Get to know your benefits plan

Please note, you and your dependents must be residents of Canada in order to be eligible to participate in the CAEAS-ECAB benefits plan.

For a full overview of your coverage and applicable limits/maximums, please read the Benefits Plan Design Summary.


You play an important role in understanding your plan, making smart choices and protecting your benefits, now and in the future. Health insurance works just like any other insurance you might have, such as home or auto. It’s important to use your plan for the benefits you need: that’s what the plan is there for. But its financial sustainability depends on careful, appropriate and prudent use by all members – so use it wisely!

Specialty drugs and the FACET program

To help ensure its future sustainability, the CAEAS-ECAB plan includes clinical review of specialty drug claims by Cubic Health, through the FACET program. Specialty drugs are often biologic drugs used to treat complex conditions that have different lines of therapy, such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, multiple sclerosis and plaque psoriasis.

Here’s how the process works:

  • Specialty drug claims are reviewed by a clinical pharmacist at Cubic Health – one who has no financial involvement in the claim – using a transparent, evidence-based protocol and set of clinical criteria by independent experts.
  • The review is focused on two fundamental questions:
    1. Based on all clinical information provided (and subsequently validated), does the member meet the established evidence-based criteria for any specialty drug for the specific disease state?
    2. If so, is the medication prescribed the most appropriate first-line specialty product, at the most appropriate dose?

The goal is to make sure people are getting the right drug, at the right dose, at the right time, for the right condition. For more information on FACET, visit www.facetprogram.ca/caeas-ecab/.


How your Optional Life insurance works

In addition to the Basic Life Insurance provided under ONE-T, you can purchase Optional Life insurance for yourself, your spouse and/or your child(ren). (Please refer to your Benefits Plan Design Summary for details.) If you previously had Member or Spousal Optional Life under your Board plan and purchased this coverage when we moved to the consolidated plan under ONE-T, you may have noticed a change in your premiums. This is due to the way the premiums are calculated.

Some prior school board plans were using a “blended rate” to determine the premiums for Member and Spousal Optional Life – meaning risk was spread equally across all those who purchased the coverage, and all members paid the same rate.

Your plan under ONE-T uses a rate table, meaning individual premiums will vary based on age, gender and smoking status. This is a common approach used by the vast majority of benefits plans today, to make sure individual premiums accurately reflect the level of risk being taken. As a result, you may find that your Optional Life premiums have increased or decreased. For example, if you’re a younger member and a non-smoker, you will pay a lower premium than an older member who smokes.

You can end your Optional Life insurance at any time by contacting Cowan. However, Cowan can only process the termination as of the 1st of the following month; it can’t be done retroactively. For example, if it is July 15, 2019, and you contact Cowan on that date, then they will ensure the termination of your Optional Life insurance is processed for August 1, 2019.

If you have further questions on any of the optional benefits available to you, please refer to the fact sheets on the Resources page.


Understanding coordination of benefits

If both you and your spouse have benefits plans, you can coordinate your benefits – even if you are both members of the CAEAS-ECAB plan – to ensure you’re getting the most from your coverage.

Coordination of benefits (COB) simply means submitting a claim to your plan first, and then to your spouse’s plan. If your spouse is the claimant, then he/she must first submit the claim to his/her plan and then to yours. If the claim is for a dependent child and both parents have benefits coverage, then the claim can be submitted:

1. To the plan of the parent with the earlier birthdate (month/day) in the calendar year; then
2. To the other parent’s plan. (If both parents have the same birthdate, then priority is based on the alphabetical order of the parents’ first names.)

It’s important to remember, however, that claims are subject to Reasonable & Customary (R&C) limits. These limits are the normal range of fees for a medical service in a specific geographical area. Coordinating benefits will increase your overall reimbursement, but due to R&C limits, your claim may not be reimbursed at 100%.


Here’s an example….

Jennifer is covered under the CAEAS-ECAB benefits plan. She gets a pair of orthotics. The CAEAS-ECAB benefits plan covers up to a maximum for orthotics, but Jennifer’s pair exceeds that limit, so the complete cost is not covered.

Mark (Jennifer’s husband) has orthotics coverage under his employer’s benefits plan. Neither Jennifer nor Mark have made any prior orthotics claims this year. To maximize their coverage, Jennifer could:

1. Submit the claim to her benefits plan with Great-West Life for reimbursement, subject to R&C, up to the plan maximum; and then
2. Submit the claim to Mark’s plan for additional reimbursement. If Mark’s plan is also with Great-West Life, the claim would be subject to the same R&C limit, so Jennifer may not be eligible for additional reimbursement. If Mark’s plan is with another insurance carrier the R&C limit may be different.

By coordinating benefits, Jennifer and Mark can maximize their benefits coverage and get higher overall reimbursement for her orthotics claim.


For more information on COB, visit www.greatwestlife.com.

For your personal benefits statement,
please contact Cowan:
https://clients.cowangroup.ca/
one-t@cowangroup.ca

ONE-T benefits image

Make sure to designate your beneficiaries

If you’re an active member, you will need to complete two beneficiary forms: one for Life insurance (with Great-West Life) and one for AD&D (with Chubb). If you’re a retiree, you only need to fill out the Great-West Life form (for Life insurance).

Please note, if you are appointing a minor (under age 18) as a beneficiary, then you will also need to complete the section on Trustee designation on these forms.

You can find the appropriate beneficiary designation forms on Cowan’s Member Access site.

Mail your completed form to:
Cowan Insurance Group
700-1420 Blair Place
Ottawa, Ontario
K1J 9L8

Why does it matter? Submitting these forms will enable the insurance company to pay the benefits to your beneficiaries without the delay of settling your estate. It also ensures that your estate won’t be reduced by additional probate fees, and that the insurance money is provided to your beneficiaries tax-free.

If Cowan does not have signed beneficiary designation forms on file for you:

  • Benefits will be paid to your estate and not directly to your desired beneficiaries; and
  • Payment could be delayed under the rules and laws governing estates.

You may want to consider obtaining legal advice for more information on the implications of having your estate as your beneficiary.

Can I designate more than one beneficiary for a particular benefit? Yes. You can also choose different beneficiaries for Life insurance and for AD&D, based on your estate planning needs.

Beneficiary designations must be completed in ink and in the appropriate section, specifying your beneficiaries’ first and last names, along with the percentage allocated to each person. If you need to make changes, please strike through and initial the change – corrective liquid (e.g., “wite-out”) is not permitted.

How can I confirm my beneficiaries on file? You can view your designated beneficiaries by logging on to Cowan’s Member Access site. Keep in mind, if you experience a life event (e.g., getting married, having a baby, etc.) – or you simply want to change your beneficiaries – you can submit new beneficiary designation forms at any time.

Revocable versus irrevocable beneficiary: what’s the difference?

A revocable beneficiary can be changed by the plan member without the beneficiary’s signature, while an irrevocable beneficiary requires the beneficiary to sign off on any changes.

If you want to designate an irrevocable beneficiary for life insurance, you will have to fill out an additional Great-West Life form. If you want to designate an irrevocable beneficiary for AD&D, just write “irrevocable” on the Chubb form and initial it.

Have questions or need help? Please contact Cowan at 1-888-330-4010 or one-t@cowangroup.ca.