Summary of Benefits and Pension Plan. AUT / Non-Union

Transcription

1 Summary of Benefits and Pension Plan AUT / Non-Union

2 TABLE OF CONTENTS Introduction... 1 Employee and Family Assistance Program... 2 Health Plan... 4 Emergency Travel Assistance (ETA) Group Life Insurance Basic Accident Insurance Long Term Disability Optional Group Life Insurance Optional Accidental Death & Dismemberment Insurance Group Travel Accident Insurance Retirement Plan... 33

3 INTRODUCTION The St. Francis Xavier University employee benefits program is designed to provide you and your family with basic income protection in the event of accident, illness, disability or death. The program also includes a comprehensive pension plan to help employees achieve financial security in retirement. This Summary of Benefits and Pension Plan has been prepared to give you a summary of the main features of your group insurance and pension programs. It is not an insurance policy, and does not grant or confer any contractual rights. All rights under this program shall be governed by the provisions of the Master Policy and by applicable law. This Summary of Benefits and Pension Plan is for your reference. Please read it carefully and keep it for future use. 06/14/10 1

4 EMPLOYEE AND FAMILY ASSISTANCE PROGRAM (inconfidence) What is an Employee and Family Assistance Program? An Employee and Family Assistance Program (EFAP) is a voluntary, confidential, short term counseling service that connects employees and their eligible family members to a network of dedicated professionals who are able to provide assistance 24 hours a day, 7 days a week. This network includes psychologists, social workers, addiction and career counselors, childcare and elder care specialists and legal and financial specialists. Practical, relevant support will be provided fast and in a way that is most suited to your employee s preferences and learning approach. Caring professionals can help select a support option that works best for them, such as telephonic, in-person, on-line, and through a variety of issue based health and wellness resources. An EFAP enables employees to resolve personal, family or job concerns before they begin to affect other areas of their lives. Employees with sound psychological health, such as the ability to concentrate, are able to achieve greater personal and professional success. Who is covered under the EFAP? All employees of StFX and their eligible family members, excluding student employees. What is covered under the EFAP? Medavie Blue Cross has partnered with Shepell fgi in order to offer the inconfidence program to help Saint FX employees meet strategic health and wellness objectives. Both Medavie Blue Cross and Shepell fgi are recognized and trusted by employers, employees and their families. Exemplifying quality, confidentiality and accessibility, our assessment, counselling and referral services are a direct route to problem resolution and employee wellness. Delivered by qualified and caring clinicians the inconfidence EFAP provides professional assistance for a wide range of issues, including: M AINSTREAM COUNSELLING W ork Issues Addiction Issues Relationship Issues Parenting Issues Personal / Emotional Issues Acute Situations Situational Stressors WORK-LIFE SUPPORT Legal Financial Health Support Family Support Homecare Access Nutritional Services Smoking Cessation TRAUM A SERVICES Non-Urgent Urgent Life-Threatening W orkplace Accidents Robbery Downsizing W orkplace Violence Corporate Fraud This short-term counselling model is very flexible and offers as many sessions as required within inconfidence s brief, solution-focused model to successfully resolve the individual s problem. We only refer out to community resources for long-term or very specialized circumstances. 06/14/10 2

5 How do I access the EFAP? To learn more about the services available and to access any of the counselling or work/life consultation services including child, elder and dependent care; legal and financial support; nutritional counselling and a health information service, call: toll-free 7/24/365 service crisis counselling English- or French-language service Confidentiality and privacy are assured, within the limits of the law, to each employee and family member who uses inconfidence. You are contacting Shepell-fgi directly, and they do not share any information on any individual case with StFX or with Medavie Blue Cross. 06/14/10 3

6 HEALTH PLAN and DENTAL PLAN Policy Number: Medavie Blue Cross administers the following benefits on behalf of St. Francis Xavier University: - Drug Benefit - Vision Benefit - Hospital Benefit - Extended Health Benefit - Dental Benefit The information contained in this booklet summarizes the important features of your group program; is prepared as information only; and does not, in itself, constitute an agreement. The exact terms and conditions of your group benefit program are described in the group policy held by your employer. The information contained in this booklet is important, and we suggest it be kept in a safe place. This booklet replaces any previously issued booklet. To access a wealth of savings on medical, vision care and many other products and services, visit HOSPITAL BENEFIT If you (or your dependents, if applicable) incur charges in Canada for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, co-insurance or maximum amount shown below, less the amount allowed under any government health program. Benefit maximums are applied on a per person basis. Co-insurance: 100% HOSPITAL ROOM The difference between standard ward accommodation and semi-private room accommodation. TERMINATION Hospital benefit ceases at the earlier of retirement, termination of employment or on August 31 st following the employee s 68 th birthday. WHEN AND HOW TO MAKE A CLAIM Hospital benefit is paid directly to the hospital. Your identification card should be shown at the hospital who will arrange to bill Medavie Blue Cross directly. Claims must be submitted within 12 months of receiving services or supplies. No claims will be paid by Medavie Blue Cross after the termination date of this plan. 06/14/10 4

7 EXTENDED HEALTH BENEFIT - IN CANADA If you (or your dependents, if applicable) incur charges in Canada for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, co-insurance or maximum amount shown below, less the amount allowed under any government health program. Benefit maximums are applied on a per person basis. Co-insurance: 100% DIAGNOSTIC AND X-RAY SERVICES Charges for laboratory service and X-ray examinations. OXYGEN Charges for oxygen on the written authorization of the attending physician. PHYSICIAN SERVICES Charges outside the covered person's province of residence in excess of the allowance under a government health plan. PRIVATE DUTY NURSING Maximum: $5,000 in a calendar year Provided you do not reside in a convalescent nursing home and the nurse is not a relative, charges for medically necessary home nursing care performed by a registered nurse, registered nursing assistant or certified nursing assistant are eligible. Written authorization of the attending physician is required. All nursing services must be pre-approved by Medavie Blue Cross in order to be considered for reimbursement. PROFESSIONAL AMBULANCE Maximum: $50 in a calendar year Charges for licensed ground ambulance services required to transport a stretcher patient to and from the nearest hospital able to provide essential care. Charges for air transport are included to the maximum deemed appropriate by the airline on a regularly scheduled flight. SPECIAL AMBULANCE ATTENDANT Maximum: $300 in a calendar year Travel expenses of a Registered Nurse (not a relative) when medically necessary and approved by Medavie Blue Cross. 06/14/10 5

8 EXTENDED HEALTH BENEFIT - WORLDWIDE If you (or your dependents, if applicable) incur charges for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, co-insurance or maximum amount shown below, less the amount allowed under any government health program. Benefit maximums are applied on a per person basis. Co-insurance: 100% ACCIDENTAL DENTAL Dental treatment when natural teeth have been damaged by a direct accidental blow to the mouth or jaw. Services must be rendered or approved for payment by Medavie Blue Cross within 180 days of the accident. Benefits will be paid up to the usual and customary fee of the current Dental Association Fee Guide for general practitioners in your province of residence at the time of treatment. DIABETIC EQUIPMENT Charges for the following equipment on the written authorization of the attending physician for treatment and control of diabetes: preci-jet, glucometer or equipment that performs similar functions and approved by Medavie Blue Cross. HEARING AIDS Maximum: $600 in any three consecutive calendar years Charges for hearing aids (excluding batteries and exams) when prescribed by an otolaryngologist, otologist and/or registered audiologist. MEDICAL SUPPLIES AND EQUIPMENT Charges for the following medical supplies and equipment, when prescribed by an authorized physician: - purchase of burn pressure garments is limited to a maximum of $500 in a calendar year; - rental (or purchase, if approved by Medavie Blue Cross) of a wheelchair or hospital-type bed; - equipment for the administration of oxygen; - insulin pump; - compression pump; - lymphoedema sleeves (limited to 2 in a calendar year); - transcutaneous electrical nerve stimulator (TENS machine) is limited to a maximum eligible expense of $300 every 5 consecutive calendar years. Once the original equipment purchase is approved, the rental or approved purchase of another piece of similar equipment will be limited to once every 5 consecutive calendar years. 06/14/10 6

9 EXTENDED HEALTH BENEFIT - WORLDWIDE MOLDED ARCH SUPPORTS Maximum $70 in a lifetime Charges for molded arch supports when prescribed by the attending physician, excludes replacement except when due to pathological change. ORTHOPEDIC FOOTWEAR & SUPPLIES Maximum: $40 in a calendar year Charges for orthopedic footwear when the footwear has been customized with special features to accommodate relieve or remedy some mechanical foot defect or abnormality. A prescription from an orthopedic surgeon, physiatrist, rheumatologist, chiropodist/podiatrist or the attending Physician is required along with a copy of the biomechanical or gait analysis from the health care professional. Also, charges for footwear modifications, adjustments, and supplies when prescribed by one of the health care professionals noted above to accommodate, relieve or remedy some mechanical foot defect or abnormality. OSTOMY SUPPLIES Charges for essential ostomy supplies on the written authorization of the attending physician. PHYSIOTHERAPIST Maximum Frequency: 20 treatments in a calendar year Charges for treatment, except when performed in a hospital, by a licensed physiotherapist PROSTHETIC APPLIANCES Charges for the following remedial appliances or supplies, when authorized by the attending physician: - artificial limbs (limited to one prosthetic appliance to each limb in a lifetime); - breasts (limited to a left and a right prosthesis every two consecutive calendar years); - eyes (limited to one left and one right prosthesis in a lifetime); - canes or crutches (limited to two in a lifetime); - splints; - casts; - trusses (limited to one truss every five consecutive calendar years); and - braces (limited to one cervical collar in a calendar year and all other braces are limited to one in a lifetime). Replacement must be due to pathological or physiological change. Repairs and/or adjustments are provided to a maximum eligible expense of $50 in a calendar year. Hair prosthetics (wigs), when hair loss is due to an underlying pathology or its treatment, to a maximum eligible expense of $300 in a lifetime. Hair prosthetics, replacement therapy and other procedures for physiological hair loss are excluded (i.e., male pattern baldness). 06/14/10 7

10 EXTENDED HEALTH BENEFIT - WORLDWIDE TERMINATION Extended Health benefit ceases at the earlier of retirement, termination of employment or on August 31 st following the employee s 68 th birthday. WHEN AND HOW TO MAKE A CLAIM Extended Health benefit is reimbursed to the employee. The employee must pay the provider of service, obtain an official paid in full receipt and submit to Medavie Blue Cross for processing. Some services may require a completed claim form to accompany the receipt. You may obtain claim forms from your employer or provider of service as appropriate. To make a claim, complete the claim form that is available. Claims must be submitted within 12 months of receiving services or supplies. No claims will be paid by Medavie Blue Cross after the termination date of this plan. 06/14/10 8

11 VISION BENEFIT If you (or your dependents, if applicable) incur charges for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, co-insurance or maximum amount shown below. Benefit maximums are applied on a per person basis. Co-insurance: 100% LENSES, FRAMES AND CONTACT LENSES Maximum: $250 every 24 consecutive months for adults and every 12 consecutive months for dependent children less than 18 years of age Charges for corrective eyeglasses, including lenses, frames and contact lenses, but excluding safety glasses or glasses/contacts for cosmetic purposes. EYE EXAMINATIONS Maximum: $50 every 24 consecutive months for adults and every 12 consecutive months for dependent children less than 18 years of age Charges of a licensed optometrist or ophthalmologist for eye examinations. TERMINATION Vision benefit ceases at the earlier of retirement, termination of employment or on August 31 st following the employee s 68 th birthday. WHEN AND HOW TO MAKE A CLAIM Vision benefit is reimbursed to the employee. The employee must pay the provider of service, obtain an official paid in full receipt and submit to Medavie Blue Cross for processing. Some services may require a completed claim form to accompany the receipt. Claims must be submitted within 12 months of receiving services or supplies. No claims will be paid by Medavie Blue Cross after the termination date of this plan. 06/14/10 9

12 DRUG BENEFIT If you (or your dependents, if applicable) incur charges for certain prescription-requiring drugs, the eligible drug may be subject to quantity maximums, dollar maximums, deductibles, copayments or other maximums as approved by Medavie Blue Cross. Benefit maximums are applied on a per covered person basis. Co-payment: the dispensing fee for each eligible drug on the prescription Co-insurance: 100% of the remaining eligible expense Method of payment: paid directly to the pharmacy Includes prescription drug items approved by Medavie Blue Cross and many commonly prescribed over-the-counter items approved by Medavie Blue Cross. Charges for the following are also included: - diabetic supplies - preventive vaccines - smoking cessation benefit to a maximum of $350 every two calendar years Eligible drug expenses include medically necessary items that, by law, can only be obtained with a prescription of a physician or dentist, which are authorized as benefits by Medavie Blue Cross, and are dispensed by an approved provider. Preventive vaccines, approved by Medavie Blue Cross are eligible when submitted in a reimbursement basis only. Your submission must be accompanied by an official receipt indicating the drug identification number (DIN) or the name, strength and quantity of the vaccine purchased. Medavie Blue Cross will reimburse only for the lowest priced interchangeable drug when prescribed by a physician and dispensed by a pharmacist, unless the physician indicates no substitution. *For purposes of clarity, Post 65 active employees must enroll in the Nova Scotia Pharmacare Program and are responsible for fulfilling all requirements under that Program. The StFX benefits are a top-up of eligible expenses to the Pharmacare Program. TERMINATION Drug benefit ceases at the earlier of retirement, termination of employment or on August 31 following the employee s 68 th birthday. WHEN AND HOW TO MAKE A CLAIM The Medavie Blue Cross Identification Card should be shown and the provider will arrange to bill Medavie Blue Cross directly. st 06/14/10 10

13 DENTAL BENEFIT Your dental program covers you and your dependents for a wide range of dental services including the following benefits. Dental benefits are based on the usual and customary charges up to the current Dental Fee Guide for general practitioners in effect in the covered person s province of residence. PREVENTIVE CARE SERVICES Co-insurance: 100% Oral examinations and diagnosis complete oral examination - recall oral examination (one per 12 consecutive months for participants age 19 and over, one per six consecutive months for participants under age 19) - emergency oral examination (one per calendar year) - specific oral examination (one per calendar year) X-rays - complete series films (one per 12 consecutive months) - intra-oral films periapical - intra-oral films occlusal - intra-oral films bitewings (two per six consecutive months) - extra-oral films - sialography - panoramic film (one per two calendar years in combination with complete series films) - radiopaque dyes Laboratory tests and examinations - bacterial culture - biopsy of soft oral tissue - biopsy of hard oral tissue - cytological examination Preventive treatment - polishing of coronal portion of teeth (one per six consecutive months for Participants under 19 years old and one per 12 consecutive months for Participants over 19 years old) - topical application of fluoride - scaling Space maintainers (Participants under 19 years old) 06/14/10 11

14 Endodontic services Co-insurance: 80% - pulp capping - pulpotomy - emergency pulpotomy - endodontic traumatism - root-canal therapy - endodontic surgery Periodontics Co-insurance: 100% Maximum: $5,000 in a lifetime - periodontal surgery - provisional splinting - management of acute infections - desensitizations - other adjunctive periodontal services - root planing ($5,000 in a lifetime per Participant in combination with scaling) - periodontal curettage - occlusal Adjustments (three units* per calendar year) - periodontal appliances (one per two calendar years) - adjustments to appliances (three units* per calendar year) Removable dentures adjustments Co-insurance: 80% Maximum: $500 in a lifetime - minor adjustments - rebasing and relining (one per two calendar years) Oral surgery Co-insurance: 100% for the removal of erupted tooth (uncomplicated) and 80% for the complicated surgical removal and surgical excision of cysts and neoplasms - removal of erupted tooth (uncomplicated) - complicated surgical removal - surgical excision of cysts and neoplasms General adjunctive services Co-insurance: 80% - anaesthesia (related to surgery) Temporary dressing for the emergency relief of pain * A unit of time is equal to 15 minutes of service 06/14/10 12

15 MAJOR RESTORATIVE SERVICES Co-insurance: 80% Maximum: $500 in a calendar year Extensive Restorations - inlays/onlays/crowns (once per tooth every 5 calendar years) Prosthodontic Services - complete and partial dentures (once every 5 calendar years) - bridgework (once every 5 calendar years) This program excludes replacement of the denture unless it is at least five years old and cannot be made serviceable, and the replacement of dentures that may have been lost, mislaid or stolen; except where the replacement is required because of extraction, loss, or fracture of one or more sound natural teeth. Note: Implant related codes such as crown over implants or dentures over implants are not a benefit. ORTHODONTIC SERVICES Co-insurance: 50% Maximum: $3,500 in a lifetime The following charges are eligible if orthodontic services are included in the Benefit Summary. - Observation and Adjustments - Oral examination - Unmounted diagnostic - Removable active appliances for tooth guidance - Fixed or cemented appliances - Appliances to control harmful oral habits - Retention appliances - Comprehensive treatment Reasonable expenses incurred for orthodontic services given by an orthodontist to correct the dental irregularities. Payment of Orthodontic Claims Notwithstanding anything to the contrary in this contract, the payment of orthodontic claims will be made according to one of the following methods: a) If a single charge is estimated for the entire course of treatment and the Covered Employee pays this charge to the orthodontist in pre-arranged installments over an estimated period of treatment, the Company will reimburse the Covered Employee each time he submits a bill or receipt for any pre-arranged installment. b) If a single charge is estimated for the entire course of treatment and the Covered Employee pays this charge to the orthodontist in one lump sum, the Company will reimburse up to 1/3 of the total cost initially and equal installments thereafter over the entire treatment period. If instead of a single charge, each treatment is charged as it is performed; the Company will reimburse the Covered Employee as each charge is incurred. 06/14/10 13

16 EXCLUSIONS AND LIMITATIONS 1. This benefit does not cover the following expenses: a) Treatment or appliance, related directly or indirectly to full mouth reconstruction, to correct vertical dimension and temporomandibular joint dysfunction unless specified otherwise in your benefit summary. b) Services rendered by a dental hygienist but not administered under the supervision of a dentist, except in those provinces where it is no longer a legal requirement. c) Services and supplies relating to any appliance worn in the practice of a sport. d) Expenses that are payable or reimbursable under a public or private insurance plan or that would normally be so if a claim had been submitted. e) Charges payable under any occupational health and safety board or by any automobile insurance bureau, or any other similar law or public plan, if applicable. f) Any suicide attempt or any self-inflicted injury, whether the Participant is sane or not. g) Any injury or Illness resulting from the Covered Employee s active participation to civil unrest, riot, insurrection, unless while performing work-related functions, or injury sustained in a war. h) Services that are not medically required, that are given for cosmetic purposes, except for composite fillings that are not subject to this exclusion. i) Services that exceed the ordinary given in accordance with current therapeutic practice. j) Care or services rendered free of charge, or that would be if there were no coverage, or that are not chargeable to the Participant. k) Expenses incurred for veneers. l) Splinting for periodontal reasons, where cast crowns or inlays are used for this purpose, with or without onlays. 2. Restriction No reimbursement will be made for any portion of the charge that is over the suggested fee in the appropriate fee guide for the least expensive treatment that will provide a professionally adequate result. Reimbursement of laboratory fees will be limited to the reasonable and customary charges for such services in the area where the services are provided. 3. Limitation of Benefits For any Participant whose insurance becomes effective more than thirty-one (31) days after his eligibility date, the maximum amount reimbursed under this benefit for all eligible services (other than orthodontics) is limited to $100 during the first twelve (12) months of insurance. PREDETERMINATION OF BENEFITS When the total cost of any proposed dental treatment is expected to exceed $500, the Covered Employee or his Dependent must submit a detailed treatment plan to the Company before the start of treatment. The Company will then notify the Covered Employee of the amount of reimbursement for which the latter or his Dependent is eligible according to the provisions of this contract. The treatment plan should outline the type of treatment to be provided, the anticipated dates of treatment and the amounts to be charged for each service. The treatment plan must be performed by the dentist who first presented the treatment, otherwise the Covered Employee or his Dependent will be required to submit a new treatment plan to the Company for re-assessment. 06/14/10 14

17 ALTERNATE BENEFITS When one or more form of alternative treatment exists, the Company, in consultation with its Health Care Consultants, reserves the right to make payment for eligible services and supplies based on an alternate procedure with a lower cost, when deemed appropriate and consistent with good health management. COVERAGE AFTER TERMINATION No benefits are payable for expenses incurred after the termination date of the Covered Employee s coverage, even if a detailed treatment plan was submitted under the Predetermination of Benefits provision and even if benefits were approved by the Company prior to such termination date. TERMINATION Dental Benefit ceases at the earlier of retirement, termination of employment or on August 31 following the employee s 68 th birthday. WHEN AND HOW TO MAKE A CLAIM Dental benefits are reimbursed to the employee. The employee must pay the provider of service, obtain an official paid in full receipt and submit to Medavie Blue Cross for processing. Some services may require a completed claim form to accompany the receipt. To make a claim, complete the claim form that is available. Claims must be submitted within 12 months of receiving services or supplies. No claims will be paid by Medavie Blue Cross after the termination date of this plan. st 06/14/10 15

18 GENERAL EXCLUSIONS AND LIMITATIONS Medavie Blue Cross does not cover the following expenses: 1. Medical examinations or routine general checkups required for use by a third party. 2. Elective services obtained outside the covered person s province of residence. 3. Charges which normally would not be made if the covered person was not covered under the plan. 4. Any item or service not listed as a benefit in this plan. 5. Medications restricted under federal or provincial legislation. 6. Registration charges or non-resident surcharges in any hospital. 7. Services performed by an unqualified practitioner. 8. Charges for missed appointments or the completion of forms. 9. Charges for health care planning assessments. 10. Any health care services and supplies that are not provided by a Medavie Blue Cross approved provider. 11. Convalescent, custodial or rehabilitation services, unless otherwise specified. 12. Conditions not detrimental to health. 13. Services that are not medically required, that are given for cosmetic purposes or that exceed the ordinary services given in accordance with current therapeutic practice. 14. Benefits the covered person receives or is entitled to receive from Workers' Compensation. 15. Mileage or delivery charges. 16. Any injury or illness resulting from the covered person s active participation in or related to civil unrest, riot, insurrection or war. 17. Participation in the commission of a criminal offense. 18. A service or supply that is experimental or investigative in nature. 19. A service or supply that is not medically necessary or proven effective. 20. Services for which the government prohibits the payment of benefit. 21. Services provided without charge or normally paid for directly or indirectly by the employer. 22. Services for which the employee or dependent is entitled to indemnity from any government plan, or any plan or arrangement. 23. Services as a result of self-inflicted injuries or any suicide attempt, whether the covered person is sane or not. 06/14/10 16

19 HEALTH AND DENTAL INFORMATION ALTERNATIVE BENEFIT Where more than one form or alternative form of treatment exists, Medavie Blue Cross, in consultation with its Health Care Consultants, reserves the right to make payment for eligible services and supplies based on an alternate procedure or supply with a lower cost, when deemed appropriate and consistent with good health management. CO-ORDINATION OF BENEFITS In the event that benefits may be claimed under more than one section of the health care plan, the claim will be assessed in a manner that provides the greatest benefit to the employee. If you are eligible for similar benefits under another group benefit plan the amount payable through this plan shall be co-ordinated with all benefit plans and will not exceed 100% of the eligible expense. Where both spouses of a family have coverage through their own employer benefit plans, the first payer of each spouse s claim is their own employer s plan. Any amount not paid by the first payer can then be submitted for consideration to the other spouse s benefit plan (the second-payer). Claims for dependent children should be submitted first to the benefit plan of the spouse who has the earlier birth month in the calendar year, and then to the other spouse s benefit plan. When submitting a claim to a second payer, be sure to include payment details provided by the first payer. Benefit payments will be co-ordinated with any other plan or arrangement, in accordance with the Canadian Life and Health Insurance Association (CLHIA) guidelines. CONVERSION PRIVILEGE If you should terminate employment, you may convert to an Individual Health and Dental plan currently issued by Blue Cross provided that application is made within 31 days following your date of termination. 06/14/10 17

20 ADDITIONAL BENEFIT INFORMATION ELIGIBLE EMPLOYEES To be eligible for group benefits, you must be a permanent employee who is a resident of Canada, covered under your provincial government plan, actively at work and working a minimum of 20 hours per week on a regular basis and have completed the plan waiting period. Coverage commences immediately upon employment for all employees with the exception of the below contract employees: Executive Contract Employees and Contract Employees with two or more year Contracts - Coverage commences immediately. Contract for one year but renewed for an addition year - Coverage commences at the beginning of the second year of the contract. AUT Early Retirees are eligible if they reach his or her 60th birthday before the beginning of the academic year in which early retirement would commence and has completed 25 years service as a Faculty member at the University. Employees may elect coverage, within 31 days of becoming eligible following the waiting period, by completing an application. Coverage is effective on the date of eligibility, except when: (a) the employee is not actively at work on the day that coverage would otherwise become effective, or (b) the application is made after the 31 day period. If not actively at work when you would normally have become eligible, your coverage will commence when you return to work on a full-time basis. ELIGIBLE DEPENDENTS Dependents are defined as your legal spouse (as described below), and unmarried, unemployed dependent children including natural, legally adopted or step-children. Children of a common-law spouse may be covered if they are living with the employee. All dependents must be residents of Canada and be eligible for benefits under the provincial government health care programs in the province of residence in order to be eligible for coverage. The term spouse is defined as a person of the opposite or same sex who is legally married to the employee, or has continuously resided with the employee for not less than one full year having been represented as members of a conjugal relationship (common law). In the event of divorce, legal separation, or discontinuance of cohabitation ("common law" spouse), you may elect to continue membership of the former spouse or to provide notice to Medavie Blue Cross to terminate coverage for the spouse. Medavie Blue Cross will at no time provide coverage for more than one spouse under the same plan. Dependent children are eligible for benefits if they are less than 21 years of age* or, if 21 years of age* but less than 25 years of age**, they must be attending an accredited educational institution, college or university on a full-time basis. Unmarried, unemployed children 21 years of age* or older qualify if they are dependent upon the employee by reason of a mental or physical disability and have been continuously so disabled since the age of 21*. Unmarried, unemployed children who became totally disabled while attending an accredited educational institution, college or university on a full-time basis prior to the age of 25** and have been continuously disabled since that time also qualify as a dependent. * Benefits cease on December 31st of the year the dependent children turn age 21. ** Benefits cease on December 31 st of the year the dependent children turn age /14/10 18

21 Dependent coverage begins for your eligible dependents on the same date as your coverage, or as soon as they become eligible dependents if added later, provided that dependent benefits were applied for within 31 days of their becoming eligible. If coverage is not applied for within this 31 day period, evidence of health on the dependents may have to be submitted and approved before coverage begins. EVIDENCE OF HEALTH Proof of good health is not required if application is made within 31 days of first becoming eligible. If coverage is not applied for within this 31 day period, evidence may be requested for the employee and his dependents, if any, before benefits commence. Certain other situations may require the submission of evidence of health before coverage will be approved. The cost of obtaining evidence of health is to be provided at your own expense if you or your dependents do not apply for coverage within 31 days of becoming eligible. 06/14/10 19

22 CARDHOLDER SITE INSTRUCTION FOR MEMBERS Medavie Blue Cross is continually developing its Web technology to respond to the needs of our customers. One such innovation, the Cardholder Site, will help you better understand, manage and co-ordinate your benefit plan. The Cardholder Site is simple to use and is delivered in a secure environment. Now, when you want to access general information about your plan, view your claims and payment history, or print generic claim forms, you just have to click your mouse. The Cardholder Site is available 24 hours a day, seven days a week from home or work, all you need is an Internet connection. The Cardholder Site makes life easier for you. ON THE CARDHOLDER SITE There are a variety of options available to you on the Cardholder Site. Coverage Inquiry: Detailed information about the member s Blue Cross benefit plan Forms: Printable versions of generic Medavie Blue Cross claim forms Member Information king information for direct deposit of claim payments (where applicable) Member Statements ount balances (where applicable) FIRST-TIME ACCESS TO THE CARDHOLDER SITE 1. Log on to the Medavie Blue Cross Web site at 2. Select English 3. Select For Cardholders / Member Services from the e-service Centre menu on the right 4. Select Go to Secure Site 5. Select First Time, Register Now 6. Complete the online registration form 7. A temporary password will be ed to the address entered during registration 8. Return to the Cardholder Site and enter the user ID and temporary password 9. The member will be prompted to change the password. Click Submit to save the new password 10. Click Done once the changes are saved, you will be directed to the Welcome Page **Please ensure you make note of your user ID and password for future reference** PLEASE NOTE For security reasons, the Cardholder Site is for use of the cardholder only. We look forward to helping you take advantage of our online technology. For further information on the Cardholder Site, or for any questions about your Medavie Blue Cross benefit plan, please contact our Customer Information Center toll free at the number on the back of your identification card or inquiry@medavie.bluecross.ca /14/10 20

23 Policy: EMERGENCY TRAVEL ASSISTANCE (ETA) AXA Assurance Inc. administers the emergency out of province/country insurance against injury & sickness on behalf of St. Francis Xavier University. ELIGIBILITY of INSURANCE All participating members, their Spouses and Dependent Children must be covered under a Canadian federal and / or provincial health and hospitalization insurance plan and must be covered under the Policyholder s other group health and hospitalization insurance plan. Covered Expenses: Medical Hospitalization Ambulance Nursing Care Drugs & Medicine Emergency Dental Treatment Evacuation Repatriation Family Transportation and Accommodation Return of Vehicle Rental Expense Hotel Convalescence Referral Services outside of Canada Note: AXA Assistance must be notified within 48 hours of an Emergency, or when reasonably possible. Claims may be reduced if contact is not made with AXA Assistance within 48 hours of admission to Hospital. For more information on how to contact AXA Assistance, refer to the last page of this booklet. Coverage is limited to a maximum duration of 180 days with respect to any one Trip. TERMINATION OF INSURANCE Coverage for you and your dependents will cease on the earliest of: - the contract termination date, - the date you terminate employment, - the date you cease to be eligible due to retirement, death, leave of absence, age limitation (end of the month you attain age 70), change in classification, etc., 06/14/10 21

24 GROUP LIFE INSURANCE Eligibility All regular, full-time (minimum 20 hours per week), active academic, administrative and support staff must participate in the Group Life Insurance Plan as a condition of employment if they commenced employment after June 1, Life Insurance for Members The amount of your Life Insurance benefit will be paid to your beneficiary upon your death, regardless of the cause. When you enroll in the plan, you should name a beneficiary to whom you wish your Life Insurance proceeds paid. Your estate will be your beneficiary if you do not name one. Subject to provincial laws, you may change your beneficiary at any time. Although Life Insurance proceeds are usually paid in the form of a lump sum, it need not be so. At the time you appoint your beneficiary, you may also choose to have the amount of death benefit paid as either a life income or in installments over a number of years. Make sure that your beneficiary understands that Life Insurance proceeds need not be taken as a lump sum. Amount of Benefit As a member of the plan, you are entitled to an amount of Life Insurance as outlined in the following schedule: Religious Personnel $5,000 Employees Having Attained as at September 1 the Age of: At Least But Less Than /2 times your annual salary* times your annual salary* /2 times your annual salary* times your annual salary* /2 times your annual salary* times your annual salary* /2 times your annual salary* *rounded to the nearest $100. The minimum amount available is $5,000 and the maximum amount available is $165, /14/10 22

25 If Your Life Insurance Terminates If your Life Insurance terminates because you change jobs or retire, you may convert up to the full amount of your Group Life Insurance. Should you die within 31 days after your termination date, an amount equal to your Group Life Insurance benefit will be paid whether or not you have applied for a converted policy. If our coverage terminates because the Group Policy terminates, and if you have been continuously insured as a member of the group for at least five years, you may convert part of your Group Life Insurance. The convertible amount will be limited to the greater of $5,000 or 25% of the Life Insurance in force on the date the Group Policy terminates. This amount will be further reduced by any Life Insurance being replaced by another Group Policy. When you convert your Group Life Insurance you may choose an Individual Life Policy, or if you have not reached age 65, a Convertible Term to 65 Policy or a non-renewable One Year Term plan. The converted policy may be obtained without supplying evidence of insurability, but you must apply within 31 days following termination of your Group Life Insurance. Life conversion forms can be found on the Manulife Financial website. Claims Procedure Life claim forms will be provided by Human Resources. Keep this summary in a place where your beneficiary may refer to it. Taking a lump sum settlement is only one of the ways of settling a Life claim. A settlement option such as a life income should be considered. If you do not make a settlement option election, your beneficiary may do so at the time of claim. Make sure that your beneficiary knows that these options are available. Life claims must be submitted within three months of the loss. 06/14/10 23

26 BASIC ACCIDENT INSURANCE This is the equivalent of a double indemnity feature under your Group Life Program. Eligibility All permanent, active, full-time academic, administrative and support staff of St. Francis Xavier University who are between the ages of 16 and 69 inclusive and are participating in the University s Group Life Insurance program. Effective and Termination Date of Individual Insurance The Insurance with respect to an Insured Employee takes effect or terminates on the date that his/her Group Life Insurance with the University takes effect or terminates. Coverage All accidents resulting in Death or Dismemberment are covered, anywhere in the world, 24 hours per day. Schedule of Insurance Benefits If within one year after the date of an accident, an Insured Employee suffers a loss listed below, the Insurer will pay: For Loss or Percentage of Loss of Use of: Principal Sum Life % Both Hands % Both Feet % Entire Sight of Both Eyes % One Hand and One Foot % One Hand and the Entire Sight of One Eye % One Foot and the Entire Sight of One Eye % One Arm... 75% One Leg... 75% One Hand... 66% One Foot... 66% Entire Sight of One Eye... 66% Thumb and Index Finger or at Least Four Fingers of One Hand... 33% For Loss of: All Toes of One Foot... 25% Speech and Hearing in Both Ears % Speech % Hearing in Both Ears... 66% Hearing in One Ear... 25% For Total Paralysis of: Both Upper and Lower Limbs (Quadriplegia) 200% Both Lower Limbs (Paraplegia) % Upper and Lower Limbs of One Side of Body (Hemiplegia) % Only one benefit, the largest to which you are entitled, is payable for all losses resulting from any one accident. 06/14/10 24

27 Amount of Principal Sum The amount of Principal Sum applicable to each Insured Employee is equal to the amount of Group Life Insurance as shown in the Life Insurance summary. Losses are payable for: Accidental Death and Dismemberment Loss of Speech and/or Hearing Paralysis Loss of Use Repatriation Rehabilitation Occupational Training Waiver of Premium Exclusions No coverage will apply: a) While on service in the armed forces of any country; b) As the result of declared or undeclared war or act thereof; c) As the result of air travel, except as a passenger in any aircraft having a current and valid certificate of airworthiness; d) As the result of flying in any aircraft owned, operated or leased by your employer; e) In case of suicide or self-destruction or any attempt thereat while sane or insane. Beneficiary Indemnity for Loss of Life of an Insured Employee shall be payable to the beneficiary designated on his/her Group Life Insurance with the University. All other indemnities shall be payable to the Insured Employee. Claims Procedure Written notice of claim for loss must be given to the Insurer, within 90 days after the date of such loss or as soon thereafter as it is reasonably possible, but in no event later than one year after the day of the accident. For assistance with all claims contact Human Resources. 06/14/10 25

28 LONG TERM DISABILITY Eligibility and Classification Class A - All full-time Employees actively at work for a minimum of 20 hours per week who are participating in the employer's defined contribution pension plan (this excludes maintenance and cleaning personnel). Class B - All full-time Employees actively at work for a minimum of 20 hours per week who are not participating in the employer's defined contribution pension plan (this excludes maintenance and cleaning personnel). Schedule of Benefits Income Benefit - 60% of regular monthly salary rounded to the next higher $1.00, if not already a multiple thereof. Maximum Income Benefit - $10,000 per month (no evidence limit) Elimination Period days Maximum Benefit Duration - To age 65 For Class A employees only, 13% of monthly salary shall be paid direct to the Employer's Pension Plan. All Source Maximum An employee s total monthly income while disabled cannot exceed 85% of net monthly earnings as of the date disability commences. If total income exceeds 85%, the Long Term Disability income benefit will be reduced by the amount of such excess. With respect to a disabled employee participating in a program of rehabilitation, total monthly income while disabled cannot exceed 100% of net monthly earnings as of the date disability commences. If total income exceeds 100%, the Long Term Disability income benefit will be reduced by the amount of such excess. Description of Benefit If you are totally disabled by accident or sickness while insured under the Plan, this insurance will provide the disability benefit specified in the Schedule of Benefits. The benefits will commence after the elimination period shown in the Schedule of Benefits and will continue while you are totally disabled or until you attain age 65. Income benefit payments will be paid monthly at the end of the month for which they are due. Totally disabled, for the first 24 consecutive months of benefit payment, shall mean the employee is not able to perform any and every duty of the employee s occupation or employment. After 24 months, totally disabled shall mean the employee is not able to perform any and every duty of any occupation or employment for which the employee is reasonably qualified by education, training or experience. 06/14/10 26

29 Benefits payable under this Policy shall be reduced by the amount of benefits paid or payable to you (excluding benefits for which your dependents may qualify) for permanent or temporary total disabilities under: (a) (b) (c) Workmen's/Workers' Compensation Act; and the disability or retirement provisions of the Canada/Quebec Pension Plan, which shall be the initial amount that you are entitled to as of the commencement date of disability under such plan; and any disability benefit or retirement benefit paid under any group insurance or retirement plan available through the employer. If during or immediately following a period of disability for which benefits were payable, you engage in rehabilitative employment, the Insurer will pay your monthly benefit less 50% of the amount of compensation or income received by you from the rehabilitative employment. Rehabilitative Indemnity will continue for the period you are employed, but not beyond age 65. Exclusions (1) suicide, attempted suicide or intentionally self-inflicted injury, while sane or insane; (2) insurrection or war, whether war is declared or not, or active full-time service in the armed forces of any nation; (3) services or supplies in respect to benefits not specifically included under this Policy. Termination of Employee Insurance Your coverage terminates under the following circumstances: (1) When you are no longer in an eligible class either by virtue of being transferred to an ineligible class or by termination of active full-time employment; (2) When the Policy providing the coverage terminates; (3) When you are on a leave of absence without pay; (4) When you reach age 65. For employees who are on Sabbatical or other approved paid leave, coverage is to remain in full force at the amount the employee would have been eligible for had he/she not been on leave. Waiver of Premium The Insurer will waive the payments of premium for an insured employee for the period during which benefits are payable under this Policy and the insured employee's insurance will remain in force during such period, subject to all other provisions of this Policy. Claiming and Payment of Benefits Preliminary claim forms are available from Human Resources. Should subsequent claim forms be required, they will be sent to you as needed. Instructions for completion are indicated on the claim forms. However, should you have any difficulties, please do not hesitate to contact Human Resources. 06/14/10 27

30 OPTIONAL GROUP LIFE INSURANCE In addition to your Basic Group Life Insurance, you may wish to apply for an additional amount of group life by completing the Optional Group Life Insurance application form. If your application is approved, coverage will take effect on the first day of the next month. The Insurer will be responsible for any medical expenses incurred for information required in order to proceed with your application. The amount of insurance shown below is available for your selection. Option A One (1) times your annual salary, rounded to the nearest $100. Option B Two (2) times your annual salary, rounded to the nearest $100. Option C Three (3) times your annual salary, rounded to the nearest $100. The maximum benefit is $165,000. Schedule of Rates for Optional Group Life Insurance AGE Retirement Benefit SMOKER RATE (Per $10,000/month) NON-SMOKER RATE (Per $10,000/month) $ 0.55 $ $ 0.71 $ $1.05 $ $1.53 $ $2.66 $ $4.07 $ $7.06 $ $10.79 $6.08 If you retire prior to age 65, your optional group life insurance will continue in force until your 65th birthday or the December 31st coincident with or next following your retirement date, whichever first occurs. Total Disability Benefits Should you become totally disabled for more than six (6) months prior to age 65, the amount of your Optional Group Life insurance will continue without payment of premiums until recovery or until terminated according to the master contract. Exclusions This benefit is not payable where the cause of death is suicide occurring within one (1) year from the date your coverage became effective. Termination Age Your Optional Group Life Insurance benefit terminates at: i) for active employees, the December 31st coincident with or next following your 65th birthday, or ii) for employees who retire prior to age 65, your 65th birthday or the December 31st coincident with or next following your retirement date, whichever first occurs. 06/14/10 28