Long Term Disability (LTD)

NEWSLETTER November 2009

TO: ACTIVE PLAN MEMBERS OF THE MILLWRIGHT REGIONAL COUNCIL OF ONTARIO BENEFIT PLANS

Our commitment to you and your family is to provide the best affordable benefit program and to advise you immediately of all changes to your benefit program through newsletters such as this. The Trustees have a commitment to you as members and your beneficiaries, to ensure that we deliver the highest level of care and good judgment when managing the Trust Fund. For a description of your benefit program, please see the member booklet which is available on your Millwright Regional Council website at www.millwrightsontario.com Dental Benefits –  Eligible dental expenses incurred on or after January 1, 2010 will be paid up to the maximums in the 2009 ODA fee guide (previously the 2008 fee guide). Long Term Disability (LTD) –  Effective January 1, 2010, any Member currently receiving Long Term Disability benefits of less than $2,000 per month will have their LTD benefit payments increased by $40 per month.

MESSAGE FROM YOUR BOARD OF TRUSTEES MANAGED HEALTH CARE – There is a great deal of focus in the marketplace today on benefit management and the effective utilization of health plan dollars, especially drug plan dollars since they account for 80% of all health care costs. In order to provide the important benefits you and your family need, your Trustees must control costs. One of the ways to do this is by having a Managed Drug Program. This is a drug program with methods of claims measurement and cost controls built in. Some of the features of the Managed Drug Program are: 1. Promotion of the use of generic drugs, wherever possible. 2. Promotion of the purchase of a 90 day supply of maintenance drugs at one time to save on dispensing fees. 3. Complete monitoring and reporting of drug utilization by cost and class of drugs. 4. Coordination of Benefits (explained below). 5. Pharmacy audits (to verify practices and identify any improper practices that would impact the cost of drugs. 6. No more than 30 day supply allowed for acute-care drugs (narcotics, anti-depressants, etc…). 7. Claimant must use up 2/3rds of the prescription dispensed before being allowed to purchase more. 8. Prior authorization program for high dollar and multi-use products (some drugs can be used for multiple purposes and some purposes are covered while others are not eg. Botox). 9. Exclusions of life style choice products (smoking cessation, fertility, anti-obesity). 10. Dispensing fee cap (the current limit is $8.00). 11. Drug ingredient cost mark-up limited to 15%.

Coordination of Benefits (COB) When you and your spouse both have benefit coverage for yourselves and your dependent children, claims for coordinated benefits (health and dental through this Plan) are to be submitted for payment as follows:  Your own claims go to the Millwright plan first. Page 1 of 3  Your spouse’s claims go to her/his plan first.  The expenses for dependent children are also to be coordinated. The parent with the earliest month of birth is to submit dependent claims to their insurer first. For more information on COB, please refer to your member booklet on pages A-7 and A-8.

of 3 Overuse and Abuse of Narcotic Drugs One of the areas of concern with the drug plan is the overuse and abuse of narcotic drugs. Each patient reacts differently to pain medication, and may need more or less pain medication than the average person. However, your Plan has guidelines designed to protect you, such as:  You should obtain your pain medication from one doctor and one pharmacist. Using multiple doctors and/or pharmacists can lead to harmful drug interactions and the possibility of overdose.  Never share your prescription medication with another person.  Do not take over-the-counter medications with narcotic pain medications except on the advice of your doctor or pharmacist.

Orthotics and Orthopedic Shoes Over the past few years, there have been a number of claims submitted by members for Orthotics, Orthopaedic Shoes, Support Stockings and braces that are not payable or only partially payable under your Welfare Plan. Many members are out-of-pocket hundreds of dollars because the expenses submitted were not payable under the Plan. No company or provider can say with certainty that 100% of the cost of these devices and services will be paid by your union or your Plan. The Plan rules clearly state what is payable in your member booklet and periodic newsletters.

Fraud, Misuse and Abuse These serious problems are estimated to cost health and welfare plans in Canada 5 to 10% of total plan expenses. These types of activities may cause benefits to change, be reduced or eliminated to manage costs. One of the best defenses against fraud is being an informed consumer and being aware that fraud is an issue. It is the duty of the Board of Trustees to prevent misuse and abuse of the Benefit Plans. As a plan Member, there are a number of ways that you can help prevent fraud, misuse or abuse of your plan:  Keep personal information safe – this includes your policy numbers.  Do not sign blank claim forms  Question providers who ask you to sign blank claim forms  Assist by providing additional information when requested  Review receipts and claim submissions to ensure they’re consistent with the treatment or goods and services actually received  Report providers who try to initiate abusive behavior  Keep track of your appointments, treatments and dates.  If you feel there is an abuse or misuse of your plan, you have the right to call the Plan Administrator’s Office in confidence.

Important: The member booklet and newsletters are not the governing policies or plan documents. They are an outline of the provisions of the plans and are to be considered as such. These are for your information. They do not create or confer any contractual or other rights. Also, remember that no benefits are guarantee. Your Trustees are committed to providing the best possible benefit plan, as affordable.

Full details of all the benefit plans are set out in the actual plan documents. In the event of any discrepancy benefits will be paid according to the terms of the plan documents, insurance policies and government regulations, as applicable.

If you have any questions or require further information contact the Plan Administrator’s Contact Centre:

MANION, WILKINS & ASSOCIATES LTD. 500 – 21 Four Seasons Place, Etobicoke, ON M9B 0A5 Contact Centre Number: 416-234-3511 Toll Free: 1-800-263-5621 – Fax: 416-234-2071 Yours very truly,

THE BOARD OF TRUSTEES Employer Trustees Union Trustees Larry Brokenshire Ian McIsaac Robert LeChien Ed Spence Denis Magne Dan Trudel