HEALTH FREQUENTLY ASKED QUESTIONS
The following are the most commonly asked questions by
Members regarding the Health Benefit Plan.
If you would like detailed information on any of these topics, please consult the Health Benefit Plan Booklet.
If you still have questions after reading this information,
please contact the Plan Administrator.
How can I tell if I'm covered by the Plan?
To ensure that you are indeed covered at the time you incurred
or will incur a claim, and to ensure that your employer has
submitted the appropriate hours to the Plan on your behalf,
you will need to contact the Plan Administrator. Individual
Member records are not available on this web site. The Group
Insurance Plan Booklet describes how you qualify and maintain
coverage. (Please refer to the Eligibility sections, under General Information in the Health Benefit Plan Booklet.)
When does my coverage end?
Coverage will be terminated on the last day of the calendar month in which employment terminates. However, “lay-days” shall constitute continuation of employment. For example, if employment is terminated and the employee has “lay-days” to his credit, his coverage will terminate on the last day of the calendar month in which such credit is exhausted. Dependents’ coverage will terminate on the same day as that of the employee or upon ceasing to be a dependent as defined. Eligibility for Long Term Disability coverage will terminate on the last day of the calendar month in which the employee attains age 65, even if the employee remains employed thereafter.
Who is eligible as a dependent?
Eligible Dependents are:
- The employee’s legal spouse, by virtue of a religious or civil ceremony except that if an employee is residing with a person of the opposite sex who he has publicly represented as his spouse and with whom he has resided for a period of at least 12 consecutive months, such common-law spouse shall be deemed to be the employee’s spouse.
- Under the age of 21 years, except in the case of a dependent child when by virtue of his own employment is entitled or eligible for coverage; or
- at least 21 years of age but under 25 years of age and a registered student in regular full-time attendance at school; or
- at least 21 years of age and dependent upon the employee by reason of mental or physical infirmity.
Please refer to the Definition of Dependent section, under General Information in the Health Benefit Plan Booklet.
What is my Vision Care benefit?
Vision care for employees, spouse and dependent children to provide payment up to a maximum of $400 per person in any 24-consecutive month period, for charges incurred relative to the purchase of lenses and frames or contact lenses when prescribed by a person legally qualified to make such prescription, including prescription sunglasses for employees only.
The cost of eye exams which are not covered under any provincial medical plan.
Please refer to the Vision Care section, under Extended Health Benefits in the Health Benefit Plan Booklet.
Please be sure to read the entire section, including the Benefit Exclusions listed at the end of the section.
What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to
receive similar benefits simultaneously under the Health Benefit Plan or any
other group insurance plan (including Provincial Plans), to prevent over
payment, benefits payable under this Plan would be co-ordinated with the other Plan.
For example: A Member’s wife is covered under her employer’s plan with
family coverage. The Member, his spouse and their three children are all covered
under both Plans. To determine which Plan would be primarily responsible for
the dependent children: Between the Member and the spouse, whomever’s birthday falls first in
the calendar year, their plan is responsible for the initial reimbursement of benefits
for the dependent children, then, any amounts that are not paid by that Plan are
submitted to the other parent's plan.
In the event that the Member’s birthday is in April and the spouse’s
birthday is in January. The spouse’s plan would be primarily responsible for the spouse's
claims and the claims of the children. Any amounts not paid by the spouse's plan can be
submitted to the Member’s Plan for reimbursement. Any amounts for the Member that are
not paid by the Member's Plan, can be submitted to the spouse's plan for reimbursement.
Please see the Coordination of Benefits section of the Health Benefit Plan Booklet.