FREQUENTLY ASKED QUESTIONS

ADMINISTRATION 

 

How long does it take to update an address or beneficiary?

Turnaround for these requests is usually within 1 business day.

 

I sent a benefit payment in the mail, how do I know it was received and applied?

If a payment has been sent by mail, it will be the responsibility of the member to call or email the Member Services Department to see if payment has been received.

 

Do I continue to pay for my benefits if I am on CPP disability?

If a member has been approved for Canada Pension Plan (CPP) disability benefits, he/she would have to notify the Trust Administration Office with a letter from the Canada Pension Plan (CPP) and complete an Extension of Benefits form at the benefits office for review. If approved, benefit payments will be waived provided proof from the Canada Pension Plan (CPP) is submitted annually until his/her 65th birthday. See benefit booklet for benefit details.

 

Do I continue to pay for my benefits if I am on WSIB disability?

If a member has been approved under Workers Safety Insurance Board (WSIB) disability benefits, he/she would have to notify the Trust Administration Office and provide proof from the Workers Safety Insurance Board and will be fund assisted for benefits for a maximum of 12 consecutive months from the date of disability. Once the 12 month of fund assistance expires, he/she will complete an Extension of Benefits form at the benefits office advising he/she is still in receipt of WSIB disability benefits and benefit payment will commence at $95.00/month provided proof from the Worker Safety Insurance Board (WSIB) is submitted annually. See benefit booklet for benefit details.

 

I never received my T4A, can I request a duplicate?

Yes, if member has not received his T4A, we can issue a duplicate at any time. Please contact the Member Services Department  [416 240 7487]

 

Do I claim my vacation pay cheque on income tax?

No, the vacation monies reported have already been processed through your employer's payroll and necessary taxes have been deducted.

 

How can members request vacation pay withdrawal, without coming into the office?

Members must complete a Vacation Pay Withdrawal Application and could either mail, fax, or email the completed form to info@183membersbenefits.ca

 

How long does it take to process a vacation pay withdrawal request?  If faxing or emailing the form, why do I not get a confirmation?

Vacation pay requests for pickup is typically 3 to 5 business days and mail out requests is typically 5 to 7 business days. If the member is faxing or mailing the completed application, it would be up to the member to call and confirm if it has been received. If the member emailed the completed application, an acknowledged receipt will be sent to confirm processing of request.

 

Can I apply to the Retiree Benefit Plan before I am 55 years of age?

No, member can only apply for the Retiree Plan if they are at least 55 year of age at the date of retirement, must be a member in good standing with the Union and working for a consecutive five years prior to retirement. Members must also be in benefit status under his/her active plan when applying.

 

Can you check if my union dues are up to date?

Members are required to contact the union office directly.

 

I just had a new addition to my family. What do I need to provide to have them covered under my benefits and is there any other benefits associated with this?

For the birth of a child, a new Application Card would need to be completed with the new child and anyone who was on the previous Application Card should be included. If the member took any time off work for the birth of a child, then they could be entitled to parental leave benefits. With the parental leave application form, we require a letter from the employer on company letterhead stating the dates of absence and a copy of the temporary health card for the child.

 

Can I pay for my benefits over the phone?

No, benefit payments can only be made in person by debit/personal cheque or money order. Member can mail in cheque or money orders but are reminded to include their Name and Union ID/SIN on memo line or on the back of cheque to avoid any delays. Union dues must be paid up to date.

 

How long do I have benefit coverage once I stop working for Local 183?

If you have hours in your hour bank account, they would be used first for benefit coverage. Following the exhaustion of all hours in your account, you can self pay for benefits for a maximum of 12 consecutive months provided you remain a Member in good standing with Local 183.

 

I moved and want to make sure you have my current address on file, what do I do?

Please complete a member Change of Address form and you can either mail, fax or email the completed form to info@183membersbenefits.ca.

 

Can a bereavement claim be submitted for a still born child?

Yes, provided the child was older than 6 months. A death certificate will be provided to the parents if the child was older than 6 months.

 

If member loses their child and the child was only 6 days old, does the member still qualify for parental leave if they were away from work for the first 3 days of birth?

Yes, provided the required forms are submitted.

 

CLAIMS

 

How long does it take to get my claim paid?

Turnaround time on claims can range from 5 to 10 business days depending on the information submitted.

 

Can I fax or email my claim along with copies of receipts?

No, most claims must be sent in with original completed and signed claim form and all original paid in full receipts and any other required documentation.

 

Can Hospital Cash claims be faxed or emailed?

Yes, hospital cash claims could either drop off at the front counter in person, mailed, faxed, or emailed if submitting under the Local 183 Members Benefit Fund. Members are reminded that, if at a later date the insurer is questioning for further medical, the original documents may be requested.

 

Who can sign specialty claims?

All specialty claim forms need to be signed by the member unless a Power of Attorney (POA) is on file.

 

Can a dental estimate be assessed less than 8 -10 days if an appointment is booked within a couple of days?

Members can call the Member Services Department and ask for their estimate to be pulled and assessed as a rush with an explanation.

 

My dental office sent an estimate for me 3 months ago but I need work done now, is it still valid?

Estimates are valid for three months, but if other dental work has been done within those three months, maximums may be different. It is recommended that members resubmit the estimate before commencing with the work.

 

My spouse no longer has coverage with their benefit plan, what do I need to send you to have them covered under my plan?

We require a letter from the spouse’s insurance company stating type of coverage, policy number and the termination date of coverage for your spouse. If the policy was with GWL, then we will accept a letter from the employer with the same information above.

 

I am currently unable to work and have heard I could claim for short term disability; how do I do this?

If you are a member in good standing with Local 183 and if you are entitled to Short Term Disability benefits, please contact Homewood Health at [416-240-2104] / [1-888-315-6011] for additional details on Short Term Disability Benefits.

 

I was recently in a motor vehicle accident and cannot work, can I claim for Short Term Disability?

No benefits are paid for Short Term Disability or Long Term Disability for any injury or illness caused or contributed to by a motor vehicle accident. This applies to motor vehicle accidents that occur in Ontario or Quebec.

 

How do I claim for Life Insurance benefit if my spouse or dependent passed away?

A Life Insurance claim form would have to be completed, along with a copy of the death certificate (An original death certificate is required, if death occurred out of country) and a new Application Card would be required to change either only the dependent listed or both dependent and beneficiary.

 

How long do I have to submit an old claim?

We will review all medical and dental claims with service dates as far back as 18 months. Speciality claims are to be submitted within 12 months.

 

What do I do to keep my dependants eligible when they turning 21 years of age?

Dependent children from 21 years of age, but under age 25, will be covered provided they are attending an accredited school, college or university as a full time student. Annual proof of student registration must be provided to the Trust Administration office on school letterhead.

 

DRUGS

 

What pharmacy can I use?

You may use any pharmacy in Canada that will accept your drug card. 

 

Why is my drug card not working?

There can be many reasons why your drug card is not working. Some issues include you are not in benefit status, your application card has not been fully completed, your dependents are not active on your benefit plan, the spelling of your name is incorrect, date of birth is incorrect, or the pharmacy may be entering the incorrect information. Please contact Member Services at [416-240-7487] for details.

 

I just received my drug card but my name has been misspelled -  What do I do?

If your name has been misspelled on your drug card, then it may have been misspelled on your Application Card. A new application card must be completed in order for a new drug card to be generated. Application Cards are available online and originals can be dropped off or mailed in provided all fields have been completed.

 

What is considered a maintenance drug?

Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.

 

Why can’t I get three months supply of my drug?

Unfortunately, non-maintenance drugs are only covered up to a maximum of 30 days, unless you are traveling for a longer period.

 

I am going away and need more the 1-month medication, what do I do?

We require an doctor’s (M.D.) referral indicating the date you are leaving and date returning along with the name of medications that are required for that time and can be faxed directly to our office at [416-240-7488]. This request can take up to 5 business days.

 

I am travelling tomorrow and need medication but the Doctor’s office is closed, what should I do?

Member can pay for medication out of pocket and once they return, they can get a doctor’s (M.D.) referral and submit along with a claim form and receipts for drugs purchased.

 

My doctor prescribed me Sovaldi® but the pharmacist is not dispensing. The pharmacy advised I need to have this drug approved before being dispensed? What do I do?

There are a number of prescription drugs that require authorization prior from the insurance company prior to being dispensed by a pharmacist.  This helps the member and their eligible dependents by ensuring that a pre-determined clinical condition is present before the drug is approved. Please contact the Member Services Department at [416-240-7487] to request a Prior-Authorization Application.

 

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