Proposing Benefit Changes
A key focus of the Pension & Benefit Board of Directors is to provide a valuable benefits package that promotes the physical, mental and emotional well-being of Saskatchewan teachers. To ensure the Members' Health Plan continues to provide relevant benefits to teachers, members can request changes to the health benefits by submitting a proposal through a Council resolution or by submitting their proposal directly to the Board using the form below. All requests are compiled and considered as part of a comprehensive benefit and Plan design review, which are performed every three to five years.
How does the Board decide what to cover?
While the Board welcomes all suggestions, there are limits to what benefits can be covered under the Plan. Here are a few things to consider when submitting proposed benefit changes:
1. The Health Plan has fixed funding.
The Members’ Health Plan is solely funded by the provincial government which remits 2.1% of teacher salaries to pay for the benefits. That amount of funding is fixed based on the collective agreement. As such, the Board must ensure that the current and/or proposed benefit levels can be supported by the fixed funding levels over the long-term.
2. The Health Plan is already very comprehensive.
Check the Benefits page to make sure your proposed benefit isn't already covered.
3. Coverage Is limited by the Canada Revenue Agency.
Because the Plan is a non-taxable private health service plan, there are certain limitations to what services it can cover to maintain its tax-free status which are defined by the CRA. For example, amounts paid to a medical practitioner will only qualify as an eligible expense if the person providing the service is recognized as a medical practitioner according to the laws in which the service is provided. Usually, this requires that the service provider to be registered with a regulatory body in Saskatchewan.
4. The Plan utilizes three different formularies to determine what drugs are covered.
Those formularies are:
- Tier 1: National Formulary – Eligible drugs are covered at 100 percent of expenses incurred (approximately 12,150 eligible drugs)
- Tier 2: Special Authorization Formulary – Eligible drugs are covered at 75 percent of expenses incurred (approximately 2,780 eligible drugs)
- Tier 3: Saskatchewan Formulary – Eligible drugs are covered at 100 percent of expenses incurred (approximately 5,100 eligible drugs).
The Board does not have the expertise to manage the drug formularies for the Plan. Each of the formularies listed above are managed by independent third-party providers who employ health pharmacists and industry experts to assess which drugs will be included in the formulary. To this end, prescription drugs which are not covered under one of the three formularies above, will not be approved by the Board for coverage under the MHP.