Collective Agreement Appendix G: Medical Travel Referral Benefit

Collective Agreement Appendix G: Medical Travel Referral Benefit

APPENDIX G – MEDICAL TRAVEL REFERRAL BENEFIT

 

Benefit Summary

 

Deductible Amount:  None

 

Benefit Amount:  100% of eligible expenses

 

Individual Maximum:  $10,000 per year

 

Coverage Limitations:

 

  • $125 per day for a maximum of 50 days per calendar year for all eligible expenses combined;
  • Where an employer requires it, receipts must be submitted with the expense claim;
  • Where the eligible expenses exceed $125 per day, but do not exceed the average of $125 per day for the year, the average will be paid. For example, where the expenses claimed in a given calendar year are $150 day 1, $125 day 2 and $160 day 3, a total of $375 will be paid.  Where the expenses claimed in a given calendar year are $150 day 1, $75 day 2 and $300 day 3, a total of $375 will be paid;
  • Coverage will not be provided for travel and expenses incurred outside of BC except where the cost of travel to Alberta is less than the required travel within BC;
  • Referral must be made by a physician to a specialist (a physician whose specialized services and treatments routinely performed are those that general practitioners do not perform).

 

List of Eligible Expenses

 

Medical Travel: When ordered by the attending physician because in his/her opinion adequate medical treatment is not available within a 100 kilometer radius of the employee’s home campus, the following are included as eligible expenses:

 

  • Public transportation (e.g. scheduled air, rail, bus, taxi and/or ferry);
  • Automobile use as set out in the policy or collective agreement (as applicable) of employee’s institution

 

 

Accommodation: Where transportation has been provided as outlined above, accommodation in a commercial facility, Easter Seal House, Heather House, Vancouver Lodge, Ronald McDonald House, or other similar institutions as approved by the administrator, before and after medical treatment.

 

Meals: Where transportation has been provided above, reasonable and customary expenses for meals as set out in the policy or collective agreement (as applicable) of the employee’s institution.

 

Attendant: Where necessary, and at the request of the attending physician, transportation and accommodation of an attendant (e.g. family member or registered nurse) in connection with expenses incurred under items 1 and 2 above.

 

Superior Benefits

 

A superior benefit that existed in an institution’s Medical Travel Referral Benefit Plan or Collective agreement that was in place prior to the 1998 Common Agreement continues to apply.

 

Exclusions

 

No benefit shall be payable for:

 

  • Charges which are considered an insured service of any provincial government plan;
  • Charges which are considered an insured service under the extended health plan, or any other group plan in force at the time;
  • Charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;
  • Charges for medical treatment, transport or travel, other than specifically provided under eligible expenses;
  • Charges not included in the list of eligible expenses;
  • Charges for services and supplies which are furnished without the recommendation and approval of a physician acting within the scope of his/her license;
  • Charges which are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy;
  • Charges which are from an occupational injury or disease covered by any Workers’ Compensation legislation or similar legislation;
  • Charges which would not normally have been incurred but for the presence of this coverage or for which the employee or dependent is not legally allowed to pay;
  • Charges which the administrator is not permitted, by any law to cover;
  • Charges for dental work where a third party is responsible for payments of such charges;
  • Charges for bodily injury resulting directly or indirectly from war or act of war (whether declared or undeclared), insurrection or riot, or hostilities of any kind;
  • Charges for services and supplies resulting from any intentionally self-inflicted wound;
  • Charges for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical specialty society;
  • Charges made by a physician for travel, broken appointments, communication costs, filling in forms, or physician’s supplies.

 

 

Claims Adjudication

 

To claim benefits, the employee or dependent must:

 

  • Submit original receipts or photocopies of receipts if accompanied by an explanation of benefits from another carrier, and a claim form;
  • Provide explanation and proof to support the claim including itemized bills and the attending physician’s statement that the referral to the location where treatment was received was medically necessary;
  • Provide explanation and proof to support the claim that an attendant (if any) was necessary and made at the request of an attending physician.
2018-06-12T14:57:04-07:00 June 8th, 2018|