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5060
Tecumseh Rd. E. |
Administration Guide
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Life Insurance, Accidental Death and Dismemberment
Who's Eligible?Sole proprietors, partners and employees are all eligible to apply for benefits as long as they are under age 75 and Canadian residents. They must be permanent, full time employees working two thirds or more of the company's normal hours and not less than 20 hours per week. Eligible employees must apply for coverage based on their current marital status. When to EnrollAll new, full time employees must complete an Employee Application when they join the firm. We must receive the completed application in our office within 120 days of the employee's employment date. Late EntrantsA late entrant is any eligible employee who did not complete an Employee Application when your firm applied for coverage, or any employee who does not enroll in the plan within 120 days of their date of employment. A completed Statement of Health must accompany the Employee Application:
When Coverage StartsNew employees starting after the plan's effective date become eligible for insurance once they have been continuously employed for three months. For firms with 4 or fewer individuals, coverage for eligible employees takes effect on the first of the month following the date on which the Insurance Company accepts the individual's application. For firms with 5 or more individuals, coverage up to the guaranteed level takes effect on the first of the month following the date we receive the eligible employee's completed application. When individuals apply for excess coverage it takes effect on the first of the month following the date the Insurance Company accepts the excess. For Late Entrants, coverage takes effect on the first of the month following the date on which the Insurance Company accepts the individual's application. Dental benefits are limited to $250 per person (employee or dependent) in the first 12 months of coverage. If an individual is absent from full-time work on the effective date because of accident or sickness, coverage takes effect on the first of the month following the date the individual returns to active full-time work. We must receive the application in our office within 31 days of the individual's return to active full-time work, or they will be considered a Late Entrant. Updating Employee RecordsWhen an employee's status changes or an employee is terminated, please update your plan records by sending us a completed Employee Change Request within 60 days of the change. The following events can affect an individual's coverage:
Ending CoverageWhen an employee leaves your firm, is granted a leave of absence, is laid off or goes on strike, all benefits except disability stop at the end of the month in which the event takes place. Disability benefits stop on the day the employee stops working. If the Plan Administrator isn't immediately notified of an Employee termination, your premium can be adjusted (backdated) to a maximum of 30 days, so long as no benefits were paid during that time. This link provides a sample letter we recommend you give to employees who leave. Claiming BenefitsUse the Service Centre to make all claims. Note that claims are not payable for any month in which we have not received your premium. Employees who leave your firm have 120 days from their termination to submit any claims for eligible expenses incurred up to the end of the month in which their work ended. Extended HealthIf you have an ASSURE Card option, prescription drug benefits are paid at the pharmacy when the insured makes the purchase. If you don't use your ASSURE Card for prescription purchases for any reason, send a completed Employee Reimbursement Form for Drug Claims directly to Emergis. For traditional, paper-based claims, employees must submit a completed Extended Health Claim form, including the employee's signature - not the spouse's, along with original receipts. Claims must be made within 12 months of the date of service. DentalPlease ensure that Group Dental Claim forms are fully completed when you send them to us. This means:
Claims must be made within 12 months of the date of service. Before an individual starts treatment for any significant amount (more than $500), or treatment that includes 'major services' or orthodontics, you should confirm how much the plan will cover. Write "Treatment Plan" on a regular claim form, then have the dentist outline the proposed work and expected charges. We will confirm for the employee how much the plan can cover. Coordination of BenefitsIf an employee and spouse both have group benefits through their respective employers, insurance companies will pay health and dental benefits following a standard procedure. When the employee is the patient, send the claim to the employee's plan first. When the spouse is the patient, send the claim to the spouse's plan first. When a dependent child is the patient, send the claim to the plan of the parent whose birthday falls earlier in the year. If the first plan does not pay the whole amount, send the explanation of benefits provided by the first plan along with a claim form to the second plan. Disability BenefitsTo be eligible for benefits, the employee must be totally disabled and under the regular care and attendance of a licensed physician. That means the employee must keep regular appointments with the doctor: telephone consultations are not sufficient. Contact the Plan Administrator's claim department for the appropriate claim forms. Send the completed forms to the Service Centre as soon as possible to avoid benefit payment delays. Weekly Indemnity (short term disability) claims sent to us later than 90 days after the onset of the disability will be declined. For Long Term Disability claims, the deadline is 150 days. Life Insurance, Accidental Death and DismembermentCall the Service Centre as soon as you hear about such an incident. We will send you the appropriate claim forms and tell you what additional documentation (i.e. funeral director's statement or death certificate) is required for that particular claim. Completed claim forms must be submitted within 90 days of the death or dismemberment. Critical IllnessEmployees who wish to make a critical illness claim should advise the Plan Administrator in writing within 30 days of the initial diagnosis of an eligible condition. The employee has 90 days from that diagnosis to provide medical evidence of the diagnosis. Your Ongoing Plan Premiums are due and payable on the first of each month, but 31 days of grace are provided so that your payment can reach the Plan Administrator. If your premium is not paid by the end of the grace period, insurance coverage automatically terminates. Firms that pay their premiums monthly by cheque will be mailed a premium statement on the first of each month. Firms that choose the pre-authorized payment option will be sent a premium statement whenever there is a change in the billing (such as the addition of an employee), unless otherwise requested. Coverage RenewalPremiums are reviewed each April 1st for all Chambers Plan groups. At this time you will see Life and Disability rate updates based on changes to the ages and salaries of people in your firm. Any Health and Dental rate adjustments reflect provincial fee guide changes and health care inflation. Your renewal package will be sent to you early in the calendar year, with details of how the rate review will affect your firm. An Eligible CompanyRemember that your business (or one of its principals) must maintain a membership in a participating Chamber of Commerce or Board of Trade in order for your firm to remain eligible for the Chambers Plan. For firms with 4 or fewer employees, all eligible employees must participate in the plan. For firms with 5 or more employees, at least 75% of eligible employees must participate in the plan. Insuring CompaniesDesjardins Financial Security, RBC Insurance and Western Life are the primary insurers for the plan. The guide and booklets you receive explain the principal features of the plan, but the Master Contracts held by the Chamber Insurance Corporation of Canada apply in all cases. my benefits®my benefits® is a secure on-line utility for benefit administrators in firms covered by Chambers Plan benefits. This free service lets the firm's authorized contact administer the group plan instantly and directly. You can add employees, change benefits and search for plan information. Everything is at your fingertips, 24 hours a day. Click here (http://www.my-benefits.ca/) to see what my benefits can do for your company.
Our national service centre is open from 7:30 am to 6 pm CST, Monday to Friday Chambers of
Commerce Group Insurance Plan Toll-free 1-800-665-3365
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