Who can complete the “Attending Physician’s Initial Statement Form” for me?

The licensed physician or a nurse practitioner who is involved in your care and treatment must fully complete and sign this statement.

Chiropractors, and registered psychologists can complete the statement for up to eight weeks from your disability start date.

If your time on disability extends longer than eight weeks, a licensed physician or a nurse practitioner must complete any further medical forms to support your disability claim.

What will happen to my health and dental benefits while I am on a leave of absence?

Your coverage will continue for up to 18 months. There will be no cost to you. All extended health care and dental insurance will terminate at the end of 18 months. If your disability claim is approved, your coverage will remain in effect for up to two years and 119 days from your date of disability. There will be no cost to you. After two years and 119 days, you will have the option to join the retiree health and dental plan on a premium paying basis.

If I am on a leave of absence, what happens to my Group Life insurance?

Your coverage for Basic Life insurance must continue for up to 18 months as a condition of your employment. You are responsible for paying the monthly premium. You can elect to continue Optional Life insurance for up to 18 months. You are responsible for paying the monthly premium. All life insurance will terminate at the end of 18 months.

You must elect to continue your Optional Life Insurance within the first 30 days of your leave of absence. If you do not elect to continue Optional Life insurance then upon your return to work, you must submit medical evidence of insurability as your application for coverage.

If 3sHealth approves your disability claim, your group life insurance coverage remains in effect for the approved disability period. There is no cost to you. Coverage includes Basic Life, Accidental Death and Dismemberment (AD&D), Dependent Life, Optional Life, and Voluntary Accidental Death and Dismemberment insurance.

How long does it take to adjudicate my application for disability benefits?

An adjudicator will review your application to determine your eligibility for benefits within eight business days of receiving your complete application. The adjudicator may request additional medical information. If deemed necessary, the request for additional information may delay the adjudication process. We will advise you if additional medical is required.

How soon will I receive my disability benefit payment after 3sHealth approves my claim?

3sHealth pays bridge benefits weekly for the prior week. Benefit payment deposits occur weekly on Friday.

Example: Your adjudicator calls you on Friday, Jan. 31, 2020 and approves your claim from Feb. 3, 2020 to Feb. 28, 2020. On Friday, Feb. 14, 2020, you will receive the first deposit of your weekly bridge benefit payment for the period of Feb. 3 to Feb. 9, 2020.

3sHealth pays long-term disability benefits monthly for the current calendar month. Benefit payment deposits occur monthly on the last banking Friday.

Example: Your adjudicator calls you on Friday, Jan. 31, 2020 and approves your claim from Feb. 3, 2020 to March 31, 2020. On Friday, Feb. 28, 2020, you will receive your first deposit of your monthly long-term disability benefit payment for the period of Feb. 3 to Feb. 29, 2020. On Friday, March 27, 2020, you will receive your next deposit of your monthly long-term disability benefit payment for the period of March 1 to March 31, 2020.

Why do I need to provide my banking information to 3sHeath?

3sHealth will directly deposit disability benefit payments into your bank account.

Do I have to apply for Canada Pension Plan (CPP) benefits?

3sHealth may require you to apply for CPP disability benefits at some point during your disability claim. Your 3sHealth adjudicator will advise you if and when you should apply.

You may elect to apply for a CPP disability benefit at any time. If you do, you must advise 3sHealth that you have applied. Make sure to forward your CPP denial or approval letter to your adjudicator at 3sHealth.

3sHealth may require you to appeal any denial of your CPP disability application.

Do I have to apply for Saskatchewan Workers’ Compensation Board (WCB) benefits?

Yes. 3sHealth requires you to apply to WCB if your illness or injury is the result of a workplace incident.

3sHealth may require you to appeal any denial of your WCB application.

Do I have to apply for SGI benefits?

Yes. 3sHealth requires you to apply to SGI if your illness or injury is the result of a motor vehicle accident.

3sHealth may require you to appeal any denial of your SGI application.

Does my Canada Pension Plan (CPP) benefit affect my claim?

Yes.

Both CPP retirement and CPP disability benefits are a direct offset to your claim. This means that 3sHealth subtracts what you receive from CPP from your disability benefit.

3sHealth may require you to apply for CPP disability benefits.

Do I have to report other sources of income?

Yes.

Employment, retirement, CPP, SGI, WCB, and private disability insurance earnings may reduce the amount of the disability benefit you are eligible for. Income received due to a disability from a 3sHealth-participating employer, government agency, or any retirement benefits may also reduce your disability benefit paid by 3sHealth.

In order for 3sHealth to determine if your earnings reduce your disability benefit, we require you to report them to us. Failure to report alternate income, including alternate employment income, can result in an overpayment. In the event of an overpayment, 3sHealth may reduce your future disability payments or may require you to repay the overpayment.

It is your responsibility to notify 3sHealth if you are employed or self-employed while on an approved disability claim, regardless of whether you are in receipt of earnings.

How can I check the current status of my claim?

You can check the status of your claim by phone at 1-866-278-2301 or by email at ebp@3sHealth.ca.

What medical forms does 3sHealth need to support my application for disability benefits? Can I just provide a note from my doctor?

A doctor’s note is not sufficient to support an application for disability benefits.

To qualify for benefits, you must provide medical evidence that clearly shows you are totally disabled from performing the duties of your own occupation throughout the 119 calendar day qualifying period and, potentially, for up to two years after the qualifying period. This is called the “own occupation” period of disability.

The plan requires you to be under appropriate medical supervision and treatment for your condition from the beginning of your absence from work.

Am I responsible for the cost of the “Attending Physician’s Initial Statement Form” needed for my initial application?

Yes.

Under the terms of the plan, it is your responsibility to provide medical information in support of your application. You are also responsible for the costs.

Does 3sHealth share my private medical information with my employer?

No.

3sHealth does not share your personal medical information with your employer. We are committed to protecting your privacy. We limit access to your personal information to 3sHealth employee benefits staff and to any third-party authorized by 3sHealth and by law in order to facilitate your disability benefits.

Your adjudicator may share information about your restriction and limitations with your employer in order to support your accommodation/return-to-work planning.

How can I submit my application to 3sHealth Employee Benefits?

You can mail, email, fax, and drop off applications at:

Email: ebp@3sHealth.ca
Mail: 600-1919 Saskatchewan Drive, Regina, SK. S4P 4H2
Fax: 306.347.5910
In person: 600-1919 Saskatchewan Drive, Regina

Submitting electronic forms is easy. Simply download the fillable PDF form found here, fill out the details, sign it, and scan and email it to ebp@3sHealth.ca.

How will I know when 3sHealth approves my claim for disability benefits?

As soon as your adjudicator makes a decision about your claim, your adjudicator will call you and inform you of the decision. Following the telephone call, your adjudicator will send you a letter to document the decision.

How soon will I receive my disability benefit payment after 3sHealth approves my claim?

3sHealth pays bridge benefits weekly for the prior week. Benefit payment deposits occur weekly on Friday.

Example: Your adjudicator calls you on Friday, Jan. 31, 2020 and approves your claim from Feb. 3, 2020 to Feb. 28, 2020. On Friday, Feb. 14, 2020, you will receive the first deposit of your weekly bridge benefit payment for the period of Feb. 3 to Feb. 9, 2020.

3sHealth pays long-term disability benefits monthly for the current calendar month. Benefit payment deposits occur monthly on the last banking Friday.

Example: Your adjudicator calls you on Friday, Jan. 31, 2020 and approves your claim from Feb. 3, 2020 to March 31, 2020. On Friday, Feb. 28, 2020, you will receive your first deposit of your monthly long-term disability benefit payment for the period of Feb. 3 to Feb. 29, 2020. On Friday, March 27, 2020, you will receive your next deposit of your monthly long-term disability benefit payment for the period of March 1 to March 31, 2020.

What deductions will 3sHealth take from my disability benefit payment?

Disability benefit payments are taxable income. 3sHealth will reduce your gross benefit payment by the federal income tax deduction in accordance with the Canada Revenue Agency’s (CRA) basic tax table.

Other sources of income you are eligible to receive, such as employment, retirement, CPP, SGI, WCB, and private disability insurance earnings reduce the amount of the disability benefit you are eligible to receive from 3sHealth.

Will I receive a T4A for income tax purposes?

Yes. 3sHealth will prepare and send you a T4A for the current tax year before the end of February each year.

Do I have to pay for a physician or other health-care provider to provide requested medical information?

Once 3sHealth approves your long-term disability claim, 3sHealth will pay a standard fee to your physician or provider for the completion of medical forms, if requested. With your permission, we will contact your physician or provider directly and request the information we need to continue to assess your claim.

Will I have access to my extended health care and dental benefits when I am on an approved disability claim?

Yes. If you had extended health care and dental coverage on the date your disability claim started, then your benefits will continue for up to two years and 119 days during your approved disability claim.

What happens if 3sHealth does not approve my application for disability benefits or closes my claim?

3sHealth will inform you in writing of any decision to deny your application or close your claim. This written notification will include an explanation of why you do not qualify or no longer qualify for benefits under your plan.

As a Disability Income Plan member, you have the right to request a review if you believe that information was missing from your application or if you think 3sHealth has not correctly applied the terms of the plan to your claim.

How do I appeal?

To appeal a decision, you must send in a written request within 60 days of the later of: the date of the written decision to close your benefit claim or deny your application, or the date your benefit terminates.

What information should I include with my appeal?

You should submit any additional or new information that supports your reasons for requesting the review, including:

• More comprehensive information on your medical condition from your physician or a nurse practitioner. If you think 3sHealth’s assessment of your condition is inaccurate or incomplete, your physician or a nurse practitioner can submit a further report explaining medical investigations, treatment, and clinical observations.
• More accurate information from your employer. Sometimes 3sHealth disqualifies an application because the dates and other details that 3sHealth received from an employer do not match the employee’s physician’s, or a nurse practitioner’s submission. If you find an error, ask your employer to submit the correction to 3sHealth in writing.
• New or additional information that 3sHealth should consider in support of your claim. Include this information with your request for a review. You may also indicate clearly in your letter what information you intend to send. Please specify when 3sHealth can expect to receive it. Not submitting a clear indication of your intentions may delay the review.

Can someone help me with my appeal?

If you appoint another person to represent you, you must notify 3sHealth in writing. For example, some plan members appoint a union representative, family member, or lawyer to assist with the phone calls, letter writing, and other activities involved in the review process.

Who reviews my appeal?

Three 3sHealth team members will reassess your claim along with the new supporting information. The team will include an adjudicator or manager, and, if necessary, a rehabilitation or mental health advisor, medical consultant, or rehabilitation consultant. 3sHealth will phone you when the assessment is complete.

How long will it take for my appeal to be reviewed? 

Once your appeal and supporting information is received by 3sHealth, the review of your appeal will be complete within 30 business days.

What if my appeal is denied?

You are entitled to a second review. You must request a second review in writing within 60 days of the later of the termination of your benefit or of 3sHealth’s notification to you of the decision to maintain the closure of your claim or denial of your application.

Address your request for review to Claims Services Manager, Employee Benefits. If you have new or additional information that supports your claim, either include it with your request or indicate clearly in your letter what information you intend to send, and when 3sHealth can expect to receive it.

The Claims Services Manager will conduct a full review of all information and determine if further internal review is required. The Claims Services Manager may also seek advice from 3sHealth’s medical consultant. When the second review is complete, the Claims Services Manager will write to you to explain the results of the review.

The second internal review is complete and I don’t agree with the decision. What are my options?

There is an external, independent review process available. This process is available after 3sHealth’s two-stage internal review process is complete.

How does the external “Independent Review of Disability Decisions” work?

If you wish to appeal the decision that 3sHealth’s internal appeal process reached, there is an opportunity for an adjudicator who is external to, and independent of, 3sHealth to review your claim. You are entitled to a final adjudication of a disability plan appeal. 3sHealth must receive the request for review within 60 days of 3sHealth’s notification to you of their final internal review decision.

This process is “the final adjudication of a disability appeal.” The independent adjudicator will complete a review of your complete disability claim file.

3sHealth will inform you of your option for a final independent adjudication of your disability appeal.

Final adjudication of a disability appeal is available only on decisions that relate to medical matters and is not available on decisions relating to the administrative terms of the plans such as late applications or lack of plan membership.

In accordance with collective bargaining agreements, the decision of the independent adjudicator is final and binding.

Who should I notify when I am able to return to work?

You must contact both your employer and 3sHealth immediately when you are able to return to work. By notifying 3sHealth, you can prevent an overpayment of benefits from occurring. Benefit overpayments must be re-paid to 3sHealth.

Do I have the option to return to work gradually?

3sHealth, along with your employer, union, and physician or a nurse practitioner will work together to customize a suitable return-to-work program based on your functional abilities and restrictions.

If you experience difficulties while participating in your return-to-work program, contact your employer, your adjudicator, and your physician or a nurse practitioner. Any suspension in your return-to-work program requires medical information and support.

What is a Rehabilitative Employment Program?

A Rehabilitative Employment Program is a return to work on a part-time or gradual basis. Typically, you will work reduced hours compared to the hours you worked prior to your illness or injury.

3sHealth and your physician or a nurse practitioner must be approve the program before it begins.

What is a vocational rehabilitation consultant?

From time to time, 3sHealth may engage the services of a vocational rehabilitation consultant. The vocational rehabilitation consultant is provided to you to support your return to employment. Vocational rehabilitation services may include, but are not limited to, career exploration and counseling, vocational testing, resume production, job searching skills, etc.

For more information on gradual return-to-work programs, please contact ebp@3sHealth.ca or your employer.

What happens to my disability benefits when I receive earnings from my employer when I return to work?

If you return to work through a 3sHealth-approved rehabilitation program and you receive earnings from your employer, 3sHealth will adjust your disability benefits based on the amount of your rehabilitative earnings. However, your adjusted disability benefits plus your rehabilitative earnings may be greater than the disability benefits you received before your rehabilitative employment.

3sHealth requires your employer to report your gross weekly (for bridge) or gross monthly (for long-term disability) earnings to 3sHealth. Your disability benefit will be delayed by one to two weeks so 3sHealth can adjust the amount of your benefit by the amount of your employer paid earnings.

What happens to my benefits if I do not return to work and my disability claim closes?

If your disability claim closes and you do not return to work, your Group Life insurance can continue for up to 12 additional months from the date your claim closes.Your health and dental benefits continue for up to 18 months from the original date of your leave of absence. Your disability coverage will end effective the date your claim closes.

When you return to work, 3sHealth will reinstate your benefits.