EMPLOYEE BENEFITS for Partial-Load Academic …

1 EMPLOYEE BENEFITS for Partial-Load Academic Employees of the ontario Colleges of applied arts and technology Contract Number 50832 and 50090 Effective January 1, 2015 Contract No. 50832 and 50090 - Partial-Load Employees Table of Contents Effective January 1, 2015 Table of Contents Section 1 - General 1 About this booklet .. 1 About the Group Insurance BENEFITS Program .. 1 Section 2 - Roles and Responsibilities .. 2 college Employer Council .. 2 About the Joint Insurance Committee .. 2 Colleges .. 2 OPSEU .. 2 Sun Life .. 2 EMPLOYEE .. 3 Section 3 - Definitions.

2 3 Accident .. 3 Actively At Work .. 3 Appropriate Treatment .. 3 Benefit Year .. 3 Calendar Year .. 3 Dentist .. 3 Dependent(s) .. 3 5 Eligibility Requirements .. 5 Partial-Load EMPLOYEE .. 5 Hospital .. 5 Illness .. 6 Incurred Expense .. 6 Reasonable and Customary Expenses .. 6 Survivor(s) .. 6 Section 4 - Categories of BENEFITS .. 6 Basic Benefit .. 6 Optional BENEFITS .. 6 Section 5 - When Coverage Begins .. 7 New EMPLOYEE .. 7 Bridging BENEFITS and Waiting Period .. 8 Coverage begins .. 8 Dependent(s) .. 9 Contract No. 50832 and 50090 - Partial-Load Employees Table of Contents Effective January 1, 2015 Section 6 - Enrolment.

3 9 Enrolment Form .. 9 Your Certificate Number .. 10 Confidentiality .. 10 Updating your Records .. 10 Section 7 - Changing Benefit Coverage .. 10 Changes affecting your coverage .. 10 To add or increase Life Insurance coverage .. 11 Proof of good health .. 11 Effective date of coverage .. 11 Section 8 - Bridging Group Insurance BENEFITS .. 11 Section 9 Termination of Coverage .. 12 When coverage ends .. 12 Coverage after Retirement .. 12 Section 10 - Survivor BENEFITS .. 13 Survivor BENEFITS .. 13 Section 11 - Extended Health Care (Medicare Supplement) .. 14 General description of the coverage.

4 14 Coverage under more than one plan .. 15 Hospital expenses in Canada .. 15 Prescription Drugs and Vaccines .. 15 Reimbursement Amount .. 16 Medical services .. 17 Paramedical services .. 20 What is not covered .. 20 Moving Out of Province .. 21 Section 12 - Vision Care .. 22 Vision Care .. 22 Coverage .. 22 PVS Preferred Vision Services Inc.. 22 Section 13 - Hearing Care .. 22 Hearing Care .. 22 Your coordination with Government Plans .. 24 Contract No. 50832 and 50090 - Partial-Load Employees Table of Contents Effective January 1, 2015 Section 14 - Expenses out of your province and Your Extended Health Care Plan.

5 25 Expenses out of your province .. 25 Section 15 - Dental Care .. 33 General description of the coverage .. 33 Preventive Dental Procedures .. 33 Restorative Dental and Surgical Procedures .. 34 Denture Procedures .. 35 Crowns and Bridges .. 35 Orthodontic Procedures .. 36 Predetermination .. 36 Coverage under more than one plan .. 37 What is not covered .. 37 Expenses Outside of Province/Canada .. 38 Section 16 - Short Term Disability Plan (STD) .. 39 General description of the coverage .. 39 Section 17 - Life Insurance Coverage .. 41 General description of the coverage.

6 41 Accidental Death and Dismemberment .. 43 General description of the coverage .. 43 Accident .. 43 Your Accidental Death and Dismemberment Insurance .. 43 What the Plan will pay .. 43 Accidental Loss .. 44 What is not covered .. 44 Dependent Life Insurance Coverage .. 45 General description of the coverage .. 45 Proof of good health .. 45 Appointing a Beneficiary .. 45 Beneficiary 45 Contract No. 50832 and 50090 - Partial-Load Employees Table of Contents Effective January 1, 2015 Life Insurance Conversion .. 47 Section 18 Critical Illness Insurance .. 48 Section 19 - Submission of Claims.

7 52 Making Claims .. 52 Making an Extended Health Care Claim .. 53 Time limits for filing a claim .. 53 Co-ordination of BENEFITS .. 53 ontario Assistive Devices Program .. 54 Contacting Sun Life .. 54 Out-of-Province Claims .. 55 Making a Dental Claim .. 55 Time limits for filing a claim .. 56 Co-ordination of BENEFITS .. 56 Contacting Sun Life .. 57 Making a Life Insurance Claim .. 57 How to make a claim .. 57 Making a Critical Illness Insurance Claim .. 58 How to make a claim .. 58 Contract No. 50832 & 50090 - Partial-Load Employees General Information Effective January 1, 2015 (6) 1 Section 1 - General Information About this booklet This booklet has been developed for you and your family by individuals currently on the Academic Joint Insurance Committee (JIC) who represent the ontario Public Service Employees Union (OPSEU), the Colleges of applied arts and technology (CAAT), the college Employer Council, and representatives from the Insurance Company, Sun Life.

8 BENEFITS for Partial-Load employees were established under the Academic Pay Equity Plan as required by the 'Pay Equity Act, (1987)'. The effective date for participation in BENEFITS was July 1, 1990. The information contained in this booklet will not in any way diminish current benefit levels in effect as of the date of issue. The information in this booklet is important to you and should be kept in a safe place. It describes all group insurance BENEFITS available to you, explains your entitlements and various administrative issues relating to the Group Insurance Benefit Program.

9 For confirmation of the specific benefit coverage you have elected, please refer to your copy of your Group Insurance Positive Enrolment Form or contact your college s BENEFITS Plan Administrator. It is important to note that this booklet is only a summary of your group contract. It is not a legal document. If there are any discrepancies between the group contract and the information in this booklet, the group contract will take priority and the Insurance Company will follow the group contract when making a decision to pay a claim.

10 BENEFITS described in the booklet are applicable only if you and your Dependent(s) are insured according to the records maintained for the group contract. If you have any questions about the information in this EMPLOYEE BENEFITS booklet, or if you need additional information about your group BENEFITS , please contact your college s BENEFITS Administrator or Union Local Representative. About the Group Insurance BENEFITS Program The group insurance benefit program and the cost-sharing arrangements provided to the CAAT Academic Partial-Load EMPLOYEE Group are a result of negotiations and are set out in the Academic Staff Collective Agreement.