- Enrollment Questions
- Claim Submission
- Prescription Drugs
- Travel Coverage
- Appeal Questions
- Other Questions
Is the STS Group Benefits Plan the same as the STF Members’ Health Plan?
No, they are two completely separate plans. Please contact STF for information on the STF Members’ Health Plan and the STS for information on the STS Group Benefits Plan.
Can I enroll in the health plan after the open enrollment period?
You will have to submit evidence of good health if you apply for coverage more than 60 days after the date:
- You retire, or
- Coverage terminates under a spouse’s group plan, or
- Coverage terminates under any other group plan.
What does evidence of good health mean?
Evidence of good health means you would be required to complete a statement of health in order to determine your eligibility for the plan. This is required if you did not join the Extended Health Care plan within the 60-day open enrollment window.
Can I add my spouse to the Group Benefits Plan?
A spouse can be added to the plan within 60 days of:
- Termination of coverage under any group plan.
- Date of marriage.
- One-year common law date.
If a request is made to add a spouse after 60 days, he/she is considered a late applicant and must submit evidence of good health.
Can I suspend my STS Group Benefits if I go back to work?
Yes, if you have group coverage with an employer, you may suspend your STS Group Benefits. You may reinstate your STS Group Benefits within 60 days of the termination of your group plan. Coverage can be suspended or reinstated for the 1st of any month, provided the STS Office receives written notification before the 15th of the previous month. Notification must be from the member in writing, by email, mail or fax.
In the event of my death, can my spouse apply for the Group Benefits Plan?
The surviving spouse of a deceased superannuate may join the Group Benefit Plan within 60 days from the date of death of the superannuate without medical evidence, or at a later date with medical evidence. The surviving spouse of a deceased active teacher is also eligible to join the Group Benefits Plan within 60 days from the expiration of coverage under the STF Members Health Plan without medical evidence, or at a later date with medical evidence. In order to be on the Group Benefits Plan, he/she needs to become an STS member.
What is the definition of an eligible dependent?
Dependents are defined as your spouse, unmarried, unemployed dependent children under 21 years of age, and unmarried, unemployed children under 26 years of age who are attending an educational institution or training at a school of learning on a full-time basis. Dependent children who are physically or mentally infirm will be covered beyond the limiting age.
How do I submit a claim?
All claims should be sent to Saskatchewan Blue Cross, whether you reside in Saskatchewan or in another province. The address is located on your claim form. You can also submit a claim online or through the mobile app.
Where can I get a claim form?
Claim forms can be printed from the Saskatchewan Blue Cross website at www.sk.bluecross.ca or you can call the STS office at 306-373-3879 to request a form be mailed to you. You can also submit claims online on the Saskatchewan Blue Cross website or through the mobile app.
I have not heard back from Blue Cross regarding my claim. What should I do?
Please contact the Customer Service Team at Saskatchewan Blue Cross at 306-244-1192 or toll free at 1-800-667-6853 and they would be pleased to assist you. If you have a question regarding a travel claim, please contact the claims department at CanAssistance at one of the following options: 1-800-264-1852 | 1-514-286-8336 | bluecross@canassistance.com
What drugs are covered under the Prescription Drug Benefits?
Prescription drugs listed on the Saskatchewan Formulary are covered by the plan. Some drugs are listed on the Formulary as Exception Drug Status. Your pharmacy/physician must apply for Exception Drug Status and a copy of your approval letter must be submitted to Saskatchewan Blue Cross.
Can the pharmacist submit drug claims directly?
Yes, your plan is currently set up with a Pay Direct drug card so the pharmacy can submit your drug claims directly. You will still have to pay your $6 deductible per prescription and your 20% coinsurance.
Can we submit more than one month prescription at a time?
The pharmacist can only submit one month worth of prescriptions on your behalf. You can submit additional months either by paper or online, however please indicate on them that they are not duplicates.
Can diabetic supplies be submitted directly by the pharmacist?
Diabetic supplies must be submitted either by paper or online; they cannot be submitted by the pharmacist as they are paid under the Extended Health Benefit and not the Drug Benefit. This is done so they do not go towards your yearly drug maximum.
What is the Saskatchewan Seniors’ Drug Plan?
The Saskatchewan Seniors’ Drug Plan is a program through the Government of Saskatchewan. Eligible seniors 65 years and older pay a maximum of $25 for prescription drugs listed on the Saskatchewan Formulary and those approved under Exception Drug Status. Eligibility is based on income. Applications can be obtained from your pharmacy.
What do I do if I qualify for the Saskatchewan Seniors’ Drug Plan?
If you are the planholder and you qualify for the Saskatchewan Seniors’ Drug Plan you will receive a letter from the Ministry of Health. You will need to forward a copy of that letter to the STS office in order to receive the reduced premium for your Extended Health plan.
My doctor says that a specific prescription drug will be best for my condition. If the doctor prescribes the medication and I require it, will it be covered?
Not necessarily as the prescription drugs covered by the plan are only those listed on the Saskatchewan Formulary. Your pharmacist will be able to confirm whether a specific prescription drug is listed on the Saskatchewan Formulary. If it is not, your doctor may be able to prescribe an alternative prescription drug that is on the Saskatchewan Formulary.
What is a pre-existing condition?
A pre-existing condition is any medical condition (whether or not the condition has been diagnosed or the diagnosis has changed) that existed prior to travelling.
Do my travel benefits provide coverage for pre-existing conditions?
Pre-existing conditions are covered provided the covered person’s condition is stable and/or has been controlled by consistent treatment with prescribed medication for the three months immediately preceding the day of departure, and medical attention is not reasonably anticipated during the travel period. To be considered stable a condition must not have required medical investigation, diagnosis, treatment or hospitalization in the three months immediately preceding the departure date. Routine checkups with no change in medication or treatment are not considered medical investigation, diagnosis or treatment, so they will not affect your coverage.
What are considered high risk activities under the travel benefit?
Participation in professional sports, any speed contest, parachuting, bungee jumping, mountaineering, spelunking, or a flight accident if the person is not riding as a fare paying passenger.
What number do I contact in case of an emergency out of province?
The Travel Assistance Provider must be called for emergency medical assistance when travelling outside your province of residence. Failure to call the Travel Assistance Provider may invalidate your claim. Telephone service is provided on a 24-hour basis around the world in any language. If in Canada or the United States: 1-866-330-3633 toll free All other locations: 306-667-5299 collect
Do I need travel insurance if I am only travelling within Canada?
Travel insurance is recommended even when travelling within Canada. Your STS travel benefits provide coverage for the first 65 days from your date of departure from your province of residence.
How do I get additional days of travel beyond the 65 days of group coverage?
For trips exceeding 65 days, it is your responsibility to purchase top-up insurance. Interested travelers should contact Saskatchewan Blue Cross directly. Remember that coverage under a top-up policy is not an extension of your STS travel benefits. The benefits and exclusions (including the pre-existing condition clause) may differ, so be sure you understand your top-up policy.
What is considered Emergency Medical Care?
Coverage is limited to emergency medical expenses incurred by a covered person as a result of a sudden illness or accident that occurs outside your province of residence. Emergency medical coverage does not include medical services for elective, non-emergency, ongoing or follow-up treatment, or when travelling outside your province of residence to seek medical advice or treatment.
My doctor has indicated that even with my pre-existing condition that medically I am okay to travel. Does this ensure that I have travel insurance coverage?
Not necessarily as your doctor cannot speak on behalf of Blue Cross travel benefits.
Emergency travel coverage is designed for sudden and unforeseen medical emergencies while travelling away from your home province. If you have been diagnosed with a medical condition or are working with a doctor to explore a current health condition, the condition must be considered stable if any travel is planned.
To be considered stable, a condition must not have required new medical investigation, diagnosis, treatment or hospitalization in the three months immediately preceding the departure date. Routine checkups with no change in medication or treatment are not considered medical investigation, diagnosis or treatment.
What evidence is suitable to confirm when I initiated my travel outside of the province for the purpose of beginning the 65-day period of coverage?
An airfare itinerary, boarding pass, accommodation receipt, fuel receipt, or a bank statement showing when purchases made outside the province began are all suitable evidence for the purposes of confirming when you left your province of residence.
How do I appeal an assessment of a claim?
If you have questions about your claim, the STS office may be able to assist you in seeking answers to your questions. However, if necessary, you may appeal your claim denial or reimbursement decision as follows:
- Within 3 months from the date of the initial claim decision, submit a written request outlining the basis for your appeal to the attention of Manager, Health and Dental Claims at Saskatchewan Blue Cross (516 2nd Avenue N Saskatoon SK S7K 2C5). This request should include any additional documentation in support of your claim that you would like considered. A written decision and explanation will be provided to you, in most cases within 30 days from the receipt of your appeal.
- If you are still not satisfied with the claim decision, you may request a second and final level of appeal by submitting a written request to the attention of VP, Customer Service at Saskatchewan Blue Cross (516 2nd Avenue N Saskatoon SK S7K 2C5). Please include any additional documentation in support of your claim that you would like considered. This subsequent appeal, along with any additional documentation, must be received within 3 months from the date of the initial appealed decision. A written decision and explanation will be provided to you, in most cases within 30 days from the receipt of your appeal.
- If you are still not satisfied with the claim decision, you may contact the OmbudService for Life and Health Insurance (OLHI) who provide independent assistance to consumers at no cost to you. Additional information about OLHI can be found on their web site www.olhi.ca or by calling them directly at 1-888-295-8112.
Is a doctor’s prescription required each time orthotics are purchased?
Yes, a prescription is required every time an orthotic is purchased.
Who do I contact to update my address?
To update your address for your STS Group Benefits Plan or for Outreach, please contact the STS Office in writing. You can send an email to sts@sts.sk.ca or send it by mail to 2311 Arlington Ave, Saskatoon, SK, S7J 2H8. An address change form is available on our website.