U. A. LOCAL 628 MEMBERS BENEFIT PLANS EMPLOYEE BENEFIT PLAN MEMBERS PENSION PLAN GROUP LEGAL PLAN

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1 U. A. LOCAL 628 MEMBERS BENEFIT PLANS MEMBERS PENSION PLAN GROUP LEGAL PLAN Effective Date: January 1, 2009

2 U. A. LOCAL 628 MEMBERS BENEFIT PLANS MEMBERS PENSION PLAN GROUP LEGAL PLAN Effective Date: January 1, 2009 This Booklet contains important information and should be kept in a safe place for future reference.

3 TABLE OF CONTENTS MEMBERS BENEFIT PLAN U. A. LOCAL 628 EMPLOYEE BENEFIT PLAN Employee Benefit Plan _ 3 Members Pension Plan _ 45 Group Legal Plan 61 FOR MEMBERS AND THEIR DEPENDENTS Effective Date: January 1, 2009 Group Contract No.:

4 TABLE OF CONTENTS Introduction _ 5 Benefit Highlights _ 7 Eligibility and Coverage Provisions 11 Occupational Accident or Illness _ 16 How to Claim for Benefits 19 General Information 20 Member Life Insurance Benefit 22 Member Accidental Death and Dismemberment Benefit _ 24 Member Weekly Disability Benefit 25 Member Long Term Disability Benefit 28 Canada Pension Plan Disability Benefit 33 Health Care Benefits for Members and Dependents 33 Dental Benefits for Members and Dependents 39 Coordination of Benefits _ 43 INTRODUCTION The Plumbers and Pipefitters Union Local 628 Employee Benefit Plan provides eligible participants with a wide range of benefits including Life Insurance, Accidental Death and Dismemberment, Weekly Disability, Long Term Disability, Health Care, Vision Care, and Dental Care. The purpose of this Booklet is to explain and summarize the U.A. Local 628 Employee Benefit Plan so that each Member will know: How it operates What the member is entitled to receive How to claim benefits The Benefit Plan operates under the supervision and direction of a Board of Trustees representing both the Union and participating employers. The Plan is financed primarily by participating employers through contributions determined on a cents-per-hour basis through collective bargaining. Such contributions are deposited in a benefit trust fund to secure the future delivery of benefits. The rights of Members, recipients and all other persons entitled to receive any payments or benefits under the Plan are limited by the assets held in such benefit trust fund from time to time. The Trustees wish to assure you that they will continue to carefully administer the program, in consultation with advisors, so that you will receive the maximum benefits that may be provided from the contributions made to this Benefit Plan. This Booklet describes the main features of the Plan in effect as of January 1, 2009 and every effort has been made to ensure that the information is accurate. If any questions of interpretation arise, the Group Contract (Manulife Policy No. 4329) will be the sole governing document. The Booklet is not a substitute for the Plan s official provisions as established from time to time by the Plan s Trustees and Manulife. We encourage you to read each section of this Booklet to understand more fully your benefits and the conditions under which they are payable. If you are unclear about the benefits program or your particular coverage or circumstances, please be sure to direct your questions to the Benefits Department at the Union Office. 4 INTRODUCTION 5

5 To help us ensure you receive the benefits to which you are entitled, please keep your Member information up to date at all times. Address changes and changes in your status should be reported promptly within 31 days to the Benefits Department at the Union Office. CLAIMS SHOULD BE SUBMITTED TO THE PLAN ADMINISTRATOR AT: Union Benefits Plumbers and Pipefitters Union Local 628 Employee Benefit Plan Administrator 151 Frobisher Drive, Suite E-220 Waterloo, Ontario N2V 2C9 Telephone: (519) or Fax: CONTACTING YOUR UNION OFFICE For more information about the Life, Accidental Death & Dismemberment, Weekly Disability, Long Term Disability, Dental and Health Benefits, call or write your Union Office. Plumbers and Pipefitters Union Local 628 Employee Benefit Plan 969 Alloy Drive Thunder Bay, Ontario P7B 5Z8 Telephone: (807) MAILING INSTRUCTIONS When writing the Union OR sending a claim to the Plan Administrator, make sure you include the following information: Your name clearly written or printed Your full home address and telephone number including area code Your Social Insurance Number/ Identification Number BOARD OF TRUSTEES Plumbers and Pipefitters Union Local 628 Employee Benefit Trust Terry Webb Dave Andrusyk Alan Vanderploeg Andrew Sinclair John Jurcik Barry Leochko BENEFIT HIGHLIGHTS FOR ELIGIBLE MEMBERS The following section briefly summarizes the benefits available to you and highlights the main provisions of the Plan. Life Insurance BENEFITS FOR YOU For all eligible active and retired* members: $30,000 for members under age 70. $15,000 for members age 70 and over. * $5,000 for retired members in good standing who are in receipt of a pension and who do not elect to make the required contributions to continue coverage. This benefit is provided by the Fund. Accidental $30,000 for all eligible active members Death and under age 70. Dismemberment Weekly Disability For all eligible active members: First 17 weeks of benefit payments - $210 per week. After 17 weeks of benefit payments - $250 per week. Benefit Duration: 26 weeks. Waiting Period: Accident Nil. Illness 7 days. Illness, if hospitalized for at least 18 hours lesser of 7 days or period prior to hospitalization. continued CONTACTING 6 BENEFIT HIGHLIGHTS 7

6 Weekly Disability (continued) BENEFITS FOR YOU (continued) If you qualify for Accident and Sickness benefits from Employment Insurance, the Member Weekly Disability Benefit will be suspended when E.I. benefits begin. If you continue to be disabled after exhaustion of your E.I. benefits (maximum 15 weeks), the Member Weekly Disability Benefit will resume to you for a maximum period of protection of 26 weeks of benefit payments, including the period covered by E.I. benefits. If you do not qualify for E.I. Benefits, Member Weekly Disability Benefits will be payable as long as you remain so disabled up to a maximum period of 26 weeks of benefit payments. Charges for the completion of medical forms and reports by a licensed doctor (M.D.) or specialist are limited to $75 per calendar year. Long Term $1,000 per month for all eligible active members Disability under age 65. Waiting Period: 26 weeks. The benefit begins after 26 weeks of total disability until the earliest of: the date you attain age 65*; the date you retire; the date you recover; or the date you die * If you are age 64, but under age 65 when the Waiting Period of 26 weeks is satisfied, benefit payments may continue for 12 consecutive months provided you remain Totally Disabled. BENEFITS FOR YOU AND YOUR DEPENDENTS HEALTH CARE Overall Lifetime Benefit Maximum: $100,000* Calendar Year Deductible: NIL. The Plan pays: - 50% for smoking cessation aids (applies to second course of treatment only); - 100% for all other eligible medical expenses * $100,000 for all expenses combined, excluding Out-of-Hospital Nursing Benefit. Drugs Drug Dispensing $10.00 per Fee Maximum prescription or refill. Smoking Cessation Aids $600 per lifetime By prescription only including Zyban. - First Course of Treatment $400 - Second Course of Treatment $200 Maximum Drug Benefit for Viagra and Viagra type drugs $500 per cal. yr. Hospital Semi-Private. (Within Home (Difference between standard ward accommodation Province) and the hospital s charge for a semi-private room). Convalescent/ Room and Board Limit $10.00 per day Rehabilitation Hospital (Within Maximum Stay Home Province) (per period of disability) 100 days (Confinement must begin before age 65) Out-of-Hospital $10,000 Nursing (per calendar year) Health Podiatrist and Chiropodist $200* combined Practitioners Benefit Chiropractor, Osteopath, $200* per type of Maximum (per Naturopath, Psychologist, practitioner calendar year) or Speech Therapist * The $200 Maximum includes $25 per disability for X-rays. continued 8 BENEFIT HIGHLIGHTS 9

7 BENEFITS FOR YOU AND YOUR DEPENDENTS (continued) Vision Care Lenses and Frames or $400 (per 24-month Contact Lenses or Laser Eye Surgery or Prescription period) Safety Glasses (Contact Lenses if required following cataract surgery or when visual acuity can be improved to at least the 20/70 level by contact lenses but cannot be improved to that level by spectacle lenses.) Hearing Care Benefit Maximum $300 (per lifetime) Foot Care Orthopedic Shoes Benefit $200 every 12-month period if part of a brace. Maximum $75 every 12-month period if not part of a brace. DENTAL CARE Calendar Year Deductible: NIL. Arch Supports, Molds or Orthotic Devices $200 every 24-month period. $200 every 12-month period if under age 18 Payments under this plan will be based on the 2006 Dental Association Fee Guide for General Dental Practitioners of the Province of Ontario. The Plan pays 100% for Routine Care, Dentures, and Crowns and Bridgework, subject to a combined maximum benefit of $2,500 per calendar year. Orthodontics For Children Benefit Maximum 50% of the orthodontic fee up to a maximum of $1,500 per child per lifetime. ELIGIBILITY AND COVERAGE PROVISIONS When am I eligible for benefit coverage? Member Eligibility To be eligible for coverage you must be: a member in good standing of Local 628 of the United Association of Journeymen and Apprentices of the Plumbing and Pipefitting Industry of the United States and Canada; or you are an apprentice duly indentured through the Joint Training Committee; or a retired member certified as such by the Union; and have completed an enrollment card; in a class shown in the Schedule; and covered under a Provincial Health Insurance Plan. Retiree Eligibility A retired member will be covered as if an active member until the end of the month in which there is less than 150 credited hours (effective November 1, 1995) in the member s hour bank. To then be eligible for retired coverage, the retired member must be in good standing with the Union and must be receiving a pension from the U.A. Local 628 Pension Plan or have applied for and will be receiving a pension from the U.A. Local 628 Pension Plan. Members who retired prior to June 1, 2002 may elect to continue all benefits, excluding the Member Weekly Disability, Member Long Term Disability Benefits, and the Member Accidental Death and Dismemberment Benefit, by making the required contributions to the Fund. Members who retired on or after June 1, 2002 may elect to continue all benefits, excluding the Member Weekly Disability, Member Long Term Disability Benefits, Dental Benefits and the Member Accidental Death and Dismemberment Benefit by making the required contributions to the Fund. The retired member must apply within 90 days of their retirement or expiration of their hour bank to be eligible for this election. If the contributions are not continuous or if the retired member does not elect to make the required contributions, the retired member will be eligible for the reduced amount of Member Life Insurance only, which will be provided by the Fund. Once a retired 10 ELIGIBILITY AND COVERAGE PROVISIONS 11

8 member is receiving the reduced amount of Member Life Insurance the member may not later elect to continue the benefits that were available by making the required contributions to the Fund. Dependent Eligibility To be eligible for coverage your dependent must be insured under a Provincial Health Insurance Plan. Your dependent becomes eligible for coverage when you become eligible or, if acquired later, upon becoming your dependent, and you must be covered in order for your dependents to be covered. When does my coverage start? You will be eligible for coverage on the later of: the Effective Date of this plan; or the first day of the second month following the accumulation of 450 credited hours in your Hour Bank. Coverage for you and your dependents will become effective on the date of eligibility. Coverage, or any increase in coverage, for your dependent (other than a new-born child who becomes covered within 31 days of becoming eligible) who is confined in a hospital because of illness or injury on the date such coverage would otherwise become effective, will not become effective until the date such dependent is no longer so confined. Who pays for benefits? While you are actively working, your participating employer is required to make negotiated contributions to the Plumbers and Pipefitters Union Local 628 Employee Benefit Trust on your behalf. How do I get credit for Hours reported by my employer? Once you become eligible, additional hours reported will be credited to your Hour Bank by the Plan Administrator, and each month 150 credited hours (effective November 1, 1995) will be deducted from your Hour Bank for coverage. What happens if my hour bank is credited with more than the monthly hour bank deduction per month? If hours reported on your behalf total more than the required Monthly Hour Bank Deduction, these hours will stay in your Hour Bank to be used in those months when you are working fewer hours which results in credited hours being below the Monthly Hour Bank Deduction. You may accumulate up to a maximum of 3,600 credited hours in your Hour Bank which will provide you with 24 months of coverage after you have stopped working. When will my coverage terminate under this Plan? Coverage for you and your dependents will terminate on the earliest of: the end of the month in which there is less than 150 credited hours in your Hour Bank; the date you retire (and have exhausted your hour bank), unless otherwise indicated in the Schedule; the date you cease to be a member of an eligible class; the date you cease to be a member in good standing of U.A. Local 628; the date premium payments cease; or the date this plan is discontinued. Coverage for your dependents will terminate on the date such dependents cease to be eligible. Can I become covered again after my coverage stops? If your coverage terminates because of not enough credited hours and if, during a period of 12 consecutive months following such termination, you accumulate at least 300 credited hours in your Hour Bank, you will be eligible for reinstatement of coverage on the first day of the second month following such accumulation. If you do not accumulate 300 hours within 12 months any hours remaining in your bank of credited hours will be forfeited. You will then have to satisfy the initial eligibility requirements. 12 ELIGIBILITY AND COVERAGE PROVISIONS 13

9 Can Incapacitated Children continue for benefits beyond the limiting age for coverage? Health Care and Dental Care Benefits will continue beyond the date an unmarried child attains the limiting age for coverage, provided proof is submitted to the Plan Administrator within 31 days after such date that such child: is incapable of self-sustaining employment by reason of mental retardation or physical handicap; became so incapacitated prior to attainment of the limiting age; and is chiefly dependent upon you for support and maintenance. Thereafter, such proof must be submitted to the Plan Administrator as required, but not more often than yearly. How does the apprentice Hour Bank work? An apprentice who is attending Trade School on approval by the Joint Training Committee will have his Hour Bank frozen for up to a maximum of 2 months. The fund will continue coverage during this time. Can I pay for benefit protection personally? You may pay for continued benefit coverage under the Plan s Pay-Direct provision for up to 12 consecutive months, excluding Member Weekly Disability and Member Long Term Disability Benefits, if you are an initiated member in good standing with the Plumbers and Pipefitters Local Union 628. How does the Pay-Direct provision work? The Pay-Direct provision is available to you if you are an initiated member in Good Standing whose coverage will otherwise cease because your Hour Bank has dropped below the Monthly Hour Bank Deduction (150 hours). Under this provision, you will be allowed to make monthly contributions to keep your coverage in force, until you earn/work enough hours to bring your Hour Bank back up above the Monthly Hour Bank Deduction. During this period, Member Weekly Disability and Member Long Term Disability Benefits will not be covered. If you decide not to make direct payments, during the 12-month period following the termination of your benefits, you will be eligible for reinstatement of insurance on the first day of the second month following an accumulation of 300 hours in your bank. The Administrator will notify you when you first need to make a Pay- Direct contribution. You are responsible for maintaining Pay-Direct contributions thereafter if you are not working for a contributing employer but wish to maintain your benefit coverage. Retroactive Pay-Direct contributions will not be allowed. All Pay-Direct contributions must be received by the 15th of the month for which they are due. The Pay-Direct contributions may be waived if you are receiving Disability benefits from the Plan or from Workers Compensation. What are the Pay-Direct options and how much will Pay-Direct cost? The Pay-Direct option provides full coverage for active members excluding Weekly Disability and Long Term Disability Benefits. If you are not retired, the Pay Direct option is available for a maximum of 12 months. Members who retired prior to June 1, 2002 may pay-direct for Life, Health Care and Dental Care. Members who retired on or after June 1, 2002 may pay-direct for Life and Health Care only. The Pay-Direct contribution rate is $ plus an 8% retail sales tax of $16.15 (total $218 effective July 1, 2002) for active members, and $ plus an 8% retail sales tax of $10.59 (total $143 effective July 1, 2002) for retired members, and $ plus an 8% retail sales tax of $13.70 (total $185 effective July 1, 2002) for members who retired prior to June 1, However, these rates will be adjusted from time to time to reflect the expected cost of coverage. What happens if I become disabled? If an eligible member is disabled due to illness or injury and if benefits are payable under: any Workers Compensation Law, the Fund will continue coverage for up to 12 months; or the Weekly Disability Benefits or Long Term Disability Benefits under this Plan, the Fund will continue coverage during such time. What is the Medical Information Bureau (MIB)? MIB Group Inc. (MIB) is a non-profit membership organization of life insurance companies, which operates an information exchange on behalf of its members. 14 ELIGIBILITY AND COVERAGE PROVISIONS 15

10 Manulife or its reinsurers may periodically report information to the MIB. If you apply to receive life, disability or health insurance coverage from another MIB member company or submit a claim for benefits to such a company, the MIB upon request will supply the other insurer with the information on file. Manulife or its reinsurers may also release information in its file to other life and health insurance companies to whom you may apply for insurance or submit a claim for benefits. All information obtained will be treated as confidential. Upon your request, the MIB will arrange disclosure of any information it may have in your file. If you question the accuracy of information in the MIB file, you may contact the MIB and seek a correction. Their address is: Medical Information Bureau 330 University Avenue Suite 501 Toronto, Ontario M5G 1R7 Telephone: (416) OCCUPATIONAL ACCIDENT OR ILLNESS If you become disabled as a result of an occupational accident or illness while you are covered by this Plan and are in receipt of Workers Compensation Benefits, you and your Dependents will continue to be covered for the first twelve (12) months. While you are entitled to this free coverage, your Hour Bank will be frozen and any applicable Pay- Direct contributions will be waived. Thereafter, if you are an initiated Member in Good Standing of the Plumbers and Pipefitters Union Local 628, are under age 65, continue to receive temporary disability benefits or a lifetime pension from a Workers Compensation Board, the cost of covering you and your Dependents will continue to be paid from the general reserves of the Fund until the earliest of the following dates: the date you are no longer disabled as defined under the Plan; the end of the month in which you attain age 65; the date you are no longer a Member in Good Standing. Free coverage may also be continued if you are at work under a rehabilitation programme of a Workers Compensation Board. Who are my eligible dependents? Dependent means a spouse or unmarried child under 21 (25, if regularly attending school) and solely dependent upon the member for support. Spouse means a husband or wife by virtue of a religious or civil marriage ceremony; except that, a person living with the member under a common-law relationship will deemed to be the member s spouse, if such person: is publicly represented as the member s spouse; has completed the Statutory Declaration; and has been living with the member for a period of at least one continuous year. Child means: a natural or legally adopted child; or a step-child or other child, who is dependent upon the member for support and lives with the member in a regular parentchild relationship. What happens to my dependent coverage in the event of my death? Your dependents who are covered under this plan at the time of your death may request to continue to be covered for Health Care and Dental Care Benefits provided: the required contributions for such coverage are made to the Fund; and such request for continuation of coverage is made to your Administrator within 30 days of the date of your death; but not beyond the earliest of: the date such dependents cease to be eligible; the date your spouse remarries (children will continue to be covered); the end of the remaining hours in your Hour Bank (if your 16 OCCUPATIONAL ACCIDENT OR ILLNESS 17

11 Hour Bank on the date of your death had sufficient hours to provide 12 months or more of benefit coverage); the end of the 12-month period after the date of your death (if your Hour Bank on the date of your death had sufficient hours to provide less than 12 months of benefit coverage, then your dependents may use the hours in the Hour Bank and then may elect to pay direct for a total of 12 months of coverage); or the date coverage for your dependents terminates for any reason. Upon your death, benefits are payable to your spouse if living, or to your child (or legal guardian). What if my Spouse also has group insurance benefits? If you or your Dependents are covered under more than one Group Health Care or Dental plan, the Coordination of Benefits provision allows claims to be made under more than one plan, but the total reimbursement received cannot exceed 100% of the actual expenses incurred. What if the accident or illness involves a Third Party? If you receive disability benefit payments under the Member Weekly Disability Benefit or under the Member Long Term Disability Benefit for loss of income for which there may be a cause of action against a third party, you will be required to complete a Reimbursement Agreement. This will entitle Manulife to be reimbursed for any amount(s), including interest you recover from a third party for: loss of income; or medical or dental expenses; which, together with any amount(s) paid or payable under any of the benefits of this plan, would exceed your actual loss. Following notification to Manulife of payment by a third party of any judgment or settlement, further disability payments will terminate until Manulife has been reimbursed the amount set out in the Reimbursement Agreement. If a lump sum payment is made under judgment or settlement for loss of future income, no further disability benefits will be paid until such time as the sum of the benefit payments otherwise payable equals the amount of such lump sum. HOW TO CLAIM FOR BENEFITS How to Claim? Claims forms are available from your Employer. Be sure to complete them fully, attach original bills where applicable to substantiate your claim and submit to your Administrator: Union Benefits 151 Frobisher Drive, Suite E-220 Waterloo, Ontario N2V 2C9 At Manulife s option, you may by written request direct that all or part of the benefits for Health Care and Dental Care Benefits be paid directly to the hospital or person rendering such care. How do I name or change my beneficiary(ies)? For member death benefits, you may name a beneficiary(ies) and, from time to time, change such named beneficiary(ies), subject to Provincial Law, by written request filed at: the Administrator s Office; or Manulife s Head Office; to take effect as of the date such request was executed, but without prejudice to Manulife for any payments made before such request is received at its Head Office. Is there a time limit for submitting claims? Written proof stating the occurrence, character and extent of loss must be submitted for each Benefit to Manulife within: 6 months after the date of death under the Death Provision for Life Insurance Benefits; 12 months after the date the member ceases active work 18 HOW TO CLAIM FOR BENEFITS 19

12 because of Total and Permanent Disability under the Disability Provision for Life Insurance Benefits; 6 months after the date of the loss for Accidental Death and Dismemberment Benefits; 6 months after the start of Disability for the Member Weekly Disability Benefit; 6 months after the end of the Waiting Period for the Member Long Term Disability Benefit; and 18 months after the date of the loss, but not more than 6 months after the date coverage terminates, for Health Care and Dental Care Benefits. Legal action to recover benefits under this plan must begin within 2 years (6 years for Life Insurance) of the date of loss. Manulife shall have the right and opportunity to examine any person whose injury or illness is the basis of claim, when and as often as it may reasonably require during the pendency and payment period, if any, of such claim. GENERAL INFORMATION What should I do if my address or my dependent status changes? Complete a new Member Information Card. You must notify the Administrator within 31 days of any change in your address or family status such as: Change of address; Change in marital status; Establishment of a common-law relationship; Birth or adoption of a child; Change of beneficiary for any reason, including your beneficiary s death; A Dependent Child becoming disabled; or A Dependent Child commencing full-time attendance at a post-secondary school. What if my claim for benefits is fraudulent? Any Member of the Plan who obtains, or attempts to obtain, a Plan benefit to which the Member is not entitled (inducing a benefit greater than the entitlement) by submitting false, misleading or inaccurate information, may, at the discretion of the Trustees: be refused payment of every such benefit; be denied coverage under the Plan; and be declared ineligible for future benefits under the Plan unless the member can establish that any discrepancy in the information submitted was due solely to a bona fide error on his/her part. This provision also applies if a Member fails to repay any benefit overpayments received from this Plan as a result of benefits granted by any government authority, including benefits received under any Workers Compensation Act or Canada/Quebec Pension Plan. Member who knowingly obtain, or attempt to obtain, benefits under false pretences may be subject to criminal prosecution. What income tax is payable? You will receive a T4-A tax slip from the Administrator for the portion of the contribution representing the cost of your Life Insurance. Taxes will not be deducted from payments under this Plan but will have to be paid by you when you file your income tax return for the year. For example, Weekly Disability, and Long Term Disability benefit payments are taxable income which you will need to report on your income tax return. T4-A tax slips will be issued to you annually reflecting the taxable benefits you received for the calendar year. Medical expenses reimbursed under the Plan cannot be claimed as deductible expenses when filing your income tax return. Can the Plan be changed? The Plan is financed principally by negotiated contributions. The Trustees have established the terms of the Plan that can be provided by such contributions and the Plan s assets. If there are losses or gains from operations of future increases in contributions, then the Trustees, in cooperation with Manulife, may change the provisions of the Plan accordingly. The Trustees may modify a Plan requirement in an individual situation, in cooperation with Manulife, if they consider the requirement unreasonable under the circumstances and a cause of undue hardship to a Member or the Member s family. 20 GENERAL INFORMATION 21

13 Any person wishing to appeal any action by the Plan s Administrator must notify the Trustees by letter. The decisions of the Plan s Trustees, in cooperation with Manulife, are final, conclusive and binding to all persons. Does the Plan cover accidents at work? The Plan provides a lump sum benefit for death or dismemberment as a result of an accident at work. Workers Compensation provides benefits for loss of income, death, dismemberment and medical expenses resulting from occupational accidents or occupational sickness. MEMBER LIFE INSURANCE BENEFIT What is paid if I die? In the event of your death due to any cause while covered, your named beneficiary(ies), if living, otherwise your estate will receive a lump sum payment in the amount of your Member Life Insurance Benefit. If you are covered under the Plan as an Active* member, or as a Retired member who made the necessary contributions to continue coverage, $30,000 will be paid to your beneficiary(ies) if your death occurs under age 70, or $15,000 if your death occurs at age 70 or over. If you are covered under the Plan as a Retired member, who does not elect to make the required contributions to continue coverage, you will be eligible for $5,000 of Member Life Insurance only, which will be provided by the Fund. * A member who is receiving LTD benefits, and later begins to receive a pension from the U.A. Local 628 Pension Plan, will be deemed to be an active member until the LTD Benefit payments cease. What is paid if I die while disabled? If you are an Active member and become Totally and Permanently Disabled while covered, and continue to be so disabled for the next 6 months and are under age 65, the Member Life Insurance for which you were covered at the time you are so disabled will continue while you are so disabled, but not beyond your 65th birthday subject to any reduction or termination due to a change in class. You must submit proof satisfactory to Manulife, within 12 months of the date you cease active work, that you are so disabled. From then on you must submit proof satisfactory to Manulife, as required, that you are still so disabled. What does Totally and Permanently Disabled mean? Totally and Permanently Disabled means that solely because of an illness or injury, you are, and will continue to be, unable to work at any occupation for which you are, or may reasonably become, fitted by education, training or experience. Can I continue coverage for death benefit after my Member Life Insurance terminates? If your Member Life Insurance terminates because your employment or class membership terminates or because you no longer qualify for coverage under the Disability Provision, then on or before your 65th birthday, you may convert up to 100% of the terminated amount, less any amount of group life insurance for which you may become eligible within 31 days of the date of the termination. Note: The conversion option does not apply to reduction of life insurance or termination of insurance which become effective at specified ages or upon your retirement. You may convert to individual: ordinary life plan then being issued by Manulife; one-year convertible term insurance (if you have not passed your 65th birthday); or term insurance to age 65. In no event may the converted policy exceed $200,000 nor may it include disability or other added benefits. You must apply in writing and pay the first premium to Manulife within 31 days of the date your insurance terminates. The premium rates will be based on your age and class of risk at the time you convert. No medical exam or health questionnaire will be required. 22 MEMBER LIFE INSURANCE BENEFIT 23

14 What if I die after my Member Life Insurance terminates? If you die within 31 days of the date your Member Life Insurance terminates, the amount you could have converted will be paid as a death benefit under this plan even if you did not apply for conversion. MEMBER ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT Not more than the largest percentage shown for a body member will be paid for the loss of more than one part thereof. What is paid if I am injured in an accident? If you sustain an accidental bodily injury while covered and if a covered loss occurs as a direct result, and within one year, of the accident, the following will be paid to you, if living, otherwise to your beneficiary(ies), if living, or to your estate: Loss of Life $30,000 Loss of both hands or both feet $30,000 Loss of sight of both eyes $30,000 Loss of sight of one eye $15,000 Loss of one hand or one foot $15,000 A maximum benefit of $30,000 will be paid for all losses suffered, in any one accident, while you are covered under this Plan. Loss of a hand or foot means severance at or above the wrist or ankle joint; loss of sight means loss that is total, cannot be recovered, lasts at least one year and is deemed to be permanent. Exposure and Disappearance Loss due to exposure will be deemed to be accidental if the exposure was a direct result of an accident. If you disappear as a direct result of the accidental disappearance, wrecking or sinking of the conveyance in which you were an occupant, accidental death will be deemed to have occurred; provided, there is no evidence within one year thereafter that you are still alive. Are there any limitations to the payment of this benefit? Accidental Death and Dismemberment benefits will not be paid for a loss that results from or is contributed by: illness or disease of any kind; infection, unless the result of an accidental wound; medical or surgical treatment of other than an accidental injury; war, whether declared or not; insurrection, rebellion or participation in a riot or civil commotion; suicide or attempt thereat, while sane or insane; self-inflicted injury, while sane or insane; your commission of, or attempt to commit, an assault or a criminal offence; or traveling or flying in, or descending from, any kind of aircraft except as a passenger with no duties whatever, on an aircraft being solely used for the transportation of passengers or of passengers and cargo. MEMBER WEEKLY DISABILITY BENEFIT What does disabled mean? Disabled means that solely because of either an illness or accidental injury that is non-occupational, you cannot perform your job duties. What is paid if I am ill or injured in an accident? If you become disabled while covered and are seen by, and treated by, a licensed doctor (M.D.), and absent from work for more than the Waiting Period; weekly benefit payments of $210 per week will be made to you for the first 17 weeks of benefit payments and $250 per week thereafter. 24 MEMBER WEEKLY DISABILITY BENEFIT 25

15 When do my benefit payments start? If your disability results from a non-occupational accident and you cannot perform your job duties, your benefit payments will commence on the later of the first day of disability or the date you are first seen by, and treated by a licensed doctor (M.D.). If your disability results from an non-occupational illness and you cannot perform your job duties, your benefit payments will commence on the later of the eighth day of disability or the date you are first seen by, and treated by a licensed doctor (M.D.). How long will benefit payments be made to me? If you qualify for Accident and Sickness benefits from Employment Insurance, the Member Weekly Disability Benefit will be suspended when E.I. benefits begin. If you continue to be disabled after exhaustion of your E.I. benefits (maximum 15 weeks), the Member Weekly Disability Benefit payments will resume to you for a maximum period of protection of 26 weeks of benefit payments, including the period covered by E.I. benefits for as long as you are Disabled and under the ongoing care of a licensed doctor (M.D.). If you do not qualify for E.I. benefits, the Member Weekly Disability Benefit will be payable as long as you remain so disabled for as long as you are Disabled and under the ongoing care of a licensed doctor (M.D.) for up to a maximum of 26 weeks of benefit payments. Note: Be sure to apply for Employment Insurance Commission Accident and Sickness Benefits immediately upon becoming disabled. What if I recover and then become disabled again? A new Waiting Period and Benefit Duration will start, if you return to active full-time work for a period of 2 weeks before you again become disabled because of the same or a related cause; or 1 full day before you again become disabled because of a different or an unrelated cause. What happens if coverage under this benefit or the Plan terminates after I become disabled? If you are disabled on the date coverage under this benefit or the Plan terminates, you will be entitled to the same benefit as though coverage had not terminated. Can I claim benefits under this Plan while receiving workers compensation? Occupational disabilities are not covered under this Plan. Disabilities arising from work-related injuries or illness may be covered by Workers Compensation Benefit payments. Can I claim benefits under this Plan for disabilities caused by an automobile accident? Disabilities arising from or to an automobile accident may be covered as an eligible expense under the Plan. However, no benefits will be payable for illness or injury for which benefits are payable under the Quebec Automobile Insurance Act. Are there any limitations to the payment of this benefit? No benefit will be paid for: any day you do any kind of work for pay or profit; illness or injury for which benefits are payable under the Quebec Automobile Insurance Act; the period you are entitled to pregnancy or parental leave by statute, contract or employer agreement*; or any period of disability for which the insured member is eligible, qualified or entitled to receive a benefit under Employment Insurance. *This plan will, however, pay benefits for the post-natal recovery period of maternity leave in accordance with Manulife s claim practices; No benefit will be paid for any Disability that results from or is contributed by: war, whether declared or not; insurrection rebellion or participation in a riot or civil commotion; purposely self-inflicted injury; or your commission of, or attempt to commit, an assault or a criminal offence. Manulife may require you to report for a medical examination as often as is reasonable, by a licensed doctor (M.D.) of their choice. Failure to 26 MEMBER WEEKLY DISABILITY BENEFIT 27

16 report for a medical examination may result in termination of your benefit payments. Charges for the completion of medical forms and reports by a licensed doctor (M.D.) or specialist are limited to the maximum shown in the Benefits Highlights for Eligible Members. MEMBER LONG TERM DISABILITY BENEFIT What is paid if I am disabled for a prolonged period? After you have been totally and continuously disabled for 26 weeks while covered under this Plan, monthly benefit payments of up to a maximum of $1,000 will be made to you while you remain totally and continuously disabled, until the earliest of your recovery, death, or attainment of age 65. If you are age 64, but under age 65, when the Waiting Period is satisfied, benefit payments may continue for 12 consecutive months provided you remain Totally Disabled. The benefits you receive from Long Term Disability are considered earnings subject to income tax. Are my benefits reduced by income from other sources? Your Long Term Disability benefit will be reduced by income payable (or would have been payable had you applied for it): from any job for pay or profit (including under an approved rehabilitation or partial disability program); because you are disabled or retired under any plan required or provided by a government or pursuant to a statute, such as, but not limited to, Worker s Compensation, any Automobile Insurance Act and the Canada or Quebec Pension Plan (CPP/QPP), including income payable for your spouse, children or other dependents; and because you are disabled or retired under any other group coverage, benefit, pension or other arrangement for members of a group (whether on an insured basis or not); by any amount necessary to limit to 85% of pre-disability Earnings the income payable as a Long Term Disability Benefit. Should you receive income from any of the above sources payable: as a retroactive award, benefit payments will be adjusted to reflect any overpayment that may have been made; other than monthly, such income will be converted to a monthly basis; or in a lump sum payment for loss of future income, no further benefits will be paid until such time as the sum of the benefit payments otherwise payable equals the amount of such sum. Your benefit will not be reduced by income payable from: a CPP/QPP cost of living increase that occurs after the date you became Totally Disabled under this benefit; disability or retirement benefits at the level that you were receiving them prior to the date you became Totally Disabled under this benefit; or any individual disability insurance, exclusive of accident benefits payable under an automobile policy. Recovery of Benefits If you receive a benefit under this plan in excess of what should have been paid, Manulife has the right to recover the amount of such excess from you or deduct it from future monthly benefits payable to you. What does Totally Disabled mean? Totally Disabled means that solely because of an illness or accidental bodily injury that is non-occupational, you are unable to perform the essential duties of your own occupation (type of work, not just your own job) during the first 26 weeks of disability and for the next 24 months you are disabled; and thereafter, continue to be unable to work at any occupation for which you are, or may reasonably become, fitted by education, training or experience. The availability of employment will not be considered in the assessment of your disability. How long will benefit payments last? If you became Totally Disabled while covered and are seen by and treated by, a licensed doctor (M.D.) within 31 days of the date you became Totally Disabled, and 28 MEMBER LONG TERM DISABILITY BENEFIT 29

17 are absent from work for more than the Waiting Period (26 weeks), your Long Term Disability benefit payments will be made to you for the period following the waiting period for as long as you are: totally disabled; under the ongoing care of a licensed doctor (M.D.); and residing in Canada, unless prior approval to the contrary is obtained from Manulife; but not beyond the end of the month in which the Benefit Duration is completed. What happens if I am disabled during a maternity / parental leave? No benefit will be paid for the period you are entitled to pregnancy or parental leave by statute, contract or employer arrangement. What if I recover and then become disabled again? Any 2 periods of disability due to the same or a related cause, that are separated by return to active full-time work for less than 6 months (2 weeks during the Waiting Period) from the first period of disability, will be deemed to be 1 period of Total Disability with only the initial Waiting Period applying, provided the first period begins while you are covered under this Benefit. What is rehabilitative employment? Long Term Disability benefits are paid during periods when you are Totally Disabled and cannot work. However, you may be able to work at some type of job and earn an income, even though you are not yet fully recovered. If you recover enough from your disability to be able to work full-time or part-time at any job under a rehabilitation program approved in writing by Manulife, you will still be deemed to be Totally Disabled and entitled to a benefit. If you refuse to participate in a rehabilitation program recommended by Manulife, your benefit payments will be terminated. Can benefit payments continue if I am partially disabled? If your are Totally Disabled but able to work under a program approved in writing by Manulife and perform at any time: during the Waiting Period and the next 24 months: - any of the duties of your own occupation on a part-time basis; or - the duties of any other occupation on a full-time or parttime basis; or from then on: - the duties of any occupation on a part-time basis; you will still be entitled to a benefit. Are any disabilities excluded from coverage? Coverage is excluded for a disability that results from or is contributed to by: war, whether declared or not; insurrection, rebellion or participation in a riot or civil commotion; purposely self-inflicted injury; you commission of, or attempt to commit, an assault or criminal offence; chronic alcoholism, or use of narcotics, barbiturates or hallucinogens, unless you are receiving ongoing active professional treatment deemed appropriated for the condition being treated; or a pre-existing condition as described below. What is the Pre-existing condition limitation? If during the first 12 months that you are covered, you become Totally Disabled, directly or indirectly, because of an illness or injury for which you: received medical treatment, consultation, care or service including diagnostic tests; or 30 MEMBER LONG TERM DISABILITY BENEFIT 31

18 took prescribed drugs; during the 90-day period before the date you became covered, no benefit payments will be made. If, after the first 12 months that you are covered, but before you have been covered 24 months, you again become Totally Disabled because of the same or related cause, you must: have returned to active full-time work for at least 6 months; and be absent from work for more than the Waiting Period; before benefit payments will be made. How do I apply for free coverage? If you are in receipt of Long Term Disability Income from the Plan, your free coverage will be granted to you automatically once you commence receiving benefits. No premium is required for this coverage during a period for which you are entitled to receive benefit payments under this benefit. What happens if coverage under this benefit or the Plan terminates after I become disabled? If you are Totally Disabled on the date coverage under this benefit or the Plan terminates, you will be entitled to the same benefit as thought insurance had not terminated. What are the exclusions and limitations to the payment of this benefit? Benefit payments may be terminated if you: fail to provide proof of ongoing disability when requested to do so; refuse or fail to complete and return or comply with the terms of the Reimbursement Agreement in accordance with the Third Party Liability provision; fail to report for a medical examination, as often as may reasonably be required, by a licensed doctor (M.D.) of Manulife s choice; or are not receiving accepted standard professional treatment for the condition being treated and, where appropriate, treatment by a relevant and certified specialist. CANADA PENSION PLAN DISABILITY BENEFIT If you are totally and permanently disabled and the disability will continue for a long time, you should apply for CPP/QPP disability benefits. Claims forms for CPP/QPP disability benefits can be obtained by contacting your local Service Canada office, and these benefit payments are available after you have been totally and permanently disabled for a minimum of four months. HEALTH CARE BENEFITS FOR MEMBERS AND DEPENDENTS The Health Care Benefit helps pay for certain expenses not covered by the Provincial Medicare program. The Plan pays 50% for smoking cessation aids (applies to second course of treatment only) and 100% for all other eligible expenses up to certain specified maximums. What health care expenses are covered by the Plan? Covered Charges are reasonable and customary charges up to the Overall Lifetime Benefit Maximum shown in the Benefit Highlights For Eligible Members for needed medical care, services or supplies, as described below, and received while the person is covered, for either an illness or injury that is non-occupational or for pregnancy: 1. Hospital (Within Home Province) Daily charges in excess of the ward rate up to the hospital s charge for semi-private room plus user fees. A hospital is a place that: - chiefly provides inpatient medical care of the injured, sick or chronically ill; 32 HEALTH CARE BENEFITS FOR MEMBERS AND DEPENDENTS 33

19 - has a staff of licensed doctors (M.D.) and 24-hour nursing care by registered nurses (R.N.); and - is approved as a hospital for payment of the ward rate under the Provincial Health Plan. 2. Convalescent/Rehabilitation Hospital (Within Home Province) Daily charges in excess of the ward rate up to the Room and Board Limit of $10 per day plus user fees, but not beyond the Maximum Stay (per period of disability) of 100 days. Confinement must immediately follow at least 3 consecutive days of hospital confinement and must begin before age 65. A Convalescent/rehabilitation hospital is a place that: 3. Ambulance - has a transfer arrangement with hospitals; - provides inpatient nursing care (that meets minimum Provincial regulations) for the convalescent/rehabilitation stage of an injury or illness; and - is approved as a convalescent/rehabilitation hospital for payment of the ward rate under the Provincial Health Plan. Charges in excess of the amount payable under the covered person s Provincial Health Plan for professional licensed ambulance service, including air or rail ambulance service subject to prior approval of Manulife, to transport the covered person: from the place of injury (or where illness struck) to the nearest hospital where treatment is available; directly from the first hospital where treatment is given to the nearest hospital for needed specialized treatment not available at the first hospital; or from a hospital to a convalescent/rehabilitation hospital. 4. Out-Of-Hospital Nursing Charges for home nursing care, up to $10,000 per calendar year, by a registered nurse (R.N.), a licensed practical nurse (L.P.N.) a certified nursing assistant (C.N.A.) or a Victorian order nurse (V.O.N.) who: is not a member of your family; and does not normally live in your home; when ordered by a licensed doctor (M.D.) as medically necessary for a disability that requires the specialized training of an R.N., L.P.N., C.N.A. or V.O.N. 5. Physiotherapy Charges by a physiotherapist who is registered and legally practicing within the scope of his license. No amount will be paid for any visits for which any amount is payable under the covered person s Provincial Health Plan, unless permitted by law. 6. Health Practitioners Charges, including x-ray charges, up to the Benefit Maximums as indicated below by a practitioner who is registered and legally practicing within the scope of his license as: a chiropractor, osteopath, naturopath, podiatrist, chiropodist, speech therapist or psychologist. Services per type of practitioner are subject to a benefit maximum of $200 per calendar year, except for podiatrist and chiropodist, which has a combined maximum of $200 per calendar year. The $200 maximum includes $25 per disability for x-rays. No amount will be paid for any visit for which any amount is payable under the covered person s Provincial Health Plan, unless permitted by law. For Ontario residents, for chiropractors and podiatrists, no amount will be paid for any visit for which any amount is payable under the covered person s Provincial Health Plan. 7. Dental Care For Accidental Injury Charges for dental care by a licensed dentist for the prompt repair of sound natural teeth when required for a non-occupational accidental injury, external to the mouth, that occurs while the person is covered. Treatment must be completed within 12 months of the accident. 8. Diagnostic Laboratory and X-Ray Expenses 9. Drugs Charges for drugs, including smoking cessation aids and Viagra, up to the Benefit Maximums, and oral contraceptives, obtainable only upon a licensed doctor s (M.D.) or licensed dentist s prescription (or that of other professionals authorized by provincial legislation to prescribe drugs), and dispensed by a registered pharmacist or licensed doctor (M.D.) legally authorized to dispense such drugs. Drugs are subject to 34 HEALTH CARE BENEFITS FOR MEMBERS AND DEPENDENTS 35

20 a maximum dispensing fee of $10.00 per prescription or refill. Smoking cessation aids are covered up to $600 per lifetime, which includes a benefit maximum of $400 for the first course of treatment and $200 for the second course of treatment. The maximum drug benefit for Viagra (or other virility drug) is $500 per calendar year. 10. Durable Medical Equipment and Supplies Charges for supplies and the rental of or, at Manulife s option, the purchase of durable medical equipment of the type and model adequate for the covered person s medical needs based on the nature and severity of the disability, such as, but not limited to: hospital beds, wheelchairs, canes, crutches, walkers and trusses; rigid or semi-rigid braces for back, neck, arm or leg and non-dental prostheses such as artificial limbs and eyes; including replacement if required because of a change in physical condition; respiratory equipment, including oxygen; kidney dialysis equipment; contact lenses or glasses following cataract surgery (limited to 1 pair per lifetime); and splints, casts, catheters, and hypodermic needles; but excluding personal comfort, convenience, exercise, safety, selfhelp or environment control items, or items which may also be used for non-medical reasons, such as, but not limited to: heating pads or lamps, communication aids, air conditioners or cleaners, and whirlpool baths or saunas. Before incurring any major expenses you should submit details to the Plan Administrator to determine to what extent benefits are payable. In any event, a letter will be required from a licensed doctor (M.D.) describing the nature of the disability and the type, medical need and estimated duration of any required durable medical equipment. 11. Vision Care Charges for lenses and frames, or for contact lenses, or for laser eye surgery, when prescribed by an ophthalmologist or optometrist, up to $400 every 24 months. No amount will be paid for sunglasses, antireflective coatings, or for tints other than No. 1 or No. 2. The Plan will reimburse up to $400 in any 24 consecutive months peri- od for Contact Lenses if required following cataract surgery, or when visual acuity can be improved to at least the 20/70 level by contact lenses but cannot be improved to that level by spectacle lenses. 12. Hearing Care Charges for hearing aids, excluding batteries, when provided by a certified licensed audiologist, up to $300 per lifetime. 13. Foot Care Orthopedic shoes when recommended by a licensed doctor (M.D.) are covered up to $200 if part of a brace or $75 if not part of a brace for every 12 months. Charges for arch supports, molds or orthotic devices (excluding sports orthotics) when recommended by a licensed doctor (M.D.) or podiatrist are covered for $200 in any 24 month period (12 month period for dependents under 18 years of age.) Restoration and Reinstatement of Overall Benefit Maximum On each January 1, up to $1,000 of the Overall Lifetime Benefit Maximum which has been paid by Manulife will be restored. When a covered person s maximum is at least $1,000 lower than the Overall Benefit Maximum, he may have it reinstated to the Overall Benefit Maximum by submitting evidence of good health satisfactory to the Plan Administrator. Is there any limit to the dollar amount that will be paid under this Plan? The Plan will pay covered health care expenses up to a lifetime maximum of $100,000 per person while you are covered as an eligible active or retired member. However, the lifetime maximum of $100,000 per person will not apply to the Out-of-Hospital Nursing Benefit. Am I covered for Medical Expenses when I travel outside my home province? You are not covered for Medical Expenses for travel outside your home province. Please carefully review the limitations on your benefits as you may want to consider purchasing additional coverage for travel outside your home province. 36 HEALTH CARE BENEFITS FOR MEMBERS AND DEPENDENTS 37