Self-Administration of the ARTA Retiree Benefits Plan
As you have likely read in the last edition of news&views and in the most recent ARTAfacts newsletter, ARTA is moving administration of its Retiree Benefits Plan to provide these services in-house.
Our plan has been administered by a third-party administrator (TPA) since its inception in 1995. It is currently administered by the Alberta School Employee Benefit Plan (ASEBP), which has been a wonderful partner for ARTA.
Unfortunately, because of legislation changes affecting the definition of Health Trusts, ASEBP is unable to provide TPA services for ARTA members going forward. This means ARTA had a choice to make: find a new TPA or bring administration of the plan in-house. Both options were reviewed and, based on the financial benefits that could be realized by ARTA and the plan’s covered members, ARTA’s Board of Directors elected to move administration in-house.
Prior to now, ARTA’s membership was simply not large enough to self-administer our plan. But over the past eight years we have reached a critical mass, thanks to our phenomenal growth rate. When we first moved to ASEBP in 2012, we had 8,200 covered members. Now, our membership is almost triple that number.
To accommodate this exciting change, new administration systems were developed to make operation of the plan as efficient as possible. This is good news, as ARTA is now a “one-stop shop” for managing ARTA membership and administering our Retiree Benefits Plan. All your calls, emails, and mail will go to one location and be responded to by one team of ARTA staff. Communications and processes will be streamlined, as you will no longer need to contact ASEBP regarding your benefits matters.
To accommodate the additional volume of calls and inquiries, we have hired five new Member Services front-line staff members, a team manager and a trainer/quality control expert, as well as a new human resource representative, communications personnel, systems management personnel, and a new accounting resource. With the sizable growth in staff count (more than doubling since this time last year), we outgrew our office space and moved into a new move-in-ready office, which is still located in northwest Edmonton.
Next, we needed a new claims adjudicator to pay the claims submitted by our members. We found a new partner in HBM+, a division of Greenshield Canada (GSC). We worked closely with GSC to ensure the same plan design currently in place will continue when they begin to pay claims, with only very minor changes (such as the drugs subject to Enhanced Special Authorization and Therapeutic Alternative Reference-based Pricing).
We have also been able to leverage services already developed by GSC, including online claims capabilities and a smartphone app that will help you quickly and easily access your health and dental benefits information. You can check your drug coverage, find a nearby health provider, submit a claim, access your electronic ID card, and more.
Finally, you will be able to access online claims submissions and other self-help services from the new member web portal.
What You Need to Know
- If you are a Retiree Benefits Plan member, your new ARTA Member ID card will be mailed to you in December. We encourage you to sign up for online services on myarta.net and download the new ARTA smartphone app.
- Submit your unpaid 2019 and 2020 paper claims to ASEBP up to December 31, 2020. Beginning January 1, 2021, all claims must be submitted to GSC. You will now be able to submit claims online for immediate processing; paper claims forms will still be available on your MyARTA web portal for downloading. Any health and dental claims incurred in 2020 that you do not send to ASEBP prior to December 31, 2020, can be sent to GSC for adjudication up to December 31, 2021.
- Share your new Member ID card with your health service provider for claims submitted electronically, including your pharmacist and dentist. They can update their records and submit claims directly to our new claims adjudicator beginning January 1, 2021.
- If you are taking a drug (approved and filled in the last year) that requires prior authorization, your existing approval from ASEBP will be honoured for that same drug at the same dosage.
- Dental and medical pre-authorizations approved by ASEBP will continue to be valid. However, there may be a delay with receiving the information from the prior carrier. Please submit a copy of the approved pre-authorization with your claim.
- Compound Drugs: A compound drug is prescribed by a doctor but requires the pharmacist to mix or adjust different drug ingredients to customize a specific medication. Given their complex nature, compound drugs will not be grandfathered. Claims for compound drugs should be submitted along with the applicable prescription.
2020 brought with it many challenges but also new opportunities for ARTA. We look forward to the year to come; excitement is in the air and ARTA is ready to take on the new and exciting challenge of self-administering our Retiree Benefits Plan to ensure its long-term sustainability. We thank you for your patience and assistance in this transition.