Supplementary Medical Benefits Ratification Questions & Answers

  1. I am curious whether Occupational Therapy is or will be covered?

A: The changes do not include the introduction of occupational therapy benefits.

  1. When would the changes go into effect?

A: If QUFA members and the Administration both ratify the proposed changes, the revised plan design would become part of the Request For Proposals tendering process this fall.  The changes would go into effect at the end of the RFP process, on or about July 1, 2019.

  1. What happens if the ratification fails?

A: We stay with our current plan design.

  1. If a physician’s script says NO SUBS I assume the brand named drug is still covered?

A: QUFA members will still have full drug coverage if the physician’s script indicates NO SUBS for the brand name drug. (The benefit carrier may require additional paperwork from the physician, but there is no loss of benefit.)

  1. If a spouse of a QUFA member is over 65 while the member is under 65, drug claims have to be submitted to GWL on paper.  Will this change with the pay-direct drug card?

A: Good question. The pay-direct drug card should eliminate the need to drug claim paper submissions (since payment to the pharmacy is made directly by the insurance carrier). However, benefit carriers may introduce other reporting requirements for beneficiaries over age 65.

The proposed changes focus on the benefits in the group plan design. This is an important process question which QUFA will raise as part of the criteria in the RFP selection process.

  1. Where can I find more information about the current benefit plan?

A: The Queen’s Human Resources webpage is a good starting point for information about the current plan design.

  1. Most of these changes seem not to bad, though the cost of living adjustment change for LTD is a relatively large reduction.  What was the reasoning there?  I also wonder about the cap on pharmaceutical dispensing fees, since the pharmacies I’ve used all tend to be a bit above 10$.

A:  Professor Santeramo and I have been working on the benefits review for the past couple of years so we will share our thoughts with you on these two items.

  1. LTD premiums are fully paid by employees and the premiums at Queen’s tend to be much higher than the industry average for faculty associations. The challenge is to contain costs without significantly degrading the benefit. 3% CPI protection is the industry norm and we have been paying premiums based on a 5% percent assumption. (CPI has been relatively low for the past decade, but the premiums still need to reflect the potential costs of this life time benefit.) This was the only cost containment strategy we could identify that would not create a prohibitively high trade off of benefits. Again, this is a fully employee paid benefit so the process is trying to achieve the best value for money. A 5% percent reserve put a lot of money into benefits that we never triggered by a CPI rate of that level.
  2. Yes, the $10 dispensing fee cap is a cost containment item. Given the hyper-escalation of drug benefit costs, we would not move on any major cost containment in terms of a co-pay or other benefit reduction form our current fully paid drug benefit plan.  You are right that many pharmacies currently charge $12 for dispensing fees, but there are providers who charge $10, in part, because this cap has become an industry norm for drug benefit plans.

I hope these points are helpful and provide some context for how we arrived at this set of changes.

  1. I like some of the proposed changes to the benefits package, but I am concerned about a couple of them, especially the changes to physiotherapy coverage. It is awkward that we have to vote Yes or No to the whole package, can the changes be reintroduced to be voted on individually?

A: No. It is a package because the changes have to be cost neutral.