***The EHB Fund has been exhausted for Summer 2020. Adjudication for the fund will resume in September.***
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. Please note these funds are not administered by the Sun Life Insurance Plan, rather they are administered by the “Extended Health Benefits Committee” and the Equity Officer of CUPE 3903 (ex officio).
- The Committee meets on a monthly basis to adjudicate funds. Please allow for a possible 4-6 weeks to receive a decision from the committee, in the event that you submit your application just after the committee has met for that month.
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.
What is covered under the EHBF?
- Non-MD Psychotherapy
- Travel Health Insurance
- Additional health funds in the event that you exceed your Sun Life coverage; proof of exhaustion of core benefits plan coverage is required
- 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
- Other services de-listed from OHIP
How do I apply?
If you are applying for a service for which you have already paid, receipts are required. If you are applying for a foreseeable expense, 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 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 of 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.