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| Partial Load Benefit Plan | |||||||||||||||||||||||||||||||||||||||||||||||
In accordance with Article 26 of the Collective Agreement, regular partial-load employees are eligible to take part in the following benefit plan. A "regular partial load" employee is employed more than six hours and up to and including 12 hours per week, for a period of more than 8 weeks. You will be notified by Human Resources Services should you meet these criteria. For detailed information regarding benefits, please click here to access and print a copy of your own Benefit Booklet. Quicklinks: 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 be eligible to participate in the Group Insurance Benefit Plan, you must be a regular partial load employee who is currently employed by the College. A "regular partial load" employee is employed more than six hours and up to and including 12 hours per week, for a period of 8 consecutive weeks or longer. You will be notified in writing by Human Resources Services if you meet these criteria. Enrolment in the Plan is optional. Partial-Load employees over the age of sixty-five (65) are eligible for inclusion in the Plan. Please contact Human Resources Services to discuss your eligibility . For new plan members, you must respect the following waiting periods before becoming eligible to receive benefit coverage:
Coverage begins on the first day following the completion of the waiting period, provided you are actively at work on the date your coverage becomes effective. If you are absent, coverage will begin on the day you return to active work. During active partial-load employment benefit premiums are divided as follows:
For up-to-date information on current premiums, please contact Human Resource Services. Please note that payroll deductions for benefit premiums are not available to partial-load employees. Benefit premium amounts must be paid through automatic withdrawal from your personal bank account. "Bridging" refers to your entitlement to maintain benefit coverage between your current partial-load payroll authorization and re-employment under a subsequent partial-load payroll authorization. You may elect to continue your benefits at the end of your authorization if your manager has provided written confirmation of future partial-load employment. The maximum bridging period is 6 months. During this time benefits may be maintained at the cost of the employee. It is recommended that Life Insurance is maintained during the bridging period. Should you choose to bridge your benefits there will be no effect on any waiting periods, provided that you are rehired within 6 months as a partial-load employee. A new waiting period is only required when you choose not to bridge benefits between partial-load authorizations, or if more than 6 months has elapsed between partial-load authorizations. 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 $1,500 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:
In order to receive vision care benefits, you must also be enrolled in the Extended Health Care Plan. Partial-load 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. In order to receive hearing care benefits, you must also be enrolled in the Extended Health Care Plan. Partial-load 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. This coverage may be coordinated with Ontario's Assistive Devices Program. In order to receive dental care benefits, you must be enrolled in the Extended Health Care Plan. 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. The following types of life insurance are available to partial-load employees who are actively at work. Basic Life Insurance & Accidental Death and Dismemberment (AD&D):
Supplementary Life Insurance:
Employee Pay-All Life Insurance:
Dependent Life Insurance:
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 Human Resource Services. 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 Resource Services 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 Human Resource Services 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 Human Resource Services for all benefit related inquiries. Human Resources Services is able to intervene on your behalf for declined claims (you must provide claim number). HRS 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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