Enhancement of direct coordination of benefits

Alberta – British Columbia – Manitoba – New Brunswick Nova Scotia – Ontario – Saskatchewan

Communiqué

As part of our commitment to continuous improvement, in May, we will roll out new functions that will make it possible to broaden the direct coordination of benefits between your drug insurance plan and the various provincial plans.

Because direct coordination of benefits is an integral part of iA Financial Group drug insurance plans, you will automatically benefit from the improvements.

Starting May 1st, these functions will facilitate the addition of new prescription drugs that have the following qualities:

  • Approved for several therapeutic indications but covered by a provincial plan for only some*, or
  • Covered by a provincial plan for certain categories of individuals only

This improvement to claim management at the pharmacy will allow for greater control of drug insurance plan costs while ensuring that plan members benefit from available provincial reimbursement plans.

For drugs requiring prior authorization, coordination with provincial plans is already included in our authorization process and will continue to be applied.

Impact on plan members
When a plan member has a prescription filled at the pharmacy for a drug covered under a provincial reimbursement plan, the pharmacist will submit the claim to the provincial plan first.

It is important to specify that if the pharmacist forgets to submit the claim to the provincial program, the system will inform him/her. If the plan member is not eligible, the cost of the drug can be reimbursed based on the parameters of the private insurance plan and the pharmacist will inform the insured, if applicable.

Click here to see the communication to your plan members. We strongly recommend that you forward it to them.

If you have any questions, please feel free to contact your advisor or your iA Financial Group Account Executive.

*iA Financial Group may continue to cover therapeutic indications not covered by the provincial plan.