The 2020 claims freeze is on

January 1, 2020

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. This year, the annual measure will run on Jan. 9, 2020.

To facilitate the measure, a claims freeze for all plan members will start on Jan. 1, 2020, and will run for a few weeks. 3sHealth will post a news story when the freeze is over.

Please note: during the annual measure, plan members will experience a delay in having their 2020 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.

Dentists who submit claims electronically to Great-West Life will receive a 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 Jan. 1, 2020. The number of hours worked between Jan. 1, 2019, and Dec. 31, 2019, determines eligibility. You must work a minimum of 780 hours in the last 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 Dec. 16, 2019. They will also put a hold on claims incurred in January 2020. 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 Feb. 15, 2020.
 
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 Jan. 31, 2020. This means that if you are an employee that had extended health-care coverage in 2019, and you lose coverage on Jan. 1, 2020, because you worked fewer than 780 hours, you will retain the out-of-country medical emergency portion of your coverage until Jan. 31, 2020.
 
Do you have questions about your eligibility? Or about the benefits available to you in the extended health-care/dental plans? If so, please contact a 3sHealth Benefit Services Officer by telephone at 1.866.278.2301 or by email at ebp@3sHealth.ca.

 


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