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IUPAT LOCAL 177 HEALTH
AND PENSION TRUST FUNDS
Consent to Release Version 1.0
Electronic Funds Transfer (EFT) Authorization for Claim Payments Version 1.0
Guide to Applying for Freezing of Hours Version 1.0
Guide to Applying for Weekly Disability Benefits Version 2020
Health Spending Account Claim Form Version 1.0
Pre-Determination - Hospital Bed Assessment Form Version 2017
Pre-Determination - Knee Brace Version 2017
Pre-Determination - Nursing Care Assessment Form Version 2017
Pre-Determination - Oxygen Concentrator Assessment Form Version 2017
Pre-Determination - Wheelchair Assessment Form Version 2017
Prescription Drug Special Authorization Request Form Version 1.0
Consent to Release Version 1.0
Electronic Funds Transfer (EFT) Authorization for Claim Payments Version 1.0
Guide to Applying for Freezing of Hours Version 1.0
Guide to Applying for Weekly Disability Benefits Version 2020
Health Spending Account Claim Form Version 1.0
Pre-Determination - Hospital Bed Assessment Form Version 2017
Pre-Determination - Knee Brace Version 2017
Pre-Determination - Nursing Care Assessment Form Version 2017
Pre-Determination - Oxygen Concentrator Assessment Form Version 2017
Pre-Determination - Wheelchair Assessment Form Version 2017
Prescription Drug Special Authorization Request Form Version 1.0
Tips & Questions
Can I continue coverage if I run out of hours
If you have less than 100 hours in your Hour Bank Account, you can make direct payments to the Fund to maintain your coverage provided:
- you are a member in good standing with the Union,
- you are registered with the Union and available for work and are not working or employed by any employer who conducts any work that falls within the jurisdiction of the Union and who does not contribute to the Benefit Trust Fund under the terms of a Collective Agreement.
Once your Hour Bank Account is exhausted, the Trustees have initiated a provision enabling members to make self-payments to continue their benefit coverage for up to three (3) months.
Ellement will send you a Self-Payment Notice the month prior to you losing eligibility. If you chose to make self-payments you will be directed to the Painters website to submit the request. The amount of this Self-Pay Notice is determined by the Board of Trustees and may change from time to time.
Members making self-payments are NOT eligible for Weekly Disability benefits.
​Coverage will be maintained while a member is attending required schooling. No deductions will be made from the member’s Hour Bank Account (Hour Bank is frozen) during this period. The period will commence on the first of the month coinciding with or immediately following the date of the required schooling, and end with the month that the schooling ends. You must notify Ellement by completing the Freezing of Hours form which is available on the website or from your Local Union office.
A "Registration Form" must be completed fully, signed and sent to Ellement. The forms can be obtained from the Painters site. www.paintersbenefits.ca
Whenever you have an address change you may log into your account to make the changes necessary or complete the Change of Address form. To change your name, you must submit a completed Registration Form to the Ellement Office along with supporting documentation of name change.
A Registration Form will be required to have your new dependent(s) added to your benefit plan. Select “Update” on the Registration Form and ensure the form is signed and dated.
A) Coverage for unmarried dependents may be extended beyond the age of 18 but under 25 years of age if the dependent is attending an accredited educational institute, college or university on a full-time basis and provided they meet the criteria for an Over Age Dependent. Proof of school from the institution's registrar's office must be submitted to Ellement.
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B) Children who are incapable of supporting themselves because of a physical or mental disorder are covered without an age limit if the order begins before they turn 18, or while they are a student under the age of 25 and the disorder has been continuous since that time. You would need to provide a report or letter from the dependent's personal physician confirming the diagnosis and prognosis for the dependent, and the extent to which the physician determines the dependent is unable to work.
Your eligible dependents become covered for benefits at the same time you become eligible. A Registration Form must be on file for at least one year before your common-law spouse and any children of that common-law spouse (as indicated on the form) are eligible for coverage (unless the Statutory Declaration on the Registration form has been completed). Refer to the Plan Booklet for a description of the benefits for which your dependents qualify . A copy of the Booklet can be found in the Health section on the Painters website (www.paintersbenefits.ca) or can also be requested by contacting the Call Centre.
If you or your dependents are covered under more than one Group Health or Dental plan, this Plan will coordinate payment of benefits with the other plan or plans under which the person is covered. This provision ensures that, while claims may be made under all plans, the total reimbursement will not exceed the actual expenses incurred.
To coordinate payments, the insurance carrier must determine which plan pays first and which plan pays the remaining balance.
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Under the Coordination of Benefits provision, the term plan includes medical and dental care benefits under a law or governmental program, group insurance or other coverage for a group of individuals, including student coverage obtained through an educational institution above the high school level.
Benefits are coordinated with other plans as follows:
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The plan that does not have a Coordination of Benefits provision pays before the plan that does.
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The plan that covers the person as an employee or member pays before the plan that covers that person as a dependent.
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When coordinating benefits for a covered dependent child, the plan covering the parent with the earlier birthday (month and day) pays before the plan covering the parent with a later birthday.
If you become totally disabled due to a non-occupational injury or sickness you will receive a disability benefit, provided you are under the continual treatment of a qualified and licensed physician.
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Weekly Disability benefit payments begin once the elimination period of 119 days has been met. Benefit payments may continue for up to a maximum of 35 weeks if you remain disabled and are under the care of a physician. Contact Ellement as soon as you are off work to make an application. You can also electronically apply for benefits via the TELUS Adjudicare site .
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No benefits are payable during the 119 day elimination period during which Employment Insurance Act benefits are paid or are payable to you. You will only receive benefits under this plan during the 119 day elimination period if you provide proof you are not eligible for Employment Insurance benefits.
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To be eligible for weekly disability, applications MUST be received within 180 days from the date of disability.
Whenever an eligible member is disabled and is receiving Workers' Compensation benefits or Weekly Disability benefits from this Fund or Employment Insurance Accident and Sickness benefits for at least two consecutive weeks in any calendar month, no deductions will be made from his/her reserve account for that month. In other words, his/her reserve account will be "frozen". The maximum period for which an employee's hours will be frozen under this rule for any one continuous period of disability is 12 months.
A pre-determination is a proposed course of treatment submitted to the Plan by your dentist or orthodontist (by your provider) to determine allowable procedures, the eligible amount payable, and the maximum allowance for the calendar year (January to December).
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We strongly recommend you submit a pre-determination well in advance of any proposed treatment if the estimated cost is $300 or more. If necessary, your dentist (provider) may be required to submit dental x-rays or documents to support the planned treatment. If so, the original x-rays will be promptly returned to your dentist after the review is complete. Pre-determinations can be submitted electronically through the App. (www.paintersbenefits.ca)
Yes, your dentist or orthodontist must submit a pre-determination to Ellement prior to the start of the treatment for your expenses to be eligible for reimbursement. Failure to do so will cause unnecessary delays.
Please refer to the Summary of Plan Options or log into your Telus Adjudicare account to view the benefits available to you.
Orthodontic Claim
Orthodontic claims can be submitted by mail, email or through the app. Monthly adjustments will only be reimbursed once the service has been provided.
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Paramedical Practitioner
For paramedical practitioner services such as massage therapy and physiotherapy, please ensure that the practitioner's name and license number are on the receipt. Having the practitioner include their registration and license number will allow for faster payment of your claim. Attach the receipts to the Supplementary Health Claim form along with the doctor's referral, if required. Claims can be submitted electronically by the provider if they are set up on Telus or by you from your Telus account or submitted by mail.
Where should I send completed claim forms?
Send completed claim forms, original receipts and other supporting documentation to:
Ellement Consulting Group
10154 – 108 Street, NW
Edmonton, Alberta T5J 1L3
Or by email to: painters@ellement.ca
Is there a deadline for submitting my claims?
A claim for a waiver of premium benefit must be submitted within 12 months of the date you become disabled.
A claim for disability income benefits must be submitted within 6 months of the end of the Qualifying Disability Period. Refer to your booklet for further details.
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For all Supplementary Health and Dental Care Benefits, when your insurance terminates for any reason, written proof of claim must be given to the Administrator within 90 days of the date of termination of insurance. Otherwise, eligible expenses must be claimed WITHIN 12 MONTHS OF THE DATE THE EXPENSES WERE INCURRED
Providers may submit claims electronically if they have an account with TELUS eclaims. Claims must include the following:
Policyholder - IUPAT Local 177 Welfare Trust Fund
Group Policy Number – 59315
Carrier Identification Number – 034
Please contact the Call Centre during regular business hours at 1-800-770-2998 or (780) 452-5161 to confirm eligibility .
I want to confirm eligibility or view my hours/contributions - what is my username and password?
You should have received a letter in the mail which confirmed your username and password. If you did not receive this letter, please email us at painters@ellement.ca to request a new letter with your username and password. Please include confirmation of your mailing address in your email. You can also call us during regular business hours at 1-800-770-2998 or (780) 452-5161.
Can't find your Question here?
You may also contact our Call Centre if your question requires a more immediate response.