GROUP INSURANCE PLAN Contract 6000 FTQ

Transcription

1 (Isurer) FTQ Itersectoral Parity Committee (Policyholder) GROUP INSURANCE PLAN Cotract 6000 FTQ Health ad Social Services Sector for wage-earers represeted by Pla modified o Jauary 1, 2016

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3 THE GROUP INSURANCE PLANS FOR CONTRACT 6000 ARE OFFERED TO WAGE-EARNERS WHO ARE MEMBERS OF THE FOLLOWING FTQ-AFFILIATED UNIONS: HEALTH AND SOCIAL SERVICES SECTOR Caadia Uio of Public Employees (CUPE) Sydicat québécois des employés et employées de service, Local 298 (SQEES) Caadia Office ad Professioal Employees Uio Québec (SEPB Québec) ELEMENTARY AND SECONDARY EDUCATION SECTOR Caadia Uio of Public Employees (CUPE) Service Employees Uio (UES-800) Caadia Office ad Professioal Employees Uio Québec (SEPB Québec) COLLEGE EDUCATION SECTOR Caadia Uio of Public Employees (CUPE) ORGANIZATIONS SOCIÉTÉ QUÉBÉCOISE DES INFRASTRUCTURES (SQI) SOCIÉTÉ DE DÉVELOPPEMENT DES ENTREPRISES CULTURELLES (SODEC) MUSÉE NATIONAL DES BEAUX-ARTS DU QUÉBEC SOCIÉTÉ QUÉBÉCOISE D INFORMATION JURIDIQUE (SOQUIJ) LA FÉDÉRATION DES COMMISSIONS SCOLAIRES DU QUÉBEC (FCSQ) INSTITUT NATIONAL DE SANTÉ PUBLIQUE DU QUÉBEC (INSPQ) Caadia Uio of Public Employees (CUPE) RÉGIE DE L ÉNERGIE Caadia Office ad Professioal Employees Uio Québec (SEPB Québec)

4 THIS BOOKLET IS FOR WAGE-EARNERS WORKING IN ESTABLISHMENTS REPRESENTED BY: THE HEALTH AND SOCIAL SERVICES SECTOR Miistère de la Saté et des Services sociaux (MSSS) Associatio québécoise d établissemets de saté et de services sociaux (AQESSS) Associatio des cetres de réadaptatio e dépedace du Québec (ACRDQ) Associatio des établissemets privés covetioés saté et services sociaux (AEPC) Associatio des établissemets de réadaptatio e déficiece physique du Québec (AERDPQ) Fédératio québécoise des cetres de réadaptatio e déficiece itellectuelle et e troubles evahissats du développemet (FQCRDITED) Associatio des cetres jeuesse du Québec (ACJQ) Health ad social services agecies

5 YOUR GROUP INSURANCE PLAN IMPORTANT The Policyholder may at ay time, upo agreemet with the Isurer, make modificatios to the cotract with respect to the idividuals eligible for isurace, the scope of coverage ad the sharig of costs amog classes of isureds. Ay such modificatios shall the apply to all isureds, whether they are active, disabled or retired. This booklet does ot iclude all the cotractual provisios regardig defiitios, eligibility, erolmet, effective date ad termiatio of isurace ad other specificatios. For more iformatio about the cotet, you may cosult the admiistrative guide available from your employer or obtai a copy of the policy by cotactig the local uio represetative. This booklet is produced for iformatio purposes oly ad i o way modifies the terms ad coditios of the cotract.

6 100% The electroic versio of this booklet is available olie at uder Idividuals/Group Isurace/Iformatio for Isureds. This booklet is prited o paper made from 100% post-cosumer recycled material. A simple gesture that goes a log way to help protect our eviromet ad the resources aroud us.

7 TABLE OF CONTENTS INSURANCE PLANS Schedule of Isurace... 9 Isurace Plas Complete Basic Health Isurace Pla Reduced Basic Health Isurace Pla Optioal Exteded Health Isurace Pla Optio I Optioal Detal Care Isurace Pla Optio II Active Participat s ad Retiree s Optioal Life Isurace Pla Optio III Active participats a) Participat s Basic Life Isurace b) Participat s Optioal Life Isurace c) Participat s Accidetal Death ad Dismembermet Isurace d) Participat s Spouse s ad Depedet Childre s Life Isurace e) Participat s Spouse s Optioal Life Isurace Retired participats a) Retiree s Life Isurace b) Retiree s Spouse s ad Depedet Childre s Life Isurace c) Retiree s Spouse s Optioal Life Isurace Accelerated beefit paymet i the evet of termial illess GENERAL INFORMATION CLAIMS PROCEDURE Geeral Iformatio Claims Procedure Travel Isurace TRAVEL INSURANCE TRIP CANCELLATION INSURANCE Trip Cacellatio Isurace

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9 INSURANCE PLANS Schedule of Isurace The followig tables preset a brief summary of the coverage provided uder the plas for active ad retired participats ad a summary of the beefits payable uder Cotract For a full descriptio of each pla, please refer to the correspodig pages i the booklet. ACTIVE PARTICIPANTS Complete Basic Health Isurace Pla (page 13) (Madatory participatio) Prescriptio drugs ad other expeses 80% of the first $2,500 of eligible expeses ad 100% of ay excess Automated paymet service Direct Coagulatio self-moitorig device 100%, up to the maximums specified o (CoaguChek) pages 16 ad 17 Hearig aid Trip Cacellatio Isurace 100%, maximum per trip, per isured: $5,000 Travel Isurace 100%, lifetime maximum: $5,000,000 Blood glucose moitor Detoxificatio Hospitalizatio i a semi-private room Itrauterie device (IUD) 100%, up to the maximums specified o pages 16 ad 17 Isurace Plas Geeral Iformatio Claims Procedure Travel Isurace Reduced Basic Health Isurace Pla (page 19) (Madatory participatio) Prescriptio drugs 71% of the first $2,586 of eligible expeses ad 100% of ay excess Automated paymet service Direct Travel Isurace 100%, lifetime maximum: $5,000,000 Trip Cacellatio Isurace 100%, maximum per trip, per isured: $5,000 Detists fees i the evet of accidetal 71% of the first $2,586 of eligible damage to atural teeth expeses ad 100% of ay excess Trip Cacellatio Isurace 9

10 Chiropractor ACTIVE PARTICIPANTS Exteded Health Isurace Pla (Optio I) (Page 22) (Optioal participatio for a miimum period of 36 moths) Healthcare professioals Homeopath, osteopath, aturopath, acupucturist or dietitia Kiesitherapist, orthotherapist, kiotherapist ad massage therapist Physiotherapist ad physical rehabilitatio therapist Podiatrist ad foot care urse Psychologist, psychiatrist, psychoaalyst, psychotherapist ad social worker Registered urse or ursig assistat Ultrasoud examiatios (excludig fetal) ad thermographic evaluatios X-rays 80%, up to a maximum reimbursemet of $20 per treatmet ad $400 per caledar year 80%, up to a maximum reimbursemet of $20 per treatmet ad $400 per caledar year, per specialist 80%, up to a overall maximum reimbursemet of $20 per treatmet ad $400 per caledar year, for all of these specialists 80%, up to a overall maximum reimbursemet of $20 per treatmet ad $400 per caledar year, for all of these specialists 80%, up to a overall maximum reimbursemet of $20 per treatmet ad $400 per caledar year, for all of these specialists 50%, up to a overall maximum reimbursemet of $500 per caledar year, for all of these specialists 80%, up to a maximum reimbursemet of $200 per day ad $4,000 per caledar year Other expeses 80%, up to a overall maximum reimbursemet of $400 per caledar year, for all of these expeses 80%, up to a maximum reimbursemet of $40 per caledar year 10

11 ACTIVE PARTICIPANTS Detal Care Isurace Pla (Optio II) (page 24) (Optioal participatio for a miimum period of 36 moths) 80%* Diagostic, prevetive, basic restorative ad major restorative services Fixed prosthodotics Removable prosthodotics Automated paymet service 50%* * Up to a maximum reimbursemet of $1,000 per caledar year, for all of these expeses 80%, up to a maximum reimbursemet of $1,000 per caledar year, 1 replacemet per period of 4 cosecutive years Direct Isurace Plas Life Isurace Pla (Optio III) (Page 35) (Optioal participatio) Participat s Basic Life Isurace Uder age 65: 1 times the salary Age 65 or over: 1 /2 the salary Participat s Accidetal Death ad Uder age 65: 1 times the salary Dismembermet Isurace Age 65 or over: 1 /2 the salary Participat s Optioal Life Isurace 1 to 5 times the salary Spouse s Life Isurace $5,000 Depedet Childre s Life Isurace $2,500 Spouse s Optioal Life Isurace 1 to 20 uits of $5,000 This pla provides for a accelerated beefit paymet i the evet of termial illess. RETIRED PARTICIPANTS Life Isurace Pla (Optio III) (page 37) (Optioal participatio) Upo retiremet, participats may apply for, uder the retired participat s group life isurace, the beefits they held uder the active participats life isurace pla immediately prior to retiremet. All applicatios must be submitted withi 30 days followig the retiremet date. The form may be obtaied from the employer or dowloaded from the Isurer s website at uder Idividuals/Group Isurace/Iformatio for Isureds/Itersectoral Parity Committee (Group 6000). 11

12 RETIRED PARTICIPANTS (cot.) LIFE INSURANCE COVERAGE TABLE Retiree s Life Isurace 1 to 20 uits of $5,000, up to the amout held before retiremet Spouse s Life Isurace $5,000 Depedet Childre s Life Isurace $2,500 Spouse s Optioal Life Isurace 1 to 20 uits of $5,000, up to the amout held before retiremet This pla provides for a accelerated beefit paymet i the evet of termial illess. Idividual Healthcare Isurace product Policy 3992 (Optioal participatio) Participats who are retirig ad are ot eligible for aother group Health isurace pla that icludes prescriptio drug isurace must register for coverage with the Régie de l assurace maladie du Québec (RAMQ). They may also apply for the idividual Healthcare Isurace product Policy 3992, which also icludes Travel ad Trip Cacellatio isurace. Participats may choose betwee 3 plas: Basic, Itermediate ad Eriched. A optioal coverage supplemet is also available for Detal Care ad Visio Care isurace, as well as for the reimbursemet of the deductible ad coisurace required for prescriptio drugs eligible uder the RAMQ s Prescriptio Drug Isurace Pla. All applicatios must be submitted withi 60 days followig the retiremet date or the date of termiatio of the pla which eabled the exemptio. Beyod this period, evidece of isurability will be required. The documets required for erolmet (leaflet ad erolmet form) may be obtaied from the employer or dowloaded from the Isurer s website at uder Idividuals/Group Isurace/Iformatio for Isureds/Itersectoral Parity Committee (Group 6000). 12

13 COMPLETE BASIC HEALTH INSURANCE PLAN Madatory participatio Isurace Plas Eligible expeses are reasoable expeses that are justified by the seriousess of the case as well as by curret medical practice ad customary charges, ad icurred by a isured followig a accidet, illess, pregacy or surgical procedure related to family plaig or orga or boe marrow doatio. 1. The followig expeses are reimbursed at 80% for participats ad their depedets, if applicable, ad at 100% oce the total expeses exceed $2,500 i a give caledar year. a) Expeses for drugs prescribed by a physicia or a detist ad dispesed by a licesed pharmacist or by a duly authorized physicia, subject to the followig exclusios: The term prescriptio drugs refers to products icluded i the drug formulary of the Régie de l assurace maladie du Québec (RAMQ) or i the drug formulary of the Associatio québécoise des pharmacies propriétaires (AQPP), with the exceptio of drugs coded V or Z. The followig products are ot cosidered to be prescriptio drugs: Products cosidered to be food substitutes, cosmetic products, soaps, suscrees ad taig oils, ski emolliets, shampoos ad other products for scalp treatmet, except o medical recommedatio deemed satisfactory by the Isurer Dietetic substaces or foods Homeopathic medicies Ay substaces used for the purpose of isemiatio, ad cotraceptive ad prophylactic jellies ad foams Prevetive vaccies Ijectios provided as part of a weight reductio program Over-the-couter laxatives ad atacids, except o medical recommedatio deemed satisfactory by the Isurer Drugs or substaces used for the treatmet of impotece 13

14 Drugs admiistered primarily for prevetive purposes Smokig cessatio products (except those icluded o the RAMQ list) Drugs admiistered for aesthetic purposes, except if required due to a accidet. Notwithstadig ay defiitio or the above-metioed exclusios, all prescriptio drugs that must be covered uder the group isurace cotract i accordace with the Quebec Act respectig prescriptio drug isurace are cosidered to be eligible expeses. For ay drug approved after Jauary 1, 1997, the Isurer reserves the right, upo agreemet with the Committee: to limit the reimbursemet accordig to the criteria stipulated by the regulatio regardig the Quebec Act respectig prescriptio drug isurace, if it is registered as a exceptio drug o the list uder sectio 60 of the Act to exclude it or establish the reimbursemet criteria if it is ot icluded o said list. b) Trasportatio to hospital by ambulace (roud trip), icludig emergecy or medically required air or rail trasportatio. c) Expeses for the purchase of artificial limbs, exteral prostheses, trusses, special badages (severe burs), corsets, crutches, splits, casts, artificial eyes, support stockigs with a compressio ratio of 13 mm Hg or more (maximum 4 pairs per caledar year), icurred o medical recommedatio ad required by the isured s physical coditio. For the purposes of this pla, breast ad capillary prostheses (wigs) are ot cosidered to be exteral prostheses. d) Expeses that exceed those payable by the RAMQ for the purchase of breast prostheses followig a mastectomy, up to a eligible maximum of $500 per period of 24 cosecutive moths, per isured. e) Expeses for the purchase of a iitial capillary prosthesis (wig) required followig chemotherapy or radiotherapy treatmets, up to a eligible maximum of $700 per caledar year, per isured. f) Expeses for the purchase, retal or replacemet of ay product or equipmet required by the isured s physical coditio made by a orthotist-prosthesist or other professioal specialized i the maufacturig of such equipmet or products ad prescribed by a physicia (e.g. compressio garmet for bur victim, device other tha a foot orthosis, kee brace, device for asthmatics). These expeses are eligible for reimbursemet oce per caledar year, per isured. 14

15 g) Expeses for the retal, repair or purchase of a basic model if this optio is deemed more ecoomical, of a wheelchair, a hospital bed (excludig the mattress) or a breathig assistace apparatus. h) Expeses icurred for the followig services ad supplies provided uder medical supervisio or o prescriptio ad ot otherwise eligible for reimbursemet: Audiology Ijectable medicatios, with the exceptio of professioal fees Laboratory tests Occupatioal therapy Oxyge therapy Speech therapy Test strips, syriges ad eedles for diabetics. i) Expeses for the substace used i sclerosig ijectios, with the exceptio of professioal fees, if treatmet is medically required, up to a maximum reimbursemet of $30 per treatmet ad 10 treatmets per caledar year, per isured. j) Professioal services of a detist to repair accidetal damage to atural teeth occurrig after the isurace is i force ad provided that the treatmet takes place withi 12 moths followig the date of the accidet. k) Expeses for the purchase of orthopedic shoes that are custom-desiged ad made for a isured from a mould to correct a foot defect, icludig straight, flared or ope shoes, as well as shoes required for Deis Browe splits, up to a maximum of three pairs per caledar year, per isured. The cost of additios or modificatios to shoes is also eligible. This equipmet must be made by a specialized orthopedic laboratory licesed uder the Public Health Protectio Act (R.S.Q., Chapter P.35). l) Expeses for the purchase of foot orthoses, up to a eligible maximum of $525, per caledar year, per isured, for a adult or a child. These orthoses must be made by a specialized orthopedic laboratory licesed uder the Public Health Protectio Act (R.S.Q., Chapter P.35). m) Expeses for a eye examiatio carried out by a ophthalmologist or optometrist for isureds age 18 to 64, up to a maximum reimbursemet of $40 per period of 24 cosecutive moths, per isured. Isurace Plas 15

16 ) Trasport ad accommodatio for remote areas If, o medical prescriptio, a isured is required to travel outside his or her area of residece to cosult or receive treatmet from a medical specialist ot available i the isured s area of residece, the followig expeses are eligible, up to a maximum reimbursemet of $1,000 per caledar year, per isured: Expeses for travel with a public carrier (bus, plae, boat or trai) or by automobile if the situatio requires roud-trip travel of at least 400 kilometres from the isured s place of residece to the place where the isured is required to cosult with or receive treatmet from a medical specialist. However, whe travellig by automobile, eligible expeses are equal to those that would have bee icurred had the trip bee made by bus. Expeses for accommodatio icurred i a public establishmet, up to a eligible maximum of $60 per day, provided the cosultatio or treatmet requires a overight stay. Eligible expeses must be icurred for cosultatios or treatmets i the provice of Quebec ad are reimbursed o productio of receipts or paid ivoices, except if the meas of trasport used is a automobile. If the participat has Idividual coverage, eligible expeses must be icurred for ad explicitly apply to the participat. If the participat has Family or Sigle-Paret coverage, eligible expeses must be icurred for ad explicitly apply to the participat or depedets. This coverage allows for the presece of a perso accompayig the isured, if justified by the situatio. The expeses reimbursed are those exceedig the amouts reimbursed by the Régie de l assurace maladie du Québec (RAMQ). 2. The followig expeses are reimbursed at 100%. a) Blood glucose moitor Expeses icurred for the purchase or repair of a blood glucose moitor, up to a maximum reimbursemet of $250 per period of 60 cosecutive moths, per isured, upo presetatio of a complete report from the attedig physicia statig that the isured is isuli-depedet ad that his or her coditio requires the use of this appliace. 16

17 b) Coagulatio self-moitorig device (CoaguChek) Expeses for the purchase or repair of a coagulatio self-moitorig device, if such a device is required due to the isured s medical coditio ad it is obtaied o medical recommedatio. The expeses are limited to a maximum reimbursemet of $500 per period of 60 cosecutive moths, per isured. c) Detoxificatio I the evet of rehabilitatio treatmet for alcoholism or drug use, excludig addictio to the use of tobacco, eligible expeses are provided for a stay i a establishmet officially recogized for such purpose, subject to a maximum reimbursemet of $40 per day ad $1,000 per caledar year, per isured. d) Hearig aid Expeses icurred for the purchase or repair of a hearig aid, up to a maximum reimbursemet of $500 per period of 36 cosecutive moths, per isured. e) Hospitalizatio i a semi-private room Hospitalizatio expeses that are icurred i Caada i excess of amouts payable uder ay govermet isurace pla, up to the cost of a semi-private room for each day of hospitalizatio at the rates i force i the provice i which the expeses are icurred, without ay limit as to the umber of days. f) Itrauterie device (IUD) Expeses for the purchase of a itrauterie device (IUD), up to a maximum reimbursemet of $100 per period of 24 cosecutive moths, per isured. g) Travel Isurace A full descriptio of each beefit is provided o Page 67 of the booklet. Maximums apply. h) Trip Cacellatio Isurace A full descriptio of this beefit is provided o Page 75 of the booklet. Maximums apply. Isurace Plas 3. Exclusios Subject to the provisios of the Quebec Act respectig prescriptio drug isurace, o beefit is payable for expeses icurred: For the purchase or adjustmet of detal prostheses, eyeglasses or cotact leses. For hearig examiatios. 17

18 For periodic medical examiatios, medical examiatios for the purposes of employmet, admissio to a educatioal istitutio or isurace, or required for health trips. Due to self-mutilatio, regardless of the isured s state of mid at that time. For plastic surgery. For ay coditio occurrig while the isured is o active duty with the armed forces. For treatmet, services or products that the isured is ot required to pay. For expeses payable uder ay public or private, idividual or group pla. Ay such expeses are deducted from ay beefits payable uder this pla. Active participatio i a isurrectio, whether real or appreheded. Followig the isured s participatio i a crimial act. I the evet of hospitalizatio for exteded care. Expeses for a stay i a receptio cetre, icludig hospital cetres providig the same type of service (accommodatio) or ay other establishmet, are ot eligible for reimbursemet. For ay user charge, deductible or coisurace required by ay public pla for products ad services eligible for reimbursemet uder this pla. These exclusios also apply to the Travel Isurace beefit i additio to those icluded i the descriptio for that coverage. 18

19 REDUCED BASIC HEALTH INSURANCE PLAN Madatory participatio Isurace Plas Eligible expeses are reasoable expeses that are justified by the seriousess of the case as well as by curret medical practice ad customary charges, ad icurred by a isured followig a accidet, illess, pregacy or surgical procedure related to family plaig or orga or boe marrow doatio. 1. The followig expeses are reimbursed at 71% for participats ad their depedets, if applicable, ad at 100% oce the total expeses exceed $2,586 i a give caledar year. a) Expeses for drugs prescribed by a physicia or a detist ad dispesed by a licesed pharmacist or by a duly authorized physicia, subject to the followig exclusios: The term prescriptio drugs refers to products icluded i the drug formulary of the Régie de l assurace maladie du Québec (RAMQ) or i the drug formulary of the Associatio québécoise des pharmacies propriétaires (AQPP), with the exceptio of drugs coded V or Z. The followig products are ot cosidered to be prescriptio drugs: Products cosidered to be food substitutes, cosmetic products, soaps, suscrees ad taig oils, ski emolliets, shampoos ad other products for scalp treatmet, except o medical recommedatio deemed satisfactory by the Isurer Dietetic substaces or foods Homeopathic medicies Ay substaces used for the purpose of isemiatio, ad cotraceptive ad prophylactic jellies ad foams Prevetive vaccies Ijectios provided as part of a weight reductio program Over-the-couter laxatives ad atacids, except o medical recommedatio deemed satisfactory by the Isurer Drugs or substaces used for the treatmet of impotece 19

20 Drugs admiistered primarily for prevetive purposes Smokig cessatio products (except those icluded o the RAMQ list) Drugs admiistered for aesthetic purposes, except if required due to a accidet. Notwithstadig ay defiitio or the above-metioed exclusios, all prescriptio drugs that must be covered uder the group isurace cotract i accordace with the Quebec Act respectig prescriptio drug isurace are cosidered to be eligible expeses. For ay drug approved after Jauary 1, 1997, the Isurer reserves the right, upo agreemet with the Committee: to limit the reimbursemet accordig to the criteria stipulated by the regulatio regardig the Quebec Act respectig prescriptio drug isurace, if it is registered as a exceptio drug o the list uder sectio 60 of the Act to exclude it or establish the reimbursemet criteria if it is ot icluded o said list. 2. The followig expeses are reimbursed at 71% for participats ad their depedets, if applicable, ad at 100% oce the total expeses exceed $2,586 i a give caledar year. a) Professioal services of a detist to repair accidetal damage to atural teeth occurrig after the isurace is i force ad provided that the treatmet takes place withi 12 moths followig the date of the accidet. 3. The followig expeses are reimbursed at 100%. a) Travel Isurace A full descriptio of this beefit is provided o Page 67 of the booklet. Maximums apply. b) Trip Cacellatio Isurace A full descriptio of this beefit is provided o Page 75 of the booklet. Maximums apply. 20

21 4. Exclusios Subject to the provisios of the Quebec Act respectig prescriptio drug isurace, o beefit is payable for expeses icurred: For the purchase or adjustmet of detal prostheses, eyeglasses or cotact leses. For hearig examiatios. For periodic medical examiatios, medical examiatios for the purposes of employmet, admissio to a educatioal istitutio or isurace, or required for health trips. Due to self-mutilatio, regardless of the isured s state of mid at that time. For plastic surgery. For ay coditio occurrig while the isured is o active duty with the armed forces. For treatmet, services or products that the isured is ot required to pay. For expeses payable uder ay public or private, idividual or group pla. Ay such expeses are deducted from ay beefits payable uder this pla. Active participatio i a isurrectio, whether real or appreheded. Followig the isured s participatio i a crimial act. I the evet of hospitalizatio for exteded care. Expeses for a stay i a receptio cetre, icludig hospital cetres providig the same type of service (accommodatio) or ay other establishmet, are ot eligible for reimbursemet. For ay user charge, deductible or coisurace required by ay public pla for products ad services eligible for reimbursemet uder this pla. Isurace Plas These exclusios also apply to the Travel Isurace beefit i additio to those icluded i the descriptio for that coverage. 21

22 OPTIONAL EXTENDED HEALTH INSURANCE PLAN Optio I Optioal participatio for a miimum period of 36 moths Eligible expeses are reasoable expeses that are justified by the seriousess of the case as well as by curret medical practice, ad icurred by a isured followig a accidet, illess, pregacy or surgical procedure related to family plaig or orga or boe marrow doatio. NOTE: Healthcare professioals must be members i good stadig of their professioal order or of a professioal associatio, or must be recogized by the Committee ad the Isurer. They must work withi the legal scope of their practice. 1. The followig expeses are reimbursed at 80%. a) Professioal services of a chiropractor, up to a maximum reimbursemet of $20 per treatmet ad $400 per caledar year, per isured. Oly oe treatmet per day, per isured, is eligible for reimbursemet. The iitial examiatio doe by the chiropractor is eligible i the same capacity as a treatmet, it beig uderstood that oly oe of these two services is eligible for reimbursemet if both are received o the same day. b) Professioal services of a registered urse or ursig assistat for medical care provided i the isured s home, excludig ay perso who usually resides i the isured s home or is a member of the isured s family, up to a maximum reimbursemet of $200 per day ad $4,000 per caledar year, per isured. c) Professioal services of a homeopath, a osteopath, a aturopath, a acupucturist or a dietitia, up to a maximum reimbursemet of $20 per treatmet ad $400 per caledar year, per isured, per specialist. Oly oe treatmet per day, per specialist, per isured, is eligible for reimbursemet. d) Professioal services of a physiotherapist ad a physical rehabilitatio therapist, up to a overall maximum reimbursemet of $20 per treatmet ad $400 per caledar year, per isured, for all of these specialists. Oly oe treatmet per day, per isured, is eligible for reimbursemet. 22

23 e) Professioal services of a podiatrist ad a foot care urse, up to a overall maximum reimbursemet of $20 per treatmet ad $400 per caledar year, per isured, for all of these specialists. Oly oe treatmet per day, per isured, is eligible for reimbursemet. f) Professioal services of a kiesitherapist, a orthotherapist, a kiotherapist ad a massage therapist, up to a overall maximum reimbursemet of $20 per treatmet ad $400 per caledar year, per isured, for all of these specialists. Oly oe treatmet per day, per specialist, per isured, is eligible for reimbursemet. g) Expeses for X-rays required for the treatmet provided by a specialist covered uder Optio I, up to a overall maximum reimbursemet of $40 per caledar year, per isured, for all of the specialists covered uder this pla. h) Expeses for ultrasoud examiatios ad thermographic evaluatios, excludig fetal ultrasouds, up to a overall maximum reimbursemet of $400 per caledar year, per isured, for all of these expeses icurred o medical prescriptio. Isurace Plas 2. The followig expeses are reimbursed at 50%. Professioal services of a psychologist, a psychiatrist, a psychoaalyst, a psychotherapist ad a professioal social worker are reimbursed up to a overall maximum of $500 per caledar year, per isured, for all of these specialists. Oly oe treatmet per day, per specialist, per isured, is eligible for reimbursemet. The oly professioal services of psychiatrists eligible for reimbursemet are those redered as psychoaalytic treatmets, isofar as these professioals are members of the Caadia Psychoaalytic Society. 3. Exclusios The exclusios provided for the Basic Health Isurace Pla also apply to the Exteded Health Isurace Pla. 23

24 OPTIONAL DENTAL CARE INSURANCE PLAN Optio II Before icurrig ay major treatmet expeses, participats should first check with the Isurer as to the amouts that may be eligible for reimbursemet. To do so, they should use the Caadia Detal Associatio or the Associatio des chirurgies detistes du Québec (ACDQ) detal claim form available i the detist s office, or the Isurer s Detal Claim Form available through their employer or olie, specifyig Treatmet Pla. Optioal participatio for a miimum period of 36 moths Eligible expeses are expeses for treatmet reasoably provided ad recommeded by a detist, up to the amout of the fees specified i the fee guide approved by the Associatio des chirurgies detistes du Québec (ACDQ) at the time services are redered. The Isurer reimburses 80% of expeses for the diagostic, prevetive, basic restorative ad major restorative services ad 50% of expeses for fixed prosthodotics described below, up to a overall maximum reimbursemet of $1,000 per caledar year, per isured, for all of these expeses. The Isurer reimburses 80% of expeses for removable prosthodotics. These expeses are eligible up to a maximum reimbursemet of $1,000 per caledar year, per isured. See restrictios o Page 33. The codes used i the descriptio are draw from the documet etitled 2014 Fee Guide ad Descriptio of Detal Treatmet Services approved by the Associatio des chirurgies detistes du Québec (ACDQ). For subsequet years, these codes are replaced by their equivalets from later documets approved by the Associatio. All ew detal procedure code umbers related to the followig expeses, added while the cotract is i force, are automatically recogized. 1. Eligible expeses Descriptio of diagostic services Cliical oral examiatio a) Complete examiatio: up to oe examiatio per period of 9 cosecutive moths (01110, 01120, 01130) b) Recall or periodic examiatio: up to oe examiatio per period of 9 cosecutive moths (01200) 24

25 c) Detal examiatio for depedet childre uder age 10, if ot covered uder the public pla provided by the Régie de l assurace maladie du Québec: up to oe examiatio per period of 12 cosecutive moths (01250) d) Emergecy examiatio (01300) e) Specific oral examiatio: up to oe examiatio per period of 9 cosecutive moths (01400, 01600, 01700) f) Complete periodotal examiatio: up to oe examiatio per period of 36 cosecutive moths (01500) Limitatio: Oly oe recall, periodic, specific or complete oral examiatio is covered per period of 9 cosecutive moths. However, ay examiatio carried out by a specialist o the recommedatio of a detist (eligible accordig to the ACDQ fee guide) is ot subject to this limitatio. Radiographs a) Itraoral radiographs i) Radiograph, periapical (02111 to 02116) ii) Occlusal film (02131, 02132) iii) Bitewig film (02141 to 02144) iv) Radiograph of soft tissue (02151, 02152) b) Extraoral radiographs i) Extraoral film (02201, 02202) ii) Radiograph, sius (02304) iii) Radiograph, sialography (02400) iv) Radiopaque dyes (02430) v) Radiograph, temporomadibular joit (02504) vi) Paoramic film (02600) vii) Cephalometric film (02701, 02702) c) Radiograph, had ad wrist, as diagostic aid for detal treatmet (02915) d) Tomography (02920, 02929) Limitatio: No more tha oe series of radiographs is eligible for reimbursemet per period of 9 cosecutive moths, except for a series of radiographs take durig a emergecy examiatio or a examiatio carried out by a specialist o the recommedatio of a detist. Furthermore, a complete series of periapical ad bitewig films is eligible for reimbursemet oly oce per period of 36 cosecutive moths. Isurace Plas 25

26 Tests ad laboratory examiatios a) Bacteriological culture to idetify pathological agets (04100) b) Bacteriological culture to determie susceptibility to cavities (04201) c) Biopsy of soft tissue or hard tissue (04302, 04311, 04312) d) Cytology tests (04401, 04402) Diagostic casts a) Umouted (04501, 04502) b) Mouted (04510, 04520) c) Diagostic wax-up (04730) Presetatio of case/treatmet pla (05101) Cosultatio (04500, 05201) Descriptio of prevetive services Polishig of coroal portio of teeth (prophylaxis): up to oe treatmet per period of 9 cosecutive moths (11100, 11200, 11300) Periodotal scalig: up to oe treatmet per period of 9 cosecutive moths for all related detal procedures (43411 to 43414, 43417, 43419) Topical applicatio of fluoride: up to oe treatmet per period of 9 cosecutive moths (12400) Nutritioal cousellig (13100) Oral hygiee istructio (13200, 13210) Plaque cotrol program (13220) Fiishig restoratios (13300) Removal of subgigival fillig material, requirig aesthesia, without flap, per tooth (13301) Pit ad fissure sealats (13401, 13404) Mouth guard (13510) Tooth discig a) Iterproximal discig of teeth (13700) b) Eameloplasty, per tooth (13715) 26

27 Space maitaiers a) Bad type (15108 to 15111, 15120) b) Stailess steel crow type (15200, 15210) c) Removable appliace (15400, 15410) d) Acid etched boded type (15420) Isurace Plas Descriptio of basic restorative services RESTORATION Primary teeth a) Amalgam, o-boded ateriors or posteriors (21101 to 21105) b) Amalgam, boded ateriors or posteriors (21121 to 21125) c) Composite, boded ateriors (23311 to 23315) d) Composite, boded posteriors (23411 to 23415) Permaet teeth a) Amalgam, o-boded ateriors or bicuspids (21211 to 21215) b) Amalgam, o-boded molars (21221 to 21225) c) Amalgam, boded ateriors ad bicuspids (21231 to 21235) d) Amalgam, boded molars (21241 to 21245) e) Composite ateriors (23111 to 23115, 23118) f) Veeer (ateriors ad bicuspids) (23121, 23122) g) Diastema closure, per tooth (23124) h) Composite, boded bicuspids (23210 to 23215) i) Composite, boded molars (23220 to 23225) Retetive pis (amalgam or composite) (21301 to 21304) Supplemet for restoratio of a tooth uder a appliace or supportig a existig removable partial deture: per restoratio (i additio to the code used for retrofillig) (21601) Gold foil (24101, 24102) 27

28 Ilays/olays a) Metal (25100, 25200, 25300, 25500) b) Porcelai, resi or ceramic (25121 to 25123, 25521) Retetive pis for ilays or olays (25601 to 25604) ORAL SURGERY Removal of erupted teeth (ucomplicated) (71101, 71111) Surgical removals a) Erupted teeth (complex) (72100, 72110) b) Impacted tooth (72210, 72220, 72230, 72240) c) Residual roots (72300, 72310, 72320) d) Removal of fragmet(s) of a fractured tooth (72350) e) Surgical exposure of teeth (72410 to 72412) f) Surgical movemet of teeth (72430, 72440) g) Eucleatio of teeth (72450) Supplemet for suturig, per visit: these expeses are oly eligible if claimed together with expeses for removal of erupted teeth (ucomplicated) (71121) Remodellig ad recotourig of oral tissues a) Alveolectomy (73020) b) Alveoloplasty (73100, 73110) c) Stomatoplasty (73123) d) Osteoplasty (73133 to 73135, 73140) e) Tuberoplasty (73150, 73151) f) Removal of hyperplasic tissue (by radiosurgery or dissectio) (73171 to 73176) g) Removal of excess mucosa (by radiosurgery or dissectio) (73181 to 73186) h) Alveolar ridge recostructio with alloplastic material (73360, 73361) i) Extesio of mucous folds with secodary epithelizatio (icludig vestibuloplasty) (73381 to 73384) j) Extesio of mucous folds with mucous or ski graft (73401 to 73404) 28

29 Surgical excisio (cyst ad tumor) a) Removal of tumor (74108, 74109) b) Removal ad curettage of itra-osseous cyst or grauloma (74408 to 74410) Surgical icisio ad draiage (75100, 75101, 75110) Removal of foreig body from the boe or soft tissue (75301, 75361) Freectomy (77801 to 77803) Hemorrhage, cotrol (79400, 79401) Post-surgical treatmet (79601, 79602) Isurace Plas GENERAL ADDITIONAL SERVICES Local aesthesia (04470, 04471) Coscious sedatio by ihalatio (92311 to 92319) Coscious sedatio, itraveous (92331 to 92339) Oral or percutaeous coscious sedatio (92421 to 92429) Professioal visits (94100, 94200, 94400) Descriptio of major restorative services ENDODONTICS Caries/trauma/pai cotrol a) Sedative fillig/idirect cappig (20111, 20121) b) Recotourig ad polishig of traumatized tooth (20131) c) Bodig/cemetatio (20161) Edodotic emergecy a) Pulpotomy (32201, 32202, 32210) b) Ope ad drai through atural tooth (separate emergecy procedure) (39201, 39202) c) Pulpectomy through atural tooth (separate emergecy procedure) (39901 to 39904) d) Relievig traumatic occlusio (39970) e) Reimplatatio of avulsed tooth (39981) f) Repositioig of traumatically displaced tooth (39985) 29

30 Other edodotic services: supplemet for edodotic treatmet through a metal ad/or porcelai crow (32101, 32102) Preparatio of tooth for treatmet (39100, 39110, 39120) Root caal therapy a) Root caal treatmet ad retreatmet i) Oe caal (33100 to 33102, to 33112) ii) Two caals (33200 to 33202, to 33212) iii) Three caals (33300 to 33302, to 33312) iv) Four caals (33400 to 33402, to 33412) v) Additioal caal (33475) b) Apexificatio i) Oe caal (33521, 33531, 33541) ii) Two caals (33522, 33532, 33542) iii) Three caals (33523, 33533, 33543) iv) Four caals or more (33524, 33534, 33544) c) Perforatio repair (34511) Periapical edodotic surgery a) Apicoectomy (as a separate procedure from root caal) (34101 to 34104) b) Apicoectomy ad root caal treatmet performed joitly, with or without retrofillig (34111, 34112, 34114, 34115) c) Apicoectomy ad root caal retreatmet performed joitly, with or without retrofillig (34171, 34172, 34174, 34175) d) Apicoectomy ad retrofillig (as a separate procedure from root caal) (34201 to 34203, 34212, 34215) e) Root amputatio (34401, 34402) f) Itetioal reimplatatio (34451 to 34453) g) Hemisectio (39230) Bleachig of tooth, i office, by a detist: subject to a overall maximum of 10 sessios per caledar year, per isured for all teeth a) No-vital (39410) b) Vital, i office (97101, 97102) 30

31 PERIODONTICS Maagemet of acute ifectios ad other oral lesios (41200) Desesitizatio: up to a overall maximum of 10 applicatios per caledar year, per isured, for all teeth (41300) Periodotal surgery a) Root plaig ad curettage (42000, 42001) b) Gigivoplasty ad/or gigivectomy (42002, 42003, 42010) c) Fibrotomy (42330, 42331) d) Flap approach with osteoplasty ad/or ostoectomy (42100) e) Grafts i) Soft tissue (42200, 42300, 42301, 42560, 42561, 42565) ii) Gigival (42570, 42575) iii) Osseous tissue (42611, 42700, 42711) f) Proximal wedge (mesial or distal) (42400) g) Exploratory surgery, flap approach (42441, 42451) h) Postoperative visit for dressig chage (42720) Adjuctive periodotal procedures a) Temporary splits or ligatios (43200, 43211, 43212, 43260) b) Cast metal split, acid etch boded (43290) c) Removal or recemetatio of split, per tooth (43295) d) Occlusal equilibratio (43300, 43310) e) Periodotal appliaces (to cotrol bruxism) (43611, 43612, 43622, 43631) f) Itraoral appliace for temporomadibular joit (occlusal guard) (43711, 43712, 43732, 43741) g) Periodotal irrigatio, subgigival (49211) h) Itra-sulcular applicatio of slow release atimicrobial ad/or chemotherapeutic agets (49221, 49229) Isurace Plas FIXED PROSTHODONTICS Idividual crows a) Acrylic processed (27100) 31

32 b) Provisioal, acrylic (trasitioal) (27130, 27140, 27150) c) Porcelai, acrylic, ceramic, resi or metal (27200, 27210, 27300, 27310) d) Complemetary services (27401, 27501, 27503, 28211) Other restorative services a) Crow or veeer repair (27721 à 27723) b) Recemetatio ad/or removal (29100, 29200) c) Removal of ilay, olay, o-prefabricated crow or veeer (i additio to preparatio of a ew restoratio), first uit of time ad each additioal uit (29301, 29302) Restrictios cocerig crows Replacemet of idividual crows will be refudable provided satisfactory evidece may establish that the idividual crows may ot be repaired ad, if this crow has bee iserted while this detal care coverage was i force, that at least 4 years have goe by prior to the replacemet. Descriptio of expeses for removable prosthodotics REMOVABLE PROSTHODONTICS Complete detures a) Stadard (51100, 51110, 51120) b) Equilibrated (51201 to 51203) Immediate complete detures (51300, 51310, 51320) Immediate complete detures (trasitioal) (51600, 51610, 51620) Detures, complete, overdeture a) Stadard (51701 to 51703) b) Equilibrated (51711 to 51713) Partial detures, acrylic base (immediate, trasitioal, or permaet) (52101 to 52105, to 52124, 52129, to 52232) Cast partial detures, chrome-cobalt alloy with cast ad/or wrought rests ad clasps (52400, 52410, 52420, 52500, 52510, 52520, to 53133, 53150, to 53223) Complete detures with partial detures (opposig arch), chrome-cobalt, with or without free ed base (52531, 52532, 52542, 52543) 32

33 Removable cast partial detures with precisio attachmets (52600, 52610, 52620) Semi-precisio cast partial detures (52601, 52611, 52630) Hybrid partial detures, cast (52701, 52702) DENTURE ADJUSTMENTS Mior adjustmets, provided that adjustmets are made more tha six moths after the iitial isertio of the deture (54250, 54251) Remout ad equilibratio of complete or partial detures (54300 to 54302) Isurace Plas COMPLETE OR PARTIAL DENTURE REPAIRS Complete deture repairs without impressio (55101 to 55104) Complete deture repairs with impressio (55201 to 55204) Structural additios to partial deture (55520, 55530) Replacemet of teeth i prosthesis (56602) Vertical dimesio recuperatio by additio of acrylic to existig prosthesis (56631) DENTURE CLEANING AND POLISHING (55700) DUPLICATE OF A PROSTHESIS (56100, 56101) REBASING AND RELINING Reliig of complete or partial deture (56200, 56201, 56210, 56211, to 56222, to 56232) Rebase (jump) (56260 to 56263, 56280, 56290) Therapeutic tissue coditioig (56270 to 56273) REMAKE, PARTIAL DENTURES (usig existig framework) (56411 to 56413) Restrictios cocerig removable prosthodotics Ay replacemet of a prosthesis or the additio of teeth to a removable prosthesis is oly eligible for reimbursemet if satisfactory proof is provided that: a) the replacemet or additio of teeth is ecessary followig the extractio of teeth after the iitial deture isertio; or 33

34 b) at least 4 years have elapsed sice the iitial deture isertio. Limitatios to eligible expeses The followig detal procedures are ot eligible for reimbursemet by the Isurer: Detal care provided free of charge or for which the isured does ot have to pay Detal care for which the isured is etitled to reimbursemet uder the Act respectig idustrial accidets ad occupatioal diseases, the Quebec Automobile Isurace Act, or ay other Caadia or foreig law with similar provisios Detal treatmets payable uder ay health isurace pla i which the isured participates 2. Exclusios No beefits are payable for detal care expeses icurred: for a third party for cosmetic surgery, icludig the trasformatio, extractio or replacemet of healthy teeth i order to modify their appearace for ay coditio occurrig while the isured is o active duty with the armed forces 34

35 ACTIVE PARTICIPANT S AND RETIREE S OPTIONAL LIFE INSURANCE PLAN Optio III Isurace Plas Optioal participatio 1. Active participats a) Participat s Basic Life Isurace The amout of Basic Life Isurace payable i the evet of the participat s death is equal to: 1 times the aual salary, rouded to the earest multiple of $5, for participats uder age 65 1 /2 the aual salary, rouded to the earest multiple of $5, for participats age 65 ad over b) Participat s Optioal Life Isurace NOTE: Participatio i this beefit is coditioal o participatio i Basic Life Isurace. Participats may opt for a additioal amout of life isurace equal to their choice of 1 to 5 times their aual salary. This amout is rouded to the earest multiple of $5. This beefit is subject to evidece of isurability i accordace with the Isurer s stadards i force at the time of erolmet ad each time a ew uit of Optioal Life Isurace is added. This beefit does ot apply if the participat dies from suicide or the effects of ay attempted suicide durig the first year followig the effective date of this beefit, its reistatemet or ay icrease i the beefit amout, whether or ot he or she is of soud mid at the time of suicide or attempted suicide. I such case, isurace uder this beefit, or the icrease i isurace, as the case may be, shall be ull ad void, ad the liability of the Isurer shall be limited to a refud of the premiums collected. 35

36 c) Participat s Accidetal Death ad Dismembermet Isurace NOTE: Participatio i this beefit is coditioal o participatio i Basic Life Isurace. If the participat sustais ay of the losses specified below withi 365 days followig the date of a accidet, provided the participat is covered uder this beefit at the time of the accidet, the Isurer will pay the percetage of aual salary idicated below, without exceedig 100% of salary for all losses related to the same accidet. This percetage is reduced by half whe the participat reaches age 65. PERCENTAGE TABLE OF LOSSES OF ANNUAL SALARY Loss of life 100% Loss of both hads or both feet or loss of sight i 100% both eyes Loss of oe had ad oe foot 100% Loss of oe had or oe foot ad the sight i oe eye 100% Loss of oe had or oe foot 50% Loss of sight i oe eye 50% Loss of oe figer 10% The word loss meas, for a had, foot or figer, total ad defiitive loss of use; with respect to eyesight, it meas the total, defiitive ad irrecoverable loss of eyesight. I the evet of a loss sustaied by a disabled perso, the percetage of aual salary remais that established at the oset of disability. For isurace purposes, a disabled perso is deemed to be a retiree as of his or her 65th birthday. This coverage does ot apply if the loss sustaied occurs i the followig cases: While the participat is carryig out ay of the duties of a airplae crew, except as required i the course of his or her duties as stipulated i the collective agreemet or idividual employmet cotract Due to war, whether declared or ot, or participatio i a isurrectio Due to attempted suicide or suicide of the participat, or volutary self harm or ijury, whether or ot the participat is of soud mid Participatio i a crimial act or a act deemed to be crimial, icludig the act of drivig a motor vehicle while havig a blood alcohol level i excess of the prescribed legal limit 36

37 While the participat is o active duty with the armed forces Subsequet to a illess or afflictio that does ot result from a accidet ad becomes apparet at the time of a accidet d) Participat s Spouse s ad Depedet Childre s Life Isurace Isurace Plas NOTE: Participatio i this beefit is coditioal o participatio i Participat s Basic Life Isurace. The beefits payable i the evet of death are equal to: $2,500 for a isured depedet child age 24 hours or older $5,000 for the isured spouse e) Participat s Spouse s Optioal Life Isurace NOTE: Participatio i this beefit is coditioal o participatio i Spouse s ad Depedet Childre s Life Isurace. Participats may choose a additioal amout from 1 to 20 uits of $5,000 o the life of their spouse. This beefit is subject to evidece of isurability i accordace with the Isurer s stadards i force at the time of erolmet ad each time a ew uit of Optioal Life Isurace is added. This beefit does ot apply if the spouse dies from suicide or the effects of ay attempted suicide durig the first year followig the effective date of this beefit, its reistatemet or ay icrease i the beefit amout, whether or ot he or she is of soud mid at the time of suicide or attempted suicide. I such case, isurace uder this beefit, or the icrease i isurace, as the case may be, shall be ull ad void, ad the liability of the Isurer shall be limited to a refud of the premiums collected. 2. Retired participats a) Retiree s Life Isurace Startig o the date of retiremet, participats may cotiue to be isured without evidece of isurability ad choose a amout of up to 20 uits of $5,000, without exceedig the amout held as a active participat, provided they submit a applicatio to the Isurer withi 30 days followig the date of retiremet. 37

38 However, for part-time participats or participats o upaid leave without maitaiig participatio, whose amout of isurace i force immediately prior to retiremet was lower tha $5,000, the amout is deemed to be $5,000. Participats may subsequetly reduce, but caot icrease, the amout of isurace selected. I additio, they may termiate their isurace at ay time, i which case they will o loger be able to participate. Retired participats who retur to work may keep the amout of isurace held as a retiree. I such case, ay ew amout of life isurace for the participat or his or her depedets to which the participat becomes etitled oce he or she retires agai is added to the amout of isurace already held. The total of these amouts therefore forms a sigle amout of isurace for the purposes of applyig the maximums provided uder this beefit (retiree ad depedets). b) Retiree s Spouse s ad Depedet Childre s Life Isurace Retired participats may keep the amout of isurace they held uder the active participat s pla for their spouse ad depedet childre, if applicable, provided they take out Retiree s Life Isurace coverage. Erolmet must occur at the same time for all life isurace plas available to the retiree. The beefits payable i the evet of death are equal to: $2,500 for a isured depedet child age 24 hours or older $5,000 for the isured spouse c) Retiree s Spouse s Optioal Life Isurace Retired participats may keep some or all of the amout of optioal life isurace coverage they held o the life of their spouse uder the active participat s pla, i.e. betwee 1 ad 20 uits of $5,000, provided they take out Retiree s Life Isurace ad Spouse s ad Depedet Childre s Life Isurace coverage. Premium rates are the same as those for the amout of Retiree s Life Isurace coverage, takig the retiree s age ad spouse s geder ito accout. Erolmet must occur at the same time for all life isurace plas available to the retiree. 38

39 3. Accelerated beefit paymet i the evet of termial illess A perso who is isured uder ay of the life isurace plas, whose life expectacy is o more tha 12 moths, may obtai a accelerated beefit paymet by submittig a writte request to the Isurer, accompaied by appropriate medical evidece ad the beeficiary s writte coset. The total amouts paid out (Basic ad Optioal) may ot exceed $50,000 or 25% of the isured s amout of life isurace. All of the provisios regardig the accelerated beefit paymet ca be foud o Page 65 of this booklet. Isurace Plas 39

40 40

41 GENERAL INFORMATION 1. Defiitios a) Assistor CaAssistace Ic. or ay other assistace provider desigated by the Isurer. b) Busiess parter A perso with whom the isured is associated for busiess purposes as part of a compay with four shareholders or fewer, or a profit-makig corporatio with four parters or fewer. c) Close relative The isured s spouse, child, father, mother, father-i-law, mother-i-law, brother, sister, brother-i-law, sister-i-law, so-i-law, daughter-i-law, gradparet or gradchild. Geeral Iformatio d) Commercial activity A assembly, coferece, covetio, exhibitio, show or semiar of a professioal or commercial ature. The activity must be public, uder the resposibility of a official orgaizatio ad i compliace with the legislatio, regulatios ad policies of the regio where it will be held. I additio, the commercial activity must be the oly reaso for the plaed trip. e) Committee The Itersectoral Parity Committee Fédératio des travailleurs et travailleuses du Québec (CPI FTQ). f) Depedet The participat s spouse or depedet child, as defied below. Spouse A perso of the same or opposite geder who, o the date of the evet givig etitlemet to beefits: a) is legally married or civilly uited to the participat; or 41

42 b) has bee livig i a cojugal relatioship with the participat for over a year, or less tha oe year if that perso is the mother or father of a participat s child; or c) has bee livig i a cojugal relatioship with the participat for at least a year. Note that the status of spouse may be cacelled by ay of the followig evets, as the case may be: I the case of a marriage, a judgmet of divorce betwee the participat ad the spouse I the case of a commo-law uio, de facto separatio for at least 90 days I the case of a civil uio, dissolutio of the uio by a otarized act or court decisio If the participat has a spouse who correspods to the defiitio uder item a) above ad aother spouse who correspods to the defiitio uder items b) or c), the Isurer shall recogize as the spouse the perso desigated by the participat as his or her spouse by writte otice to the Isurer. Depedet child Refers to ay of the followig persos: A perso uder 18 years of age over whom the participat or spouse exercises paretal authority A perso age 25 or uder who has o spouse, atteds a recogized educatioal istitutio as a duly registered full-time studet, ad over whom the participat or spouse would exercise paretal authority if a mior A perso who has reached the age of majority, without a spouse, who is domiciled i the participat s home ad is afflicted with a total disability which occurred while the perso met either of the two previous defiitios, ad has remaied totally ad cotiuously disabled sice that date, over whom the participat or spouse would exercise paretal authority if he or she were a mior A perso who has reached the age of majority, without a spouse, afflicted with a fuctioal deficiecy defied i the Regulatio respectig the Basic Prescriptio Drug Isurace Pla that occurred before he or she reached age 18, who receives o beefits uder a last resort assistace pla provided uder the Act respectig icome security, who is domiciled i the participat s home ad over whom the participat or spouse would exercise paretal authority if the perso was a mior. 42

43 The cocept of paretal authority over a perso other tha a child of the participat or participat s spouse must be cofirmed by a court judgmet or by a valid will of the father or mother or by a statemet o their part to such effect forwarded to the public curator or public trustee. g) Disability i) Disability of 48 moths or less Disability meas a state of icapacity that results either from a illess, icludig a accidet or a complicatio resultig from pregacy, tubal ligatio, vasectomy or similar cases relatig to family plaig or from doatio of a orga or boe marrow requirig medical attetio which makes the wageearer totally icapable of carryig out the ordiary tasks of his or her employmet, or ay equivalet employmet offered by the employer that pays similar remueratio. ii) Disability of more tha 48 moths Disability meas a state of icapacity which reders the wage-earer completely icapable of performig ay gaiful occupatio for which he or she is reasoably suited give his or her educatio, traiig ad experiece. The wage-earer is ot deemed to be disabled for ay period of disability durig which he or she is ot uder the care of a physicia or surgeo legally authorized to practise medicie, except i statioary cases where the disability is recogized to the Isurer s satisfactio. I the evet of a disability due to metal illess, the disabled wage-earer must be uder the care of a psychiatric specialist, except i the evet of statioary cases where the disability is recogized to the Isurer s satisfactio. Geeral Iformatio h) Disability period For the first 36 moths, a period of disability is ay cotiuous period of disability or series of successive periods of disability separated by a period of effective fulltime work or availability for full-time work, uless the wage-earer establishes to the satisfactio of his or her employer or its represetative that a subsequet period is due to a illess or accidet that is completely urelated to the cause of the previous disability. The period of effective full-time work or availability for full-time work is: i) Less tha 15 days if the period of disability is less tha 78 weeks ii) Less tha 45 days if the period of disability is 78 weeks or more. 43

44 After the 36th moth, a period of disability is ay cotiuous period of disability which may be iterrupted by less tha 6 moths of effective full-time work or availability for full-time work, if the same disability is ivolved. NOTE: A period of disability resultig from a sickess or ijury that has bee volutarily self-iflicted by the wage-earer, from alcoholism or substace abuse, active participatio i a riot, isurrectio or crimial acts or service i the armed forces is ot recogized as a period of disability for the purposes herei. However, a period of disability resultig from alcoholism or substace abuse durig which the wage-earer receives treatmet or medical care for rehabilitatio purposes is recogized as a period of disability. i) Health ad Social Services sector The Health ad Social Services sector icludes all cetres operated by public istitutios uder the meaig of the Act respectig health ad social services (R.S.Q., c.s-4.2), private istitutios cotracted uder the meaig of this law, ad ay orgaizatio that provides services to a cetre or users i compliace with the act ad declared by the govermet to be a establishmet withi the meaig of the Act respectig health ad social services ad represeted by the followig groups of employers: Miistère de la Saté et des Services sociaux (MSSS) Associatio québécoise d établissemets de saté et de services sociaux (AQESSS) Associatio des cetres de réadaptatio e dépedace du Québec (ACRDQ) Associatio des établissemets privés covetioés saté et services sociaux (AEPC) Associatio des établissemets de réadaptatio e déficiece physique du Québec (AERDPQ) Fédératio québécoise des cetres de réadaptatio e déficiece itellectuelle et e troubles evahissats du développemet (FQCRDITED) Associatio des cetres jeuesse du Québec (ACJQ) Health ad social services agecies j) Host at destiatio The perso at whose pricipal residece the isured is plaig to stay by prior agreemet. 44

45 k) Isured The participat or oe of his or her depedets uder this cotract. l) Participat The wage-earer or retired perso isured uder this cotract. m) Prepaid travel expeses Ay amout paid by ad for the isured to purchase a package trip, icludig tickets from a public carrier ad retal of motor vehicles from a accredited firm. Also icludes amouts paid by the isured for lad arragemets usually icluded i a package trip, whether the reservatios are made by the isured or by a travel agecy, as well as amouts paid by the isured i relatio to registratio fees for a commercial activity. Geeral Iformatio ) Salary Salary to scale icreased, if applicable, by seiority pay ad regioal differetials, icludig additioal remueratio for cotiuig educatio, but excludig paymets for overtime ad ay lump-sum paymets. o) Travel compaio The perso with whom the isured shares accommodatio at the travel destiatio, or whose trasportatio expeses were paid with those of the isured. p) Trip A trip for the purposes of tourism or recreatio, a trip for the purposes of humaitaria aid or cooperative work that is supervised by a registered charity, or a commercial activity. No other type of trip is covered uder this beefit, uless the Policyholder ad the Isurer have agreed otherwise. For the purposes of Trip Cacellatio Isurace, the isured s trip must iclude a stay of at least oe (1) ight at the trip destiatio, either i or outside the isured s provice of residece. 45

46 2. Eligibility a) Wage-earers All wage-earers workig either full-time or 70% or more of a full-time schedule: i a permaet positio: after 1 moth of cotiuous service i a temporary positio: after 3 moths of cotiuous service. All part-time wage-earers workig less tha 70% of a full time schedule: after 3 moths of cotiuous service. b) Depedets All depedets of a participat are eligible for coverage as of the same date as the participat if they are already a depedet, or as of the date o which they subsequetly become depedets. c) Retirees All wage-earers become eligible for Retiree s Life Isurace coverage as of the date of retiremet if they were covered uder the Active Participat s Optioal Life Isurace pla. A retired participat who is rehired o or after May 14, 2006 remais covered by the Retiree s Life Isurace pla ad the Idividual Health Isurace policy, if he or she had erolled prior to retiremet. This participat is ot eligible for ay of the group isurace plas for active participats. 3. Participatio a) Basic Health Isurace (Madatory) Erolmet Erolmet is madatory for ay eligible wage-earer uder the age of 65 ad for his or her depedets, if ay, subject to the exemptio etitlemet. Wageearers must select oe of the followig tiers at the time of erolmet: Complete Reduced 46

47 Wage-earers must complete a applicatio form withi 30 days followig the date they become eligible or the date o which they lose coverage uder aother cotract uder which they were isured. This provisio also applies to wage-earers who were disabled o the effective date of the ew pla, i.e. Jauary 1, If a disabled wage-earer wats to select the reduced tier, the applicable 30-day period begis o the date o which the wager-earer returs to active work. If the applicatio is submitted after the 30-day period, the wage-earer will automatically have the complete tier. The participat s coverage etails coverage of the participat s depedets, if he or she opts for Family coverage (spouse ad depedet childre) or Sigle- Paret coverage (depedet childre oly). Participats must complete a applicatio form withi 30 days followig the date o which they become eligible. Erolmet is optioal for wage-earers age 65 or over. A wage-earer age 65 or over who chooses ot to erol i the pla caot erol at a later date. Geeral Iformatio However, a participat with o depedet childre ad whose spouse is age 65 or over may opt to replace Family coverage with Idividual coverage. Participats who exercise this optio caot make ay subsequet chages to the choice of Idividual coverage status. Miimum participatio period Wage-earers who opt for the complete tier must maitai their participatio for a miimum period of 36 moths. This period icludes ay exemptio period of which a wage-earer has take advatage or ay disability period. No miimum participatio period applies to the reduced tier. Wage-earers who have opted for this tier may upgrade to the complete tier at ay time. Coverage chage request All wage-earers may apply for a chage of coverage followig ay of these evets: Marriage or civil uio Cohabitatio for at least oe year, or for less tha oe year if a child has bee bor of their uio or if legal adoptio procedures have bee iitiated Birth or adoptio of a first child Death of the spouse Termiatio of the spouse s or a depedet child s isurace requirig a chage of coverage. 47

48 All coverage chage requests must be submitted to the Isurer withi 30 days of the date of the evet givig rise to the request. The isurace the becomes effective o the date of the evet. If the request is submitted more tha 30 days after the date of the evet, the isurace becomes effective o the first day of the premium period followig the date of receipt of the request. Exemptio etitlemet A wage-earer may waive or termiate coverage for him or herself ad depedets, if ay, uder this pla provided that they are isured by a group isurace pla with similar coverage. The wage earer s decisio may also apply oly to depedets, i which case the same provisios apply. This decisio is irreversible as log as the wage-earer ad depedets, if ay, are eligible for the other pla. However, as soo as coverage uder the other group isurace pla eds, they must participate i this pla. Wage-earers who have exercised their exemptio etitlemet for the Basic Health Isurace pla may opt to take out coverage uder the optioal plas, for themselves ad their depedets, by completig a applicatio form withi 30 days followig the date o which the depedets become eligible. Termiatio of exemptio etitlemet A wage-earer or depedets, if ay, who is exempt from the Basic Health Isurace Pla may termiate the exemptio. This also applies to a disabled participat. The followig coditios must be met to the Isurer s satisfactio: Prior to the applicatio, the wage-earer must establish that he or she was covered by a group isurace pla providig similar coverage. The wage-earer must establish that it has become impossible for him or her to cotiue to be isured by the pla or plas that provided the exemptio etitlemet. Wage-earers must therefore sed a applicatio form to the Isurer withi 30 days followig the ed of their exemptio, idicatig the coverage tier selected. If the applicatio is ot received withi 30 days followig the ed of the exemptio period, the wage-earer will automatically have the complete tier. The wage-earer will the have to maitai participatio for the miimum period before beig able to chage for the reduced tier. 48

49 IMPORTANT For participats reachig age 65 As this group isurace pla does ot iclude ay additioal premium for prescriptio drugs, La Capitale cosiders that participats will remai isured uder this group pla. Participats must therefore esure they opt out of the RAMQ s Basic Prescriptio Drug Isurace Pla. This decisio is reversible, as participats may erol i the RAMQ pla at ay time. Participats age 65 who choose to maitai erolmet i the RAMQ pla may erol i the 3992 idividual Health Isurace product if they wish to maitai coverage for expeses other tha those icurred for prescriptio drug purchases. As erolmet i the RAMQ pla is irrevocable, these participats may o loger choose to be covered by La Capitale for prescriptio drugs covered by the RAMQ. Geeral Iformatio b) Optioal plas Exteded Health Isurace (Optio I) Detal Care Isurace (Optio II) Participatio i each pla is optioal. No evidece of isurability is required if the wage-earer erols withi 30 days followig eligibility or the date o which the participat ceases to be eligible for aother group isurace pla uder which he or she was isured. If the Isurer receives the applicatio more tha 30 days after the eligibility date, the participat must provide evidece of isurability for him or herself ad depedets to the Isurer s satisfactio. Isurace the becomes effective o the date o which the Isurer accepts the evidece of isurability. The miimum participatio requiremet is 36 moths for all participats ad their depedets, if applicable, as of the effective date of their isurace. After this period, participats may cease to participate i these plas at ay time by otifyig their employer. 49

50 Participats with Idividual coverage may choose to isure a spouse ad depedet childre (Family coverage) or depedet childre oly (Sigle- Paret coverage) as soo as they have depedets or their depedets are o loger eligible for aother group isurace pla offerig similar beefits. Isurace for depedets becomes effective at that time, provided that a ew applicatio form is completed by the wage-earer ad received by the Isurer withi the followig 30 days. A participat caot have Sigle-Paret or Family coverage uder the optioal plas if that participat has Idividual coverage uder the Basic Health Isurace pla. A participat who has Sigle-Paret or Family coverage uder the Basic Health Isurace Pla may, however, take out Idividual coverage uder the optioal plas. Followig examiatio of the evidece of isurability, the Isurer may grat Family or Sigle-Paret coverage that excludes oe or more members of the family from coverage. I additio, coverage uder the optioal pla (Idividual, Sigle-Paret, Family) must be the same. Note that Sigle-Paret coverage is oly for participats who do ot have a spouse. Life isurace for active participats ad retirees I) ACTIVE PARTICIPANTS Participat s Basic Life Isurace Participatio is optioal. No evidece of isurability is required if the wageearer erols withi 30 days followig eligibility. After this time, evidece of isurability deemed satisfactory by the Isurer is required. Wage-earers may also erol i Participat s Basic Life Isurace without havig to provide evidece of isurability by completig a applicatio form withi 30 days followig the adoptio or birth of a first child, or the date o which the wage-earer takes a spouse i accordace with the defiitio of spouse uder this cotract. If the wage-earer ceases to participate i this beefit, evidece of isurability must be provided to the Isurer s satisfactio if a ew applicatio is submitted. 50

51 Participat s Optioal Life Isurace Participat s Accidetal Death ad Dismembermet Isurace Participat s Spouse s ad Depedet Childre s Life Isurace Participatio i each of these beefits is optioal but coditioal o participatio i Participat s Basic Life Isurace. For Participat s Accidetal Death ad Dismembermet Isurace ad Spouse s ad Depedet Childre s Basic Life Isurace, whe the Isurer receives the applicatio more tha 30 days after the eligibility date, the participat must provide evidece of isurability for him or herself ad depedets to the Isurer s satisfactio. For Participat s Optioal Life Isurace, all amouts of isurace require evidece of isurability. If the wage-earer ceases to participate i ay of these beefits, evidece of isurability must be provided to the Isurer s satisfactio if a ew applicatio is submitted. Participat s Spouse s Optioal Life Isurace Participatio is optioal but coditioal o participatio i Participat s Basic Life Isurace ad Spouse s ad Depedet Childre s Life Isurace. All amouts of optioal life isurace require evidece of isurability. Geeral Iformatio Whe a participat obtais a first positio Ay eligible wage-earer who does ot hold a positio ad has ot erolled i the optioal plas may do so without evidece of isurability by completig a applicatio form withi 30 days followig the date o which he or she obtais a first positio. II) RETIRED PARTICIPANTS Retiree s Life Isurace Participatio is optioal but coditioal o participatio i this beefit uder the active participat s pla. A retired participat ca choose to erol i this beefit by submittig a applicatio withi 30 days followig the retiremet date. No applicatios will be accepted after this period. However, if the participat should die before the 30-day period is up, he or she is assumed to have take out the coverage ad maitaied the amout of life isurace held immediately prior to retiremet, without exceedig the maximum amout of $50,

52 Retiree s Spouse s ad Depedet Childre s Life Isurace Retiree s Spouse s Optioal Life Isurace Participatio i each of these beefits is optioal but coditioal o participatio i these beefits uder the active participat s pla ad o participatio i Retiree s Life Isurace. For life isurace of a ew depedet, a retiree must submit a applicatio to the Isurer withi 30 days followig the date o which the ew depedet becomes eligible. If the Isurer receives the applicatio more tha 30 days after this period, the participat must provide evidece of isurability for the ew depedet to the Isurer s satisfactio. 4. Effective date of isurace a) Wage-earer ad depedets WAGE-EARNER Basic Health Isurace Pla (Madatory) Complete ad Reduced Tiers Wage-earers are covered as of the date o which they become eligible. Optioal Plas I II III Wage-earers are covered as of the date o which they become eligible, provided they are at work or were at work o the last day they would usually have bee at work, otherwise the day of their retur to work, provided they complete a applicatio form withi 30 days followig that date. If the applicatio is completed after that time, the wage-earer will be covered as of the date o which the Isurer approves the evidece of isurability, provided the wage-earer is at work or was at work o the last day he or she would usually have bee at work, otherwise the day of his or her retur to work. DEPENDENTS Isurace for depedets begis o the latest of the followig dates: The date o which they become eligible The date the Isurer approves ay required evidece of isurability The date o which they cease to be eligible for aother group isurace pla, provided the applicatio is submitted withi 30 days of termiatio of coverage uder the other pla. 52

53 b) Retirees ad their depedets RETIREES Optioal Life Isurace pla Isurace for retirees begis o the date they become eligible, provided they complete a applicatio withi 30 days followig that date. DEPENDENTS Isurace for depedets begis o the latest of the followig dates: The date o which they become eligible The date the Isurer approves ay required evidece of isurability. 5. Coversio privilege Geeral Iformatio a) Complete ad reduced Basic Health Isurace ad Exteded Health Isurace Ay participat whose coverage uder the terms of the Basic Health Isurace pla ceases because that perso is o loger eligible or ay wage-earer age 65 or over who has opted to cease participatio i the pla may, without evidece of isurability, apply for the idividual Healthcare Isurace product offered by the Isurer, which also icludes Travel ad Trip Cacellatio isurace. Participats may choose betwee 3 plas: Basic, Itermediate ad Eriched. Participats wishig to exercise their coversio privilege must submit a applicatio withi 60 days followig the termiatio date of their group isurace. They must also register for coverage with the Régie de l assurace maladie du Québec (RAMQ) i order to obtai basic coverage for prescriptio drug expeses. b) Detal Care Isurace Ay participat uder age 65 whose coverage ceases because he or she is o loger eligible for a reaso other tha retiremet may apply, without evidece of isurability, i the 31 days followig the date o which coverage termiates, for a idividual Detal Care Isurace product offered by the Isurer. 53

54 c) Participat s Basic Life Isurace Participat s Optioal Life Isurace Active participats who are o loger eligible for this pla for a reaso other tha retiremet are etitled, without evidece of isurability, if they apply i writig to the Isurer withi 31 days followig the termiatio of their eligibility, to covert all or part of their coverage amout, with the exceptio of Accidetal Death ad Dismembermet coverage, to a idividual whole life or term life isurace policy, without accessory coverage, offered by the Isurer. The amout of isurace that may be coverted caot exceed the sum of all life isurace coverage held by the participat uder the cotract o the coversio date or $400,000, whichever is lower. However, this amout caot be lower tha $10,000. d) Spouse s ad Depedet Childre s Life Isurace Spouse s Optioal Life Isurace Whe a active participat s spouse or depedet child ceases to be eligible due to the termiatio of the active participat s coverage subsequet to his or her death, termiatio of employmet (for a reaso other tha retiremet) or termiatio of membership i the group, or due to the fact that the spouse or depedet child o loger meets the defiitio of depedet, provided that he or she makes a request i writig to the Isurer s head office withi 31 days followig termiatio of eligibility, he or she may, without evidece of isurability, covert the amout of isurace held to a idividual whole life or term life isurace policy, without accessory coverage, offered by the Isurer. The amout of life isurace that may be coverted caot exceed the amout of isurace held o the life of these idividuals o the date of the coversio. However, this amout caot be lower tha $5, Maitaiig isurace durig a temporary iterruptio of work a) I the evet of temporary absece without pay of more tha 30 days, participatio i all plas is suspeded from the start of the temporary absece, except i the Basic Health Isurace pla, ad coverage automatically resumes without evidece of isurability upo retur to active work with pay. The participat must persoally pay the total premium stipulated for the Basic Health Isurace Pla, except where the Act respectig labour stadards obliges the employer to pay its cotributio. However, the participat may choose to maitai participatio i other plas by payig the full applicable premium persoally. 54

55 I additio, for a wage-earer who is temporarily struck off the recall list for more tha 30 days, the provisios of the previous paragraph apply. Durig a authorized absece, if a participat maitais participatio i ay of the optioal plas but fails to pay the required premiums, the optioal plas will be cacelled util the participat s retur to work. Upo returig to work, if the participat wishes to obtai coverage oce agai uder the optioal plas, he or she must provide evidece of isurability deemed satisfactory by the Isurer. b) A participat who takes a partial leave without pay as a extesio of materity, paterity or adoptio leave maitais participatio i the plas as if he or she were ot takig a leave. c) A participat who is takig progressive retiremet, as provided uder his or her collective agreemet, must maitai participatio i all plas. The premium ad life isurace amouts are determied based o the salary he or she would receive if he or she had ot participated i this type of program. d) A participat who is participatig i a deferred pay leave program, as stipulated i his or her collective agreemet, must maitai participatio i the Basic Health Isurace Pla. This participat may also maitai participatio i the other plas. The premium ad life isurace amouts are determied based o the salary he or she would receive if he or she had ot participated i this type of program. e) Participatio i the plas is maitaied i cases of temporary absece with pay ad for a temporary leave without pay of 30 days or less. Amouts of coverage are based o amouts held prior to the begiig of the leave. f) Whe a participat is dismissed or suspeded ad disputes the dismissal or suspesio by meas of a grievace or recourse to arbitratio uder his or her collective agreemet, he or she must maitai participatio i the Basic Health Isurace Pla, with paymet of premiums. He or she ca also maitai participatio i the other plas i which he or she participates by payig, through the employer, the total premium stipulated i the cotract util a decisio is redered. If the dismissed or suspeded participat wis the case ad has ot maitaied participatio i the optioal plas, participatio i these plas is reistated o the date the decisio is redered ad applicatio of the provisios regardig these plas cotiues. Geeral Iformatio 55

56 g) For a part-time wage-earer who maitais participatio i the Optioal Life Isurace Pla durig a temporary leave without pay, the premium ad beefit payable i the evet of death are based o a portio of his or her salary established o a prorata basis of the time paid i relatio to time paid o a fulltime basis over the 12 moths before the begiig of the temporary leave or paretal leave for which o period of disability, materity, paterity, adoptio or upaid leave was authorized. The period over which the average time is calculated caot, however, precede the participat s date of hire. I this case, calculatios are doe usig the reduced period. If disability arises durig this period, the wage-earer is etitled to a waiver of premiums ad, i the evet of death, the beefit payable is based o the exempt isurace amout. h) Whe a participat temporarily ceases to be at work due to a strike or lockout, participatio i the Basic Health Isurace Pla is maitaied, with paymet of premiums, for a 30-day period. Thereafter, participatio i the Basic Health Isurace Pla remais i force if the regular premiums are paid or there is a agreemet betwee the Isurer ad the uio sectio of the Committee. Isurace uder the other plas also remais i effect if regular premiums are paid or there is a agreemet betwee the Isurer ad the uio sectio of the Committee, as log as participatio i the Basic Health Isurace Pla is maitaied. i) For upaid leave, life isurace amouts are based o the amouts held prior to the begiig of the leave. 7. Extesio a) Complete ad reduced Basic Health Isurace Exteded Health Isurace (Optio I) Detal Care Isurace (Optio II) Upo the death of a participat, isurace coverage for the participat s depedets will be exteded without paymet of premiums util the earliest of the followig dates: 12 moths followig the participat s death The date o which the depedets isurace would have eded if the participat had bee alive The date o which the cotract termiates The date idicated i the Committee s writte otice cofirmig the termiatio of uio affiliatio of the group of wage-earers to which the deceased participat beloged. 56

57 8. Waiver of premiums i the evet of total disability a) Start of waiver For participats I the evet of disability, the participat s isurace, ad that of ay depedets, remais i force without paymet of premiums as of: the 8th workig day for full-time wage-earers; or the 6th workig day for full-time wage-earers workig 4 days a week as part of a program to reduce workig time; or the 9.9th caledar day for part-time wage-earers. For the employer The employer is oly exempt from payig its portio of the premium at the ed of the paymet period for salary isurace beefits stipulated i the collective agreemet, i.e. after the 104th week of disability. Geeral Iformatio b) Ed of waiver The waiver of premiums eds at 24:00 o the earliest of the followig dates: The date o which the participat is o loger disabled The date o which the participat reaches age 65 The date o which the participat is o loger etitled to Log-Term Disability Isurace beefits For Health Isurace (Basic ad Exteded) ad Detal Care Isurace plas: The date that correspods to the ed of a period of 36 moths from the oset of the disability The date o which the cotract or pla termiates, or the date o the writte otice from the Committee cofirmig that the group of wageearers to which the disabled perso beloged is o loger affiliated with the uio party The date o which the participat s employmet is termiated The waiver of premiums does ot apply: to a participat who is takig a CSST-approved prevetive withdrawal due to pregacy; 57

58 to Retiree s Life Isurace coverage, Retiree s Spouse s ad Depedet Childre s Life Isurace coverage, ad Retiree s Spouse s Optioal Life Isurace coverage. NOTE: The participat is exempt as of the first full pay period followig the date o which he or she is etitled to the waiver. Whe the waiver termiates, adjustmets are made to the first full pay period followig the date of termiatio of the waiver. c) Provisios regardig employmet ijury No-cosolidated employmet ijury Whe a participat suffers a employmet ijury, caot retur to work, ad the ijury is still ot cosolidated accordig to the attedig physicia, the participat is exempt from paymet of premiums, subject to the provisios set out i item b) Ed of waiver, ad coverage is maitaied for a maximum of oe (1) year as of the ed of the icome replacemet idemities paid by the CSST. Temporary assigmet Whe a participat who has suffered a employmet ijury is temporarily assiged to a positio: he or she beefits from waiver of premiums for ay pay period durig which he or she is receivig a icome replacemet idemity, subject to item b) Ed of waiver; he or she does ot beefit from waiver of premiums if he or she is ot receivig a icome replacemet idemity. Employmet ijury with right to rehabilitatio Whe a participat suffers a employmet ijury ad is etitled to rehabilitatio as provided uder Sectio 145 ad the followig sectios of the Act respectig idustrial accidets ad occupatioal diseases, he or she beefits from waiver of premiums ad coverage is maitaied i the followig cases: The participat is lookig for employmet as part of a rehabilitatio program The participat is workig i a job that is ot his or her usual employmet with the origial employer The participat is workig i a job with aother employer However, the waiver of premiums termiates oce the participat has completed 36 moths of disability. 58

59 d) Prevetive withdrawal A participat who is takig a CSST-approved prevetive withdrawal due to pregacy is ot eligible for waiver of premiums. e) Filig a grievace related to disability A participat who files a grievace subsequet to the cotestig of his or her disability or impositio of a admiistrative measure related to his or her disability is, durig grievace proceedigs, exempt from paymet of premiums for all of the plas i which he or she is participatig, util the earliest of the followig dates: The date of his or her retur to work The date of a arbitrator s decisio The date of a agreemet betwee the parties The date that correspods to the ed of a period of 36 moths from the oset of the disability. Geeral Iformatio f) Gradual retur to work Whe a participat o disability makes a gradual retur to work as provided for uder the collective agreemet, he or she cotiues to be exempt for the whole gradual retur to work period. However, the waiver of premiums termiates oce the participat has completed 36 moths of disability. 9. Termiatio of isurace Subject to the waiver of premiums i the evet of disability, a participat s isurace eds at 24:00 o the earliest of the followig dates: The date o which the cotract termiates or, for each pla, their respective termiatio dates The date o which the participat ceases to meet the eligibility criteria The date o which the participat leaves his or her employmet, subject to the coversio privilege for Participat s Life Isurace coverage ad erolmet i the Retiree s Life Isurace pla The date o which coverage uder aother group isurace pla begis for a participat who has termiated coverage uder the Basic Health Isurace pla because he or she has exercised his or her right of exemptio, if the applicatio is made withi 30 days, otherwise the date of receipt by the Isurer 59

60 The date o which the Isurer receives writte otice from a participat who wishes to termiate his or her coverage uder a pla other tha the Basic Life Isurace pla or a beefit, or the termiatio date idicated o the otice, whichever is later, subject to the obligatio to maitai coverage for 36 moths for optioal plas I ad II The date idicated i the Committee s writte otice cofirmig the termiatio of uio affiliatio of the group of wage-earers The date o which the disabled participat s employmet is termiated The date that correspods to the ed of a period of 48 moths from the oset of the disability, except if he or she is workig for the origial employer, i the case of a participat who has suffered a employmet ijury ad is etitled to rehabilitatio. Isurace for depedets termiates at 24:00 o the earliest of the followig dates: The date o which the participat s isurace termiates, subject to the extesio provided for the basic plas ad optioal plas I ad II The date o which the perso ceases to be cosidered a depedet The date o which the Isurer receives writte otice from a participat who wishes to be isured idividually, subject to the obligatio to cover depedets uder the basic pla ad the 36-moth miimum participatio requiremet for optioal plas I ad II The date o which coverage uder aother group isurace pla begis for depedets who termiate coverage uder the Basic Health Isurace pla because they have exercised their right of exemptio, if the applicatio is made withi 30 days, otherwise o the date of receipt by the Isurer. 60

61 10. Depedet child age 18 to 25 iclusive To cotiue to be isured, a depedet child age 18 to 25 iclusive must be a fulltime studet i a recogized educatioal istitutio. The participat must therefore cofirm to the Isurer that the depedet child who has reached age 18 is attedig a educatioal istitutio o a full-time basis. The cofirmatio must be submitted oce a year, at the begiig of the fall semester. The isurace the cotiues for oe year, util the start of the ext school year. If the aual cofirmatio is ot submitted, the depedet child s coverage will be automatically termiated o the child s 18th birthday or o the start date of the school year for which the participat does ot submit cofirmatio to the Isurer. Cofirmatio may be submitted by sedig a copy of the statemet of erolmet by mail, fax or mobile applicatio, or by meas of a telephoe call, i which case the cofirmatio will be subject to verificatio. As well, the Isurer reserves the right to verify the child s cotiued attedace at the educatioal istitutio at the time of ay claim submitted with regard to the child. Geeral Iformatio 11. Smoker ad o-smoker categories Rates for Participat s ad Spouse s Optioal Life Isurace are provided for smoker ad o-smoker categories. To be eligible for the o-smoker category, a perso must ot have smoked cigarettes i the past year. Ay perso who chages their smokig habits followig the declaratio of isurability must otify the Isurer i writig withi 30 days followig the chage. 61

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63 CLAIMS PROCEDURE Eligible expeses are reasoable expeses that are justified by the seriousess of the case as well as by curret medical practice ad customary charges, ad icurred by a isured. All claims ad correspodece must iclude the idetificatio umber of the participat, the group ad the employer. a) Hospitalizatio, medical ad paramedical expeses followig a occupatioal or motor vehicle accidet Medical, paramedical or hospitalizatio expeses arisig from a occupatioal or motor vehicle accidet are reimbursable by the CSST or SAAQ, ot the Isurer. b) Hospitalizatio expeses (semi-private room) Isureds must preset their group isurace service card upo admissio to a hospital. The establishmet will sed the claim directly to the Isurer. Certai establishmets do ot accept the service card. I such case, the isured must pay the expeses ad forward the ivoice to the Isurer with the appropriate claim form for medical ad paramedical expeses. Claims Procedure c) Prescriptio drugs (direct automated paymet service) Whe makig prescriptio drug purchases, isureds preset their service card, which shows their idetificatio umber, to the pharmacist. La Capitale will automatically issue paymet for the isured portio of prescriptio drug expeses. There s o eed to fill out a claim form, ad isureds pay oly the uisured portio of prescriptio drug expeses. d) Medical ad paramedical expeses Expeses must be claimed withi 12 moths followig the date o which they were icurred. The Isurer recommeds filig claims every 3 moths. HEALTHCARE PROFESSIONALS A official receipt must be preseted to the Isurer whe filig a claim for the services of healthcare professioals. 63

64 The back of the Claim for Prescriptio Drug ad for Medical ad Paramedical Expeses form ca be used as the receipt. I this case, it must bear the professioal s stamp or seal alog with his or her sigature, licece umber ad specific dates of services, alog with the ame of the perso receivig the treatmets. Electroic ad persoalized receipts from healthcare professioals are also accepted, provided they cotai the iformatio specified above. OTHER ELIGIBLE EXPENSES All other Health Isurace claims must be filed usig the Claim for Prescriptio Drug ad for Medical ad Paramedical Claim form. Participats must eclose origial receipts ad paid ivoices for the expeses claimed. Participats must keep a copy of the ivoices set to the Isurer as o origials will be retured. The Isurer may cotact the isured to request more iformatio, if cosidered ecessary for processig of the claim. The Isurer reimburses the expeses claimed accordig to the terms of the cotract. Electroic forms are available olie at uder Idividuals/Group isurace/iformatio for isureds/dowload or order forms. They ca also, upo request, be set to participats by mail or mobile applicatio. e) Detal expeses (direct automated paymet service) Isureds preset their service card i the detist s office. The system validates the card ad cofirms whether the detal treatmet is covered as well as the percetage of reimbursemet applicable. There s o eed to fill out a claim form sice the isured portio of treatmet expeses is claimed directly by the detist from the Isurer. Isureds pay oly the uisured portio of detal expeses. If the detist does ot offer this service, isureds must pay the treatmet expeses i full ad submit a claim to the Isurer. Note that claims may still be filed i the traditioal way, usig the appropriate form, which is available through the employer ad olie. f) Detal expeses (treatmet pla) Before icurrig ay major treatmet expeses, participats should first check with the Isurer as to the amouts that may be eligible for reimbursemet. To do so, they should use the Caadia Detal Associatio or the Associatio des chirurgies detistes du Québec (ACDQ) detal claim form available i the detist s office, or the Isurer s Detal Claim Form, specifyig Treatmet Pla. g) Life isurace The beeficiary must cotact the Isurer to obtai the required claim form ad submit a claim for the isured amout. 64

65 Whe settlig a claim for a participat s death, the Isurer checks with the employer regardig the weekly salary o which the life isurace amout is based. To calculate the amout of life isurace, the weekly salary is multiplied by h) Accelerated life isurace beefit paymet i the evet of termial illess A perso who is isured uder the life isurace pla ad whose life expectacy is o more tha 12 moths may obtai a accelerated beefit paymet by submittig a writte applicatio to the Isurer, accompaied by appropriate medical evidece ad the beeficiary s writte coset. The total amouts paid out may ot exceed $50,000 or 25% of the isured s amout of life isurace. The amout of life isurace used to calculate the accelerated beefit excludes ay amout, or fractio of a amout, expirig i accordace with the provisios of the cotract durig the 24 moths followig the date of the applicatio ad that caot be replaced with aother life isurace beefit. After the date of paymet, the premium, if ay, cotiues to be calculated o the full isurace amout as if there had bee o accelerated paymet. Upo the isured s death, the amout payable by the Isurer is reduced by the amout paid as a accelerated beefit, icludig accrued iterest o this amout at the aual rate of 6%. The Isurer assumes o resposibility with regard to the tax treatmet of ay accelerated beefit paid. Furthermore, this beefit ceases upo termiatio of the cotract, eve for participats who have bee grated a waiver of premiums. Claims Procedure i) Direct deposit If they wish, participats may receive medical ad detal care reimbursemets through preauthorized direct deposit. A statemet will be issued cofirmig the amout deposited ad the date o which the claim was processed. To register, participats must complete the Applicatio for Direct Deposit of Beefits form, available through their employer or olie, ad eclose a cheque specime marked Void. 65

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67 TRAVEL INSURANCE La Capitale will reimburse the customary ad reasoable expeses described below, if icurred followig a emergecy situatio resultig from a accidet or illess occurrig while the isured is temporarily outside the provice of residece, provided the isured is covered uder the govermet health isurace pla of the provice of residece. Beefits are grated over ad above ad ot i replacemet of ay beefits provided uder govermet programs. The maximum lifetime reimbursemet is $5,000,000 per isured. EXCLUSION AND REDUCTION OF COVERAGE To be covered uder this beefit, isureds who have a kow illess or coditio must esure before departure that their health coditio is stable ad uder cotrol, that they ca carry out usual daily activities ad that they are experiecig o symptoms that may reasoably suggest that ay complicatios may arise or that medical care may be required durig the plaed stay outside the provice of residece. A illess or coditio is cosidered to be stable i the absece of ay: deterioratio; relapse; diagosis of termial phase; chroicity likely to lead to deterioratio or complicatios durig the plaed trip outside the provice of residece. Travel Isurace Isureds with a kow illess or coditio who are usure about their health coditio or who are awaitig diagosis must cotact the Assistor at least 15 days before departure to obtai cofirmatio of isurace coverage uder this beefit. 67

68 1. Eligible expeses a) Hospitalizatio, medical ad paramedical expeses Expeses for hospitalizatio i a semi-private or private room, i excess of the amouts reimbursed or eligible for reimbursemet uder the govermet health isurace pla of the isured s provice of residece. Icidetal expeses (telephoe, televisio, parkig, etc.) related to hospitalizatio, upo presetatio of supportig documets, up to a maximum of $100 per hospitalizatio. Professioal fees of a physicia for medical, surgical or aesthetic care other tha fees for detal care; expeses icurred are payable oly for the portio of expeses i excess of the beefits payable uder the govermet health isurace pla of the isured s provice of residece. The cost of drugs obtaied o prescriptio by a physicia i a emergecy treatmet situatio. Professioal fees of a registered urse for private ursig care dispesed exclusively i a hospital, whe medically ecessary ad prescribed by the attedig physicia, up to a maximum reimbursemet of $3,000. The urse must ot be related to the isured or be a travel compaio. Retal of therapeutic devices ad purchase of trusses, corsets, crutches, splits, casts ad other orthopedic devices, whe prescribed by the attedig physicia. Professioal fees of a detist for treatmet of accidetal ijury to atural teeth caused by a accidet occurrig outside the isured s provice of residece, up to a maximum reimbursemet of $1,000 per accidet; to be covered, expeses must be icurred withi 12 moths followig the accidet. b) Expeses for trasportatio Expeses for trasportatio of the isured by air or surface ambulace to the earest medical cetre where adequate medical care is available. This service also icludes trasfers betwee hospitals whe the attedig physicia ad the Assistor deem that curret facilities are iadequate for treatig the patiet or stabilizig the patiet s coditio. Repatriatio expeses for the isured to retur to the place of residece by a adequate public carrier i order to receive appropriate treatmet, as soo as the isured s health coditio so allows ad isofar as the meas of trasport iitially plaed for the retur caot be used. 68

69 If required by the isured s health coditio, the Assistor will sed a medical escort o site to accompay the isured o the retur trip. Repatriatio must be approved ad plaed by the Assistor. Whe the isured is repatriated or trasported, the Assistor orgaizes ad pays expeses for the isured s spouse ad depedet childre or the isured s travel compaio, as applicable, to retur to the isured s provice of residece, up to the cost of a regularly scheduled airlie flight, trai or bus ticket, if the meas of trasport iitially plaed for the retur caot be used. Whe the isured s health coditio does ot allow medical repatriatio ad hospitalizatio outside the provice must exted beyod seve (7) days, the Assistor will orgaize ad pay roud-trip trasportatio expeses to eable a close relative of the isured, residig i the isured s provice of residece, to be at the bedside of the isured. The maximum reimbursemet is $1,500. However, these expeses are ot eligible for reimbursemet if the isured is already accompaied by a close relative age 18 or over, if the ecessity of a visit is ot cofirmed by the attedig physicia, or if the visit is ot approved i advace ad plaed by the Assistor. The Assistor will make ecessary arragemets to retur home ay childre uder age 18 accompayig the isured if, followig the isured s accidet or illess, the isured or aother accompayig adult is uable to do so persoally. If the isured is uable to drive the automobile used for a trip followig a illess or accidet that occurs durig the trip ad o other passeger is able to drive the vehicle, the Assistor will pay the expeses icurred by a commercial agecy to retur the isured s persoal vehicle home or retal vehicle to the earest appropriate vehicle retal agecy, subject to a maximum reimbursemet of $1,000. I the evet of the isured s death, whe ecessary, the Assistor will orgaize ad pay expeses for a roud-trip ecoomy class ticket by the most direct route (airplae, bus, trai) to allow a close relative to idetify the remais prior to repatriatio, providig that o close relative age 18 or over is accompayig the isured o the trip. The maximum reimbursemet is $1,500. I the evet of the isured s death, the Assistor will pay for the cost of preparig ad returig the remais of the isured (excludig the cost of the coffi or casket) to the place of burial i the provice of residece, subject to a maximum reimbursemet of $5,000, or a maximum reimbursemet of $3,000 i the evet of crematio or burial o site. Travel Isurace 69

70 c) Livig expeses Expeses for accommodatio ad meals i a commercial establishmet the isured must icur whe obliged to postpoe the retur home due to a illess or bodily ijury suffered by the isured, a close relative accompayig the isured or a travel compaio, subject to a maximum reimbursemet of $150 per day for a maximum of eight days. 2. Travel Assistace Service O request, the Assistor will provide isureds with worldwide travel assistace service 24 hours a day, 365 days a year, excludig coutries at war or kow to be i a state of political istability, makig ay itervetio by the Assistor physically impossible. Advaces for expeses covered uder the Travel Isurace beefit. The Assistor the files a claim for reimbursemet of expeses covered uder the govermet health isurace pla of the isured s provice of residece ad with the Isurer. I the evet of illess or accidet abroad, the Assistor will provide straightforward medical iformatio ad iformatio as to the locatio of a appropriate medical cetre. If ecessary, the Assistor will help coordiate the isured s admissio to a appropriate cliic or hospital. Subject to the provisios herei, oce otified of a illess or accidet suffered by the isured outside the provice of residece, the Assistor will coordiate commuicatio betwee its medical service, the attedig physicia, ad ultimately the isured s family doctor, i order to esure ay decisios made are best adapted to the situatio. The Assistor will take charge of trasmittig ay urget messages whe the isured is persoally uable to do so. The Assistor will esure, isofar as possible, the dispatch of ay drugs that are idispesable for the ogoig treatmet of the isured i the evet that it is impossible to obtai such drugs or equivalet drugs o site. I all cases, drugs must be paid for by the isured ad the, if eligible, reimbursed by the Isurer. Upo presetatio of supportig documets, the Assistor will reimburse the isured for ay telephoe ad other commuicatio expeses icurred by a isured i distress abroad i order to gai access to covered services. 70

71 Upo request by the isured, the Assistor will provide ay iformatio required i the evet of major problems occurrig durig the trip followig the loss of the isured s passport, visa, credit card, etc. The Assistor will provide isureds i distress abroad with telephoe access to a multiligual iterpretatio service. I the evet that a isured is ivolved i legal proceedigs followig a traffic accidet, highway code violatio or ay other civil offece, the Assistor will provide assistace by recommedig ames of lawyers. This service is oly applicable i Caada ad the Uited States. 3. Obligatios of the isureds NOTICE: Isureds must otify the Assistor of ay icidet, accidet or illess as soo as possible. RESTRICTION: As soo as they are able to do so, isureds must obtai the prior approval of the Assistor before takig ay iitiative or icurrig ay expeses. If the isured fails to fulfil this obligatio, the Assistor will be relieved of its obligatios to the isured. UNUSED TICKETS: Whe a isured has beefited from repatriatio uder the terms of this Travel Isurace beefit, the Assistor reserves the right to claim ay ticket held by the isured that was ot used due to services provided by the Assistor. SUBROGATION: For the purposes of this beefit ad with regard to ay fuds advaced or reimbursed by the Assistor, the isured hereby assigs ad subrogates the Assistor i all of his or her rights ad recourses to ay reimbursemet from which he or she beefits or claims to beefit i accordace with ay public or private pla providig isured services similar to those for which advaces or expeses have bee icurred by the Assistor. Isureds shall agree to sig ay documet ad execute ay deed required by the Assistor i order to give full ad complete effect to this assigmet ad subrogatio ad specifically madate the Assistor for this purpose as attorey ad represetative for submittig ay claim ad collectig ay reimbursemet. Travel Isurace 71

72 4. Exclusios ad reductio of Travel Isurace coverage I additio to the exclusios ad reductio of coverage specified for the Basic Health Isurace Pla, the Isurer ad the Assistor will issue o reimbursemet or provide ay assistace to the isured i the followig cases: Whe the loss occurs i the isured s provice of residece. Whe the isured refuses without ay valid medical reaso to comply with the Assistor s recommedatios with regard to repatriatio or the choice of hospital or required care; by required care is meat the treatmet eeded to stabilize the isured s medical coditio. If the isured fails to cotact the Assistor as soo as possible i the evet of a medical cosultatio or hospitalizatio followig a accidet or sudde illess. Whe expeses are icurred due to pregacy, ad ay related complicatios, withi eight (8) weeks precedig the expected date of delivery. Whe the expeses icurred outside the isured s provice of residece could have bee icurred i the provice of residece, without dager to the isured s life or health, with the exceptio of immediately required expeses followig a emergecy situatio resultig from a accidet or sudde illess. For the purposes of this exclusio, the fact that the treatmet available i the provice of residece may be of a lesser quality tha that available outside the provice does ot costitute a dager to the isured s life or health. Whe expeses are icurred for isureds i hospitals for the chroically ill, services for the chroically ill i public hospitals, exteded care homes or thermal spas. For elective or o-emergecy surgery or treatmet, or if the trip was take for the purpose of obtaiig or with the itetio of receivig medical treatmet or hospital services, whether or ot the trip was take o the recommedatio of a physicia. For a accidet occurrig while the isured is practisig ay sportig activity ivolvig remueratio, motor vehicle competitio or ay speed cotest, glidig or hag-glidig, moutaieerig, skydivig, whether i freefall or ot, bugee jumpig or ay other dagerous activity. Activities offered to the public at tourist resorts, other tha the above-metioed activities, icludig alpie skiig ad scuba divig, are ot cosidered as dagerous. Followig volutary abusive cosumptio of alcohol, drugs or medicatio ad the esuig cosequeces. 72

73 For repatriatio or travel assistace services, whe the loss occurs i a coutry that is at war, whether declared or ot, is kow to be i a state of political istability or for which the Govermet of Caada has issued a warig that Caadias should ot travel i that coutry, or durig a riot, uprisig, repressio, restrictio o free circulatio, strike, explosio, uclear activity, radioactivity or other emergecy evets makig ay itervetio by the Assistor physically impossible. The Isurer may, at ay time ad at its sole discretio, chage the Assistor for the purposes of this beefit. EMERGENCY CONTACT INFORMATION To obtai assistace services, be sure to have the iformatio show o your service card hady, ad cotact the Assistor by telephoe at oe of the followig umbers: I Caada ad the Uited States: Worldwide (collect call): BEFORE LEAVING Make sure you take your service card with you, as you will eed it i order to commuicate with the Assistor. Travel Isurace 73

74 74

75 TRIP CANCELLATION INSURANCE I accordace with the followig coditios, the Isurer will reimburse 100% of the expeses icurred by the isured followig the cacellatio or iterruptio of a trip, isofar as the expeses icurred are related to travel expeses paid i advace by the isured ( prepaid travel expeses ) ad that, at the time travel arragemets were fialized, the isured was ot aware of ay evet that could reasoably lead to the cacellatio or iterruptio of the plaed trip. The expeses covered are limited to $5,000 per trip, per isured. 1. Causes of cacellatio or iterruptio The trip must be cacelled or iterrupted due to oe of the followig causes: A illess or accidet prevetig the isured, the isured s travel compaio, a close relative of either, or a busiess parter of the isured from performig his or her usual activities, which is sufficietly serious to justify the cacellatio or iterruptio of the trip. Death of the isured, the isured s spouse, the isured s child or spouse s child, or the isured s travel compaio or busiess parter. Death of a close relative of the isured, other tha the isured s spouse or child, or a close relative of the travel compaio if the fueral is scheduled to take place durig the trip or the precedig 14 days. Death or emergecy hospitalizatio of the host at destiatio. The isured s or travel compaio s summos for jury duty or subpoea to act as a witess i a case scheduled to be heard durig the plaed trip, provided the perso ivolved is ot a party to the litigatio ad has take all ecessary measures to have the hearig postpoed. Quaratie of the isured or travel compaio, except if quaratie eds seve days or more before the scheduled date of departure. Hijackig of the airplae o which the isured is travellig. Damage rederig the pricipal residece of the isured, of the travel compaio or of the host at destiatio uihabitable, provided the residece remais uihabitable seve days or fewer prior to the scheduled date of departure, or the damage occurs durig the time of the trip. Trip Cacellatio Isurace 75

76 Trasfer of the isured or travel compaio, by the same employer, to a locatio more tha 100 kilometres from the curret place of residece, provided the trasfer is required withi the 30 days precedig the scheduled date of departure. Terrorism or ay other situatio i the coutry to which the isured is travellig, provided the Govermet of Caada issues a warig that Caadias should ot travel i that coutry durig the time of the plaed trip ad that the warig was issued after travel expeses were icurred. Missed departure due to a delay i the meas of trasportatio used to reach the poit of departure, provided that the meas of trasportatio used provides for scheduled arrival at the poit of departure at least three hours prior to the time of departure, or at least two hours prior to departure if the distace to be covered is less tha 100 kilometres. The delay must be caused by atmospheric coditios, mechaical problems (except for a private automobile), a traffic accidet or a emergecy road closure, each of the latter two causes requirig cofirmatio by a police report. Atmospheric coditios that delay the departure of the public carrier used by the isured, at the poit of departure of the plaed trip, by at least 30% (miimum 48 hours) of the plaed duratio of the trip, or that prevet the isured from makig a scheduled coectio with aother carrier, provided the coectio is delayed by at least 30% (miimum 48 hours) of the plaed duratio of the trip. Damage occurrig to a commercial establishmet or locatio where a commercial activity is scheduled to be held, prevetig the activity from takig place, provided that a writte cacellatio otice is issued by the orgaizatio officially resposible for the activity. Ivolutary loss of the wage-earer s or spouse s employmet, provided the perso i questio had bee workig for the same employer for at least oe year. 2. Expeses covered The followig expeses are covered, provided they are icurred by the isured, ad are limited to $5,000 per trip per isured. I the evet of cacellatio prior to departure: a) The o-refudable portio of prepaid travel expeses. 76

77 b) Additioal expeses icurred by the isured if the isured s travel compaio must cacel due to oe of the eligible reasos for cacellatio provided hereuder ad the isured decides to proceed with the trip as iitially plaed; expeses are eligible up to the amout of the cacellatio pealty applicable at the time the travel compaio has to cacel. c) The o-refudable portio of prepaid travel expeses, up to 70% of such expeses, if the isured s departure is delayed due to atmospheric coditios ad the isured decides ot to proceed with the trip. I the evet of missed departure, at the begiig of or durig the trip, due to oe of the reasos provided hereuder, the additioal cost charged by a scheduled public carrier for ecoomy class travel, via the most direct route, to the iitially plaed trip destiatio. If the retur is earlier or later tha plaed: a) The additioal cost of a oe-way ecoomy class ticket, by the most direct route to the poit of departure, by the meas of trasportatio iitially plaed, or if the iitially plaed meas of trasportatio caot be used, the fees charged by a scheduled public carrier for ecoomy class travel, by the most ecoomical meas of trasportatio, via the most direct route, for the isured to retur to the iitial poit of departure; these expeses must be pre-approved by the Isurer. b) However, if the retur is delayed by more tha seve days due to a accidet or illess suffered by the isured or travel compaio, expeses icurred are eligible, provided the perso i questio was admitted to hospital as a ipatiet for more tha 48 hours withi the seve-day period. c) The uused ad o-refudable portio of the groud portio of prepaid travel expeses. 3. Exclusios applicable to Trip Cacellatio Isurace This beefit does ot cover losses due to the followig causes or to which such causes have cotributed: Ay trip take for the purpose of obtaiig or with the itetio of receivig medical treatmet or hospital services, whether or ot the trip is take o the recommedatio of a physicia. Ay trip take to visit or be at the bedside of a perso who is ill or has suffered a accidet, isofar as the cacellatio or iterruptio of the trip is due to a chage i the medical coditio or the death of such perso. Trip Cacellatio Isurace 77

78 War, whether declared or ot, or active participatio i a isurrectio, whether real or appreheded. Active participatio of the isured or travel compaio i a crimial act or a act deemed to be crimial. Pregacy, ad ay related complicatios, withi eight (8) weeks precedig the expected date of delivery. Suicide or attempted suicide by the isured or travel compaio, or itetioal self-iflicted ijury or self-mutilatio, whether or ot the perso is of soud mid. If the isured has cosumed toxic quatities of alcohol, drugs or medicatio. Participatio i ay sportig activity ivolvig remueratio, motor vehicle competitio or speed cotest, glidig or hag-glidig, moutaieerig, skydivig, whether i freefall or ot, bugee jumpig or ay other dagerous activity. A medical coditio for which the isured or travel compaio has bee hospitalized, or has received or bee prescribed medical treatmet or cosulted a physicia withi 90 days precedig the date o which travel expeses were icurred, except if it is prove to the satisfactio of the Isurer that the coditio of the perso i questio is stable at the time expeses are icurred. Ay chage i medicatio, icludig use ad dosage, is cosidered to be a medical treatmet. Ay loss related to a kow coditio of the isured or travel compaio that is subject to periods of sudde deterioratio ad caot be cotrolled by medicatio or otherwise. Ay trips for purposes of fishig or hutig. 4. Deadlie for cacellig I the evet that a cause for cacellatio occurs prior to departure, the trip must be cacelled withi a maximum period of 48 hours, or if this period eds o a statutory holiday, by the ext busiess day, ad otice must be provided to the Isurer at the same time. The Isurer s liability is limited to the cacellatio costs stipulated i the travel cotract that are applicable 48 hours followig the date of the cause for cacellatio, or if a statutory holiday, o the ext busiess day. 78

79 5. Coordiatio Ay beefits payable hereuder will be reduced by ay amouts payable uder aother idividual or group isurace pla. Also excluded from coverage are ay expeses icurred that a isured would ot have had to pay if ot covered uder this beefit. IF YOU MUST CANCEL OR INTERRUPT YOUR TRIP It is essetial that you cotact the Assistor at oe of the umbers below before icurrig ay expeses. I Caada ad the Uited States: Worldwide (collect call): Trip Cacellatio Isurace 79

80 CONTACT US LA CAPITALE INSURANCE AND FINANCIAL SERVICES INC. Quebec City 625 Sait-Amable St Quebec QC G1R 2G Our mailig address: PO Box 1500 Quebec QC G1K 8X9 Toll free: Fax: [email protected] La Capitale mobile applicatio Motreal Suite de Maisoeuve Blvd W Motreal QC H3A 3G TRAVEL INSURANCE I Caada ad the Uited States: Worldwide (collect call):

81 MEMORY AID Group No.: 6000 Employer No.: Idetificatio No.: Perso cotacted: Telephoe No.: Fax No.: address:

82 NOTES

83 NOTES

84 NOTES P039 ( )