Gary Sawatzky | Chief Operating Officer, ARTA
It’s that time of year again when ARTA announces the benefit plan design changes that are incorporated each November 1.
In September, you received a personal renewal statement outlining the plan changes, which also included your updated monthly premium rates. I want to take this opportunity to remind you of the changes that were implemented so that you have a better understanding of them and how they affect your coverage.
The following changes became effective November 1, 2024, for all members covered by an ARTA Extended Health Care plan:
Weight-Loss Medications
Weight-loss medications were previously eligible for coverage under the lifestyle category of select ARTA Extended Health Care plans and the plans which utilize the ARTARx pharmacy. However, obesity is now recognized as a complex, multifactorial, progressive, and relapsing chronic disease, characterized by abnormal or excess body fat that impairs health, increases the risk of long-term medical complications, and reduces lifespan. ARTA has reclassified weight-loss medications as eligible for coverage under the general prescription drug coverage category. With more effective weight-loss medications such as Wegovy entering the marketplace, there was an opportunity to help our members reach their overall health goals. Please note these medications continue to fall under the prior authorization program, which requires pre-approval from ARTA before claim reimbursement.
Compression Stockings
The annual maximum for compression garments is being increased from $250 to $500. This includes coverage for support stockings, sleeves, and any other prescribed compression garments.
Enteral and Parenteral Feeding Supplies
Coverage for enteral and parenteral feeding supplies have been added to the plan. Enteral feeding is the intake of food when a person can’t physically or safely eat regularly. If a person has a condition that impairs movement or if they experienced an injury, enteral feeding may be used to ensure they are getting the nutrients they need. Parenteral feeding refers to giving nutrition through a person’s veins. They will have a type of venous access device, such as a port or a peripherally inserted central catheter (PICC or PIC line) inserted so they can receive liquid nutrition. Enteral and parenteral feeding supplies include tube kits, connectors, feeding bags, syringes, and pumps. Pumps are the most expensive component and are typically available through public health care plans.
ARTACares
The ARTACares program for medical second opinion services and health care system navigation has been discontinued due to low utilization.
Medical Evidence of Insurability
New benefit plan participants aged 75 and over will be subject to medical evidence of insurability, even if they are joining the plan within sixty days of losing coverage under another group plan.
Usual and Customary Charges
The Usual and Customary charges for acupuncture treatment, athletic therapy, dietician/nutritionist, massage therapy, naturopathic assessment, physiotherapy assessment and treatment, podiatry treatment or X-ray, and psychology treatment have been increased based on the marketplace charges for these services.
Detailed information on these coverage changes is included in the plan booklets, available online at artabenefits.net/benefit-booklets.
ARTA will continue to review potential plan enhancements on an ongoing basis, while keeping the plan affordable for our covered members. Please continue to submit plan change suggestions you think may be suitable for the Health Benefits Committee’s consideration. Suggestions may be mailed to the ARTA office or emailed to [email protected].
After working in group benefits consulting for twenty years, Gary joined ARTA to serve as Chief Operations Officer in November 2017. Gary has his certified Employee Benefits Specialist designation.