Welcome to the CAW 199 Benefits Page

Mark Roy Pension Rep 905-641-6444 905-658-7952

Rick Jones Alternate Benefit Rep.

E Mail Mark Roy
Union Hall Office: 905-682-2611 ext 228
In Plant Phone: 905-641-6444

Benefit Related Links

Canadian Auto Workers National Union Website
CAW Insurance Link
Printable GM Benefit Summary 2009-2012
CAW Insurance
Cuba Health Care Cover Letter
Greenshield Drug Form
Health Care Trust (asr TRUST)
GM, Dental Form
GM, Hearing Aid Form
GM, Vision Form
GM, Cataract Surgery Form
GM Out of Province Coverage

GM Benefits Information
by Mark Roy & Rick Jones

Benefit Rep Schedule

Cataract Surgery - Shop Around

It's a good idea to shop around for cataract surgeons since some in Ontario charge "predatory" prices for services not covered by OHIP, says a study from St. Michael's Hospital. While OHIP covers the cost of cataract surgery and implantation of an artificial lens, some ophthalmologists charge an extra $358 to $2,790 for special lenses that also correct far-sightedness and astigmatism, according to a study published Tuesday in the journal PLoS ONE Read Article

GM Retiree Health Care Trust

Wednesday 15th February, Gordon Graham, executive director for the asr Trust (Auto Sector Retiree's Health Care Trust) visited CAW Local 199 to explain health care benefit changes and address members questions. Aproximatly 500 retirees and active members attended this meeting at the Union Hall. Link to Image Gallery

Message From Ken Lewenza
GM Retiree Benefit Changes
Link to asrTRUST Website

GM Benefit Report

The transition from SunLife to Greenshield has not been without hiccups. The promised seamless move was anything but. At present, there are issues with both dental and vision claims. There have been no reported concerns with the hearing benefits. Because hearing claims are general produced from our retired members, there could be problems the union is not aware of yet. The dental issues are related to compensation for procedures covered under our plan. The amounts paid for services differ from what SunLife paid and what Green Shield is paying. (i.e. lab fees)

On the vision end, Greenshield is refusing to pay for yearly visions tests for our members that require them due to medical conditions, such as; diabetes and glaucoma. Although the language talks about yearly RX changes being paid for by the plan, it does not talk about exams. Given that RX change cannot be determined without an exam, it is only reasonable for the carrier to pay for the eye exam which is what SunLife in fact did. Your benefit reps. will be meeting with Greenshield on November 30th to try and resolve these and any other issues brought up during our meeting.

SunLife and S&A claims still remain contentious. The carrier/company are still very reluctant to pay stress and anxiety claims and the union has a number of claims at the fourth step in the appeal process. The union is also working hard to get claims paid that involve hospital stays and procedures that do not include admission to hospital.

G.M. Benefit Centre As a committee, we are continually frustrated with the service provided. Name changes, health care contributions employee/member status issues are rarely resolved without a number of follow up calls and requests from your reps. and our members. There is an accountability issue that never seems to get resolved. We will also be discussing this issue at GM/CAW Council on November 30th and we will report back to you through the website in the new year. On behalf of Rick Jones and myself, we wish you all a very Merry Christmas and a prosperous New Year.

Mark Roy / Rick Jones

Mark Roy and his alternate Rick Jones are the benefit rep's at GM and can assist you with GM Benefit. Questions related to: Life Insurance, Healthcare, Tuition Assistance, Dental and Eye care. For information about your benefit coverage you can contact Mark or his alternate Rick Jones or call the benefit coverage provider directly. Mark alternates his days between the Glendale and Ontario Street plants. The following benefit information is a summary and is intended as a quick reference only. If you have any questions which are not answered here or if you require more detailed information. please contact Mark Roy or Rick Jones (alternate).

Hewitt Associates,looks after pension information, tuition forms,change of beneficiary forms and dependants. Sunlife Insurance, looks after vision, dental, and hearing information forms. Green Shield Canada, looks after drugs and all other benefit information and forms. Out of Province Coverage - World Access Canada.

Toll Free Numbers Hewitt Associates, 1-877-442-4625
Sunlife Insurance, 1-888-711-1119
Green Shield Canada, 1-888-711-1119
Out of Province Coverage, Canada & the U.S.A. call (1-800-936-6226 - group number is #9623)
Out of Province Coverage, Outside Canada & U.S.A. (0-519-742-3556)

Please note; That World Access must be notified 48 hours of a medical emergency.All benefit inquiries to General Motors, outside or specific questions to Sun Life or Green Shield are now handled by the GM Canada Benefits Centre. Call toll free: 1-877-442-4625. Please have your user I.D. and PIN # ready when calling.

GM Benefit Provider Change

Please be advised that as of October 1, 2011, your dental, hearing, and vision benefits will no longer be administered by Sunlife Assurance.

On October 1, 2011, Greenshield will become the provider of these benefits. We encourage our members to submit any outstanding claims for these services to Sunlife before September 23, 2011. Any Sunlife claims incurred the week of September 23 should be held onto and submitted to Greenshield after October 1, 2011 for reimbursement.

All preauthorization's (including dental predeterminations) that have been approved by Sunlife previous to October 1, 2011 will be honored. Your claim history with Sunlife will be forwarded to Greenshield in an effort to minimize errors during the transition period. Also note your Greenshield identification number will remain the same.

The change in carrier only applies to dental, hearing, and vision. All provisions provided in our benefit plan remain the same as they are now. All other insurances including S&A, EDB, Basic Life Insurance, Optional Group Life/Dependant Insurance and SIBI (Survivor Income Benefit Insurance) will remain with Sunlife.

Should you have any questions regarding the change in carriers, please contact Rick Jones or myself at 905-641-6444 or Mark PTT 663 or Rick PTT 709 or online mark.roy@gm.com or hr.jones@gm.com.

GM Continuation of Dependant Benefits

General Motors will be sending out an audit form to all GM employees who have dependants aged 19 - 25 years of age. To avoid an interruption in your listed beneficiaries benefit coverage it is important that you complete the form and return it to GM. The annual dependant certification audit will be mailed out August 26th 2011. Any GM member who has dependants 18 years of age or older, as of September 1st 2011, must contact the GM Benefit centre to ensure their dependants remain covered by the GM benefit package.

If you do not contact the GM Benefit Centre, dependants 18 years of age or older will be dropped off your benefits as of November 11th, 2011.

Contact the benefit centre, between September 6th & 23rd, by phone 1-800-442-4625, on line Link to www.gmclbenefits.com If you have any questions about the audit or benefit coverage please contact either Mark Roy or Rick Jones. 905-641-6444

Benefit Rep Report By Mark Roy

June 11th 2011. At General Motors in St. Catharines, there are very few problems with Greenshield at this time. The issues we do encounter with this carrier are generally resolved in a timely fashion and more often then not, in favour of our members.

Dental, vision and hearing issues with SunLife are usually resolved in the same way with very few hiccups.

S&A is an entirely different story. Our St. Catharines membership are seeing claims denied at an unprecedented rate. Currently, there are 10 claims in the appeal process. Of those claims, 7 are anxiety/depression related and 3 are WSIB modified work related. In most of these appeals, the company is driving the denials as opposed to the carrier.

The case of the WSIB modified work, the claims are denied solely on the fact that no matter the injury, modified work is offered. If the member declines because the treating physician advises them not to work during this period of disability, there is no option; either comply with the company or get starved out as the appeal process plays out. This practice is not acceptable as injured workers are putting their future health at risk. Further modified work is just that – modified work, not sitting in an office idle or being paraded around the shop floor in front of their fellow workers making it appear as though they are faking injury to avoid working.

Anxiety, stress and/or depression claims are far and away the most denied claims faced by our members. There are a number of reasons for this. Firstly, mental health issues are very difficult to diagnose and usually must be made by a clinical psychologist, master of social work or psychiatrist as S&A forms for this type of illness filled out by a general practitioner always require clinical notes from a specialists. In most cases, it takes months to get an appointment with any one of these specialists. As a result, our members are left in limbo. General Motors is very reluctant to even consider that our members could be disabled from mental disorders. This is also very unacceptable.

The medical community does us no favours either as many doctors do paper work only once a month and charge upto $100 to have a form completed.

Through my discussions with representatives at the other locations, this problem is not unique to the St. Catharines location. We will be meeting as a whole this week to strategize an effective response.

Change to Health Care Premium Tax

Employees/Retirees/Surviving Spouses who reside in Ontario and are making a monthly Health Care Contribution will be subject to a 2% "Premium Tax" in addition to the "Sales Tax" currently paid. This change will be in effect for the first deduction for 2011 health care. Active employees will see the deduction in December 2010 while retirees will see the deduction in their January 1, 2011 pension payment. Employees who reside outside of the Province of Ontario will not be impacted.

Changes to the Retiree Health Care Trust (asr TRUST)

Article to be posted

Health Care Trust (asr TRUST)

Chiropractic

Dental

Reimbursement is at the 2008 Ontario Dental Association fee guide for the duration of the agreement until September 17, 2012. Coverage; $2,800 annual maximum, $3,600 lifetime maximum for orthodics(under 21)

Note, re dental claims for any procedure over $200.00, please have your dentist submit to Sun Life a predetermination form, which is an explanation of entitlement coverage's. This will avoid any hidden costs.

The following dentists are following the 2008 dental schedule.

Lakeshore Dental,168 Lake St. St. Catharines (905-688-8403)

Niagara Falls Dental Clinic, Dr. J. Schirro 905-358-0586 6453 Morrison St.(905-358-0586)

Jarvis St. Dental Centre, 120 Jarvis St. Fort Erie (905-871-5652)

Hearing Aid

Re-imbursed if 36 months since last hearing aid claim Covers cost of hearing aid (on the body, in the canal, completely in the canal, digital and programmable aids) Dispensing fees and repairs of hearing aids from dealer and repairs Pre-authorization for hearing aids and repairs.

Healthcare Items Examples

Orthotics: two pair every 36 months, up to a maximum of $400 – must go through an approved supplier

Braces: coverage with prescription from physician are limited by cost

Air casts: coverage with prescription from physician,Note: is limited by cost

Insulin Pumps: up to $1,000 every 5 years

Insulin Infusion Pump: Eligible dependent children age 18 and under with Type 1 diabetes will be eligible for an insulin infusion pump benefit allowance, once every 5 years, to a maximum of $5,500 when prescribed by a physician. Eligible dependent children age 18 and under will also be eligible for an insulin infusion pump supplies to a maximum of $250 per month. The insulin infusion pump allowance for all others has been increased from $800 to $1,000 once every 5 years.

Home Making Services (In Home Care)

5 hours per week in situations where nursing services are required maximum of $12,000.00 combined annual maximum with in home nursing

The nursing services of a registered nurse (RN) or a Registered Practical Nurse (RPN) have been increased from a maximum of 4 hours per day to a maximum of 6 hours per day

In addition, reimbursement for the services of a Personal Support Worker (PSW), commonly known as a homemaker or health care aid, will now be available under the following conditions; When prescribed by a physician, When used in conjunction with the in-home nursing care services of the RN or RPN described above, and;

The PSW has a certificate from an accredited program and is employed by a provincially recognized, bonded health care provider.

The total amount of benefits reimbursed from a RN, RPN, and/or PSW will be limited to an annual maximum of $12,000. Should any covered person reach the $12,000 annual maximum, their coverage will be continued at up to 2 hours per day for the nursing services of a RN.

Hospitalization

Coverage is limited to ward rates, no semi private.

Insurance, Home & Auto

The CAW Group Insurance Program is now available to ALL CAW active and retired members. This voluntary CAW members program was initiated October 1, 2006 for members at GM, Ford and Chrysler, and after considerable success, we are pleased to announce that all CAW members nationwide can now access this program which offers discounted automobile and home insurance rates for their personal requirements. The program is offered through Breckles Insurance Brokers and Aviva Traders and has been especially designed to meet the needs of CAW members like yourself. Link CAW Insurance Link

Insurance, Life - Group

Insurance, Life - Optional

Coverage is reduced by 20% per year begining on employees 66th birthday, terminates at age 70.

Insurance, Life - Dependant

Coverage is terminated on the last day of the month of employee's 70th birthday

Legal Services

Contact C.A.W. Legal services, 55 King Street, 2nd Floor (corner of King and Queen Street) St. Catharines 905-682-1313, or CAW Head office 1-800-268-7573

Retired workers are entitled to coverage for legal services.

Long Term Care and Chronic Care

The maximum payable after January 1, 2011 is $1,200 monthly. Current monthly maximums will continue for those residing in a Long Term Care Facility before January 1, 2011.

In-Home Nursing (RN/RPN)*

Homecare Personal Support Worker

Massage Therapy

Naturopaths

THe services of a Doctor of Naturophy (N.D.) is an eligible benefit and will be remimbursed at a maximum of $25 per visit, to an annual maximum of $325 per benefit year, per covered person.

Out of Province

When traveling, make sure you have your Ontario Health Card, your Green Shield number(s) and the numbers to call if you need assistance. From the United Stated or Canada, call 1-800-936-6226; from other locations call collect 0-519-742-3556. If you have to pay for something while out of the country, call the appropriate number and ask for the claim form to be sent to you. Keep the receipt(s) and send them with the form to Green Shield when you return home.

Out of Province or Out of Country: full coverage for medical emergencies (World Access Canada)

U.S. Healthcare (Retirees living in the United States only) Roughly OHIP equivalent but does not cover doctor's office visits.

Orthotics

Podiatrist or Chiropodist

$11.45 per visit up to an annual maximum of $200, referrral required from a doctor.

Prescription Drugs

The maximum dispensing fee covered is $9.00 per prescription. For those under age 65, the prescription drug co-pay for active members and retirees is 10% per prescription with the following out-of-pocket maximum:

As of January 1, 2010 $270/family per year
As of January 1, 2011 $290/family per year
As of January 1, 2012 $310/family per year

Out of Pocket Maximum: The current out-of-pocket maximum of $250 for the 10% co-pay on drugs is scheduled to increase to $270 on January 1, 2010 and to $290 on January 1, 2011. With the one year extension of the Collective Agreement, the out-of-pocket maximum will increase to $310 on January 1, 2012.

Drug Listings: When the Drug Plan carrier is able to negotiate a price for brand name drugs that is lower than the equivalent generic drugs, the brand name will be included on the Controlled Formulary and dispensed. This will result in lower costs for the Plan, as well as lower co-pays for participants.

Effective January 1, 2010 a new Health Care Co-Pay will come into effect as follows: Active employees and retirees under age 65 will have a co-pay of $30 per month
Surviving spouses and retirees age 65 and over will have a co-pay of $15 per month
The co-pay will be applicable to subscribers only and not their dependents.

P.S.A. Test

Age 50 years or older $15

Psychologist

Psychologist Services, Coverage for family and marital counselling to yearly maximum of $625.00 per participant (each dependent) $50 per visitAnnual maximum $625.00

Retirees GM

If you are a GM retiree age 65 years or older, your prescriptions are administered by the Ontario government.
The majority of prescriptions will cost 61 cents, which is 10% of the $6.11 dispensing fee.
If the drug is not covered by the government but is covered by Green Shield, you will be charged 10% of the cost.
The $100 yearly deductible means you pay $10 at the first of the year (10%).

There is no coverage for Physiotherapy.

Semi-private hospital coverage is now paid by the patient.

Speach Therapy

Coverage for speach therapist/pathologist up to $1,100 per participant per year, referral required from a doctor.

Tuition Assistance, Dependant

Dependants of GM members who are entering post secondary education can apply for dependant tuition assistance funding. The amount of the yearly benefit is $1,300. The tuition assistance is a taxable benefit for the recipient (the student) Application forms are available from the GM benefit Centre.

CAW Bursaries

There are (25) CAW bursaries that are awarded to sons/daughters of CAW members in good standing entering their first year of post secondary education (i.e. university, community college, technological institute, teachers' college, nursing school, etc.) One bursary will be available for CAW members with at least one year seniority attending their first year of post secondary education.

This is an entrance bursary and is not renewable for students entering subsequent years of study.To learn more about CAW bursaries, follow the links. CAW Bursaries

CAW Local 199

CAW Local 199 has three bursaries of $500 for Brock University. One is for the dependant of a Coutts Member the recipient is selected by by Local 199.

The other two bursaries are approved by Brock University. Student must apply through Brock University to be considered these bursaries. Brock University 905-688-5550. Brock University Bursaries

Vehicle Purchase (GM Employee Discount)

Employees, retiree and family members can purchase new and corporate driven GM vehicles. There are three programs available which are as follows; Option one order a new vehicle through an authorized dealer, Option 2 purchase a vehicle from dealer stock, Option 3 purchase a used company vehicle. For more information or to determine your eligibility call the GM benefits Centre 1-877-442-4625.

Vision

Eye exams, $85 once every 24 months
Single vision $220 once every 24 months
Bifocal, $275 once every 24 months
Multi-focal, $345 once every 24 months
Contact lenses, $230 once every 24 months

If a person has diabetes or other medical conditions, you will need a letter from the optometrist or ophthalmologist for coverage for the lenses when required.

In addition, the Vision Care Program will now include a one-time reimbursement for laser eye surgery up to a maximum of $345. Any person reimbursed for such laser eye surgery will not be eligible for any other reimbursement under the Vision Care Program for a period of 48 months.

Eye exams are covered by OHIP for people 19 and under and 65 and over, once every 12 months from the last exam. Anyone with the following conditions; diabetes mellitus, glaucoma, retinal disease, amblyopia, visual field defects, corneal disease, andstabismis, are eligible for an OHIP exam.

Password Reset (GM Canada Benefit Center)

To reduce the time required to establish secure access to a Benefits Centre Representative. The GM Canada Benefits Centre has added the ability to reset your security Password by e-mail. The temporary Password can now be sent to your e-mail account within 15 minutes of the request. If you have not already established a User ID or Password, you must contact the GM Canada Benefits Centre at the phone number below and establish a temporary Password by regular mail before you can set up a User ID or use the new e-mail option. To contact the GM Benefit Centre and set up your User ID and/or e-mail address, simply call toll-free 1-877-442-GMCL (1-877-442-4625). Representatives are available Monday to Friday, 8:30am to 5:00pm Eastern Time.

If you are calling from outside North America, you can reach the GM Canada Benefits Centre at 1-847-883-0745. Note that there will be a charge for this call.

In Home Nursing (RN or RPN)

Reimbursement under such coverage will be the amount charged to the patient for such service up to a maximum of six (6) hours per day, up to an annual maximum of $7,500.

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