FREQUENTLY ASKED QUESTIONS

A: In most cases, your Union has negotiated that the Company makes monetary contributions to the Plan on your behalf. In some cases, you may have to make out-of-pocket contributions toward the Plan. Your Weekly Indemnity, Extended Health Benefits, and Dental claims are paid directly by us - not by purchasing insurance.

*Please note that Extended Health Benefits and Dental claims must be received in our Plan Administrator's office by June 30th of the following year to be considered for assessment. For example, claims for 2008 must be received in our Plan Administrator's office by June 30, 2009.

A: Waiting periods can allow us to accumulate funds with which to pay claims. Also, waiting periods help protect the Plan for long-term employees by not allowing claims to be paid out for possible transient employees.

A: You must complete an addition/deletion of dependents form and send it to our Plan Administrator. You can request this form by writing to, phoning, faxing, or e-mailing our Plan Administrator or, you can download the form directly from this website.

A: Please see the above answer to, "How do I add a dependent to my C.H.I.P.S. Plan?" The form that you must complete is the same in either case.

A: Because you are our plan member/certificate holder, it is important that your name be displayed on your C.H.I.P.S. ID Card. However, over the time that you are covered by us, your dependents may be subject to change. For example, you may add or delete a spouse, add one or more children, delete one or more of those children, etc. What does not change over the time that you are covered by us is the fact that you are our plan member/certificate holder. Provided that our Plan Administrator has been notified of who is or is not an eligible dependent on your Plan, your dependent coverage will be administered properly (Your dependents' names do not have to be listed on the ID Card in order for them to be eligible for benefits). So, rather than send you and each of your dependents new cards every time you add or delete dependents, we find it more efficient to have your name on the ID Card and have you or the appropriate service provider confirm eligibility directly with our Plan Administrator.

A: In order to avoid claims cheques or other important correspondence going to the wrong address, please notify our Plan Administrator of your new address in writing as soon as possible. This can be done by regular mail, fax, or e-mail.

Any correspondence sent by the Plan to the member's last known address is considered formal notification. Therefore, if you have not informed our Plan Administrator of your new address, we cannot be held liable for sending information to the "old/wrong" address.

A: You can send claims to our Plan Administrator as they are incurred.

However, we do place a limit on when you can submit eligible Dental claims for the previous year. See below:

*Please note that Dental claims must be received in our Plan Administrator's office by June 30th of the following year to be considered for assessment. For example, claims for 2008 must be received in our Plan Administrator's office by June 30, 2009.

A: Here are some possible reasons:

• We pay according to the BC Dental Association Fee Guide for General Practitioners (hereinafter referred to as the "BC Fee Guide"). Although we adjust payments according to the annual changes in the BC Fee Guide, some Dentists choose to charge prices above those found in the BC Fee Guide. You may wish to ask your Dentist prior to your appointment if s/he charges according to the BC Fee Guide.
• With most of our Dental plans, 12 units of scaling and root planing are eligible each calendar year (one unit is 15 minutes). The majority of members within a given group will find that 12 units of scaling and root planing provides more then enough coverage. The cost for additional units of scaling and root planing are the responsibility of the patient.
• Pitt & fissure sealants are eligible for dependent children under age 19. If you submitted a claim for pitt & fissure sealants for an insured member who is age 19 or older, the claim would not be eligible.

A: Here are some possible reasons:

• Most of our Dental plans show that Composite (white) fillings are eligible for 100% reimbursement of eligible expenses on all teeth. This is a benefit that is not very common in group plans. Similar to the Question above, the service may have been performed by a Dentist who has chosen to charge higher than the BC Fee Guide.
• On the other hand, some of our Dental plans have a more common plan design, whereby Amalgam (metal) fillings are eligible for 100% reimbursement on all teeth, while Composite (white) fillings are eligible only on front teeth. If you belong to such a plan and you have a Composite filling placed on a molar, we will cover the cost of an equivalent Amalgam filling (the difference in price remains the responsibility of the patient).

A: Here are some of the possible reasons:

• With some of our Dental plans, Porcelain (white) crowns are eligible only on front teeth. If you have a Porcelain crown placed on a molar, we will cover the cost of the equivalent metal crown (the difference in price remains the responsibility of the patient).
• When a Crown, Bridge, or Partial Denture is required, your Dentist requires the services of an outside lab to construct the appliance. Since there is no Fee Guide code for lab fees, the industry standard is to allow coverage for lab fees up to 60% of the cost of the appliance (subject to your bargaining unit's plan design). Some labs may charge more than 60% of the cost of the appliance (the difference in price remains the responsibility of the patient).
• If your Dental Plan has a calendar year limit for Major Restorative services, you may have already reached that calendar year limit.
• Prior to having any extensive Dental Services rendered (ex. Over $300), we recommend that you have your Dentist submit a Pre-Authorization of benefits to our Plan Administrator's office. If a Pre-Authorization is submitted to our Plan Administrator, you will receive an "Explanation of Benefits Statement" that will detail what benefits are, or are not, eligible under the Plan.

A: No, Dental Implants are not eligible under C.H.I.P.S. If you have a crown placed on top of an Implant, the cost of the crown is eligible at the GP Fee Guide rate. Implants are very expensive and, therefore, an increase to our current level of funding would have to be negotiated before coverage for implants can be added.

A: Dental Plans can only pay/reimburse services after the services have been rendered. By paying the entire cost of his/her braces when the braces are first placed, that person is, in essence, paying for the cost of the monthly Orthodontic adjustments in advance of the services actually being rendered. We can only pay a percentage of the initial cost of the placement of braces, and a percentage of each monthly adjustment after each adjustment is rendered (Check your particular C.H.I.P.S. Plan to see if Orthodontics are part of your Plan and, if so, at what percentage your eligible expenses are reimbursed).

A: If the Dentist agrees (and we seem to have a very good reputation among Dental offices), we are more than happy to pay your Dentist directly for all of your eligible expenses.

A: You can send claims to our Plan Administrator as often as you need. Unlike some other group plans, we do not make you wait for a certain time period or until you have incurred a certain amount of expenses before you can claim. Therefore, you may claim as often as you feel is necessary.

However, we do place a limit on when you can submit EHB claims for the previous year. See below:

*Please note that Extended Health Benefits claims must be received in our Plan Administrator's office by June 30th of the following year to be considered for assessment. For example, claims for 2008 must be received in our Plan Administrator's office by June 30, 2009.

A: PharmaCare is a BC government program which pays a certain percentage of the costs of designated prescription drugs after you have reached a certain annual deductible. Before May 1, 2003, residents of BC qualified for PharmaCare and were assigned deductibles without having to make a formal application for this coverage.

Effective May 1, 2003, the BC government changed this system and renamed it "Fair PharmaCare". Now, to be eligible for coverage, you must register with this government program, and the government will assign you a deductible which they determine based on family income.

It is in your financial interest to apply for Fair PharmaCare because, after you have paid out a certain amount of money for PharmaCare-eligible drugs in a calendar year (In other words, after you have reached your deductible), Fair PharmaCare will pay 70% of the cost of any PharmaCare-eligible drugs that you purchase for the rest of that calendar year. Moreover, there is an additional deductible amount; if you reach that additional deductible, Fair PharmaCare will pay 100% of the cost of any PharmaCare-eligible drugs that you purchase for the rest of that calendar year. Therefore, by covering some of your drug costs, this program eases the financial burden on you & your family. As a "side effect", it makes your C.H.I.P.S. plan more affordable.

You can register for Fair PharmaCare in different ways:

• One way is by completing, signing, and returning a registration and consent form, which is available from most pharmacies.
• A second way is by phone: (604) 683-7151 (Lower Mainland), or 1-800-387-4977 (Long Distance).
• A third way is via the internet: www.health.gov.bc.ca/pharme

A: Some members put their drug expenses on their credit cards and submit the claim to our Plan Administrator's office for reimbursement. If you take this approach, chances are that you will get your C.H.I.P.S. reimbursement cheque before you get your credit card bill.

However, there is a second option. While you must still submit a paper claim, you can complete an assignment of benefits form and send it to our Plan Administrator. With the pharmacist's permission, we can pay the pharmacy directly for any eligible expenses that you incur.* You can request this form by writing to, phoning, faxing, or e-mailing our Plan Administrator or, you can download the form directly from this website.

*Additional feature: The assignment of benefits form can be used for more than drugs. While you must still submit a paper claim to our Plan Administrator, if the practitioner agrees, you can use the assignment of benefits form to authorize us to pay any practitioner directly under your Extended Health Benefits plan. For example, we could pay any eligible expenses directly to your ophthalmologist, chiropractor, physiotherapist, psychologist, etc.

There is a third option. You may phone our Plan Administrator's office, advise them of the expensive drug claim, and ask for a same-day appointment to visit their office and have the claim assessed that day. If you do not make an appointment before arriving at our Plan Administrator's office, they may not be able to provide same-day assessment of your claim.

A: It depends on your particular bargaining unit and how much money has been negotiated for your benefits. Please check your benefits description and/or contact our Plan Administrator's office for further details.

A: This depends on your particular bargaining unit and how much money has been negotiated for your benefits. Please check your benefits description and/or contact our Plan Administrator's office for further details.

A: No. WI is payable only for a non-occupational accident or illness. If your Workers' Compensation claim is denied, you may then apply for WI.

A: Yes. You must be under a physician's care during the period of your disability.

A: You must complete a beneficiary designation form and send it to our Plan Administrator. You can request this form by writing to, phoning, faxing, or e-mailing our Plan Administrator or, you can download the form directly from this website.