Health Benefit FAQs
The following are the most commonly asked questions by Members regarding their Health Benefit Plan. If you still have questions after reading this information, please contact the Plan Administrator.
- Where do I get information on what or how much coverage I have?
Every Member of a Health Benefit Plan is issued a Plan Booklet upon enrolment. Please refer to your Health Plan Booklet for a detailed description of the benefits for which you are covered and the amounts for which you may be eligible to be reimbursed. If you did not receive a Plan Booklet or have misplaced your copy, please contact the Plan Administrator, your employer, or local union hall for a replacement copy.
- Can I get access to my personal claims history on this web site?
No. Individual information such as claims history is not available on this web site. Please login to the Member Website, or contact the Plan Administrator for this information.
- The form that I am looking for is not on this web site. What should I do?
Some Plans may have customized forms that are not available on this web site. Please contact the Plan Administrator, your employer or your local union hall for a paper copy of any form that you can’t find on this web site.
- What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to receive similar benefits simultaneously under their Health Benefit Plan or any other group insurance plan (including Provincial Plans), to prevent over payment, benefits payable under their Plan would be co-ordinated with the other Plan.
For example: A Member’s wife is covered under her employer’s plan under with family coverage. The Member, his spouse and their three children are all covered under both Plans. The responsibility of the initial reimbursement is determined as follows: Between the Member and the spouse, whoever’s birthday falls first in the calendar year, their plan is responsible for the initial payment of benefits for the dependent children, then, any amounts that are not paid by that Plan are submitted to the other spouse’s plan.
Therefore, in the event that the Member’s birthday is in April and the spouse’s birthday is in January. The spouse’s plan would be primarily responsible for her claims and the claims of the children. Any amounts not paid by her plan can be submitted to the Member’s Plan for reimbursement.