Benefit Changes Are on the Horizon
Using Your Benefits
ASEBP regularly reviews its benefits offerings to provide covered members with a plan that suits their needs, aligns with the ever-evolving health sector landscape, and is financially sound. The following benefit changes, which take effect January 1, 2023, will enhance the programs, services and benefits we provide, and better meet the needs of covered members and their families.
OTHER MEDICAL SERVICES & SUPPLIES
Psychologists and Counsellors: ASEBP continues to focus on supporting the mental health of its covered members with the following changes:
- Inclusion of counsellors – Claim counselling services (for eligible providers) to a maximum of $120 per session.
- Assessment fees – Psychology and counselling assessment fees will be covered to a maximum of $300 per assessment. To be eligible for reimbursement, assessment fees must be noted separately if included on your counselling or psychology session receipts.
- Psychology services – will be covered on a per-visit basis (rather than per hour) up to $180 per session.
The per person per calendar year maximum of $1,200 is a combined total for all psychologist, counsellor, and assessment claims.
Air purifiers: To align with industry practice, air purifiers will not be an eligible expense; however, this equipment remains an eligible expense under a covered member’s health spending account.
Splints: Splints will become an eligible expense within the Canes, Casts, Cervical Collars, Crutches, Walkers, and Splints benefits, to a maximum of $40 per splint. The combined annual maximum of $100 is maintained.
ASEBP is making some changes to its drug management programs.
- Managed Formulary - ASEBP's drug formulary is the list of generic and brand-name prescription drugs covered by our Extended Health Care (EHC) plans. ASEBP is adopting Alberta Blue Cross’ (ABC’s) managed formulary, which will provide more flexibility and streamlining of services for covered members, their dependents, and health care providers when it comes to handling requests for special authorization drugs. With this new process, ABC will manage the drugs that will be included in our drug formulary and administer all special authorization requests. Members can find drug special authorization decisions under Documents on My ASEBP. Please note that ASEBP will no longer mail decisions to members. More information on how to submit drug special authorization requests is available on our website.
- Enhanced Special Authorization - ASEBP is retiring its Enhanced Special Authorization (ESA) program, which was previously used to administer drug requests for specific health states and will use ABC’s drug special authorization program for all requests. ASEBP will grandfather active ESA authorizations through future renewal cycles with ABC. If the renewal request does not meet ABC's clinical standard for the drug and dosage requested (i.e., the request would typically be declined under their managed formulary), but was originally approved by ASEBP, ABC will grant the renewal. Please note that any changes to the drug or dosage requested for grandfathered ESA approvals will be considered new requests and subject to current ABC criteria.
- Generic Substitution - Our generic substitution policy helps to control drug plan costs by limiting coverage of brand-name drugs to the cost of the generic alternative. ASEBP is changing from Least Cost Alternative (LCA) pricing to generic substitutions for all drugs on ASEBP’s drug benefit list. This change will expand the scope of drugs that ASEBP limits coverage to generic alternatives.
Dental fees are the amounts your dentist charges for the services they provide. The ASEBP will increase our Dental Benefit List fees to match the Alberta Dental Association and College (ADA&C) 2022 fee guide. While you may have 100 per cent coverage for certain dental services, 100 per cent of your dentist's bill may not be covered if they charge more than what is outlined in the ASEBP Dental Benefit List. To avoid surprises, have your dentist submit a predetermination to estimate how much of a certain service or procedure will be covered by your ASEBP Dental Care plan.
Dental Implants: We have increased the yearly maximum for dental implants to $3,500 payable at 60 per cent for Plan 3 or 50 per cent for Plans 2 and 4. Replacements must be 12 years old from the date of the last placement. Please note that plan maximums remain the same.
MYRETIREE PLAN: THE PLAN KEEPS GETTING BETTER!
Increased Dental Care Options – Covered members will have a choice of three Dental Care plans, starting January 1:
- Enhanced Dental Plan Option 1: our original Enhanced Dental Plan, but with a new name.
- Enhanced Dental Plan Option 2: get 80 per cent coverage for basic preventative/restorative treatments up to $1,000 per person per calendar year, and 50 per cent coverage for major/restorative treatments up to $2,500 per person per calendar year.
- Core Dental Plan: no changes.
Please note: Existing members and those who previously waived dental coverage at the time of enrolment will have until January 31, 2023, to submit a MyRetiree Plan Change Application form to switch dental plans or add dental coverage, if they wish to do so.
Moving and Eligibility - And in case you missed it, read about the previously announced MyRetiree Plan enhanced eligibility criteria, including keeping your MyRetiree Plan benefits if you move almost anywhere in Canada (excluding Quebec).
BE IN THE KNOW
While these changes won’t take effect until the new year, it’s a good idea to familiarize yourself with what they may mean to you and your family. If you have questions, please contact us.