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FACET Prior Authorization Drug Program

FACET Prior Authorization Drug Program

The UBC Extended Health Plan provides you and your eligible dependents with comprehensive coverage for medical services, supplies and prescription drugs.

Effective May 6, 2018, specialty drugs that are used to treat specific health conditions and that cost more than $5,000 per person, per calendar year will require pre-approval (“Prior Authorization”). This means that if your physician prescribes such a specialty drug for you or your covered dependents, you and your physician must submit evidence that supports the need for the drug in order to obtain coverage for it under the extended health benefit plan.

If you or your covered dependents were reimbursed for a specialty drug under UBC’s extended health plan in the 12 months prior to the effective date of the program (May 6, 2018), you will be automatically grand-parented and will not be required to apply for prior authorization for that drug. Visit the Prior Authorization webpage for more details.

Specific Health Conditions that Require Pre-approval/Prior Authorization

Certain drugs that are used to treat the following health conditions, and that cost over $5,000 per calendar year, per person, require prior authorization:

  • Asthma
  • Cancer
  • Crohn’s Disease/Ulcerative Colitis
  • Hepatitis C
  • Hypercholesterolemia
  • Multiple Sclerosis
  • Psoriasis
  • Psoriatic Arthritis
  • Rheumatoid Arthritis

About Prior Authorization

Prior authorization is used in many organizations’ extended health and dental benefit plans for high-cost medical services, supplies, procedures and prescription drugs. This approach ensures that specialty drugs are reimbursed when most needed so that extended health benefit plans remain stable and sustainable.

At UBC, our new prior authorization drug program is referred to as FACET and is administered by an independent, third-party organization called Cubic Health. FACET offers the following:

  • Prescription drug experts (licensed pharmacists) who make evidence-based decisions
  • Provides expert support in navigating related issues and collaborates with you and your physician to ensure appropriate drug and dose regiments for effective treatment
  • Coordination of coverage with the BC Fair PharmaCare Plan and other provincial drug plans, while continuing to provide choices in prescription drug treatment

Additional information about the new prior authorization drug program, including a list of frequently asked questions are available on our FACET Prior Authorization webpage.

Process for Obtaining Pre-approval for Coverage of a Specific Drug

1. Starting May 6, 2018, you can find out which prescription drugs require prior authorization by logging in to Sun Life’s website at www.mysunlife.ca (currently not available on Sun Life’s mobile app).

Once logged in, go to coverage information; medical – drug coverage; drug look up and search by drug name or DIN (drug identification number).

If your prescription drug requires prior authorization, you will receive a message indicating “to be considered for coverage for this drug, have your doctor complete the appropriate form”. You will be directed to the FACET Prior Authorization Drug Program webpage to complete the form (go to Step 2).

If you do not receive this message, prior authorization is not required at this time and no further action is required by you.

2. Go to the FACET webpage to find the Prior Authorization Request Form that matches your health condition.

3. Ensure that you and your physician complete the form – this can be completed through the “fillable” form.

4. Submit the form and supporting clinical information to Cubic Health via one of the following ways:

Note: Medical information is submitted directly to Cubic Health, and is not shared with UBC.

5. Allow three business days for review once all necessary information has been received by Cubic Health.

6. If your drug is approved, Cubic Health will notify Sun Life to cover the drug for a one-year period.

7. If the drug you were prescribed cannot be approved, your physician will be contacted by Cubic Health directly to discuss alternatives.

8. Cubic Health will send both you and your physician the decision in writing.

For more information, please visit:

What to Expect When Calling EFAP

What to Expect When Calling EFAP

Looking for confidential, solution-focused counselling support for personal, work, health or life issues? UBC’s Employee and Family Assistance Program (EFAP) can help. Through our EFAP provider, Morneau Shepell, you can access a wide range of services 24/7 and choose the counselling format that works best for you. Whether you’ve used Morneau Shepell before or are using them for the first time, here’s an overview of what to expect when you access EFAP services.

About EFAP services:

  • Available to all eligible UBC staff and faculty and their dependent family members
  • Free (no cost other than your monthly premiums)
  • Voluntary and confidential (UBC is not informed of the identity of those who use EFAP services)
  • Available 24 hours, seven days a week, 365 days a year
  • Multiple languages available
  • Short-term counselling with community referrals available for longer-term or ongoing support
  • Professional counsellors have master’s level training and five to 10 years of EFAP-specific training

Seven ways to access services:

  • Telephone counselling (Care Access Centre at 1-800-387-4765)
  • In person counselling (various locations)
  • Instant chat (First Chat)
  • Mobile in-app counselling
  • Web and e-counselling
  • Video counselling
  • Online group counselling

What to expect when you contact Morneau Shepell’s Care Access Centre (CAC):

1. When you call 1-800-387-4765, after the language prompt, choose from three selections:

  • Press 1 for immediate telephone counselling. You will be transferred to a counsellor immediately. If you would like to arrange for in-person counselling during this call, an appointment will be set up within 24 hours.
  • Press 2 to schedule an EFAP service or if you need to cancel or reschedule an appointment. (If you press 2 and you are experiencing trauma or at risk of harming yourself or others, you will be transferred to a counsellor immediately.)
  • Press 3 for critical incident debriefing (for onsite crises). This service is available to Human Resources professionals who are requesting services for their department/faculty.

2. CAC intake specialist will:

  • Gather your contact information
  • Confirm your eligibility in the program
  • Ask you some preliminary questions about your issue so that they can let you know about the available services to help you resolve it

3. If you are scheduling an EFAP service:

  • You will be asked some preliminary questions about your issue.
  • You will be asked to complete an online pre-assessment form* prior to scheduling your appointment. This form will be emailed to you within 24 hours of your call. Once you submit the form, you can call the CAC back to schedule your appointment.
  • If you are scheduling an in-person counselling** appointment, the general wait time to see a counsellor in person is within five business days (non-emergency counselling). If you have specific preferences, you may have to wait longer. For example, if you request an in-person appointment with a female counsellor in Burnaby on a weekend, you may need to wait longer than five business days.

* Your pre-assessment form gives your counsellor background details in advance, allowing you to maximize the time spent with your counsellor during your appointment. If you’ve used Morneau Shepell’s services in the past, this form was previously completed at the beginning of your counselling appointment. For each new case or series of counselling sessions, a new form must be completed.

** In-person counselling through EFAP is available at many different locations. Morneau Shepell’s main offices are located in downtown Vancouver, Richmond, Burnaby, Coquitlam, Surrey, Kelowna and Kamloops. Other private offices in the Metro Vancouver and the Okanagan are also available.

For more information:

MSP Premiums Eliminated Effective Jan. 1, 2020

In February’s 2018 BC Budget announcement, the Finance Minister announced the following changes to Medical Services Plan (MSP) premiums:

  • Beginning Jan. 1, 2020, all BC residents (and employers who pay MSP premiums on behalf of their employees) will no longer be required to pay monthly MSP premiums. For 2018 and 2019, MSP premiums will still apply.
  • Beginning Jan. 1, 2019, employers such as UBC will pay an Employer’s Health Tax (EHT) to allow for the full elimination of MSP premiums.

More information about these changes will be provided prior to their implementation date.

Reduction to MSP Premiums Effective Jan. 1, 2018

Reduction to MSP Premiums Effective Jan. 1, 2018

The Medical Services Plan (MSP) is the provincial government program that covers medically required services provided by physicians and supplementary health care practitioners, laboratory services and diagnostic procedures. In the fall, the BC Ministry of Health announced an updated calculation of MSP rates.

Effective January 1, 2018, current rates for MSP premiums will be reduced by 50% for all British Columbians. There is no need to apply for this reduction as premium amounts will be automatically adjusted.

Reminder: There are no MSP premiums charged for dependent children (under the age of 19 or between the ages of 19-25 if they are considered a full-time student).

MSP Rates 2017 Monthly Premiums Monthly Premiums Effective Jan. 1, 2018
One Adult $75.00 $37.50
Two Adults $150.00 $75.00

If you are enrolled under the UBC Group MSP plan:

Employees who pay all or a portion of their MSP premiums (i.e. 100% or 75% of the premium) will pay less than they do now.

If you are part of an employment group that does not pay MSP premiums (BCGEU Childcare, CUPE 116, CUPE 2950, BCGEU Okanagan, Executive Administrative and IUOE 882), this rate change will not impact you.

View the Eligibility & Costs page for your employment group to see the MSP monthly premium cost effective Jan. 1, 2018. The cost is broken down to show what you pay and what UBC pays (if applicable).

The change in premium or portion of premium that you pay (if applicable) will appear on your Dec. 31, 2017 pay statement (premiums are taken one month in advance). You can view your pay statement online via the UBC Faculty and Staff Self-Service website (VPN is necessary to access Self-Service off campus).

Eligibility for Reduced Premiums

Health Insurance BC provides financial assistance (full or partial subsidy) for families who have filed their taxes and have an adjusted net income of $42,000 or less. For more information, please visit the Premium Assistance section of our MSP page.

Optional Life Premium Rates Changing in 2018

Optional Life Premium Rates Changing in 2018

With the support of our Benefits Consultant, the UBC Optional Life (Employee and Spouse) Plan is reviewed each year. Based on an increase in claims for the past two years, the Optional Life rates will increase by 5% for the upcoming 2018 year. The new rates are posted here: http://www.hr.ubc.ca/wellbeing-benefits/files/Opt_Rates.pdf.

The Optional AD&D rates remain unchanged for 2018.

Those who are enrolled in UBC Optional Life (Employee and/or Spouse) received a personalized email about the rate change on Dec. 1st.

What’s my current Optional Life coverage?

You can view your current coverage online by logging into the UBC Faculty and Staff Self-Service website with your CWL login and clicking on ‘Benefits Summary’. (Note: You will need VPN if you are accessing Self-Service from off-campus.)

I want to reduce or cancel my coverage. How do I do this?

Complete the change form to reduce or cancel your current coverage and submit the form to UBC Payroll for processing.

I want to increase my current coverage or I am applying for Optional Life for the first time. What do I do?

The Optional Life (Employee and Spouse) maximum is $750,000 per individual. If you and/or your spouse are below the maximum and would like to increase your coverage or apply for the first time, please complete an application form and submit the original form to UBC Payroll for processing.

All applications are subject to proof of good health. Once you submit your application to UBC Payroll, you will be emailed a Sun Life Health Statement. Submit the completed statement to Sun Life for review; if approved, you will be advised in writing and your premiums will be paid through payroll deduction.

Where do I send my forms?

Submit your original form to UBC Payroll for processing, either by mail or in-person:

Vancouver Campuses
Attention: Payroll
UBC Financial Operations
5th Floor – TEF 3
6190 Agronomy Road
Vancouver, BC V6T 1Z3

Okanagan Campus
Attention: Payroll
UBC Finance Operations and Strategies
ADM 006 – 1138 Alumni Avenue
Kelowna, BC V1V 1V7

Work Permit Renewals & Medical Services Plan Coverage

If you are working in British Columbia under a work permit and you are enrolled in the Medical Services Plan (MSP), your medical coverage will end when your work permit expires.

If you are applying for a new work permit, it is important that you apply as far in advance of the expiry date of your current work permit as possible. This will avoid a lapse in coverage and having to serve another wait period. According to the Immigration, Refugees and Citizenship Canada website (IRCC), the current processing time for a work permit extension (same employer) is 84 days for online applications and 118 days if you submit by paper.

If you hold a work permit, UBC Human Resources will send you an email next week with more details.

 

UBC Faculty & Staff Discount on Home & Tenant Insurance with TD Insurance

UBC Faculty & Staff Discount on Home & Tenant Insurance with TD Insurance

UBC faculty and staff can now access home and tenant insurance from TD Insurance Meloche Monnex through the alumni UBC program. You will be able to take advantage of savings through preferred insurance rates and other discounts.


Home Insurance

TD Insurance can help you with your home and tenant insurance needs

Whether you own or rent your home, TD insurance can help you find the right coverage to insure your belongings, both inside and outside your home. You can choose from a variety of plans that cover most types of residences. Their insurance experts will take the time to explain all your coverage options and help you select the level of protection that best suits your needs.

TD Insurance will determine the best insurance coverage that fits your needs whether you are a:

  • Homeowner: Home or homeowner’s insurance provides protection for both the structure of your home and your contents inside.
  • Renter: Tenant insurance provides coverage for your belongings inside a rented unit. You can be renting a private home, part of a home or an apartment.
  • Condo owner: If you own a condo, condominium insurance will cover the inside structure of your unit, the belongings inside the unit, and common areas of the building that are owned in part by you and the other residents (e.g., lobby, gym or pool). You should choose this option if your home is part of a condominium corporation or strata.

Additional ways to save

You may benefit from additional savings. For example:

  • You may qualify for additional savings if you live in a recently built property.
  • You can earn a discount if you have an approved alarm system.
  • The longer you have been claims-free, the better the rate for which you can qualify.

Want more information?

TD Insurance has been providing home insurance for 65 years. To find out how much you can save with the TD Insurance Meloche Monnex program, call 1-800-339-1847 or visit melochemonnex.com/UBCFaculty_Staff.

Ask for a quote today!
1-800-339-1847
Monday to Friday: 5 a.m. to 5 p.m. (PST)
Saturday: 6 a.m. to 1 p.m. (PST)
or visit melochemonnex.com/UBCFaculty_Staff

The TD Insurance Meloche Monnex program is underwritten by SECURITY NATIONAL INSURANCE COMPANY. It is distributed by Meloche Monnex Insurance and Financial Services Inc. in Quebec, by Meloche Monnex Financial Services Inc. in Ontario, and by TD Insurance Direct Agency Inc. in the rest of Canada. Our address: 50 Place Crémazie, Montreal (Quebec) H2P 1B6.

Due to provincial legislation, our auto and recreational vehicle insurance program is not offered in British Columbia, Manitoba or Saskatchewan.

® The TD logo and other TD trade-marks are the property of The Toronto-Dominion Bank.

Disclaimer:  UBC is providing this strictly for informational purposes for faculty and staff who may wish to consider this, and does not expressly or implicitly endorse this product/service.