3sHealth: Claims Processing in January 2021

Each January, 3sHealth Employee Benefits performs an eligibility measure for all other-than-full-time employees. This year’s measure will determine if an employee is eligible for coverage effective January 1, 2021 based on the hours they worked from January 1 to December 31, 2020. An employee must work a minimum of 780 hours in the complete calendar year to be eligible for benefits. The annual measure will run on Thursday, January 7, 2021 and the eligibility results will be available Friday, January 18, 2021. For the employers who subscribe to 3sHealth payroll, a benefits bulletin will be sent to you to advise when the results are ready for your review. For those employers who do not subscribe to 3sHealth payroll, we will start sending the eligibility results to you on Monday, January 11, 2021.

Claim pre-authorizations submitted after December 14, 2020 or claims incurred in January 2021, will be held at Canada Life until the annual measure process is complete. Canada Life will begin processing pre-authorizations and claims in mid-January in the order they were received and will work diligently to be caught up by February 15, 2021.

Employers participating in the extended health care plan are encouraged to have their employees submit their drug claims by the paper method or on-line through GroupNet for Plan Members during the first three weeks in January.

To ensure that your employees are aware of the claims freeze, please post the attached Reminder Notice in a visible area within your organization. If you are aware of employees who may be losing coverage, please remind them that claims incurred after December 31, 2020, will not be paid if the employee is no longer benefit eligible. All 2020 claims must be submitted to Canada Life for reimbursement by April 30, 2021.

If you have questions about the annual measure or about claims processing during the month of January 2021, please send an email to EBP@3sHealth.ca. You may also contact a 3sHealth Benefit Services Officer by telephone at 1-866-278-2301

A Reminder to Participating Organizations of the 3sHealth Extended Health Care & Dental Plans.

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