CAAT Support Joint Insurance Committee Fact Sheet #7

CAAT Support Joint Insurance Committee

What is the Joint Insurance Committee?

Support Joint Insurance Committee

The Joint Insurance Committee (JIC) is composed of OPSEU/SEFPO union representatives, employer representatives, and the College Employer Council (CEC). The JIC meets monthly to review claim complaints and attempts to resolve them. OPSEU/SEFPO, as your advocate, takes an active role in the Committee meetings.

Who are my Joint Insurance Committee Union Representatives?

What if I am denied an insured benefit by the insurer?

If you have submitted a claim to Sun Life and were denied a benefit that you believe is covered under your plan, you can appeal the claim decision. It is important to consider appealing a denied claim as claims can be improperly denied and an appeal may rectify the decision. It is also important to consider appealing a denied claim in that claims that are denied today may highlight important benefits issues that may inform demands for future rounds of bargaining.

You can appeal the denial through the Union representatives of the JIC.  The first step is to raise your complaint with Sun Life (through phone call, email or discussion), the College Benefit Administrator at your College and your Local Union, as soon as you are made aware of the denial of benefits by Sun Life. In some cases, submitting additional information directly to Sun Life may resolve the complaint.

If the complaint is not satisfactorily resolved, contact one of the Union representatives of the JIC so they can advocate for you. It is essential that you provide your contact information and any written documentation about what you want to appeal, such as a copy of the denial letter from Sun Life and any notes or reports from your dentist or doctor.

Send your completed appeals package including the authorization form to a Union representative of the JIC or to Luc Ciza, Benefits Officer with OPSEU/SEFPO:

Attn: Luc Ciza, Benefits Officer

OPSEU/SEFPO – Pension & Benefits Unit

5757 Coopers Ave

Mississauga ON L4Z 1R9

Fax: (905) 712-3009

Email: [email protected]

All information submitted to the JIC is treated as confidential and will not be disclosed to anyone outside of the insurer, your treating health care providers, and the committee.

Bargaining Benefit Improvements

Should the insurer correctly deny the coverage, but you believe this coverage is important for your employer to provide, it will be important to identify the lack of coverage to your local leadership and colleagues. In order for coverage to be extended to provide for the benefit you believe should be included, it will likely need to be negotiated with the Employer in a future round of bargaining. If you and your colleagues believe a specific benefit is important, providing information, education and resources to your local leadership and your colleagues will be important to garner support for the change you want to see within your Collective Agreement. Bargaining begins essentially as soon as a Collective Agreement is ratified, meaning, you need to provide information and education to your co-workers often and early. That way, when your next round of bargaining is imminent, the seeds have already been planted and you’ll ideally already have the support necessary to support the change you want to see. If you’ve rallied your colleagues, they too will ideally complete the bargaining survey and attend the demand set asking for the change to the Collective Agreement.

If you wish to contact the Pension & Benefits unit, please email us at [email protected]