GROUP INSURANCE BENEFITS ELIGIBILITY

Transcription

1 GROUP INSURANCE BENEFITS ELIGIBILITY You must be a member of RTO/ERO, permanently residing in Canada and covered by your Government Health Insurance Plan (GHIP), to be eligible to participate in our insurance plans. The following charts outline who may be eligible for coverage: RTO/ERO Health Plans Member 1 Spouse 2 Children 3 Parents Friends Semi-Private Hospital and Convalescent Care Plan Extended Health Care Plan Dental Plan Supplemental Travel Plan Time Limit to Enroll for the RTO/ERO Group Insurance Benefits You may enroll without medical evidence of insurability, regardless of your age, provided we receive your application within 60 days of the termination of your most recent group insurance plan. Coverage for you, your spouse and your dependent children will begin on the date following the termination of your coverage under the following: Your school board plan; Your spouse s group plan; or Any other group plan.

2 If you apply after the 60 day eligibility period, you will be considered a late applicant and will be required to submit medical evidence of insurability to participate in the Semi-Private Hospital and Convalescent Care and Extended Health Care Plans. Under the Dental Plan, acceptance is guaranteed, but the maximum benefit payable during the first twelve months will be limited to $100 per insured person. The same requirement applies if you transfer from an individual policy. For the purpose of the RTO/ERO Group Insurance Benefits: 1 A member is defined as a full or associate member in good standing of RTO/ERO. 2 A spouse is defined as your legal or common-law spouse, or same-sex partner. 3 A dependent child is defined as unmarried children: under 21 years of age, or up to age 30 if in full-time attendance at a post-secondary institution, or any functionally impaired child who was insured as a dependent shall remain insured beyond any limiting age.

3 Individual Insurance Benefits Member 1 Spouse 2 Children 3 Parents Friends Accidental Death & Dismemberment Preferred Service Home-Auto Hospital Money Long Term Care Life Insurance For the purpose of the RTO/ERO Individual Benefits: 1 A member is defined as a full or associate member in good standing of RTO/ERO. 2 A spouse is defined as your legal or common-law spouse, or same-sex partner. 3 A child is defined as a child of any age.

4 WHO IS ELIGIBLE FOR COVERAGE? As a regular or associate member of RTO/ERO permanently residing in Canada, you are eligible to participate in the plans offered. Coverage is also available for your spouse and/or dependent children residing in Canada, including: Your legal or common law spouse, including same sex partner; Unmarried children (including adopted, foster, step children and legal wards) under 21 years of age; Unmarried children up to age 30 provided they are enrolled at an accredited post secondary institution as a full time student and dependent upon you for support. Coverage will be extended to the earlier of August 31 st of the school year, age 30, or until coverage is terminated. Confirmation of full time student status is requested each year by Johnson Inc. Any functionally impaired child who was insured as a dependent shall remain insured beyond any limiting age for dependents. For the purposes of insurance, functionally impaired includes an unmarried person who was insured as a dependent prior to becoming functionally impaired and who is wholly dependent upon the participant for support and maintenance within the terms of the Income Tax Act. (Note: A letter of diagnosis/prognosis is required from a physician.) Eligible expenses for covered dependent children studying outside their normal province of residence will be considered under the Extended Health Care Plan on the same basis as if expenses were incurred in their province of residence. Eligible expenses incurred due to a medical emergency by students travelling 500 kilometers or more away from their student residence and outside their normal province of residence will be considered under the Out of Province/Canada Travel Benefit.

5 SUPPLEMENTAL TRAVEL PLAN TRIP OPTIONS & PREMIUM RATES Coverage for the first 93 days of travel is included under your Extended Health Care Plan. Supplemental Travel Plan coverage starts on the 94 th day of travel. Rates Effective: January 1, 2015 to August 31, 2015 Single Premium** Age EHC Supplemental Total Trip Base Under 85 and Travel Plan Duration Plan 55 Over $ 11 $ 14 $ 22 $ 30 $ 39 $ 66 $ 107 $ , ,392 1, ,236 2,028 2, ,608 2,644 3, ,210 1,989 3,279 4, * 197* ,113 1,455 2,379 3,933 5, * 212* ,307 1,707 2,777 4,605 5,967 Couple Premium** EHC Base Plan Supplemental Travel Plan Total Trip Duration Under 55 Age and Over $ 22 $ 28 $ 44 $ 60 $ 78 $ 132 $ 214 $ ,554 2, ,024 1,704 2,784 3, ,136 1,492 2,472 4,056 5, ,060 1,484 1,952 3,216 5,288 6, ,316 1,848 2,420 3,978 6,558 8, * 197* 754 1,022 1,578 2,226 2,910 4,758 7,866 10, * 212* 874 1,194 1,844 2,614 3,414 5,554 9,210 11,934 * The availability of the Supplemental Travel Trip Options is subject to provincial residency requirements; currently these options are available only to Ontario, British Columbia, Manitoba, New Brunswick, and Newfoundland and Labrador residents. For all other provinces the maximum duration is 182 days. ** Retail Sales Tax will be added to these premium rates, where required by law; 8% for Ontario residents and 9% for Quebec residents.

6 The Supplemental Travel Plan Premium will be deducted in equal monthly deductions from your pension or your bank account from the first deduction date following receipt of your signed and completed application to the last deduction date in the policy year which is July. Please contact Johnson Inc. Plan Benefits Service to obtain premium rates or for any other information. Johnson Inc. Plan Benefits Service, 18 Spadina Road, Suite 100 Toronto ON M5R 2S7, Toronto area Toll free Fax rto ero@johnson.ca healthbenefits@johnson.ca Rev Jan 2015