Policy Changes (Retiree) | Scribe

Policy Changes (Retiree)

  • 5 months ago

    Changes to an existing plan (Benefits)

    This page outlines the rules and procedures for increasing or decreasing coverage levels and adding or removing optional benefit modules under the Retiree Personal Health Plan.

    General Rules for Plan Changes

    • All change requests must:

      • Be submitted in writing by the policyholder.

      • Be reviewed and approved by Saskatchewan Blue Cross (SBC).

      • Cannot be backdated. Coverage changes apply from the effective date forward only.

    • New benefit maximums may apply when changes are made.

    • Claims history will be carried over and applied to any new maximums.

    Increasing Coverage Levels (Upgrades)

    Policyholders can increase their level of coverage within a benefit module at any time, subject to SBC approval.

    If approved:

    • The new coverage level and adjusted premium will take effect on a date set by SBC.

    • Any new benefit maximums will apply, and previous claims will count toward them.

    Decreasing Coverage Levels (Downgrades)

    Policyholders may decrease their level of coverage only if:

    1. They have had their current level of coverage for at least two consecutive years, OR

    2. They have experienced a qualifying life event, such as:

      • Marriage or common-law union

      • Legal separation or divorce

      • Addition or removal of a Dependent child

      • Death of a Dependent

    If approved:

    • The lower coverage level and adjusted premium will take effect on a date set by SBC.

    • New benefit maximums may apply, and previous claims will still count toward them.

    Important Notes:

    • Changes are not retroactive. Claims made before the effective date of the change will follow the limits of the previous coverage.

    • SBC reserves the right to decline change requests if they don’t meet eligibility criteria.

    Optional Dental Benefit Module

    Adding Dental Benefits

    Policyholders may add the optional Dental benefit module at any time, subject to SBC approval.

    If approved:

    • The module will be added to the policy.

    • The new premium will take effect on a date set by SBC.

    Removing Dental Benefits

    Policyholders may remove the optional Dental benefit module, subject to SBC approval.

    If approved:

    • The module will be removed from the policy.

    • The new premium will take effect on a date set by SBC.

    • There will be a 24-month waiting period before the same module can be added again.


    Changes to an existing plan (dependent coverage)

    Adding a Dependent

    A policyholder may request to add a dependent to their policy if the individual meets the eligibility requirements outlined in the policy booklet.

    Coverage becomes effective upon approval by Saskatchewan Blue Cross and will begin on a date determined by SBC.

    Removing a Dependent

    • It is the policyholder’s responsibility to notify Saskatchewan Blue Cross if a dependent no longer meets eligibility requirements.

    • SBC will determine the termination date for coverage once notified.

    • A dependent can also be removed from the policy at any time upon request. Termination will occur on a date determined by SBC.

    Conversion Option for Ineligible Dependents

    • If a dependent no longer qualifies under the policy, they may apply for coverage under a Saskatchewan Blue Cross Conversion Personal Health Plan.

    • The application must be submitted within 60 days of the loss of coverage.

    • Alternatively, the dependent may apply for a new plan (e.g., Blue Choice or Guaranteed Acceptance), but these would be treated as new applications with no conversion privileges.

    Coverage for Surviving Dependents

    • In the event of the policyholder’s death, coverage may continue for surviving dependent(s).

    • A written request must be submitted within 60 days of the policyholder’s passing.

    • Saskatchewan Blue Cross will issue a new policy confirmation, renaming the surviving dependent as the new policyholder and outlining any applicable premium changes.

    Conversion Privileges

    A policyholder may transfer from the Retiree Personal Health Plan to a Saskatchewan Blue Cross Conversion Personal Health Plan at any time, provided the following steps are completed:

    • A new application is completed and submitted

    • The application is approved by Saskatchewan Blue Cross

    • The adjusted premium is paid

    Key Notes:

    • No medical questions are required

    • No waiting periods apply

    Important Reminder:
    Once a policyholder switches to a Conversion plan, they cannot switch back to the Retiree Personal Health Plan. To become eligible for the Retiree plan again, the individual must:

    1. Return to work after retirement

    2. Be covered under a group benefits plan through their new employment

    3. Lose that group benefits coverage again due to retirement


    Cancelling a Retiree Personal Health Plan

    Policyholder Responsibility:
    The policyholder must notify Saskatchewan Blue Cross in writing if they wish to cancel their plan.

    Termination Request Requirements:

    • Must be submitted in writing

    • Must include the date of the request and a clear statement of intent to cancel coverage

    • Backdated cancellations are not permitted

    Refund Policy:

    • Refunds will only be issued for premiums paid beyond the termination date

    • Premiums are charged in full-month increments — no partial month refunds or prorated amounts will be provided


    Renewals

    The Retiree Personal Health Plan renews each year (12 months) from the effective date of the policy. Approximately 45 days prior to the renewal date of the policy, your client will receive a Renewal Notice Letter advising them of the amount owing to renew their Saskatchewan Blue Cross plan.

    Annual premium payments can be made online through their Member Portal or Mobile App.

    Keeping current with your clients

    Your client's experiences are rapidly evolving. As life changes, so does one’s insurance needs. Touching base and providing meaningful value to their Personal Health Plan is the first step in delivering a superior customer experience.

    What’s new? What does your client need to know? Review the Personal Health Plan Checklist with your client and to ensure they have the right coverage for their needs, life stage, budget and risk tolerance.