Could you please tell me more about the prescription drug coverage changes being made effective January 1 / February 1, 2017?
Effective January 1, 2017 the ARTA Retiree Benefits Plan Extended Health Care coverage updates include the following changes to prescription drugs:
Implementing Therapeutic Alternative Reference Pricing (TARP) for certain drug classes (with one drug class change being effective February 1, 2017);
Implementing a maximum number of dispensing fees for maintenance medication;
Implementing Enhanced Special Authorization for covered members being treated for certain health states;
Removing coverage for non-life-sustaining over-the-counter medications.
Additional information can be found in this document:
Why did ARTA change emergency travel providers?
This change occurred to improve service and to enhance benefits, while positioning the benefit plan for better long term stability. With so much at stake – your health and wellness, and the overall, long-term sustainability of our plan for our members – ARTA is working hard to ensure that the ARTA Retiree Benefits Plan continues to provide a competitive plan at a competitive cost. ARTA’s members will benefit from the improved travel assistance Allianz Global Assistance provides, and from the additional benefits and improvements being covered by CUMIS General Insurance Company.
Who are the new service providers of the ARTA Retiree Benefits Plan?
ARTA’s new emergency travel plan insurer is CUMIS General Insurance Company, and travel assistance provider is Allianz Global Assistance. ARTA has partnered with Allianz Global Assistance to continue to provide you with market leading travel benefits now and into the future. Allianz is known for their efficient and world renowned claims service through their emergency travel provider assistance team.
Can I expect the plan to change under the new providers?
Yes, aside from the change in underwriter and administrator, there are a number of minor emergency travel plan enhancements effective
November 1, 2016, including an increase to $5,000,000 lifetime maximum. There will be no
change in cost. Additional details on these improvements are included below.
Will I see changes to the way I submit my claims and communicate with the ARTA Retiree Benefits Plan emergency travel assistance provider?
Yes, as of November 1, 2016, all ARTA Retiree Benefits Plan emergency travel claims must
be directed to Allianz Global Assistance, at the following number: 1.844.996.9003 toll-free in
North America, or collect from anywhere in the world at 1.519.342.0142. New claim forms will
be available November 1st.
How do I contact Allianz Global Assistance?
After November 1, 2016 Allianz Global Assistance can be reached by calling 1.844.996.9003
in North America, or collect at 1.519.342.0142.
Will there be changes to my premium?
No, ARTA was able to negotiate better coverage for members at the same premium you
What if I am out of the country on November 1, 2016, is there anything I should be aware of regarding my emergency travel benefit?
For any emergency travel expense incurred November 1, 2016 or later, you will be covered by the program underwritten by CUMIS General Insurance Company and administered by Allianz Global Assistance regardless of when your trip started, subject to policy terms and conditions.
Whom do I speak with if I have any questions?
Call your Benefits Plan Coordinator at 1.855.444.ARTA (2782)
What are the plan improvements?
- Increase overall lifetime maximum from $2,000,000 (current) to $5,000,000;
- Return of Excess Baggage (new benefit): covers the cost to return covered member’s excess
baggage up to a maximum of $500;
- Return of Animal Companion (new benefit): covers return of an animal companion up to
- Paramedical Practitioner Services: Increase limit from $225 (current) to $250;
- Meals and Accommodation: increase maximum from $1,500 to $3,000;
- Vehicle Return: increased maximum from $2,000 to $5,000; and
- Treatment of Dental Accidents: increase maximum from $1,000 to $2,000.
These plan improvements are being made with no change to your premium.
For a detailed summary of the plan benefits effective November 1, 2016, please request the Group Insurance SUMMARY from ARTA’s Retiree Benefits Plan contact at 1-780-822-2400.
How can I determine which prescription drugs are covered by the ARTA Extended Health Care Plans?
Once you are covered by the ARTA Retiree Benefits Plan, simply visit www.arta.net, log into your ARTA Members’ Health Care Account, go to the “Coverage” tab and then click “Drug Enquiry”.
Can I change my coverage level at any time, or are my options locked-in?
For Extended Health Care, upon initial enrollment you can choose between two calendar year maximums for prescription drug coverage: $1,200 or $2,000 per person per calendar year. If you select the $2,000 calendar year drug maximum option upon initial enrollment, or if you increase your coverage level to the $2,000 calendar year drug maximum, you are required to remain covered at the $2,000 calendar year drug maximum level for a minimum participation period of 24 months before reducing your calendar year drug maximum option to $1,200.
If you choose to participate in either the Health Wise Plus or Ultimate Health plans, you are required to remain covered at that coverage level for a minimum period of 24 months before reducing your coverage to either the Health Wise or Total Health coverage options.
For Dental Care, upon initial enrollment you can choose between Dental Care Plan Options A, B or C. You are required to remain covered under the selected Plan Option for a minimum period of at least 24 months from the effective date of coverage under that Plan Option prior to reducing coverage (for example, reducing coverage from Plan Option A to Plan Option B) or terminating your coverage. You may improve your coverage at any time (for example, improving coverage from Plan Option B to Plan Option A), but you are required to remain covered at that new Plan Option for at least 24 months from the effective date of coverage under that Plan Option.
How long are the rates which are included in the plan summary document guaranteed?
The ARTA benefits plans are reviewed annually, this review also includes rates. Approved rates effective September 1 of each year are in effect for a 12-month period ending August 31 of the following year.
My deceased spouse would have met the ARTA Retiree Benefits Plan eligibility criteria. Am I eligible to join the ARTA Retiree Benefits Plan as a surviving spouse of a retiree who would have otherwise been eligible?
If you can provide supporting documentation that your deceased spouse would have otherwise been eligible and you are age 55 or older, you are eligible to participate and enroll without evidence of good health in the ARTA Retiree Benefits Plan as long as you apply for coverage within your qualifying period.
I am travelling outside of Canada for the winter. Can I cancel my ARTA Extended Health Care coverage while I am away, and re-enroll without evidence of good health upon my return to Canada?
No, if you cancel your coverage while you are outside of your province of residence and subsequently wish to re-enroll in the ARTA Retiree Benefits Plan, you will be required to
August 31, 2016 Page 5 of 7 Prepared by Aon Hewitt submit evidence of good health for Extended Health Care and Emergency Travel Insurance. There is a chance that you may not be approved for coverage.
My 24 year old daughter lives with my partner and me. Can she be covered as a dependant?
If your child in under 25, and is going to school on a full-time basis at an accredited school, college or university, he or she is eligible. A child who qualifies as a dependant under CRA rules is eligible for coverage under the ARTA Retiree Benefits Plan.
I am now 65 year old and have Seniors’ Drug coverage provided by my Provincial/Territorial Government. Why would I want to enroll in the ARTA Retiree Benefits Plan?
Seniors’ drug coverage varies from province to province/territory. The Alberta Seniors’ Drug Plan covers many commonly used drugs; however, you pay a portion of the cost not covered by the Seniors’ Drug Plan, which is an eligible expense under the Extended Health Care plan. Some prescription drugs which are not on the Seniors’ Drug Plan list may also be covered under the ARTA Extended Health Care plan for ARTA Retiree Benefits Plan participants living in Alberta.
I am going to retire June 15, 2017, and will lose my employer benefit coverage effective June 30, 2017. What date would I put on the application form for the ARTA Retiree Benefits Plan coverage to start?
You should put June 30, 2017, as the date of termination for your benefit plan coverage. If you apply within 60 days of that termination date, your new ARTA Retiree Benefits Plan coverage would be effective the day after the termination of benefit coverage date—July 1, 2017. You can send your application to ARTA a month or two in advance of retirement/termination of coverage indicating date your coverage will end.
When can I join the plan without having to provide medical evidence?
You have 60 days following termination of your group benefits coverage to join the ARTA Retiree Benefits Plan without needing to submit medical evidence of insurability. Following this 60 day period, you need to provide medical evidence of insurability to participate in the Extended Health Care plan, and your Dental Care benefits are be prorated for the remainder of the current year.
As an ARTA member, what additional programs are available to retirees?
As a member of the ARTA Affinity Program, you would have access to:
- Discounts on:
- August 31, 2016 Page 2 of 7 Prepared by Aon Hewitt
- Home & Auto Insurance program
- Scholarship and endowment programs
- ARTA’s news & views Magazine
What benefit coverage is offered to retirees through the ARTA Retiree Benefits Plan?
There are five voluntary benefit packages offered:
- Extended Health Care (four plans available, each with two prescription drug plan
maximum options – $1,200 or $2,000 per person per year)
- Emergency Travel Insurance Benefit – only available with Total Health or Ultimate
Health Extended Health Care coverage
- “Evergreen” base plan of 92 day trip duration coverage, with additional single
trip supplementary coverage extend coverage up to 212 days total
- 100% coverage
- $2 million lifetime maximum
- “Evergreen” base plan of 92 day trip duration coverage, with additional single
- Dental Care
- Life Insurance, and
- Trip Cancellation/Interruption/Delay/Baggage Loss Insurance
The Extended Health Care plan, the Dental Care plan, Life Insurance, and Trip
Cancellation/Interruption/Delay insurance is available on a stand-alone basis,
meaning you may participate in as any or all of these benefits, to best suit your needs.
Only the Emergency Travel plan is not provided on a stand-alone basis – you must
participate in the Extended Health Care plan to be covered for this benefit.
What is the Step Therapy Program included in the ARTA prescription drug plan?
A step Therapy Program encourages covered members (and their physicians) to try a less expensive, therapeutically advantageous, and/or safer product in an effort to protect and optimize treatment to the patient, as well as manage benefit plan costs. Special authorization requests would be available for covered members who cannot take a first-line (less costly) drug.
What does an affiliate ARTA member mean?
To join the ARTA Retiree Benefits Plan, you are required to become a member of the Alberta Retired Teachers’ Association. Teachers and other members of the education sector have voting rights within ARTA. As an affiliate member, you enjoy all the benefits of being an ARTA member but you don’t have voting rights.
As an ARTA affiliate member, what additional programs are available to me?
Can I enrol in the Emergency Travel coverage later?
You will have to submit evidence of good health if your wish to add the Emergency Travel benefit at a later time than initial enrolment.
What does evidence of insurability or evidence of good health mean?
This means that you would be required to fill in a medical questionnaire and may as a followup be asked to submit to a medical examination. This is required if you are eligible and did not join the Extended Health Care plan within the 60 day open enrolment window. If you join within 60 days of your current coverage terminating, you do not have to provide evidence. It is a good idea to join early so that this plan is in place when your current plan ends.
Having trouble properly viewing your ARTA member benefits account?
Maybe it’s your browser! In order to properly access your Member Health Care Account and all of its functionality, you will need at least Internet Explorer 8 or the latest version of Firefox, Safari, Chrome or any other browser installed on your computer.
To upgrade your browser, use the links provided below:
Why does ASEBP need my banking information?
Banking information is needed in order to pay your claims (e.g. dental, extended health care). We also require your banking information to withdraw benefit premiums, if you are responsible for paying for them.
What is my email address used for?
Your email address is used to confirm your Members Health Care Account registration and to send transaction confirmations.
Who do I contact to update the address on my profile?
If you have a Members Health Care Account, you can update your address via the Profile page once logged in. This will update your address with the ARTA Retiree Benefits Plan. You may also contact an ARTA Benefit Plan Coordinator to update your address with the Benefits Plan by calling 780-989-8709 in the Edmonton area, or toll-free at 1-855-444-2782.
If you would like to update your address with the Alberta Retired Teachers’ Association, please contact our office directly at 780-822-2400 in the Edmonton area or toll-free at 1-855-212-2400.
What changes can I make to my benefit coverage?
You are able to make the following changes to your extended health care (EHC) options:
- Change your calendar maximums for prescription drug coverage. Please note that if you are currently enrolled in the $2,000/year maximum, you must stay at this level for a minimum of 24 months before you can change your plan to the $1,200 maximum.
- Change your EHC coverage options. Please note that if you are currently enrolled in the Health Wise Plus or Ultimate Health extended health care plans, you must stay in this plan for a minimum of 24 months before you are able to reduce your level of coverage or opt-out.
You are able to make the following changes to your dental care options:
- You may increase coverage at any time. To cancel or change your dental care coverage option, you must be enrolled in Plan A, B, or C, for a period of 24 months.
You are also able to change your coverage level from single to couple or family status, or vice versa, during a major life event such as an addition of spouse or dependent, loss of spouse’s coverage, or removal of a dependent or spouse from the plan. Changes need to be requested to the ARTA Retiree Benefits Plan within 60 days of the life event, or late applicant provision may apply.
All requests to coverage option or level changes need to be made in writing, and either mailed, emailed or faxed to the ARTA Retiree Benefits Plan.
Where can I find the details of what is covered in each benefit offered by the ARTA Retiree Benefits Plan?
The plan texts for each of the benefits coverage options offered are available on ARTA’s website, www.arta.net. You may also call the plan administrator, ASEBP, at 1.855.444.ARTA (2782) and speak with a Benefit Plan Coordinator regarding questions specific to the ARTA Retiree Benefits Plan.
What is LCA?
The ARTA retiree plan includes a Least-Cost Alternative (LCA) provision. This means that if your doctor prescribes a brand name drug and there is an approved interchangeable (most often generic) version available, the plan will only pay the equivalent of the cost of the interchangeable product.
Generic drugs are only allowed to be considered interchangeable with the brand-name drug if they are considered to be “equivalent” to the brand-name drug. Equivalent means that a generic drug must have exactly the same amount of the active medicinal ingredients as the brand-name drug. In addition, the generic drug’s intended use, effects, side effects, risks and safety must be the same as the original drug.
What drugs are covered under the ARTA plan?
Covered prescription drugs include those medical preparations approved for use by ARTA. Certain drugs which are paid by federal or provincial programs are not eligible for payment under ARTA (for example cancer drugs).
Experimental, cosmetic and natural health product drugs are not covered. Certain lifestyle drugs (for example, erectile dysfunction treatment and hair loss medication) are not covered under ARTA’s Health Wise or Total Health Extended Health Care plans, but have limited coverage under the Health Wise Plus and Ultimate Health Extended Health Care plans. Over the counter drugs are not eligible drug expenses under any plan.
How and when do I join the Alberta Seniors’ Drug Plan?
Prior to turning age 65 you will receive an application from Alberta Health for enrollment in the Alberta Seniors’ Dug Plan effective on your 65th birthday (or your partner’s 65th birthday, if he or she is older than you). You will receive a Seniors’ Drug Plan card in the mail and you must register your card with your pharmacy(ies). The ARTA Retiree Benefits Plan is second payer to the Alberta Seniors’ Drug Plan.
I am covered by the Seniors Drug coverage? Why join ARTA? Wouldn’t that duplicate coverage?
The seniors’ drug coverage varies from province to province/territory. The Alberta Seniors’ Drug Plan covers many commonly used drugs; however, you pay a portion of the cost not covered by the Seniors’ Drug Plan. This cost is an eligible expense under the Extended Health Care plan. Some prescription drugs which are not on the Seniors’ Drug Plan list may be covered under the ARTA Extended Health Care plan.
The Seniors’ Drug Plan in Alberta is the first payor of prescription drug costs. Then any amounts over what they pay may be eligible for claim under the ARTA plan.