HELPING EMPLOYEES UNDERSTAND LEAVES OF ABSENCE (LOA)

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1 HELPING EMPLOYEES UNDERSTAND LEAVES OF ABSENCE (LOA) The Saskatchewan School Boards Association Employee Benefits Plan (SSBA EBP) offers a full range of Benefits to non-teaching employees, their families, and the trustees of member school boards across Saskatchewan. The benefit plan is sponsored through the Saskatchewan School Boards Association, which acts as the thirdparty administrator and policyholder administering benefits for nonteaching employees on behalf of participating school divisions. Employee Benefit Plan The benefit plan has provision within the policies to extend the continuation of benefits during employee s Leaves of Absence. This document is intended to assist employees in understanding benefit coverage during various types of Leaves of Absence.

2 Understanding Your Coverage The Saskatchewan School Boards Association Employee Benefit Plan has provision within the Manulife policies for the continuation of benefits during employee s Leaves of Absence (LOA). Various types of LOA s with continuation of benefit coverage exist consisting of Maternity/Parental, Paid Sick Leave, Unpaid Sick Leave, SGI/WCB/Third Party, Weekly Indemnity, Long Term Disability, Personal and Other. What is a Leave of Absence (LOA) for benefit purposes? - An LOA is a period of absence from work for which the dates are fixed by legislation or by mutual agreement between the Employer and the Employee. An LOA for benefit purposes includes: o Maternity and Parental Leave o Paid and Unpaid Sick Leave o WCB / SGI / Other 3 rd Party Leaves o Personal Leave (i.e. travel, time-off, personal education, farming, extension of Maternity leave beyond 1 year) - During the LOA an employee s employment continues - The benefit plan provides for continuation of benefits based on the level of coverage in effect when the LOA commenced, up to the plan maximum, as long as premiums are paid - Disability benefits are NOT extended during any portion of a personal LOA If you do NOT maintain your benefits while on leave: - Your participation will be automatically re-activated upon your return to work - You will be treated like a new employee and may have to serve the waiting period - The Long Term Disability pre-existing clause will be reinstated Voluntary LOA without pay, normally for personal reasons, may be granted for a period not to exceed 1-year. Disability is NOT extended during personal LOA s. All other leaves, including unpaid sick leave, continue with the same level of coverage in effect when the leave first commenced, as long as premiums are paid. 1

3 Do I have an option to either retain or refuse my benefits during an LOA? Yes. You may elect to either Retain or Refuse your benefits throughout your leave; however you must make this decision when your leave first starts. You must take the same level of benefits throughout your leave as when you are still actively at work. You cannot pick and choose. Your Employer will provide you with a Leave of Absence (LOA) Benefits Declaration Form to complete. If you elect to retain benefits, you are required to provide your Employer with Post- Dated cheques or make other arrangements for payment of premiums. If your leave is a Sick leave (paid or unpaid) and you file a disability claim, you MUST continue to retain benefits and pay premiums until your disability claim is approved. Does my election to retain or refuse benefits differ depending upon the type of leave I m taking? Yes. If you elected to Retain benefits throughout your leave, all benefits (EXCEPT disability during Personal leaves), will be extended based on paid premiums. Examples of personal leaves are: travel, time-off, personal education, farming, etc. If your leave is a sick leave (paid or unpaid), SGI, WCB or other 3 rd Party leaves, you are given the choice when your leave first starts to Refuse benefits once your disability claim is approved. The LOA form provides you with this option. Why would I want to refuse benefits once my disability claim is approved? As stated earlier, you must ensure that premiums for benefits are paid until your disability claim is approved. Once approved for disability, the plan waives the requirement for premiums for Life, Accidental Death & Dismemberment (AD&D) and Disability, but your coverage remains in effect. 2

4 When you first started your leave, you may have chosen to refuse coverage for extended health, vision, dental and the employee family assistance plans (EFAP) once your disability claim was approved. Many employees continue with this coverage, however, this decision is yours to make. Employees often state they base their decision on whether or not they have coverage through another plan, their expected need for the benefits, as well as, the cost of the premiums, etc. Please keep in mind that if your benefits are terminated during your leave, you will be treated like a new employee once you return back to work and you may have to serve a waiting period prior to receiving coverage. Can I refuse benefits during my unpaid sick leave, and then elect to retain benefits once my disability claim is approved? No. When your leave first starts, you MUST make the decision to either Retain or Refuse Benefits at that time. If you Refuse benefits at the beginning of your leave, you are NOT entitled to benefits until you return back to active employment. If I elect to retain benefits at the onset of my leave, can I change my mind later and cancel my benefits? No. Once an employee elects to retain benefits, it is understood that they will continue to retain benefits throughout the entire leave. In order for coverage to be in place, premiums must be paid. If I retain benefits throughout my LOA, can I change my family status and level of coverage by adding or changing dependents? Yes. You must complete an Application for Change form and return it to your employer within 31 days if your family status changes. i.e.) birth of a child, marriage, separation/divorce, dependant no longer qualifies, dependant now qualifies, loss of life, etc. 3

5 If I retain benefits throughout my LOA, do I have to participate in Health, Vision and/or Dental if my spouse s plan provides coverage for us? No. Health, Vision and Dental benefits can be refused during a LOA if you share in the cost of the premiums and as long as there is another group plan in place, such as a spousal plan or other employer plan. What is the maximum allowable timeframe an employee can continue to have benefits once an LOA commences? Benefits will continue up to two years in accordance to plan policy as long as premiums are paid. The maximum allowable timeframe you can continue with all the benefits that were in effect on Day 1 of your approved leave is: 1. Maximum period of 1-year for Maternity, Parental, Sick Leave and/or SGI, WCB or other 3 rd Party LOA s, unless: a. Paid sick leave exceeds 1 year (i.e. you have > 260 days accrued sick leave); or b. The time period of your approved disability claim is extended c. The disability appeal period exceeds timeframe 2. A maximum of 1 year for Personal LOA s, not including the disability benefit 3. A maximum of 2 years for a combination of the 1-year Maternity, Parental, Sick Leave and/or SGI, WCB or other 3 rd Party LOA s, plus a 1-year consecutive Personal LOA Can my Employer extend my LOA beyond the maximum 2-year rule with continuation of employee benefits? Yes, but restrictions apply. The duration of your leave is between you and your employer. For the purposes of administering your Employee Benefit Plan, the policy will only extend benefit coverage 2 years, unless: 4

6 - Paid sick leave exceeds 1 year, then an additional 1 year personal leave would take you beyond 2 years; or - In the case of approved disability, the plan extends benefits beyond 2 years because coverage is based on your approved disability claim - Check with your employer to determine if the extended health, vision, dental and EFAP benefits will extend on approved disability claims beyond 2 years During my Paid Sick LOA or Unpaid Sick LOA, does my employer continue to share in the cost of the benefit plan premiums? During paid sick leave your employer will continue to share in the cost of all premiums. For benefit purposes, paid sick leave is treated the same as active at work, therefore premium cost sharing continues. During unpaid sick leave, you must check with your Employer to determine if their policy provides for continuation of premium cost sharing. Each employer s policy may vary. If filing a disability claim, you MUST continue to pay all premiums until the claim is approved, including throughout the entire appeal period. At what point do I file a Disability claim? Disability claims should be filed approximately 6 8 weeks prior to the 105 day waiting period and no later than 6 months following Day 105. Day 105 is referred to as your Qualifying Period and is the duration of time you must be off work due to a disabling condition before benefit payments will begin. Please refer to Manulife s Long Term Disability Benefits Brochure. This brochure defines disability benefits, outlines when to apply, how to apply, how you qualify, as well as, benefit payments while on approved disability. 5

7 Once I ve been approved for Disability, will my benefits be extended throughout my disability claim? - Coverage will remain in effect for up to 2 years following Day 105 of your sick leave as long as premiums are paid - Once your Disability claim is approved, premium waivers are put in place for core benefits (Life, Accidental Death & Dismemberment (AD&D) Insurance and Disability) retroactive to Day 105, and coverage remains in place for the duration of your claim - Continuation of health, vision, dental and/or Employee Family Assistance Plan (EFAP) beyond 2 years following Day 105 may continue based on paid premiums in accordance to your employer s policy How do Salary Changes impact LOA s? Future salary changes will not take place until you return back to your pre-leave duties. An exception to this is in cases where you start a leave and there is a salary adjustment retroactive to a date prior to the date your leave first started. If I m on approved Disability and I turn age 65, can I apply for further group benefits within this Association plan? - You can apply for Retirement Bridging for up to 6 months based on paid premiums - You can apply for Life Conversion with 31 days of loss of coverage without health evidence - You can apply for FollowMe benefits within 60 days of loss of coverage without health evidence 6

8 Are there situations where I may be eligible for benefits beyond the 2 year maximum leave of absence? - If you are approved for Disability, benefits will continue beyond 2 years - Combined leaves, other than approved disability, cannot exceed the maximum 2 years; however the following separate independent benefit offerings may be available at the close of the 2-year LOA o Disability Appeal Periods o Retirement Bridging up to 6-months if you retire o School Closure Dates o Survivor Benefits for eligible dependants o Life Claims within 31 days of loss of life o Continuation of health, vision, dental and EFAP beyond an LTD claimants 2 year own occupation (Employer discretion) o Gradual Return to Work (GRTW) Working Together You, and your healthcare provider if your leave involves an illness, your employer, your benefit plan administrator, SSBA Employee Benefit Plan Department and Manulife Financial all have a role to play in ensuring your leave is as smooth as possible for you. The following is an overview of individual responsibilities. YOU - Complete the Leave of Absence (LOA) Benefits Declaration Form when your leave first starts o You may choose to continue the benefits you were participating in the day before your leave started. Disability benefits will NOT be extended during any personal leaves - Return the LOA form to your Employer IMMEDIATELY - Provide your employer with post-dated cheques if you are retaining benefits 7

9 - Notify your employer of all family status changes throughout your leave (e.g. add any new dependants or remove dependants who no longer qualify) - Notify your employer of any beneficiary changes throughout your leave - Notify your employer of your Return to Work date Employer: - Forward the Leave of Absence form to the Sask. School Boards Assoc. Employee Benefit Plan Department (EBP) - Collect applicable premiums from the employee - Inform EBP of employee s return to work - Track the LOA to ensure the duration of the leave is in adherence to plan provisions SSBA Employee Benefit Plan Department: - Update Manulife website according to leave of absence information - Update ACCESS database and track the status of the leave - Provide support to the school division and employee regarding the status of the leave - Liaison between the Employee, the School Division and Manulife Financial Manulife Financial: - Maintain employee benefits based on paid premiums in accordance to plan policy - Review all disability claims filed within timelines - In cases of approved disability: o provide assistance with the disability claim o implement return to work programs when necessary, including gradual return to work o implement re-habilitation assistance if necessary o maintain contact with the employee throughout the leave o obtain additional medical updates at various stages throughout the leave o Keep school division plan administrator and SSBA EBP informed of claim status 8