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Group Benefits ProgramIntroduction
Welcome to Your Group Benefits ProgramGroup benefits are important, not only for the financial assistance they offer, but also for the security and peace of mind they provide for you and your family should unforeseen needs arise. It is your responsibility to understand the benefits and to put them to the best possible use. The purpose of this information is to outline the benefits for which you are eligible as an employee of the Evangelical Lutheran Church in Canada and its affiliated organizations. The information is a summary of the provisions of the Group Policy. In the event of a discrepancy between this information and the Policy, the terms of the Group Policy will apply. This information in either its paper or electronic form does not create or confer any contractual rights or obligations. Possession of this information alone does not mean that you or your Dependents are insured. The Group Policy must be in effect and you must satisfy all the requirements of the Policy. Protecting Your Personal InformationWe recognize and respect every individual’s right to privacy. When you apply for coverage or benefits personal information about you, your spouse or dependents, must be gathered and kept in a confidential file. This personal information is used for the purposes of providing group benefit plan administration services and insurance products to you. Maintaining the security of your personal information is a top priority. Only authorized personnel have access to your information, and the systems and procedures are designed to prevent the loss, misuse, unauthorized access, disclosure, alteration, or destruction of your information. Personal information is not collected, used or disclosed without your consent, except where authorized by law. Contact InformationThe Co-operators (Life, ADD&D and LTD Insurance)Policy # G6647Download claim forms and get general information online. www.cooperators.ca/life/group Manulife Financial (Extended Health Care and Dental Care Benefits)Policy # 29835For questions regarding claims for Extended Health and Dental Benefits, please contact Manulife Financial Group Benefits” Customer Service: 1-800-268-6195 www.manulife.ca (click on “Group” and follow the links to register for Group Benefit plan member services) Emergency Travel Assistance – World Access Plan # 9081 Canada/US 1-800-265-9977 Shepell-fgi (Employee and Family Assistance Program)For telephone access to counselling and advisory services: For E-Counselling or access to helpful information: Username is elchurch Summary of Benefits
What Happens to My Coverage If...
... I terminate employment with the ELCIC
The group coverage will end, but you can apply for individual coverage within 60 days with out a medical exam.
Coverage will end but if you are under age 65 you may purchase an individual policy from the insurer, for yourself only, without a medical examination. You must apply within 31 days of termination.
Coverage will end and you may purchase an individual policy from the insurer, for yourself only, without a medical examination. You must apply within 31 days of termination.
Coverage will end.
Coverage will end.
... I retire
The group coverage will end, but you can apply for individual coverage within 60 days with out a medical exam.
Coverage will end but if you are under age 65 you may purchase an individual policy from the insurer, for yourself only, without a medical examination. You must apply within 31 days of termination.
Coverage will end and you may purchase an individual policy from the insurer, for yourself only, without a medical examination. You must apply within 31 days of termination.
Coverage will end.
Coverage will end.
... I attain age 65
Coverage continues.
Coverage will end and you may purchase an individual policy from the insurer, for yourself only, without a medical examination. You must apply within 31 days of termination.
Coverage will end and you may purchase an individual policy from the insurer, for yourself only, without a medical examination. You must apply within 31 days of termination.
Coverage will end.
Coverage will end.
... I attain age 70
The group coverage will end, but you can apply for individual coverage within 60 days with out a medical exam.
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... I become disabled
Dental coverage will end. Health coverage may be continued at your own cost.
If you become disabled and your claim has been approved, your Basic Life and Dependent Life Insurance coverage will continue at no cost to you. This coverage will continue until the earlier of your recovery, age 65, or your date of death.
While you are disabled, you may choose to continue your current Optional Life Insurance coverage by arranging for the continuation of premium payments during the first six months of disability. If you are still disabled after this six month period and your claim has been approved, your Optional coverage will be continued at no cost to you until the earlier of your recovery, age 65, or your date of death.
If you become totally disabled and your Life Insurance coverage is continued at no cost to you, your ADD&D Insurance will also continue at no cost to you. This coverage will continue until the earlier of your recovery, age 65, termination of the policy or death.
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Eligibility
Employee Eligibility and Enrollment
As a new employee you must complete an enrollment form and return it to the ELCIC Group Services Inc. (“GSI”) office. It is important to keep your coverage up to date as your needs and circumstances change. Changes in name, Dependent coverage, or application for previously waived coverage should be promptly reported to the GSI office, preferably in writing. Coverage continues if you are not at work due to regular summer layoffs. Premiums must be paid in advance of the layoff period. Late EnrollmentPlease note that, for all late entrants, premiums are due from the date of eligibility. If you apply for extended health and dental benefits that were previously waived because you were covered for similar benefits under your Spouse’s plan, premiums are due from the date coverage was terminated under that plan. If you wish to continue coverage under your spouse’s plan, and enroll in this plan, premiums are due back to the date of your eligibility in this plan. If you are not actively at work on the date your insurance would normally become effective, your coverage will take effect on the next day on which you are again actively at work. Insurance for your Dependents will not take effect until the date your own insurance becomes effective. Termination of CoverageCoverage ends on the earlier of:
Survivor Extended BenefitIf you die while your Dependents are insured under this Group Benefit Program, the Extended Health Care and Dental Care benefits will continue without payment of premium, until the earliest of:
Extended Health Care - Overview
Extended Health CareGovernment health plans can provide coverage for such basic medical expenses as hospital charges and doctors’ fees. Often, however, it is necessary to obtain care or treatment that goes beyond “basic” in order to maintain well being and quality of life. In such cases, financial hardship can be crippling if help in the form of extended coverage is not available. Private health care supplements government plans and can provide benefits not available through any government plan. This program provides you with peace of mind and security in the knowledge that financial assistance will be provided when you and your family need it most. Overview of Extended Health Care BenefitsOverall benefit maximum: Unlimited Covered ExpensesExpenses specified are covered to the extent that they are Reasonable and Customary, as determined by the insurer, provided they are:
Extended Health Care - Prescription Drug
Prescription DrugCoverage: 80% until $250 Out-of-Pocket Maximum per person is reached every calendar year; then 100% to a maximum of $1,000,000 per person per calendar year.The ManuScript Generic Drug Plan 2 provides you and your Dependents with convenient Canada-wide coverage on your prescription Drug requirements. A plan member can simply present their Manulife Financial Card and a valid prescription at any pharmacy in Canada displaying the Pay Direct Drug decal. After entering card and prescription information, the pharmacist advises what is covered under the plan, and what the plan member’s payment will be. You will be required to pay only those amounts not covered by your plan. You may obtain additional Manulife Financial Cards for your registered Dependents, but all cards will be in your name. If you do not have access to a participating pharmacy, if you do not have your Manulife Financial Card with you at the time of purchase, or if your prescription is not available through the Pay Direct system, you must pay the entire amount and submit a claim for the covered benefit. Your Benefit is a Generic Drug plan, which means:
A quantity of up to a 100-day supply may be payable in long-term therapy cases, where the larger quantity is recommended as appropriate by your Physician and pharmacist. Charges incurred for the following expenses are payable when prescribed in writing by a Physician or Dentist, and dispensed by a Licensed pharmacist:
Extended Health Care - Vision Care
Vision CareCoverage: 100%, subject to maximums and limitations in the table below.
Extended Health Care - Professional Services
Professional ServicesCoverage: 100%, subject to maximums and limitations in the table below.Services provided by the following Certified, Licensed or Registered practitioners:
Provincial Plans may pay part of the expenses for some of these Professional Services. Coverage for the balance of such expenses prior to reaching the Provincial Plan maximum may be prohibited by provincial legislation. In those provinces where such prohibition exists, expenses under this Benefit Program are payable after the Provincial Plan’s maximum for the benefit year has been paid. Extended Health Care - Medical Services and Supplies
Medical Services and SuppliesPrivate Duty NursingCoverage: 100% to a maximum of $10,000 per calendar year.Covered Expenses include services which are deemed to be within the practice of nursing and which are provided in the patient’s home by:
Charges for the following services are not covered:
AmbulanceCoverage: 100%Licensed ambulance service, including air ambulance, is provided in the patient’s province of residence to transfer the patient to the nearest hospital where adequate treatment is available. Medical Equipment and SuppliesCoverage: 100%, with the exception of insulin pumps covered at 50%, subject to maximums and limitations.For all medical equipment and supplies covered under this provision, Covered Expenses will be limited to the cost of the device or item that adequately meets the patient’s fundamental medical needs and is approved by Manulife Financial.
Extended Health Care - What The Plan Does Not Cover
What The Plan Does Not CoverNo Extended Health Care benefits are payable for expenses related to:
Extended Health Care - Subrogation (Third Party Liability)
Subrogation (Third Party Liability)If your medical expenses result from an injury caused by another person and you have the legal right to recover damages, the insurer may request that you complete a subrogation reimbursement agreement when you submit a claim for such expenses. On settlement or judgment of your legal action, you will be required to reimburse the insurer those amounts you recover which, when added to the payments you received from the insurer, exceed 100% of your incurred expenses. Quebec Residents
Drug Benefit For Persons Who Reside In QuébecIf you and your dependents reside in Québec, the following provisions apply to your drug benefit coverage. Covered Drug ExpensesThe following expenses are covered:
Coverage for drugs on the List of Insured Drugs that is published by the Régie de l’assurance-maladie du Québec (RAMQ List)The following provisions apply only to the coverage of drugs that are on the RAMQ List, as legislated by An Act Respecting Prescription Drug Insurance (R.S.Q. c., A-29-01). Coverage for all other drugs will be subject to the regular provisions included in this information package: a) Benefit PercentagePrior to the annual out-of-pocket maximum being reached, the percentage of covered drug expenses payable under this benefit will be as follows:
After the annual out-of-pocket maximum has been reached, the percentage of covered drug expenses payable under this benefit will be 100%. b) Annual Out-of-Pocket MaximumThe annual out-of-pocket maximum is the portion of covered drug expenses which must be paid by you and your spouse in a calendar year, before the percentage payable under this benefit will be 100%. Amounts that will be applied to the annual out-of-pocket maximum are:
The annual out-of-pocket maximum for you and your spouse is as stipulated in the Legislation and includes those portions of covered drug expenses paid for your dependent children. For the purposes of calculating the out-of-pocket maximum for you and your spouse, those portions of covered drug expenses paid for your dependent children will be applied to the person who is closest to reaching the annual out-of-pocket maximum. c) DeductibleDeductible amounts (if any) for the drug benefit will apply, until the annual out-of pocket maximum is reached. Thereafter, the deductible will not apply. d) Lifetime MaximumsLifetime maximums (if any) for the drug benefit will not apply. Drug coverage provided after the lifetime maximum stated under the prescription drug coverage provision described in the extended health care tab is reached, is subject to the following conditions:
e) Eligible Dependent ChildrenYour eligible dependent children who are in full-time attendance at an accredited educational institution will be covered until the later of:
Drug coverage provided for dependent children after the age specified in the glossary is subject to the following conditions:
f) Termination AgeProvided you are otherwise eligible for the drug benefit, the Termination Age (if any) for the drug benefit will not apply. Drug coverage provided after the Termination Age specified under the prescription drug coverage provision described in the extended health care tab is subject to the following conditions:
Coverage for Drugs That are Listed as a Covered Expense in This Information Package but are not on the RAMQ ListCoverage for drugs that are listed as a covered expense under this Benefit but not on the RAMQ List will be subject to all the standard provisions included in this information package. Out of Province / Out of Country
Out of Province/Out of CountryCoverage: Reasonable and Customary charges listed below incurred outside the province of residence will be payable, less the amount payable by the Provincial Plan.Charges payable under this benefit include:
Charges for all other Covered Extended Health Care Expenses are payable on the same basis as if they were incurred in the insured person’s province of residence. Medical EmergencyCoverage: 100% of expenses to a lifetime maximum of CDN $1,000,000 in combination with Medical Referral CoverageCoverage is provided for treatment required as a result of a medical emergency which occurs during the first 60 days outside the province of residence, provided the insured person who receives the treatment is also covered by a Provincial Plan during this period. A medical emergency is a sudden, unexpected injury that occurs, or an unforeseen illness that begins while an insured person is travelling outside their province of residence and which requires immediate medical attention. Such emergency no longer exists when, in the opinion of the attending Physician, and supporting medical evidence, the patient is stable enough to return to their province of residence. Medical ReferralCoverage: 50% of expenses to a maximum of CDN $3,000 every 3 calendar years.Coverage is provided for referral outside Canada for medical treatment which is available in Canada. If, while outside Canada on referral for medical treatment, the insured person requires treatment for a medical condition, which is related directly or indirectly to the referral treatment. Non-Emergency Medical TreatmentAll non-emergency medical treatment given outside of Canada must be recommended as necessary by a Physician practicing in Canada. It is recommended that you submit a detailed treatment plan with cost estimates before treatment begins. You will then be advised of the amount of any benefit that will be provided.
Extended Health Care – ManuAssist ManuAssist is a travel assistance program available for you and your insured dependents. The assistance services are delivered through an international organization, specializing in travel assistance. The following services are provided, when required as a result of a medical emergency which occurs during the first 60 days while travelling outside your province of residence: Medical Emergency AssistanceA Medical Emergency is a sudden, unexpected injury which occurs or an unforeseen illness which begins while an insured person is travelling outside his province of residence and requires immediate medical attention. Such emergency no longer exists when, in the opinion of the attending Physician and supporting medical evidence, the insured person is stable enough to return to his province of residence. a) 24-Hour AccessMultilingual assistance is available 24 hours a day, seven days a week, through telephone (toll-free or call collect), telex or fax. b) Medical ReferralReferral to the nearest Physician, Dentist, pharmacist or appropriate medical facility, and verification of insurance coverage, is provided. c) Claims Payment ServiceIf a hospital or other provider of medical services requires a deposit or payment in full for services rendered, and the expenses exceed $200 (Canadian), payment of such expenses will be arranged and claims co-ordinated on behalf of the insured person. Payment and co-ordination of expenses will take into account the coverage that the insured person is eligible for under a Provincial Plan and this benefit. If such payments are subsequently determined to be in excess of the amount of benefits to which the insured person is entitled, Manulife Financial shall have the right to recover the excess amount by assignment of Provincial Plan benefits and/or refund from you. d) Medical Care MonitoringMedical care and services rendered to the insured person will be monitored by medical staff who will maintain contact, as frequently as necessary, with the insured person, the attending Physician, the insured person’s personal Physician and family. e) Medical TransportationIf medically necessary, arrangements will be made to transfer an insured person to and from the nearest medical facility or to a medical facility in the insured person’s province of residence. Expenses incurred for the medical transportation will be paid, as described under Medical Services and Supplies – Ambulance. If medically necessary for a qualified medical attendant to accompany the insured person, expenses incurred for round-trip transportation will be paid. f) Return of Dependent ChildrenIf Dependent Children are left unattended due to the hospitalization of an insured person, arrangements will be made to return the children to their home. The extra costs over and above any allowance available under pre-paid travel arrangements will be paid. If necessary for a qualified escort to accompany the Dependent Children, expenses incurred for round-trip transportation will be paid. g) Trip Interruption/DelayIf a trip is interrupted or delayed due to an illness or injury of an insured person, one-way economy transportation will be arranged to enable each insured person and a Travelling Companion (if applicable) to rejoin the trip or return home. Expenses incurred, over and above any allowance available under pre-paid travel arrangements will be paid. A Travelling Companion is any one person travelling with the insured person, and whose fare for transportation and accommodation was pre-paid at the same time as the insured person’s fare. If the insured person chooses to rejoin the trip, further expenses incurred which are related directly or indirectly to the same illness or injury, will not be paid. h) After Hospital ConvalescenceIf an insured person is unable to travel due to medical reasons following discharge from a hospital, expenses incurred for meals and accommodation after the originally scheduled departure date will be paid, subject to the maximum shown in part l) of this provision. i) Visit of Family MemberExpenses incurred for round-trip economy transportation will be paid for an Immediate Family Member to visit an insured person who, while travelling alone, becomes hospitalized and is expected to be hospitalized for longer than 7 days. The visit must be approved in advance by Manulife Financial. j) Vehicle ReturnIf an insured person is unable to operate his owned or rented vehicle due to illness, injury or death, expenses incurred for a commercial agency to return the vehicle to the insured person’s home or nearest appropriate rental agency will be paid, up to a maximum of $1,000 (Canadian). k) Identification of DeceasedIf an insured person dies while travelling alone, expenses incurred for round-trip economy transportation will be paid for an immediate family member to travel, if necessary, to identify the deceased prior to release of the body. l) Meals and AccommodationUnder the circumstances described in parts f), g), h), i), and k) of this provision, expenses incurred for meals and accommodation will be paid, subject to a combined maximum of $2,000 (Canadian) per medical emergency.
a) Return of Deceased to Province of ResidenceIn the event of the death of an insured person, the necessary authorizations will be obtained and arrangements made for the return of the deceased to his province of residence. Expenses incurred for the preparation and transportation of the body will be paid, up to a maximum of $5,000 (Canadian). Expenses related to the burial, such as a casket or an urn, will not be paid. b) Lost Document and Ticket ReplacementAssistance in contacting the local authorities is provided, to help an insured person in replacing lost or stolen passports, visas, tickets or other travel documents. c) Legal ReferralReferral to a local legal advisor, and if necessary, arrangement for cash advances from the insured person’s credit cards, family or friends, is provided. d) Interpretation ServiceTelephone interpretation service in most major languages is provided. e) Message ServiceTelephone message service is provided for messages to or from family, friends or business associates. Messages will be held for up to 15 days. f) Pre-trip Assistance ServiceUp-to-date information is provided on passport and visa, vaccination and inoculation requirements for the country where the insured person plans to travel. ExceptionsManulife Financial, and the company contracted by Manulife Financial to provide the travel assistance services described in this benefit, will not be responsible for the availability, quality, or results of any medical treatment, or the failure of an insured person to obtain medical treatment or emergency assistance services for any reason. Emergency assistance services may not be available in all countries due to conditions such as war, political unrest or other circumstances which interfere with or prevent the provision of any services. How to Access ManuAssist – Your Manulife Financial CardYour Manulife Financial Card lists the toll free numbers to call in case of an emergency, while travelling outside your province. The toll free number will put you in touch with the international travel assistance organization. Your Manulife Financial Card also lists your I.D. number and group policy number, which the travel assistance organization needs to confirm that you are covered by ManuAssist through Manulife Financial. If you do not have a Manulife Financial Card, please contact ELCIC Group Services Inc. What the plan Does Not CoverSee Extended Health Care - What The Plan Does Not Cover for a list of exclusions that are also applicable to the Out of Province/Out of Country Coverage. Print This Panel|Close All Panels|Close Panel|back to top Dental Care - Overview
Dental CareDental care is an important part of overall health. The cost of dental services, whether it is routine preventive care or an unexpected problem, can have a serious impact on a household budget if no assistance is available. Your dental care coverage provides financial assistance for a number of services specified. Overview of Dental Care BenefitsDeductible: $25 Individual, $50 Family (per calendar year) Deductible Carry-Forward: Covered Expenses used to satisfy a Deductible in the last 3 months of a calendar year may also be used to satisfy the Deductible in the following calendar year.
Services are covered at rates as outlined in the current Fee Guide for General Practitioners for your Province of residence. For plan members residing in Alberta, the current Fee Guide is considered to be the 1997 Alberta Dental Association Fee Guide for General Practitioners, plus inflationary adjustments as determined by the carrier. Should your Dentist charge fees in excess of the Fee Guide, the additional costs will not be covered. Covered ExpensesExpenses for the services outlined below are covered if they:
PredeterminationIf the cost of any proposed dental treatment is expected to exceed $500, it is recommended that you submit a detailed treatment plan, available from your Dentist, before the treatment begins. You can then be advised of the amount you are entitled to receive under this benefit. Alternate TreatmentWhere any two or more courses of treatment covered under this benefit would produce professionally adequate results for a given condition, Manulife Financial will pay benefits as if the least expensive course of treatment were used. Manulife Financial will determine the adequacy of the various courses of treatment available, through a professional dental consultant. Print This Panel|Close All Panels|Close Panel|back to top
Dental Care - Level 1 - Basic Services
Level I – Basic ServicesCoverage: 100% up to $1,500 per calendar year in combination with Levels II, III and IVExpenses covered under Level I include:
Dental Care - Levels 2 & 3 - Supplementary Basic Services & Dentures
Level II – Supplementary Basic ServicesCoverage: 100% up to $1,500 per calendar year in combination with Levels I, III and IVExpenses covered under Level II include:
Level III – DenturesCoverage: 50% up to $1,500 per calendar year in combination with Levels I, II and IVExpenses covered under Level III include:
Dental Care - Levels 4 & 5 - Major Restorative Services & Orthodontics
Level IV – Major Restorative ServicesCoverage: 50% up to $1,500 per calendar year in combination with Levels I, II and IIIExpenses covered under Level IV include:
Level V – OrthodonticsCoverage: 50% up to $1,500 per lifetimeOrthodontic services are for Dependent Children only, provided treatment commences prior to reaching age 18. Dental Care - Work in Progress When Coverage Terminates & Subrogation (Third Party Liability)
Work in Progress When Coverage TerminatesCovered Expenses related to dental treatment that was in progress at the time your dental benefits terminate (for reasons other than termination of the Group Policy or the Dental Care Benefit) are payable, provided the expense is incurred within 31 days after your benefit terminates. Subrogation (Third Party Liability)If your dental expenses result from an injury caused by another person and you have the legal right to recover damages, the carrier may request that you complete a subrogation reimbursement agreement when you submit a claim for such expenses. On settlement or judgment of your legal action, you will be required to reimburse the carrier those amounts you recover which, when added to the payments you received from the carrier, exceed 100% of your incurred expenses. Dental Care - What The Plan Does Not Cover
What The Plan Does Not CoverNo Dental Care benefits will be payable for expenses resulting from:
Life Insurance
Life InsuranceIt is always difficult to think of losing a loved one, and impossible to attach a dollar value to that personal loss. But such losses do have financial ramifications and there is a certain comfort in knowing that you and your Dependents can count on a degree of protection in the event of a death. Your benefits program offers insurance protection through three separate plans: Basic Life Insurance, Optional Life Insurance, and Dependent Life Insurance. Basic Life InsuranceCoverage: Three times your Annual Cash Salary to a maximum of $375,000 (effective Jan 1, 2009)This policy covers you 24 hours a day, 365 days a year. In the event of your death due to any cause, your designated beneficiary will be paid a lump sum benefit. Premiums for this coverage paid by your employer are considered to be a taxable benefit to you and will be reported on your T4 slip. Living Assistance BenefitCoverage: 50% of your Basic Life Insurance benefit, to a maximum of $50,000Your Basic Life Insurance coverage includes provision for an advance payment of benefits should you become terminally ill before age 63 and require assistance with medical or other health and welfare costs. Dependent Life InsuranceCoverage: $10,000 for a Spouse, $5,000 for a child.This benefit provides life insurance coverage for your Spouse and Dependent Children. Premiums for this coverage paid by your employer are considered to be a taxable benefit to you and will be reported on your T4 slip. Pre-Natal BenefitCoverage: A maximum of $5,000.Should a child be stillborn, your Dependent coverage will provide for funeral expenses. Optional Life InsuranceCoverage available: Units of $10,000 to a maximum of $200,000 each for you and your Spouse.Along with your Basic Life Insurance policy, you can choose to apply for additional life insurance coverage for you and your Spouse at your cost. You will be required to complete an application form and, upon approval of the application, coverage will become effective on the first day of the following month. If medical information is required to proceed with your application, the insurer will be responsible for any fees incurred. Optional Life Insurance benefits are not payable when the cause of death is suicide occurring within two years from the date your coverage became effective. Total Disability Waiver of PremiumPremiums will be waived while you are receiving long term disability benefits under this plan, commencing with the first premium that falls due after the first benefit payment is eligible to be made, retroactive to the date of your disability. Designated BeneficiaryWhen you enroll for benefits, you will designate a beneficiary or beneficiaries. You may appoint a new beneficiary at any time by completing a new Beneficiary Form which is available from the ELCIC Group Services Inc. office. If your designated beneficiary does not survive you, and you have not appointed a new beneficiary, your Life Insurance benefits will be payable to your estate. Conversion PrivilegeWhen the group coverage ends either upon termination, early retirement or when you have attained age 65, conversion of coverage to an individual plan is available without medical evidence at time of conversion up to a maximum of $200K combined, for Basic and Optional Life. Note that this is available for members on leave from call if they wish to continue their coverage on a short term basis. Application for conversion must be made within 31 days of termination. Currently GSI has contracted Co-operators to provide the group life benefit. Co-operators has various individual life products available for the members consideration. If you wish to convert your group coverage to individual coverage please call your local Co-operators agent listed in telephone directories. There is no conversion provision for Dependent Life. Insurance provided by Co-operators Life Insurance CompanyADD&D Insurance - Overview
Accidental Death, Disease and Dismemberment InsuranceWe tend to think of accidents as things that happen to other people. But it can happen to anyone, and even accident survivors may be left with devastating injuries which have significant financial implications. This benefit provides coverage 24 hours a day, 365 days a year, for death, dismemberment, paralysis, and loss of speech, hearing or sight that is incurred as a result of accidental injury. For a benefit to be payable, the loss must occur within 365 days of the Accident (Accident – An unintentional, sudden, fortuitous and unforeseeable event due exclusively to an external cause of a violent nature, inflicting bodily injury directly and independently of all other causes). Overview of ADD&D CoverageCoverage: Principal amount of $10,000 payable in the event of accidental death.Percentage of principal amount paid depending on nature of loss is outlined in the table below.
ADD&D Insurance - Additional Benefits
Additional BenefitsUnder certain circumstances, the ADD&D Insurance plan will provide the following benefits: Exposure and DisappearanceThe plan will provide benefits for any loss resulting from exposure to the elements of nature, provided the loss occurs within 365 days of the Accident. Benefits are also payable on the presumption of death due to an Accident in the event of a disappearance during any means of transport where the body is not located within 365 days of the Accident. Critical Disease BenefitIf you have been diagnosed with a Critical Disease and have been unable to work at any occupation for at least nine months, the plan will pay you an amount equal to Coverage: 10% of your Basic Life Insurance amount to a maximum of $50,000. Seatbelt BenefitIf you are injured in an Accident, the plan will increase the benefit payable by 10% provided that:
Home Alteration and Vehicle Modification BenefitCoverage: A lifetime maximum of $10,000If, as a result of an Accident, you suffer a loss that requires the use of a wheelchair, the plan will reimburse expenses for:
Rehabilitation BenefitCoverage: A maximum of $10,000 within three years of the AccidentIf you suffer a loss, as described in the table above, and due to your injury you require special training to be qualified for a specific occupation, a benefit will be paid to cover the reasonable and necessary expenses incurred. Payment will not be made for expenses related to ordinary living, travelling or clothing. Family Transportation BenefitCoverage: A maximum of $5,000 per AccidentIf, as a result of an Accident, you are hospitalized at least 150 kilometres from your residence and, upon recommendation by your attending Physician, require the attendance of an Immediate Family Member, the plan will reimburse that person’s accommodation and transportation expenses. Repatriation BenefitCoverage: A maximum of CDN $10,000If you die from any cause at least 50 kilometres from your normal place of residence, the plan will cover actual expenses for the preparation and transportation of your body to your city of residence. Daycare BenefitCoverage: $500 per child annually for a maximum of four yearsIf you die as a result of an Accident, the plan will pay a benefit for each Dependent Child who is enrolled in a daycare centre at the time of your death. This benefit will also be paid for each child who enrolls in a daycare centre within 90 days of your death. If, at the time of your death, your Dependent Children are not eligible for this benefit, your beneficiary will receive a one-time lump-sum benefit of $1,500. Education BenefitCoverage: The lesser of 5% of the employee’s basic life insurance amount or $5,000 per year for each Dependent Child, paid for a maximum of 4 consecutive years.If you die as a result of an Accident, the plan will pay a benefit toward tuition and books expenses for each Dependent Child who is attending a post-secondary institution on a full-time basis at the time of your death. This benefit will also be paid for each child enrolled at the secondary school level who goes on to enroll as a full-time post-secondary student within 365 days of your death. If, at the time of your death, none of your Dependent Children are not eligible for this benefit, your beneficiary will receive a one-time lump-sum benefit of $2,500. Spousal Retraining BenefitCoverage: A lifetime maximum of $10,000 within three years of the AccidentIn the event of your death, the plan may provide a benefit toward occupational retraining designed to help your Spouse become employed. Expenses must be approved by the insurer.
ADD&D Insurance - Designated Beneficiary & What the Plan Does Not Cover
Designated BeneficiaryYou are automatically the beneficiary for any ADD&D Insurance benefits relating to loss of use and dismemberment. Any ADD&D benefits payable as a result of your death will be payable to your designated beneficiary or beneficiaries as specified when you enroll for benefits. You may appoint a new beneficiary at any time by completing a new Beneficiary Form which is available from the ELCIC Group Services Inc. office. If your designated beneficiary does not survive you, and you have not appointed a new beneficiary, your ADD&D Insurance benefits will be payable to your estate. What the Plan Does Not CoverBenefits will not be paid if the loss results from:
Long Term Disability
Long Term DisabilityIf you became disabled for an extended period of time, would you be able to manage your financial responsibilities? Long Term Disability (LTD) Insurance is designed to support you through such difficult times by helping you meet your day to day financial obligations should illness or injury keep you off the job for more than six months. Overview of Long Term Disability CoverageThe purpose of the LTD benefit is to provide coverage should you become Totally Disabled before the age of 65 as a result of accident or injury. You will receive benefits for the first two years that you are disabled to the degree that you are unable to perform the usual and customary duties of your job, and thereafter should you be unable to perform any occupation. Coverage: The plan will pay the lesser of: In no case shall a benefit be paid beyond the earliest of:
Benefit AdjustmentAt the time of a claim, your LTD benefit will be reduced by any disability benefits you are entitled to receive from the Workers’ Compensation Act, Canada Pension Plan or Quebec Pension Plan, any criminal injuries compensation legislation and any automobile insurance act. The reduction will not include any additional amounts payable for dependents or cost of living increases. If necessary, your LTD benefit will be further adjusted so that your total income will not exceed 85% of your pre-disability gross salary. This applies to disability benefits from any other source including: pension plan; employer funded salary replacement; other insurance plan whether group or association; damages for loss of income which are payable from any legal action; employment income other than from an approved rehabilitation program; and severance. Recurrence of DisabilityIf you return to work from disability leave and become disabled again for the same or related cause within six months, it would be considered a continuation of the previous disability and benefits would resume immediately. If you return to work and, after six months, become disabled for any cause, this will be considered a new disability subject to the 181-day provision. Rehabilitation EmploymentCoverage: The lesser of:
Experience has demonstrated that rehabilitative employment is a valuable tool in speeding the recovery process. Following a period during which benefits have been paid, you may be able to return to work on a part-time basis. Benefit is payable for up to two years from the date of disability. This benefit will not extend the period for which you would otherwise have been entitled to benefits. Your benefits will cease if you refuse to participate in a rehabilitation program considered appropriate by the insurer. Progressive Disability BenefitYou may qualify for LTD benefits under this Policy if you have been diagnosed as having a chronic disease that is progressive and degenerative in nature and the usual course of the disease is such that it will lead to you becoming Totally Disabled, and the disease has progressed to a stage where you are unable to perform the substantial duties of your occupation. You must be actively employed for an employer on a part-time or reduced work load basis. Where mutually agreed, you may accept alternative employment. The 180 day elimination period requirement may be fulfilled based on the percentage of duties or hours that are lost because of your condition, provided that:
Monthly benefits may be extended beyond the second anniversary of the date of disability, if, due to the nature of the disease, it is certain (as determined by Co-operator’s) that the employee will become Totally Disabled as the disease progresses, but in no case, will benefits extend beyond the attainment of your 65th birthday. After the initial coverage for the LTD benefit has been established, the LTD benefit will not be further reduced in the future due to an increase in the amount of compensation paid by your employer if such increase was due solely to a cost of living adjustment or a merit increase, provided the total annual increase does not exceed 5%. The amount of any annual increase in excess of 5%, or compensation increases for other reasons, would be taken into account in calculation of the monthly benefit payable under this provision. Contribution to PensionThis benefit replaces your share of pension plan contributions (5% of your monthly salary) while you are receiving disability payments. This benefit will continue as long as you are receiving disability payments. Total Disability Waiver of PremiumPremiums will be waived while you are receiving disability benefits commencing with the first premium that falls due after the first benefit payment is eligible to be made. What is Not CoveredNo benefit will be payable for any disability resulting from or caused by:
No benefit will be payable for any disability if you:
No benefit will be payable for any sickness, injury or disease for which you received medical treatment or advice in the 90-day period immediately prior to becoming insured under this plan; unless, you have been covered under this plan for a period of at least 12 months and have not been absent from work due to the pre-existing condition for more than 10 days during that 12 month period. Subrogation (Third Party Liability)If you become totally disabled due to an injury or disease for which a third part is or may be legally liable, benefits will be paid when you sign and submit to the insurer a Reimbursement Agreement. You will be required to reimburse the insurer for benefits received in accordance with the terms and conditions stated in the Reimbursement Agreement. You must obtain the written consent of Co-operators before compromising or settling the action or cause of action with the third party. Failure to do so may disentitle you to any future benefits under this policy. Insurance provided by Co-operators Life Insurance CompanyEmployee and Family Assistance Plan
Employee and Family Assistance PlanMany things can affect our ability to happily function to our maximum potential, both on the job and at home. Sometimes it is helpful to have someplace to turn for an objective point-of-view about emotional issues, family matters, workplace concerns or other personal problems, whether they are big or small. That is what the Employee and Family Assistance Plan (EFAP) is all about. EFAP services are provided through an external, independent company whose staff consists of experienced professionals, including psychologists, social workers and addictions counsellors. Christian counsellors are available on request. What the Plan ProvidesEFAP is a voluntary, confidential counselling and information service, which can provide short term professional assistance for you and your eligible Dependents. Short term counselling consists of up to around 5 to 7 hours of professional assistance for each issue. If longer periods of counselling are required, your counsellor will assist in referring you to other resources. In all circumstances EFAP offers complete privacy. In a caring and professional environment away from your work place, you can discuss personal problems and concerns with professionals who are bound by a strict code of ethics concerning confidentiality. You can always rest assured that your personal information will not be shared with anyone outside of the EFAP service provider. No one will ever know you have used the service unless you tell them yourself. EFAP professionals can provide consultation, counselling, assessment and resource referral for problems related to, including but not limited to:
The program’s Core WorkLife Solution Services include provision of customized educational and resource packages with follow-up to ensure the needs were met. Crisis assessment and resource referral are also provided. The core services included in this program are:
How to Access This Service By TelephoneJust call the appropriate number as listed in the Contact Information section. You cannot contact a counsellor directly. You must call the number and you will be assigned an approved professional with the expertise specific to your concerns. For more serious concerns you will be referred to a professional in your community for a confidential personal consultation. By E-mail“E-counselling” service makes the professional counselling even more accessible, by giving you and your family members the opportunity to benefit from a high level of professional service in a confidential online setting. For many people, communicating thoughts and feelings is easier through the written word. This service is excellent for those who find face-to-face or telephonic counselling to be inconvenient or intimidating. E-counselling provides service via a direct, one-to-one therapeutic dialogue with a professional E-counsellor over the internet and at your convenience. All of the E-counselling services are secured using SSL-III, the most sophisticated encryption currently available (it is the encryption system currently used by Canada’s major banks). This will ensure you the highest level of security and confidentiality. The benefits of E-counselling include: Convenience. Employees can write to their counsellor to explore problems wherever they are and whenever they need to. E-counselling also offers a solution for those who are too busy or unable to travel to a counsellor’s office. Fewer inhibiting factors. Offers an alternative method of addressing concerns for those uncomfortable or intimidated with traditional face-to-face assistance. Self-paced format. Allows employees the opportunity to more fully consider the counsellor’s suggestions and their own interpretations and responses. To access this service log on to the Members Only website at www.fgiworldmembers.com. Username is elchurch
How to submit a claim
How to Submit a ClaimTo make a claim, you must obtain the appropriate form, as indicated below. Complete the form and ensure that you have signed and dated it before submitting it to the insurer.
Online ClaimsManulife claims for professional services or vision can be made online. You must be registered on the Manulife member secure website. Once you have logged on to the manulife member website, follow the steps under 'submit a claim'.
NOTE: Upon termination of your health or dental insurance, all claims must be submitted no later than 90 days from the termination date.
You should receive settlement of your health or dental claims within three weeks from the date of submission. Once your claim has been processed, Manulife Financial will send a Claim Statement to you. The top portion of this form outlines the claim or claims made, the amount subtracted to satisfy Deductibles, and the coinsurance used to determine the final payment to be made to you. The bottom portion of the form is your claims payment, if applicable. Simply tear along the perforated line and endorse the back of the cheque. You can then deposit it or cash it at any chartered bank or trust company. Co-ordination of Extended Health Care and Dental Care BenefitsIf you or your Dependents are insured for similar benefits under another Plan, Manulife Financial will take this into account when determining the amount of expenses payable under this Program. This process is known as Co-ordination of Benefits. It allows for reimbursement of insured medical and dental expenses from all Plans, up to a total of 100% of the actual expense incurred. For the purposes of this section, Plan means:
Plan does not include school insurance or Provincial Plans. Order of Benefit PaymentA variety of circumstances will affect which Plan is considered as the “Primary Carrier” (i.e., responsible for making the initial payment toward the eligible expense) and which Plan is considered as the “Secondary Carrier” (i.e., responsible for making the payment to cover the remaining eligible expense). If the other Plan does not provide for Co-ordination of Benefits, it will be considered as the Primary Carrier, and will be responsible for making the initial payment toward the eligible expense. If the other Plan does provide for Co-ordination of Benefits, the following rules are applied to determine which Plan is the Primary Carrier. For Claims Incurred by You or Your Dependent SpouseThe Plan insuring you or your Dependent Spouse as an employee/member pays benefits before the Plan insuring you or your Spouse as a Dependent. In situations where you or your Dependent Spouse has coverage as an employee/member under more than one Plan, the order of benefit payment will be determined as follows:
The Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birth date, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. However, if you and your Spouse are separated or divorced, the following order applies:
Where you and your Spouse share joint custody of the child, the Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birth date, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. Additonal RulesA claim for accidental injury to natural teeth will be determined under Extended Health Care Plans with accidental dental coverage before it is considered under Dental Plans. If the order of benefit payment cannot be determined from the above, the benefits payable under each Plan will be in proportion to the amount that would have been payable if Co-ordination of Benefits did not exist. If the insured person is also covered under an individual travel insurance plan, benefits will be co-coordinated in accordance with the guidelines provided by the Canadian Life and Health Insurance Association. Submitting a Claim When Co-ordination of Benefits AppliesWhen submitting such a claim, refer to the following guidelines:
Glossary A-M
GlossaryDefinitions of Terms Used Actively Employed –Working at your usual place of employment or any other location where you are required to work, and able to perform the duties of your regular occupation. If you are not required to work on a specific date, you are still considered Actively Employed if you are not disabled to the degree that you could not have reported for work. Annual Cash Salary – Actual gross earnings including overtime, bonuses and vacation pay, but not including severance pay. (See definition of Salary) Certified , Licensed or Registered – The status of a person who legally engages in practice by virtue of a license or certificate issued by the appropriate authority, in the place where the service is provided. Coinsurance – The percentage of Covered Expenses which is payable by the insurer. Covered Expenses – Expenses that will be considered in the calculation of payment due under your Extended Health Care or Dental Care benefit. Critical Disease – Any one of the following diseases, diagnosed after you became covered under this plan: Poliomyelitis, Parkinson’s Disease, Huntington’s Chorea, Multiple Sclerosis, Alzheimer’s Disease, Type I Diabetes (insulin Dependent), Amyotrophic Lateral Sclerosis (ALS), Peripheral Vascular Disease and Necrotizing Fascitis. Deductible – The amount of Covered Expenses that must be incurred and paid by you or your Dependents before benefits are payable by the insurance carrier. Dentist – A doctor of dentistry, licensed to practice dentistry in the place where services are provided. Dependent – A dependent is a Spouse or Child who is insured under the Provincial Plan. (See definition of Spouse and Dependent Child) Dependent Child/ Children – Your natural or legally adopted child (dependent on you or your spouse for financial support), or a stepchild, who is: unmarried; under age 21, or under age 25 if a full-time student; not employed on a full-time basis; and not eligible for insurance as an employee under this or any other group benefit program. A child who is incapacitated on the date he or she reaches the age when insurance would normally terminate will continue to be an eligible dependent. However, the child must have been insured under this benefit program immediately prior to that date. A child is considered incapacitated if he or she is incapable of engaging in any substantially gainful activity and is dependent on the employee for support, maintenance and care, due to a mental or physical disability. Written proof may be required of the child’s condition as often as may reasonably be necessary. Drug– Medications that have been approved for use by the Federal Government of Canada and have a Drug Identification Number. Experimental or Investigational Treatment – Not approved or broadly accepted and recognized by the Canadian medical profession as an effective, appropriate and essential treatment of a sickness or injury, in accordance with Canadian medical standards. Immediate Family Member – You, your Spouse or child, your parent or your Spouse’s parent, your brother or sister, or your Spouse’s brother or sister. Glossary N-Z
Medically Necessary – Broadly accepted and recognized by the Canadian medical profession as effective, appropriate and essential in the treatment of a sickness or injury, in accordance with Canadian medical standards. Physician – A Doctor of Medicine licensed to practice medicine in the place where the services are provided. Provincial Plan – Any plan established by the government in the province where the insured person lives, which provides hospital, medical, or dental benefits. Reasonable and Customary – Within the usual range of charges being made by others of similar standing in the area in which the charge is incurred when providing the same or comparable services or supplies. Salary – The following calculations will determine the salary basis that will be used for pension and benefit contributions. For clergy where accommodations are provided:
For clergy where no accommodations are provided:
For a lay person:
For clergy on leave without call
Spouse – The person to whom you are legally married; or a person continuously living with you in a role like that of a marriage partner for at least one year. In the latter case, discontinuation of cohabitation with you terminates coverage for such person. Only one Spouse will be eligible for insurance and will be as indicated by the Employee on the applicable form. Total Disability and Totally Disabled – Disability as a result of injury or sickness to the extent that you:
Yearly Maximum Pensionable Earnings (YMPE) – The maximum amount of annual earnings, not including reductions for the year’s basic exemption, upon which benefits and contributions for purposes of the Canada Pension Plan and Quebec Pension Plan are based. The YMPE is revised annually.
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