentist will receive an electronic notice that the claim will be held for processing. Once claims processing commences, Great-West Life will begin processing electronic claims in the order they were received.

Why an annual measure?

If you are a health system employee who works other-than-full-time hours, the annual measure determines if you are eligible for workplace benefits as of January 1, 2019. The number of hours worked between January 1 and December 31, 2018 determines eligibility. You must work a minimum of 780 hours in the preceding calendar year to be eligible for workplace benefits from 3sHealth.

How are recent claims affected?

Great-West Life will hold all pre-authorized claims submitted after December 16, 2018. They will also put a hold on claims incurred in January 2019. They will lift these holds once the annual measure process is completed. Great-West Life will begin processing pre-authorizations and claims in mid-January in the order they were received. Their goal is to finish this work by February 15, 2019.

I’m travelling outside Canada in January. Will I still have medical emergency insurance?

Many employees book out-of-country vacations in January. Often, employees are away during this annual measure period and are unsure if they have coverage in place. This leaves people wondering whether they need to purchase additional medical emergency insurance for their trip.

In partnership with Great-West Life, 3sHealth is pleased to advise that once again, we will extend the out-of-country medical emergency coverage to our plan members during the annual measure period to January 31, 2019. This means that if you are an employee that had extended health-care coverage in 2018 and you lose coverage on December 31, 2018 because you worked fewer than 780 hours, you will retain the out-of-country medical emergency portion of your coverage to January 31, 2019.

If you have any questions about your eligibility or the benefits available to you in the extended health care or dental plans, please contact a 3sHealth Benefit Services Officer by telephone 1.866.278.2301 or by email ebp@3shealth.ca.

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