Frequently Asked Questions. Boilermakers Lodge 359 Health and Welfare Plan

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1 Frequently Asked Questions Boilermakers Lodge 359 Health and Welfare Plan Question: Do I have to register for Fair PharmaCare? Answer: Yes - and your registration number provided to the plan administrator. You can register for Fair PharmaCare by phone at or online at There is no charge for registering and no premium to pay. PharmaCare provides financial assistance for prescription drugs based on net income, paying 70% of your family s eligible costs for the rest of the year once you reach your established deductible (e.g. all families with an income between $31,667 and $35,000 are assigned a family deductible of $1,000.) If you do not register for Fair PharmaCare and file your registration number with the plan administrator, the reimbursement maximum, under the Boilermakers Lodge 359 Health & Welfare Plan, for eligible prescription drug claims is limited to $ per family, per calendar year. Please note that if you do not register, Fair PharmaCare will automatically apply a $10,000 deductible to you. See the Fair PhamaCare website for more information: Question: I used to be able to drop off my dental or extended health claim and get a cheque within hours. Why is that no longer possible? Answer: The claims processing for your dental and extended health plans is now being done by Bilsland Griffith Benefit Administrators. While over the counter claims payment is not part of this service, cheque pick up can be arranged once a week on Fridays only. If you have your completed claim to the Administrator no later than noon on Thursday, you can make arrangements to pick up your cheque for that claim on Friday afternoon. If you are not picking up a cheque, Bilsland Griffith will have your reimbursement cheque in the mail usually within 3 business days. Please remit claims to: Boilermakers Lodge 359 Health & Welfare Plan c/o Bilsland Griffith Benefit Administrators Loughheed Hwy Burnaby BC V5C 0E4 Tel: Fax: Question: Has there been a change to the process for Weekly Indemnity claims? Answer: Yes, weekly indemnity claims should be submitted to BG Benefit Administrators ( BG ) at: Boilermakers Lodge 359 Health & Welfare Plan c/o Bilsland Griffith Benefit Administrators # Lougheed Hwy. Burnaby, BC V5C 0E4 Phone:

2 Once your eligibility has been confirmed, BG will forward your claim to Manulife Financial for a decision. Manulife is very experienced and will provide professional, thorough and consistent service to the Boilermaker members. Manulife also handles the Plan's Long Term Disability claims - in the event that your weekly indemnity claims turns into a Long Term Disability Claim there is a very efficient and orderly transition. Question: Is it true that I have to apply for Employment Insurance sick benefits in order to receive weekly indemnity benefits from the Health and Welfare Plan? Answer: Yes, you must exhaust your EI sick/illness benefits prior to receiving any weekly indemnity benefits from the Plan. As well, you must provide Manulife with a copy of either your EI decline letter or your EI termination of benefits letter. Question: What if my injury is work related or as a result of a motor vehicle accident? Answer: If your reason for disability is partially or wholly related to a motor vehicle accident or is potentially work related, you must apply for either ICBC or WorkSafeBC benefits. This is a requirement even if you don't believe your claim will be approved by ICBC or by WorkSafeBC. You may also file a weekly indemnity claim, but you will be asked to sign a "Reimbursement Agreement", which means that if your claim is approved by either ICBC or WorkSafeBC, you will reimburse the Health and Welfare Plan for some or for all the benefits you received. Question: What is a Special Authority Request? Answer: Special Authority Requests ( SARs ) are required when your physician is prescribing a medication that is not on the approved list of covered medications by PharmaCare or it is a medication for which PharmaCare would only provide partial or limited coverage. A listing of drugs and request forms can be found on line athttp:// Your pharmacist can also tell you if the medication requires a SAR. Question: Why do I have to go through the Special Authority Request process? Answer: You need to work with your doctor to obtain Special Authority approval to ensure that the Boilermakers Lodge 359 Health & Welfare Plan (the Plan ) does not unduly bare the financial responsibility for medications where the cost can be shared between PharmaCare. Question: What are the Steps for a Special Authority Request? Answer: Your doctor will complete the required form and submit it to PharmaCare on your behalf once you have requested him or her to do so. There is no charge to you for this service. It is not necessary to make an appointment with your doctor to have the SAR completed. You can call your doctor s office and make the request over the phone. As of the Board of Trustees meeting on March 12, 2012 a new process regarding the reimbursement of prescriptions requiring SAR's was approved. Your initial prescription for a drug requiring an SAR will be reimbursed. This will then allow you time to work with your doctor to submit the SAR to PharmaCare. Subsequent prescriptions for the same drug will not be reimbursed if confirmation of the SAR approval or denial is not received by MEBS prior to purchasing subsequent prescriptions.

3 The timing of PharmaCare s response is determined by how urgent your physician indicates your SAR is. At most, a response should be received by your physician from PharamCare within 10 business days. Once your physician receives the response from PharmaCare ask him or her to fax it to the Boilermakers Lodge 359 Health & Welfare Plan c/o MEBS Fax You should then resubmit your claim to MEBS for processing. Approved SARs are entered into the PharmaNet system which is accessible by BC pharmacies. Special Authorities are valid for various time periods, depending on the medication and its prescribed use. If necessary, Special Authority coverage may be renewed. To ensure continuous coverage, requests for renewal should be submitted at least two (2) weeks before the expiry date. Retroactive coverage is not provided. Question: I heard you can get your prescription drugs from Costco Pharmacy at a cheaper price than other pharmacies. Is this true? Answer: If you are interested in paying less for prescription drugs, COSTCO Pharmacy is known to charge less overall on prescription drugs filled at their pharmacy. Question: If I need to Self-Pay and I don t pay until the due date, am I covered still? Answer: No, until your payment is received you are not covered. If you need to get treatment in the first 2 weeks of the Self-Pay month you have to make sure your Self-Payment is received by the Administration Office before-hand. For example, if you are going to the dentist on December 10th, and the Self-Payment notice for December coverage has a due date of December 12th, then the Administration Office needs to receive your Self-Payment by December 9th to be able to tell your Dentist s office you are covered if they need to know. If you wait until the Self-Payment Due Date to pay, then any claims the Administration Office receives on your behalf will be held for payment, until your Self-Payment has been received. If your Self-Payment is not received by the due date, then the claim will be returned as not eligible. Please remember it is your responsibility to act on receiving a Self-Payment Notice and make the necessary payment, treating it responsibly like you treat your other bills. Question: Can I pay my Self-Payment by money order? Answer: Yes, BUT you must make sure that your name is on the money order, and/or attach a copy of the Self-Pay Notice to the money order. Otherwise, the Administration Office will not know who the money order is from because the money order only prints who the payment is to and the amount. Question: Do I need to do anything special if I am having major dental work done? Answer: Yes. Before you get any major dental work done (for example, crowns or bridges), your dentist should send the Administration Office a Pre-Authorization. This provides the details of the dental treatments the dentist plans to perform. The Administration Office will then send a Dental Pre- Authorization Statement to you and your dentist, in writing, which tells you what dental services and fees will be covered by the Plan. This is strongly recommended so that both you and your dentist know the amount covered by the Plan before the treatment is started. And, you will also know in advance of any out-of-pocket expenses you may have to pay.

4 Frequently Asked Questions Boilermakers Lodge 359 Pension Plan Question: Is our Pension Plan a Defined Benefit Plan, or a Defined Contribution Plan? Answer: The Boilermakers Pension Plan is a Defined Benefit Plan, which provides a pension at retirement according to a pre-determined benefit formula. The formula reflects the Pension Plan s funding status, inclusive of the Plan investment earnings. Question: Why does the Board of Trustees have Plan Rules that are restrictive when they don t have to be under Pension legislation? For example, Pension legislation says the Trustees may allow a Member to take a Termination Benefit on or after the date the Member reaches age 55, but the Plan s rule is you must be under age 55. Answer: Pension legislation establishes minimum standards, and where the Pension Benefits Standards Act states that a plan "may" do something the Trustees have flexibility in setting Plan Rules. This is important, because the Board of Trustees, as legal plan administrator, must make decisions on Plan Rules that are determined to be best for the long-term financial health of the Pension Plan in order to provide retirement benefits for all Plan Members and beneficiaries. Question: Is the requirement for Termination Benefit eligibility that the Member worked less than 350 hours in each of the two previous consecutive calendar years, or 24 months period? Answer: The requirement is less than 350 hours in total in two consecutive calendar years. The legislative requirement is that less than 350 hours were completed in any period of two consecutive completed fiscal years of the Plan - a Plan Year under your Pension Plan is a calendar year. Question: Will I receive a full payout of my Termination Benefit? Answer: No, initially you will receive 54%. The Plan s Transfer Ratio is 0.54 effective September 2012, and the BC Pension Benefits Standards Act, provides that 54% of the commuted value of a Termination Benefit may be paid out immediately upon an eligible application being processed. Question: When will I receive the rest of the payout due to me? Effective March 4th, 2013 the Trustees suspended further payment of all deferred payments pending completion of the December 31st, 2012 actuarial valuation report. Question: Who sets the interest rate for commuted value calculations of Termination Benefits? Answer: The formula for the calculation is established by the Canadian Institute of Actuaries. Question: Can I take my Termination benefit in cash? Answer: No. Your Termination Benefit must be used to provide you with retirement income. It can only be transferred, as required under pension legislation, to one of the locked-in investment vehicles listed below. 1. a locked-in Registered Retirement Savings Plan (RRSP), or

5 2. a locked-in Life Income Fund (LIF), or 3. another registered pension plan (if that plan allows it), or 4. a deferred pension or other retirement income fund that is commutable and will not commence before you attain age 50, available from an insurance company or savings institution. Question: If I retire under the Boilermakers Pension Plan and then go back to work later, how come the contributions my employer sends in don t go to my pension account? Answer: Under the Income Tax Act Regulations, Section 8503(3), a Member of a Defined Benefit Pension Plan cannot receive at the same time both a pension and have further pension contributions credited to their account because they are working after taking a pension. Under certain conditions of the Income Tax Act and the Pension Benefits Standards Act, a Defined Benefit Pension Plan may allow a Pensioner to suspend their pension while they continue to work, and therefore receive further defined benefit contribution accruals, but, this option is not available under your Plan. If the Trustees determine that it may be something that the Plan can offer in future they will consider it. Question: A Termination Benefit is based on a commuted value calculation. What is a commuted value? Answer: The commuted value is an actuarial calculation of the amount of money which, if invested today (the present day value ) and until you reached age 61 (the Plan s Normal Retirement Age), would be expected to be sufficient to provide you with the same monthly Pension as you would have received from the Plan retiring at age 61. Question: How is the commuted value calculated? Answer: A commuted value calculation reflects the prescribed standards (Canadian Institute of Actuaries), and various factors such as: a Member's age, accrued monthly pension benefit under the Plan s Normal Form (Life Guaranteed 10 Years), the Plan s Normal Retirement (age 61), actuarial mortality rates and current monthly interest rates reflective of medium/long-term bonds yields.