Joint Benefit Committee

May 13, 2010
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The 2010 arbitration award created a Joint Benefit Committee with three representatives from the University administration and three from UTFA.

The Committee’s terms of reference are to review all claims experience that may affect benefit plan provisions and claims patterns. ‘Experience’ here refers to internal matters, such as the impact of plan changes negotiated by the parties, and external factors such as legislative changes to OHIP, the Ontario Drug Benefit Plan, or any other factor that could have an effect on the U of T plan’s provision of benefits.

The Committee is also mandated to review annual plan financial statements and renewal/premium recommendations; to advise in the selection of plan administrators; to review claims rejection or denial reports to identify trends or patterns; and to review and advise on communications.

A member may bring forward to UTFA a denied claim that has been unsuccessfully appealed to the Plan Administrator, and UTFA can in turn forward the claim, with appropriate relevant documents, to the Joint Benefit Committee for review. If the Committee cannot resolve the issue, UTFA may forward the claim, on behalf of the member, to the Chair of the GRP for adjudication – such adjudication to be in accordance with the current plan provisions.