GENERAL INFORMATION
WELFARE PLAN
  BENEFIT HIGHLIGHTS
  ELIGIBLE DEPENDENTS
  DESCRIPTION OF BENEFITS
  LIFE INSURANCE
  ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS
  WEEKLY INDEMNITY
  LONG TERM DISABILITY
  MAJOR MEDICAL BENEFITS
  DENTAL BENEFITS
  EMERGENCY OUT OF PROVINCE
  MEMBER AND FAMILY ASSISTANCE PLAN
  GENERAL EXCLUSIONS
  COORDINATION OF BENEFITS
  GENERAL INFORMATION
  PAY-DIRECT COVERAGE
  EXTENSION OF MAJOR MEDICAL AND DEATH BENEFITS ON AN EMPLOYEES' DEATH
  EXTENTION OF MAJOR MEDICAL AND DENTAL BEFEFITS IF SICK OR DIABLED
  NO BREAK IN SERVICE ARRANGEMENT
  DESIGNATION OF A BENEFICIARY
  BENEFITS PERTAINING TO PENSIONERS
  TERMINATED FORMER EMPLOYEES
  HOW TO SUBMIT CLAIMS
  TERMINATION OF WELFARE COVERAGE
  FUTURE OF THE PLAN
PENSION PLAN
MEMBER BENEFIT BOOKLET
 

 

WELFARE AND PENSION PLANS

Welfare Plan

DESCRIPTION OF BENEFITS


Long Term Disability (ALL ACTIVE EMPLOYEES)

Definitions applicable to this coverage
Appropriate treatment is defined as any treatment that is performed and prescribed by a doctor or, when the Insurer believes it is necessary, by a medical specialist. It must be the usual and reasonable treatment for the condition and must be provided as frequently as is usually required by the condition. It must not be limited solely to examinations or testing.

Illness means a bodily injury, disease, mental infirmity or sickness. Any surgery, needed to donate a body part to another person, which causes total disability, is an illness.
Total disability means you will be considered totally disabled:

  • while you are continuously unable due to an illness to do the essential duties of your own occupation, during the elimination period and the following 36 months, and
  • afterwards while you are continuously unable due to an illness to do any occupation for which you are or may become reasonably qualified for by education, training or experience.

Description of coverage

You are entitled to payment of a Long-Term Disability benefit if you present proof of claim acceptable to the Insurer that:

  • you became totally disabled while covered,
  • your total disability has continued beyond the elimination period or the date day benefits are payable under any Weekly Indemnity benefit, loss of income or other salary continuation plan, whichever is later, and
  • you have been following appropriate treatment for the disabling condition since the onset of the condition.

You will be entitled to benefits while the total disability continues. Benefits are paid at the end of each month. If you are totally disabled for part of any month, the Insurer will pay 1/30 of the monthly benefit for each day you are totally disabled.
The amount of the benefits is based on the coverage you had on the date you became totally disabled.

Elimination period

  • 52 weeks of uninterrupted total disability or the last day benefits are payable under any Weekly Indemnity income, loss of income or other salary continuation plan, whichever is later.

Maximum benefit period

Period ending on the last day of the month in which you reach age 65 or when you are eligible for an unreduced pension.Benefits may be payable after your attainment of age 65, if you satisfy the elimination period while age 64 in which case the maximum benefit period shall be 12 consecutive months. In no event shall benefits be paid after attainment of age 66.

Proof of claim
The Insurer must receive the notice of claim by the earlier of the following dates:

  • the 365th day after the total disability begins.
  • the 30th day after the termination of this Long-Term Disability provision.

The Insurer must receive proof of a claim no later than 180 days after the end of the elimination period.

Any required proof of ongoing disability must be provided to the Insurer within 30 days of their request.

When Long-Term Disability payments begin

If you become totally disabled, you will be eligible for Long-Term Disability payments after the elimination period.

If you become totally disabled during a lay-off or approved leave and your coverage continues during this time, you will be eligible for payments on the later of:

  • the end of the elimination period, or
  • the date you are recalled or scheduled to return to active full-time work with the employer unless the terms under Maternity / Parental Leave Of Absence apply.

Interrupted periods of total disability during the elimination period

Interrupted periods of total disability occurring before the elimination period has been completed are treated as one period of disability and are accumulated to complete the elimination period as long as all of the following conditions are met:

  • this Long-Term Disability benefit is still in force.
  • there is no interruption of more than 2 weeks.
  • each period of total disability is due to the same or related causes.

The difference between your normal number of scheduled hours and the number of hours actually worked is credited towards the elimination period.

If this Long-Term Disability benefit is terminated, any balance of the elimination period must subsequently be completed by uninterrupted total disability.

Interrupted periods of total disability after benefit payments begin


If you had a total disability for which the Insurer paid you Long-Term Disability benefits and total disability occurs again due to the same or related causes, the Insurer will consider it a continuation of the previous total disability if it occurs after the waiting period, within 6 months after returning to work. You must be covered when the disability reoccurs.

In such cases, a new elimination period will not be applied. Benefits will be based on the coverage in force on the original date of total disability.

What the Insurer will pay
Here is how the Insurer calculates your Long-Term Disability payments. All references to income in this disability provision are to the gross amounts before any deductions.

Step 1: The Insurer takes your monthly benefit of $2,750.

Step 2: The Insurer subtracts any income provided to you:

  • under any government plan, law or agency for the same or a subsequent disability, excluding dependent benefits, Employment Insurance benefits and automatic cost-of-living increases that occur after benefits begin.
  • under any Workers' Compensation Act or similar law for the same or a subsequent disability, excluding automatic cost-of-living increases that occur after benefits begin.
  • under a motor vehicle insurance plan which provides disability benefits but only as long as the law does not prohibit such a deduction.
  • under a group plan, including any coverage resulting from the employee's membership in an association of any kind.
  • under a retirement or pension plan funded in whole or in part by the employer, as a result of a disability or medical condition.
  • under the Québec Parental Insurance Plan.

The result from Step 2 is the amount you will normally receive as a Long-Term Disability payment. However, if the amount calculated under Step 2 plus the above sources of income and all the additional sources of income listed below exceeds 75% of your pre-disability basic earnings after income tax, since the benefit is non-taxable, the Long-Term Disability payment will be reduced by the excess.

Additional sources of income are amounts provided to you:

  • on behalf of a dependent under any government plan, law or agency payable for the same or a subsequent disability, excluding Employment Insurance benefits or automatic cost-of-living increases that occur after benefits begin.
  • under any Workers' Compensation Act or similar law for another disability, excluding automatic cost-of-living increases that occur after benefits begin.
  • under any Criminal Injuries Compensation Act or similar law, where allowed by law.

If you are eligible for any of the income amounts above and do not apply for them, the Insurer will still consider them part of your income. The Insurer can estimate those benefits and use those amounts when calculating your payments.
If you receive any of the income amounts above in a lump sum, the Insurer will determine the equivalent compensation this represents on a monthly basis using generally accepted accounting principles.

The Insurer will not take into account any benefits that began before your disability began. However, increases in those benefits as a result of your disability will be taken into account.

The Insurer has the right to adjust your benefit payments when necessary

Maternity / parental leave of absence
Maternity leave agreed to with the employer will begin on the date you and the employer have agreed will be the start of your leave or the date the child is born, whichever is earlier. The leave will end on the date you and the employer have agreed that you will return to active, full-time work or the actual date you return to active, full-time work, whichever is earlier. Parental leave is the period of time that you and the employer have agreed on.

The Insurer will determine any portions of a maternity or parental leave which are voluntary and any portions which are health-related. The health-related portion of the leave is the period in which a woman can establish, through appropriate medical documentation, that she is unable to work for health reasons related to childbirth or recovery from childbirth. Long-Term Disability benefits will be payable for health-related portions of the leave, provided coverage has been continued for the employee.

However, if the employer has a Supplemental Unemployment Benefit (SUB) plan as defined in the Employment Insurance regulations covering the health-related portion of the maternity or parental leave, the Insurer will not pay any benefits under this plan during any period benefits are payable to you under the employer's SUB plan.

Rehabilitation program

As per the insurance policy, you may be required to participate in a rehabilitation program approved by the Insurer in writing. It may include the involvement of a rehabilitation specialist, part-time work, working in another occupation or vocational training to help you become capable of full-time employment.

During the rehabilitation program, you will continue to be eligible for Long-Term Disability payments. However, during any month, the total income you receive from all sources cannot be more than 50% of your pre-disability basic earnings (after income tax). In cases where the total income exceeds this limit, the Long-Term Disability payments will be reduced by the excess.
                                                                  
Entering a rehabilitation program during the elimination period is not considered an interruption of the elimination period.

Waiver of premium
Long-Term Disability premiums for an employee will be waived while the employee is receiving Long-Term Disability benefits.

What is not covered
The Insurer will not pay benefits for any period:

  • you are not receiving appropriate treatment.
  • you do any work for wage or profit except as approved by the Insurer.
  • you are not participating in an approved partial disability or rehabilitation program, if required by the Insurer.
  • you are on a leave of absence, strike or lay-off except as stated under Maternity / Parental Leave Of Absence or except where specifically agreed to by the Insurer.
  • you are absent from Canada, due to any reason, for longer than 90 consecutive days or for a total of 180 days or more in any 365 day period, unless the Insurer agrees in writing in advance to pay benefits during the period.
  • you are serving a prison sentence or are confined in a similar institution.

The Insurer will not consider you totally disabled if your disability results from drug or alcohol abuse. However, this limitation will not apply while you are participating in the Insurer’s approved treatment program or you have an organic disease which would cause total disability even if drug and alcohol abuse ended.

The Insurer will not pay benefits for total disability resulting from:

  • the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
  • intentionally self-inflicted injuries or attempted suicide, while sane or insane
  • participation in a criminal offence.

 

 


 

   

READ CAREFULLY, BUT REMEMBER…

This is a general outline of the Plans and its purpose is to explain as briefly and clearly as possible each of the benefits to which you are entitled. The benefits outlined under the Plans are subject to the terms and conditions of the Plan documents and Group Master Policies. If there is any conflict between this outline and the Plan documents and Group Master Policies, the Plan documents and Group Master Policies will apply in all cases. Also remember that no benefits are guaranteed and that the benefits can be changed by the Trustees at any time.

 
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