Flex Plan Benefits
Employee Benefits
As an eligible employee of the University of Winnipeg you and your dependents have comprehensive health benefits coverage.
Effective January 1, 2016, health benefits are covered under a Flex Plan.
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.
Coverage levels, percentage of reimbursement, and benefit specific maximums are dependent upon the Flex Option in which you are enrolled. Please refer to the appropriate Flex Plan Booklet as well as the General Information below for an overview of your coverage.
Reimbursement under all Flex Plan Options is subject to reasonable and customary charges for eligible health services, up to the benefit specific maximums, where applicable.
The University pays the cost of coverage under all Flex Options; however since Flex Option 4 includes coverage enhancements, employees are responsible for paying the cost of the enhanced coverage through semi-monthly payroll deductions.
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Flex Plan Booklets:
Information in the booklets is sorted firstly by Benefit and secondly by Flex Option. Ensure you are reading the information applicable to your Flex Option.
The Travel Health benefit information applies to Flex Options 1, 2, 3 and 4.
Flex Plan Enrolment Information:
Health Spending Account Brochure
General Information
- Eligibility and Family Status
- Life Event
- Changes in Status
- Leave of Absence Without Pay
- Pharmacare Program
- Travel Health
- Vision Care
Eligibility and Family Status
Employees must be enrolled according to true Family Status.
Eligibility
Spouse
Your legal spouse or the person you have continuously resided with for not less than one full year having been represented as members of a conjugal relationship. A person is no longer eligible for spousal benefits upon date of separation.
Dependent
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 an accredited educational institution, college, or university.
Unmarried, unemployed children over 21 years of age shall qualify if they are dependent upon the covered employee by reason of a mental or physical disability and have been continuously so disabled prior to the attainment of age 21. Unmarried, unemployed children who become totally disabled while attending an accredited educational institution, college or university on a full-time basis prior to attaining age 25 shall also qualify as a Dependent.
Family Status
| Single | You have no spouse (married or common-law) and have no eligible dependent children. |
| Couple | You have a spouse or one eligible dependent child. |
| Family | You have a spouse and one or more eligible children, or two or more eligible children. |
Flex Option 4: Refer to the Flex Plan Options Summary for the employee semi-monthly payroll cost based on Family Status.
Life Event
A Life Event for the purpose of the Flex Plan is:
- Addition of an eligible spouse
- Addition of an eligible dependent child
- Removal of a spouse due to death, separation or divorce
- Removal of an ineligible dependent child only if this results in a change in Family Status (e.g. Family to Couple)
- Your spouse gains or loses coverage through his/her own employer's group insurance plan
You have sixty (60) days from the date of your Life Event to contact Human Resources and choose a new Flex Option. You do not have to make a new benefit selection, but if you feel that the Flex Option you have selected is no longer best for your new situation, you can make a new selection.
Note: Employees must be enrolled according to true Family Status.
Changes in Status
You must notify Human Resources within sixty (60) days of change in your own or your dependents' status resulting from:
- addition of spouse (marriage or common-law)
- birth or legal adoption
- separation
- divorce or termination of common-law relationship
- death
- change of residence
Any changes not reported promptly will be subject to the underwriting rules of Blue Cross.
Note: Employees must be enrolled according to true Family Status.
Leave of Absence Without Pay
Coverage may be continued during a leave of absence without pay for up to a maximum period of 12 months provided you take the necessary action to continue coverage and pay the required employee and University costs. Details can be obtained from Pay & Benefits at 204.258.3805, 204.786.9205 or 204.789.1489
▲Pharmacare Program
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 $1,500 in prescription drug claims per family in a calendar year. When your claims have reached $1,000, Blue Cross will send you a letter asking you to register with Pharmacare. Reimbursement of prescription drug claims will be suspended when claims reach $1,500 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.
Travel Health
The Group Travel Health Plan protects you as an eligible employee as well as your eligible family members from the high cost of EMERGENCY TREATMENT(defined as unexpected, sudden or unforeseen) if required outside Manitoba.
Definitions & Clarifications
- "Departure Date" means the date the plan member leaves their province of residence.
- "Trip" means the total number of days the plan member is outside the boundaries of their province of residence.
- Health Care Practitioner means a person who has met the professional and legal requirements of the jurisdiction where the care or services are provided giving them authority to provide health care services. Where no such professional authority or legal requirements exist, the person must have a certificate of competency from a professional body which is responsible for established standards of competence for the conduct for the particular health care profession and the person must be acting within the scope of that license. In all instances, a person may not be a relative of the insured to be considered a health care practitioner for the purposes of this plan.
- "Emergency Treatment" means unexpected, sudden or unforeseen emergency treatment.
It is recommended the International Travel Assistance service be contacted in all situations where medical services are required.
Vision Care
If you or your spouse are over 65 years of age, 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 Manitoba Blue Cross.