TO: Faculty who are Members of the CP/M Scheme
FROM: Joint Administration/Faculty Association Committee
RE: Supplementary Benefits
In the 1996 remunerations settlement the Faculty Association and the Administration agreed to review specific components of the benefits package. During the summer of that year the principal elements of the medical and dental benefits were reviewed, and changes were ratified by ballot in the fall of 1996.
Some items were deferred from consideration because they are used less frequently and are more complicated. These items were primarily the assistive medical devices that are being used increasingly.
Since the University contribution to the dental plan is in excess of what is needed to provide our coverage, and is indeed now in surplus, we propose to use some of that allocation to improve the dental plan and some of it to improve our medical devices provisions. These changes are described below.
The Joint Committee is now in a position to recommend revisions as follows:
It is recommended that the Major Restorative Coverage, effective July 1, 1998, be amended from 50% of the ODA scale to 70% of the scale.
We are recommending a new structure for partial reimbursement of the costs of medical devices as set out in the attachment to this letter. Our proposals will provide assistance in the purchase of hearing aids and of items not previously covered such as wigs following radiotherapy or chemotherapy, and glucometers. They will provide a structure for dealing with the increased use of devices that is predicted with the shift from institutional to home care and with new technologies. In order to pay for the new items and the increase in cost it is recommended that the University's defined contribution to dental benefits be reduced by $3.00 per month for each active faculty member, and that a deductible of $50 and coinsurance for some parts of the programme, as defined in the attachment, be introduced. You will note that the reimbursement schedule has been defined to provide protection against catastrophic costs.
It is recommended that the Assistive Medical Devices Programme be amended as set out in the attachment and that the University's defined contribution to the dental programme be reduced by $3.00 per month per active faculty member.
As we have made changes to benefits in recent years, we have provided retired faculty with such a choice. Many have made such an election in order to have access to items such as the revised drug and vision care programmes.
We shall provide such a choice again. Retired faculty may have access to the new restorative dental programme and the extended assistive medical devices on condition that they accept the medical and dental programmes for active faculty with the difference noted for out-of-province coverage. We believe that this is an attractive option that retired faculty should take and that it would simplify administration of the benefits programme.
| H. P. Weingarten | C. Beattie |
| A. L. Darling | L. J. King |
| A. J. Harrison | B. Lynn |
1. All benefits payable under the Provincial Assistive Devices Program, other group programs or community organizations should be claimed first. These programs establish protocols, normal prescribing and payment guidelines and our program builds on these.
2. Equipment must be prescribed by a physician (or other licensed professional as necessary) for medical conditions and must be generally accepted as standard medical practice. The plan is intended to reimburse individuals for devices purchased that are considered reasonable and customary services or expenses in the treatment of the illness or injury.
3. Devices necessary only for sports or recreation are not covered.
4. The plan is limited to the purchase of one device for the intended purpose in any year and is not generally liable for lost or damaged devices, nor for the repair and maintenance of such devices unless otherwise noted. Devices may be replaced when the normal lifetime of such devices has expired.
5. All amounts eligible under the plan are based on expenses beyond those payments made from other sources, unless otherwise noted.
For example, if the individual chooses a device which costs $450 and the Assistive Devices Program pays up to $200 for this device, this plan will consider the balance payable by the individual $250 ($450-$200) as an expense payable by this plan. It should be noted, however, that the $450 device must meet the other criteria set out herein.
Type 1: Examples would be diabetic supplies (syringes, glucometers, reagent strips), colostomy and ileostomy supplies, oxygen, dialysis equipment, IV pumps, respiration assistance (neutralizers, mist tents, respirators, percussers, etc.), pressure gradient garments.
Benefit levels for these items would be 100% of the cost.
Type 2: Hearing aids prescribed by an otolaryngologist are reimbursed at 75% of the individual's cost to a maximum benefit of $500 every 3 years. Repairs are covered, subject to the same maximum. Batteries are not covered. In those cases where the otolaryngologist prescribes hearing aids for both ears, the claimant may submit to and receive reimbursement from McMaster for the second hearing aid under the same conditions.
Type 3: For prescription glasses and contacts, an amount of either (i) up to $150 is payable where the period between purchases payable from the plan exceeds 2 years, or (ii) up to $200 where the period exceeds 3 years. Repairs are not covered.
Examples are custom built shoes and custom designed and manufactured orthotic inserts.
Orthotics must be:
I. Custom made and medically required,II. Prescribed by a physician, podiatrist or chiropodist,
III. Prescribed prior to purchase.
To be eligible for payment an orthotic claim must be accompanied by a copy of the recommendation from the prescribing physician, podiatrist or chiropodist including the medical condition necessitating the use of the orthotic device.
Benefit levels are 80% of the cost to a maximum benefit of $400 in any two years.
0% for the first $50, (the "deductible")75% for the next $400,
100% for the cost beyond the deductible plus $400.
The deductible will be revised for the benefit year commencing July 1, 2003, and at five year intervals thereafter. The deductible will be reset at the increment of $10 that falls below the following computation:
$50 X (CPI index in December 2002) / (CPI index in December 1997)
For subsequent revisions the deductible shall be at the $10 increment below:
$50 X (CPI index in December of year [n-1]) / (CPI index in December 1997)
A. HOME CARE DEVICES
These cover expenses required to care for the infirm outside hospital, excluding the cost of home or other renovation.
Examples are hospital beds, bath lifts, commodes, eggcrate/gel mattresses, etc.
If the equipment is only required for a limited period, only the cost of rental will be payable. The decision whether to rent or buy shall be left to the Plan Administrator. For any rental of home care devices, the deduction for the first $50 applies only in the first year.
B. MOBILITY DEVICES
These cover expenses required to allow increased mobility in and outside the house if medically appropriate.
Examples are wheelchairs (electric only if individual cannot power a manual chair), wheelchair lifts, scooters, rollabout chairs, walkers, canes, crutches, etc. Wheelchair inserts and pads required for use with a chair are also covered.
If the equipment is only required for a limited period, only the cost of rental will be payable. The decision whether to rent or buy shall be left to the Plan Administrator. In the case of rental, the $50 deduction applies only to the first year.
C. BRACES, TRUSSES, SUPPORTS
These cover eligible devices required to minimize pain or support part of the body in an appropriate position. Devices
required for only sports or recreation are not covered.
Examples are leg, knee and neck braces.
D. PROSTHETICS
Expenses required to replace parts of the body lost due to illness/injury or malformation. Devices
required to support only sports or recreation are not covered.
Examples are artificial eyes, legs, arms, etc. and breast prosthetics or chin reconstructions are covered following surgery. Wigs are covered following radiotherapy or chemotherapy or if hair loss is due to disease to a maximum of $500 subject to the same co-insurance levels noted above.