CT Flex. reference guide. Human Resources

Transcription

1 CT Flex reference guide Human Resources

2 CT Flex Reference Guide Canadian Tire Health & Dental Care Plan Health Care Spending Account Plan Life Insurance & Long Term Disability Plan The information on all benefits insured or administered by Manulife Financial is up to date as of July 1, The Basic and Voluntary Accidental Death and Dismemberment benefits described in this booklet are insured by ACE INA Insurance. The Vacation Buying, Group RRSP and Taxable Cash options described in this booklet are self-insured by Canadian Tire. All other benefits are insured or administered by The Manufacturers Life Insurance Company. Your Health Care, Dental Care and Health Care Spending Account Benefits are provided directly by Canadian Tire. Manulife Financial has been contracted to adjudicate and administer your claims for these benefits following standard insurance rules and practices. Payment of any eligible claim will be based on the provisions and conditions outlined in this booklet and your employer s Benefit Plan. Canadian Tire reserves the right to change the benefits outlined in this booklet at any point in time. This overview is based on official plan documents. Every effort has been made to describe the program accurately. However, should there be a question of interpretation, the official plan documents will prevail.

3 GENERAL INFORMATION... 1 Introduction...1 What are our Contract Numbers?...1 What is CT Flex and how does it work?...1 Who is Eligible for Coverage?...1 Is there a Waiting Period?...2 Default Coverage...2 Changing Your Coverage...2 Submitting a Claim...3 Online Claims submission...3 Coordination of Benefits...4 General Exclusions...4 When Coverage Ends...4 Annual Enrolment...4 HOW TO ENROL... 5 First Steps...5 Completing the Benefit Selections...5 YOUR BENEFIT OPTIONS... 6 HEALTH CARE... 6 Benefit Summary...6 Choice Chart...6 Annual Enrolment Rules...8 Conditions of Reimbursement...9 Eligible Expenses...9 Drugs - Reasonable and customary charges incurred for medically necessary drugs which...9 Dispensing Limits...9 Payment of Covered Expenses...10 No Substitution Prescriptions...10 Emergency Travel Assistance...10 Hospital...11 Vision Care...11 Eye Exams...12 Ambulance...12 Nursing Care...12 Hearing Aids...12 Stock-Item Orthopaedic Shoes (Modifications or Adjustments only)...12 Custom-Made Orthopaedic Shoes...12 Foot Orthotics...12 Orthotics or Orthopaedic Shoe Coverage Criteria...13 Claim Submission Requirements for Orthotics or Orthopaedic Shoes...13 Accidental Dental...14 Services, Aids and Supplies...14 Diagnostic Tests...15 Paramedical Services...15 Non-Eligible Expenses...16 DENTAL CARE Benefit Summary...17 Choice Chart...17 Annual Enrolment Rules...17 Conditions of Reimbursement...18 Eligible Expenses...18 Basic Diagnostic and Preventative Expenses...18 Diagnostic...18 Preventative...18 Minor Restorative...19 Minor Surgical (once per tooth/lifetime)...19 Additional Services...19 Major Surgical...19 Endodontics (Root Canals) (Once per tooth per lifetime)...19 Periodontics (treatment of gum disease)...19

4 Dentures...19 Options 4 & 5- Fixed Prosthodontics (Bridges)...20 Options 4 & 5- Major Restorative,...20 Options 4 & 5 - Orthodontics (Braces)...20 Exclusions...20 SHORT TERM DISABILITY LONG TERM DISABILITY Benefit Summary...22 Choice Chart...22 Levels of Coverage and Monthly Benefit...22 Cost of Living Adjustments (COLA)...24 Payment of Disability Benefits...24 Recurrence of Disability...25 Annual Enrolment Rules...25 Tax Considerations...25 When Coverage Ends...25 Exclusions...25 Pre-Existing Conditions Clause...26 Submitting a Claim...26 EMPLOYEE & OPTIONAL LIFE INSURANCE Benefit Summary...27 Annual Enrolment Rules...27 Points to Remember...27 Conversion of Your Life Insurance...27 Waiver of Premium for Disability...28 DEPENDENT LIFE INSURANCE Benefit Summary...29 Annual Enrolment Rules...29 Points to Remember...29 Waiver of Premiums...29 Conversion Privileges...29 ACCIDENTAL DEATH & DISMEMBERMENT OPTIONS VACATION BUYING Buying Extra Vacation Time...31 LIFE EVENT CHANGES HEALTH CARE SPENDING ACCOUNT What is a Health Care Spending Account?...33 Account Balance...33 Eligible Health and Dental Care Expenses...33 Out-of-pocket expenses such as deductibles and co-insurance...33 Payments to licensed medical practitioners...33 Transportation Expenses to Receive Medical Care...33 Other Expenses...34 How to Submit a Health Care Spending Account Claim...34 Points to Remember...34 GROUP RRSP TAXABLE CASH QUESTIONS AND ANSWERS TERMS AND DEFINITIONS... 39

5 GENERAL INFORMATION Introduction This user's guide will assist you in making your benefit choices. The following pages detail each benefit area. Please read the reference guide carefully and take time to compare your needs with the benefits offered before making your final CT Flex choices. What are our Contract Numbers? Your contract number is for life insurance and long term disability. Your contract number for health and dental coverage is Your contract number for Health Care Spending Account coverage is Your certificate or identification number is you employee number. Manulife Financial administers the plan. What is CT Flex and how does it work? CT Flex is an innovative benefits program which enables you to choose benefit coverage to suit your individual needs. Canadian Tire provides you with flex dollars which you use in combination with your own money (via payroll deductions) to purchase varying levels of coverage in these benefits areas: Health Care; Dental Care; Long Term Disability; Employee & Optional Life Insurance; Employee & Voluntary Accidental Death and Dismemberment Insurance; Dependent Voluntary Accidental Death and Dismemberment Insurance; Dependent Life Insurance; Vacation Buying; Health Care Spending Account; Group Registered Retirement Savings Plan; Taxable Cash. Who is Eligible for Coverage? If you are a permanent full-time employee of Canadian Tire working a minimum of 37.5 hours per week or a permanent part-time employee of Canadian Tire working a minimum of 15 hours per week, you may purchase coverage for yourself and your eligible dependents, provided you are covered under your provincial health plan. Eligible Dependent is defined as the Spouse or Child of the employee who is covered under the Provincial Medical Plan. Definitions of Spouse and Child are as follows: Spouse The Employee s legal spouse or common-law partner. Common-law partner refers to a person who cohabits in a conjugal relationship and a) has cohabited continuously for a period of at least 12 months; and/or b) is the natural or adoptive parent of a child of whom the employee is also the parent. A spouse or common-law partner shall not include a person living separately and apart for more than 6 consecutive months. Only one Spouse will be eligible for coverage under the plan, and will be as indicated by the Employee on the application for insurance under this plan. Where this information is not contained on the Employee s application, the person who qualified last under this plan s definition of Spouse will be the eligible Spouse. 1

6 Child The employee s natural, adopted child or stepchild who meets all the following criteria: a) Is unmarried b) Is not employed on a full-time basis c) Is not covered for benefits as an employee under this or any other group contract; d) Is either under 21 years of age, or, if a full-time student at an accredited school, college or university, under 25 years or age. Proof of full-time student status must be provided when the child reaches the age of 21 on an annual basis otherwise coverage will be terminated. A newborn child shall become eligible from 15 days for Dependent Life insurance and from the moment of birth for all other benefits. A child covered under this plan, who is incapacitated due to a functional impairment on the date the child reaches the age when they would otherwise cease to be an eligible Dependent, will continue to be an eligible Dependent under this plan. A child is considered incapacitated if he/she is incapable of engaging in any substantially gainful activity and is dependent on the Employee for support, maintenance and care, due to a functional impairment. If the employee should die, coverage for health and dental benefits under the plan will continue for eligible dependents for up to 24 months providing the employee was enrolled in this coverage. This coverage ends earlier should the spouse remarry or if dependent children reach the plan s maximum age. Is there a Waiting Period? Permanent full-time employees receive benefit coverage effective on their date of hire. Coverage is effective on hire date providing the employee is active at work and Manulife Financial approves any required Evidence of Insurability. Permanent part time employees have a six (6) month waiting period. Default Coverage Should you not make any benefit selections during your initial enrolment period, you will be provided with the following Default Coverage: Health Care Option 3 Employee Only Dental Care Option 3 Employee Only Long Term Disability Option 1 Life Insurance two times base salary Accidental Death and Dismemberment Insurance two times base salary Excess flex dollars will be allocated to your Health Care Spending Account. Changing Your Coverage You select your coverage when you first join Canadian Tire. You may then change your coverage during the Annual Enrolment Period (effective July 1st each year) or if you have a Life Event Change; when you either marry, divorce, acquire a common-law partner, lose or gain your spouse's benefits, acquire a dependent, change your employment status, or become widowed. Note: You must notify Manulife Financial of your Life Event change within 31 days of the event by contacting the Manulife Call Centre at or visit the Manulife website. You may be asked to provide evidence of your Life Event Change. You must be actively at work to change coverage levels - employees on Long Term Disability (LTD), Sick Leave or Leave of Absence (LOA) other than maternity leave or a legislated leave of absence must return to work before coverage levels may be changed. 2

7 If you are increasing your Optional Life Insurance, Dependent Life Insurance or LTD coverage, you will be required to complete an Evidence of Insurability form. Any increases in coverage will become effective after our insurer has authorized the increase. During a Life Event change you are not able to reallocate flex dollars previously selected to purchase Vacation Buying or to your Health Care Spending Account. Submitting a Claim Claim forms are available in your area's kiosk, from your Human Resources Department or online via InTireNet or CTFS Bulletin Board. Health and Dental claim forms must be completed in full and submitted to Manulife Financial with any original bills within twelve months of the date the expense occurred. Disability Claims must be submitted within 180 days of completion of the qualifying period. There is also a 90-day limit to submit claims if your coverage terminates. Online Claims submission Submitting your health and dental claims just got easier. Online claims submission lets you enter all the information online. It s quick, easy, secure and now just 3 steps. It s Easy When you login to the Plan Member Secure Site at you simply select Claims from the top navigation and then Online Claims or simply select Online Claims which is located under the Quick Links navigation. Once you confirm your direct deposit and contact information you re ready to tell us about your claim. Follow the steps Each step is easy to understand. Enter the requested information found on your receipt and then submit your claim. You only need to provide your receipts if we ask for them. Get paid sooner Sign up for direct deposit and you ll receive your money up to 70% faster than by cheque. You ll even receive an as soon as your claim is paid! Safe and Secure All your personal information, such as your banking information, is always retrieved from Manulife s secure system network. There is no way for the general public to access your personal information from our website. What you ll need Be sure you have the receipts from your provider, including details on your provider s name, address and other information. Once you ve registered all you have to do is.. Go to Select Plan Member then Login/Register from the left hand side of the screen Enter your plan contract number Confirm your plan contract number then enter your plan certificate number and password Select Claims from the top navigation and then Online claims or select Online Claims which is located on the Quick Links navigation Enter the details of your claim found on your receipt from your provider, along with details on your provider s name, address and their contact information Make sure you ve signed up for direct deposit too! 3

8 Coordination of Benefits If you and your dependents are covered under more than one Health or Dental plan, it is to your advantage to coordinate benefits to receive the maximum reimbursement. Your personal Health and Dental claims must be submitted to the Canadian Tire plan first. If you coordinate benefits with your spouse's plan, the balance of your claim goes to your spouse's plan second. If there is any remaining balance after the claim has been processed through your spouse's plan, you can then put through a third claim to your Health Care Spending Account. Spousal claims must be submitted to their carrier first then to Canadian Tire's plan. Dependent claims must always be submitted first to the plan of the parent whose month and day of birth comes earlier in the calendar year (excluding the year of birth). Expenses not covered under your benefit plan or any other plan for which benefits may be payable, i.e., spousal plan, may be claimed against the Health Care Spending Account directly by requesting that the unpaid portion of the plan be paid on your Health and /or Dental claim form. Claims should be submitted to all other benefit plans under which you and your dependents are covered before they are submitted for reimbursement through the Health Care Spending Account. General Exclusions Listed below are some of the general exclusions in this plan: No amount of benefit will be payable for any charge that resulted either directly or indirectly from, or as in any manner associated with, any of the following: Self-inflicted injuries or illnesses, whether the person is sane or insane; War, insurrection or hostilities of any kind whether or not you or your dependent was a participant in such action; Participation in a riot or civil commotion; Committing or attempting to commit a criminal offense. The exclusions listed above do not apply to Life Insurance (refer to page 21). 2 When Coverage Ends Your coverage terminates on the earliest of the following: Non-payment of contributions; A change in your classification to one not covered; Termination of your employment; Termination or amendment of the Master Contracts or Administrative Services Only Agreement; Your commencing active duty in any armed forces; The date outlined in the Summary of Benefits. Note: In the event you are absent from work due to sickness, injury, layoff or leave of absence, your coverages may continue for a period as outlined in the Master Contracts and Administrative Services Only Agreement, provided the required contributions are made. Annual Enrolment At Annual Enrolment time, you are automatically enrolled in CT Flex at the same level of coverage as you had the prior year. However, funds currently directed to the Group RRSP and vacation buying will not automatically be continued and must be re-elected online annually. Your Manager must approve vacation buying. Please keep the coverage statement as your record of your benefit choices and payroll deductions (if applicable). 4

9 HOW TO ENROL First Steps 1. Review your Enrolment Kit, CT Flex Reference Guide and Web Enrolment Tool. 2. Go online and register with Manulife Financial. 3. Enrol your benefit selections online. 4. Send any required forms, beneficiary form and Evidence of Insurability form (if applicable) to Manulife Financial. Completing the Benefit Selections When you are ready to complete your Enrolment simply follow the instructions on the Web Enrolment Tool. 5

10 YOUR BENEFIT OPTIONS HEALTH CARE Benefit Summary There are five options offered under Health Care, varying according to levels of coverage offered deductibles and co-insurance. The chart below outlines your Health Care options. You have three choices you can choose to cover just yourself, yourself plus one dependent or yourself plus two or more dependents. If you choose to elect Option 1, you receive opt-out flex dollars. Choice Chart Benefit Year Deductible Option 1 Option 2 Option 3 Option 4 Option 5 Prescription Drug Expenses No Coverage None None None None Drugs other than Drugs other than Drugs other than Drugs other compound compound compound than compound medications are medications are medications are medications are subject to an $8 subject to an $8 subject to an $8 subject to a $12 prescription prescription prescription prescription dispensing fee dispensing fee dispensing dispensing cap cap fee cap fee cap Co-Insurance for Prescription Drugs Plus Standard/Volun tary Generic Substitution Out-of-pocket maximum per Benefit Year for Health Care, including Prescription Drugs Plus Standard/Volun tary Generic Substitute but excluding Vision Care and Emergency Out of Country No Coverage Plan pays 50%, unless otherwise stated, up to the Out-of-pocket maximum and 100% thereafter You pay 50% up to the Out-ofpocket maximum No coverage $5,000 per person Plan pays 75%, unless otherwise stated, up to the Out-of-pocket maximum and 100% thereafter You pay 25% up to the Out-ofpocket maximum $2,500 per person Plan pays 90%, unless otherwise stated, up to the Out-of-pocket maximum and 100% thereafter You pay 10% up to the Out-ofpocket maximum $1,000 per person Plan pays 100% None 6

11 Health Care Benefits continued. Other Health Care Expenses Option 1 Option 2 Option 3 Option 4 Option 5 No Coverage None None None None Benefit Year Deductible Co-Insurance No Coverage Plan pays 50%, unless otherwise stated, up to the Out-of-pocket maximum and 100% thereafter You pay 50% up to the Out-ofpocket maximum Out-of-pocket maximum per Benefit Year for Health Care, including Prescription Drugs Plus Standard/Volun tary Generic Substitute but excluding Emergency Out of Country and Vision Care Emergency Out of Country and Travel Assistance Hospital No Coverage Covers out-of country emergency expenses only. Limited to 60 days of travel. Ward accommodation through your provincial $5,000 per person Covers out-of country emergency expenses only. Limited to 60 days of travel. Ward accommodation through your provincial health health plan. plan. Vision Care No Coverage Medically required contact lenses only Ambulance No Coverage Local Unlimited Emergency equal to economy airfare. Plan pays 75%, unless otherwise stated, up to the Out-of-pocket maximum and 100% thereafter You pay 25% up to the Out-ofpocket maximum $2,500 per person Covers out-of country emergency expenses only. Limited to 60 days of travel. Ward accommodation through your provincial health plan. Medically required contact lenses. Once per 24 months for eye exams. Local Unlimited Emergency equal to economy airfare. Plan pays 90%, unless otherwise stated, up to the Out-of-pocket maximum and 100% thereafter You pay 10% up to the Out-ofpocket maximum $1,000 per person Covers out-of country emergency expenses only. Limited to 60 days of travel. Semi-private accommodation, no maximum. $200/24 months combined for prescription glasses, elective contact lenses and laser vision correction. Once per 24 months for eye exams. Local Unlimited Emergency equal to economy airfare. Plan pays 100% None Covers out-of country emergency expenses only. Limited to 60 days of travel. Semi-private accommodation, no maximum. $300/24 months combined for prescription glasses, elective contact lenses and laser vision correction. Once per 24 months for eye exams. Local Unlimited Emergency equal to economy airfare. 7

12 Health Care Benefits continued. Option 1 Option 2 Option 3 Option 4 Option 5 Private Nursing No Coverage $20,000/benefit $20,000/benefit $20,000/benefit $20,000/benefit year year year year After age 65, lifetime maximum of $25,000. After age 65, lifetime maximum of $25,000. After age 65, lifetime maximum of $25,000. After age 65, lifetime maximum of $25,000. Reasonable and Customary $500/48 months including repairs Lab Tests and X-Rays No Coverage Reasonable and Customary Reasonable and Customary Reasonable and Customary Hearing Aids No Coverage $500/48 months $500/48 months $500/48 months including repairs including repairs including repairs Stock-Item No Coverage Unlimited Unlimited Unlimited Unlimited Orthopaedic Shoes (modifications & adjustments only) Custom-Made No Coverage Shoes One Shoes One Shoes One Orthopaedic pair/benefit year pair/benefit year pair/benefit year Shoes Orthotics No Coverage Children 18 years and under $300/benefit year Adults - $300/2 benefit years Psychologist No Coverage $1,000/benefit year Speech No Coverage $1,000/benefit Therapist year to lifetime (requires a maximum of doctor s note) $10,000 Physiotherapist (requires a doctor s note) Chiropractor, Osteopath, Podiatrist, Naturopaths, Massage Therapist, Acupuncturist, Chiropodist, Dietician Children 18 years and under - $300/benefit year Adults - $300/2 benefit years Children 18 years and under - $300/benefit year Adults - $300/2 benefit years Shoes One pair/benefit year Children 18 years and under - $300/benefit year Adults - $300/2 benefit years $1,000/benefit year $1,000/benefit year $1,000/benefit year $1,000/benefit $1,000/benefit $1,000/benefit year to lifetime year to lifetime year to lifetime maximum of maximum of maximum of $10,000 $10,000 $10,000 No Coverage $500/benefit year $500/benefit year $750/benefit year $1,000/benefit year No Coverage $500 per benefit year per type of practitioner to a combined maximum of $500 per benefit year $500 per benefit year per type of practitioner to a combined maximum of $1,000 per benefit year $500 per benefit year per type of practitioner to a combined maximum of $1,250 per benefit year $750 per benefit year per type of practitioner to a combined maximum of $1,500 per benefit year Annual Enrolment Rules Note: Dental Care and Health Care Option 5 has a 2 year lock-in provision. In Quebec, employees selecting Option 1 or Option 2 must provide proof of coverage under a spousal plan. The proof must be forwarded to Manulife Financial. 8

13 Conditions of Reimbursement You will be paid for any of the charges incurred by you or your dependents provided that the charge meets all of the following conditions: 1. It is medically necessary; 2. It is reasonable and customary; 3. It is recommended and authorized by a physician or surgeon legally licensed to practice medicine; 4. Payment is not prohibited by the government sponsored plan in your province of residence; 5. It is not more than the difference between the actual cost of the charge and the amount you are entitled to apply for and receive under any government sponsored plan in your province of residence. Option 2 Option 3 Option 4, Eligible Expenses Drugs Plus Standard/Voluntary Generic Substitute - Reasonable and customary charges incurred for medically necessary drugs which 1) are dispensed by a licensed pharmacist or physician legally authorized to dispense such drugs, and 2) are prescribed by a physician or other professionals who are authorized by the provincial legislation to prescribe drugs, for the treatment of an illness or injury and are either: a) drugs requiring a prescription in accordance with the Food and Drugs Act, Canada, or b) other specified drugs which have been identified by the carrier as covered expenses and are by convention usually not dispensed without a prescription, or c) injectable preparations identified by the carrier, insulin preparations and supplies, and allergy serums. Note: Smoking cessation aids that require a prescription are covered, subject to a lifetime maximum benefit of $500 per individual. Fertility drugs, lab tests and x-rays, including ultrasound are covered, subject to a lifetime maximum benefit of $6,000 per individual. Sclerotherapy is covered, subject to $20 per day, per individual. General supplies, as well as fees for the services of physicians, nurses, technicians, anesthetists, and administrative staff are not covered. Dispensing Limits Reimbursement for Drug purchases is limited to any single purchase of drugs which would be considered reasonable and customary to be consumed or used within a 34-day period or, with respect to maintenance drugs, a 100-day period. The following is a list of covered maintenance drugs: Anti-asthmatics; Antibiotics for acne; Anticoagulants; Anti-convulsants; Anti-hypertensives; Potassium replacements; Thyroid agents; Cardiac agents; Estrogens; Glaucoma; Hypoglycoemic; Anti-parkinson; Anti-tuberculosis; Oral contraceptives. 9

14 Payment of Covered Expenses Covered expenses for any prescribed drug will not exceed the price of the lowest cost generic equivalent product that can legally be used to fill the prescription, as listed in the Provincial Drug Benefit Formulary. If there is no generic equivalent product for the prescribed drug, the amount covered is the cost of the prescribed product. No Substitution Prescriptions If your prescription contains a written direction from your physician or dentist that the prescribed drug is not to be substituted with another product and the drug is a covered expense under this benefit, the full cost of the prescribed product is covered. When you have a "no substitution prescription", please ask your pharmacist to indicate this information on your receipt, when you pay for the prescription. This will help to ensure that your expenses will be reimbursed appropriately when your claim is submitted to Manulife Financial for payment. Emergency Travel Assistance Manulife Financial offers Emergency Travel Assistance (ETA) services which are administered by Mondial Assistance. Only covered individuals under age 70 who are not retired are eligible for this coverage. The employee's spouse and eligible dependents are eligible as long as the employee is covered. Coverage is limited to a period of 60 days from the date the covered person leaves their province of residence. The following benefits are covered in the event of an emergency that occurs while you or your dependents are traveling for non-medical reasons outside your province of residence. The total lifetime benefit payable in respect to a covered employee or dependent is unlimited. If you or your eligible dependents require medical assistance while traveling, contact Mondial Assistance as soon as possible (before seeking treatment) so they can ensure you get the care you need without incurring unnecessary expenses. The following eligible expenses are covered: Multilingual assistance by toll-free telephone ( ), 24 hours a day, 365 days a year, for covered individuals and providers of medical services to obtain aid and assistance; Referral to a legally qualified physician, dentist, legal advisor, or an appropriate medical care facility; Assistance in replacement (but not cost) of necessary travel documents or tickets in the event of theft or loss; A centre for communication of messages between you and your family, friends or business associates. Messages are held for 15 days; Medical consultation and monitoring of medical care and services if you or your dependent(s) is hospitalized, and arrangement for contact with the patient, the attending physician and the patient s personal physician and family if necessary; Medical services - Charges incurred for medical and surgical fees, semi-private hospital accommodation and prescribed drugs; Emergency transportation - Emergency transportation to the nearest appropriate medical care facility and if medically necessary from the medical care facility to a hospital in Canada. Upon written recommendation of a physician, such charges shall include a medical attendant if necessary who is neither a resident in your home nor a relative of you or your spouse; Return of deceased - Charges incurred for the return of a deceased employee or dependent to the place of former residence in Canada, subject to a maximum benefit of $5,000 per individual; Return of dependent children - Charges incurred for the return of dependent children to their residence in Canada in the event you and/or your spouse is hospitalized and the children are left 10

15 unattended. The children must be under 16 years of age. Arrangements for an escort to accompany the children will be made if necessary; Return trip delay (transportation) - Charges incurred for delay of the return trip of a covered individual due to the hospitalization of that individual or another covered individual with whom the individual is traveling, limited to the cost of one way economy class transportation. If a covered person must return home due to the hospitalization or death of an immediate family member, one-way economy transportation will be arranged and expenses incurred, over and above any allowance available under pre-paid travel arrangements, will be paid. Visit of family member - Charges incurred for transportation of an immediate family member to visit a hospitalized covered individual. The covered individual must have been traveling alone and confined to a hospital for more than seven consecutive days. The cost of transportation is limited to return economy fare for one family member. An immediate family member is defined as a spouse, parent, child, brother or sister or a person with whom the covered individual normally resides; Return of vehicle - Charges incurred in connection with the return of your vehicle. In the event you are unable to return it due to illness, injury or death, subject to a maximum benefit of $1,000 per trip. The vehicle will be returned to your residence or nearest appropriate rental agency. Such charges shall not include commercial transport vehicles; Return trip delay (accommodation) - Charges incurred for commercial accommodation and meals for covered individuals while staying with a hospitalized covered family member when their return trip is delayed due to an illness or accident. Such charges are subject to a maximum benefit of $2,000 per emergency; and Convalescent benefit - Charges incurred for accommodation for covered individuals requiring convalescence following hospitalization. Hospital The difference between the charges made for ward and semi-private room and board in a licensed Canadian hospital. Please note that there should be no charge for semi-private accommodation if a ward room is unavailable. Vision Care For all Options, charges for one pair of contact lenses if visual acuity is improved to at least 20/40 level and this level of acuity is not possible through wearing eye glasses, to a maximum of $150 per 24 months. Eligible charges for vision care are limited to: $200 per 24 months per covered person for Option 4 $300 per 24 months per covered person for Option 5 Eligible charges include the following: 7 Charges for eye glasses or contact lenses and the fittings of such eyewear, Charges for Laser Eye Surgery. Charges defined above may be included only to the extent that they are recommended or approved by a legally licensed physician, surgeon, ophthalmologist or optometrist. 11

16 Eye Exams Eye examinations by a legally licensed Ophthalmologist or Optometrist, one per 24 months for Options 3, 4 and 5 Ambulance Licensed ambulance or other emergency services used to transport you or your dependent to the nearest hospital where adequate treatment can be rendered. Nursing Care The services of a registered nurse or registered practical nurse at your residence up to an individual maximum of $20,000 per benefit year. However, the maximum for each covered person will be $25,000 during any period from the first day of the benefit year coinciding with or following a covered person's 65th birthday, until their death. The types of nursing designations covered under this benefit are RN, CNA, RNA, RPN, LPN, LNA, or VON. The services will not be considered as eligible expenses while you or your dependent are residing in a nursing home, home for the aged, rest home, or any other facility providing similar care, or confinement in a licensed hospital. Payment will not be made for services which are for custodial care and do not require the skill of a registered nurse or registered practical nurse. The service will not be considered an eligible expenses if the RN or RPN is an immediate family member or is normally a resident in your home. Hearing Aids The purchase of hearing aids and repairs, including batteries, provided by a certified clinical audiologist, up to an individual maximum of $500 every 48 months. Stock-Item Orthopaedic Shoes (Modifications or Adjustments only) Unlimited Custom-Made Orthopaedic Shoes 1 pair per Benefit Year Foot Orthotics $300 per covered person every benefit year for children 18 years of age and under $300 per covered person every 2 benefit years for any other person 12

17 Orthotics and Orthopaedic Shoes Claiming Instructions Effective January 1, 2012 This information sheet outlines the requirements and the documentation you must submit for an Orthotic or Orthopaedic shoe claim to be considered eligible. Manulife recommends that, once you have obtained the required information outlined below, you submit a predetermination for coverage of your orthopaedic shoes to Manulife prior to purchasing them. This can be done either in writing or by telephone and will provide you with confirmation of contractual eligibility prior to incurring any expenses. Orthotics or Orthopaedic shoe Coverage Criteria: Your benefit program (Health options 2, 3, 4 & 5) provides coverage to you and your dependents for Orthotic and Orthopaedic shoes that are medically necessary. Coverage is as follows: Stock-item Orthopaedic Shoes (modifications or adjustments ONLY): Unlimited Custom-made Orthopaedic Shoes: 1 pair per Benefit Year Custom-made Orthotics 1 pair every benefit year, to a maximum of $300 for persons under age 18 and 1 pair every 2 benefit years, to a maximum of $300 for persons age 18 and over Claim Submission Requirements for Orthotics or Orthopaedic Shoes Manulife does not wish to cause unnecessary delays in processing your claim, yet Manulife needs specific and complete information to accurately adjudicate your claim. The claim requirements listed below will assist Manulife in evaluating your claim in a timely manner and help ensure the purchase of good quality, custom-made Orthotics or Orthopaedic shoes. 1. Charges for modifications or adjustments to stock-item orthopaedic shoes or regular footwear which are recommended by a Physician or podiatrist, up to the Stock-Item Orthopaedic Shoes maximum shown in the Benefit Schedule. Physician, Podiatrist/Chiropodist referral including the diagnosis The following information from the supplier of the footwear: o Name of manufacturer and model name and/or model number of the shoes or boots; o Confirmation that the shoes are attached to or part of a brace, if applicable; o Confirmation of any alterations/adjustments made by the supplier for the specific medical needs of the wearer, including a description of the alterations; o A complete, itemized list of all costs, with costs for the footwear shown separately from the costs for any alterations; o The date the shoes or boots were picked up from the supplier; o Original receipt, showing the date and method of payment. 2. Charges for Custom-made shoes which are: constructed by a Certified Orthopaedic Footwear Specialist; and Required because of a medical abnormality that, based on medical evidence, cannot be accommodated in a stock-item orthopaedic shoe or a modified stock-item orthopaedic shoe. Charges will be subject to the Custom-made Orthopaedic Shoes maximum shown in the Benefit Schedule. Physician, Podiatrist/Chiropodist referral including the diagnosis Confirmation that the shoes were made from a last of the patient's foot. Confirmation that the patient can not be accommodated in a stock-item or stock modified orthopedic shoe, and the reason why Original receipt. 3. Charges for casted, custom-made orthotics which are recommended by a Physician or podiatrist, up to the Custom-Made Orthotics maximum shown in the Benefit Schedule. Casted, custom-made orthotics that are purchased from BMSI Orthopedics and are dispensed from the on-site physiotherapist, do not require a recommendation from a Physician or podiatrist. Physician, Podiatrist/Chiropodist referral including the diagnosis 13

18 Description of the casting technique and the materials used. copy of the biomechanical exam and gait analysis report Original receipt including any breakdown of charges. Note: You must include the above documentation with the original claim submission to avoid delays in claim assessments and payments. Please keep a copy of all receipts and documents you submit for your records. To be considered eligible for payment, Orthotics or Orthopedic shoes MUST also meet the following criteria: They must be medically necessary (i.e. used to treat a diagnosed physical condition) The prescription must be written prior to you purchasing the Orthotics or Orthopaedic shoes They cannot be solely used for sporting activities They must be custom-made (this DOES NOT INCLUDE an off-the-shelf product) Modification and/or Adjustment to an off-the-shelf product are an eligible expense. They must be dispensed and paid in full Please note that any costs associated with obtaining this information are the responsibility of the patient. It should also be noted that upon Manulife s review, additional information may be required. You will be notified in writing as to Manulife s decision or, when necessary, Manulife s requirement for additional information. If you have any questions please contact Manulife at to speak With a Customer Service Representative. Accidental Dental Charges by a legally licensed dentist for dental treatment of injuries to natural teeth, or replacement of natural teeth due to accidents suffered by you or your dependent while covered under this benefit, subject to a maximum of $5,000 per accident. The charge will be subject to all of the following conditions: The treatment is necessitated by a direct, accidental blow to the mouth and not by an object or food placed wittingly or unwittingly in the mouth; The accidental blow occurs while the person is covered; The treatment is received within 12 months of the accidental blow; The treatment is the least expensive that will provide a professionally adequate treatment; and No payment will be made for any part of the charge which exceeds the amount shown for the treatment in the current Dental Association Schedule of Fees for General Practitioners in your province of residence. Services, Aids and Supplies Purchase of braces, crutches, artificial limbs or eyes and prosthetic devices approved by Manulife Financial. Two breast prostheses every two years and two surgical brassieres per benefit year. Rental of a wheelchair, hospital bed or other approved durable equipment for temporary therapeutic use. This equipment must be purchased subject to Manulife Financial's approval prior to the purchase. Oxygen. Two pairs of surgical stockings per plan year. Wigs and hairpieces for temporary hair loss as a result of medical treatment, up to a lifetime maximum of $

19 Diagnostic Tests Charges for microscopic and other similar diagnostic tests and services rendered in a licensed laboratory in the province of Quebec. Paramedical Services Expenses for some of these Professional Services may be payable in part by provincial plans. Coverage for the balance of such expenses prior to reaching the provincial plan maximum may be prohibited by provincial legislation. In those provinces, expenses under this Benefit are payable only after the provincial plan's maximum for the benefit year has been paid. Remember: If you have dollars in your Health Care Spending Account any amounts not reimbursed through the Provincial or Manulife Financial's Health Plan can be reimbursed through your Health Care Spending Account. Laboratory tests and X-ray examinations recommended or approved by a legally licensed chiropractor, osteopath, or podiatrist are covered. The services of any of these legally licensed practitioners are covered: Chiropractor; Chiropodist; Osteopath; Podiatrist; Naturopath; Massage Therapist; Acupuncturist; Psychologist; Speech Therapist (requires a doctor s note); Physiotherapist (requires a doctor s note); Dietician. Benefit claims for health practitioners are adjudicated according to Manulife Financial s reasonable and customary fee schedules, based on published guidelines established by the various health practitioners associations. See your choice chart for benefit maximums. 15

20 Non-Eligible Expenses Charges for the following are not covered whether or not they have been prescribed for medical reasons: 1. First aid kits or equipment, spring loaded devices used to hold lancets, alcohol, alcohol swabs, disinfectants, cotton, bandages or supplies and accessories for the above. 2. Oral vitamins, minerals, dietary supplements, infant formulas or injectable total parenteral nutrition solutions whether or not prescribed for a medical reason, except where Federal or Provincial law requires a prescription for their sale. 3. Diaphragms, condoms, jellies/foams/sponges/ suppositories, intrauterine devices, contraceptive implants or appliances normally used for contraception, whether or not prescribed for a medical reason. 4. Proprietary medicines which a. are registered under Division 10 of the Food and Drug Act, Canada, and b. bear a General Public (GP) number on their label. 5. Prescriptions dispensed by a physician, clinic, dentist or in any non-accredited hospital pharmacy, or for treatment as an in-patient or out-patient in any hospital, including emergency status and investigational status drugs, unless otherwise approved by Manulife Financial. 6. All preventative immunization vaccines and toxoids. 7. All homeopathic preparations. 8. Items deemed cosmetic (even if a prescription is legally required) e.g. topical minoxidil, sunscreens, etc. 9. Any medication which the covered person is eligible to receive under a Provincial Drug Benefit Plan, except for residents of the province of Quebec. 10. Supplies for recreation or sports, whether or not medically necessary. 11. Any service or treatment which you or your dependent would receive without being charged. There is no reimbursement for any costs resulting directly or indirectly: a) From an accident occurring while the covered person was operating a vehicle, vessel or aircraft, if the covered person: was impaired by drugs or alcohol, or had a blood alcohol level higher than 80 milligrams of alcohol per 100 millilitres of blood. b) From the abuse of illegal substances. Other exclusions: 1. Any cause which entitles you or your dependent to apply for and receive indemnity or compensation under the Workers Compensation Board. 2. An examination by, or the services of, a physician or surgeon, if required solely for the use of a third party other than Manulife Financial or Canadian Tire Corporation, Ltd. 16

21 DENTAL CARE Benefit Summary You have five dental options to choose from in the CT Flex plan. There are no deductibles under the Dental plan. The options vary according to co-insurance and levels of coverage. Choice Chart Basic Diagnostic & Preventative Expenses Major Surgical, Endodontics/ Periodontics Dentures, Major Restorative Expenses Orthodontic Expenses Option 1 Option 2 Option 3 Option 4 Option 5** No Coverage Plan pays Plan pays Plan pays Plan pays 50%* 90%* 90%* 100% You pay 50% You pay 10% You pay 10% $1,000 benefit $1,500 benefit year limit per year limit per covered person covered person combined with combined with Major Major Surgical/Endod Surgical/Endod ontics/periodon ontics/periodon tics tics No Coverage Plan pays 50% You pay 50% $1,000 benefit year limit per covered person combined with Basic Diagnostic & Preventative Expenses Plan pays 90% You pay 10% $1,500 benefit year limit per covered person combined with Basic Diagnostic & Preventative Expenses Plan pays 90% You pay 10% No Coverage No Coverage No Coverage Plan pays 50% You pay 50% $1,500 benefit year limit per covered person No Coverage No Coverage No Coverage Plan pays 50% $1,500 lifetime limit per covered person (for children under age 18 only) Plan pays 100% Plan pays 80% You pay 20% $2,000 benefit year limit per covered person Plan pays 80% $2,500 lifetime limit per covered person (for children under age 18 only) *Per the current Provincial Dental Fee Guide ** There is a 2 year lock in provision for this dental option. The lock in provision does not apply during a Life Event. Annual Enrolment Rules Note: You may only increase or decrease your current Dental Care coverage during annual enrolment. Dental Option 5 has a 2 year lock-in provision. 17

22 Conditions of Reimbursement If you or your dependents require any covered treatments or services, you will be reimbursed for such charges under the following conditions: 1. That they are the least expensive service, supply or method of treatment which Manulife Financial determines will produce a professionally adequate result. 2. That if the charge exceeds the least expensive service, Manulife Financial may provide payment based on the cost of alternative services which are defined in this provision as eligible charges. 3. That the treatment has been performed, recommended or approved by a legally licensed dentist or denturist. 4. That Manulife Financial is not prohibited from paying by any applicable law of the jurisdiction where you reside at the time the charge is incurred. Eligible Expenses Remember to submit estimates for the cost of any dental treatment in excess of $500, prior to having the work completed by your dentist to avoid any unexpected costs. As a service to you, Manulife Financial will advise you in advance of the amount covered. Options 2, 3, 4 & 5 Basic Diagnostic and Preventative Expenses Basic coverage includes: Diagnostic Preventive Minor Restorative Minor Surgical Additional Services Further details on each of the above is noted below. Diagnostic Initial examinations (one per benefit year). Recall examinations (one per nine months for Option 2 and one per six months for Options 3, 4 and 5). Specific examinations (one per nine months for Option 2 and one per six months for Options 3, 4 and 5). Bitewing X-rays (one per nine months for Option 2 and one per six months for Options 3, 4 and 5). Full-mouth X-rays (one per 2 benefit years). Routine diagnostic and laboratory procedures. Consultations. Preventative one unit of light scaling and one unit of polishing, when the service is performed outside Quebec, or prophylaxis (polishing), when the service is performed in Quebec (one every 9 nine months for Option 2 and one every six months for Options 3, 4 and 5). Periodontal scaling and/or root planing (12 units combined maximum per Benefit Year). Fluoride treatment (one per nine months for Option 2 and one per six months for Options 3, 4 and 5). Oral hygiene instruction (one per nine months for Option 2 and one per six months for Options 3, 4 and 5). Space maintainers. 18

23 Minor Restorative Caries, trauma and pain control. Amalgam restorations (only if 12 months have elapsed since last restoration). Pit and fissure sealants. Retentive pins (once per tooth per 12 months). Stainless steel, plastic and polycarbonate restorations (dependent children under 16 years only). Tooth coloured restorations (only if 12 months have elapsed since last restoration). Veneer applications (only if 12 months have elapsed since last restoration). Minor Surgical (once per tooth/lifetime) Extractions. Residual root removal. Additional Services Anaesthesia (used in conjunction with an eligible surgical procedure, maximum $ per appointment). Major Surgical Surgical exposure. Alveoloplasty, gingivoplasty, stomatoplasty, vestibuloplasty. Surgical excision. Surgical incision. Fractures. Frenectomy. Oral surgery. Endodontics (Root Canals) (Once per tooth per lifetime) Pulpotomy. Pulpectomy. Root canal therapy. Apexification. Periapical services. Root amputation. Decompression. Surgery. Hemisection. Endodontic Bleaching. Intentional removal, apical filling and reimplantation. Endosseous implants. Periodontics (treatment of gum disease) Non-surgical: the maximum benefit payable includes charges for packing and post surgical treatment. Surgical (1 type of each surgery per sextant per year). Adjunctive services. Occlusal equilibration (eight units per Benefit Year). Periodontal appliance and repair. Options 4 & 5- Continued Removable Prosthodontics (Dentures) (Only if more than 5 years have elapsed since last placement) Dentures Includes removable Prosthetic Devices (replacement of dentures only after 12 months of coverage and provided the dentures are at least 5 years old). 19

24 Complete dentures. Transitional partial dentures. Acrylic partial dentures. Cast partial dentures. Denture adjustments. Denture repairs. Tissue conditioning, denture rebasing and relining. Options 4 & 5- Fixed Prosthodontics (Bridges) (Only if more than 5 years have elapsed since last placement) Pontics. Repairs. Retainers and abutments. Splinting. Retentive pins in retainers and abutments. 13 Charges for replacing an existing denture or bridgework will only be paid if such replacement is for an equivalent denture or bridgework and it meets one of the following conditions: 1. The existing denture or bridgework was installed at least five years prior to its replacement and cannot be made serviceable. 2. The existing denture or bridgework is an immediate temporary denture or bridgework, for which impressions were taken while you were covered under this provision. The permanent replacement denture or bridgework must be placed within twelve months from the date of installation of the immediate temporary denture or bridgework. 3. The existing denture or bridgework is replaced because additional teeth have been extracted after the denture or bridgework insertion, and while you are covered under this provision. Options 4 & 5- Major Restorative, including Fixed Prosthetic Devices (replacement of bridges only after 12 months of coverage and provided that more than 5 years have elapsed since last placement) Foil restoration. Inlay/Onlay restorations. Retentive pins in inlays, onlays and crowns. Crowns. Veneer applications. Posts. Options 4 & 5 - Orthodontics (Braces) Charges incurred by a dependent child under the age of 18, for diagnosis or correction of teeth irregularities and malocclusion of jaws. Manulife Financial will pay for the charges incurred based on one of the following: If an estimated cost of treatment is used in place of an itemized statement, benefits for the covered cost of the charge will be payable on a monthly or quarterly basis as billed by the dentist. The average monthly benefit will be the total estimated cost of treatment, less the initial costs (diagnosis, initial appliance cost, treatment plan) divided by the number of months in the treatment plan as specified by the dentist. If a separate estimate of the cost of the initial appliance is included, the first payment will be an amount equal to the covered cost of the appliance. If a statement is submitted for each treatment as the charge is incurred, payment for the covered cost of the charge will be made as incurred. Exclusions The following exclusions, depending on your CT Flex Option choices, are in addition to those outlined under General Exclusions. 20

25 Any cause for which you may apply for and receive indemnity or compensation under any Workers Compensation Board. Any Group or Plan Holder Sponsored dental care or treatment. Any dental treatment rendered for a full mouth reconstruction, for a vertical dimension or for a correction of temporomandibular joint dysfunction. Replacement of mislaid, lost or stolen appliances. Any crowns placed on teeth that are not functionally impaired by incisal or cuspal damage. Any orthodontic expenses which were incurred before you or your dependent became covered under this benefit. Services or supplies that are primarily for cosmetic dentistry, unless required because of an accidental injury which occurred while the patient was covered under this benefit. Charges which were considered a covered service of any provincial government plan at the time this plan/benefit was issued and subsequently were modified, suspended or discontinued. Services or supplies which are not furnished by a legally qualified dentist or denturist acting within the scope of his license. Any charge for an injury resulting from war, riot, insurrection or participation in a criminal act. Any miscellaneous charges such as counselling or instruction, travel, broken appointments, communication costs or filling in of forms. Any charge resulting from any intentionally self-inflicted injury. Any services covered in whole or in part by any government plan, services for which no charge is made, or services which the plan is not permitted by law to cover. Any charge for services which would not normally have been incurred, but for the presence of this coverage, or for which you are not required to pay. Any dental examinations required by a third party. Services or supplies which are not medically necessary to the care and treatment of any existing or suspected injury, or disease. Procedures in connection with any benefit categories excluded as eligible expenses. Services or supplies for including tooth implantation or transplantation and surgical insertion of fabricated implants. 21

26 SHORT TERM DISABILITY You may be eligible for continuous income security through the Short Term Disability (STD) plan if you are totally disabled from attending work because of a non-occupational illness/injury or disability. If you meet the criteria for STD, you may be eligible for benefits up to a maximum of 26 weeks coverage per fiscal year. All statutory and employee deductions will continue with payment of STD benefits. The business requires that you inform your manager on the first day you are absent from work. Your manager will periodically check on your progress to manage and plan the department workload. On the 4 th consecutive day, you are required to provide medical documentation substantiating your absence and stating your expected return to work date. You are required to communicate with your manager regarding any absences. Your manager is required to notify health services and/or human resources in order to initiate an STD application. To qualify for ongoing STD benefits, an application to Manulife must be completed within 2 weeks of the last day worked. Manulife Financial will contact you regularly to assist you throughout the process of applying for STD benefits and planning for your return to work in a safe, timely and sustainable manner. LONG TERM DISABILITY Benefit Summary Canadian Tire automatically covers you for non-occupational illness or injuries for up to 26 weeks through the Short Term Disability Plan (STD). If you are still disabled after 26 weeks of disability you may apply for coverage through the Long Term Disability (LTD) Plan. Choice Chart The following chart outlines the various LTD Plan options available to you through the CT Flex program. Option Benefit Maximum Monthly Benefit 1 50% of gross monthly earnings rounded to the $20,000** next higher $1 2 60% of your first $7,500 of earnings, plus 55% $20,000** percent the next $7,500 of monthly earnings, plus 40% of any excess amount rounded to the next higher $1 3 60% of your first $7,500 of earnings, plus 55% percent the next $7,500 of monthly earnings, plus 40% of any excess amount rounded to the next higher $1, plus COLA* $20,000** *COLA - Cost of Living Adjustment **medical evidence required for benefits in excess of $15,000 Option % Pay Replaced Maximum Monthly Benefit Levels of Coverage and Monthly Benefit The LTD plan provides you with a percentage of your regular gross pay, excluding bonuses, overtime pay, incentive pay and automobile allowances, to a maximum benefit of $20, per month. (If your salary includes commissions, your regular pay will be determined by averaging your income for the last two years. If you have been employed for less than 2 years, your earnings will be estimated). Net pay is defined as gross pay, less federal and provincial taxes. Evidence of Insurability satisfactory to Manulife Financial is required for amounts in excess of $15,000 per month. Such amount will not become effective until approved by Manulife Financial. 22

27 Your benefit will be reduced directly by any amount you are entitled to receive from any Workers' Compensation or similar coverage, CPP/QPP disability (excluding dependent benefits) or income replacement benefits received from a provincial automobile insurance plan, where permitted by law. If you are eligible to receive other types of payments, Canadian Tire's LTD Plan will combine with these other sources to bring your total income from all sources up to 85% of your pre-disability net earnings. Income from all sources include any amount of income from any Workers' Compensation or similar coverage, CPP/QPP disability and/or pension payments, income replacement benefits received from a provincial automobile insurance plan, any other group sick leave/insurance plan, employee retirement plan, continuation of salary, damages for loss of income recovered from a third party, income from any employment or government plan where permitted by law. If you elect a different/lesser paid occupation not related to the program of rehabilitation, the benefit less reductions shall be further reduced by 50% of the earnings from the lesser paid occupation, subject to the All Source maximum. 23

28 Cost of Living Adjustments (COLA) If you have selected a level of coverage with a Cost of Living Adjustment, your LTD benefit will be increased each January 1st by the change in the Consumer Price Index in the last 12 months or 3%, whichever is less. Payment of Disability Benefits Payment of any disability benefits is subject to the following conditions: During the first 24 months while collecting Long Term Disability payments, you must be unable to perform any and every duty of your occupation or employment. After you have received 24 monthly payments, in order to continue collecting benefits, you must be disabled from performing any work for which you would reasonably be qualified by education, training or experience. Manulife Financial will periodically request updated medical evidence to assess your condition as required; You are not engaged in any business or occupation; For any portion of a period of disability during which you are receiving treatment by a therapist unless such treatment is recommended by a physician deemed appropriate by the Insurer; and Manulife Financial may request written proof of the continuance of your illness and may require you to attend an independent medical examination by a specialist that they select. If you fail to furnish satisfactory proof of continued disability when requested or refuse to attend an independent medical examination, your benefits will be discontinued. Rehabilitation Assistance Once Manulife Financial determines that you are Totally Disabled, if appropriate, and at Manulife Financial s discretion, you may be offered rehabilitation to assist you in returning to gainful employment, either to your pre-disability occupation or to another occupation. In considering whether Rehabilitation Assistance is appropriate for you, Manulife Financial will take into account: the nature, extent and expected duration of your disability your level of education, training or experience the nature, scope, objectives and cost of a Vocational Plan - Vocational Plan A Vocational Plan is a training or job placement program that is expected to facilitate your return to gainful employment. If it is determined that Rehabilitation Assistance is appropriate for you, in partnership with you and your employer, Manulife Financial will provide a structured Vocational Plan that will prepare you for a return to work, either: with your employer with an alternate employer in a self-employed capacity - Disability Benefits During Rehabilitation You will continue to be entitled to disability benefits while participating in the Vocational Plan. Although most income reduces your benefit payment, only half of your income from a Rehabilitation program will be used to reduce your payments. The benefit will be further reduced once your total income (your disability benefit plus your earnings) exceeds 100% of your pre-disability gross earnings; net earnings if your benefit is not taxable. 24

29 If you cease to participate in the Vocational Plan because of a change in your medical status, Manulife Financial will require medical evidence documenting how your current medical status prevents you from continuing with the Vocational Plan. If you are not available or do not co-operate or participate in the Vocational Plan, you will no longer be entitled to disability benefits. Recurrence of Disability If you cease to be totally disabled while receiving benefits and within six months again become totally disabled due to the same cause, the later disability will be considered to be a continuation of the previous disability. If you return to active work full-time and full pay, benefits will be paid at the same rate as before. No benefit will be payable if you are entitled to receive any other group income benefits, on account of your disability. Annual Enrolment Rules You may elect a different option at annual enrolment or when you have a Life Event change. Increases in LTD coverage are subject to completion of an Evidence of Insurability form and approval by Manulife Financial. Tax Considerations Your LTD coverage must be purchased with after tax payroll deductions and therefore are tax-free benefit to you. When Coverage Ends LTD payments will cease on the earliest of the following dates: The date you no longer meet the definition of disability; The date you do not supply the insurer with appropriate medical documentation showing that you continue to meet the definition of disability; The date you refuse to participate or stop participating in a rehabilitation program; The date you reach age 65 less the qualifying period; or The date of death (LTD benefits are not extended to dependents). Exclusions No benefits will be paid for any period of total disability during which: You are not receiving appropriate treatment, or are not under the continuous care of a licensed physician; You are on a leave of absence, including a maternity/parental leave; You are engaged in any occupation for compensation or profit, other than in a rehabilitation program approved by Manulife Financial; You refuse to participate and cooperate in a rehabilitation program; You are outside of Canada unless the leave is approved in advance by Manulife Financial; or You are incarcerated in a jail, prison, mental institution or other correctional facility due to a Criminal Code offence. No benefit will be paid for any total disability resulting directly or indirectly from any one of the following: Self-inflicted injuries or illnesses, whether the person is sane or insane; Participation in a riot, civil commotion, insurrection, war or hostilities of any kind; Abuse of addictive substances, including drugs and alcohol, unless you are actively participating and co-operating in an in-patient medical treatment program for substance abuse which has been approved by Manulife Financial; 25

30 Commission or attempting to commit a criminal offence or provoking an assault; and Operating a motor vehicle or has the care or control of a motor vehicle: 1. Your ability to operate the motor vehicle is impaired by alcohol or drug; or 2. Your blood alcohol concentration exceeds 80 milligrams of alcohol per 100 millilitres of blood. Pre-Existing Conditions Clause No benefits are payable to an insured employee for any total disability commencing within 12 months of the insured employee s effective date of insurance if the disability is caused or contributed to by a sickness or accidental injury for which the employee has received medical treatment services or has taken a prescribed drug at any time within ninety days before his or her effective date of insurance. Submitting a Claim During your Short Term Disability (STD) leave you will be working closely with a Canadian Tire representative. On or about the 16th week of illness an LTD package may be sent to you for completion. You may also be required to apply for the CPP disability pension. 26

31 EMPLOYEE & OPTIONAL LIFE INSURANCE Benefit Summary Canadian Tire automatically provides you with life insurance equal to two times your annual pay to a maximum of $2,000,000 with medical evidence required for any basic life insurance benefit above $1,500,000. Coverage for both basic and optional life insurance ends on your 70 th birthday or retirement, whichever is earlier. You also have the option to purchase optional life insurance. This benefit allows you to supplement your basic insurance by purchasing additional coverage in units of $10,000. If you choose to purchase optional life insurance you must complete an Evidence of Insurability form and submit it to Manulife Financial for approval. The rates you pay for this coverage are shown on the enrolment tool and depend on your age and whether or not you smoke. To qualify for the lower non-smoking rates, you must not have smoked for at least the past 12 months. A false statement may disqualify a payment to your beneficiary. Payroll deductions will not commence until coverage has been approved. The maximum amount of optional life insurance available is $1 million. Annual Enrolment Rules You may increase or decrease your optional life insurance coverage to any level during annual enrolment. If you increase coverage, you will be required to complete an Evidence of Insurability form for approval by Manulife Financial. Payroll deductions will not commence until your increase in coverage is approved. Points to Remember Optional Life Insurance benefits are paid in addition to the Basic Insurance of two times your base pay that is provided by Canadian Tire. All Optional Life Insurance ceases at age 70 or retirement, whichever comes first. If you are choosing optional life insurance for the first time then you will need to complete an Evidence of Insurability form. When you apply to increase your coverage during annual enrolment or through a Life Event, you must complete an Evidence of Insurability form. No payment will be made for any Optional Life Insurance amount in force for less than one year if death is due to suicide. Any amount of insurance for which there is no beneficiary will be payable to your Estate. Your named beneficiary will be paid a lump sum amount in the event of your death. You may appoint one or more beneficiaries or change your appointment at any time by completing the necessary forms (available from Manulife Financial). Beneficiaries who are Minors must have a Trustee assigned to them. You may appoint a "contingency" beneficiary or beneficiaries. If you and your primary beneficiary die at the same time (in an automobile accident, for example), the life insurance funds/payment will be made to the contingency beneficiary or beneficiaries. As a typical example, one's primary beneficiary could be their spouse, with their children named as contingency beneficiaries. Conversion of Your Life Insurance If your Group Benefits terminate or reduce, you may be eligible to convert your Employee Life Insurance to an individual policy, without medical evidence. Your application for the individual policy along with the first monthly premium must be received by Manulife Financial within 31 days of the termination or reduction of your Employee Life Insurance. If you die during this 31-day period, the amount of Employee Life Insurance available for conversion will be paid to your beneficiary or estate, even if you didn t apply for conversion. 27

32 Please contact Manulife Financial for complete details regarding conversion and the types of plans that are available. Provincial differences may exist. Waiver of Premium for Disability If you become totally disabled to the extent that: - you qualify for Long Term Disability benefits provided under this plan; and - you begin to receive Long Term Disability benefit payments from this plan; Your optional life insurance will be continued free of charge from the date the Long Term Disability benefit payments begin. Note: In order to qualify for the Waiver of Premium benefit you furnish proof of your disability satisfactory to Manulife Financial within 180 days of completion of the qualifying period. Your Waiver of Premium application is part of the Long Term Disability application. 28

33 DEPENDENT LIFE INSURANCE Benefit Summary If you have dependents, you may purchase life insurance coverage for them under the CT Flex program. This benefit allows you to purchase dependent Life Insurance for your spouse and children. Spousal Life Insurance may be purchased in units of $10,000 up to a maximum of $250,000. For your children, you may purchase coverage in units of $5,000 to a maximum of $15,000 per child. The benefits for children commence on the 15th day after birth. Annual Enrolment Rules You may increase or decrease coverage on your spouse to any level during annual enrolment. An Evidence of Insurability form must be completed for approval by Manulife Financial to increase coverage. Payroll deductions will not commence until coverage has been approved. Points to Remember If both you and your spouse work for Canadian Tire, neither of you may purchase spousal insurance. However, one partner may select to cover your dependent children. Insurance for your spouse is discontinued when your spouse reaches age 70 To increase the coverage at annual enrolment or during a Life Event change, your spouse must complete an Evidence of Insurability form and submit for approval. Waiver of Premiums If you are eligible for waiver of premiums under your Employee Optional Life benefit, your Dependent Life insurance premiums will also be waived. Conversion Privileges If your spouse s insurance terminates, he or she may be eligible to convert the terminated insurance to an individual policy, without medical evidence. Your spouse s application for the individual policy, along with the first monthly premium, must be received by Manulife Financial, within 31 days of the termination date. If your spouse dies during this 31-day period, the amount of Dependent Optional Life Insurance available for conversion will be paid to you, even if your spouse didn t apply for conversion. If you reside in the province of Quebec and if your dependent child s insurance terminates, you may be eligible to convert the terminated insurance as outlined by the Conversion Privilege for spousal coverage. Please contact Manulife Financial for complete details regarding conversion and the types of plans that are available. Provincial differences may exist. 29

34 ACCIDENTAL DEATH & DISMEMBERMENT OPTIONS Accidental Death & Dismemberment (AD&D) Insurance can help protect you and your family in the event of a serious accident causing severe injury or death. This benefit is underwritten by ACE INA Life Insurance. Under your CT Flex Benefits Program, you have two (2) times your annual salary to a maximum of $2,000,000 for your Basic Accidental and Dismemberment Insurance under the age of 70. In the event of your death, the benefit amount is payable to the beneficiary you have named under your Group Life Insurance or in the absence of such designation, to your Estate. You have the option to purchase AD&D Insurance coverage for yourself (optional coverage), your spouse and children, as described in the table below. Coverage Maximum Employee Units of $10,000 $1,000,000 Spouse Units of $10,000 $250,000 Children Units of $5,000 $15,000 In the event of accidental death, the full coverage amount is paid. The percentage of the amount payable varies depending on the extent of the loss, as show in the following table: Percentage of Benefit Amount Loss of Life 100% Loss of Both Hands or Both Feet 100% Loss of Entire Sight of Both Eyes 100% Loss of One Hand and One Foot 100% Loss of One Hand and Entire Sight of One Eye 100% Loss of One Foot and Entire Sight of One Eye 100% Loss of Speech and Hearing in Both Ears 100% Brain Death 100% Loss of Both Arms, Both Hands, Both Legs or Both Feet 200% Loss of Use of Both Arms, Both Hands, Both Legs or Both Feet 200% Quadriplegia 200% Paraplegia 200% Hemiplegia 200% Loss of One Arm or One Leg 75% Loss of Use of One Arm or One Leg 75% Loss of One Hand or One Foot 66 2/3% Loss of Entire Sight of One Eye 66 2/3% Loss of Use of One Hand or One Foot 66 2/3% Loss of Speech or Hearing in Both Ears 66 2/3% Loss of Thumb and Index Finger of Same Hand 33 1/3% Loss of Four Fingers of Same Hand 33 1/3% Loss of Hearing in One Ear 25% Loss of All Toes of Same Foot 12 1/2% Exclusions The plan does not cover any loss, which is the result of: 1. intentionally self-inflicted injuries, suicide or any attempt thereat, while sane or insane; 2. war or any act thereof; 3. flying in an aircraft owned or leased by your employer, yourself or a member of your household, or aircraft being used for any test or experimental purpose, firefighting, powerline inspection, pipeline inspection, aerial photography or exploration; 4. full-time, active duty in the armed forces. 5. flying as pilot or crew member in any aircraft or device for aerial navigation. 30

35 VACATION BUYING Buying Extra Vacation Time An additional feature of CT Flex is that you can buy extra vacation time in addition to your regular time off. You can buy up to five (5) days or forty (40) hours, provided you are currently entitled to four (4) weeks of vacation or less. You must use Flex dollars only to buy vacation, you cannot use Payroll deductions. You must obtain your manager's permission if you wish to buy extra vacation time. Whenever you purchase vacation time with your Flex dollars, you will see a separate line for Flex vacation time on your pay stub. Bought vacation time is taxable and must be used during the plan year in which they were purchased. Remember to report your flex vacation time as FLV on your payroll time sheet

36 LIFE EVENT CHANGES If you have a Life Event change during the year and you bought vacation units or made a deposit into your Health Care Spending Account (HCSA), you keep all of the units that you have bought or the deposits in the HCSA. The cost of your vacation units or deposits to HCSA will be deducted from the total flex dollars assigned to you, as you have already allocated those dollars. If the total cost of the benefits you choose, plus the vacation units exceed the flex dollars assigned to you, then the difference will be deducted from payroll dollars for the balance of the plan year. The deductions will then be recalculated during the upcoming annual enrolment at which time you can adjust your benefit selections if needed. You cannot buy vacation during a Life Event, nor can you decrease amounts allocated to your Health Care Spending Account. 32

37 HEALTH CARE SPENDING ACCOUNT What is a Health Care Spending Account? The Health Care Spending Account is a secondary heath care plan that provides for the reimbursement of eligible Health Care and Dental Care expenses (provided there are sufficient dollars in the account to cover the claim) as defined by the terms of the plan. Account Balance You may have flex dollars left over after you have determined the benefits and options that you require under CT Flex. You may choose to take the extra flex dollars as taxable cash or to deposit them into the Health Care Spending Account ("HCSA"). Please note that any balance in your HCSA account cannot be paid out in cash and can only be used for eligible health and dental expenses. Eligible Health and Dental Care Expenses Expenses eligible for reimbursement from the Health Care Spending Account must be qualifying medical expenses as defined in the Income Tax Act to maintain its non-taxable status. The following is a list of some of the qualifying Health and Dental expenses that can be claimed through the CT Flex Health Care Spending Account: Out-of-pocket expenses such as deductibles and co-insurance Payments to licensed medical practitioners Medical doctors, dentists, including doctor s notes. Osteopaths. Naturopaths. Therapcutists (therapist). Optometrists. Practical nurses. Christian Science practitioners. Psychologists. Speech therapists. Nurses. Occupational therapists. Physiotherapists. Dental mechanics. Payments to licensed private hospitals. Full-time attendants or care in a nursing home (for confinement to a bed or wheelchair). Care in self-contained domestic establishment by a full-time attendant. Care in a nursing home. Care in an institution. Care of a blind person. Transportation Expenses to Receive Medical Care Cost of using public transportation or private vehicle, if not available, for distances of 40 km or more. Cost of meals and accommodations if travel is at least 80 km. Reasonable transportation, meals and accommodation for one accompanying person, if a doctor certifies that a person is not capable of travelling alone. 33

38 Other Expenses Purchase price or rental charges for artificial limbs, aids or other equipment: iron lung, oxygen tents, spinal braces, limb braces, ileostomy or colostomy pads, laryngeal speaking aids, hearing aids, kidney machines. Eyeglasses - frames and lenses. Contact lenses. Artificial eye. Acquisition, care and maintenance of guide and hearing-ear dogs. Preventative diagnostic, laboratory and radiological procedures. Insulin. Acupuncturists. Prescription drugs. How to Submit a Health Care Spending Account Claim Simply check off the box marked Health Care Spending Account on your Health or Dental claim form and submit along with the appropriate receipts. Manulife Financial will do the rest! Forms must be completed in full and submitted to Manulife Financial with any original bills by the end of the benefit year in which the expense was incurred. Points to Remember Once you have allocated flex dollars to the HCSA, they cannot be taken out as cash or be transferred to another benefit. There are two balances - prior year (prior to July 1) and current year (after July 1). Eligible health and dental expenses incurred in the prior year will be applied against your prior year's balance ONLY. Eligible health and dental expenses incurred in the current year are first applied to your prior year balance (if any) and then against your current year balance if there are insufficient dollars in the prior year balance. Flex dollars remaining in your HCSA at the end of the year can be carried over to pay for expenses the following year. However, the Canada Revenue Agency does not allow them to be carried over beyond the end of the second year. They would therefore be forfeited at that time. For example, If you have a prior year balance of 200 dollars and your current year flex dollars are 600, you will then have a total of 800 dollars in your HCSA to use in that current year (see example chart). Any unused prior year s deposit would be forfeited at the end of the second year. Any balance carried in the HCSA will be forfeited by the employee upon resignation, termination of employment or death. 26 Example: Prior Year Current Year Current Year Claim Balance Deposit Balance Year 1 $200 $600 $800 $250 $550 $550 would carry over to Year 2 End of Year Balance Year 2 $550 $500 $1050 $200 $500 $350 of Year 1 balance would be forfeited at end of Year 2 and $500 would carry over to Year 3 To clarify an expense's eligibility for the Health Care Spending Account, please call the Manulife Financial Claims Department at (416) or 1-(866)

39 GROUP RRSP You have the option of directing excess Flex dollars that you have not spent on benefits to your personal Group RRSP account. These dollars will be allocated to your Group RRSP account on a bi-weekly basis. In order for Canadian Tire to contribute any balance of remaining Flex dollars to your Group RRSP on a pre-tax basis, the Corporation must obtain reasonable evidence that your contribution is deductible and this selection must be made annually. Standard EI and CPP deductions will be withheld on Group RRSP contributions. Please note you can only contribute to a RRSP up until December 31 in the year you attain the age of

40 TAXABLE CASH You have the option of taking any Flex dollars that you have not spent on benefits as taxable cash. The amount you have elected to receive as taxable cash will be paid to you in bi-weekly installments with your regular pay. The amount of the taxable cash paid will be net of income tax withholding, EI and CPP deductions

41 QUESTIONS AND ANSWERS What happens if I have a Life Event? Employees with an eligible life event can change their selected coverage during the year. Eligible life event changes include: Marriage (including common law co-habitation, period of 12 months); Divorce, birth or adoption of first child; or Loss or acquiring coverage under a spouse s plan. If you need to change your benefits, you must visit the Manulife Financial website within 31 days of the life event change or you can contact the Manulife Financial Customer Service Centre at 1 (800) What do I need to do if I want to add or delete a dependent? Follow the same procedures as outlined under the life event change. While I'm away on vacation, do I still have Health coverage? Yes, your Health coverage continues through vacations up to 60 days of travel. Please remember to carry your Benefits Card with you when you travel. It can provide you with emergency contacts and assist with arranging a cash advance if you are unexpectedly ill or injured when traveling. When does my coverage end? Your current coverage ends June 30th. Your new choices are effective from July 1st of each year until June 30th of next year. Your CT Flex coverage ends when you retire or stop working for Canadian Tire. Also, if you continue to work when you reach age 65, modifications will be made to your benefit coverage. For example, Optional Life Insurance ceases at age 70. Finally, coverage for your dependent children ceases when they reach age 21, or age 25 if in full-time attendance at college or university. What can I do if I want to change a benefit choice? There is a limited time period in which you may submit your annual enrolment form and notify Manulife Financial of coverage changes. It is important that you review your benefit coverage carefully and contact Manulife Financial. Once the annual enrolment period ends, your benefit selections are final until you have a Life Event, or until the next annual enrolment period. What happens to my benefits if I go on Long Term Disability or receive Workplace Safety Insurance Board Benefits? You are still covered through CT Flex until you return to work, or your employment with Canadian Tire ends. Your benefits options will remain unchanged during your leave, as you must be actively at work in order to change your benefits coverage. If you have any benefits that are currently being paid with payroll deductions, it is your responsibility to continue paying for these benefits or, for Health Care and Dental care, you may decrease to Option 3. If you are on LTD, premiums are waived for LTD, Optional Life and Optional AD&D coverage. If I'm taking a leave of absence, what must I do to ensure that I have benefit coverage? For leaves of absence (non legislated leaves) in excess of four weeks, you are responsible for paying the cost of your benefits in addition to the company paid portion if you want the coverage to continue. Only health, dental and basic life can be extended. For leaves of absences that are legislated leaves (such as maternity leave) you are responsible for paying the cost of your benefits during the leave. You can contact your Human Resources Department to arrange to continue this coverage. 37

42 What happens when I leave the company? If you leave the company but are not retiring, your benefit coverage through Canadian Tire ceases as of your termination date and all Health Care Spending Account balances are forfeited. However, you do have a 90 day period to submit any outstanding claims which were incurred before your termination date. If you meet the retiree benefits eligibility criteria and become a retiree of Canadian Tire, you are eligible to receive Retiree Benefit Coverage. How do I know what's covered under my benefit plan? If you have specific questions, please call the Manulife Financial Customer Service Centre at 1 (800) How do I make a claim? For Health or Dental claims, you must fill out a Manulife Financial claim form. Copies are available on the InTireNet/CTFS Business Forms Database and Manulife website. To ensure efficiency, please make sure you have included the proper plan (Plan 84277) and certificate (your employee number) numbers on the form. If you wish to make a claim against your Health Care Spending Account, check off the box on the claim form when you are submitting your Health or Dental forms. How do I have my claim reimbursements deposited directly to my bank account? All you need to do is log into the Manulife website and activate this feature. How do I find out if my Health or Dental claim has been processed? Canadian Tire has signed your group up for our Web-based benefits inquiry services. You can log into our secure site and check your claims to see if they have been processed and how much was paid. Simply open the Manulife Financial website at click on Plan Member, then enter your Benefit Plan number (84277). Follow instructions from there. If you prefer, you may contact the Manulife Financial Customer Service Centre at 1 (800) Who do I call when I want to change my beneficiary information or have a Life Event? Please call the Manulife Financial Customer Service Centre at 1 (800) or complete the Manulife beneficiary form that can be found on the InTireNet/CTFS Business Forms Database. 38

43 TERMS AND DEFINITIONS Annual Pay For the purposes of basic life insurance, annual pay refers to your annual gross base earning for one year, excluding income received from bonuses, overtime, and profit sharing. Beneficiary This is the person you designate to inherit your life insurance benefits upon your death. If you change your beneficiary, please notify Manulife Financial. Your witness for your beneficiary designation cannot be the beneficiary. Certificate Number Manulife Financial uses the certificate number and plan number to identify individuals within a plan. Your certificate number is your Employee Number. Co-insurance This is the percentage of expenses that the plan pays. For example, 90% co-insurance means that the plan pays 90% of the expense and you pay 10%. Contingency Beneficiaries In the event that you and your beneficiary die at the same time, the person you name as your contingency beneficiary becomes the beneficiary. Coverage statement This statement confirms your enrolment into the benefits you selected under the program. You should print and retain this statement in order to refer to your benefits coverage throughout the program year. The coverage statement is available to you via the Manulife website at any time during the plan year. It also lets you know what your payroll deductions are (if applicable). The coverage statement also provides proof of coverage. Default Coverage Should you not make any benefit selections during your initial enrolment period, you will be provided with the following Default Coverage: Health Care-Option 3 Employee Only, Dental Care-Option 3 Employee Only, Long Term Disability-Option 1, Life Insurance-two times base salary, and Accidental Death and Dismemberment Insurance-two times base salary. Excess flex dollars will be allocated to Health Care Spending Account. Payroll deductions You may choose to purchase benefits using your own money; this money is referred to as Payroll deductions. Contributions made with Payroll deductions are deducted from your pay on a bi-weekly basis. Flex Dollar A Flex Dollar is equal in value to a real dollar. Flex dollars are assigned to you and are used to purchase your benefits. The number of Flex dollars that you receive is based on your salary, the options you select and the number of people you cover for Health and Dental. Life Event Change Employees with an eligible life event can change their selected coverage during the year. Eligible life event changes include: Marriage (including common law co-habitation, period of 12 months); Divorce, birth or adoption of first child; or Loss or acquiring coverage under a spouse s plan. Out-of-Pocket Maximum This is the maximum amount in co-insurance that you are required to pay. Once the out-of-pocket maximum has been reached, you will not have to pay any co-insurance going forward. 39

44 Contract Number A unique identifying number assigned to your Group Contract by Manulife Financial. The contract number is Contributions Contributions refer to the cost of coverage for Health, Dental, Long Term Disability and Optional Insurance Benefits. The contributions for benefit coverage are set by Manulife Financial and are based on qualifiers such as age, smoking status, salary and plan usage rates. Pro-rated This refers to the way in which the value of your flex dollars and price tags are allocated during the year. For example, $100 may pay for an entire year of Health coverage, while $50 would provide coverage for one half of the plan year. The figures on the enrolment tool for employees who request a Life Event or join the company part-way through the year are pro-rated. Travel Assistance This program is provided to eligible employees by Manulife Financial. Brochures are available at your local Human Resources Department or through the Manulife website. 40