Self Administration of Health Benefits: Q and A

At the January 19 Zoom meeting, attendees had a number of questions about ARTA’s move to Self Administration and how the new system has been working since January 1.   ARTA Health Benefit specialists were asked the questions and here are their responses below.

ARTA is and always has been, the administrator of our Benefits Plan. As of January 1, 2021, ARTA hired Green Shield Canada to adjudicate and send out the statements and the percentage of money from the plan. It is not the Green Shield plan, they work for ARTA.
If we have a copy of the ARTA Benefit Plan booklet from last year, our benefits will be the same this year. Included also will be the additions from the November changes received from ARTA/ASEBP last year. The kind of benefits now covered has not changed.
Previously ASEPB administered our plan and Blue Cross adjudicated it.

Q1. Why are we getting cheques instead of direct deposit?

A1. The original enrolment data which was transferred from ASEBP only included banking information for a handful of people (~700). We are not sure why ASEBP provided banking information for some members but not all. In any event once we learned what happened we provided every member’s bank account information to Green Shield for claim payment. The data was loaded last Thursday, so any claims made since Friday should be reimbursed via direct deposit.

Q2. Why can we not access a year’s worth of our data on the MyARTA portion of the website? A member put in the range of dates and it came back with nothing.

A2. MyARTA.net is a brand new portal which will only provide details on claims adjudicated by Green Shield since January 1, 2021. We asked Green Shield if it was possible to include the claims information on the same page they provide information on those claims which they adjudicated (since they were provided this data during the transition), but the only way they can load the data in the claims reporting system is by running each claim through their adjudication system (just short of 1.3m claim lines in 2020), which was not feasible. Claims history will be available, however, via the annual premiums and claims statement. ASEBP is pulling together the data for the statement, and we will be posting the 2020 premiums and claims statements in February.

Q3. Concerns that Green Shields is using their global adjudication rules and not ARTA’s. For example, one member could not get the pharmacy to give a three month refill. They said that Green Shields would not accept it.

A3. There were a few rules still in place at the time of transition that have since been corrected. The first was a rule Green Shield normally implements which indicates any maintenance medications could not be dispensed for more than 30 days if it was the first time a person is taking the medication, to reduce any likelihood of drug waste in the event of adverse drug reactions. Another rule they normally apply is a 30 day maximum supply for narcotic medications. We had Green Shield remove each of these rules since they were not applied before the change.

Q4. Lots of questions about not being able to get into the phone lines to ARTA from one reason or the other. Long wait times, answering the voice system that told them to call back. Queue was full most likely expected.

A4. Call volumes have been very high. With all of the changes we implemented at once members are calling with a number of questions which are taking a lot of time to answer – especially members who want a walkthrough helping to enroll in myarta.net, which quickly becomes a 20 minute phone call instead of a 3 minute phone call. In light of these common questions we hosted a number of webinars during which we walked members through how to enroll in the portal, how to submit a claim, and how to use the smartphone app. The webinars were well received and allowed us to answer questions asked by the attendees at the same time. We’ve also made recordings of the webinars available on the ARTA YouTube channel.
We also had to turn off the voice mail messaging system due to the propensity of our members to leave multiple messages, each of which needs to be reviewed by a person who is then not able to answer phone calls. We will turn the messaging system back on once the call volumes come back down and we can achieve our Key Performance Indicatorss again.
Call volumes are starting to come down but the front line staff are still busy. Our front-line staff are becoming adept at providing the information members are looking for (keep in mind they are all working with new systems, most are net-new to the ARTA Retiree Plan, and they don’t have direct person-to-person interaction with each other as they would in an office setting due to currently working from home).

Q5. I was never sent a membership card. Why is there only one card if we are paying for a couple. ASEBP gave us two.

A5. We elected to send one card per person given numerous responses we’ve seen in previous surveys with members expressing their concern with the amount of paper that was being sent to members. With members being able to print their cards at home using myarta.net, or (my personal preference) the ability to have your card available on your smartphone, we expected people would take advantage of the new technology available.

Q6. A need for a much better card than a paper one that can’t really be plasticized. Quote, “We should have the money as you keep saying we will be saving $$$ by self-administering”.

A6. We now include all pertinent ARTA information on one card – ARTA membership, Benefits ID, Allianz contact information, etc. It would have been too much information to include on one card while still being readable (we tried). The best we could make was to use a durable paper card stock.