How do I add or remove a spouse/partner or child(ren)?
You can add your spouse/partner or child(ren) to your benefits plan by submitting a Change Form within 30 days of the applicable "life event", defined by the insurance industry as date of marriage or reaching common law status (12 months cohabitation), or birth or adoption for children. If it has been more than 30 days, you must also submit a Statement of Health directly to our insurance carrier, SSQ Insurance, and your application could be declined or restricted. If you had previously waived health/dental for your dependants because they had coverage elsewhere, losing the alternative coverage is also considered a "life event".
You can remove dependants at any time using the same form, but do note that adding them again in the future (if they are still eligible) will be subject to approval by the insurance carrier.
If you are a midwife plan member, please note that adding dependants may increase your monthly premiums, thereby reducing the amount of benefits funding available for contribution to your GRSP. Read more about benefits funding. If you are also changing your Life/AD&D beneficiary(ies), the AOMBT must receive your original signed form by regular mail. Any other changes can be submitted by email, fax, or regular mail.
If you are a staff plan member, please check with your employer to confirm your eligibility for couple/two-party or family benefits coverage. Your employer must sign your Change Form. Please submit to us (by fax, email or regular mail) a copy of the form; the original must be retained by your employer in a secure but accessible location.
What determines the cost of benefit premiums?
The cost of group benefit premiums is a complex calculation based on many factors. Here are just a few of the ways benefits premiums can be impacted:
The Benefits Plan
Is the benefit pooled or experience-rated?
Pooled benefits allow a group of companies to support each other during high and low claiming years to keep premiums stable and affordable. AD&D, Critical Illness, Group Life, and Long-Term Disability are generally pooled benefits. Premiums for experience-rated benefits are based on the actual claims experience of the group. Short-Term Disability, Extended Health Care and Dental benefits are all experience rated.
Factors such as age, gender or profession can influence rates and the use of certain benefits, as can level and frequency of claims.
External factors such as the cost of new medication and health care inflation can impact premiums.
The Insurance Company
Each company has different practices that impact their fees such as administration fees or reserve funds (money set aside to cover unexpected costs).
AOMBT and group insurance
When it comes to the AOMBT, there are demographics and utilization trends related to midwifery, which influences our benefit premiums. For instance:
AOMBT’s disability plan cost is 12% above comparable groups of our size and profession.
AOMBT’s incidence of mental health claims in Long-Term Disability is 26% above comparable groups of our size and profession.
AOMBT’s paramedical claims as a percentage of total health claims is 45% above comparable groups of our size and profession. Per capita paramedical claim for AOMBT is $1,256 compared to average $450 above comparable groups of our size and profession. Most plans have a per practitioner maximum.
While it’s unfortunate we have higher premiums than some groups in some areas, it’s good to know that these benefits are available when we/our colleagues need them.
We Advocate for You
The good news is that the Benefit Trust works hard to ensure the best possible benefits plan and benefits rates for our membership are negotiated. This is done in a number of ways:
- Through our Investment Plan Guiding Principles which highlight the AOMBT’s priorities for managing a cost-effective, competitive and equitable plan.
- Through the efforts of the Benefit Trust to communicate your benefits options and hear your feedback in terms of valued benefits
- Through our own advocacy efforts, to ensure the plan continues to meet the needs of our diverse membership
- Through collaboration with our Benefits Consultant, Gallagher, whose job it is to understand the insurance industry landscape, what innovations and new solutions may exist to support our members and who are able to use their professional leverage to advocate for us.
Do I have coverage when I travel?
AOMBT plan members travelling outside the province/country have coverage for up to 180 days for emergency medical services required as a result of emergency illness or injury. Remember to take your SSQ Insurance benefits card with you when you travel; if you do require emergency medical services when travelling, please call the number located on your benefits card as soon as possible. You may also wish to jot the numbers down in a separate location from your wallet just in case.
It's important to note that you must be in general good health before departure. Expenses related to a medical condition you knew you had before your trip may not be covered. If you have any doubts about your health or the safety of your destination, please call the number on the back of your SSQ Insurance card before you travel.
How do I submit claims?
Claims can be submitted by fax, regular mail, through the SSQ Insurance website, or through the SSQ mobile app, available for iPhone and Android devices. You must activate your online account in order to submit claims online or via the app by going to ssq.ca. Click "Activate account", then "Plan Member". You can find your policy and certificate number on your SSQ Insurance benefits card, which you will receive at your home address 4-6 weeks after enrolling. To mail your claim, download the appropriate claim form, and submit to the address on the form.
How can I find out if my prescription or paramedical practitioner is covered?
Login to ssq.ca for your plan member group. The website provides details about the paramedical and dental services and medical supplies that are covered, and the Benefits at a Glance provides an overview of the coverage.
If you have specific questions (i.e. about a particular prescription, or whether your paramedical practitioner is eligible for coverage), please contact SSQ Insurance directly at 1.888.651.8181. Please note that the AOMBT benefits plan is a mandatory generic drug program, and uses a managed formulary. Mandatory generic means that you will be automatically provided with a generic drug substitute (if available) at your pharmacy. Generic drugs are the bio-equivalent of brand name drugs and contain the same medicinal ingredients as the brand name, but at a lower cost. A managed formulary means that the insurance company maintains a frequently-updated list of the medications that are eligible for coverage under the plan. Medications are evaluated on the basis of safety, efficacy and cost. For more information about prescriptions, check the Factsheets for your plan member group in the links below.
For significant or non-routine dental work, you may wish to speak with your dentist about submitting a Predetermination of Benefits to SSQ Insurance in advance of the treatment/procedures to confirm coverage.
Where do I go to check on my retirement savings or make investment changes or withdrawals (midwives, AOMBT and TBC employees)?
You can make changes to your investments and review your GRSP details online at dfs.ca/GroupPlanMember (for information on how to register for the Desjardins website, click on your plan member group and review How to Enrol Online: Midwives | AOMBT | TBC) . You can also make changes, ask questions and get information from Desjardins’ bilingual call centre at 1.800.968.3587. The call centre is open from 8am to 8pm.