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As an employee, you are responsible to:
For detailed information regarding benefits, please see the appropriate benefits booklets. These booklets can be obtained directly from Human Resources in Room C426 or by calling ext. 7660. For additional information about your benefit plan, please contact Kelly Irwin in Human Resources . For Vision and Hearing care, benefits are allocated based on the dollar amount spent during specified benefit years. One "benefit year" refers to the period of September 1 to August 31 inclusive. If you have questions regarding the amount you have spent during the current benefit year, please contact Sun Life directly. Current benefits periods for Vision and Hearing care are as follows:
For Dental and Extended Health Care, benefits are allocated based on the dollar amount spend during a given "calendar year". This refers to the period of January 1 to December 31 inclusive. If you have questions regarding the amount you have spent during the current benefit year, please contact Sun Life directly. In order to qualify for the benefit plan outlined below, you must be employed by Algonquin College on a full-time basis as an Academic employee and covered by the terms of the Academic Collective Agreement. Participation in the Plan is mandatory. For new plan members, you must respect the following waiting periods before becoming eligible to receive benefit coverage:
As a supplement to the provincial hospital and medical insurance plan, OHIP, your Extended Health Care Plan pays for all eligible services or supplies that are medically necessary for the treatment of an illness. The Plan will cover 100% of the cost of semi-private in-patient hospital care while in Canada, as well as all out-patient services provided in Canada. The Plan will also cover 85% of the cost a semi-private hospital room (based on Canadian fee schedules) while outside of Canada. It should be noted that the Plan is NOT intended to function as out-of-country medical insurance. For information regarding coverage while traveling outside of Canada, please click here. The Extended Health Care Plan covers 85% for medical services, including:
The Plan also covers 85% of paramedical services, up to a combined maximum of $1500 in any calendar year. Paramedical service providers must be licensed, and include the following:
* Includes one x-ray examination per specialty per calendar year. Services that are excluded from Extended Health Care Plan coverage include:
Full-time Academic employees are entitled to 100% coverage up to $400 for vision-related expenses in any two benefits years. Dependents under the age of 18 are entitled to $400 in any one benefit year. Vision-related expenses include glasses (lenses and/or frames), contact lenses, prescription sunglasses, lens tinting, and laser eye corrective surgery that is performed by an ophthalmologist. * Effective January 1, 2008, the maximum limits under the Vision Care Plan are increased to $400. Please refer to the link regarding these changes - Group Insurance Benefits Communique Full-time Academic employees are entitled to 100% coverage up to a maximum of $3000 every 3 calendar years. Hearing related expenses include hearing aids, including maintenance and repair, prescribed in writing by an ear, nose, and throat specialist. Please note that this coverage may be coordinated with Ontario's Assistive Devices Program. Under the Plan, dental procedures are divided into five categories: Type A procedures are preventative in nature and include oral examinations (once per 24 months), recall visits (up to two per calendar year), and emergency examinations. Type B procedures, which are restorative dental and surgical procedures, include consultations and professional visits, extraction of teeth, endodontics (root canals), periodontics (treatment of gum disease), and oral surgery. Type C procedures are prosthodontic and include removable dental prosthesis such as maxillary and/or mandibular dentures (once per 3 years), removable partial dentures (once per 3 years), denture adjustments and repairs, and lab fees associated with the above.
Type D procedures are orthodontic in nature and are designed to treat misaligned and crooked teeth. This includes braces, removable appliances, repairs, alterations, and examinations.
Type E procedures include crowns, bridges, repairs to either, inlays, onlays, posts and cores. Charges for a replacement bridge or replacement standard dentures are not considered an eligible expense during the 3 year period following the construction of its predecessor except when it is needed to replace a bridge or denture that has caused joint disturbances, or a bridge or denture that was inserted shortly following extraction(s) and cannot be economically modified.
Services and procedures that are not covered by the Plan include:
It is strongly recommended that you obtain a predetermination to ensure coverage for any major dental procedure or treatment. In order to determine what expenses will be paid by Sun Life prior to any major treatment or procedure, it is recommended that you complete a Predetermination Form and submit it for evaluation. This will provide you with an 'estimate' for available coverage. For dental work, your dentist may be able to submit the Predetermination Form electronically to Sun Life. If this service is not available to you please obtain a blank form from Kelly Irwin in HR. You must complete the form jointly with your dentist before submission. If you are covered by the Extended Health Care Plan and you and/or your spouse are covered under another plan, your benefit coverage may be coordinated with the other plan according to insurance industry standards. The maximum amount that you can receive from all plans is 100% of the actual expenditures. As outlined in your benefit booklet, the following standards determine where the claim is sent first:
Eligible dependents include your spouse/partner, your biological or adopted children, the children of your spouse/partner (other than foster children). All children must be under the age of 21 and a resident of Canada or the United States. Children attending college or university on a full-time basis may continue to receive coverage until the age of 25. If a child is disabled before the age of 21, coverage will continue beyond that age provided:
In order to ensure there is no disruption in benefit coverage, you must notify Human Resources within 31 days of the dependent's 21st birthday. Only one person at a time can be covered under the Plan as your spouse/partner. Coverage under the above plan will terminate:
Please contact Kelly Irwin in Human Resources to complete the necessary Sun Life forms for the following changes to benefit coverage:
It is important for you to contact the Benefits Administrator to discuss your benefit coverage prior to an employment status change (e.g., early retirement, sabbatical) or within 31 days following a personal status change (e.g., marriage). Please contact Kelly Irwin in Human Resources for all benefit related inquiries. Human Resources is able to intervene on your behalf for declined claims (you must provide claim number). HR is also able to assist you should you have any difficulty resolving issues with Sun Life. If you have previous claims, claims payment history or specific coverage questions, please contact Sun Life directly:
Whenever you contact Sun Life, you MUST have your policy information ready:
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