There was a spirited exchange on the university newsgroup Shoptalk recently about some glitches in implementing the Clarica Assure Direct Pay and Emergency Travel Card system, introduced in November.

The card, which is handled by BCE Emergis, is designed to bypass the paperwork previously required to receive a reimbursement for most eligible drug expenses, i.e. drugs listed on the RAMQ listing.

Through the card, you should also be able to find out right away what proportion of your purchase is covered by the plan and how much you will be reimbursed by the Concordia Health Insurance plan.

Here’s how the new system works

You give your card with your prescription to any participating pharmacist in Canada. The pharmacist enters the data from your card and your prescription into the computer system. Within seconds, this data is electronically processed.

You pay the total cost of the claim to the pharmacist. He or she will give you a receipt showing your portion of the cost and the plan’s portion.

You have no claim form to complete. You will receive a reimbursement cheque at a later date from BCE Emergis, on behalf of Clarica, in 90 days, or as soon as your accumulated unpaid reimbursement amount reaches $150, whichever comes first.

The card is valid for you and for any eligible dependents that you registered during the first registration campaign last July.

A reminder to register eligible dependents was sent out in November and employees were asked to fill out a Registration of Eligible Dependents form to submit to Benefits Services. As mentioned in the documentation, claims for dependents who are not properly registered will be rejected.

The Assure Card can be used only for drugs on the province’s RAMQ list. The plan covers these drugs at 80 per cent of the first $2,000 of eligible expenses per calendar year and 100 per cent thereafter, for the balance of the year.

To obtain a reimbursement for drugs not on the RAMQ list, you must complete and submit the regular Clarica form, available from Clarica. The plan covers these drugs at 50 per cent. You will receive a reimbursement by mail in the same way as you would for any non-drug claim.

Accurate information about claimants and their dependents will help to ensure that claims are processed quickly and efficiently.

Dealing with growing pains

Robert Lacasse, Manager of Compensation and Benefits (Human Resources/Employee Relations), explains how he has been dealing with the program’s growing pains:

In line with the orientation set out by the Concordia Employee Benefits Committee and as part of the agreement with Clarica, the university took on the responsibility for registering dependents eligible for the plan. The university was also responsible for upgrading the computer systems and electronic interface with Clarica to manage the card system.

There have been some problems on both levels. The employee response to the solicitation drives was weak. Some employees did not respond at all or responded very late, and many failed to provide complete information and to register their dependents. Because the default for Clarica card users is “single,” employees who failed to register their dependents in the new system, but whose dependents had been previously covered under the old one, found that their claims for dependents were denied.

Difficulties with rapidly interfacing the university and Clarica systems slowed the processing of the refused claims, adding to the frustration and anger of some employees. Benefits Service has been inundated with phone calls at a time when major projects stemming from the part-time faculty health plan and ACUMAE dental plan are also being introduced. There have also been problems with updating lists of retirees and part-time faculty eligible for benefits under the card program.

A review of the claim administration system and data reporting was done. New staff were added to the Benefits Service; the non-pension benefits team is now composed of four employees and is led by Senior Benefits Officer Nicole Desrochers. As a result, service is expected to improve quickly.

We are also planning to improve the way we communicate benefits information. We are doing all we can to ensure that claims are processed efficiently.

If you have any comments or questions, please feel free to contact me at (514) 848 3675 or by e-mail: rlacasse@alcor.concordia.ca, or call Clarica: (514) 848-6003; outside Montreal: 1- 800 - 463-3572. Benefit Services: Nicole Desrochers at 848-3661 or nicoled@alcor.concordia.ca. Please forward your Clarica card system questions to Nicole Desrochers by e-mail at: nicoled@alcor.concordia.ca.