Coverage under new benefits’ provider must not be reduced
The Ontario Nurses’ Association (ONA) calls it a “significant” decision for the province’s 50,000 nurses who work under a myriad of benefit plans and providers.
“This is a big heads-up to employers,” said Linda Haslam-Stroud, a registered nurse and provincial president of the ONA. “When they are changing carriers, they have an obligation to ensure benefits are not reduced.”
Nurses in Ontario are covered by a central collective agreement which contains an article that prevents hospitals from decreasing benefits when they change carriers. Haslam-Stroud said hospitals are supposed to tell a union about any changes in benefits coverage, but often that doesn’t happen, which is what took place in this case.
“It was approved by Sun Life in 2008, but when the hospital changed to Great-West Life in 2010, we knew nothing until they advised our member that they would no longer cover her,” she said.
Great-West Life replaced Sun Life Financial in February of this year as the hospital’s extended health and benefits administrator. Under the Great-West Life plan, in-home nursing care would be provided only for acute, convalescent or palliative care — not chronic care, as it deemed the nurse’s husband’s condition.
At the arbitration hearing, the hospital argued the benefit had not changed. It argued both plans have a limitation for chronic care. The arbitrator disagreed.
John Stout wrote, “I accept that providing unlimited private nursing care is not usual or ordinary. I also acknowledge that the cost associated with this benefit is extraordinary in the circumstances of this case. However, the clear language of the Sun Life Plan and the manner in which it was applied indicates that this was the level of benefit enjoyed prior to the carrier being changed to Great-West Life.”
At the hearing, the union accepted that it was not Mount Sinai’s intention to reduce benefits when it issued the RFP for an extended health and dental benefits provider. Haslam-Stroud said while it may not have been the hospital’s intention, it was still ultimately responsible for ensuring benefit coverage was not being reduced.
“The insurance industry spends multi-millions of dollars on plans, words and interpretations [to avoid paying],” she said. “So, it’s the fault of the employer. It has the ultimate obligation to ensure there isn’t a reduction.”
The problem in Ontario, according to Haslam-Stroud, is that it’s difficult to keep track of what’s happening from hospital to hospital.
“There are more than 150 employers in the hospital sector,” she said, “and they’re all negotiating with carriers. Each one is tweaking the benefits coverage as they go along.”
Haslam-Stroud said often when hospitals switch carriers the changes are so subtle that nurses either don’t notice or don’t say anything when they do.
“They just think, ‘Oh, I guess that’s changed,’ ” she said. “We know that employers are looking for cost savings. They want to do anything to reduce premiums. But quality is often eroded.”
Haslam-Stroud said the decision underscores the need for better clarity in the central collective agreement vis-à-vis benefits coverage. She said some areas are fairly clear, such as chiropractic, eyewear and dental. However, she said there is increasing disparity across the province when it comes to new technology, such as respirators.
