Employee Benefit Funds Administration Ltd

Employee Benefit Funds Administration Ltd.


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Page updated: Sept 3, 2014

 

Frequently Asked Questions

 

Do I need to submit all of my claims by the end of each calendar year?

There is no requirement that you submit your claims in the same calendar year that you incurred the claims. You have twelve (12) months from the date that the product or service was incurred in which to submit your claim. For example, a prescription drug receipt dated February 1, 2014 can be submitted at any time up to and including January 31, 2015. As the product was incurred in 2014, it will count towards your 2014 calendar year maximum, even if the claim is submitted after January 1, 2015.

We recommend that Plan Members submit their claims as soon as possible. There are several advantages to submitting your claims quickly. The sooner that you submit your claims, the sooner you will receive reimbursement for the eligible amount under the Plan. You are also less likely to lose your receipts, or forget to send your claims within the twelve (12) month time period. As well, we traditionally receive a large volume of claims in November and December each year. If you wait until November or December to submit your claims, it may take longer than normal to receive your reimbursement due to the volume of claims.

How Do I Register for Health & Welfare Benefits?

A Plan Member must complete a "Registration and Declaration of Beneficiary card" on behalf of their family in order to qualify for Benefits. The card can be completed during the initiation process with Local 424, or you can obtain a card from the Fund Office.

If your personal information changes and you need to change a Beneficiary, or change/add a Dependent, you must complete a new Registration and Declaration of Beneficiary card and then submit it to the Fund Office. An original Registration card must be received in the Fund Office in order to make changes to your Beneficiaries or Dependents.

Address changes can be performed without the Plan Member having to complete a new registration card by contacting the Fund Office by telephone, or in writing.

When Do My Dependents Become Eligible For Benefits?

Your Dependents (spouse and children) become eligible for Benefits when you become eligible for Benefits, provided they are properly registered on the Registration and Declaration of Beneficiary card, the card has been received in the Fund Office and the Dependent qualifies as a Dependent under the Plan rules. For all Dependent children from ages 18 to 25, the Fund Office will also require a "Dependent Update form" be completed by the Plan Member.

The Dependent Update form ensures that the Dependent meets the requirements of a Dependent under the Plan rules (refer to Article 1.15 of the Plan booklet). Along with the other requirements, Dependents between the ages of 21 and 25 must be attending an accredited education institute on a full-time basis. The educational institute will be required to complete the verification of enrolment form advising which school terms the Dependent is registered in during the calendar year.

Dependent Update forms can be found on our website at www.ebfa.ca, or you may contact the Fund Office to obtain the form.

How Do I Claim Benefits When Both My Spouse and I Have Our Own Insurance Coverage?

If you are a Plan Member under a plan, that Plan will always pay before a plan that covers you as a Dependent. In other words, you must submit your claims to your own Plan first.

If you are a Plan Member with the Electrical Industry Insurance Benefit Trust Fund of Alberta, you must submit your claims to the Fund Office for payment first. Please ensure to keep a copy of your claim with your records until you receive the statement showing what was paid from the Fund Office. This statement is usually called the "co-insurance statement". Once you receive the statement, you can attach it to the copy of the claim held in your records and submit it to your Spouse's insurance company for payment of the balance.

Your Spouse would submit his/her claims to his/her insurance company first, then to the Electrical Industry Insurance Benefit Trust Fund to pay the balance.

How Do I Claim Benefits If A Plan Member Has Two Insurance Plans?

If you are covered under more than one insurance company at the same time, you must first submit your claims to the plan that covers you as an active full-time employee, secondly to the plan that covers you as an active part-time employee and then to the plan that covers you as a retiree.

If you are a considered a part-time employee under both plans, then you would submit your claims to the plan that has been in effect the longest. The same holds true if you are considered a retiree under both plans.

How Do I Claim Benefits for my Dependent children?

When both parents have plans, the children's claims must be sent to the plan of the parent that has the earlier birth date in the calendar year. For example, the father is born October 11th and the mother is born January 5th. Therefore, the children's claims must first be sent to the mother's plan for payment.

If both parents are born on the same month and day, the plan of the parent whose first name begins with the earlier letter in the alphabet will pay first. For example the mother and father are both born on October 11th. The father is named Bill and the mother is named Jane. Therefore, Bill's plan will pay first.

Children who have coverage under an educational institution must first submit their claims to this institution, then through one of the parent's plans (see above paragraphs) as a Dependent.

What is my Stakeholder Number?

A stakeholder number is a unique number given by the Fund Office to each Plan Member and Dependent of the Plan. The stakeholder number replaces the need to use a Social Insurance Number as an identification number when submitting claims to the Fund Office. If you do not know your stakeholder number, you may contact the Fund Office to obtain this number.

Why are some medical and dental expenses covered and others are not?

On a regular basis, the Trustees, with input from the Plan Consultant and feedback from Plan Members, review which types of Benefits should be available to Plan Members and their Dependents. While it would be nice to have everything covered, the Plan is limited by the amount of employer contributions that are received based on the Collective Bargaining Agreement. Benefits covered are those that are medically necessary, benefit the majority of Plan Members and their Dependents and are items that the Plan can afford to cover on an on-going basis.

Why are referrals required for paramedical services?

Under the rules of the Plan, paramedical services are covered provided the charges are Medically Necessary to the care and treatment of any existing or suspected Injury, Disease or pregnancy. In order for the Fund Office to determine this rule, each Plan Member (or Dependent) must submit a medical doctor's referral which confirms the type of paramedical service that the doctor is referring the claimant for. The Fund Office will also accept referrals from chiropractors for chiropractic services. Upon receipt of the referral by the Fund Office, the referral will remain in effect for one year from the date the doctor/chiropractor signed and dated the referral.

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By accessing this website you are agreeing to be bound by the Terms and Conditions of Use. The information contained in this Questions of the Month section is for general use and information and is not individualized. You should not necessarily rely on or take any action or course of action based upon the information contained herein without seeking professional advice or without confirming your understanding with our offices. While we strive to offer up-to-date information and assistance, it is possible that the information contained in this Question of the Month section may not be suitable for your particular situation and/or may contain errors and/or omissions. We specifically disclaim any and all liability for any information, misinformation, and omissions or for any usage or reliance on this Questions of the Month section whatsoever.