Addiction & Substance Use Treatment Cost-Sharing
Members who have a substance use disorder or substance misuse face many challenges, including the high cost of treatment and medical monitoring (which is the randomized drug and/or alcohol tests when the worker is back at work).
The Public Education Benefits Trust (PEBT) wants to partner with you and your school district/local so you can receive the treatment and medical monitoring you need. We support your recovery and a healthy return to work.
Eligibility
Any member, as defined in the Core Long Term Disability (LTD) Program text, who is eligible to receive Core LTD benefits, and who is off work or expected to be off work because of a diagnosed addiction or substance misuse.
What are the first steps?
If you are off work, your school district will contact the PEBT service provider, Desjardins Insurance, within six working days. Once notified, a Desjardins Insurance Healthcare Management Specialist (HCMS) will contact you by phone within 24 hours. The HCMS may also contact your doctor, and you may be asked to attend an appointment with a medical specialist.
Any information about your medical condition and treatment will be confidential.
If you are still working or have not yet been contacted, you may contact the PEBT at 604-292-0288 for more information.
If you have a substance misuse disorder, the HCMS will review treatment options with you. Treatment costs and available cost-sharing will also be discussed.
To be eligible for any treatment cost-sharing, you are expected to obtain pre-approval from Desjardins Insurance before your treatment starts.
Treatment costs and eligibility for cost-sharing
The PEBT service provider, Desjardins Insurance, will work with you based on information from your doctor to ensure the treatment is appropriate and delivered in the most cost-effective manner. Eligible treatment should focus on a healthy, safe, and timely return to work. It is anticipated that you will be ready to return to work within two weeks of the successful conclusion of treatment. However, more time may be needed according to your individual circumstances.
When the PEBT service provider has completed their review, usually within a few days, the HCMS will contact you to confirm what portion of treatment costs will be paid by the PEBT. Your HCMS will then guide you through the next steps.
Coverage
Reflecting long-standing best practices, treatment costs are expected to be divided among yourself, your school district and the PEBT, when possible. Effective January 1, 2024, your 1/3 portion is limited to $1,000.
Example: residential addiction treatment – $12,000 cost
- Your portion – $1,000
- School district’s portion – $4,000
- PEBT’s portion – $7,000
Please note that this cost-sharing is recommended and is not intended to replace arrangements already established by school districts.
Disclaimer:
The information contained on this website is provided for general information purposes only. Every effort has been made to ensure that this information is accurate, but this site is not a substitute for the official Plan documents, nor is it an employment contract. In the event there is a discrepancy between this website and the official Plan documents, the official Plan documents will prevail. For more information, or if you have questions about the information provided on this website please contact your School District Benefits Administrator.
