Need To Know
Benefit Details
How to Claim
Other Advantages
Forms
About
FAQ

The Arts & Entertainment Plan®

Making health insurance accessible for Artists.

You can find all benefit and claim information here, as well as forms. If you're interested in other insurance products like home and auto, go to the Other Advantages page.

NEED TO KNOW

Important Information

Here are a few things we recommend you do as a member.

Register Your Plan Certificate Number

Register your certificate/group number at your pharmacy and dental office for electronic submission of claims.

Read through your welcome package then remove the perforated section that contains your certificate/group number (on the front) and your travel emergency medical information (on the back) and put it in your wallet.

Call us BEFORE you claim

Not sure if something is covered? Call us to make sure.

Keep our contact info handy
1-800-387-8897 x238.

Keep All Receipts and Documentation

Photocopy all your receipts.

Keep all your statements (Explanation of Benefits (EOB's), invoices etc.).

Hold on to your plan documents (Certificate of Insurance).

Important Dates

Claims must be submitted not more than 90 days following the close of each Benefit Year.

Remember your annual insurance renewal date; it's the start of each Benefit Year.

What To Do When Your Family Status Changes

Click here for details

Simple.

We give you the coverage you need - minus the confusion

WE'VE GOT YOU COVERED

What's In The Arts & Entertainment Plan®?

Prescription Drug

Standard Comprehensive
All Years Year One Year Two Subsequent Years
Reimbursement Percentage for each Insured Person 70%* 70%* 70%* 70%*
Annual Maximum for each Insured Person $400 $1,000 $2,000 $3,000
AFBS Drug Formulary The AFBS prescription drug formulary will be used to settle all drug claims The AFBS prescription drug formulary will be used to settle all drug claims

*We cover ingredient costs only. Ingredient costs cover usual and customary costs. They do not include "dispensing fees".

For those Members who reside in Québec the requirements of the Régie de l’assurance maladie du Québec (RAMQ) will take precedence.

Extended Health Care (including Vision/Paramedical Care)

Standard Comprehensive
All Years Year One Year Two Subsequent Years
Reimbursement Percentage for each Insured Person 70% 70% 70% 70%
Annual Maximum for each Insured Person $5,000* $7,500* $7,500* $7,500*
Annual Maximum for each Insured Person for Vision/Paramedical Care $350 $500 $500 $750

*Maximum includes benefits paid for Vision/Paramedical Care

Dental Care

Standard Comprehensive
All Years Year One Year Two Subsequent Years
Reimbursement Percentage for each Insured Person 50% 50% 50% 50%
Annual Maximum for each Insured Person $800 $800 $1,250
Basic Services $400 combined all services $300 $300 $500
Major Services (crowns, bridges, dentures) including Periodontal (gum disease) and Endodontic (root canal) $500 $500 $750

Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

Access to coverage and the amount of coverage is based on your age as indicated in the table below.


Standard Comprehensive
Group Term Life AD&D Group Term Life AD&D
Age at Annual Renewal
16 - 64 $10,000 $10,000 $10,000 $20,000
65 - 69 $5,000 $5,000 $5,000 $10,000
70 - 75 $5,000 Not covered $5,000 Not covered
Travel Emergency Medical

If you have an accident or become ill outside your province of residence, your provincial health care program may not cover all your medical bills, even when travel is within Canada.

The Travel Emergency Medical benefit has been designed to cover many of the types of expenses that can occur when a medical emergency occurs while away from home.

  • 60 day maximum duration per trip for those under age 80*
  • 30 day maximum duration per trip for those age 80 but not yet 85**
  • Unlimited trips per benefit year – recreational or business
  • $1,000,000 Lifetime maximum

This benefit is made available through iA Financial Group who is the provider of this benefit. Additional details are available below.

*The policy is null and void if you schedule or extend a trip beyond a 60 day duration, regardless of whether the extended period is insured by other parties.

**The policy is null and void if you schedule or extend a trip beyond a 30 day duration, regardless of whether the extended period is insured by other parties.

Member and Family Assistance Program (MFAP)

The Member and Family Assistance Program (MFAP) benefit reflects AFBS’ continuing commitment to the physical and emotional well-being of our membership. Through the Member and Family Assistance Program, offered by Morneau Shepell, confidential help is available to members and their families to assist with resolving the personal problems that can interfere with their lives and work, including:

Counselling Services, provided on a voluntary, confidential and short-term basis either in person, online or by telephone; and

Work/Life Services which can include telephone and/or text-based resources either online or printed material in a wide-ranging number of areas including:

  • Family Support Services;
  • Financial Support Services;
  • Legal Support Services;
  • Nutritional Support Services;
  • Naturopathic Services; and
  • Health Coaching.

Community.

We are truly a case of Artists helping Artists.

How To Claim

How Do You Make A Claim?

Prescription Drug Benefit

Electronic Submission

In most cases, your pharmacist will file claims electronically. AFBS works with ClaimSecure to provide members and their covered dependants with pay-direct claims payments for Prescription Drug Benefit coverage. Since these claims are processed through the ClaimSecure network, the pharmacist requires your certificate and group number to process your claim.

If Electronic Submission is Not Possible (By Mail)

Electronic submission is not possible for all prescription drug claims. For example, some expenses may require a special authorization, some compounds and coordination of benefits cannot be submitted electronically. If your pharmacist cannot submit your claim electronically, you must send AFBS a completed prescription drug claim form.

If AFBS is the second payor, please include the receipt of claim settlement information, often called an Explanation of Benefits (EOB), from the other insurance company along with copies of the official receipt from the pharmacy with a completed prescription drug claim form to AFBS.

If Electronic submission is not possible:

  • Print this form
  • Complete the form in full
  • Sign it and send the completed form along with your original receipts to:

AFBS
1000 Yonge Street
Toronto, ON M4W 2K2

Extended Health Care

To submit health care expenses like medical, paramedical (acupuncture, massage etc...), vision care, please:

  • Print this form
  • Complete the form in full, remember to obtain any medical recommendations that may be necessary when reimbursement for certain supplies or services is included in your submission
  • Sign it and send the completed form along with your original receipts to:

AFBS
1000 Yonge Street
Toronto, ON M4W 2K2

Dental Care

Electronic Submission

In most cases, your dental office will file claims electronically. AFBS works with ClaimSecure to provide members and their covered dependants with pay-direct claims payments for Dental Care coverage. Since these claims are processed through the ClaimSecure network, the dental office requires your certificate and group number to process your claim.

If Electronic Submission is Not Possible (By Mail)

Electronic submission is not possible for all dental claims. For example, dental claims for procedures, including certain x-rays and major restorative work, cannot be submitted electronically. If your dental office cannot submit your claim electronically, you must send AFBS an original standard dental claim form which must be completed by your dentist.

If AFBS is the second payor, please include the receipt of claim settlement information, often called an Explanation of Benefits (EOB), from the other insurance company along with copies of a completed standard dental claim form to AFBS.

If Electronic submission is not possible :

  • Have your dentist complete an original standard dental claim
  • Make sure the dentist and you sign the form
  • Send the completed form to:

AFBS
1000 Yonge Street
Toronto, ON M4W 2K2

Group Term Life and AD&D Insurance

In the event of your death, notification of a claim for the Group Life benefit must be made to AFBS. AD&D benefits may also be payable if death is a result of an accident. The necessary forms and instructions will be sent to your beneficiary, executor or lawyer.

If you suffer a covered loss of use or dismemberment, as a result of an accident, your AD&D claim must be submitted to AFBS within 90 days of the accident.

AFBS
1000 Yonge Street
Toronto, ON M4W 2K2

Travel Emergency Medical

To submit a claim for expenses incurred while travelling out of your province of residence, you must send your original invoices and/or receipts with the required form.

  • Print this form
  • Complete the form in full,
  • Sign it and send the completed form along with your original receipts to:

INDUSTRIAL ALLIANCE INSURANCE AND FINANCIAL SERVICES INC.
Life and Health Claims Department, Special Markets Solutions
2165 Broadway W, PO Box 5900
Vancouver, BC V6B 5H6

Tel: 1-800-266-5667
www.solutionsinsurance.com

Coordination of Benefits (COB) with Other Insurance Programs

Step 1

If you or your spouse/partner have coverage with another insurance company, you should send the claims to that insurer for payment. However, if you are a dependant under your spouse/partner’s coverage, your claim must be sent to AFBS first. Usually, claims for insured dependant children must be submitted to the plan of the parent whose birth day and month falls first within the calendar year. When administering coordination of benefits AFBS follows the guidelines established by the Canadian Life and Health Insurance Association (CLHIA).

Step 2

After settling a claim with the primary insurer, any portion not paid by the other insurance company will be reported on the Explanation of Benefits (EOB) statement. Submit this explanation to AFBS along with a completed claim form and copies of your original receipts.

Step 3

AFBS will adjudicate the remaining amount that was not paid by the primary insurer. You will be reimbursed up to your benefit level or 100% of the eligible health or dental expenses unpaid by the other insurer.

When you are coordinating claims between insurance companies, you will be required to provide copies of your receipts to the second insurer in order to be reimbursed by them.

Deadlines for Claims Submission

Claims for a previous Benefit Year must be submitted within 90 days of the close of the Benefit Year indicated on your Certificate of Insurance to remain eligible for payment.

Supportive.

We look for ways to make our services go farther.

OTHER ADVANTAGES

Take Advantage of Other Member Advantages

Everything from home insurance to personal and commercial banking.

All these products and services are completely voluntary. Please contact the program provider directly for all payment and processing.


Accessible.

Find what you need, when you need it.

For Artists.

We give you the coverage you need - minus the confusion

WHAT MAKES US DIFFERENT?

Artists Helping Artists

The Arts & Entertainment Plan® is offered by AFBS, a not-for-profit insurance provider owned by performers and writers. As an organization, we understand the unique needs of people who earn their living through their creativity and only insure those working in the writing community. We’re committed to the continued development of a plan that works for the community.

How it all started

Canadian author, social activist and past chair of the Writers Union of Canada (TWUC), Susan Swan found herself musing on the fact that access to an affordable health care safety net – something enjoyed by salaried workers in the private and public business sector – was denied to too many people in the creative and artistic world.

The results of her conversations and considerations ultimately led to a dialogue with AFBS, about underwriting a benefits program for the writing community. AFBS launched the first Canadian benefits insurance program specifically for uninsured writers and the writing industry in 2009. Two years later, the Arts & Entertainment Plan® was launched to serve the rest of the artistic community.

Who is AFBS?

AFBS Logo
AFBS is a Member-owned, federally incorporated insurance company and financial institution operating since 1975. Members of AFBS are primarily members of ACTRA and The Writers Guild of Canada. AFBS has proudly underwritten the Arts & Entertainment Plan® since November 1, 2011. AFBS is proud to expand its membership across Canada to include associate members from within the artistic community.

FAQ.

100% Canadian. We are a national plan, from coast to coast.

FAQ

Application/Enrollment

The Standard plan is available for new applicants age 70 and under and is renewable for those who have been insured prior to age 70.

The Comprehensive plan is available for new applicants age 64 and under and is renewable for those who have been insured prior to age 64.

No, if you would like to apply offline simply print an Enrollment form and mail, scan or fax it in with your payment (be sure to sign and date it).

No, your coverage will start the first of the following month in which you apply (and only after you've been approved and premium has been collected). During the online enrollment process, your effective date of coverage will be noted and you will receive information on next steps.

No. When a plan is chosen, each family member must be covered by the same plan.

No, your provincial health care plan provides in-hospital care and doctor’s fees which are not covered through the Arts & Entertainment Plan®. It is very important that you always keep your provincial health care benefits in place.

You would apply as a couple paying the lower rate.

As long as we know when your other benefits are terminating we’ll try to ensure that there is no lapse in coverage.  Your benefits under the Arts & Entertainment Plan ® will commence on the 1st of the month following receipt and approval.  We’ll need your completed application and premium payment in advance of your termination in order to avoid any lapse.  Depending on when your other insurance terminates you might have some duplication of coverage for a short while. Contact us to discuss your particular scenario.

Yes. This is a guaranteed acceptance plan – no medical questionnaires need to be filled out.

If we receive your application and payment on or before the last of the month (and it has been approved), your benefits will be effective the first (1st) day of the following month.

If you’re a member of a company that provides group benefits and you leave that company, you may be able to join the Comprehensive plan at Year 3 levels (Subsequent years). Call for more details.

Benefits

You may upgrade/downgrade between plan options however, you must satisfy the 12 month period in which your original contract was issued. Also, if your move is an upgrade to the Comprehensive plan, you must satisfy the 2 year lock-in provision. This means once you make the move it is a 24 month commitment under your new plan option.

No, this is a group plan and increasing the duration or changing the benefits is not possible.

Claims

Many prescription drug and dental claims can be processed immediately at your pharmacy or dentist’s office. Be sure to provide your pharmacist and dental office with your group number and certificate number which can be found on your welcome letter included as part of your enrollment package. When claims are processed at your pharmacy you’ll find in many instances that you only pay your portion of the costs. And when dental claims can be processed electronically through your dental office your reimbursement will be on its way to you immediately. Make sure you have confirmation on whether your prescription or dental expense was adjudicated electronically.

Sometimes electronic adjudication is not possible and in these situations or when you are submitting an extended health care claim your expense receipt must be submitted to AFBS for reimbursement. Generally, once all of the pertinent information has been received at AFBS your claim will be adjudicated within 10 business days.

Once you submit a claim, whether it was handled electronically or by submission, you will receive an Explanation of Benefits (EOB) which details what was processed and the amount of any reimbursement. You will want to keep this document for income tax purposes or to coordinate benefits with another insurer. When you submit a claim and it is processed manually, in most cases the EOB will be accompanied with a cheque however, if there is no payment you will just receive the EOB.

Premiums

You can pay monthly or annually by credit card online (we accept American Express, MasterCard and Visa) or by cheque with a paper application. For monthly withdrawals from your bank account, please include a void cheque with your application.

If you’re paying monthly via your credit card, the premium payment will occur on the 28th of each month. If you’re paying monthly from your bank account the payment will come out on the 15th of each month (you can’t change the day of the withdrawal).

Your initial premium rate is guaranteed for the one year, as long as you do not make any changes to your chosen coverage. Changes in age bands, determined based on your age at the annual renewal, will also result in changes to your premium costs. Further, the premium rates for the program are reviewed regularly and changes may be implemented at anytime. The premium costs at each renewal are further guaranteed for one year as long as there are no coverage changes.

Medical (Health and Dental) premiums may be tax deductible for individuals or businesses. Please consult your tax advisor for more information.

Terminology

Refers to the 12 month period from the date your benefits commence. For example, if your benefits start November 1st your benefit year would be November 1st to October 31st.

Natural children, stepchildren, common law children or legally adopted children.

The applicant and his/her married or common-law spouse/partner or a single parent with one child who qualifies as a dependant.

Spouse/partner and/or unmarried children (as defined above), under age 18. Note: Children between 18-26 may be covered as a dependent if they are in school or are disabled or handicapped.

The applicant and his/her spouse or common-law spouse/partner and any children who qualify as a dependant or a single parent with 2 or more children who qualify as dependants.

Products that contain medical ingredients identical to the original brand name drug in dosage form, safety, strength, administration, quality, performance and intended use. Generic drugs may be produced and marketed after the brand name drug’s patent has expired.

Any treatment, service or supply which is generally accepted by the medical profession as essential, effective and appropriate in the care and treatment of a medical condition, sickness or injury.