ARTA Retiree Benefit Plan’s Response to the COVID-19 Pandemic
COVID-19 is an unprecedented event, affecting nearly every aspect of business around the world, including the Alberta Retired Teachers’ Association. ARTA has taken a number of measures to ensure the ongoing safety of our members and employees in this trying time. We have worked extensively with our partners to meet our members’ needs, facilitating access to benefits and ensuring appropriate coverage is in place wherever feasible.
In response to the COVID-19 pandemic, we have implemented the following changes to the ARTA Retiree Benefits Plan to enable continued access to the plan’s benefits:
1. Members with Extended Health Care coverage normally can claim a maximum of five dispensing fees for maintenance medications. There are nine categories of maintenance medications (for example, anti-hypertensive medications used to treat high blood pressure), and this maximum encourages covered members to purchase three months of medications at a time to minimize dispensing fees.
On March 25, however, the provincial governments of Alberta and British Columbia (among other provinces) advised pharmacies to provide a maximum thirty-day supply of prescription drugs to proactively protect the drug supply. In light of this advisory, we temporarily suspended the maximum number of dispensing fees allowed, and the plan will continue to cover your dispensing fees if you are only able to receive a thirty-day supply of maintenance medications at one time.
UPDATE: Effective June 15th, 2020, the Alberta Government has approved pharmacists dispensing up to a 100-day supply of drugs. Accordingly, the ARTA Retiree Benefits Plan will resume its Maintenance Medication Management program, covering up to five dispensing fees per year for maintenance medications starting June 16. The dispensing fees count will be refreshed as of this date (i.e. the start of the count for the five dispensing fees for 2020 beings June 16, 2020). To read the Government of Alberta’s announcement about relaxing the 30-day limit for prescription drugs, click here.
2. To reduce the number of times you need to leave your home to mail claim forms and receipts for adjudication, we now allow claims to be submitted via email. We were already working toward electronic submission of all claims but have learned this is a lengthy process. Since the system to submit claims electronically is not yet ready, members can submit claim forms and scanned receipts to an email address. We will continue to work toward the electronic submission of all claims and will have more to share with you in the near future.
3. Covered members who use the services of eligible and certified paramedical practitioners (such as psychologists, dieticians, and speech therapists) providing services virtually through FaceTime, Zoom, Skype, or other electronic means will have their claims covered.
ARTA took a long-view approach when it came to monthly benefit premiums. With the changes mentioned earlier, the claims experience was more difficult to predict — we assumed the plan would be paying considerably more for dispensing fees but less for services provided virtually, such as chiropractor visits. Dental care was even more difficult to predict — while claims certainly decreased in April and May, we knew that the majority of these claims were being warehoused; dental work will still be required and covered members will eventually need to make a dental care claim. The reduced claims in April and May will likely be offset by a surge in claims once people are able to visit their dentists again.
Our health plan is completely self-insured, with monthly rates based on the actual costs paid for services. If overall claims increase due to the COVID-19 pandemic, rate action may be required. At the time of writing (late April), it’s too early to predict the overall impact to the health plan, but we continue to monitor the situation to ensure members are paying fair rates for the services used.