Supplementary
Health and Dental Plans |
The procedure in presenting
an appeal based on the Health Care plan is the
following:
- If you do not agree with the initial decision
of health care plan provider (HCPP), submit
your request for a review in writing to the
HCPP.
- If you do not agree with the review decision,
contact either the NAV CANADA Benefits Section
at (613) 563-3853 or contact the NAV CANADA
Joint Council Secretariat at (613) 563-3817.
You will be required to provide a copy of
the claim in dispute and the response provided
by the HCPP. If personal medical information
is required to pursue potential adjustment
to the claim, written consent must be provided
before any further action will and can be
taken. The documents belonging to the HCPP
are made available to the Benefits Section
or the NAV CANADA Joint Council Secretariat
for consideration during the appeal. All such
documents remain the sole property of the
HCPP and no copies are to be made. All documents
so obtained immediately upon completion of
the consideration of the appeal, shall be
returned to the HCPP. Neither the Benefits
Section nor the NAV CANADA Joint Council will
instruct the HCPP to reimburse the appellant
in cases where the HCPP disagrees with the
interpretation without the agreement of the
benefits committee.
- In the event that the response at this level
is not satisfactory, you have the right to
file an appeal with the NAV CANADA Joint Council’s
benefits committee. A written request
must be forwarded to the NAV CANADA Joint
Council Secretariat at Room 1091, 77 Metcalfe
St., Ottawa, Ontario, K1P 5L6, for consideration
at the next meeting of the benefits committee.
The case file always eliminates
the name of the appellant to protect their
identity during the review.
- The benefits committee schedules
the appeal and considers the information to
determine if the HCPP have interpreted the
benefits plan correctly. In the case where
the benefits committee finds that
the benefits plan has not been interpreted
correctly, the Board provides direction to
the HCPP.
N.B. Where the
benefits committee determines the
HCPP has interpreted the health plan correctly,
there is no further appeal process.
Disability
Insurance (DI) |
The procedure in presenting
an appeal for disability insurance is the following:
- If you do not agree with the initial decision
of insurance plan provider (IPP), submit your
request for a review in writing to the IPP.
- If you do not agree with the review decision,
contact either the NAV CANADA Benefits Section
at 613-563-3853
or contact the NAV CANADA
Joint Council Secretariat at (613) 563-3817.
You will be required to provide a copy of
the claim in dispute and the response provided
by the IPP. If personal medical information
is required to pursue potential adjustment
to the claim, written consent must be provided
before any further action will and can be
taken. The documents belonging to the IPP
are made available to the Benefits Section
or the NAV CANADA Joint Council Secretariat
for consideration during the appeal. All
such
documents remain the sole property of the
IPP and no copies are to be made. All documents
so obtained immediately upon completion of
the consideration of the appeal, shall be
returned to the IPP. Neither the Benefits
Section nor the NAV CANADA Joint Council
will
instruct the IPP to reimburse the appellant
in cases where the IPP disagrees with the
interpretation without the agreement of the
benefits committee.
- In the event that the response at this level
is not satisfactory, you have the right to
file an appeal with the NAV CANADA Joint Council’s
benefits committee. A written request
must be forwarded to the NAV CANADA Joint
Council Secretariat at Room 1091, 77 Metcalfe
St., Ottawa, Ontario, K1P 5L6, for consideration
at the next meeting of the benefits committee.
The case file always eliminates
the name of the appellant to protect their
identity during the review.
- The benefits committee schedules
the appeal and considers the information to
determine if the IPP has interpreted the insurance
plan correctly. In the case where the benefits committee finds that the benefits
plan has not been interpreted correctly, the
Board provides direction to the IPP.
N.B. Where
the benefits committee determines
the IPP has interpreted the insurance plan correctly,
there is no further appeal process.
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