OPS Benefits Booklet (116 pages)
CURRENT LIST OF LIBERALIZATIONS
* under the Supplementary Health & Hospital Plan AS OF MAY 1, 2003
* A liberalization is a term that is used for a benefit allowed for a member which is not necessarily or normally listed in the benefits booklet or in the collective agreement.
Appealing OPS Benefit Claims
(Posted to this website Feb 1/10 - for up to date information check the OPSEU website)
What insured benefits can I appeal?
- Supplementary Health and Hospital Insurance
- Dental
- Long Term Income Protection (LTIP)
- Group Life Insurance (including Basic, Supplementary and Dependant Life Insurance)
- Any other benefits that may be added to the Group Insurance Plan
Why would I want to appeal an Insured Benefit claim that had been denied?
- Your claim may have been improperly denied
- Claims that are denied today may highlight important bargaining demands for tomorrow!
How can I appeal claims for denied insured benefits?
If you work in the Ontario Public Service (OPS) and represented by OPSEU, then you can appeal the denial through the Joint Insurance Benefits Review Committee (JIBRIC). The JIBRC is comprised of OPSEU representatives and Employer representatives from Management Board Secretariat. The OPSEU member representatives are Jamie Tocker (Co-Chair), Carl Thibodeau, Jennifer Roukkula and Diana Clark (OPSEU Benefit Counsellor).
The Joint Insurance Benefits Review Committee will review the claim problems and attempt to resolve the appeal. OPSEU takes an active role in the Committee meetings as your advocate. All information submitted to the JIBRC is confidential. Meetings are usually held monthly.
If the appeal cannot be resolved at the Committee level, the appeal can be referred to the Claims Review Subcommittee and will be heard before designated arbitrators.
How do I commence an appeal to the JIBRC?
- Discuss your complaint with your employer, the union and the insurance carrier when you become aware of the denial of benefits by the insurance carrier. Sometimes, submitting additional information directly to the insurance carrier may resolve the problem.
- If the complaint is not satisfactorily resolved, you can appeal to in writing to the JIBRC by mailing or faxing the written documentation about what you wish to appeal, copies of any denials from the insurance carrier and your contact information to:
Diana Clarke, Benefits Counsellor
Ontario Public Service Employees Union
100 Lesmill Rd., Toronto, ON M3B 3P8
Ph: 416-443-8888 x8652
Toll free: 1-800-268-7376
Fax: 416-443-0553
Email: dclarke@opseu.org
(Posted to this website Feb 1/10 - for up to date information check the OPSEU website)
What insured benefits can I appeal?
- Supplementary Health and Hospital Insurance
- Dental
- Long Term Income Protection (LTIP)
- Group Life Insurance (including Basic, Supplementary and Dependant Life Insurance)
- Any other benefits that may be added to the Group Insurance Plan
Why would I want to appeal an Insured Benefit claim that had been denied?
- Your claim may have been improperly denied
- Claims that are denied today may highlight important bargaining demands for tomorrow!
How can I appeal claims for denied insured benefits?
If you work in the Ontario Public Service (OPS) and represented by OPSEU, then you can appeal the denial through the Joint Insurance Benefits Review Committee (JIBRIC). The JIBRC is comprised of OPSEU representatives and Employer representatives from Management Board Secretariat. The OPSEU member representatives are Jamie Tocker (Co-Chair), Carl Thibodeau, Jennifer Roukkula and Diana Clark (OPSEU Benefit Counsellor).
The Joint Insurance Benefits Review Committee will review the claim problems and attempt to resolve the appeal. OPSEU takes an active role in the Committee meetings as your advocate. All information submitted to the JIBRC is confidential. Meetings are usually held monthly.
If the appeal cannot be resolved at the Committee level, the appeal can be referred to the Claims Review Subcommittee and will be heard before designated arbitrators.
How do I commence an appeal to the JIBRC?
- Discuss your complaint with your employer, the union and the insurance carrier when you become aware of the denial of benefits by the insurance carrier. Sometimes, submitting additional information directly to the insurance carrier may resolve the problem.
- If the complaint is not satisfactorily resolved, you can appeal to in writing to the JIBRC by mailing or faxing the written documentation about what you wish to appeal, copies of any denials from the insurance carrier and your contact information to:
Diana Clarke, Benefits Counsellor
Ontario Public Service Employees Union
100 Lesmill Rd., Toronto, ON M3B 3P8
Ph: 416-443-8888 x8652
Toll free: 1-800-268-7376
Fax: 416-443-0553
Email: dclarke@opseu.org