(UWOPA) Police Association - that are Members of the for Regular Full-Time employees
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for Regular Full-Time employees
that are Members of the
Police Association
(UWOPA)INTRODUCTION
This booklet summarizes the key features of the Group Benefit Plans available to Regular Full-Time
employees that are Members of the Police Association (UWOPA). Your benefits represent an important
component of your overall compensation at the Western University. These benefits have
INTRODUCTION
been strategically developed to provide protection against health and dental costs, protect your income if
an illness or injury prevents you from working, and provide survivors with financial protection in the event
of death.
While every effort has been made to ensure the accuracy of this outline, this booklet does not contain all
of the plan provisions. Your benefits and rights are governed by the terms of the Group Master Contract
providing the group benefit coverage and the Collective Agreement between Western University and the
Police Association.
Human Resources - Benefits administers the Group Benefit Plans. Requests for information about
coverage or relevant plan provisions of the governing document may be obtained by contacting a
Human Resources - Benefits Representative.TABLE OF CONTENTS
TABLE OF CONTENTS
Contact Us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i
Benefits at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii
Claim Forms . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Extended Health Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Life Insurance Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Voluntary Personal Accident Insurance Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Disability Income Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Other Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Cost of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25CONTACT US
Western University
Human Resources
Room 5100, Support Services Building
London, Ontario
N6A 3K7
CONTACT US
Inquiries: hrhelp@uwo.ca
Hours of Operation: 8:30 a.m. to 4:30 p.m.
Telephone: (519) 661-2194
Fax: (519) 661-4104
Website: http://www.uwo.ca/hr
Please refer to our website for a list of
Human Resources-Benefits representatives and email addresses.
iBENEFITS AT A GLANCE
The following summary is intended to give a brief overview of the Group Benefit Plans available to Regular
Full-Time employees that are Members of the Police Association (UWOPA).
EXTENDED HEALTH PLAN
• compulsory; however, if you are covered for similar benefits under your spouse’s plan you may
exempt yourself
BENEFITS AT A GLANCE
• coverage for you and your eligible dependents
• 85/15 Co-insurance Arrangement
• Health Spending Account
FOR UWOPA
• prescribed drugs legally requiring a prescription
• those drugs not legally requiring a prescription which are in an injectable format or life sustaining
• generic substitutions unless specifically prescribed by the attending physician or dentist
• semi-private/private hospital room
• medically necessary services and supplies
• services of a licensed chiropractor: $15 a vist after the 15th visit per calendar year
• services of a licensed chiropractor, podiatrist, physiotherapist, naturopath, masseur and speech
therapist
• a visioncare benefit: $300 per person every twenty-four (24) months
• out-of-country emergency medical and travel assistance; limited to $200,000 per person per 90 day
trip
DENTAL PLAN
• compulsory; however, if you are covered for similar benefits under your spouse’s plan you may
exempt yourself
• coverage for you and your eligible dependents
• 85/15 Co-insurance Arrangement
• based on current year’s Dental Society Fee Guide for General Practitioners and/or Specialists
• basic expenses - 85% reimbursement:
Preventive services: routine dental examination and cleaning once every nine consecutive
months, root canal therapy, bitewing X-rays, fluoride treatment, restorations, etc.
• major expenses - 80% reimbursement:
Restorative services: inlays and crowns, dentures, periodontal surgery, fixed bridgework, etc.
• initial orthodontic consultation fee
LIFE INSURANCE PLANS
BASIC LIFE
• compulsory
• life insurance on your life
• 2 times your normal basic annual salary (minimum $50,000)
OPTIONAL LIFE
• optional
• additional life insurance on your life
• coverage levels vary between 1/2 times to 2 times your normal basic annual salary
DEPENDENT LIFE
• optional
• life insurance on your eligible dependents
• $40,000 coverage on your eligible spouse and $10,000 coverage on your eligible dependent children
iiVOLUNTARY PERSONAL ACCIDENT
INSURANCE PLAN
• optional
• coverage for you and your eligible dependents
• 24 hour protection against accidents worldwide
BENEFITS AT A GLANCE
• level of coverage between $20,000 and $250,000 (in multiples of $10,000)
FOR UWOPA
DISABILITY INCOME PROGRAM
• compulsory
• protection against loss of income due to injury or illness
• Sick Leave-Salary Continuance Plan - 100% of your normal basic monthly salary, continued up to a
maximum of 15 consecutive weeks
• Long Term Disability Insurance Plan - 70% of your normal basic monthly salary in effect immediately
prior to the commencement of your Sick Leave
ADMINISTRATIVE STAFF PENSION PLAN
• optional
• your monthly contribution is 2.5% of your normal basic monthly salary
• Western University monthly contribution:
Service University’s Contribution
(as a % of basic monthly salary)
Under 10 years 7.5%
10-19 years 8.0%
20 or more years 8.5%
• a wide range of investment options are available
• vesting is immediate upon enrollment
• monthly option to change investment direction
• option available to make additional pension contributions and transfer funds in from an RRSP
For a complete description of your Group Benefit plans, refer to your applicable booklet or access the
information on our website at http://www.uwo.ca/hr.
iii April 2012CLAIM FORMS
Need a claim form? Click here
You can also log into the Manulife website, any time to obtain a claim form. You will see the forms that are
the right ones for you. The forms will be pre-filled with the new Plan Contract Number and Plan Sponsor
Name every time you need a form.
After completion of the claim form(s), simply maintain a copy for your records and forward your claim with
the original receipts directly to Manulife Financial at the following address:
Manulife Financial Group Benefits
Health Claims
PO Box 1653
Waterloo ON N2J 4W1
1EXTENDED HEALTH PLAN
he University’s Extended Health benefit is DEFINITION OF DEPENDENTS
T issued as a supplement to the Ontario Health
Insurance Plan (O.H.I.P.) or equivalent which
You may also cover your spouse and dependents,
as defined below:
includes the University Health Insurance Plan
(U.H.I.P.). It provides payments towards usual and Spouse/Partner: A spouse is defined as a person
customary charges for medically necessary health who is legally married to the employee or, although
services and supplies (incurred by you and your not legally married, has continuously cohabited in a
EXTENDED HEALTH PLAN
covered dependents) for which government common-law like relationship of the same or
legislation does not prohibit reimbursement. opposite sex with the employee for not less than
one full year.
CO-INSURANCE ARRANGEMENT Dependent Children: A dependent child is
Your Extended Health and Dental plans are subject defined as unmarried (including legally adopted
to an 85/15 co-insurance arrangement. You are children, foster or step-children), not engaged in
required to pay 15% of claims for eligible expenses full-time employment, dependent on you for
submitted under these plans. The maximum you financial support under the age of 21 unless the
would pay in a calendar year is $450 for Single child is registered as a full-time student in which
coverage and $900 for Family coverage. Once the case the child must be under the age of 25 or if
maximum is reached in any given calendar year, incapable of self support due to mental or physical
you will no longer be required to pay 15% towards infirmity which began while the child was covered
eligible claim expenses for the as the Employee’s dependent will continue to be
remainder of that calendar year. This co-insurance eligible.
arrangement does not apply to the following:
HEALTH SPENDING ACCOUNT
• the $6.11 dispensing fee cap For the purpose of payment of health related
• any internal maximums already defined within expenses as defined by the Income Tax Act,
the plans including out-of-pocket costs arising from the 85/15
(i.e. Visioncare - $300 Orthotics - $400) co-insurance arrangement and expenses incurred
above the dollar maximums for particular benefits.
PARTICIPATION IN THE PLAN
If you are a Regular Full-Time employee that is a All members of the Police Association (UWOPA)
Member of the Police Association (UWOPA), you will have a health spending account with a base
are eligible to participate in the Extended Health amount of $200. This base amount may be
benefit. supplemented with an allocation (up to $300)
from a member’s Flex Credits. Flex Credits will
Participation is compulsory; however, if you are increase to $500 in 2013 and $600 in 2014.
covered for similar benefits under your spouse’s
group plan, you may exempt yourself from our plan. CHANGE IN STATUS
Coverage for an employee who acquires a spouse
Coverage is effective on the first day of your or dependent(s) after becoming covered may be
Regular Full-Time appointment. changed upon notification to provide coverage for
the spouse or dependent(s) effective as of the date
COST OF THE PLAN of eligibility or the date of application, whichever is
For a breakdown of the cost, refer to our web site later. However, evidence of insurability is required if
or contact a Human Resources - Benefits the change is not received within 31 days of the
Representative. change.
ENROLLMENT PROCEDURE
Enrollment is initiated by the completion of an
application form available in Human
Resources - Benefits.
2EXPENSES FOR WHICH PAYMENTS ARE Licensed Psychologist
MADE INCLUDE THE FOLLOWING:
• group therapy (limited to $6 per hour per
Services and Supplies of a Licensed Hospital person)
For services and supplies of a licensed hospital • family therapy (limited to $18 per half hour)
such as: • individual therapy and testing (limited to $15
per half hour)
EXTENDED HEALTH PLAN
Hospital Accommodation - the difference • all other visits (limited to $15 per visit)
between ward and semi-private or private
accommodation: Licensed Osteopath, Naturopath,
Chiropodist/Podiatrist, Acupuncturist, Speech
In Canada - no limit Therapist, Physiotherapist, and Massage
Out of Canada (for Canadian residents Therapist
only)
• up to $15 a visit
• if an emergency while travelling or on • includes X-rays by a chiropractor (limited to
vacation, or while on leave of absence from $35 a person per calendar year)
employer - no limit • surgery performed by a licensed
• if a non-emergency or elective - limited to podiatrist (limited to $200 a calendar year
$200 a day per person)
• if a referral (approved by O.H.I.P. or
equivalent) - no limit Licensed Chiropractor
• up to $15 a visit after the 15th visit per
Services of Physicians & Surgeons calendar year
For services of physicians & surgeons such as: • includes X-rays by a chiropractor (limited to
$35 a person per calendar year)
Out of Province for Canadian residents, over the
amount allowed under O.H.I.P. or equivalent: Note: Any difference between the benefits paid by
O.H.I.P. or equivalent for services rendered and
• if an emergency while travelling or on the fees charged by the above practitioners is not
vacation, or while on leave of absence from eligible.
employer - unlimited less the amount
covered by O.H.I.P. or equivalent
• if a non-emergency - unlimited less the Optometrist/Ophthalmologist
amount covered by O.H.I.P. or equivalent • eye examinations not covered under O.H.I.P.
• if elective - up to the amount in the Medical or equivalent (limited to $25 per visit)
Fee Schedule of the province where you • for visual training and remedial eye
reside exercises (limited to $10 per half hour)
• if a referral (approved by O.H.I.P. or • contact lenses or eyeglasses due to a
equivalent) - unlimited less the amount medical condition such as after cataract
covered by O.H.I.P. or equivalent surgery (limited to $100 per eye per lifetime)
Note: All expenses are paid in Canadian funds.
Note: For information on additional benefits for
Other Services visioncare see Visioncare Benefit section on
page 5.
Diagnostic and X-Ray Services - eligible charges
for diagnostic and x-ray services when carried out
by a hospital or private laboratory such as: Dentist
• laboratory services • for accidental injury to natural teeth from an
• x-ray examination external blow (excluding biting accident)
within twelve (12) months of the accident
3Ambulance to $350 per calendar year)
• if condition requires it, to the nearest hospital • respirators
where treatment facilities are available • dialysis equipment
• equipment for the administration of oxygen
Private Duty Nursing • obus formes (limited to $100 per five (5)
Services of private duty nursing in your home by a calendar years)
Registered Nurse (RN) and/or a Registered • crutches, canes, walkers
EXTENDED HEALTH PLAN
Practical Nurse (RPN). • transcutaneous nerve stimulator referred to
as a TENS machine (limited to payment at
Pre-approval is required. 50%)
• essential ostomy supplies
Further information can be found under the Private • custom-made orthopaedic shoes (limited to
Duty Nursing Claim Predetermination Submission one (1) pair per calendar year minus a $75
Guidelines. deductible) or modifications to street
shoes such as insoles or molded arch
Prosthetic Appliances & Supplies
supports (limited to one (1) pair per calendar
Prosthetic appliances and supplies such as: year)
• artificial limbs • custom-made orthotics (limited to $400 for
• splints one (1) pair per calendar year)
• braces • hearing aid and repairs
• cervical collars
• surgical brassieres (limited to six (6) per Note: Many of the above prosthetic devices and
calendar year) medical supplies may require a written
• stump socks (limited to six (6) per calendar recommendation of a physician. As well, if due to
year) an extended illness or disability it is felt the need for
• tracheotomy supplies any of the above-mentioned items will be long term,
• surgical elastic stocking (limited to two (2) a purchase may be approved rather than a rental.
pairs per calendar year)
• wigs for permanent or temporary hair loss CO-ORDINATION OF BENEFITS
(limited to $700 lifetime maximum) If you or your dependent(s) are entitled to benefits
under this plan and any other plan for the same
Note: Replacement will not be a benefit unless the expense, the amount payable under this plan will
replacement is required due to normal wear and be reduced to ensure that the total amount payable
tear or pathological change. under all plans does not exceed the actual expense
incurred.
Medical Supplies and Assistive Devices
Medical supplies and assistive devices such as: DRUGS AND MEDICINES
• surgical bandages/dressings Prescription Drugs
• burn pressure garments In the treatment of an injury or illness, the following
• rental of a hospital bed drugs will be considered eligible expenses if
• rental of a wheelchair dispensed by a licensed physician or dentist, or by
• equipment for the treatment of cystic fibrosis a licensed pharmacist on the written prescription of
• equipment for the treatment and control of a licensed physician or dentist:
diabetes such as: glucometer (limited to $200
per claim) or Preci-Jet insulin injector (limited • drugs legally requiring a prescription, in
accordance with the Food and Drug Act,
Canada or similar provincial legislation
4• eligible fertility drugs (limited to a lifetime (HCP) Pharmacy Component brochure available in
maximum of $12,000) Human Resources - Benefits or access information
• contraceptive devices (limited to $50 per on our web site: www.uwo.ca/humanresources.
calendar year per person)
• eligible smoking cessation products (limited EXAMPLES OF EXPENSES NOT COVERED
to a lifetime maximum of $500) Listed below are a few examples of expenses not
• drugs not legally requiring a prescription, but eligible for coverage:
EXTENDED HEALTH PLAN
which are in an injectable format, or are life
sustaining and identified under the following • duplicate payments from the Provincial
headings in the Therapeutic Guide section of Health Insurance or any Worker’s
the then current Compendium of Compensation Coverage - this limitation
Pharmaceutical and Specialities: does not apply to the differences between
ward and semi-private or private
anti-anginal agents accommodations in a licensed hospital
anticholinergic preparations • food and dietary supplements
antiparkinsonism agents • cosmetic or hygienic products
anti-arrhythmic agents • experimental drugs
bronchodilators • any hospitalization or service rendered
glaucoma therapy concerning general health examinations for
antihyperlipidemic agents “check-up” purposes
insulin preparations • travel for health, dental services, or cosmetic
hyperthyroidism therapy surgery
oral fibrinolytic agents • expenses resulting from an act of war or
parasympathomimetic agents hostilities of any kind
potassium replacement therapy • any health services provided without cost to
tuberculosis therapy you or your dependent(s) or expenses for
topical enzymatic debriding agents which coverage is provided under any other
anti-inflammatories insurance plan or policy to the extent of such
anti-histamines coverage
• drugs not considered by the Canadian
Generic Substitutions Medical Association, or by the Medical
Where the drug dispensed is interchangeable with Association of the province of residence of
any other drug, the charges will not exceed the the employee, to be therapeutically useful
cost of the lowest priced interchangeable drug,
unless specifically prescribed by the attending VISIONCARE BENEFIT
physician or dentist. The Extended Health plan provides a Visioncare
benefit for reasonable and customary charges for
Dispensing Fee necessary expenses for eyeglass lenses or
You may visit any pharmacy to have your contact lenses prescribed by a physician or
prescription filled, however, the maximum allowed surgeon legally licensed to practice medicine or an
for reimbursement is $6.11. optometrist for the correction of impaired vision,
and frames for such lenses recommended by a
A partnership has been set up with various physician or optometrist. Laser Eye Surgery may
pharmacies referred to as the Southwestern also be claimed as an expense under the
Ontario Health Care Partnership (HCP). HCP Visioncare benefit.
pharmacies charge less for dispensing/
professional fees while providing competitive drug VISIONCARE BENEFIT:
ingredient prices and professional advice. For
further details on participating pharmacies such as: $300 per person every twenty-four (24)
address, telephone number, hours of operation, months.
delivery services available and agreed dispensing
fee, please refer to the Health Care Partnership
5General Limitations for the Visioncare benefit Note: If hospitalization occurs due to accident or a
Visioncare benefits are designed to reimburse you sudden unexpected illness, the Assistance Centre
only for your out-of-pocket expenses. No must be contacted within 24 hours of the
reimbursement will be made for the following admission. Your coverage will be validated and
expenses: payment to the health care provider guaranteed.
• safety glasses (paid through Occupational As well, Deluxe Travel pays for the reasonable
Health & Safety) and customary charges for the following
VISIONCARE BENEFIT
• non-corrective glasses or sunglasses, eligible expenses:
whether prescribed or not
• glasses or contact lenses for cosmetic or Repatriation
decorative purposes Extra costs of return economy fare by the most
direct route (air, bus, train) when an illness is such
DELUXE TRAVEL that the covered person must return home and be
Deluxe Travel provides various benefits as a result accompanied by a qualified medical attendant (not
of an accident or a sudden unexpected illness a relative). Written authorization is required from
incurred outside the employee’s province of the attending physician. On a commercial aircraft
residence in Canada or outside Canada while this this coverage includes:
plan is in effect. Coverage is only for the first 90 • two economy seats by most direct route to
days of being out of the country and has a limit of the covered person’s home city in Canada
$200,000 per person per trip. These benefits include: (one for the covered person and one round
trip fare for a medical attendant)
Medical Assistance Services • the number of economy seats required to
• provides emergency response in any major accommodate the covered person if on a
language stretcher and one round trip for a medical
• referrals to an appropriate physician, clinic or attendant, and the attendant’s overnight hotel
hospital and meal expenses if required
• confirms you have coverage • economy seats to return any covered
• guarantees or arranges payment to the person of the immediate family who is
hospital or physician for eligible expenses travelling with the patient
• provides assistance in contacting your family,
place of business or family physician Vehicle Return
• supervises the medical treatment and keeps An allowance of up to $1,000 Canadian will be
the family informed reimbursed for the cost of driving the patient’s
• arranges for transportation of a family vehicle, either private or rental, to the patient’s
member to the patient’s bedside residence or nearest appropriate vehicle rental
• arranges for transportation home of the agency when the patient or any travelling
patient companion is unable to return it due to sickness or
accident.
Non-Medical Assistance Services
• arranges for local care of dependent RETURN OF DECEASED
child(ren) and coordinates the safe return Up to $5,000 Canadian towards the cost or
home if the person is hospitalized preparation (including cremation) and homeward
• arranges the transmission of urgent transportation of a deceased covered person
messages to family members (excluding the cost of a coffin) to the point of
• provides assistance in the event of loss of departure in Canada by the most direct route.
passport(s) or airline ticket(s) Up to $2,000 Canadian towards these same costs if
• provides legal counsel referral in the event of the deceased is not returned to Canada.
a serious accident
• coordinates claims processing and Meals & Accommodation Allowance
negotiation of health care provider discounts Up to $1,500 Canadian ($150 per day) per calendar
• provides pre-departure information year for extra costs of commercial accommodation
concerning Visa’s and Vaccines
6and meals incurred by the employee or by a BENEFITS AFTER TERMINATION OF
covered dependent when the trip is delayed due to COVERAGE
illness or accident to a covered person. This must If you are totally disabled at the time your
be verified by the attending physician and coverage terminates and disability continues, this
supported with receipts from commercial benefit may be continued for a period up to ninety
organizations. (90) days.
EXTENDED HEALTH PLAN
Transportation to Visit the Covered Person If any of your dependents are confined in a
One return economy fare by the most direct route licensed hospital when this coverage terminates,
for transportation costs (air, bus, train) when the the benefit for that dependent may be continued,
covered person is confined to hospital for at least during the period of hospital confinement, for a
seven days or has died and the attending eriod up to ninety (90) days.
physician advised the necessary attendance of a
family member or close friend of the covered If following termination you are interested in
person. purchasing alternate coverage, our current
insurance carrier offers a Group Conversion
BENEFITS WHILE ON LEAVE OF ABSENCE OR Program for employees who have recently left a
TRAVELLING Group Benefit Plan. The benefits available
If you are going on a leave of absence, you may include: Extended Health benefits, prescription
arrange to continue your coverage by contacting drugs, semi-private hospital and dental benefits.
Human Resources - Benefits to cover the cost of
your benefits prior to leaving. Did you know...
When travelling outside of the country, you and
your dependent(s) will continue to be covered. If you are planning on leaving Canada for a period
exceeding six months, the Ministry of Health in your province
Reimbursement for any eligible claims will be of residence must be notified to request approval for
made in Canadian funds. continued Provincial Health Insurance. You must complete a
Change of Information form for you and/or your dependents.
To obtain this form or to request further information, contact
TERMINATION OF COVERAGE
the Ministry of Health branch below:
Coverage will terminate on the earlier of one of the
following: Ministry of Health
217 York Street, 5th Floor
(1) the end of the month in which you P.O. Box 5700, Station A
terminate your employment London, Ontario N6A 5P9
(519) 675-6800
(2) the date on which you are no longer Forms are also available on the OHIP website at
http://www.health.gov.on.ca/en/public/forms/ohip_fm.aspx
eligible to participate in the plan
It is your responsibility to maintain your Provincial
(3) the date the plan is cancelled for any Health Insurance.
reason
DEPENDENT TERMINATION OF COVERAGE
A dependent’s coverage ceases on the earlier of:
the date the person is no longer an eligible
dependent under Definition of Dependents, and/or
the date your coverage terminates.
If you should die prior to termination, benefits for
your covered dependent(s) will be continued for an
additional thirty-six (36) months at no additional
cost to the surviving dependent(s).
7DENTAL PLAN
he University’s Dental benefit provides although not legally married, has continuously
T payment towards usual and customary
charges for necessary dental services (incurred by
cohabited in a common-law like relationship of the
same or opposite sex with the employee for not
you and your covered dependents) up to the less than one full year.
current Fee Guide.
CO-INSURANCE ARRANGEMENT Dependent Children: A dependent child is
Your Extended Health and Dental plans are defined as unmarried (including legally adopted
subject to an 85/15 co-insurance arrangement. children, foster or step-children), not engaged in
You are required to pay 15% of claims for eligible full-time employment, dependent on you for
DENTAL PLAN
expenses submitted under these plans. The financial support under the age of 21 unless the
maximum you would pay in a calendar year is child is registered as a full-time student in which
$450 for Single coverage and $900 for Family case the child must be under the age of
coverage. Once the maximum is reached in any 25 or if incapable of self support due to mental or
given calendar year, you will no longer be required physical infirmity which began while the child was
to pay 15% towards eligible claim expenses for covered as the Employee’s dependent will
the remainder of that calendar year. This co- continue to be eligible.
insurance arrangement does not apply to the
following:
CHANGE IN STATUS
• the major restorative benefits under the Coverage for an employee who acquires a spouse
Dental plan or dependent(s) after becoming covered may be
(already subject to an 80/20 co-insurance) changed upon notification to provide coverage for
the spouse or dependent(s) effective as of the
PARTICIPATION IN THE PLAN date of eligibility, or the date of application,
If you are a Regular Full-Time employee that is a whichever is later. However, evidence of
Member of the Police Association (UWOPA), you insurability is required if the change is not received
are eligible to participate in the Dental benefit. within 31 days of the change.
Participation is compulsory; however, if you are
covered for similar benefits under your spouse’s FEE SCHEDULE
group plan, you may exempt yourself from our All eligible expenses are based on the current
plan. Dental Society Fee Guide for General
Practitioners and/or Specialists in the provider’s
Coverage is effective on the first day of your province of residence. Claims for specialists will
Regular Full-Time appointment. be payable up to 120% of the General
Practitioners Fee Guide amount with the exception
COST OF THE PLAN of Denturists which will be payable based on the
For a breakdown of the cost, refer to our web site current Denturists Fee Guide in the provider’s
or contact a Human Resources - Benefits province of residence. Claims incurred outside
Representative. Canada will be reimbursed at the current Dental
Society Fee Guide for General Practitioners and/or
ENROLLMENT PROCEDURE Specialists in the employee’s province of
Enrollment is initiated by the completion of an residence.
application form available in Human
Resources - Benefits.
BASIC DENTAL EXPENSES
DEFINITION OF DEPENDENTS You may recover the usual and customary
You may also cover your spouse and dependents, charges for Basic Dental expenses such as:
as defined below:
Spouse/Partner: A spouse is defined as a
person who is legally married to the employee or,
8PREVENTIVE DENTAL SERVICES
Diagnostics Restorative Services (Basic)
Clinical Oral Examination: • amalgam (metal) and tooth coloured (plastic)
restorations
• complete oral examination of a new patient • tooth coloured veneer applications
(limited to once every three (3) calendar • porcelain staining (chairside)
years) • prefabricated steel crowns (primary teeth)
• recall oral examination (limited to once every
nine (9) consecutive months)
DENTAL PLAN
• emergency oral examination Endodontics Services
• specific oral examination • treatment of pulp chamber - pulpotomy and
pulpectomy
Radiographs • root canal therapy - root canals and
• periapical apexification
• sialography • periapical services - root amputation,
• postero-anterior and lateral skull and facial retrofilling, exploratory endodontics surgery,
bone canal and/or pulp chamber enlargement,
• use of radiopaque dyes surgical and non-surgical root repair or pulp
• cephalometric films chamber repair
• cephalometric tracing
• tomography Periodontic Services (Basic)
• full mouth series, including bitewings (limited • non-surgical services - application of
to once every five (5) years) displacement dressings, management of oral
• panoramic (limited to once every five (5) infections, desensitization
calendar years) • adjunctive periodontal services - occlusal
• occlusal adjustment, root planning, topical application
• bitewing (limited to once every nine (9) of antimicrobial agent
consecutive months)
• extraoral Oral Surgery (Basic)
• tests and laboratory examinations • extractions of erupted teeth, impacted teeth,
• microbiological tests residual roots, surgical exposure of teeth,
• pulp vitality tests surgical movement of teeth
• lab reports • oral surgical procedures including the
• emergency services removal of teeth, but excluding periodontal
surgery
• surgical excisions and incisions
Preventive Services • other oral surgery services such as: post
• polishing (limited to once every nine (9) surgical care, repairs, lacerations, fractures,
consecutive months) replantation of avulsed teeth, repositioning of
• fluoride treatment (limited to once every nine traumatically displaced teeth
(9) consecutive months)
• scaling Adjunctive General Services
• preventive recall packages (limited to once • local anaesthesia (not in conjunction with
every nine (9) consecutive months) operative or surgical procedures)
• pit and fissure sealants • general anaesthesia
• space maintainer appliances - including • provisions of dental and anaesthetic
maintenance and repair facilities, equipment and supplies
• interproximal disking of teeth • conscious sedation - inhalation technique,
• recontouring of teeth for functional reasons intravenous sedation, intramuscular injections
(not associated with delivery of prosthesis) of sedative drugs
9MAJOR DENTAL EXPENSES CO-ORDINATION OF BENEFITS
You may recover up to 80% of the reasonable If you or your dependent(s) are entitled to benefits
customary charges for Major Dental expenses such under this plan and any other plan for the same
as: expense, the amount payable under this plan will
be reduced to ensure that the total amount payable
RESTORATIVE SERVICES under all plans does not exceed the actual expense
incurred.
Restorative Services (Major)
• inlay and onlay restorations (limited to once EXAMPLES OF EXPENSES NOT COVERED
per tooth per five (5) consecutive years) - Listed below are a few examples of expenses not
DENTAL PLAN
metal, composite and porcelain/ceramic eligible for coverage:
• retentive pins and posts
• indirect overdenture restorative services • services other than those provided by a
• crowns (limited to once per tooth per five (5) dentist, except those services which may be
consecutive years) performed by legally qualified auxiliary
• recontouring of existing crowns personnel under the supervision of a dentist,
• removal of inlays, onlays and crowns or those services which may be performed
by periodontal practitioner under the terms of
Prosthodontics Services the practitioner’s license
• complete dentures (limited to one (1) • cosmetic services
complete upper and one (1) complete lower • dentures and bridgework (including crowns
denture in five (5) calendar years) and inlays forming the abutments) to replace
• partial dentures (limited to one (1) partial any teeth removed before the covered person
upper and one (1) partial lower denture in five became insured under this benefit
(5) calendar years) • dentures which have been lost, stolen or
• transitional dentures (limited to one (1) mislaid
complete upper and one (1) complete lower • prosthetic devices which were ordered before
denture in five (5) calendar years) the covered person was insured under this
• denture adjustments, repairs and additions benefit
• denture reline and rebase • replacement of an existing partial or full
• denture remake denture or fixed bridgework unless
• fixed bridge (i) the existing denture or bridgework is at
• fixed bridge repairs least five (5) years old, OR
(ii) the replacement is required to replace
Oral Surgery (Major) an immediate temporary denture which
• remodelling and recontouring oral tissues was installed while the covered person
was insured under this benefit
Periodontic Services (Major) • the addition of teeth to an existing partial
• periodontic surgical services denture or fixed bridgework unless the
• adjunctive periodontic services addition is required to replace one or more
• periodontal appliances - maintenance, teeth removed while the covered person is
adjustments, repairs and relines (limited to insured under this benefit
any one (1) maxillary (upper) and any one (1) • orthodontic services other than initial
mandibular (lower) appliance in two (2) consultation
calendar years)
PREDETERMINATION OF DENTAL CLAIMS
If your dentist has recommended dental treatment
Miscellaneous Services that is expected to cost more than $500, you
• diagnostic casts should have your dentist prepare a pre-treatment
• initial orthodontic consultation plan. This will allow you to determine your own
financial obligation prior to the commencement of
treatment.
10GENERAL LIMITATIONS DEPENDENT TERMINATION OF COVERAGE
Dental benefits are designed to reimburse you only A dependent’s coverage ceases on the earlier of:
for your out-of-pocket expenses. Listed below are the date the person is no longer an eligible
a few examples of expenses not eligible for dependent under Definition of Dependents, and/or
coverage: the date your coverage terminates.
• services payable under any Workers If you should die prior to termination, benefits for
Compensation Act or any other statute your covered dependent(s) will be continued for an
• self-inflicted injuries additional thirty-six (36) months at no additional
• services required as a result of war or cost to the surviving dependent(s).
hostilities of any kind
DENTAL PLAN
• services required as a result of your BENEFITS AFTER TERMINATION OF
participation in a criminal offence COVERAGE
• services performed by a person who is If you are totally disabled at the time your
ordinarily a resident in the covered person’s coverage terminates and disability continues, this
home benefit may be continued for a period up to ninety
• services for which reimbursement is payable (90) days.
due to the legal liability of any other party, to
the extent of such reimbursement If following termination you are interested in
purchasing alternate coverage, our current
insurance carrier offers a Group Conversion
Program for employees who have recently left a
BENEFITS WHILE ON LEAVE OF ABSENCE OR Group Benefit Plan. The benefits available
TRAVELLING include: Extended Health benefits, prescription
If you are going on a leave of absence, you may drugs, semi-private hospital and Dental benefits.
arrange to continue your coverage by contacting
Human Resources - Benefits to cover the cost of
your benefits prior to leaving.
When travelling outside of the country, you and
your dependent(s) will continue to be covered.
Reimbursement for any eligible claims will be
made in Canadian funds.
TERMINATION OF COVERAGE
Coverage will terminate on the earlier of one of the
following:
(1) the end of the month in which you
terminate your employment
(2) the date on which you are no longer
eligible to participate in the plan
(3) the date the plan is cancelled for any
reason
11LIFE INSURANCE PLANS
he University’s Life Insurance plans provide life site or contact a Human Resources - Benefits
T insurance on your life and on your dependent’s
life payable to your beneficiary in the event of
Representative
death. The plans available are: OPTIONAL LIFE
• Basic Life PARTICIPATION IN THE PLAN
LIFE INSURANCE PLANS
• participation is optional
• Optional Life • you are eligible to participate on the first day
• Dependent Life of your Regular Full-Time appointment,
however, if you do not make an application
If you are a Regular Full-Time employee that is a within 31 days of first becoming eligible,
Member of the Police Association (UWOPA), you evidence of health is required and is subject
are eligible to participate in the following Life to approval by the insurance carrier
Insurance plans:
COVERAGE AMOUNT
BASIC LIFE The Optional Life Insurance plan provides you with
the opportunity to purchase additional life insurance
PARTICIPATION IN THE PLAN coverage on your life at a level of one half times,
• participation is compulsory one times, one and a half times or two times your
• coverage is effective on the first day of your annual basic salary rounded to the next higher
Regular Full-Time appointment $1,000.
COVERAGE AMOUNT COST OF THE PLAN
The Basic Life Insurance plan provides coverage You pay the full cost of the coverage which is
on your life based on two times your annual basic dependent on your age and whether you are a
salary rounded to the next higher $1,000 with smoker or non-smoker. For a breakdown of the
minimum coverage of $50,000. cost, refer to our web site or contact a Human
Resources - Benefits Representative.
COST OF THE PLAN
DEPENDENT LIFE
• the University pays the full cost of the first
$25,000 of coverage
PARTICIPATION IN THE PLAN
As the University provides a Sick Leave • participation is optional
Benefit that qualifies for a reduction in • if you have eligible dependent(s), you may
Employment Insurance Premiums, a portion participate in the plan on the first day of your
of the reduction (5/12) is used to pay the full Regular Full-Time appointment, however, if
cost of an additional amount of the Basic you do not make an application within 31
Life Insurance plan. Currently this reduction days of first becoming eligible, evidence of
amount provides sufficient funding for an health is required on your dependent(s) and
additional $25,000 of coverage. (For the is subject to approval by the insurance carrier
most up-to-date additional amount of Basic
• if you do not have a dependent(s) when you
Life being funded through this arrangement,
refer to our web site or
first became eligible to participate in the plan
contact a Human Resources - Benefits as outlined above, you may make an
Representative) application when you have a dependent(s),
however, if you do not make an application
• you pay the remaining cost of the coverage within 31 days of the dependent(s) becoming
• the cost being paid by the University is a eligible, evidence of health is required on
taxable benefit your dependent(s) and is subject to approval
• for a breakdown of the cost, refer to our web by the insurance carrier
12COVERAGE AMOUNT AMOUNT OF BENEFIT PAYABLE
The Dependent Life Insurance plan provides you The Life benefit pays 100% up to the maximum
with the opportunity to purchase life insurance on benefits provided by the plans.
your spouse’s life at $40,000 and for each of your
eligible dependent children at $10,000. MAXIMUM BENEFIT
The combined maximum benefit for the Basic and
COST OF THE PLAN Optional Life Insurance plans is $500,000.
LIFE INSURANCE PLANS
You pay the full cost of the coverage. For a
breakdown of the cost, refer to our web site or BENEFICIARY DESIGNATION
contact a Human Resources - Benefits You may designate whomever you wish as your
Representative. named beneficiary and may initiate a change at
any time. However, if the named beneficiary is
DEFINITION OF ELIGIBLE DEPENDENTS FOR under the age of 18, a trustee must be designated.
THE DEPENDENT LIFE PLAN
You are automatically the named beneficiary for the
Spouse/Partner: A spouse is defined as a person Dependent Life plan.
who is legally married to the employee or, although
not legally married, has continuously cohabited in a DELAYED EFFECTIVE DATES IN CASE OF
common-law like relationship of the same or DISABILITY
opposite sex with the employee for not less than
Employees not actively at work on the date the life
one full year.
insurance plan becomes effective are not entitled to
coverage at that time. In such cases, coverage will
Dependent Children: A dependent child is
commence upon return to active full-time
defined as unmarried (including legally adopted employment.
children, foster or step-children),
not engaged in full-time employment, dependent on
CHANGES IN AMOUNTS OF COVERAGE
you for financial support under the age of 21 unless
the child is registered as a full-time student in
Basic and Optional Life
which case the child must be under the age of 25 The total amount of Basic and Optional Life
or if incapable of self support due to mental or Insurance coverage changes whenever your basic
physical infirmity which began while the child was
annual salary is adjusted. If you are not at work at
covered as the Employee’s dependent will continue
that time, the change will be made on the date you
to be eligible.
return to work.
Note: A dependent child confined to hospital Optional Life
when becoming eligible is not insured until released
• you may elect to change the level of your
from the hospital. Children confined to hospital
Optional Life Insurance coverage without
since birth will be insured when they are 15 days
evidence of health when any change in
old.
marital status takes place provided you make
application within 31 days of the date of the
GENERAL PLAN PROVISIONS FOR ALL change
LIFE PLANS: • you may elect to increase or apply for new
(BASIC, OPTIONAL AND DEPENDENT LIFE) coverage for any other reason, however,
evidence of health is required and is subject
ENROLLMENT PROCEDURE to approval of the insurance carrier
Enrollment is initiated on the completion of an • you may elect to decrease or cancel
application form available in Human Resources - coverage at any time
Benefits.
13Dependent Life you directly. A Human Resources - Benefits
• there is not an option to change the level of Representative will assist you with the processing
coverage as outlined above in the “Changes of the claim.
in Amounts of Coverage” section
• you may elect to cancel your coverage at any TERMINATION OF COVERAGE
time
Basic and Optional Life
LIFE INSURANCE PLANS
BENEFITS WHILE ON LEAVE OF ABSENCE OR Your Basic and Optional Life Insurance plans cease
TRAVELLING on the earlier of one of the following dates:
If you are going on a leave of absence, you may
arrange to continue your coverage by contacting (1) 31 days after you terminate your
the Human Resources - Benefits to cover the cost employment
of your benefits prior to leaving. (2) 31 days after you retire
(3) on your death
When travelling outside of the country, you and (4) the date the plan is cancelled for any
your dependent(s) will continue to be covered. reason
Reimbursement for any eligible claims will be made Dependent Life
in Canadian funds. Your Dependent Life Insurance plan ceases on the
earlier of one of the following dates:
TOTAL DISABILITY BENEFIT
If you become totally disabled before your normal (1) 31 days after you terminate your
retirement date, your life benefits continue as employment
follows: (2) 31 days after you retire
(3) on your death
• your Basic Life Insurance plan will be kept in (4) when your dependent(s) are no longer
force without cost to you eligible
• your Optional Life and Dependent Life (5) the date the plan is cancelled for any
insurance plans may be kept in force without reason
cost to you if the premiums are waived by the
insurance carrier based on acceptable proof BENEFITS AFTER TERMINATION OF
of disability. If the premiums are not waived COVERAGE
by the carrier, the plans may be continued at
full cost to you. Basic and Optional Life
• your life insurance coverage may be
DEATH BENEFIT converted to an individual policy
• application for this individual policy must be
Basic and Optional Life made within 31 days of termination of
In the event of your death, the Basic and Optional employment or retirement
Life Insurance plan coverage amount in effect prior • the individual policy issued will be without
to your death will be paid to your named disability or double indemnity benefits and not
beneficiary. Note: If death is the result of suicide or in excess of the amount of your group life
any attempt thereof, sane or insane, a limitation insurance
clause will apply. A Human Resources - Benefits • no medical examination is necessary to
Representative will assist beneficiaries with the convert your insurance and the premium rate
processing of the claim. will be the same as would apply to a new
policy
Dependent Life
In the event of the death of your dependent(s), the
Dependent Life Insurance plan coverage amount in
effect prior to the dependent’s death will be paid to
14Dependent Life
• the life insurance coverage you have on
your spouse can be converted to an
individual policy
• no medical evidence is required providing an
application for the individual insurance is
made within 31 days of termination of
LIFE INSURANCE PLANS
employment, retirement or death
• the conversion privilege does not apply to
the coverage on your children
15VOLUNTARY PERSONAL ACCIDENT
INSURANCE PLAN
here are two Voluntary Personal Accident THE PLANS
T Insurance Plans available. You may purchase
any amount of insurance in multiples of $10,000
The Plans offer 24 hour, full year protection against
accidents anywhere in the world, whether you are
subject to a minimum of $20,000 and a maximum on or off the job.
VOLUNTARY PERSONAL ACCIDENT
of $250,000 covering yourself, or yourself and your
dependents. Plan 1 - Staff Member Only
You may purchase any amount of insurance in
PARTICIPATION IN THE PLAN multiples of $10,000 subject to a minimum of
If you are a Regular Full-Time employee that is a $20,000 and a maximum of $250,000. You are
INSURANCE PLAN
Member of the Police Association (UWOPA), you insured for the principal sum elected.
are eligible to participate in the Voluntary Personal
Accident Insurance benefit. Plan 2 - Staff Member and Family
You may purchase any amount of insurance in
Participation is optional. multiples of $10,000 subject to a minimum of
$20,000 and a maximum of $250,000. You are
Coverage may be effective on the first day of your insured for the principal sum elected. Your spouse
Regular Full-Time appointment. and children will be insured as follows:
COST OF THE PLAN • if there are no eligible children, your spouse
You pay the full cost of the coverage. For a will be insured for a spouse’s principal sum
breakdown of the cost, refer to our web site or which is equal to 60% of your principal sum
contact a Human Resources - Benefits • if there are eligible children, your spouse will
Representative. be insured for a spouse’s principal sum which
is equal to 50% of your benefit, and each
ENROLLMENT PROCEDURE eligible dependent child will be insured for a
Enrollment is initiated by the completion of an child’s principal sum which is equal to 15% of
application form available in Human your principal sum to a maximum of
Resources - Benefits. $100,000
• if there is no spouse, each eligible dependent
DEFINITION OF DEPENDENTS child will be insured for a child’s principal
Spouse/Partner: A spouse is defined as a person sum which is 20% of your principal sum to a
who is legally married to the employee or, maximum of $100,000
although not legally married to the employee, has
continuously cohabited with the employee for a An example:
period of one year immediately before a loss is
incurred under the policy, and who is publicly Under Plan 2 - Staff Member and Family
represented as the employee’s spouse. You elect $50,000 on your life and wish to insure
your family consisting of spouse and three children.
Dependent Children: A dependent child is The amounts insured would be as follows:
defined as unmarried (including legally adopted
children, foster or step-children), not engaged in Employee.......$50,000 (Employee’s Principal Sum)
full-time employment, dependent on you for Spouse...........$25,000 (Spouse’s Principal Sum)
financial support under the age of 21 unless the Each Child......$ 7,500 (Child’s Principal Sum)
child is registered as a full-time student in
which case the child must be under the age of 25
or if incapable of self support due to mental or
physical infirmity which began while the child was
covered as the Employee’s dependent will continue
to be eligible.
16BENEFITS
If injuries result in death, dismemberment or loss of use within 365 days after the date of the accident,
the plan provides the following benefits:
VOLUNTARY PERSONAL ACCIDENT
Benefit Entitlement You or Your Spouse Your Child
(based on you or your spouse’s (based on your child’s
your spouse’s principal sum) principal sum)
INSURANCE PLAN
Loss of Life Principal Sum Principal Sum
Loss of Both Hands, Both Feet or Both Eyes Principal Sum 4x Principal Sum
Loss of One Hand and One Foot Principal Sum 4x Principal Sum
Loss of One Hand and One Eye or One Foot
and One Eye Principal Sum 4x Principal Sum
Loss of Speech & Hearing in Both Ears Principal Sum 4x Principal Sum
Loss of Use of Both Arms or Both Hands Principal Sum 4x Principal Sum
Loss of Use of Both Feet Principal Sum 4x Principal Sum
Loss of One Arm or One Leg Principal Sum 2x Principal Sum
Loss of Use of One Hand or One Foot 2/3 of Principal Sum 1.5x Principal Sum
Loss of Use of One Arm or One Leg 3/4 of Principal Sum 2x Principal Sum
Loss of One Hand or One Foot 2/3 of Principal Sum 2x Principal Sum
Loss of One Eye 2/3 of Principal Sum 2x Principal Sum
Loss of Speech or Hearing in Both Ears 2/3 of Principal Sum 1x Principal Sum
Loss of Thumb and Index Finger of Same Hand
or at least Four Fingers 1/3 of Principal Sum 1/2x Principal Sum
Loss of Hearing in One Ear 1/3 of Principal Sum 1/4x Principal Sum
Loss of All Toes of the Same Foot 1/4 of Principal Sum 1/2 of Principal Sum
Loss of Both Arms or Both Legs Principal Sum 4x Principal Sum
Quadriplegia (total Paralysis of both Upper
and Lower Limbs) 2x Principal Sum 4x Principal Sum
Paraplegia (total Paralysis of both Lower Limbs) 2x Principal Sum 4x Principal Sum
Hemiplegia (total Paralysis of both Upper and
Lower Limbs of One Side of the Body) 2x Principal Sum 4x Principal Sum
17The definition of “Loss” in the previous chart shall COMMON DISASTER
mean: If as a result of a “common accident” you and your
spouse should both lose your lives, the spouse’s
• with respect to hand or foot, the actual loss of life benefit shall be increased to equal 100%
VOLUNTARY PERSONAL ACCIDENT
severance through or above the wrist or of the insured employee’s Principal Sum to a
ankle joint but below the elbow or knee joint maximum of $1,000,000.
• with respect to arm or leg, the actual
severance through or above the elbow or “Common accident” means the same accident
knee joint or separate accidents occurring within the same
INSURANCE PLAN
• with respect to eye, the total and 24 hour period.
irrecoverable loss of sight
• with respect to speech, the total and
irrecoverable loss of speech which does not REHABILITATION BENEFIT
allow audible communication in any degree When “injuries” to you shall result in a payment
• with respect to hearing, the total and being made by the Plan under the “specific loss
irrecoverable loss of hearing which cannot be benefits” section of the policy, the Plan will pay in
corrected by any hearing aid or device addition:
• with respect to thumb, the actual severance
through or above the first phalange The reasonable and necessary expenses actually
• with respect to fingers, the complete loss of incurred up to a limit of $10,000 for your special
two (2) entire phalanges of the finger training provided:
• with regard to toes, the complete loss of one
(1) entire phalanx of the big toe, and all (a) such training is required because of such
phalanges of the other toes “injuries” and in order for you to be qualified
to engage in an occupation in which you
would not have been engaged except for
The definition of “Loss” in the previous chart shall such “injuries”
mean the complete and irrecoverable paralysis by:
(b) expenses be incurred within two (2) years
• quadriplegia (paralysis of both upper and from the date of the accident
lower limbs)
• paraplegia (paralysis of both lower limbs) (c) no payment will be made for ordinary living,
• hemiplegia (total paralysis of both upper and travelling or clothing expenses
lower limbs of one side of the body)
The definition of “Loss of Use” in the previous OCCUPATIONAL TRAINING BENEFIT (FOR
chart shall mean: YOUR SPOUSE)
When injuries to you shall result in a payment being
• the total and irrecoverable loss of function of made by the Plan under the section entitled
an arm, hand or leg, provided such loss of “Benefits”, of this policy, the Plan will pay in
function is continuous for twelve (12) addition:
consecutive months and such loss of function
is thereafter determined on evidence The expenses actually incurred by your spouse,
satisfactory to the carrier to be permanent within 365 days of the date of accident, for a formal
occupational training program for the purpose of
specifically qualifying your spouse to gain active
AMOUNT OF BENEFIT PAYABLE employment in an occupation for which your
The Voluntary Personal Accident Insurance benefit spouse would otherwise not have sufficient
pays 100% up to the maximum benefit provided by qualifications. The maximum payable hereunder is
the plan. $10,000.
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