3sHealth’s Employee Benefit Plans (EBP) team is happy to be taking their slogan, “We care for the caregivers,” to the next level thanks to a new funding structure for disabled workers receiving treatment.

Each year, 3sHealth tracks the number of patients and/or health-care providers who benefit from improvements made together with health system partners. In 2023-24, that included a change made by the Employee Benefit Plans Board of Trustees to improve how health-care workers on approved disability claims receive funding for treatment.

EBP’s mandate is to work collaboratively with plan beneficiaries and provide support. For disability claims, that includes helping them along the “path to health” so they can recover and return to work. An important part of that path to health includes investing in treatment, such as physiotherapy or psychological services, that helps plan members in their recovery. A Treatment Funding structure was introduced to allow 3sHealth to pay treatment providers directly, then submit claims for reimbursement from the Extended Health and Dental Care Plan provider (Canada Life).

When treatment funding was first introduced, the process was built around the concept that the Disability Income Plan (DIP) trust fund would be the “payer of last resort.” This meant that plan members on an approved disability claim would have to exhaust their Extended Health and Dental Care Plan benefits for that category of treatment before payments would be made from the trust. An unintended result was that some plan members had reduced amounts, or no funds at all, left in their benefit allotments when their disability claim ended and they returned to work.

“When we started the process, we didn’t know how many requests there would be, what the success rate would be,” explained Jade Lea-Wilson, Director of 3sHealth’s Claims Services team. “Our motivation was to start investing in plan members’ recovery and make it as easy as possible for them to receive their funds.”

The decision was made by the Board of Trustees to instead pay for approved treatments directly from the Long-term Disability Plan trusts, starting in December of 2023. This ensured that health-care workers on approved long-term disability benefits would no longer have to use their extended health benefits for treatments that are related to their claim, and that they would still have access to their full extended health coverage balance available when they return to work. 

It is a change that makes a lot of sense, not only for plan members, but also for employers.

“Plan members returning to work after an approved disability and participating in a treatment program will enjoy peace of mind knowing they can access the rest of their benefits if they face a flare-up or develop a new condition,” explained Jody, a 3sHealth Adjudicator. “This means they won’t need to take additional time off work to receive the care they need, ensuring both their health and productivity are protected.”

This also creates a trickle-down benefit for patients, as keeping health-care workers healthy contributes to high-quality patient care.

According to the audited methodology 3sHealth uses to measure the number of lives positively impacted, this improvement means more equitable, customer-centred care for 455 health-care workers on approved disability claims each year. 

“Being on disability is hard, and going back to work can be harder,” insisted Patient Family Partner Wendy Kopciuch. “Having access to benefits and being able to continue treatment when you’re back to work is an important part of recovery and the path to health. I’m really glad for this improvement.”

If you have questions about your benefit plan, call 3sHealth at 1.866.278.2301 or email ebp@3sHealth.ca.