GENERAL INFORMATION
WELFARE PLAN
  BENEFIT HIGHLIGHTS
  ELIGIBLE DEPENDENTS
  DESCRIPTION OF BENEFITS
  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 DISABLED
  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

General Information

BENEFIT HIGHLIGHTS

FRIENDLY REMINDER

The Pay-Direct Drug Card must be used for all prescription drug claims.  No prescription drug claims will be paid if the drug card is not used.
Fee After July 1, 2012  There is a fee of $20 applied per cheque that is produced after July 1, 2012 for health and dental benefit payments. This fee will be deducted from your health and/or dental benefit payment.

MAJOR MEDICAL BENEFITS

Effective December 1, 2014: Emergency Dental benefit is added to the Welfare Plan for eligible dental services required as a result of an accidental injury to natural teeth provided the accident occurred while covered and subject to a maximum of $1,500 per calendar year per covered person.   Details and limitations are outlined under Description of Benefits – Major Medical Benefits.

Effective July 1, 2015: Hearing Aid coverage is changed from $1,500 Lifetime maximum to $1,500 every 5 years.

Effective March 1, 2016: Occupational Therapy is added as eligible paramedical expenses in the Welfare Plan – Services of the following legally licensed and duly qualified paramedical practitioners up to a maximum of $50 per treatment.  There is no limit to the number of visits but subject to a combined maximum of $2,500 for all paramedical practitioners in a calendar year: Chiropractor, Acupuncturist, Naturopath, Massage Therapist, Athletic Therapist, Occupational Therapist, Osteopath, Physiotherapist, Speech Therapist, Podiatrist or Chiropodist.  Written physician’s prescription is required for all services except acupuncture.

Effective June 1, 2015: LIFE INSURANCE AND LONG TERM DISABILITY BENEFIT
Change of insurance carrier: These benefits are insured by The Great West Life Assurance Company under Policy No. 168236.  To obtain the appropriate claim forms, please contact your employer or the Plan Administrator, Manion Contact Centre at 1-866-532-8999.

Effective July 1, 2015: WEEKLY INDEMNITY BENEFIT - Weekly Indemnity benefit increases from $500 per week to $550 per week.

Effective July 1, 2015: DENTAL BENEFITS - Major Dental (including Dental Implants)/Orthodontics combined maximum increases from $2,000 per year to $2,500 per calendar year.

Effective August 1, 2014: MEMBER AND FAMILY ASSISTANCE PROGRAM (MFAP)
Change of provider’s name: The provider Human Solutions has changed the name to Homewood Health Inc.

The Welfare Plan was designed to provide you and your eligible dependents with health and welfare protection.  You, as the member, will be reimbursed for specific medical, health and dental costs which you have incurred.  In addition, the Plan provides you with life, accidental death and dismemberment, and disability insurance. 

The various benefits are described in full in Section 3 of this booklet.

1.         BENEFIT HIGHLIGHTS

  • LIFE INSURANCE – ACTIVE EMPLOYEES ONLY

Amount

$100,000. This benefit terminates when you retire or reach age 70, whichever is earlier.

 

 

  • ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS – ACTIVE EMPLOYEES ONLY

Amount

$100,000 (The Principal Sum). This benefit terminates when you retire or reach age 70, whichever is earlier.

 

 

  • WEEKLY INDEMNITY BENEFIT – ACTIVE EMPLOYEES ONLY

Weekly Benefit

$500.  This benefit terminates when you retire.

  • LONG TERM DISABILITY BENEFIT – ACTIVE EMPLOYEES ONLY

Monthly Benefit

$2,750 (non-taxable) This benefit terminates when you reach age 65, you retire, or when you are eligible for an unreduced pension, whichever is the earliest.


 

  • MAJOR MEDICAL BENEFIT FOR EMPLOYEES AND DEPENDENTS

Overall Maximum

$25,000 per covered person’s lifetime. When this maximum is reached, each covered person will be reimbursed up to a maximum of $5,000 per year thereafter.
Note: These maximums do not apply to the Prescription Drug or the Vision Care benefits.

 

Eligible Expenses

Maximum Amount Payable
(per covered person)

Drugs prescribed by a person legally authorized to prescribe drugs  – Generic Substitution unless specified in writing by the attending health care practitioner

  • Smoking cessation products payable at 75%
  • Erectile dysfunction drugs

Reasonable and customary

Note: Dispensing fee is limited to a maximum benefit of $8.50 per prescription

  • $500 per calendar year
  • $1,000 per calendar year

 

 

Services of a Psychologist

$50 per visit, not to exceed 50 visits in a calendar year

Services of a Chiropractor, Acupuncturist, Naturopath, Massage Therapist, Athletic Therapist, Osteopath, Physiotherapist, Speech Therapist, Podiatrist or Chiropodist

$50 per treatment.  There is no limit to the number of visits but subject to a combined maximum of $2,500 for all paramedical practitioners in a calendar year

 

 

Durable Medical Equipment, Medical Aids and Prostheses

Rental (or, purchase at the option of the Plan Administrator) – please refer to Description Of Benefits for the list of eligible items

Orthopedic Shoes or Orthotics

A total maximum of one pair in a calendar year

Hearing Aids

$1,500 per lifetime

 

 

Vision Care

 

  • Lenses and frames for eyeglasses, contact lenses or laser eye surgery

$400 every two calendar years ($400 each calendar year for eyeglasses for dependent children under age 14)
Note: If a covered person has laser eye surgery, he or she may submit his or her laser eye surgery claim every two calendar years and he or she will receive up to the maximum amount payable under the Plan until the total charge for the laser eye surgery has been paid.

  • Contact Lenses, when vision cannot be improved to at least 20/40 level by eyeglasses

$550 every 5 calendar years

  • Eye examinations

$90 every two calendar years

 

 


  • DENTAL BENEFITS FOR EMPLOYEES AND DEPENDENTS

Dental Fee Guide

The Ontario Dental Association Fee Guide (current minus two years) applies in all provinces

Combined Maximum for Crowns, Dental Implants, Bridges, Dentures and Orthodontic Services

$2,000 per covered person per calendar year

  • EMERGENCY OUT OF PROVINCE/COUNTRY MEDICAL COVERAGE FOR EMPLOYEES AND DEPENDENTS

Members are eligible to be reimbursed for the cost (premium) to purchase out of Province/Country coverage up to a combined family maximum of $200 per calendar year.

  • MEMBER AND FAMILY ASSISTANCE PROGRAM (MFAP)

The Member and Family Assistance Program (MFAP) provides confidential, professional counselling for a broad range of personal and family problems as well as a full suite of additional health and wellness tools and services.

.


   

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.

 
FAQ's | Contacts | Table of Contents | Français