BASIC & ENHANCED Group Benefit Plans - Your complete guide to Group Insurance Plans designed for employers with 3 to 15 employees - Dezyne Benefits
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Group Benefit Plans
BASIC & ENHANCED
Your complete guide to
Group Insurance Plans
designed for employers
with 3 to 15 employees.
®
CONTENTS
BASIC & ENHANCED PLAN DETAILS
Plan Benefit Summary ........................................................................ 1
General Information ........................................................................... 3
Eligibility Details ................................................................................. 4
Key Elements ...................................................................................... 5
Life ......................................................................................... 5
Critical Illness ......................................................................... 5
Accidental Death & Dismemberment ..................................... 5
Long Term Disability .............................................................. 5
Health .................................................................................... 6
Vision ..................................................................................... 6
Dental .................................................................................... 6
BASIC & ENHANCED FREQUENTLY ASKED QUESTIONS
Explaining the Plan to Clients .............................................................. 7
Quotes & Calculating Premium ........................................................... 9
Enrollment & Getting Started .............................................................. 10
Increasing LTD for Enhanced Plans ...................................................... 11
Administration After the Sale ............................................................... 12
Changing Plan Selection ..................................................................... 13
Late Applicants ................................................................................... 14
Renewals & Rate Tables ....................................................................... 15
Electronic Administration & Claims ..................................................... 16
Plan Member Support ........................................................................ 17
Plan Advisor Compensation ................................................................ 18
BASIC & ENHANCED PLAN BENEFIT SUMMARY
BASIC ENHANCED
Life (Plan Member)
Benefit Amount $25,000 $50,000
Conversion Privilege Available to age 65
Accidental Death & Dismemberment (Plan Member)
Benefit Amount $25,000 $50,000
Critical Illness (Plan Member)
Critical Illness $1,000 single payment per Lifetime $1,500 single payment per Lifetime
Long Term Disability (Plan Member)
Without Evidence $1,500
(Minimum Salary $25,000/yr)
Benefit Amount per month $750
With Evidence $2,500
(Minimum Salary $45,000/yr)
Qualifying Period 119 days
Maximum Benefit Period 5 years
Definition of Disability 5 years own occupation
Pre-existing Condition Clause 6/12 months
Benefit Offsets No Offsets Primary CPP/QPP, WCB, EI, etc.
Waiver of Premium applies to Life, Accidental Death & Dismemberment, Critical Illness and Long Term Disability benefits, if
approved for a LTD claim.
Health (Plan Member and Dependents)
Reimbursement 80% 100%
Pay Direct Drugs
$5,000 calendar year maximum $10,000 calendar year maximum
Dispensing fee cap $5
Overall maximum of $800 per calendar Overall maximum of $1,000 per
Paramedical Services year, with a maximum of $400 per calendar year, with a maximum of
practitioner group $500 per practitioner group
Practitioners - Group 1 Chiropractors, Physiotherapists, Athletic Therapists or Occupational Therapists,
Massage Therapists and Acupuncturists
Osteopaths, Chiropodists, Podiatrists or Pedorthists, Naturopaths, Psychologists, Social
Practitioners - Group 2 Workers or Family Counsellors, Speech Therapists, Dietitians, Audiologists,
Ophthalmologists or Optometrists - eye exams only
Medical Services & Supplies $1,500 calendar year maximum $2,000 calendar year maximum
combined for all services & supplies combined for all services & supplies
included but not limited to: Custom-made Orthopedic Shoes or Custom-made Foot
Orthotics ($300 per year), Hearing Aids, Compression Garments or Stockings ($200 per
year), TENS Machine (1 per 5 years),
Insulin Pump (1 per 5 years), CPAP Machine (1 per 5 years)
1
BASIC & ENHANCED PLAN BENEFIT SUMMARY
Health - Other Services
BASIC ENHANCED
(Plan Member & Dependents)
Reimbursement (applies to Ambulance,
100%
Hospital and Emergency Out of Country)
Ambulance (Ground) $500 per calendar year
Hospital, Semi-Private $500 per calendar year $1,000 per calendar year
Emergency Out of Country/ 30 Day Trip Limit
Travel Assist $1,000,000 Lifetime
Vision (Plan Member & Dependents)
Reimbursement Not Available 100%
Frames, Lenses, Contacts &
Not Available $150 per 24 consecutive months
Laser Eye Surgery
Dental (Plan Member & Dependents)
Basic Dental Care includes: examinations and x-rays, cleaning and fluoride treatments, routine extractions and fillings, root
canals, denture repair, periodontal treatment, surgical procedures performed by dentist including anesthetics.
Enhanced provides Major Dental Care which includes (but is not limited to): bridges and crowns, full/partial dentures,
inlays and onlays including veneers.
Basic Reimbursement 80% 100%
Major Reimbursement Not Available 50%
Calendar Year Maximum $1,000 $1,500 combined Basic & Major
Recall Exam 9 months
Scaling 10 Units per calendar year
Fee Guide Current General Practitioner for Province of Residence
Other than the Dispensing fee cap for Pay Direct Drugs, no deductible applies to Health, Vision or Dental benefits.
Maximums apply individually to each Plan Member and Dependent.
With Family Coverage, a 24-month Survivor Coverage Extension applies to all Health, Vision and Dental benefits.
A Plan Member who is actively at work is eligible for coverage until age 70 (age 65 for Long Term Disability and
Critical Illness benefits). A spouse is eligible as long as the Plan Member is eligible. Dependent children under the
age of 21 or age 21-25 attending school full time, are eligible.
2
GENERAL INFORMATION
BASIC & ENHANCED
In keeping with the tradition of providing comprehensive and affordable group insurance employee benefit
packages, Wawanesa Life has designed Basic & Enhanced plans for business owners with three to fifteen employees.
Recognizing that time is a valuable commodity, the Basic & Enhanced pre-defined packages have been specifically
designed to take advantage of those “face to face” meetings with clients by making introduction, plan discussion,
quotation and enrollment possible all in one meeting.
Basic & Enhanced plans simplify the Group Insurance Quotation and Sales process.
These plans are:
• Simple to explain to clients
• Simple to quote and calculate premium
• Simple to enroll and get started
• Simple to administer after the sale
• Simple, straightforward and understandable coverage for business owners, employees and dependents
Quotations for Basic & Enhanced benefit plans are prepared by the Plan Advisor using a Propsal Tool. This tool will
quickly calculate rates based on employee demographics and plan design choices.
3ELIGIBILITY DETAILS
The following criteria apply to Basic & Enhanced plans:
1. No industry excluded and no family content 9. Any employee or dependent that did not
restrictions. Coverage is available to owner(s) and apply for coverage within the specified time
employees regardless of family ties. frame must submit evidence of insurability
by completing the Basic & Enhanced Health
2. A minimum of three eligible employees must be Statement.
enrolled at all times, including seasonal and full
time employees. 10. 100% of eligible employees must participate
in the plan. Health and Dental benefits are
3. Employees must earn the minimum hourly wage as compulsory for eligible dependents unless the
legislated in the province where they are employed. employee’s spouse and/or children already
have benefit coverage under another group
4. All employees must work a minimum of 24 hours insurance plan. If dependent coverage is not
each week. Eligible employees can be considered required, the employee must be covered on a
full-time or part-time provided they meet the Single basis and the Basic or Enhanced plan will
minimum hours worked. All employees must provide coverage for the employee only.
receive a T4 from the Plan Sponsor. Contract or
term employees are not eligible for coverage under 11. Employee participation in the Enhanced plan
this plan. requires a minimum salary of $25,000 per
calendar year. With a salary in excess of $45,000
5. Seasonal employees are eligible providing they the employee is eligible to apply for additional
work a minimum of 24 hours each week for a Long Term Disability coverage by completing
minimum of nine months of the year. Limited the Basic & Enhanced Health Statement.
benefits are available throughout any lay-off period Applicants will know immediately if they qualify
that is less than 90 days. for the additional coverage. An additional
premium will be required.
6. A three month waiting period applies to all new
employees. 12. The Basic & Enhanced benefit plans are
available in British Columbia, Alberta,
7. All dependent children under 21 are eligible Saskatchewan, Manitoba, Ontario, Nova Scotia,
for coverage. Dependent children age 21-25 New Brunswick, Newfoundland and Labrador,
attending school on a full-time basis can continue and Prince Edward Island. All eligible employees
to be covered under the plan. A Dependent Child and dependents must reside in one of the
Eligibility form must be completed for each child provinces listed and must be enrolled in the
over age 21. provincial healthcare program in the employee’s
province of residence.
8. An employee who is actively at work is eligible
for coverage until age 70 (age 65 for Long Term
Disability Benefit). A spouse can continue to be
covered under the plan as long as the employee is
eligible.
4KEY ELEMENTS
Life, AD&D, LTD and CI are for the Plan Member only.
Health, Vision and Dental are available for Plan Members and Dependents.
Plan Member Life
• Coverage provided is a Flat Benefit amount.
• Benefit amount does not reduce because of age.
• Conversion Privilege available to age 65.
• Wavier of Premium available if approved for LTD claim.
• Coverage terminates at the earlier of age 70 or retirement.
Plan Member Accidental Death & Dismemberment
• Coverage provided is a Flat Benefit amount.
• Benefit amount does not reduce because of age .
• Wavier of Premium available if approved for LTD claim.
• Coverage terminates at the earlier of age 70 or retirement.
Plan Member Critical Illness
• Coverage provided is a flat benefit amount.
• Single payment per lifetime.
• 10 conditions covered.
• Waiver of Premium available if approved for LTD claim.
• Pre-existing Condition Clause is included.
• Coverage terminates at the earlier of age 65 or retirement.
Plan Member Long Term Disability
• Coverage provided is a Flat Benefit amount, depending on the plan chosen and minimum salary
requirements.
• Definition of Disability is 5 year own occupation.
• Waiver of premium available if approved for LTD claim.
• The benefit is non-taxable providing employees pay a minimum of 15% of the monthly premium
for any Basic or Enhanced benefit plan regular premium plus the full “With Evidence” Long Term
Disability premium.
• Pre-existing Condition Clause included.
• Coverage terminates at the earlier of age 65 or retirement minus the qualifying period.
5KEY ELEMENTS continued
Health
• Drugs provided on a Pay Direct Drug Card basis with the allowable Dispensing fee capped at $5
• Paramedical Coverage broken into two groups:
1. Chiropractors, Physiotherapists, Athletic Therapists or Occupational Therapists, Massage
Therapists and Acupuncturists
2. Osteopaths, Chiropodists, Podiatrists or Pedorthists, Naturopaths, Psychologists, Social Workers
or Family Counsellors, Speech Therapists, Dietitians, Audiologists, Ophthalmologists or
Optometrists - eye exams only
• Expenses for services of each group of practitioners is subject to a maximum
• Medical Services and Supplies include but are not limited to: Custom-made Orthopedic Shoes and Foot
Orthotics, Hearing Aids, Surgical Bras, and Surgical Stockings. Some individual maximums apply.
Health - Other Services
• Ambulance Services – Ground Transportation
• Semi-Private Hospital Room
• Emergency Out of Country Coverage and Travel Assistance
• Out of Country Coverage and Travel Assistance - coverage is limited to maximum of 30 days and
$1,000,000 overall. Other restrictions and limitations may apply.
Vision
• Available with the Enhanced plan
• Eye Glasses and Contact Lenses
Dental
• Basic Dental coverage is part of both benefit plans. Covered expenses include: examinations and x-rays,
cleaning and fluoride treatments, routine extractions and fillings, root canals, denture repair, periodontal
treatment, surgical procedures performed by dentist including anesthetics.
• The Enhanced plan includes Major Dental coverage. Covered expenses include but are not limited to:
bridges and crowns, full/partial dentures, inlays and onlays including veneers.
6? FAQ: Explaining the Plan to Clients
What is a Qualifying Period? What is Emergency Out of Country
The time a Plan Member is absent from work due coverage?
to an injury or illness before being considered for Emergency Out of Country coverage is medical
Long Term Disability Benefits. care that a Plan Member or dependent may
receive for a medical emergency while travelling
outside of Canada. Medical emergencies are a
What is pre-existing condition clause? result of a sudden and unexpected injury, or when
a sudden, unexpected illness or an acute episode
Long Term Disability: If the Plan Member has a
of a disease occurs that could not have been
medical condition that was treated or attended to
reasonably anticipated.
by a physician or for which drugs were prescribed
within 6 months prior to the date the employee’s
insurance became effective, they have a pre-
What does 30 day trip limit mean?
existing condition.
Emergency Out of Country coverage is available
If a disability occurs during the first 12 months during the first 30 days of any trip. The Plan
of coverage and is the result of a pre-existing Member and/or dependent must return home for
condition, the Long Term Disability claim will not a period of at least 14 days between trips to reset
be approved. the 30 day trip limit.
Critical Illness: A 24-month pre-existing condition
clause will apply.
What is a dispensing fee cap?
Most pharmacies charge a fee for dispensing drugs
What are Paramedical Practitioner Groups? or supplies prescribed by a physician. This amount
Paramedical Services are broken into two groups of may vary by pharmacy. The claimant’s deductible
practitioners: will be any amount of the dispensing fee in excess
1. Chiropractors, Physiotherapists, Athletic of the $5 cap.
Therapists or Occupational Therapists,
Massage Therapists and Acupuncturists
2. Osteopaths, Chiropodists, Podiatrists or
Pedorthists, Naturopaths, Psychologists What types of individual limits apply
Social Workers or Family Counsellors, under Medical Services & Supplies?
Speech Therapists, Dietitians, Audiologists,
Ophthalmologists or Optometrists - eye Some examples, but not limited to, are:
exams only. • Foot Orthotics/Orthopedic footwear -
The Plan Member (or dependent) can use the $300 per year (combined)
services of one or more of the practitioners within • Surgical Stockings - $200 per year
the group subject to the calendar year maximum • TENS Machine - 1 per 5 years
for each group. • Insulin Pumps - 1 per 5 years
• CPAP Machines - 1 per 5 years
Total medical services/supplies are subject to the
overall calendar year maximum shown in the Plan
Summary.
7? FAQ: Explaining the Plan to Clients continued
Business Assistance Program
Wawanesa Life have partnered with Arete Human Resources Inc. to provide all Group plans with the Acumin®
Business Assistance Program.
The Acumin® Business Assistance Program provides confidential telephone coaching in situations where Human
Resources advice is required. Experts are available to assist you with such matters as: conflicts between employees,
absenteeism, negative reactions to change, difficult behaviours and strategies for effective return to work after
prolonged employee absence. This coverage provides up to 2 hours per issue, with an unlimited number of calls
and issues.
Acumin® coverage also provides:
• Face-to-face counselling on a referral basis for employees experiencing personal problems.
• Up to 12 hours of coverage is provided in any 12 month period per insured individual.
• Business Legal advice provides practical, up-to-date company, partnership, taxation,
and insolvency law, plus all relevant aspects of common and civil law.
• 2 hours of coverage per 12 month period.
• Business Accounting advice provides practical and confidential financial advice for
Owners and managers.
• 2 Hours of coverage per 12 month period.
Acumin® is included as a standard service within all Wawanesa group plans.
Employee Assistance Program
Wawanesa Life offers the Arive® Employee Assistance Program (EAP) as an optional product with support
provided by Arete Human Resources. Arive® provides Plan Members and their dependents with support
and guidance to help resolve personal or work-related issues.
Insured Plan Members and their eligible family members can share up to 12 hours of in person, telephone,
or video counselling annually with professionals to help address issues affecting productivity and
psychological health. Most common concerns discussed through this self-referral service include:
Family challenges Work-related difficulties Dependency concerns
• Relationship or marital • Stress, burnout • Excessive use of drugs, alcohol
• Separation/divorce • Adjusting to change • Compulsive gambling and gaming
• Conflict and communication • Interpersonal problems with • Internet or electronic device
• Parenting problems, blended family supervisors or co-workers dependency
• Conflict, harassment, bullying • Coping though self-medication
Personal problems Eldercare issues
• Fatigue, sleep disturbances • Assessment of needs
• Depression, anxiety and isolation • Custom care strategies
• Loss of self-esteem, motivation • Support accessing local resources
• Coping with bereavement
In addition, up to three hours of telephone consultation can be accessed for personal legal issues, and another
three hours for financial concerns per calendar year. Telephone coaching for managers helps the organization
build expertise in handling people management issues. Maximum 2 hours per issue, unlimited issues.
Arive® is available to add onto any Wawanesa Life group plan. This can be added on or off renewal.
Arive® can be added for either all classes within a policy or for selected classes only.
8? FAQ: Quotes & Calculating Premium
How are employee monthly premium How do I prepare a Basic &
rates determined? Enhanced benefit plan quote?
a) Employee monthly premium rates are You can use our web portal Basic & Enhanced
determined using the following criteria: Proposal Tool and receive the monthly premium
• Plan – Basic or Enhanced. rates instantly.
• Age Band (age of employee).
• Gender of the employee.
• Single or Family coverage option. Basic & Enhanced Proposal Tool
• Province of the Head Office of the Simply log into our Group Broker page on the
Employer. Wawanesa Life website and click on the Basic &
• Approval of “With Evidence” LTD Enhanced Proposal Tool. You will be required to
coverage (if applicable). enter your name, province, the employee details
and the plan selected. The proposal tool will
b) Each member’s criteria is referenced against the automatically calculate the monthly premium rates
applicable rate table. for you based on the information entered and the
applicable rate table. You are able to revise your
The rate table provides the basic monthly
quote as needed, print the final Proposal, Master
premium rates applicable for each employee.
Application, Employee Enrollment forms and the
The rates shown will be the required monthly
premium for the employee. The amounts do not Basic & Enhanced Health Statement (only required
include provincial taxes, if applicable. if applying for excess Long Term Disability).
What is a rate table guarantee?
The rate table guarantee is the number of months
the rate table (starting at the time of sale) will be
used to determine the monthly premium due for
the group plan. The length of the rate table
guarantee is noted within the Proposal tool.
9? FAQ: Enrollment & Getting Started
When can a Basic & Enhanced Is there a waiting period before an
benefit plan become effective? employee’s benefits start?
In the first month of coverage, the Plan will On the effective date of the plan, all eligible
commence on the first of the month with the full employees will be enrolled with immediate
calculated monthly premium due. coverage. After the effective date, all future
employees will have a three month waiting period.
No premiums are payable during the waiting
Do all employees have to apply for period.
the plan?
Basic & Enhanced benefit plans require 100%
What if an employee’s spouse has
participation of eligible employees. All employees
must receive a T4 from the policyholder. Contract coverage under another group plan?
or term employees are not eligible for coverage All employees must be enrolled as Single or
under this plan. Family. In the event that an employee’s spouse
and/or children have coverage elsewhere, the
employee can choose to have “additional” or
What is needed to enroll in a Basic & “coordinated” coverage for the family under
Enhanced benefit plan? the Basic & Enhanced benefit plans by choosing
Family Coverage. If additional coverage is not
The following documents are required: desired, the employee must be covered on a
• The Basic & Enhanced Master Single basis and the Basic or Enhanced plan will
Application with original signatures. provide coverage for the employee only.
• Cheque payable or Pre-Authorized Debit Should spousal coverage terminate, an application
agreement for the first month’s premium. to change employee coverage from single to
• Subsequent monthly premium payments family can be made. If the application is made
are done through Pre-authorized Debit within 31 days, no coverage restriction will apply.
(PAD). Simply fill out page 4 of the Master
Application and attach a void cheque.
• Signed enrollment forms for each
What is coordination of benefits?
employee under the plan.
• A copy of the Proposal. Coordination of benefits refers to the coordination
• If prior coverage is applicable, a copy of of claims under two plans of group insurance
the last monthly premium statement and which may or may not be with the same insurance
a copy of employee booklet. carrier.
• Plan Members applying for excess Coordination of benefits (COB) allows the
Long Term Disability coverage must employee to potentially claim under two plans
submit a completed Basic & Enhanced of insurance for up to a maximum of 100% of an
Health Statement. eligible expense. Family coverage will be required
in order to coordinate claims for a dependent.
If dependents are covered under two plans, claims
for dependent children are submitted first to the
plan that covers the spouse whose birthday falls
earliest in the calendar year. Any part of the claim
not covered under the “first” plan can then be
submitted to the other spouse’s plan.
10? FAQ: Increasing LTD for Enhanced Plans
Under the Enhanced plan, how Will Wawanesa Life grandfather LTD
do employees apply for the benefit amounts in place with a prior
$2,500 Long Term Disability (LTD) carrier?
coverage? If the employee has a long term disability benefit
In order to be enrolled in the Enhanced plan, an of $2,500 or more in place with a prior carrier
employee must have an annual income which is immediately before the plan moves to Wawanesa
equal to or exceeds $25,000. If so, the LTD benefit Life, and the Plan Sponsor requests that the benefit
will be $1,500 per month. Should an employee amount be $2,500:
have an annual income which is equal to or • The employee must have a current
exceeds $45,000, the employee can apply to have salary of $45,000 or more.
the LTD coverage increased to $2,500 per month • A copy of the prior carrier’s billing must
by completing a simple questionnaire on the Basic confirm the current benefit is $2,500 or
& Enhanced Health Statement form. more.
• Plan Sponsor must indicate on the
If all questions are answered “No”, coverage is Master Application the desire to have
automatically approved. The completed Health Wawanesa Life provide the employee
Statement must be forwarded to Wawanesa Life $2,500 coverage.
within 21 days of completion for processing. There
If all conditions are met, the $2,500 maximum
will be an additional premium for the increased
Enhanced LTD coverage will automatically be
disability coverage amount. However, if any
approved.
questions are answered “Yes”, the employee is not
eligible for the increase in coverage. Application for coverage must be applied
consistently to all employees.
The “With Evidence” LTD coverage premium rates
for Enhanced Plans are calculated on the Proposal
Tool as an optional plan design.
When does the application for “With
Evidence” LTD take place?
Application can be made at the time of enrollment
for benefits under the plan or at any time in the
future providing the Plan Member is enrolled in
the Enhanced Plan and has an annual salary of
$45,000 or greater.
11? FAQ: Administration After the Sale
How and when are premium What if Plan Member information
statements delivered to the Plan changes?
Sponsor? Revised monthly premium rates for each Plan
Member will be applicable if there is a change to
All Basic & Enhanced benefit Plan Sponsors will
the benefit plan in effect, the Plan Member’s age
receive a monthly premium statement directly from
which causes movement to a higher age band, a
Wawanesa Life approximately 10 days prior to the
change to the Single/Family coverage option, and/
due date. The Plan Sponsor has one method for
or an increase to the “With Evidence” Long Term
payment:
Disability amount.
• Monthly by Pre-authorized Debit -
directly from the Plan Sponsor’s bank The new premium will be applicable as follows:
account. Premiums will be withdrawn on
the first of each month (or the first • Change in Age: If a Plan Member has
banking day thereafter). An application a birth date which causes movement
and a void cheque will be required to set to a new age band, the applicable rate
up this banking arrangement. will become effective on the birth date
(if the first of the month) or on the
first of the month following the birth
date.
How and when does the Plan • Change in Single/Family coverage:
Sponsor report Plan Member If an employee changes coverage
changes? options (Single/Family) the applicable
monthly premium rate will take effect
As soon as the Plan Member experiences a change on the date of coverage selection
in salary, a change in marital status, a change in change (if the first of the month) or
dependent coverage requirements or a change on the first of the month following the
in employment status, Wawanesa Life should be change in selection.
notified. The Plan Sponsor can use the Notice of
• Change in Long Term Disability
Change form to submit changes or changes can be
maximum: If a Plan Member is
submitted electronically through Group Benefits
approved for an increase in the Long
Online.
Term Disability coverage, the
applicable rate will become effective
A Plan Member termination can be emailed to:
on the date of approval, if approval
planadmin@group.wawanesa.com happens on the first day of the month.
If approved after the first of the
month, coverage is effective on the
first of the following month.
12? FAQ: Changing Plan Selection
The decision to include the Basic and/or the Enhanced plan as a part of the benefit plan is made by the Plan
Sponsor.
If only the Basic plan is included, all employees will be eligible for the same level of coverage provided they meet the
minimum number of hours worked each week.
If the Enhanced plan is the only benefit plan chosen at the time of sale, all employees must have a minimum annual
salary of $25,000. If an employee’s annual salary drops below $25,000, they will be removed from the plan for all
benefits.
If Basic & Enhanced are included in the plan design, employees will be enrolled according to a specified class
structure chosen by the Plan Sponsor or if no class structure has been provided, employees will be enrolled in the
appropriate plan with annual salary being the determining factor. Plan Members do not have the option to select
between the Basic or Enhanced benefit plans. When both Basic & Enhanced are included in the plan design, if at any
time the Plan Member’s annual salary falls below $25,000, the employee will automatically be moved into the Basic
benefit plan, providing the Plan Member meets the requirements to join the class under the basic plan.
What happens to the calendar year maximums outlined for Health, Vision or Dental
when a Plan Member moves between the Basic and the Enhanced plan?
Extended Health, Vision or Dental calendar year plan maximums are coordinated with the current group benefit
plan in effect for each Plan Member and his or her dependents. In the event that a Plan Member is moved from one
plan to another and a claim has been incurred, the maximum under the plan on the date of service will prevail. The
overall total amount paid for any claim(s) incurred will not exceed the highest maximum of either benefit plan.
13? FAQ: Late Applicants
If the employee applies for insurance for himself/herself or dependent(s) more than 31 days after first becoming
eligible for coverage, the employee and/or the dependent(s) will each be required to complete a Basic & Enhanced
Health Statement form.
If all answers are “No”, coverage is approved. The employee and/or dependent(s) must submit both the application
form (if not already done) and the completed, signed Health Statement form to Wawanesa Life for processing.
These documents must be received within 21 days of signature.
If approved, coverage will be restricted. During the first 12 months the employee and/or dependent(s) is on the
plan, Dental coverage will be restricted to a total of $250 per person. Full premium will be due and payable in
accordance with the rate table calculations during this time despite the reduction in coverage.
If any questions on the Health Statement form are answered “Yes”, the employee or dependent will not be eligible
to join the plan.
What are the time-frames in which an employee must apply for coverage under a Basic
or Enhanced benefit plan?
New employees are eligible to join the plan after completing a three month waiting period. In order for coverage
to commence, a completed Basic & Enhanced Employee Application must be submitted by the Plan Sponsor to
Wawanesa Life.
An employee can complete the Basic & Enhanced Employee Application during the waiting period but coverage
will not be effective until the waiting period has been satisfied. If the employee completes the application after
becoming eligible for coverage and does so within 31 days of that date, insurance will become effective on the day
the employee first became eligible.
Applications are time sensitive and if they are not received by Wawanesa Life within 21 days of signature, coverage
may be denied.
14? FAQ: Renewals & Rate Tables
Basic & Enhanced benefit plans What is the difference between a Plan
are sold with an initial Rate Table Anniversary Date and a Renewal Date?
Guarantee. What does this mean?
The Plan Anniversary Date is the annual
A rate table provides the monthly premium charges anniversary of the Effective Date of the Plan.
for Basic & Enhanced plans which is calculated by
The Renewal Date is the date on which Wawanesa
the Proposal Tool. These rates do not include any
Life will review the Basic & Enhanced benefit
provincial taxes, if applicable. On the effective date
plan in effect and the applicable rate table. A
of the plan, the initial Rate Table is established.
change (if necessary) to the Rate Table will be
communicated.
The established rate table will apply to:
changes from the Basic plan to the Enhanced plan,
changes to Single or Family coverage, selection for
the existing Plan Member, the addition of any new
employee, any rate changes due to Plan Member
aging and moving to a new age band, and
increases to “With Evidence” Long Term Disability
coverage.
Once a benefit plan is effective, changes between
the Basic plan and the Enhanced plan do not reset
the initial Rate Table guarantee period.
Once a plan is in effect, a new rate table may
apply at first renewal which will be the month
immediately following the expiration of the
guarantee period.
15? FAQ: Electronic Administration & Claims
Group Benefits Online is Wawanesa Life’s Group Electronic Administration and Plan Member
Online Claim system.
Plan Sponsors can enroll for Plan Sponsor Online Administration .
Plan Members can enroll for Plan Member Online Claims.
To access or register:
1. Go to www.wawanesalife.com.
2. Click on the Group Benefits Online tab.
3. A separate registration is required to gain access to each site.
Using Plan Sponsor Online Administration, the Plan Sponsors/Plan Administrators can:
• Enroll/change/terminate plan member coverage
• Add, update or terminate plan member or dependent information
• View monthly billings
Using Plan Member Online Claims the Plan Member can:
• Submit Health, Vision and Dental claims
• View the Plan Member booklet
• View personal claim information, including a breakdown of how claims have been processed
• Print personalized claim forms and ID card replacements
• Sign up for direct deposit for claim payments
• View what portion of a claim may be covered by submitting a “mock claim”
• Obtain specific drug information, using the tool “Is My Drug Covered”
• Find a dental, paramedical or vision care provider in a specific area
Using the Wawanesa Life’s Group Benefits Mobile App the Plan Member can:
• Submit health, dental, drug, and paramedical claims
• Find healthcare providers
• Access claims information and view processed claim details
• Store Wawanesa Life ID cards in their digital wallet
• Search for prescription drugs that may be covered by plans and determine coverage amounts
• View Health Care Spending Account balances
16? FAQ: Plan Member Support
Basic & Enhanced Plans
Simple coverage for all employers (Plan Sponsors), employees (Plan Members) and dependents.
What kind of documents will be How do Plan Members submit claims
issued providing information for reimbursement?
regarding the Basic & Enhanced The type of claim will determine the claim
benefit plan details? submission process:
Wawanesa Life will issue the following Drug claims will be submitted by use of the Pay
documents: Direct Drug card. This electronic process links
the pharmacy with the benefit plan for online
• Informative and easy to understand adjudication and processing.
Plan contract.
• Informative and easy to understand All claims can be submitted to:
Plan Member booklets. Wawanesa Life
• Certificate / Pay Direct Drug Card for Other Claims
each Plan Member. P.O. BOX 1606
• The reverse side of the drug card Windsor, ON N9A 6W1
contains key plan contact information.
All other claim forms are available on our website
at: www.wawanesalife.com.
Choose the Group Insurance Tab and then select
Who does the Plan Sponsor or Forms from the drop down menu.
Plan Member contact if they have Select and print the desired claim form.
questions about their benefit plan?
Wawanesa Life is pleased to provide fast,
friendly and helpful Customer Service. Our
Group Customer Service Department can be
reached at:
Telephone (204) 985-3806
Toll Free (800) 665-7076
17? FAQ: Plan Advisor Compensation
Wawanesa Life’s Basic & Enhanced plans pay competitive compensation to the Plan Advisor.
The commission rate payable will be reflected in the Plan Advisor agreement and will be calculated and paid on a
monthly, AS EARNED basis for the life of the plan. All commission is released on a direct deposit basis to the Plan
Advisor’s bank account. No commissions will be paid until the Plan Advisor has submitted all paperwork required
and the commission agreement has been approved.
Requirements:
• A signed Plan Advisor Agreement. All Basic & Enhanced plan sales will be added to this agreement as they
occur.
• A copy of your Life/Accident & Sickness Licence for the applicable province.
• A copy of your Errors & Omission Insurance.
• A Master Application form with original signatures.
• A cheque payable to Wawanesa Life representing the first month’s premium.
• All signed Employee Application forms. One for each eligible employee under the plan.
• A completed original Basic & Enhanced Proposal.
Executive Office
400 - 200 Main Street, Winnipeg, MB R3C 1A8
Toll-Free: 1-844-905-2192
Email: groupsales@wawanesa.com
wawanesalife.com
18Executive Office
400 - 200 Main Street, Winnipeg, MB R3C 1A8
Toll-Free: 1-844-905-2192
Email: groupsales@wawanesa.com ®
wawanesalife.com
B&E GUIDE 02/2021
®
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