Frequently Asked Questions
- What if I don't want to be a part of the benefits plan?
- I was under my spouse's coverage when he/she lost their job, can I be added to my company's benefit plan?
- I am living common-law; can my common-law spouse receive benefits?
- When I cancel a member's coverage mid-month and have paid the premium, are they covered for the full month?
- Can I change my beneficiary at any time?
- Can benefits be continued for members who leave our company?
- What options do I have for Maternity leave in Alberta?
- At what age does coverage for dependent children cease?
- If the Long Term Disability, and/or Short Term Disability benefits are paid by the employer, are these benefits taxable or non-taxable?
- Are premiums charged while a member is ill or injured?
- Are premiums charged during a member's qualifying period for Long Term Disability?
- What forms are required for Extended Health Care claims?
- What forms are required for Dental claims?
- What is Co-ordination of Benefits?
- If the plan includes a deductible and/or the benefit isn't covered reimbursed at 100% (e.g., 80%), how does the insurance carrier determine the amount payable?
What if I don't want to be a part of the benefits plan?
In all small size group benefits plans, the plan is mandatory. However an employee can waive health and dental if they have a spouse that is covered under another plan. Back To Top
Yes, you can be added to the current benefit plan as long as it is within 31 days of the date of termination or lay-off. Back To Top
With most insurance carriers, common-law is covered from first day of living together, however there are some carriers that have a one year wait period. (please check your contract) Back To Top
No, the member's coverage is terminated that day at midnight. This works oppositely in the case of an employee who is added to the plan mid-month. They do not get charged premium until the following month but have coverage after the waiting period). Back To Top
Yes. in Alberta, beneficiary changes are considered revocable. Forms must be sent into the insurance carrier with an ink signature. In Quebec, you can designate a beneficiary as revocable or irrevocable. If you have a policy with an irrevocable beneficiary you would have to obtain consent from the beneficiary to make any changes. Back To Top
Can benefits be continued for members who leave our company?
Severance arrangements must have prior approval and sent to the insurance carrier for acceptance. Back To Top
You have three options, continue all coverage, continue all coverage except disability, or discontinue all coverage. Back To Top
Most carriers cover dependent children to the age of 21 and to 25 if attending a full-time educational institution. Back To Top
They would be taxable and the proceeds that are payable to the member would be taxed at source. (the majority of most plans are set up as non-taxable and the employee should be paying 100% of their disability premium). Back To Top
If a member is receiving Short Term Disability benefits during their illness or injury, premiums are charged on all insurance benefits. Back To Top
Yes. Premiums are charged for all benefits. However, members who are approaching their 65th birthday, LTD premiums are not charged. LTD premiums will be stopped on the date of their 65th birthday less the qualifying period. Back To Top
An Extended Health Care Claim Form (all carriers have a different name for this form, but all forms should include the words 'health care' in the title)and any supporting documents, such as original receipts, referrals from the doctor (if plan requires), or original statements from other insurance carriers involved in the claim. Back To Top
Standard Dental claim (most dentists use their own). Back To Top
Co-ordination of Benefits is a method used by the insurance industry to determine the order of paying benefits when the spouse and/or children are covered under more than one group insurance plan. For example, a spouse must submit to claims to their own employer plan first, then to the spouse's carrier when the Explanation of Benefits is received back. Children who are dependents must submit to the plan of the parent whose birth date comes first in the calendar year. A student who is covered under the University plan must submit to this plan first and then through the parent's plan. Back To Top
In this hypothetical situation, the maximum eligible under the contract for glasses is $150.00 every 24 months; however the glasses were $250.00. ($100.00 is ineligible). The deductible per family unit is $50.00 and the reimbursement is 80%. After the claim is approved, the member receives an Extended Health Claim Statement explaining how the claim was paid. $150.00 - less the deductible of $50.00 = $100 x co-insurance of 80%. $80.00 is reimbursed back to the member. Back To Top
Need more information or have further questions? Contact us and we will be happy to answer your questions.