Alberta.ca » Income and Employment Supports Policy Manual


Expected to Work/Barriers to Full Employment Policy & Procedures

Published Date: August 01, 2010
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19 Administrative Procedures

Payment Methods and Processes

Health Benefits Card / EMP 1976 Drug Authorization

Health Benefits Cards

The Health Benefits Card (HBC) is attached to the first cheque or deposit statement issued each month on files that are assigned any medical code except 7. For any supplementary payment(s) issued, VOID is printed on the HBC portion of the cheque or deposit statement.

Coverage Entitlement

Individual Coverage

Not all individuals within a household unit may be entitled to health benefit coverage (e.g., adults or dependants who are a Registered/Status First Nations person). The HBC shows which members of the household unit are covered for Community and Social Services health benefits.

The worker indicates in the Health Benefits Coverage (Medical Coverage) field in Client file function 7:

  • Y” – yes, this person is to be included on the Health Benefits Card (HBC) or
  • N” – no, this person is not to be included on the HBC

The HBC identifies the persons covered (including full given name and surname), their date of birth and the benefits provided.

When the head of household is not covered, an asterisk (*) appears beside his or her name at the top of the HBC. The name will NOT appear under “Persons Covered”.

Health Benefits Card (Med Codes)

Code 1 – Health Benefits – Supplementary Dental Benefits

  • AISH code only

Code 3 – Health Benefits – Supplementary Dental Benefits, Restricted Drugs

  • AISH code only

Code 6 – Health Benefits – Standard Dental Benefits

Code 7 – No Coverage for Anyone on the File

  • This code is used for household units where all members are registered under the Indian Act, and for One-Time Issue client sub-types (sub-types 81 and 82).
Note
Only VOID is printed on the HBC portion of the cheque or deposit statement.

Code 9 – Medical – Standard Dental Benefits, Restricted Drugs

  • Same coverage as Code 6

Restricted Drugs

The worker uses Code 9 to restrict drugs when:

  • The worker suspects a client is over-utilizing drugs 
  • The client is identified on the High Volume Drug Use Listing report and there is no legitimate reason to not restrict the client such as:
    • Client receives medical treatment from numerous doctors due to serious illness 
    • Client receives prescriptions from different pharmacies due to proximity to their medical appointments
Note
When drugs are restricted on the HBC (Code 8 or 9), the HBC is printed with “R-DRUGS” on it. This restricts drug purchases to the first drug store used by the client for the benefit period indicated.

No Coverage

The worker uses Code 7 to prevent health benefit coverage when:

  • All members of the household unit are not entitled to health benefit coverage (e.g., Registered/Status First Nations person’s health needs are covered by Health Canada).
Note
Where a non-status partner and/or dependent children of a Registered/Status First Nations person requires health benefit coverage, do not use Code 7 – No Coverage. The appropriate code for the household unit type is entered and the worker indicates “Y” in the Health Benefits Coverage (Medical Coverage) field in Client file function 7 for the non-status partner and/or dependent children and “N” in the Health Benefits Coverage (Medical Coverage) field for the registered/status person.
  • All members of the household unit are receiving complete health benefit coverage from another source (e.g., employer) and do not require coverage from Community and Social Services.

Partner or Dependent Child Added to File After HBC Printed

When a partner or dependent child is added to the client’s file after the HBC has been printed, the new household member cannot access health benefits using the HBC for the remainder of that benefit period. The client must be advised to contact their worker if the new recipient requires a health benefit in that benefit period.

A health benefit for an eligible recipient not listed on the HBC is provided through the EMP 1976 Drug Authorization or an EMP 0018 Purchase Authorization.

EMP 1976 Drug Authorization

If the recipient is entitled to prescription drug services, but does not have a HBC, the worker issues an EMP 1976 Drug Authorization and records this in the EMP 1987 Drug Authorization Log.

The EMP 1976 Drug Authorization is used when:

  • Clients require drugs prior to issuance of a Health Benefits Card. 
  • A new dependant is added to the file during the benefit period (i.e., after the first cheque or deposit was issued for that month). 
  • A restricted client must obtain a prescription from a drug store other than the one they were restricted to at the beginning of the benefit period, if for example they moved or had to travel to another location in Alberta for medical treatment. 
  • One-time issue clients require Emergency Prescription Drugs.
Note
Pharmacists should be reminded that the EMP 1976 Drug Authorization is not an approval for a specific drug, but rather an authorization for drug services in accordance with the drug benefit program guidelines.

EMP 0018 Purchase Authorization

An EMP 0018 Purchase Authorization and Invoice is used to provide health coverage or other needs other than prescription drugs when a recipient is eligible but not listed on the HBC. The worker enters the standard message according to the Goods and Services Table.

Clients Without their HBC

Clients are responsible to carry their HBC with them. Clients who require health benefit coverage, and who have been issued a HBC but do not have their HBC with them, are requested to locate and produce their card in order to receive the necessary coverage.

Staff may provide the client’s file number to the health professional requesting authorization for service only when locating the HBC would cause undue hardship for the client.

Note
The HBC is issued monthly, as long as the client remains eligible, and cannot be re-issued in any benefit period.

Returned HBC

When an HBC is returned use the same procedures as any returned mail. If there is a cheque attached to the HBC use the procedures for returned DOC and CCP cheques.

HBC for Manual (Handwritten) Cheques

When a manual cheque is issued, the Site Contact VOID’s the HBC.

Note
When a manual cheque is issued as the main payment, the required health coverage is issued by an EMP 1976 Drug Authorization or EMP 0018 Purchase Authorization and Invoice.

Reconciliation of HBCs

When a DOC payment prints with a HBC, and the client data rejects for an invalid PID or date of birth, the rejected client data will be identified on three different exception reports:

  • SIMP 2400-1 LISA – CCD Upload Exception Report 
  • SIMP 2420-1 LISA – CN Cheque Reject Report 
  • SIMP 2480-1 LISA – EI Medical Card Upload Exception Report
Note
The SIMP 2420-1 LISA – CN Cheque Reject Report and the SIMP 2480-1 LISA – EI Medical Card Upload Exception Report are retained by the Site Contact with daily reports for reconciliation purposes.

The Site Contact forwards a copy of the SIMP 2400-1 LISA – CCD Upload Exception Report to the worker. When the report(s) is received, the worker:

  1. Reviews the error message on the report(s) 
  2. Reviews the client’s file and makes the correction on LISA or CCD 
  3. Identifies the correction has been made and returns the SIMP 2400-1 LISA – CCD Upload Exception Report.
  4. Enters comments in Mobius.
Note
Workers must respond to errors identified on the exception report before the next day’s data transmission.