Flex Plan FAQ
How often can I change my Flex Option?
Employees will have the opportunity to change their Flex Option every two years. This way, you can choose a different Flex Option to meet your changing needs. If the Flex Option you’ve chosen still works for you when it’s time to re-enrol, you do not need to make a change.
Should you experience a Life Event before it’s time to re-enrol, you may make a new Flex Option choice within 60 days of the event.
What is considered a Life Event?
A Life Event is:
- Adding a dependent through marriage, common-law relationship, or birth/adoption of a child
- Losing a dependent through death, divorce, or a child losing their eligibility as a dependent under your plan
- Your spouse loses/gains coverage through their own employer’s group plan
You have 60 days from the date of your Life Event to contact Human Resource Services and choose a new Flex Option. You don’t have to make a new choice, but if you feel that the Flex Option you’ve chosen is no longer best for your new situation, you can make a new selection. Regardless, you must notify Human Resource Services when you have a change in dependent status.
Who are considered my Dependents?
Eligible dependents include:
- Your legal spouse, common-law spouse or former spouse. You can only insure one spouse at a time.
- You or your spouse’s unmarried and financially dependent natural, adopted, or step child or any other unmarried financially dependent child for whom you or spouse has been appointed guardian and who meets at least one of the following conditions:
- Is under 22 years of age,
- Is under 25 years of age and attends an educational institution on a full-time basis, or
- Became totally and permanently incapacitated for a continuous period while still considered to be a Dependent under points 1 or 2 above.
A more detailed definition of a Dependent is provided in the Flex Benefits Booklet.
Will I be receiving Canada Life ID and Drug cards?
Yes, you will receive Canada Life ID and Drug cards. Your Canada Life ID and Drug cards contain all the information required when submitting a claim form, including the Division and Class for your chosen Flex Option.
Present your Drug card to your Pharmacist so that they can update your information for direct drug claim submissions at the pharmacy, and to your Dentist, so that they can update your coverage information for direct claims submission.
What is Paramedical?
The term Paramedical is used to describe medical professionals including:
- Athletic Therapist
- Massage Therapist
- Psychologist/Social Worker
- Speech Therapist
Please refer to your Flex Benefits Booklet for more specific details of what paramedical coverage is included under each Option.
What is an HCSA?
An HCSA is a Health Care Spending Account which can be used to cover a range of benefits not normally covered under other types of group benefits plans, or by provincial medical plans. The HCSA is like a bank account for benefits. You use your benefit dollars to pay for covered expenses out of your HCSA. That means $1 from the HCSA buys you $1 of eligible dental or medical services.
Please refer to the Health Care Spending Account pamphlet included with your benefits package.
What is Coinsurance?
Coinsurance is the portion of eligible claim covered by the plan, expressed as a percentage.
For example, Flex Option 2 has an 80% coinsurance on Basic Dental, which means that you would be reimbursed for 80% of the cost of a dental cleaning up to the yearly maximum. The remaining 20% of the cost will be your responsibility. If you had paid $80 for a cleaning, the plan would cover $64 and you would pay $16 as illustrated below:
Plan covers 80%: $64 = $80 x 80%
You pay 20%: $16 = $80 x 20% = $80 – $64
What does Maximum up to Pharmacare Deductible mean in Options 4 and 5?
As a Manitoba resident, you and your family are eligible to receive prescription drug benefits through the Manitoba Pharmacare Provincial Drug Program (Pharmacare).
Pharmacare sets your deductible based on your annual family income. For Options 4 and 5, you can submit drug claims to the Flex Benefits Program up to your Pharmacare deductible amount. Once your Pharmacare deductible is met, Pharmacare will pay 100% of the cost of eligible prescription drugs. The Pharmacare deductible can be satisfied through the claims paid by a group benefits program. Once your claims reach $750, Canada Life will send you a notification to apply for your MB Pharmacare deductible and confirm back to Canada Life the amount.
Application to MB Pharmacare can either be made on a one-time basis or annually. For more information on MB Pharmacare and to calculate your MB Pharmacare deductible, please visit their website.
What is a Dispensing Fee Deductible in Option 4?
The price of every drug prescription is made up of two parts: (a) the cost of the ingredients to make the drug and (b) the cost of the pharmacist’s services and advice called the dispensing fee. Dispensing fees can be different from pharmacy to pharmacy, and from drug to drug.
A deductible is the amount you pay before expenses are covered for each time you claim or purchase an eligible prescription. A Dispensing Fee Deductible means that the deductible is equal to the dispensing fee.
For example, if you were enrolled in Flex Option 4, which has 50% coinsurance for prescription drugs and has a deductible equal to the dispensing fee, for a $50 prescription with a $10 dispensing fee, you would pay $30 as illustrated below:
Plan covers 50% of drug ingredient cost: $20 = ($50 – $10 dispensing fee) x 50%
You pay 50% plus dispensing fee: $30 = [($50-$10) x 50%] + $10 deductible = ($40 – $20) + $10
What is a Deductible per Script in Option 5?
A Deductible per Script (prescription) is the amount you pay before expenses are covered for each time you claim or purchase an eligible prescription drug.
For example, if you were enrolled in Flex Option 5, which has a 90% coinsurance for prescription drugs and has a $4.00 deductible per prescription, for a $50 prescription, you would pay $8.60 as illustrated below:
Plan covers 90% of cost less deductible: $41.40 = ($50 – $4 deductible per script) x 90% = $46 x 90%
You pay deductible plus 10% of balance: $8.60 = [($50 – $4) x 10%] + $4 deductible = $8.60
How does the Manitoba Pharmacare Drug Formulary affect my coverage through Canada Life?
For drugs to be considered eligible under the Manitoba Formulary, prescription drugs must be prescribed by a doctor or dentist and must be included in the provincial drug listing (provincial formulary). Canada Life follows this same listing when determining drug eligibility under our Flexible Benefits plan.
The Manitoba drug listing is constantly changing, with Pharmacare adding and removing drugs frequently. As Canada Life reimburses drug claims according to this formulary, you may find a drug that has been covered in the past is no longer eligible when you try to refill your prescription. Or you may find a drug that was not previously eligible becomes eligible.
There are three different levels of drug coverage under the Manitoba formulary:
- Part 1 medications – are drugs that are covered regardless of the medical need; e.g. Tylenol 3 is eligible regardless if you broke your toe or have a migraine.
- Part 2 medications – are prescriptions that are only eligible under the Pharmacare program if they have been prescribed for a specific eligible condition and it must be noted on the prescription by the doctor; the need determines whether the drug is eligible.
- Part 3 medications – this category is also known as Exception Drug Status (EDS). Medications listed in this category are only eligible if the patient has received prior approval from Manitoba Pharmacare. Approval is given on a case-by-case basis. Your doctor must submit the application on your behalf to Manitoba Health. Manitoba Health will send a letter to the patient confirming their eligibility for coverage. If you are approved, simply send a copy of the letter to Canada Life to have your record updated and retain the original.
I have Exception Drug Status (EDS) and/or Prior Authorization Drugs. Will I be covered?
Yes, if you have been previously approved by Manitoba Pharmacare for a specific medication on an exception basis, it will be eligible. However, Canada Life will require a copy of the documentation approving the drug(s). Please submit a copy to Canada Life for their records to avoid any claim payment delays. If you require a refill of the drugs prior to submitting the information to Canada Life, you must pay for the prescription and then submit the claim with the appropriate documentation for reimbursement.