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What's
New
The
following improvements have been made to the Plan effective April 1, 2006:
The Dental expenses in
Benefits 02, 03, and 04 will be reimbursed in accordance with the
current Dental Association Fee Guide in effect where the expense is incurred
(if in Canada).
Alcohol and Drug
Counseling
services are now provided under the umbrella of the Member
Assistance Program (MAP) benefit with Family Services.
Alcohol and Drug
Counseling is available to provide confidential and professional
alcohol, drug and addiction counseling and referral services for you and
your family. Specially trained addiction counselors are available 24
hours a day / 7 days a week by telephoning Family Services’ dedicated
toll-free number: 1-800-668-9920.
Qualifying Medical
Expenses commencing April 1st following the members 70th birthday up to
the members 75th birthday are limited to an annual maximum of $3,000. per
person.
Information
for Benefit Plan Members
Generic
Drugs
Prescription drugs
are generally the most costly element of any health care plan—and health
plan costs continue to soar as drug use increases and
new expensive drugs are introduced to the marketplace.
This increase has
led physicians and medical institutions across Canada to make more of an
effort to prescribe
‘generic’ drugs rather than more costly brand name drugs. Plan sponsors
across the country are also working to keep costs to a minimum by
offering coverage for generic prescription medications rather than brand
name drugs.
What
is a generic drug?
When a
manufacturer’s patent protection for a brand name
drug has expired, other manufacturers are allowed to
produce and sell the medication at a lower, more competitive
price. These ‘generic’ drugs must pass the same
rigorous tests for safety, effectiveness and quality as
the brand name form. In order for a generic equivalent
of a brand name drug to be approved, it must release
its active ingredient into the body at the same rate
as the brand name drug. Only non-medicinal ingredients
can differ; these are the substances that give drugs
their shape and color. The true difference between a generic form and a
brand name form is that the brand name
drug was marketed first and is usually more expensive.
What
does my plan cover?
Your drug
plan covers the cost of generic drugs. However,
where no generic drug exists, a brand name drug
replacement will be provided. Under your plan, if you
choose to buy the more expensive brand name drug, or
if your doctor specifies “no generic substitutes” the cost
will be covered up to the generic equivalent, and you
must pay the pharmacist the remaining amount. Before
your doctor prescribes a medication for you, it’s a
good idea to discuss generic options and your plan coverage
so he or she can prescribe your medications appropriately.
What
impact will this change in coverage have on me?
Perhaps
the biggest difference you will see is a reduction in
the amount of money you spend out-of-pocket on prescription
medications. Because the cost of generic medications
is significantly lower, the percentage you are
required to pay (your co-pay) is lower. For example, if
you are a regular user of the asthma drug, Ventolin 1mg/ml
Solution, which typically has a unit cost of 0.9655,
the generic equivalent Gen-Salbutamol has a unit
cost of 0.6083. If you have a 20% co-pay, you will
see a savings of $3.93 (This calculation assumes a
quantity dispensed of 50ml and a dispensing or professional
fee of $7.00. The dispensing fee will vary
by pharmacy.)
Because
generic drugs must pass the same extensive tests
for safety, effectiveness and quality as brand name drugs,
there is no need to worry about the effectiveness of
the treatment. In most cases, generic drugs are already
prescribed where they are available.
This
switch to generic prescription drugs will help you contain
or even reduce personal and health plan costs, without
compromising the quality of your coverage. It will
also help plan sponsors ensure the cost of the plan remains
affordable.
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