Changes in health plan resulted in benefit discrepancies
After more than a decade, a grievance filed by the Kingston Professional Fire Fighters’ Association was finally settled.
The union claimed the City of Kingston, Ont., failed to maintain extended health-care benefits as required under the parties’ collective agreement. The grievance was filed during the collective agreement in effect from Jan. 1, 2003, to Dec. 31, 2005, and finally addressed by arbitrator Christopher Albertyn in September 2015.
The employer’s extended health-care benefits — originally provided under the Blue Cross Extended Health Care Plan in the 1990s — became the Liberty Health Plan.
The Liberty Health Plan then became part of Maritime Life which eventually became part of Manulife.
These changes resulted in a discrepancy between the benefits originally provided to employees (the "base plan") and the benefits currently available to employees (the "later plan").
The parties continued to negotiate collective agreements in the subsequent years and were able to address some of the issues covered by the grievance in that time.
While the parties were able to resolve issues such as travel coverage and dependant coverage, they could not come to terms on coverage for hair growth stimulants and for erectile dysfunction drugs.
The later plan included exclusions for erectile dysfunction treatments and hair growth stimulants, as they were not deemed to be medically necessary.
The union argued it was not consulted on those changes, nor was there any agreement by the union to any changes.
The base plan included coverage for certain drugs that, before modern erectile dysfunction drugs, sometimes served as treatments for impotence.
In order to maintain equivalence with the base plan the union argued coverage had to include any and all erectile dysfunction treatments, including newer treatments such as Viagra, Cialis and Levitra.
Albertyn agreed, saying, "The erectile dysfunction drugs are prescription drugs so, in the absence of anything more, provided they are prescribed by a physician, they ought to be covered, as they were under the base plan."
Albertyn ordered that all members who had been denied reimbursement of the prescriptions for those drugs be reimbursed.
Turning to the issue of hair loss treatment, Albertyn found that treatment primarily for cosmetic purpose had always been excluded.
Treatment to address a genuine medical necessity, however, ought to be covered.
"To the extent that such a treatment is excluded," Albertyn said, "there has been a change from what existed in the base plan, and that constitutes a violation."
The grievance was upheld.
Reference: Corporation of the City of Kingston and the Kingston Professional Fire Fighters’ Association. Christopher Albertyn — arbitrator. Chris Edwards for the employer, Howard Goldblatt for the union. Sept. 4, 2015.