Pension Life - Summer 2021
Ensuring sustainable health coverage
We are taking action to ensure your retirement health group benefits remain sustainable, and we’re making changes to improve coverage for most prescription drugs. Currently, 70 per cent of the cost of prescription drugs is reimbursed by the group benefits program.
Effective January 1, 2022, the main changes include:
- Modifying the drug plan by creating a tiered formulary based on BC PharmaCare coverage. A formulary is a list of drugs that are covered by a plan. The new tiered formulary will group drugs into two levels of reimbursement:
- Tier 1—drugs covered by BC PharmaCare: reimbursement will increase from 70 to 80 per cent.
- Tier 2—drugs not covered by BC PharmaCare: reimbursement will decrease from 70 to 60 per cent.
- Providing a 12-month grace period for retired members taking a tier 2 drug for a chronic condition. The grace period will be based on members’ recent claims history (claims made in the six-month period before January 1, 2022). Reimbursement remains at 70 per cent during this period. The new reimbursement for the tier 2 drug will take effect January 1, 2023.
There will be no changes to drug coverage for members who live outside of BC.
Why are we changing to a tiered formulary?
BC PharmaCare helps BC residents pay for eligible prescription drugs, so by encouraging the use of drugs covered by BC PharmaCare, the group benefits program will remain sustainable. You will have to satisfy an annual BC Pharmacare deductible based on your net family income. The BC PharmaCare deductible is paid by your health care carrier, Green Shield Canada (GSC). After the BC PharmaCare deductible is paid by GSC, drug costs for you and your family will shift from GSC to BC PharmaCare, which will save you and the plan money.
It is a priority for us to make health benefits available to members. Unlike your lifetime pension, the health benefits are not guaranteed and depend on funding limits (watch a video on how health benefits are funded by clicking on the link in Related content).
How did the board decide on changes?
We conducted a full review to understand the opportunities for change. This work included analyzing claims data, comparing similar plans, and looking at administrative expenses and premiums.
We also asked members for feedback through a survey in fall 2020. We thank the 1,350 members who participated.
Where can you find more information?
Learn about the changes in the Changes to retirement group health benefits section of the website. If you are directly affected by these changes, GSC will send you a letter between October 2021 and January 2022 to outline next steps and options. We will also offer a webinar in fall 2021 to provide an overview of the changes. Check the plan website for upcoming information on how to register.
You can also:
- Visit the BC PharmaCare website to find out which drugs are covered under its formulary. BC PharmaCare covers a comprehensive list of cost-effective drugs.
- Talk to your physician about switching to a BC PharmaCare formulary drug if you are currently taking a drug not covered by its formulary.
- Contact GSC’s Customer Contact Centre beginning January 4, 2022, for specific questions relating to these changes. For other enquiries about health care coverage, members can reach a GSC representative at 1-888-711-1119, Monday to Friday, 5:30 a.m. to 5:30 p.m. PT.