Gary Sawatzky | Chief Operating Officer, ARTA
Every year, the ARTA Health Benefits Committee reviews submissions by members as part of the benefit plan design review.
The Committee reviews every submission from members to determine if the suggested plan change would fit within ARTA’s Benefit Plans. If it does, a financial report is completed to determine how much it would cost members to implement, and the cost is then weighed against the potential benefit and the level of demand.
One aspect of the plan that is automatically reviewed, regardless of member input, is the Usual and Customary Fees that determine the basis of payment for certain eligible claims. The Committee considers real claims data from the past year relevant to each specific good or service. If the actual submitted amounts are significantly different from the current Usual and Customary Fees in place, often due to inflation, a change is typically made. These amounts submitted are the determining factors for the amounts ARTA will pay for each claim, such as paramedical practitioner claims.
For example, in 2024 there were 66,600 claims submitted for physiotherapy treatment, with an average treatment costing $92.45. The Usual and Customary amount that was in place for the 2024–25 plan year was $90.00, meaning the average submitted amount in 2024 exceeded the base amount ARTA had established under the benefits plan, which meant an increase to the Usual and Customary fee appeared to be in order.
This disparity was rectified by the ARTA Health Benefits Committee passing a motion recommending to the ARTA Board of Directors to increase the Usual and Customary Fee for physiotherapy treatment from $90 per treatment to $95 per treatment effective November 1st, 2025, which was accepted by the Board and communicated to plan members as part of their annual renewal communication in September. This was but one update to Usual and Customary Fees made at that time – fees were also increased for massage therapy treatment, naturopathic treatment, and psychology treatment among others.
This disparity was rectified by the ARTA Health Benefits Committee passing a motion recommending to the ARTA Board of Directors to increase the Usual and Customary Fee for physiotherapy treatment from $90 per treatment to $95 per treatment effective November 1st, 2025, which was accepted by the Board and communicated to plan members as part of their annual renewal communication in September. This was but one update to Usual and Customary Fees made at that time – fees were also increased for massage therapy treatment, naturopathic treatment, and psychology treatment among others.
This increase to Usual and Customary Fees is one of the things that makes ARTA’s benefit plans unique. Most other group benefit plans set their Usual and Customary Fees once—at time of inception—and they are rarely reviewed or updated, if ever. It's also why it is so important to read the fine print when comparing benefit plans; a competitor plan may say they cover 100% of eligible expenses but will have relatively low inside limits for these types of benefits, meaning covered members will never come close to getting 100% coverage.
Dental Care procedure rates are set somewhat differently. ARTA does not determine what the procedure fees are for dental care benefits. Instead, those fees are set by the Alberta Dental Association (ADA) each year and published in the ADA Fee Guide. ARTA uses the current years’ ADA Fee Guide to determine what the appropriate fees are for each dental care procedure and use those published fees as the basis of payment for dental care claims. Using the current ADA Fee Guide is also somewhat unique in the retiree benefit plans space; other competitor plans will often use a proprietary fee guide, which typically pays at a lower level than the current ADA Fee Guide, or even an older version of the ADA Fee Guide. ARTA prides itself on using the most current and relevant fee guide to ensure our covered members are getting the best benefits they can.
Dental Care procedure rates are set somewhat differently. ARTA does not determine what the procedure fees are for dental care benefits. Instead, those fees are set by the Alberta Dental Association (ADA) each year and published in the ADA Fee Guide. ARTA uses the current years’ ADA Fee Guide to determine what the appropriate fees are for each dental care procedure and use those published fees as the basis of payment for dental care claims. Using the current ADA Fee Guide is also somewhat unique in the retiree benefit plans space; other competitor plans will often use a proprietary fee guide, which typically pays at a lower level than the current ADA Fee Guide, or even an older version of the ADA Fee Guide. ARTA prides itself on using the most current and relevant fee guide to ensure our covered members are getting the best benefits they can.
ARTA also prides itself on being completely transparent with our members, which is why we publish the full plan details online, as part of our benefit booklets, which include the Usual and Customary Fees. ARTA will continue to update these fees each year and communicate them to the covered ARTA members in a timely manner, along with the other plan changes approved by the board of directors.
After working in group benefits consulting for twenty years, Gary joined ARTA to serve as Chief Operating Officer in November 2017. Gary has his Certified Employee Benefits Specialist designation.