Effective September 1, 2014, the Alberta School Employee Benefit Plan (ASEBP) will be unable to process Extended Health Care and Vision Care claims and Dental Care claims that are submitted on outdated forms. This refers to all Extended Health Care and Vision Care Claim forms and Dental Care Claim forms with an old ASEBP logo, produced before 2011.
Using old forms delays the processing and payment of claims, as the forms do not provide enough information to ASEBP or, in some cases, they provide information that is no longer required.
The most current forms are always available on our website, in the forms section. You can also contact a Benefit Specialist at 1-877-431-4786, and request to have a claim form mailed to you.
The Government of Alberta, the Alberta Pharmacists’ Association and Alberta Blue Cross recently approved the new Pharmaceutical Services Provider Agreement. This agreement provides additional support to pharmacies in offering services that will provide better access to health services for Albertans. It also outlines a number of important changes for pharmacies across the province and how prescription costs are calculated.
While a number of the changes presented in the new agreement will not affect the ASEBP Benefit Plan directly, there are a few that have the potential to greatly impact the plan. While we are still in the process of analyzing how the agreement will affect us, the first change to take effect for ASEBP’s Extended Health Care (EHC) Plan concerns prescription medication dispensing fee maximums.
Starting April 1, 2014—when the new agreement comes into effect— ASEBP will be moving to a flat rate system which will result in a dispensing fee maximum of $9.00 for drugs including purchased compounds and $13.50 for compounds mixed by the pharmacist in-store. This will ensure ASEBP is aligned with the new provincial agreement which has moved to a flat dispensing fee system. You can find more information on this, including definitions of purchased compounds and compounds on our EHC Plan Descriptions page.
What does this new agreement mean for me?
Depending on the particular prescription medication that a covered member is getting filled, some may find they are incurring higher out-of-pocket expenses when the changes go into effect, while others may find they are paying less. ASEBP expects that most covered members will not notice a significant difference.
As mentioned, we continue to analyze the Pharmaceutical Services Provider Agreement and expect there will be additional adjustments to the ASEBP EHC Plan in light of the changes the agreement enacts. We will share any further changes with covered members accordingly. It’s important to note that all benefit providers in Alberta are also affected by changes to new costing for drug ingredients and pharmacy upcharges under the new Pharmaceutical Services Provider Agreement. If you would like to learn more about what makes up a prescription, check out the article of the same name in the Rx Benefits section of our website.
The internet and the development of mobile technologies have really put more power in our hands to take control of our health at all stages of our lives. We now have access to more health and wellness information than ever before. With this in mind, ASEBP would like to know where you turn for health-related advice and information. You can access our short survey here.
As you likely already know, during this year’s teachers’ conventions, ASEBP suspended its assignment of benefits service as a measure to address concerns from covered members regarding products and services provided by some vendors at the conventions.
While this year’s conventions are now over, it has come to our attention that a number of service providers took the temporary suspension of assignment privileges as an opportunity to simply postpone submitting assignment billing rather than billing covered members directly for their products, particularly in the case of compression stockings and orthotics purchases.
In an effort to continue to offer our covered members the service and fiscal responsibility they have come to expect of ASEBP, we have decided to continue the suspension of assignment privileges for compression stockings and orthotics pending a thorough review of billing procedures. While this review may take several months to complete, it is a necessary step in determining the most appropriate way forward with assignment billing.
We will provide further communication on this matter after the review is complete. We thank everyone for their patience and understanding as we work through this issue. If you have questions regarding how this may affect you, please contact an ASEBP Benefit Specialist at 1-877-431-4786.
Visiting the dentist regularly is one of the best way to keep your mouth health in check, but did you know that what we eat and how we exercise also affects our teeth and gums? This month in the For Your Health section, we feature an article on dealing with dental anxiety and phobia, along with a tipsheet that has some great suggestions for eating for better teeth, and an article on keeping your whole body healthy through exercise.
Be sure to check out For Your Health each month for new content!
Once you've registered for a My ASEBP account don't forget to download our free mobile app. It allows you to manage your ASEBP benefits anytime, anywhere!
Check out our new Prescription Benefits section (Rx Benefits button). It's your “go to” resource for insights about prescription drug benefits and what we’re doing, together, to help keep the ASEBP plan affordable for everyone.
For a wealth of Canadian health resources, visit our new and improved Apple-a-Day site!
Find out how the ASEBP plan supports your health in our new Prescription Benefits section.
Visit our For Your Health section each month. It features tip sheets on emotional health, exercise, nutrition and superfoods.