The purpose of the “Extended Health Benefits Fund” is to support members with health care costs that would cause an undue financial burden and that are not covered by the Sun Life Insurance plan provided by our collective bargaining agreement. There are two fund types which fall under this fund. Please note these funds are not administered by the Sun Life Insurance Plan, and are administered by the “Extended Health Benefits Committee” and the Equity Officer of CUPE 3903 (ex officio).
- Unexpected and Urgent (Option A Form): These applications forms are adjudicated monthly and are for members who have health care costs.
- Foreseeable or planned (Option B Form): These forms are for extended health care needs that are foreseeable or planned, which present an undue financial burden. These applications are adjudicated three times a year, with applications deadlines of September 10, January 10 and May 10.
Who is eligible for the Extended Health Benefits?
- CUPE 3903 members in good standing potentially qualify for this fund.
- This fund does not cover dependents of said members. Please also members who are covered by a dependents’ coverage plan are ineligible for these funds. The only exception is for reproductive technologies, as members and their partners are eligible for reimbursement.
- International Students: If you are under contract and a member in good standing with CUPE 3903
How is the fund calculated?
The EHB committee currently adjudicates using the following criteria and formula. For applications that fall within the committee mandate, applications approved for under $500 are paid out in full immediately. For approved applications that exceed $500, a formula is applied. This formula has the committee immediately pay out the first $500 plus 30% of the remaining approved amount. The portion that is not immediately paid out is recorded. At the end of the funding year (September – August) the committee calculates the available funds remaining and tops up those members whose application was paid out according to the formula to as close as the remaining amount as the committee can afford given funds left available.
What is provided under the Extended Health Benefits Fund?
Amounts given are based on the availability of the funds’ reserves. Approved applicants will generally receive between 25% and 50% of costs for which they apply. Because this fund is distributed based on consideration of financial need, the committee will take into consideration declared personal income.
What is covered under the EHBF?
- Non-MD Psychotherapy
- Travel Health Insurance
- Additional health funds, with proof of exhaustion of core benefits plan coverage (ex. vision care, emergency dental work, prescription drugs
- Parking costs related to a hospital or a doctor’s visit.
- Over the counter supplements that are prescribed by a physician, i.e. Iron supplements. You must provide the prescription and the prescription must be from a medical doctor.
- Naturopathy, Chriopractic, Physiotherapy, Podiatry and Massage Therapy
- Other services de-listed from OHIP
How do I apply?
Option A covers paid expenses and therefore, receipts are required. Option B is for foreseeable expenses and estimates are required from the health care practitioner. Receipts and estimates for travel health insurance must clearly indicate that baggage and cancellation insurance is not included or must separately indicate the cost of those items. Additionally, referral notes are required for massage therapy and orthotics. If you are applying to EHB for any service also covered by Sun Life, proof of exhaustion of Sun Life coverage must be provided. The proof of Sun Life coverage exhaustion can be obtained from the Sun Life website, which usually consists the following message:
R15 We are not able to pay this expense because this claimant has already reached the annual maximum amount covered under the plan for this type of expense.
When a member notifies the committee that they wish to appeal a decision on the application, the member’s application will be reviewed by one committee member, one designated executive member and the Equity Officer (ex-officio). To be considered the appeal must be submitted within one month of the member’s receipt of the committee’s original decision.