Managing your Coverage
What's the eligibility criteria for ASEBP benefits? What if you apply late, or have a change in your employment status? Read on for the ins and outs of your benefits, explained.
In order to be eligible to receive ASEBP benefits coverage through your employer, you must:
- Be an employee actively at work and have completed at least one full day of work for your employer
- Work a minimum number of hours that’s equivalent to at least a 0.2 of a full-time position (your employer’s eligibility criteria may include a higher number of minimum hours or a waiting period)
- Be covered under a provincial health care insurance plan
- Be under the age of 70
- Be a resident of Canada
When you start working for your employer, they’ll send us the basic information required to enrol you in ASEBP coverage. There are a few things you may need to do as well.
- Depending on your employment arrangement, you may have to make some of the following choices about your benefit coverage:
- If your coverage or participation is optional, you’ll need to decide whether to participate or not. Note that if you waive coverage but want to apply at a later date, you'll be considered a late applicant.
- If you have benefit coverage through your spouse you can choose not to participate in benefits that you receive under their coverage. Note that it’s important to indicate that you’re waiving the benefit because of spousal coverage so you aren't considered a late applicant if you lose that coverage at a later date.
- You'll need to let your employer know whether you want single or family coverage.
- Depending on your situation, you may also need to enrol your dependants or designate beneficiaries for your benefits.
All of the above must be completed and submitted to your employer within 31 days of becoming eligible. If you submit your application after 31 days, you'll be considered a late applicant.
In most circumstances, when all of the above has been completed and submitted to your employer within the 31 days, the effective date of your coverage will be your first day of employment or the first day that you become eligible for benefits under your collective or employment agreement.
There are a few different reasons you or your dependants will be considered a late applicant, including:
- Not making your benefit choices within 31 days of becoming eligible
- Not adding your dependants within 31 days of them becoming eligible
- Waiving a benefit but then deciding to apply for it after the 31-day eligibility window
Please let your employer know if you're interested in applying for benefits as a late applicant.
Coverage effective dates for late applicants are different depending on the benefit, and special considerations may be applied for certain benefits as outlined below.
- If these benefits are mandatory with your employer, your coverage will take effect retroactively to your eligibility date
- If these benefits aren't mandatory, your coverage will take effect on the first day of the month following when enrolment information is received by your employer (e.g. if they receive enrolment information on October 15, your coverage will be effective November 1)
- Your coverage will take effect on the first day of the month following when enrolment information is received by your employer (e.g if they receive enrolment information on October 15, your coverage will be effective November 1)
- For drug coverage, pre-existing condition considerations under the Enhanced Special Authorization (ESA) program will apply. This means that if you're currently taking a medication that falls under ESA, you'll have to apply to ESA to determine if this medication will be covered by your benefits. This process may result in conditional approvals or declinations.
Working Past Age 65
If you’re planning to work past the age of 65, you can continue some of your existing benefit coverage as long as you’re actively working at the time that you turn 65. Please note that if you're eligible to continue your benefit coverage, the following rules and limitations apply:
- Your benefits can be extended up to June 30 following your 70th birthday as long as you remain actively at work
- Your coverage remains at the same level/plan you had prior to turning 70 but shifts to be the plan that pays second when you have coverage available through government-sponsored seniors’ health programs like Alberta’s Coverage for Seniors plan
For Accidental Death & Dismemberment:
- Your benefits can be extended up to the June 30 following your 70th birthday as long as you remain actively at work
For Life Insurance:
Please see Life Insurance for details.
For Extended Disability Benefits:
- If you’re receiving Extended Disability Benefits (EDB) payments as you approach age 65, you’ll receive a notification from ASEBP regarding the termination of these benefits.
- If you’re not receiving EDB payments as you approach 65, your eligibility for EDB coverage will end three months before you turn 65, due to the 90-day EDB elimination period.
For the Supplemental Package:
- If you're entering into a new employment contract and are under age 70, you may be eligible to participate in our Supplemental Package. Learn more about these benefits on the Supplemental Package page.
Changes to Your Employment Status
Employment changes can have important implications for your benefit coverage.
If you're on a Leave of Absence
See While on Leave for the full details around how your benefit coverage might change while on a leave of absence.
If you're Laid Off
You may be eligible for ASEBP benefit coverage for up to 90 days after you've been laid off. The first place to start is by connecting with your employer.
If you're on an Exchange or Secondment Outside Canada
If you’re considering participating in an approved teacher exchange program or accepting a secondment position, know that you are eligible for ASEBP benefit coverage as long as:
- You have an Outside Canada Teacher Exchange/Secondment Agreement that outlines the coverage provided and any special conditions and it is signed by you, your employer and ASEBP before you start your placement
If these conditions are met, your coverage will be subject to the following limitations:
- If you qualify for Extended Disability Benefits (EDB) and decide to remain outside Canada, the maximum period you can receive benefits is 24 months. If you return home within the 90-day elimination period, the regular provisions of EDB will apply
- ASEBP Extended Health Care (Drugs, Other Medical Services & Supplies and Travel Emergencies), Dental Care and Vision Care benefits (if enrolled) pay second to any other health care coverage the sponsoring agency or government involved requires you to have
- If you need to be medically evacuated, your Travel Emergencies benefit (if enrolled) will use your current place of residence so you will not be returned to Canada unless you ask to be
If you do not have a signed contract to extend your benefit coverage while you’re on your exchange or secondment, your coverage will be further subject to the following limitations:
- You will have only emergency services for the following benefits (if enrolled):
- Drugs, Other Medical Services & Supplies, Dental Care and Vision Care
- If you need to be medically evacuated, your Travel Emergencies benefit will return you to Canada
- If you require Extended Disability Benefits and refuse to return home, your eligibility to make a claim may be impacted
Before you leave on your exchange or secondment, be sure to:
- Contact your provincial health care insurance plan (in Alberta this is AHCIP)
- Include a copy of your signed agreement and cover letter with your VISA application if you're going to Australia
- Update your email address and banking information on My ASEBP
- Complete the Greater Than 100 Day Supply of Prescription Drugs Request to obtain a supply of your current prescriptions for your entire stay
- Remember to use the Emergency Out-of-Country Claim form for all claims you incur during your stay
If you're no Longer Employed
Your benefits are cancelled when you are no longer working for your employer (terminated) for any reason, though you will still have an additional 60 days to submit any expenses that were incurred up to the date you were terminated for your Spending Account benefits (if applicable) and will still be eligible to convert your ASEBP group life insurance plan into an individual policy.
Changes to Your Personal Information
It’s important to ensure your banking information is current. Benefit reimbursements and withdrawals of your benefit premiums (if applicable) are all done electronically. To change your banking information, visit the My Profile page under the profile icon on My ASEBP. You can add a deposit account, and a withdrawal account depending on your needs.
Address and Contact Information
You can change your contact email address on My ASEBP by clicking the profile icon and choosing My Profile. We recommend using a personal email address so we can reach you regardless of any changes in your working status.
To change your address, you'll need to contact your employer. If you’re an early retiree or participating in the Supplemental Package, please contact us.
Name and Marital / Dependant Status
For name changes and changes to your marital status and dependants, you'll need to fill out a Change Application form. Active employees should submit the form to their employers. If you’re an early retiree or participating in the Supplemental Package, please submit the form to us.
Reasons for Cancelled Benefits
Your ASEBP benefit coverage will be cancelled if:
- You are no longer employed with the participating employer (e.g. termination, resignation, retirement (except Early Retirement), death)
- You are no longer eligible for coverage according to the terms and conditions of ASEBP benefit plans (see Basic Eligibility for details)
- You transfer to an employee group that doesn’t have ASEBP coverage
- Your employer’s participation in the ASEBP plan ends
- The premiums for your coverage are outstanding
Making an Appeal
General Benefits Appeal
ASEBP’s appeal process is designed to ensure that:
- no one entitled to benefits is denied them because procedure was not followed correctly
- you have an opportunity to appeal if you are unsatisfied with the decision regarding your claim because of ASEBP policy
For more information, contact us.
Extended Disability Benefits Appeal
You can appeal a claim decision in either of the following two cases:
- when you submit the claim, if your EDB claim is declined
- after a period of disability where benefit payments were received, if Extended Disability Benefits are terminated
The Extended Disability Benefits appeal process is designed to ensure that no one with an entitlement to EDB is denied them because:
- procedure was not followed correctly
- medical information on file was misinterpreted
For more information about the appeals process, contact your claims facilitator.
Fraud and Abuse of Benefits
To prevent fraud and the abuse of benefits, ASEBP routinely reviews claims for accuracy and has measures in place designed to prevent and detect inappropriate and unusual claims. This includes working directly with our covered members in the investigation of all areas of suspected fraud and abuse of benefits.
The vast majority of claims are submitted in good faith, but sometimes covered members and service providers take advantage of benefit coverage for their personal gain. Some examples include:
- An unauthorized person getting access to your benefits account and claiming their expenses under your plan
- Claiming benefits that aren’t covered by the plan as an eligible benefit (e.g. receiving a spa treatment and claiming it as a therapeutic massage)
- Service providers claiming for services that aren’t medically necessary or weren’t provided
- Misrepresentation of conditions in a disability claim
Fraud and the abuse of benefits is unlawful, and affects everyone. It has lasting impacts, including higher premiums, a reduction in benefit coverage and can even lead to loss of benefit coverage.
Prevention starts with you! There are things you can do to help protect your benefits, including:
- Be cautious of aggressive sales tactics to persuade you to buy unnecessary products or services. Only purchase products or services that are medically necessary.
- Never sign blank claim forms. Only sign claim forms once you’ve confirmed they’re complete and accurate.
- Only share your ASEBP ID number with your health care providers.
- Regularly check your claims history and benefit utilization on My ASEBP or the My ASEBP Mobile App to make sure all claim details are correct. If you notice anything wrong, report it!
How to Report Unusual Claims
If you become aware of an abuse of benefits or any fraudulent claims, please contact us through any of the means below. You can report any suspected cases of fraud anonymously through our confidential hotline.
Toll Free: 1-844-827-TIPS (827-8477)