Retiree plans

You are eligible to apply if you are between the ages of 55 and 70 and are coming off of an employer/group sponsored benefit plan. This application age is based solely on the age of the applicant. There are no age restrictions for a spouse or any dependents provided that the applicant is eligible for the plan. You must apply within 60 days of termination from your group benefit plan. You must also be a Manitoba resident, registered with and entitled to benefits from Manitoba Health or be a resident of Nunavut.

If you apply within 60 days of the termination of your group benefit plan, a medical review is not required. Coverage will be effective the first of the month following the group plan end date.

If you apply for coverage from 61 to 182 days after leaving your group plan, medical information for each participant is required to determine acceptance.

After 182 days of leaving your group plan you will not be eligible to enroll on the retiree plan.

A couple or family rate does not apply for this plan, as all rates are per plan participant.

If your plan includes a spouse or dependents, rates for each additional plan participant are determined using the rates specified within their age bracket at the coverage level you've chosen. The monthly premium is calculated as the sum of all rates for each of the plan participants included on the plan. These rates will change as each plan participant reaches a new age bracket or upon changes to the overall rate by Manitoba Blue Cross.

The effective date of your retiree plan can be the first of the month following the termination of your employer-sponsored group plan or it can be backdated to the first of the month in which your employer-sponsored group plan ended.

A member can transfer from a Retiree Standard plan to a Retiree Basic plan at any time. When enrolled on a Retiree Basic plan, a member cannot transfer to a Retiree Standard plan unless the request is made within 182 days of their termination from an employer/group sponsored benefit plan. Medical information may be required.

The plan does not have a termination age. However, travel coverage outside of Canada, which is included as part of the Retiree Standard plan, terminates at age 75, based on the age of the individual plan participant. For example, when you turn 75, your outside-of-Canada travel coverage will terminate, but your spouse's will remain active until he or she turns 75. Travel coverage within Canada, but outside Manitoba, does not have an age restriction.

Yes, as long as you maintain your status according to the requirements of your Manitoba Health plan, you can remain on the retiree plan. Note that Manitoba has rules for individuals maintaining their health care coverage, and you should review the rules. Please refer to the Province of Manitoba website: https://www.gov.mb.ca/health/mhsip/leavingtemporarily.html#section-one

Our retiree plan provides coverage for our customers outside of Manitoba for a period of up to three months. However, all Blue Cross plans across Canada have reciprocal agreements with each other for individual plan transfers. If you move to another province, you should contact the Blue Cross office in that province to enroll in one of their plans.

No, there are differences between the travel coverage you had with your group benefit plan and your individual retiree plan. The most important difference is the stability clause that applies to the retiree plan. This states that a claim will not be paid for services related to a medical condition that was not deemed stable 90 days prior to your trip departure date.

Manitoba Blue Cross defines that a pre-existing condition is a sickness, injury or medical condition, whether or not diagnosed by a physician:

• for which you exhibited signs or symptoms; or
• for which you required or received medical consultation, treatment or
• hospitalization; or
• for which you were prescribed a new medication or given a change in prescribed medication; and
• which existed prior to the departure date of your coverage

Manitoba Blue Cross defines stable as a medical condition that is not worsening, and there has been no change in prescribed medication for the condition, nor any other treatment prescribed or recommended or received.

Not all changes to medication will be affected by the stability clause. A change in prescribed medication means any increase or decrease in dose, strength or frequency of a prescribed medication, as well as the addition or discontinuation of any medication. The following are not considered changes in prescribed medication:

• The daily sliding scale or glucometer adjustments for insulin injections.
• A change from a brand name medication to the generic form of the same medication provided the dosage is the same.
• The routine adjustment of Coumadin, Warfarin, or other anticoagulant medication except where newly prescribed or stopped.

The 90-day stability clause applies at time of claim and is calculated back from your trip departure date. Manitoba Blue Cross will determine if the claim relates to a medical condition, symptom or illness that you experienced 90 days prior to your trip departure date.

Yes, being deemed medically stable to travel in a doctor’s opinion is not the same thing as meeting our definition of stable as it relates to coverage of a medical condition. Your medical condition may be considered stable from a medical point of view; however, due to the timing of the most recent change in symptoms, medications, treatment, requisition or recommendation for a test or procedure, that does not necessarily mean you’ll be covered in the event of an emergency relating to that condition.

If a pre-existing medical condition was directly or indirectly related to the need for emergency medical care during your trip, we will access your medical records to confirm whether the medical condition in question met our definition of the 90-day stability period.

Yes, every travel plan you purchase or have through a group benefit plan includes specific limitations and exclusions. It is important and your responsibility to carefully read and understand your travel plan benefits, eligibility, exclusions and limitations.

Your travel benefit contains limitations and exclusions that could affect your coverage. Some exclusions include the following:

• medical conditions that are not stable;
• participation in high-risk activities or extreme sports;
• seeking treatment, medical consultation or a second medical opinion while travelling;
• travelling against medical advice; or
• travelling after your receipt of a terminal prognosis

Even though outside-of-Canada travel benefits are no longer available for you on the Retiree Standard plan upon turning age 75, you are still eligible for a retiree plan travel discount of 10 per cent when you purchase travel coverage from Manitoba Blue Cross. You will continue to have travel coverage within Canada and outside of Manitoba.