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July 28, 2003
Employers must resume paying 80% of full cost of paramedical extended health claims
Arbitrator rules in favour of BCNU
HEABC has been ordered to direct Pacific Blue Cross (PBC) to provide the appropriate coverage to members for claims for paramedical expenses. This was the outcome of a grievance filed by BCNU in February, 2002 when employers balked at reimbursing claims for paramedical services previously covered by the Medical Services Plan.
Immediately, PBC must pay 80% of the full cost of all visits each year to physiotherapists, massage therapists, chiropractors, naturopaths and for non-surgical podiatry, subject to any deductible owing and yearly maximums.*
As a result of the arbitration award, PBC must also review and re-adjudicate all claims since January 1, 2002. PBC must fully reimburse any claims that were disallowed or for whom full reimbursement of the eligible expense was not made.
BCNU will monitor to ensure that all claims are fully reimbursed. If you have a claim that will need to be reconciled you do not need to take any action at this time. Further information will be sent out as the union receives it.
*Note: The amount of reimbursement is still subject to a yearly deductible and yearly maximums, and the plan will only cover what is deemed to be a "usual or recognized" fee for each service. Physio and massage treatments have no yearly maximums. Refer to the pamphlet, Your Group Benefit Plan, for details on coverage under your Extended Health plan available from your employer. |
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