Human Resources - Employee Benefits

Health Benefits

As an eligible employee of the University of Winnipeg you and your dependents have comprehensive coverage under a variety of health benefits.

The Ambulance, Hospital, Extended Health, Dental, Vision and Health Spending Account benefits are insured by the University of Winnipeg and administered by Manitoba Blue Cross. The Travel Health plan is insured and administered by Manitoba Blue Cross. The Wellness/Sustainability Account is insured and administered by the University of Winnipeg. The University pays the entire cost of these benefits.

Benefits

Manitoba Blue Cross e-service

Identification Certificate

Soon after your coverage becomes effective you will receive an Identification Certificate. This certificate identifies you, your eligible dependents, and the type of coverage provided. Whenever you are claiming benefits through Manitoba Blue Cross, be sure to quote your group and contract number in the appropriate space on the Claim Form.

If you have lost or misplaced your Identification Certificate, please go to Blue Cross e-service where you can access your group and contract number and/or request a new Identification Certificate.

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Eligible Family Members

Your spouse and dependent children are also covered under the Ambulance, Hospital, Extended Health, Dental, Vision and Travel health plans. Expenses for services for your spouse and dependents may also be submitted under the Health Spending Account, although you do not receive an additional HSA credit for them. You may not claim for any expenses incurred by your spouse and dependents under the Wellness/Sustainability Account.

The term "Spouse" means a person who:

a) is legally married to you, or

b) although not legally married to you, has continuously resided with you in a conjugal relationship for not less than one full year and has been publicly represented as your spouse. The term "conjugal relationship" is deemed to include a conjugal relationship between partners of the same sex.

A common-law opposite sex spouse or same sex spouse being added after your coverage commences will become eligible on the completion of a one-year cohabitation period. Employees applying for coverage will be required to provide the date of cohabitation on the application form to verify eligibility. Adding a common-law spouse will be based on the date of eligibility and handled in the same manner as adding a spouse following marriage.

The term "Dependent" means:

all natural children, legally adopted children, and stepchildren. Children of the person with whom you are living in a conjugal relationship are also eligible, provided such children are living with you. All children must be unmarried, under the age of 21 and dependent upon you for support or unmarried and under the age of 25 and be in full-time attendance at a specialized school, college or university. Coverage for your dependent child is effective to the end of the month in which he/she ceases to be eligible for benefits.

The age restriction does not apply to a physically or mentally incapacitated child who had this condition prior to the attainment of age 21.

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Claiming for Benefits

All claims with the exception of the Wellness/Sustainability Account should be mailed directly to Manitoba Blue Cross. The Wellness/Sustainability claim should be submitted to Human Resources for reimbursement.

Before mailing your claim to Blue Cross, please ensure that you have identified yourself with your group number and contract number (shown on your Identification Certificate or available from Blue Cross e-service) and that the claim form is signed by you and in the case of a Vision claim, by the service provider.

Electronic Funds Transfer (EFT) is available through Blue Cross. You may register through Blue Cross e-service to have claims payments deposited directly into your bank account, and you will receive e-mail notification from Blue Cross when the payment has been deposited. To register for EFT do the following:

Go to www.mb.bluecross.ca
Click on customer e-service
Register for customer e-service by creating your own User ID and Password
Login using your User ID and Password
Click on electronic funds online application
Complete the application and submit online

When payments are made through EFT you do not receive a Statement of Benefits which you would need to send to the secondary carrier if you are co-ordinating benefits with your spouse. Proof of coverage/payment may be obtained via customer e-service by clicking on the details button and printing out the statement using the printer friendly option.

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Claiming for Ambulance and Hospital Benefits

In Manitoba, ambulance services and semi-private hospital accommodation are provided automatically upon presentation of the Blue Cross Identification Certificate, and no further action is necessary.

Outside Manitoba, you must pay for these services privately and then submit itemized receipts for reimbursement.

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Claiming for Extended Health Benefits

Prescription Drugs

You must submit itemized receipts (specifying name of drug, date purchased, drug identification number, drug cost and amount paid by you) with a completed Extended Health Claim Form for reimbursement.

Claims for Prescription drugs may be made at any time during the year.

NOTE: The Blue Cross plan is integrated with the provincial Pharmacare Program. The Pharmacare Program provides 100% reimbursement for eligible prescription drug expenses that are in excess of the Pharmacare deductible which is calculated as a percentage of family income.

You must register with the Manitoba Pharmacare Program once you have reached $800 in prescription drug claims per family in a calendar year. When your claims have reached $500, Blue Cross will send you a letter asking you to register with Pharmacare. Reimbursement of prescription drug claims will be suspended when claims reach $800 in a calendar year until Blue Cross receives proof of your registration with Pharmacare.

Dependent children over the age of 18 should register with Pharmacare apart from their parents. Drug claims submitted for dependent children over the age of 18 will be suspended when claims for the dependent child reach $100 in a calendar year until Blue Cross receives proof of Pharmacare registration.

Other Expenses

Claims for other eligible expenses under the Extended Health Care Program must be submitted with a completed Extended Health Benefits Claim Form and must include itemized receipts and any required documentation ie: doctor's prescription, referral, Manitoba Health statements, etc.

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Claiming for Dental Benefits

When you, or a member of your family, plan to visit your dentist:

Obtain a separate Dental Claim Form for each member of your family obtaining dental services.

Complete the portions of the Form marked "Subscriber".

Present the Claim Form to your dentist at your first appointment. Following the examination, your dentist will discuss a proposed course of treatment with you and possibly book follow-up appointments. If the cost of treatment exceeds $500, or if treatment consists of Major Dental Services (crowns, bridges, orthodontics, etc.) it is recommended you submit a completed Claim Form to Blue Cross for approval before treatment is started. If the cost is less than $500 or if it is for Basic Dental Services, the dentist will usually retain the Claim Form until the course of treatment has been completed.

Your dentist has the option of billing Blue Cross directly or of continuing to bill you. Please ask at the beginning of treatment how the billing will be made.
1. Should your dentist choose to seek payment directly from Blue Cross, it will NOT be necessary for you to submit a claim. You will be asked to sign the Plan benefits over to the dentist, where indicated on the Claim Form, and the dental office will submit the claim on your behalf.
2. Should your dentist choose to bill you, it will then be necessary for you to submit the completed Claim Form to Blue Cross for reimbursement.

Approximately 10 days after the claim has been submitted, you will receive a "Statement of Benefits" from Blue Cross outlining the benefits that have been paid on your behalf. Should you have any questions concerning the Statement, please call Blue Cross Customer Service at 775-0151, or the Benefits Assistant at 786-9066.

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Claiming for Health Spending Account Credits

All claims must be submitted through your basic Blue Cross plan first, even those that are only eligible for reimbursement under the HSA. Any unpaid balance from your basic plan will then be eligible for reimbursement under the Health Spending Account. You do not have to complete a HSA claim form unless you are co-ordinating benefits.

If you and your spouse are co-ordinating benefits, you must submit a completed HSA claim form along with a Statement of Benefits from the other carrier. The claim must be received by Blue Cross no later than 60 days after the end of the calendar year in which the expense was incurred.

Only one claim may be made against the HSA in a calendar year. Payment under the HSA will be made by Blue Cross when:

Eligible medical expenses for you and/or your family members reach the full calendar year credit, or

At the end of the calendar year if eligible medical expenses are less than the full calendar year credit, or

Within 60 days following termination of employment or retirement.

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Claiming for Travel Health Benefits

Travel Health Claims should be submitted directly to Blue Cross and Blue Cross will co-ordinate claim payments with Manitoba Health on your behalf.

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Claiming for Vision Care Benefits

You must submit a receipt along with a completed and signed Vision Care claim form. If you are not attaching a copy of the prescription, the lower portion of the claim form must be completed and signed by the supplier of the vision care item. If you or your spouse are over age 65, you are also eligible for a limited vision care benefit from the Manitoba Health Program. You must apply for the government benefit before you will be reimbursed by Blue Cross.

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Claiming for Wellness/Sustainability Account Credits

Your completed and signed Wellness/Sustainability Account claim form, along with appropriate receipts, should be submitted to Human Resources for reimbursement.

Reimbursement under the Wellness/Sustainability Account will be added to your taxable earnings and will be subject to Income Tax, Canada Pension Plan and Employment Insurance deductions.

Credits will be available on a calendar year basis, with no carryover of either credits or eligible expenses.

A completed Claim Form with receipt(s) should be submitted to Human Resources when your claim amount for the year has reached at least $25, or at the end of the calendar year, irrespective of the amount.

Reimbursement will be made on the next available pay period following the receipt of your Claim Form in Human Resources.

Due to the taxable nature of the program, current year claims must be submitted for reimbursement in time to be processed for the final pay of the calendar year.

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Co-ordination of Benefits

This situation may arise if both you and your spouse are regularly employed and health plans are provided at both places of employment, or if you both have Blue Cross coverage as employees of the University of Winnipeg.

Under the "Co-ordination of Benefits" provision included in all health and dental plans, you are entitled to claim benefits from both plans, as long as the total benefits received do not exceed the health expenses actually incurred.

In order to obtain these additional benefits, please ensure that you complete the appropriate section of the Claim Form.

If you and your Spouse have coverage through Blue Cross

If the services are provided to you then your name should be indicated on the claim form as the patient and the subscriber with the duplicate coverage through your spouse being indicated in the appropriate section of the claim form.

If the services are provided to your spouse, the above procedure should be followed in reverse.

If the services are provided to your dependent children, benefits should be claimed under the contract number of the spouse with the earlier day and month of birth in the year, with the other spouse's contract number being indicated in the appropriate space on the claim form.

If your Spouse has coverage through a carrier other than Blue Cross

If the services are provided to you then the claim should be submitted for reimbursement under your Contract and Group number to Blue Cross. After receiving payment, any unpaid eligible expenses can be claimed from your spouse's carrier by submitting a copy of the claim and a statement of benefits paid by Blue Cross. Your spouse's employer will provide you with the appropriate claim form.

If the services are provided to your spouse, the claim should be submitted for reimbursement to the other carrier. After receiving payment, any unpaid eligible expenses can be claimed from Blue Cross by submitting a copy of the claim, a statement of benefits paid by the other insurer, and your Blue Cross contract number on a Blue Cross claim form.

If the services are provided to your dependent children, benefits should be claimed from the carrier of the spouse with the earlier day and month of birth in the year, with a claim being made through the other spouse's carrier for any eligible unpaid balance.

If you are separated or divorced, the plan that will pay benefits for your dependent children will be determined in the following order:

The plan of the parent with custody of the child,

The plan of the spouse of the parent with custody of the child,

The plan of the parent without custody of the child,

The plan of the spouse of the parent without custody of the child.

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e-service

You can access information about your health benefits plans directly through the Blue Cross website at www.mb.bluecross.ca

The website provides quick access to:

Plan Information - check who you have listed on your plan or view other demographic information

Benefit Details - check on specific details of a particular benefit, or look at the glossary of terms to better understand benefits

Benefit Eligibility - check if a particular benefit is eligible and what you need to submit a claim

Claim Information - check current claims history for your health and dental claims

Temporary ID certificate - the site provides you with the facility to print a temporary card - a message is automatically sent to Blue Cross to order a permanent certificate

EFT - you can sign up for Electronic Funds Transfer service for payment of claims

For additional information see:MBC Customer E-Service [PDF 2P/309KB]

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General Exclusions

The following exclusions and limitations apply to the Blue Cross Plan as a whole.

The Blue Cross Plan will not pay for:

Medical or surgical services that you obtain on an elective basis.

Services obtained outside the subscriber's province of residence for the treatment of illness or injury for which the subscriber is not entitled to benefits from the provincial medical plan including services obtained on a referral or elective basis.

Services due to riot, civil commotion, war, invasion, act of foreign enemy, hostilities by any armed force (whether war is declared or not), civil war, rebellion, revolution, or insurrection.

Services due to illness injury that is compensable under Workers' Compensation or the Manitoba Public Insurance Corporation.

Mileage or traveling time of any provider of services.

Services for general health examinations, check up purposes or in the nature of rest cures or travel for health; or for travel undertaken for the purpose of seeking medical attention.

Services for cosmetic purposes.

Services to which the subscriber is entitled under the terms of any government or legislative hospital, medical or health plan, or services which he/she is entitled to without charge by law, or for which there is no actual cost to him/her, or to which he/she is entitled to for any other reason.

Fees for completion of claim forms or missed appointments.

Services rendered prior to effective date of coverage or after termination of coverage.

Services not listed as benefits in the Agreement between The University of Winnipeg and Manitoba Blue Cross.

Services rendered by a provider who is not approved provider as determined by Blue Cross.

Any charges which, in the absence of this or similar coverage, would not be charged to the Subscriber.

Expenses for services and supplies rendered or prescribed by a person who is ordinarily a resident in the patient's home or who is a Close Relative of the patient.

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Ambulance/Hospital Exclusions

The following exclusions are specific to the ambulance/hospital plan.

If you or your dependent are hospitalized prior to your coverage becoming effective, you or your dependent (as the case may be) will not be entitled to benefits until the first of the month following 30 days after discharge from the hospital.

Manitoba Blue Cross is not responsible for the availability or provision of any of the services or supplies described herein.

Manitoba Blue Cross is not responsible for any semi-private/private hospital room charges which, in the absence of this or similar coverage, would not be charged to the subscriber.

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Dental Exclusions

The following exclusions and limitations are specific to the dental plan.

Blue Cross will not pay for.

Charges for broken appointments.

Congenital malformations, e.g. cleft palate prosthesis.

Fees arising out of extra services arranged for privately between the patient and the dentist.

Implants.

Charges for oral hygiene instruction, plaque control program, nutritional counselling, or supervised fluoride brush-in (self-administered).

Charges for completion of claim forms.

Charges for appliances which have been lost, broken or stolen.

Gold, crown, fixed bridge, veneers, or other extensive treatment when another material or procedure would have been a reasonable substitute consistent with generally accepted dental practice. Where a reasonable substitute was possible, the covered expense is that of the customary substitute.

Services for Temporo-Mandibular Joint Dysfunction, including night guards.

Charges for treatment other than by a Dentist, except for treatment performed in a dentist office under the supervision and direction of a Dentist by a personnel duly licensed or certified to perform such treatment under applicable professional statutes and regulations.

Separate charges for general anaesthesia except in connection with office procedures as specified in the agreement.

Diagnostic Photographs.

Bleaching of teeth.

Precision Attachments.

Provisions for facilities in connection with general anaesthesia.

Hypnosis and Dental Psychotherapy.

Root Canal on a permanent tooth more than once per lifetime per tooth.

Polishing restorations.

Any procedure in connection with forensic dental.

Complete series of x-rays, panoramic and cephalometric x-rays more often than once every 2 calendar years.

Complete clinical examinations more often than once every 3 calendar years.

Application of fluoride, recall and oral examinations, and a combination of 1 1/2 units of polishing and/or scaling under Basic Services more than twice in any calendar year.

Orthodontic services other than as provided in the agreement, or services for orthodontic treatments rendered to eligible dependents who begin the treatment after their 17th birthday.

Services purely cosmetic in nature, or for purely cosmetic reasons.

Charges for services rendered prior to the effective date of coverage.

Inlays, or onlays more than one procedure per tooth every 5 calendar years.

A crown, veneer, or bridge, (including facing on crown or pontic) more than one procedure per tooth every 5 calendar years.

Full or partial dentures more than once every 5 calendar years.

Relines or rebases more often than once every 3 calendar years.

Snoring/sleep apnea appliances.

Any procedures not specifically listed in the agreement.

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Extended Health Benefits Exclusions

The following exclusions and limitations are specific to the Extended Health Benefits plan.

Blue Cross will not pay for the following:

Any drug or medicine not listed in the most current Manitoba Drug Benefits and Interchangeability Formulary (or in the case of non-Manitoba residents, the applicable provincial drug plan formulary or Blue Cross formulary) regardless of whether the prescription has been issued by a physician and dispensed by a pharmacist.

Orthodontic services.

Services related to the treatment of Temporo-Mandibular Joint dysfunction.

Dental implants.

In excess of a 100-day supply for any drug or medicine.

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Health Spending Account Exclusions

Manitoba Blue Cross shall not pay for the following:

Expenses for Services incurred prior to coverage becoming effective.

Expenses for Services not allowed as an eligible medical expense, for Income Tax purposes, by Canada Revenue Agency.
Services for which benefits would exist outside of the Health Spending Account agreement.

Interest charges on any amount payable as Benefits

Under no circumstances shall unused Health Spending Account credits be paid out as cash.

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Travel Health Exclusions

Blue Cross will not pay for any travel health services if:

You are retired.

You are a student in full-time attendance at a learning institution outside of Canada.

You travel outside Manitoba for the purpose of obtaining medical or hospital services whether or not such trip is taken on the advice of a Physician.

You are beyond age 70 (First of the month following attainment of age 70 for support employees and first of September following attainment of age 70 for academic employees). If you continue in active employment beyond this date, limited travel health coverage is available under the Extended Health Plan

You travel outside Canada for a period in excess of 90 days (or a period in excess of 12 months if traveling outside Manitoba on approved sabbatical leave). If you cease to be actively at work due to accident or illness, you and your dependents will be limited to trips of 90 days in duration outside Canada.

You are traveling against medical advice.

The charges are associated with the required confinement due to childbirth and delivery, in the event that any portion of travel outside your province of residence falls after the 36th week of gestation.

The charges are for any treatment or surgery which is not required for the immediate relief of acute pain or suffering or which reasonably could have been delayed (on medical evidence) until the patient's return to his/her province of residence.

All travel health benefits shall be considered eligible only on submission of certification by the attending Physician that the services were for emergency treatment.� To be eligible, the hospital or medical benefits must have been provided at the nearest facility capable of providing adequate service at the time of illness of injury.��

Blue Cross reserves the right to return the patient to his/her province of residence in an appropriate mode of transportation subject to agreement by the international travel assistance provider and the attending physician that such transportation would not be harmful to the patient's health.� The refusal by the patient or the patient's family to be returned will absolve Blue Cross of any claim liability.

Only charges incurred while traveling outside the boundaries of the province of residence are eligible expenses under the Travel Health Plan.

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Vision Care Exclusions

The following exclusions are specific to the Vision care plan.

Blue Cross will not pay for any of the following:

Charges for fitting of eyeglasses.

Non-corrective sunglasses, photo sensitive, anti-reflective lenses or clip-ons.

Lenses which do not require a prescription from a Physician, Ophthalmologist or Optometrist.

Procedures determined by Blue Cross to be special or unusual such as, but not limited to, Orthoptics, Vision Training, Subnormal Vision Aids, and Aniseikonic Lenses.

Charges for the completion of claim forms.

Charges incurred outside the frequency limitations of the vision care plan.

Eyeglasses must be purchased and repairs must be made for the sole use of the subscriber or his/her dependents.

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Wellness/Sustainability Account Exclusions

The following exclusions are specific to the Wellness/Sustainability Account.

Any expenses for services and supplies rendered by a person who is ordinarily a resident in the employee's home or who is a Close Relative of the employee

Expenses for services or supplies for spouse, dependents or other family members

Fees or expenses for clubs/organizations where the singular focus is not on physical activity

Fees or expenses for services associated with use of a fitness facility (e.g. locker room fees)

Services offered by health practitioners that could be payable under a provincial health plan, the University of Winnipeg group health plans or the Health Spending Account

Fees for services incurred prior to the effective date of the program.

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Changes in Status

Reporting Changes

You must notify Human Resources within sixty (60) days of change in your own or your dependents' status resulting from:

addition of spouse (marriage, common-law, or same sex)

birth or legal adoption

separation

termination of a conjugal relationship

divorce

death

change of residence

Any changes not reported promptly will be subject to the underwriting rules of Blue Cross.

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Long Term Disability

If, after becoming covered for benefits you become totally disabled, and qualify for benefits under The University of Winnipeg Long Term Disability Plan, health coverage will remain in force until you cease to be eligible for Long Term Disability benefits.� If you are a term employee, health coverage will remain in force until you cease to be eligible for Long Term Disability benefits or until the end date of your term, whichever occurs first.

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Leave of Absence Without Pay

Coverage may be continued during leave of absence without pay for up to a period of 12 months provided you take the necessary action to continue coverage and pay the required subscriptions. Details can be obtained from the HR Administrator 258-3805.

Reinstatement following Leave

If coverage has not been maintained during a leave of absence without pay, you will re-establish eligibility immediately upon return to continuing employment status as designated by The University of Winnipeg.

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Termination

When you terminate employment or retire from the University of Winnipeg, your coverage will automatically be canceled as at the date of termination or retirement. Terminated employees are encouraged to submit claims promptly.

Please note that in the event that employment continues beyond age 65, Travel Health coverage terminates on the first of the month following age 70 for support employees, and on September 1st following age 70 for academic employees.

Note: Employees enrolled in this group plan will not be permitted to opt out while still employed by the University except in the event of duplicate coverage. If this situation arises the employee's request to cancel must be received by Manitoba Blue Cross within sixty (60) days of the effective date of the new plan.

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