Benefits Online provides the information you need to get the most from our benefit program.

Transcription

1 Welcome to NAV CANADA s provides the information you need to get the most from our benefit program. Plan Health Care Plan - contract # Dental Care Plan - contract # Basic Life Insurance Plan - contract # Provided by Sun Life Assurance Company of Canada NAV CANADA is legally and financially responsible for the benefits provided under the Health Care Plan, Dental Care Plan and Health Spending account. Sun Life only acts as administrator of these plans on behalf of NAV CANADA. Great-West Life Assurance Company Long-term Disability Insurance - contract # Business Travel Accidental Death and Dismemberment Insurance Plan ACE INA Life Insurance (a division of the ACE Group of Companies) Insured plan Review what benefits apply to you as a: represented employee, or NAV CANADA represented retiree. Learn what is available to you now and what benefits may change in the future. This all-in-one benefit information tool will help you: find answers to your benefit questions, learn plan details, find forms, and find links to health-related Web sites. Is this your first time using? See How works. version: September 1,

2 Table of contents Welcome to NAV CANADA's...1 Learn...6 Health Care Benefits...6 Active employees...6 Retirees...7 Surviving spouse and children...7 Dental Care Plan benefits...8 Long-term Disability Insurance Plan benefits...8 Out-of-province benefits...8 Survivor Benefits and accident coverage...9 Benefits payable in case of your death or serious injury...9 Benefits payable in case of your death after retirement...10 Plan details...11 Eligibility for the NAV CANADA Benefit Plans...11 Am I eligible to join?...11 If you are appointed for an indeterminate period...11 If you are appointed for a term of more than six months...12 If you are appointed for a term of six months or less, and then appointed to another term of less than six months...13 If you are appointed for a term of six months or less, and then appointed to another term of six months or more...13 If you are receiving a NAV CANADA pension benefit and you retired from NAV CANADA before September 1, 2005 with at least two years of pension eligibility service...14 If you are receiving a NAV CANADA pension benefit and you retired from NAV CANADA on or after September 1, 2005 but prior to January 1, 2010 with at least two years of pension eligibility service...14 If you are receiving a NAV CANADA pension benefit and you retired from NAV CANADA on or after January 1, 2010 with at least two years of pension eligibility service...15 Is my family eligible for benefits?...15 Active employees...15 Retirees...15 Is membership optional?...16 How do I join?...16 When does coverage begin?...17 Active employees...17 Retirees...18 What if I am not at work the day my coverage is supposed to start?...19 How do I know for sure that I have coverage?...19 What if I lose or damage my benefit card?...19 Can I change from single to family coverage under the Health Care Plan or vice versa? How?...19 Can I cancel coverage?...20 Where do I call if I have questions about eligibility?...20 Benefit Costs...21 version: September 1,

3 How much do I pay for my benefits?...21 Health Care Plan...21 Dental Care Plan...23 Long-term Disability Insurance Plan...23 Basic Life Insurance...24 Basic Life Insurance after you leave NAV CANADA...25 How do I pay my part of the cost?...27 How do I pay if I am not getting a pay cheque?...27 What happens if the cost changes?...28 Where do I call if I have questions about benefit costs?...28 Tax considerations...29 Health Care and Dental Care Plans...29 Life and accident insurance premiums and benefits...29 Long-term Disability Insurance Plan...29 Beneficiaries...30 Who receives life and accident benefits if I die?...30 How do I designate someone as a beneficiary?...30 Can I choose anyone as my beneficiary?...30 What happens if I do not designate a beneficiary?...30 Can I change my designation anytime I want?...30 Making a claim...31 Health Care and Dental Care Plans...31 Maximum eligible expense under the Health Care and Dental Care Plans...31 Claims if you are only covered by NAV CANADA Plans...31 Claims submission deadlines...34 Claims under your Health Spending Account...35 Claims if you also have coverage under another plan, such as where your spouse works...35 Claims if you are separated or divorced and are claiming for your children...35 Getting approval for health and dental expenses...36 Drug Claims using the Pay Direct drug card...36 Long-term Disability Insurance Plan...39 Life and accident insurance plans...39 Checking health and dental claims status...39 If you do not agree with a decision made by the insurer...40 Health Care or Dental Care Plan claims...40 Long-term Disability Insurance claims...40 What the plans do not pay for...41 What is not covered under the Health Care Plan?...41 What is not covered under the Dental Care Plan?...42 Limitations for prosthodontic appliances...43 What is not covered under the Long-term Disability Insurance Plan?...44 What is not covered under the Basic Life Insurance Plan?...44 What is not covered under the Business Travel Accidental Death and Dismemberment Insurance Plan...44 When coverage ends...46 When does my coverage end?...46 Health Care and Dental Care coverage...46 Long-term Disability Insurance Plan coverage...47 Life and accident insurance coverage...47 version: September 1,

4 When does coverage for my spouse and children end?...47 What happens if...48 Admnistrative events...49 Joining NAV CANADA...49 Transferring from a represented to a management employee or vice-versa...49 Changing from part-time to full-time or vice-versa...49 Change in earnings...50 Traveling on business...50 Taking an authorized leave of absence...50 Leaving NAV CANADA...51 Retiring...52 Personal/family events...54 Change in marital status...54 Adding a child to my family...54 Child reaching age Child going to school or university...55 Both spouses working at NAV CANADA...55 Changing personal information...55 Common/other events...56 Buying medical supplies and services Buying perscription drugs...59 Getting eye exams and glasses/contact lenses...64 Buying hearing aids...65 Going to the dentist...67 Going to the doctor...73 Visiting a health practitioner...74 Using my Health Spending Account...76 Health events...77 Calling an ambulance...77 Going to the hospital...79 Getting private nursing care...80 Illness or injury outside my province of residence...81 Becoming disabled...84 Suffering a permanent accidental injury...90 Death of a family member...93 Death of an employee...94 Death of a retiree...97 Plan...98 Health tips...98 Diet and exercise...98 Staying healthy...98 Conquering stress...98 Getting the best care possible from health professionals...99 Travel Tips Things to consider before you leave Important legal notice version: September 1,

5 Contact us How Works Benefit Dictionary Acupuncturist Adjusted insurable earnings Chiropractor Child/children Chiropodist/Podiatrist Chronic disease Commensurate occupation Continuous employment Deferred pension Dental fee guide Dentist Disabled/disability Electrologist Elimination period Full-time employee Hospital Loss Loss of use Medical care Naturopath Nurse Ophthalmologist Optometrist Osteopath Part-Time employee Pension eligibility service Physician Physiotherapist Psychologist Reasonable and customary Recurrence Registered massage therapist Registered pharmacist Rehabilitation Retiree Speech-language pathologist Spouse Supplemental coverage Transportation Vehicle version: September 1,

6 Learn Benefit program overview Health Care Plan benefits Active employees Retirees Surviving spouse and children Active employees Who can join Coverage for What the plan pays for eligible expenses Maximum benefit Supplementary coverage All full-time or part-time NAV CANADA employees living in Canada with provincial health coverage Extended Health Care: prescription drugs vision care (including laser eye surgery) health practitioners oral surgery and treatment of dental accidents health supplies emergency travel assistance Hospitalization: semi-private accommodation 100% emergency travel, hospitalization and expenses with maximum reimbursable amounts 80% all other expenses Varies by expense All active employees covered under the Health Care Plan are entitled to a Health Spending Account version: September 1,

7 Retirees Who can join Coverage for What the plan pays for eligible expenses Maximum benefit Supplementary coverage Eligible retirees living in Canada with provincial health coverage Extended Health Care: prescription drugs vision care (including laser eye surgery) health practitioners oral surgery and treatment of dental accidents health supplies emergency travel assistance Hospitalization: semi-private accommodation 100% emergency travel, hospitalization and expenses with maximum reimbursable amounts 80% all other expenses Varies by expense Surviving spouse and children Who can join Coverage for Supplementary coverage Surviving 1 spouse and children of eligible NAV CANADA employees or retirees, receiving a NAV CANADA pension benefit and living in Canada with provincial health coverage Extended Health Care: prescription drugs vision care (including laser eye surgery) health practitioners oral surgery and treatment of dental accidents health supplies emergency travel assistance What the plan pays for eligible expenses Hospitalization: semi-private accommodation 100% emergency travel, hospitalization expenses with maximum reimbursable amounts 80% all other expenses Maximum benefit Varies by expense 1 only available if the deceased was a represented employee who retired or passed away prior to January 1, version: September 1,

8 Dental Care Plan benefits Who is covered What the plan pays for eligible expenses Maximum benefit All full-time or part-time NAV CANADA employees 90% basic services 50% major services and orthodontics $1,500/person/year basic and major services combined ($750/person if coverage begins on or after July 1 st for the first year of coverage) $2,500/person/lifetime orthodontic treatments (separate maximum than for basic and major services) Long-term Disability Insurance Plan benefits Who is covered What the plan pays All full-time or part-time NAV CANADA employees 70% X adjusted insurable earnings, when you are disabled and your claim is approved by Great-West Life, after the end of the elimination period Out-of-province benefits Who can join What the plan pays in case of a medical emergency All NAV CANADA employees or retirees and their covered family members who have supplementary coverage and are: travelling outside their province of residence for business or pleasure referred by their physician, when the treatment or service is not offered in their province of residence For those who live in Canada, coverage equals the amount above that is paid by a provincial health plan during the first 60 days of travel or while on travel status : emergency treatment of an injury or disease, including hospitalization in a public ward, physician, and out-patient hospital charges 24-hour travel assistance For those who work outside Canada for NAV CANADA, coverage equals the amount in place of provincial health coverage for: all benefits covered by provincial health plans, on the same basis and in the same amount version: September 1,

9 Survivor benefits and accident coverage Benefits payable in case of your death or serious injury Benefits payable in case of your death after retirement Benefits payable in case of your death or serious injury All active employees Basic Life Insurance Plan Who is covered What the plan pays All full-time or part-time NAV CANADA employees Basic Life Insurance 2 X adjusted insurable earnings Coverage reduces by 10% (of your full coverage in effect on your 61 st birthday), on April 1 or October 1 immediately following your 61 st birthday and every year after that, until it reaches $5,000 or 1/3 of adjusted insurable earnings at the time of death, whichever is greater Business Travel Accidental Death and Dismemberment Insurance Who is covered What the plan pays in case of death All active employees under age 75 who live in Canada and are travelling for business Spouse under age 75 and children of covered employees, during relocation or related house-hunting trip Represented employees 3 X adjusted insurable earnings (maximum $350,000) Your spouse and children Spouse $100,000 Child $10,000 A percentage of this coverage amount is payable for certain serious injuries version: September 1,

10 Benefits payable in case of your death after retirement Retirees Who is covered What the plan pays All NAV CANADA retirees who opted to maintain coverage within 30 days of the date the coverage would otherwise have ended Basic Life Insurance Coverage is equal to the amount in effect on your last day of work Coverage reduces by 10% (of your full coverage in effect on your 61 st birthday), on April 1 or October 1 immediately following your 61 st birthday and every year after that, until it reaches a minimum* of $5,000 Retroactive earnings changes do not affect the level of coverage after retirement * If you are a former employee and you deferred your pension and opted to maintain Basic Life Insurance coverage within 30 days of the date you left NAV CANADA, your coverage reduces to $0 on April 1 or October 1 immediately following your 70 th birthday (the minimum coverage of $5,000 does not apply) version: September 1,

11 Plan details Eligibility for the NAV CANADA Benefit Plans Am I eligible to join? Is my family eligible for benefits? Is membership optional? How do I join? When does coverage begin? What if I am not at work the day my coverage is supposed to start? How do I know for sure that I have coverage? What if I lose my benefit card? Can I change from single to family coverage under the Health Care Plan or vice versa? How? Can I cancel coverage? Where do I call if I have questions about eligibility? Am I eligible to join? Yes, as long as you are appointed on a full-time or part-time basis or your status is that of one of the scenarios indicated below. Your coverage may begin at a later date. See When does coverage begin? for details. If you are appointed for an indeterminate period You are eligible the date you are appointed. Health Care Plan Example Date of appointment June Eligible to join June 8, 2009 If application is received Coverage begins July 8, 2009 August 1, 2009 October 13, 2009 February 1, 2010 version: September 1,

12 Dental Care Plan Example Date of appointment June 8, 2009 Eligible to join June 8, 2009 Coverage begins September 8, 2009 Basic Life Insurance and Long-term Disability Insurance Plans Example Date of appointment June 8, 2009 Eligible to join June 8, 2009 Coverage begins June 8, 2009 If you are appointed for a term of more than six months You are eligible the date you are appointed. Health Care Plan Example Term period April 6, 2009 to November 23, 2009 Eligible to join April 6, 2009 If application is received Coverage begins May 12, 2009 June 1, 2009 July 15, 2009 November 1, 2009 Dental Care Plan Example Term period April 6, 2009 to November 23, 2009 Eligible to join April 6, 2009 Coverage begins July 6, 2009 Basic Life Insurance and Long-term Disability Insurance Plans Example Term period April 6, 2009 to November 23, 2009 Eligible for coverage April 6, 2009 Coverage begins April 6, 2009 version: September 1,

13 If you are appointed for a term of six months or less, and then appointed to another term of less than six months You are eligible the day after you complete six months of continuous employment. Health Care Plan First term period April 6, 2009 to August 5, 2009 Second term period August 6, 2009 to January 11, 2010 Eligible to join October 6, 2009 If application is received Coverage begins November 9, 2009 December 1, 2009 January 7, 2010 Not eligible, unless appointed to another term Example Dental Care Plan First term period April 6, 2009 to August 5, 2009 Second term period August 6, 2009 to December 11, 2009 Eligible to join October 6, 2009 Coverage begins Not eligible, unless appointed to another term Example Basic Life Insurance and Long-term Disability Insurance Plans First term period April 6, 2009 to August 5, 2009 Second term period August 6, 2009 to December 11, 2009 Eligible for coverage October 6, 2009 Coverage begins October 6, 2009 Example If you are appointed for a term of six months or less, and then appointed to another term of six months or more You are eligible the date your new appointment begins. Health Care Plan First term period April 6, 2009 to August 5, 2009 Second term period August 6, 2009 to February 11, 2010 Eligible to join August 6, 2009 If application is received Coverage begins September 14, 2009 October 1, 2009 October 22, 2009 February 1, 2010 Example version: September 1,

14 Dental Care Plan Example First term period April 6, 2009 to August 5, 2009 Second term period August 6, 2009 to February 11, 2010 Eligible to join August 6, 2009 Coverage begins November 6, 2009 Basic Life Insurance and Long-term Disability Insurance Plans Example First term position April 6, 2009 to August 5, 2009 Second term position August 6, 2009 to February 11, 2010 Eligible for coverage August 6, 2009 Coverage begins August 6, 2009 If you are receiving a NAV CANADA pension benefit and you retired from NAV CANADA before September 1, 2005 with at least two years of pension eligibility service You are eligible for: Basic Life Insurance, as long as you apply within 30 days of leaving NAV CANADA, and Health Care Plan, from the date your NAV CANADA pension benefit becomes payable. If you are receiving a NAV CANADA pension benefit and you retired from NAV CANADA on or after September 1, 2005 but prior to January 1, 2010 with at least two years of pension eligibility service You are eligible for: Basic Life Insurance, as long as you apply within 30 days of leaving NAV CANADA, and Health Care Plan, from the date your NAV CANADA pension benefit becomes payable (only if, when you left NAV CANADA, you were either eligible for an immediate pension or have 15 years of pension eligibility service). version: September 1,

15 If you are receiving a NAV CANADA pension benefit and you retired from NAV CANADA on or after January 1, 2010 with at least two years of pension eligibility service You are eligible for Basic Life Insurance, as long as you apply within 30 days of leaving NAV CANADA. Is my family eligible for benefits? Supporting documents as defined below must be provided to and approved by your Pay & Benefits Advisor /Pension Advisor before family coverage under the Health Care and Dental Care Plans can be in effect. Spouse: Birth certificate of spouse and marriage certificate Common law: Birth certificate of common law partner and statutory declaration Child: Birth certificate Foster Child: Birth certificate and legal guardianship documentation Adopted Child: Birth certificate and legal guardianship documentation (if not indicated on birth certificate) Step-Child: Birth certificate (will only be eligible if spouse/common-law approved) Active employees You may choose family coverage under the Health Care and Dental Care Plans to cover your spouse and children, once they meet the plans definitions and proof of eligibility has been provided. Only one spouse may be covered at one time. In the event of your death, your surviving spouse who is eligible for a pension from the NAV CANADA Pension Plan, can join the Health Care Plan once his or her pension becomes payable if your date of death is prior to January 1, Retirees If you are an eligible retiree, you may choose family coverage under the Health Care Plan to cover your spouse and children, once they meet the plans definitions and proof of eligibility has been provided. Only one spouse may be covered at one time. In the event of your death, your surviving spouse who is eligible for a pension from the NAV CANADA Pension Plan, can join the Health Care Plan once his or her pension becomes payable if your date of retirement was prior to January 1, version: September 1,

16 Is membership optional? It depends on the plan and on your employee classification. Health Care Plan employees retirees surviving spouse and children 1 Dental Care Plan employees retirees While receiving pay or pension While on leave without pay Compulsory Optional Compulsory Optional N/A Long-term Disability Insurance Plan employees retirees N/A N/A Basic Life Insurance employees retirees N/A Business Travel Accidental Death and Dismemberment Insurance employees N/A retirees N/A N/A 1 only available if deceased member was a represented employee who retired or died prior to January 1, N/A N/A N/A How do I join? Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... They will provide you with the forms you need to complete, and information about optional benefits. If you are an active employee and want to enroll in the Health Care plan and/or cover your spouse and eligible children to your Health Care or Dental Care Plans you must do so through Oracle NAV Employee Self-Service account by following the step-by-step User guide. Supporting documents must also be provided to your Pay & Benefits Advisor. version: September 1,

17 When does coverage begin? Active employees For... If... Coverage starts... Long-term Disability Insurance Plan Basic Life Insurance Health Care Plan Supplementary coverage You are eligible Your application is received within 90 days of the date you become eligible Immediately The first day of the month after the application is received Health Spending Account Your application is received more than 90 days after you become eligible You are eligible The first day of the fourth month after the application is received The same date as your Health Care Plan coverage Dental Care Plan You are eligible After a waiting period of exactly 3 months of continuous employment For Business Travel Accidental Death and Dismemberment Insurance, coverage begins when you start a trip on NAV CANADA business from your place of employment, home, or other location. version: September 1,

18 Retirees For... If Coverage Basic Life Insurance Health Care Plan Eligible retirees receiving an immediate pension at retirement Employees who choose to defer their pension 1 All eligible retirees You opt to maintain your coverage within 30 days of leaving NAV CANADA You opt to maintain your coverage before leaving NAV CANADA Your application is received more than 90 days after your pension becomes payable Your application is received within 90 days of the date your pension becomes payable Your application is received more than 90 days after your pension becomes payable You previously cancelled your coverage Is continuous Is continuous Begins the first day of the fourth month after the application is received Begins the first day of the month after the application is received Begins the first day of the fourth month after the application is received Begins the first day of the fourth month after the application is received 1 To be eligible for the NAV CANADA Health Care Plan when your pension becomes payable, you must have left NAV CANADA prior to January 1, For spouse and children If you have enrolled in family coverage in the Health Care and Dental Care Plans to cover your spouse and children, their coverage begins when your coverage begins if the applicable supporting documents have been provided and approved. If you are enrolled in single coverage and you get married, or change to common-law status with your spouse, or a child is added to your family, you can apply to change to family Health Care Plan coverage with the applicable supporting documents: within 90 days of the date of the change, coverage takes effect on the date of the change, or more than 90 days later, coverage takes effect on the first day of the fourth month after the application is received. version: September 1,

19 What if I am not at work the day my coverage is supposed to start? Coverage cannot begin when you are not considered to be at work. Being at work for the Basic Life Insurance and the Long-term Disability Insurance Plans, means: not disabled and: actually working at NAV CANADA, assigned elsewhere by NAV CANADA, or away for vacation, a weekend or statutory holiday, or shift variance. Being at work for the Health Care and Dental Care Plans means: Performing the usual duties of your job or, if on a scheduled workday off, at work on your last scheduled workday. How do I know for sure that I have coverage? You can visit the Sun Life Financial web site at and enter your Access ID and password to access your benefit information under the Health Care Plan and/or Dental Care Plan. To obtain your Access ID, contact a Sun Life Financial Customer Care representative at The contract number (25298) and your member certificate number (provided by your Advisor) will be required. Once on the site, choose and click on my coverage and you will see a Print my coverage card link in the bottom of the page. An image of a coverage card will appear on screen. Simply print if required. Annually, all active employees receive a personalized Total Compensation Statement that details coverage and premiums paid the previous calendar year. What if I lose or damage my benefit card? You can visit the Sun Life Financial website at and enter your Access ID and password. Once on the site, you will see a take me to drop down menu in the centre of the page. Choose and click on print a drug card. An image of the drug card will appear on screen. Simply print as many copies as you require. Can I change from single to family coverage under the Health Care Plan or vice versa? How? Yes, anytime. To change from single to family coverage, submit your application form within 90 days of marriage, change to common-law status, or birth of child and coverage takes effect the date of the event (subject to approval of proof of eligibility documents). If you miss that deadline, the change takes effect on the first day of the fourth month after the application is received. When changing from family to single coverage, the effective date of the change will be no later than 90 days following receipt of the application. version: September 1,

20 Can I cancel coverage? You cannot cancel compulsory coverage. For optional coverage, you can cancel anytime. However, if you wish to reapply later, some restrictions may apply. Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... Where do I call if I have questions about eligibility? Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... version: September 1,

21 Benefit costs How much do I pay for my benefits? How do I pay my part of the cost? How do I pay if I am not getting a pay cheque? What happens if the cost changes? Where do I call if I have questions about benefit costs? How much do I pay for my benefits? All premium rates are subject to change based on the experience of the plans. See the tables below for the monthly cost of your coverage. Health Care Plan Active employees Supplementary coverage Each month Employees pay... NAV CANADA pays... Single coverage Family coverage Single coverage Family coverage $0 $0 $73.38 $ Retirees and surviving spouses Premiums are deducted from your pension. If your premiums are higher than your pension amount, you must send a cheque for the required premium in advance to your Pension Advisor. If you leave NAV CANADA before September 1, 2005 Supplementary coverage Retirees pay... Each month NAV CANADA pays... Single coverage Family coverage Single coverage Family coverage $18.43 $33.79 $73.72 $ version: September 1,

22 If you leave NAV CANADA on or after September 1, 2005 Each month Retirees pay*... NAV CANADA pays... Supplementary coverage Single coverage Family coverage Single coverage Family coverage $36.86 $67.58 $55.29 $ * Represented retirees: If you leave before September 1, 2008: The NAV CANADA Bargaining Agents Association pays 50% of your monthly premiums if you are a represented retiree. Only 50% of the retiree premiums shown here will be deducted from your monthly pension payment If you leave on or after September 1, 2008: The NAV CANADA Bargaining Agents Association pays 37.5% of your monthly premiums if you are a represented retiree. Only 62.5% of the retiree premiums shown here will be deducted from your monthly pension payment Surviving children (dependent coverage only) If your parent dies before September 1, 2005 Each month Dependents pay... NAV CANADA pays... Supplementary coverage $17.46 $69.84 If your parent dies on or after September 1, 2005 Dependents pay*... Each month NAV CANADA pays... Supplementary coverage $34.92 $52.38 * Represented retirees: If your parent dies before September 1, 2008: The NAV CANADA Bargaining Agents Association pays 50% of your monthly premiums if you are a represented retiree. Only 50% of the retiree premiums shown here will be deducted from your monthly pension payment If your parent dies on or after September 1, 2008: The NAV CANADA Bargaining Agents Association pays 37.5% of your monthly premiums if you are a represented retiree. Only 62.5% of the retiree premiums shown here will be deducted from your monthly pension payment version: September 1,

23 Dental Care Plan All active employees Each month Employees pay... NAV CANADA pays... $0 $89.62 On certain types of leave without pay Employees pay... Each month NAV CANADA pays... Employees without dependents $0.00 $40.13 Employees with dependents $0.00 $89.62 Long-term Disability Insurance Plan All active employees Each month Employees pay... NAV CANADA pays... $0 $1.168/$1,000 of adjusted insurable earnings Example Province of residence Ontario Province of work Ontario Annual earnings $48,400 Adjusted insurable earnings $48,500 Employee s monthly premium $0 NAV CANADA s monthly premium $48,500 $1,000 X $1.168 = $56.65 NAV CANADA s monthly premium plus $ ($56.65 X 8%) = $61.18 provincial tax* * Since the employee works in Ontario, the provincial tax is 8% version: September 1,

24 Basic Life Insurance Represented employees Employees pay... Each month NAV CANADA pays... $0.20/$1,000 of coverage $0 After you reach age 65, NAV CANADA will pay 100% of the premium for the first $5,000 of coverage; you pay for any remaining coverage. Example Province of residence Quebec Province of work Ontario Age 66 Annual earnings $48,400 Adjusted insurable earnings 2 X $48,400 = $96,800 (rounded to $97,000) Reduced coverage (6 X 10% = 60%) $97,000 ($97,000 X 60%) = $38,800 Employee s monthly premium ($38,800 $5,000) $1,000 X $0.20 = $6.76 Employee s premium plus provincial tax* $ ($6.76 X 9%) = $7.37 NAV CANADA s monthly premium $5,000 $1,000 X $0.20 = $1.00 NAV CANADA s premium plus provincial $ ($1.00 X 8%) = $1.08 tax** * Since the employee resides in Quebec, provincial tax of 9% applies to the employee premium ** Since the employee works in Ontario, provincial tax of 8% applies to the employer premium version: September 1,

25 Basic Life Insurance after you leave NAV CANADA If you retire with an immediate pension prior to January 1, 2010 Retirees pay... Each month NAV CANADA pays... $0.183/$1,000 of coverage $0.017/$1,000 of coverage * After you reach age 65, NAV CANADA will pay 100% of the premium for the first $5,000 of coverage; you pay for any remaining coverage Example Age 63 Province of residence Manitoba Annual earnings $48,400 Adjusted insurable earnings 2 X $48,400 = $96,800 (rounded to $97,000) Reduced coverage $97,000 30% = $67,900 (10% for three years) Retiree s monthly premium $67,900 $1,000 X $0.183 = $12.43 Retiree s premium plus provincial tax* $ ($12.43 X 0%) = $12.43 NAV CANADA s monthly premium $67,900 $1,000 X $0.017 = $1.15 NAV CANADA s premium plus provincial tax* $ ($1.15 X 0%) = $1.15 * Since the retiree is a Manitoba resident, there is no provincial tax If you retire with an immediate pension on or after January 1, 2010 Each month Retirees pay... NAV CANADA pays... $0.20/$1,000 of coverage $0.00 Example Age 59 Province of residence Saskatchewan Annual earnings $48,400 Adjusted insurable earnings 2 X $48,400 = $96,800 (rounded to $97,000) Retiree s monthly premium $97,000 $1,000 X $0.20 = $19.40 Retiree s premium plus provincial tax* $ ($19.40 X 0%) = $19.40 * Since the retiree is a Saskatchewan resident, there is no provincial tax version: September 1,

26 If you leave NAV CANADA and defer your pension You may want to maintain your Basic Life Insurance coverage even though you are not taking your pension immediately after you leave NAV CANADA. If you defer your pension and wish to maintain your coverage, you must send a written request to your Pension Advisor within 30 days of your employment end date. You must also send a cheque for 12 months premiums at the appropriate rate from the following table. The rate is based on your age on the thirtieth day following your termination date. Annual rate/$2,000 coverage Age Rate Age Rate Age Rate 21 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $58.45 * Premium rates take reducing coverage into account 69* $61.73 Once your deferred pension becomes payable, your premiums will be deducted from your pension payment based on the following rates, unless the premiums exceed the amount of your pension. The rates continue to be based on your age on the thirtieth day following your termination date. version: September 1,

27 Annual rate/$2,000 coverage Age Rate Age Rate Age Rate 21 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $ $ $ * $4.97 * Premium rates take reducing coverage into account 69* $5.25 When you leave NAV CANADA You can continue coverage by applying for conversion to an individual policy with Great-West Life no more than 31 days after you leave. You pay Great-West Life directly for the cost at current commercial rates. How do I pay my part of the cost? By payroll deduction or NAV CANADA pension benefit deduction. If your premiums are higher than your pension amount, you can maintain coverage by providing post-dated cheques to your Pension Advisor. How do I pay if I am not getting a pay cheque? With post-dated cheques, to cover the period of your leave without pay. You must provide these cheques before you leave. version: September 1,

28 What happens if the cost changes? Your cost is adjusted as of the effective date of the change. The Compensation, Benefits and Rewards Section will advise you of any changes to the rates, in advance. If you are on leave at the time, you make up the difference once you are back at work. Where do I call if I have questions about benefit costs? Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... version: September 1,

29 Tax considerations Health Care and Dental Care Plans Life and accident insurance premiums and benefits Long-term Disability Insurance Plan Health Care and Dental Care Plans When you live in Quebec, premiums and provincial tax paid by NAV CANADA for your Health Care and Dental Care Plan coverage are subject to provincial income tax (with the exception of surviving spouses/children in receipt of pension benefits). This annual taxable benefit is reported on your Relevé 1 or Relevé 2 (but not your T4 or T4A). Applicable income taxes are deducted from your pay for employees working in Quebec, or your NAV CANADA pension benefit, for retirees residing in Quebec. In addition, provincial tax is added to your share of premiums for Ontario and Quebec residents. If you are an employee living in Quebec, covered under the Health Care Plan, and you claim health or dental expenses under your Health Spending Account, the amount you claim each calendar year is subject to provincial income tax. It is your responsibility to report the amount claimed when you file your income tax. This amount shows on your paper copy of Sun Life s explanation of benefits and in your Health Spending Account balance online. Life and accident insurance premiums and benefits Life insurance premiums and provincial tax paid by NAV CANADA constitute a taxable benefit under the Income Tax Act. This amount is added to your T4 and Relevé 1 slips, for active employees, and T4A and Relevé 2, for retirees. Applicable income tax is deducted from your pay or pension. Benefits are not taxable when paid to the beneficiary you name (any interest paid between the date of death and the date of payment is taxable). However, if your estate receives life insurance benefits, they may be subject to probate fees, since they may be considered assets. Long-term Disability Insurance Plan Benefits from the Long-term Disability Insurance Plan are taxable. Great-West Life sends you a tax form annually, indicating the benefits paid to you the previous year. Your monthly Long-term Disability Insurance Plan premiums are not tax-deductible. Once you are receiving plan benefits however, your total premiums are tax-deductible. You can carry the deduction over from year to year until deducted in full. Consult: your local tax centre for more information, and your Pay & Benefits Advisor for total premiums paid. The only taxes automatically deducted from your long-term disability benefits are Quebec provincial income taxes. Contact Great-West Life to deduct other income tax at source, or contact your local tax centre for information on paying them yourself. version: September 1,

30 Beneficiaries Who receives life and accident benefits if I die? How do I designate someone as a beneficiary? Can I choose anyone as my beneficiary? What happens if I do not designate a beneficiary? Can I change my designation anytime I want? Who receives life and accident benefits if I die? The beneficiaries you have named for each plan. How do I designate someone as a beneficiary? By completing the appropriate beneficiary designation form. All beneficiary forms must be signed, witnessed and dated. Can I choose anyone as my beneficiary? You can name: your estate, a person, a registered charitable or benevolent organization or institution (please provide the full name and registration number of the institution), or any educational or religious organization, or institution supported by donations. Insurance companies cannot pay benefits to a minor. If you name a minor, you must name a trustee (called a tutor in Quebec). What happens if I do not designate a beneficiary? Benefits are paid to your estate. Can I change my designation anytime I want? Generally, yes. In Quebec, though, if your spouse is your beneficiary, you cannot change without your spouse s permission, unless you indicated on the form that the designation would be revocable. You can print and complete a form to change your beneficiary. version: September 1,

31 Making a claim Health Care and Dental Care Plans Long-term Disability Insurance Plan Life and accident insurance plans Checking health and dental claims status If you do not agree with a decision made by the insurer Health Care and Dental Care Plans No matter whom the claim is for, you must sign the claim form. In provinces with a program to cover expenses also covered under the NAV CANADA Health Care Plan (for example, prescription drugs, artificial limbs and other assistive devices, dental services, etc.), first, submit your claim to the province. Then, submit any eligible expenses remaining under the Health Care Plan. Maximum eligible expense under the Health Care and Dental Care Plans To determine the maximum amount payable for any supplies or services, the reimbursable amount is calculated as follows: Example Claim for orthopaedic shoes $180 Reimbursement level Retirees or represented employees 100% X $180 = $180 Maximum for orthopaedic shoes in any one calendar year $150 Reimbursement amount Retirees or represented employees $150 Claims if you are only covered by NAV CANADA Plans Hospital room expenses If you, your spouse, or any of your children are hospitalized, give the admitting clerk your benefit card. Generally, hospitals bill the plan directly. If your hospital does not, send a completed claim form with the hospital s invoice to Sun Life. They will either pay the hospital directly, if the claim was sent directly from the hospital, or reimburse you, up to the value of semi-private accommodation. version: September 1,

32 Out-of-province hospital and medical expenses If you have supplementary coverage and have a travel-related emergency, contact Mondial Assist/World Access Canada (where possible, before incurring expenses) at: (in Canada or the US), or (519) (from elsewhere, call collect). Mondial Assist/World Access Canada will co-ordinate payments from the provincial health care plan and Sun Life for members under the supplementary coverage. You do not need to submit a claim, unless you want to claim for co-ordination of benefits under another plan. If you do not contact Mondial Assist/World Access Canada: get detailed receipts, submit expenses to your provincial health plan, once the province reimburses you, send Sun Life: a claim form, duplicate receipts (or photocopies), and the provincial statement of payment. Send in your claim as quickly as possible, because provincial plans have very strict time limits. If claims are late, they may not be paid by the province or Sun Life. For all expenses outside Canada under Business Travel Accidental Death and Dismemberment Insurance, call ACE INA at , leave a detailed message and a claims agent will return your call by the next business day. Vision care benefit expenses For eyeglasses or contact lenses, you can submit your claim electronically. Just go to sign in with your Access ID and PIN, click on My claims and then click on Vision Care e-claim under the Submit a claim tab. You can get an Access ID and PIN number by calling Sun Life at If you prefer: pay the expense and get a receipt, complete a claim form, and mail both claim and original receipt to Sun Life. For laser eye surgery: pay the expense and get a receipt, complete a claim form, and mail both claim and original receipt to Sun Life. version: September 1,

33 Once the next two-year calendar period begins, submit a claim form with a copy of your original receipt and explanation of benefits from Sun Life. You can continue to resubmit the laser surgery expense claim under the regular Health Care Plan until the balance is paid, as long as the person for whom you are claiming remains continuously covered under the plan. You cannot continue to resubmit the laser surgery expense claim under the Health Spending Account. Other medical supplies and services For other eligible expenses: pay the expense and get a receipt, complete a claim form, and mail the claim and original receipt to Sun Life. Health Practitioners services If you are covered under the Health Care Plan, you have access to the Paramedical e-claim feature. For eligible health practitioners services expense, you can submit your claim electronically. Just go to sign in with your Access ID and PIN, click on My claims and then click on Paramedical e-claim under the Submit a claim tab. You can get an Access ID and PIN number by calling Sun Life at If you prefer: pay the expense and get a receipt, complete a claim form, and mail both claim and original receipt to Sun Life. version: September 1,

34 Prescription drugs If you buy prescription drugs through Rexall Direct/XPress Pharm, you will not need to claim with Sun Life, since Rexall Direct invoices Sun Life directly for the 80% of eligible expenses paid by the Plan. This also applies if you are represented active employees using the Pay Direct drug card. Regular dental expenses Many dentist s offices use standard dental claim forms. If yours does not, take along a claim form. If your dentist submits claims electronically... Make sure all your personal information is correct, including plan number and your ID number If your claim is not submitted electronically... Have your dentist complete Part 1 of the form Complete Parts 2 and 3 Mail your claim to Sun Life or submit your claim electronically. Just go to sign in with your Access ID and PIN, click on My claims and then click on Dental e-claim under the Submit a claim tab. You can get an Access ID and PIN number by calling Sun Life at Dental expenses resulting from accidental injury Have your dentist complete the appropriate sections of the dental claim form. Make sure that the claim is not sent electronically to the Dental Care Plan. Attach the dental claim form to a health care claim form and send both to Sun Life. Claims submission deadlines Health Care Plan Expenses claims must be received by Sun Life no more than three months after the end of the year in which the expense is incurred. Dental Care Plan Orthodontic expenses claims must be received by Sun Life no more than 15 months after the date of each monthly visit throughout the treatment period. Other expenses claims must be received by Sun Life no more than 15 months after the date of treatment. version: September 1,

35 Claims under your Health Spending Account If you are an eligible active employee claiming health or dental expenses in whole or in part under your Health Spending Account, you must: pay the expense and get a receipt, complete the Health Spending Account claim form and check the box in Part 4 for health expenses or Part 5 for dental expenses and mail your claim to Sun Life, alternatively, you can submit your claim electronically. Just go to sign in with your Access ID and PIN, click on My claims and then click on Health Spending Account e-claim under the Submit a claim tab. You can get an Access ID and PIN number by calling Sun Life at Please note that expenses incurred in the previous calendar year must be processed using a paper-based claim. Expense claims under the Health Spending Account must be received by Sun Life no more than three months after the end of the year in which the expense is incurred or 90 after the termination of coverage whichever comes first. Claims if you also have coverage under another plan, such as where your spouse works If you and your spouse are covered by more than one Health Care or Dental Care Plan, you may be able to claim up to 100% of eligible expenses, depending on what is eligible under your spouse s plan. You can also coordinate benefits if you and your spouse both work for NAV CANADA and both have family coverage. Always submit expenses first to the plan that covers you as a full-time or part-time employee (if, for example, you are covered under another plan as a spouse or retiree). For expenses incurred by You Your spouse Your children Submit your claim... First, to NAV CANADA s Plan Then, to your spouse s plan, if a balance remains First, to your spouse s plan Then, to your Plan, if a balance remains First, to the plan of the parent whose birthday falls earlier in the year (if both parents have the same birth date, to the plan of the parent whose surname begins with the first letter in the alphabet) Then, to the plan of the other parent, if a balance remains Claims if you are separated or divorced and are claiming for your children Claims must be processed in the same order as in the table above if you have shared custody of your children. As long as you are the legal parent of the child, you can process his or her claims. Claims must be submitted first to the plan of the parent with primary custody, then, to the plan of the other parent, if a balance remains. version: September 1,

36 Getting approval for health and dental expenses Generally, if a treatment will likely cost more than $300, you may want to submit a treatment plan to Sun Life ahead of time so you know how much the plan will pay. Sun Life may also require additional information before paying a claim if they feel the treatment needs explanation. Drug claims using the Pay Direct drug card If you are a full-time or part-time represented employee covered under the Health Care Plan, you have access to the Pay Direct drug card feature. This card can be used for prescription drug expenses for you and your registered dependants (subject to the coordination of benefits rules). If you and your spouse are both NAV CANADA represented employees and you are covered as a dependant under family coverage on your spouse s Health Care Plan, you will not have access to your own Pay Direct drug card. This feature is not offered to retirees. How do I obtain a drug card? First, register on the Sun Life Members Services website if you have not already done so. This is the first step in obtaining your Access ID and Password required to access your profile and Pay Direct drug card. Registration online Visit and click on Register Now. This process requires you to enter key information to verify your identify. Once you have entered the required information, you will be provided with an Access ID. Keep this number on hand. Your password will then be sent to you by mail at your home address shortly thereafter. Registration by phone If you prefer, you can contact the Sun Life Financial Customer Care Centre at You will also be required to provide the following information to verify your identity. You will be provided with an Access ID. Keep this number on hand. Your password will then be sent to you by mail at your home address shortly thereafter. When I have my Access ID and Password, how do I print the drug card? You can visit the Sun Life Financial website at and enter your Access ID and password. version: September 1,

37 Once on the site, you will see a take me to drop down menu in the centre of the page. Choose and click on print a drug card. An image of the drug card will appear on screen. Simply print as many copies as you require. Will I have any out of pocket expenses when I used the Pay Direct drug card? When you present you Pay Direct drug card to your pharmacist, you will have to pay the following: the $4 per-script fee; 20% coinsurance that apply to your coverage; any drug amount over and above the price of the generic equivalent unless specified by a physician with an inscription no substitution on the prescription; eligible drug expenses over the annual maximum; any ineligible drug expenses; and/or eligible drug expenses for your dependants, subject to the coordination of benefits rules. What happens if I also have coverage under another plan? If the pharmacist is aware that there is a secondary plan and he/she is prepared to accommodate you, your pharmacist will be able transmit a claim under the secondary plan, indicating what amount was allowed under the primary plan. This may permit 100% reimbursement of the cost of the prescription. However, in this case both you and your spouse must have coverage with Sun Life (and both must have drug card) or your spouse must have a drug card with a carrier who uses Telus Health Solutions (formerly known as Emergis) as their pay-direct provider. Coordination of Benefits with the Pay Direct drug card If your spouse s health care coverage is not with Sun Life and/or does not have pay-direct with Telus Health Solutions (formerly known as Emergis), you will not be able to use your pay-direct drug card for those expenses and must use for a paper-based claim for the coordination of benefits portion. For expenses incurred by Your spouse Your children Submit your claim... First, to your spouse s plan Then, to NAV CANADA s Plan, if a balance remains First, to the plan of the parent whose birthday falls earlier in the year (if both parents have the same birth date, to the plan of the parent whose surname begins with the letter closest to the beginning of the alphabet) Then, to the plan of the other parent, if a balance remains As per table above, if your spouse s health care coverage does not have pay-direct with Sun Life or a provider using Telus Health Solutions (formerly known as Emergis) and his/her birthday falls earlier in the year, you will have to submit a paper-based claim for your children as well. version: September 1,

38 How do I claim drug expenses under my Health Spending Account? If, after the coordination of benefits or payment of prescription drug expenses, you have a remaining balance that you would like to claim under your Health Spending Account, you must follow the process (paper-based or electronically) as defined on page 35 of the NAV CANADA booklet for represented employees. How do I use the Pay Direct drug card outside Canada? The Pay Direct drug card can only be used in Canada. If you are outside the country, you must pay for the expenses and submit a paper-based claim to Sun Life Financial to obtain reimbursement. Why won t the pharmacist accept the Pay Direct drug card for drug expense for my dependants? There are a few reasons why the expense would be declined at the pharmacy counter: You do not have family coverage under the NAV CANADA Health Care Plan (you must apply for the family coverage and register your dependants before you can claim drug expenses with your pay-direct drug card); Your dependant is not registered in the system (e.g. positive enrolment process with your NAV Self Serve Account); or Your spouse does not have a Pay Direct drug card feature under their Health Care Plan or Telus Health Solutions (formerly known as Emergis) is not their pay-direct Provider. In cases 2 and 3, you must pay for the expense and submit a paper-based claim to Sun Life Financial. The printable drug card available on the Sun Life Financial web site does not indicate who is eligible for claims. How can I obtain a card with my dependant s information on it? The Pay Direct drug card is not personalized for every family member covered under your plan. As the employee card holder, your information is primary and the dependant information linked to your record. My name does not appear on the Pay Direct drug card. Can I still present it for use or does the named person need to be present? If you are a registered dependant of the named person on the card, you can use the Pay Direct drug card and do not require that the named person be present. You will need to advise the pharmacist of your relationship to the plan member and your date of birth, and present the prescription under your name. The pharmacist will confirm that the information matches what is in on file with Telus Health Solutions (formerly known as Emergis) and process accordingly, subject to the coordination of benefits rules. version: September 1,

39 Long-term Disability Insurance Plan If you become totally disabled and think your disability will last longer than the elimination period, you should claim as soon as possible. Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... They will provide you with the forms you and your physician(s) must complete. It is your responsibility to complete the Employee Statement Form and arrange for your physician(s) to complete the Attending Physician s Statement with medical evidence supporting the diagnosis, and the prognosis. Great-West Life adjudicates claims on the basis of all the objective medical evidence provided on your condition. Great-West Life may request additional information from your physician(s), or arrange for independent medical examinations. Make sure to provide Great-West Life with sufficient medical proof of total disability. Omissions or unclear statements could delay your claim. Send the completed forms directly to Great-West Life. To avoid delays, Great-West Life needs all information no more than 12 weeks after your disability starts. Send your claim to the following address and direct claim inquiries to the numbers listed below: Great-West Life Assurance Company Ottawa Disability Management Services Office 11 Holland Avenue, Suite 300 Ottawa ON K1Y 4W4 Telephone: (613) or Life and accident insurance plans If you die, a member of your family must notify your Benefits Advisor. They will send out the necessary forms and information. If your spouse or one of your children dies, you must complete the necessary forms. For all expenses under Business Travel Accidental Death and Dismemberment Insurance, contact ACE INA at , leave a detailed message and a claims agent will return your call by the next business day. Checking health and dental claims status Just call the Sun Life toll-free customer service number, and select the option Medical and Dental Claims Information, Monday through Friday 7 am to 8 pm, Eastern Standard Time, at version: September 1,

40 Alternatively, go online to SunBenefits at and sign-in using your Access ID and PIN. You can get an Access ID and PIN number by calling Sun Life at the above number. If you do not agree with a decision made by the insurer Health Care or Dental Care Plan claims You must submit a written request for a review to Sun Life. If you do not agree with the review decision, contact the Benefits Advisor at (613) , or the NAV CANADA Joint Council at (613) Long-term Disability Insurance claims You must submit your request for a review in writing to Great-West Life. If you do not agree with the review decision, contact Benefits Advisor at (613) , or the NAV CANADA Joint Council at (613) In both cases, if you prefer, you can: Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... version: September 1,

41 What the plans do not pay for What is not covered under the Health Care Plan? What is not covered under the Dental Care Plan? What is not covered under the Long-term Disability Insurance Plan? What is not covered under the Basic Life Insurance Plan? What is not covered under the Business Travel Accidental Death and Dismemberment Insurance Plan? What is not covered under the Health Care Plan? No benefit is payable for charges in respect of: services for which benefits are payable under any workers compensation act, any similar statute or by any government agency, services or supplies, rendered or prescribed by a person who is ordinarily resident in the patient s home or is related to the patient by blood or marriage, operations, treatments or supplies considered by Sun Life to be for cosmetic purposes, or for conditions not detrimental to health, except those required as a result of accidental injury or expressly provided for, any services of a practitioner that, in the opinion of Sun Life, are not within the practitioner s area of expertise and do not require the skills and qualifications of such a practitioner, services or supplies normally rendered without charge, services rendered in connection with medical examinations for insurance, school, camp, association, employment, passport or similar purposes, services provided by a physician licensed and practicing in Canada where eligible to be covered under a provincial health plan, unless such services are specifically included, Services or supplies payable or available (regardless of any waiting list) under any government sponsored plan or program unless explicitly listed as covered under the benefit, Services or supplies that are not approved by Health Canada or other government regulatory body for the general public, Services or supplies that are not generally recognized by the Canadian medical standards, Services or supplies that do not qualify as medical expenses under that Income Tax Act (Canada), the portion of charges that is the legal liability of any other party, the portion of charges for services rendered or products provided in a hospital outside Canada that would normally be payable under a provincial health or hospital plan if the services had been rendered or products provided in a hospital in Canada, when covered by a provincial health plan, co-payment charges or similar charges for hospital care that are in excess of charges payable by a provincial or territorial government health or hospital plan and that are not charges made for utilization of semi-private accommodation, experimental products or treatments for which substantial evidence provided through objective clinical testing of the product s or treatment s safety and effectiveness for the purpose and under the conditions of the use recommended does not exist to the satisfaction of Sun Life, drugs that, in Sun Life s opinion, are experimental, version: September 1,

42 publicly advertised items or products that, in Sun Life s opinion, are household remedies, vitamins (except injectables), minerals and protein supplements, unless specifically included, therapeutic nutrients, unless specifically included, diets and dietary supplements infant foods and sugar or salt substitutes, lozenges, mouthwashes, non-medicated shampoos, contact lens care products and skin cleanser, protectives, or emollients, surgical supplies and diagnostic aids, drugs that are used for cosmetic purposes, drugs that are used for a condition or conditions not recommended by the manufacturer, prescribed drugs that can be purchased over the counter, items purchased primarily for athletic use, repairs or replacement of purchased durable equipment, the regular treatment of an injury or disease that existed prior to your dependent s departure, or your departure, from your province of residence, benefits which are legally prohibited by the government from coverage. What is not covered under the Dental Care Plan? No benefit is payable for the following dental services and supplies: Services or supplies payable or available (regardless of any waiting list) under any government sponsored plan or program unless explicitly listed as covered under the benefit, or any portion thereof, that are the legal liability of any other party, Charges for appointments not kept or completion of claim forms, Expenses related to services or supplies of the type normally intended for sport or home use, such as but not limited tom mouth guards, Any services or supply for which there would be no charge in the absence of this coverage, received in a hospital owned or operated by a government, unless the person is required to pay for such services or supplies regardless of the existence of insurance, rendered outside Canada to persons residing in Canada, or to children of a member residing in Canada, that would be payable under a provincial health, dental or hospital plan if the services had been rendered in Canada, that, in the opinion of Sun Life, such treatment could have been rendered at lower cost by means of a reasonable substitute consistent with generally accepted dental practice, except for that portion of expenses that would have been incurred for treatment by means of a reasonable substitute, for which user fees, co-insurance charges or similar charges are made that are in excess of charges payable by a government dental, hospital or health plan, that are not yet approved by the Canadian Dental Association or that, in the opinion of Sun Life, are clearly experimental in nature, version: September 1,

43 that, in the opinion of Sun Life, are rendered principally for cosmetic purposes including, but not limited to, porcelain or composite facings on crowns or pontics on molar teeth, related to the purchase, repair, modification or replacement of a duplicate prosthodontic appliance, for any reasons, purchased before the date the person became covered under the Dental Care Plan, for an appliance or a modification of one where an impression is made for such appliance or a modification before the person became covered under the Dental Care Plan, for crowns, bridges and gold restorations for which a tooth was prepared before the person became covered under the Dental Care Plan, for root canal therapy where the pulp chamber was opened before the person became covered under the Dental Care Plan, rendered as a result of a congenital or developmental malformation that is not a Class I, II or III malocclusion, for a periodontal appliance, occlusal equilibration, and other related service as a result of a temporomandibular joint dysfunction (TMJ dysfunction) or vertical dimension correction, related to implants, other than the reasonable and customary cost of the least expensive alternate procedure as determined by Sun Life for represented employees only, and for an orthodontic treatment, in respect of a member or his or her eligible spouse, where the initial appliance was installed before the person became covered for such service under the Dental Care Plan. Limitations for prosthodontic appliances Services for the installation of prosthodontic appliances (for example, fixed bridges, pontics and abutments temporary or permanent, partial or complete dentures) constitute eligible dental services only if they are rendered for: an initial prosthodontic appliance, the replacement of an existing prosthodontic appliance, including the addition of teeth to an existing appliance, if: the replacement or the addition of teeth is required because at least one additional natural tooth was extracted after the insertion of the existing appliance, and the appliance could not have been made serviceable. If the existing appliance could have been made serviceable, only the expense for that portion of the replacement appliance that replaces the teeth extracted will be covered, the existing appliance is at least five years old and cannot be made serviceable, the existing appliance was temporarily installed, provided that the replacement appliance is installed within 12 months of insertion of the temporary appliance and that such replacement appliance will be deemed permanent for the purposes of this provision, the replacement appliance is required as a result of the installation of an initial opposing denture after the date the person becomes covered under the Dental Care Plan, the replacement appliance is required as a result of accidental dental injury to a natural tooth that occurred after the date the person became covered under the Dental Care Plan, or the replacement of a crown when the existing restoration is at least five years old and cannot be made serviceable. version: September 1,

44 What is not covered under the Long-term Disability Insurance Plan? You are not eligible for benefits if your disability: is related to a condition that existed before you became insured (with certain exceptions), arises from commission of a felony, insurrection or voluntary participation in a riot, or injury or disease suffered on active duty with any armed forces, or results from an act of war, unless you become totally disabled as a result of such an act to which you are exposed while working outside of Canada at NAV CANADA s direction. What is not covered under the Basic Life Insurance Plan? No restrictions apply to payment of this benefit. What is not covered under the Business Travel Accidental Death and Dismemberment Insurance Plan? No benefit is payable for: expenses paid for or furnished under the terms of any other Health Care Plan arranged through the employer, services provided by an agency or department of any government normally provided free-of-charge, non-emergency medical treatment, routine health check-ups, eye and ear examinations, eye glasses and hearing aids, or treatment that can be reasonably delayed until return to Canada, dental care, dental services or supplies and appliances, except as previously mentioned, hospital charges for non-medical services, such as radio or telephone, services not listed as covered expenses, services rendered before coverage became effective or after termination of employment or termination of insurance, cosmetic surgery or treatment, except as required for correction of damage caused by accidental injury sustained while this coverage is in force, services or supplies that are available through any plan established pursuant to the laws or regulations of any government, including any motor vehicle no fault coverage required by statute, any service to the extent that any government prohibits payment of benefits, services, drugs or supplies which are deemed experimental in nature, delivery and transportation charges, services and supplies which are required for recreation or sport, but which are not medically necessary for regular activities, services received for confinement, which is primarily for chronic or custodial care, services received in a government hospital unless you are required to pay for such services, version: September 1,

45 services to which you are entitled without charge, or for which there would be no charge if there were no insurance, services received from a dental or medical department maintained by NAV CANADA, a mutual benefit association, labour union, trustee or similar type of group, expenses in respect of services provided by a member of your family or by a person customarily living with you, chronic alcoholism or drug addiction, mental or nervous disorders or psychiatric treatment, unless necessitating hospital or institutional confinement, in which case coverage shall not extend beyond three months, AIDS or AIDS-related disease or disorders, or any condition for which you received medical advice for treatment during the 90 days immediately prior to becoming insured, until after the expiration of 12 months from the date you are eligible for insurance. In addition, the plan does not cover any loss or loss of use that is the result of: normal commuting to and from work, intentionally self-inflicted injuries, suicide or any attempt thereat, while sane or insane, full-time, active duty in the armed forces, injury sustained while you are performing any common, manual, or mechanical labour that may be construed as part of your regular duties for NAV CANADA, any accident that occurs during the period you are required to live in another community, away from the work premises in the city of permanent assignment, for reasons of training or work assignments lasting longer than 60 days, acrobatic flying as defined by the Department of Transport, operations requiring a special permit or waiver from the Department of Transport even though granted, other than a permit waiver issued because of the territory to be flown over or landed upon, except operations requiring a ferry permit or test flight permit from the Department of Transport where such aircraft does not have a valid certificate of airworthiness and operations requiring aerial work under Transport Canada CAR 702 Operating Certificate; or crop dusting or spraying, seeding, firefighting, sky-writing, pipeline inspection, power-line inspection, aerial photography, exploration, racing, endurance test or exhibition stunt flying. version: September 1,

46 When coverage ends When does my coverage end? When does coverage for my spouse and children end? When does my coverage end? Health Care and Dental Care coverage Generally, Health Care coverage ends when you leave NAV CANADA. You can opt out of the Health Care Plan anytime. Coverage ends no later than 60 days after your written cancellation is received. Any premium deductions end the first of the month before coverage ends. Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... Example Send written cancellation request January 29 Received February 2 Coverage ends (at the latest) March 31 Premium deductions end (at the latest) February 28 If you retire with an immediate pension prior to January 1, 2010, you may continue Health Care coverage as a retiree. Check the definition of retiree in the benefit dictionary at the end of the booklet to determine if you are an eligible retiree under the Health Care Plan. Otherwise, your Health Care Plan coverage ends on the last day of the next month after your termination date. Extension of benefits Health Care Plan coverage continues for charges related to pregnancy and delivery, until the end of the month in which the pregnancy is terminated or the end of the month in which the child is born, where a member dies leaving a widow who is pregnant and who was a covered dependent at the time of the member s death and the widow is not in receipt of a pension, she may continue her coverage by the payment of the total required contribution, and Dental Care Plan coverage ends the day you leave NAV CANADA. version: September 1,

47 Dental Care Plan coverage continues: for completion of certain dental treatments (for example, root canal treatment where the pulp chamber is opened) started before coverage ended, as long as work is completed within 31 calendar days from the end of coverage, and to the end of the calendar quarter that includes the month coverage ends, for eligible orthodontic services of a child, that began before coverage ended. Long-term Disability Insurance Plan coverage Coverage ends on the date of termination or the first day of the elimination period prior to the day you reach age 65, whichever happens first. Life and accident insurance coverage Basic Life Insurance Coverage ends when you leave or retire from NAV CANADA, unless you choose to continue coverage. If you retire with an immediate pension, coverage continues automatically, unless you cancel or reduce it. If you leave NAV CANADA and defer your pension, you can maintain your coverage at a special rate, as long as you send a written request and appropriate payment to your Pay & Benefits Advisor within 30 days of your termination date. When you leave NAV CANADA for reasons other than retirement, you can convert your coverage to an individual policy with Great-West Life. Business Travel Accidental Death and Dismemberment Insurance This coverage ends when you leave NAV CANADA, retire, or reach age 75, whichever occurs first. For each period of travel, coverage ends when you return home or to your place of employment. When does coverage for my spouse and children end? For the Health Care and Dental Care Plans, your spouse s and children s coverage ends when yours does, or when they no longer meet the plan definitions. Their coverage may extend for up to six months, if you die while they are outside of Canada, provided they request the extension of coverage within 60 days of your death. For eligible orthodontic services for your child, Sun Life will extend coverage for treatments that began before your coverage ended or the child reached age 21 (age 25 age 26 in Quebec if a full-time student). The extension will be until the end of the calendar quarter that includes the month the coverage ended or the month of the child s 21 st or 25 th (26 th in Quebec) birthday, as the case may be. version: September 1,

48 What happens if This section of answers questions about when benefits are paid, depending on different events in your life. Choose the event that applies and see for yourself what benefits apply. Administrative events Personal/family events Common/other events Health events Joining NAV CANADA Transferring from a represented to a management position or vice-versa Changing from part-time to full-time or vice-versa Change in earnings Travelling on business Taking an authorized leave of absence Leaving NAV CANADA Retiring Change in marital status Adding a child to my family Child reaching age 21 Child going to school or university Child leaving school or university Both spouses working at NAV CANADA Changing personal information Buying medical supplies and services Buying prescription drugs Getting eye exams and glasses/contact lenses Buying hearing aids Going to the dentist Going to the doctor Visiting a health practitioner Using my Health Spending Account Calling an ambulance Going to the hospital Getting private nursing care Illness or injury outside my province of residence Becoming disabled Suffering a permanent accidental injury Death of a family member Death of an employee Death of a retiree version: September 1,

49 Administrative events Joining NAV CANADA Transferring from a represented to a management position or vice-versa Changing from part-time to full-time or vice-versa Change in earnings Travelling on business Taking an authorized leave of absence Leaving NAV CANADA Retiring Joining NAV CANADA When you become eligible, your Pay & Benefits Advisor will give you the forms you need to take advantage of the Benefit Plans that apply to you as a represented employee: Basic Life Insurance Plan, Business Travel Accidental Death and Dismemberment Insurance, Long-term Disability Insurance Plan, Health Care Plan, Supplementary coverage, when you live in Canada and are covered by a provincial health plan, or Annual Health Spending Account of $750 (prorated for the first year if your coverage begins after March 31), which can be used to claim any health or dental expenses eligible under the Income Tax Act (section 118.2(2)) for you and your eligible dependent(s). Dental Care Plan. Coverage start dates vary by plan. Transferring from a represented to a management position or vice-versa If you transfer from a represented to a management full-time or part-time position, you become eligible for the management benefit plans and all management coverage and premium cost-sharing. Vice-versa, your management coverage and premium cost-sharing ends, but you can maintain the coverage you have under the Management Insurance Plan. Changing from part-time to full-time or vice-versa If you were working less than one-third of a full-time equivalent position, you may become eligible for new or revised coverage when you start working full-time. If you transfer to a position working less than one-third of a full-time equivalent position, your coverage ends. version: September 1,

50 Change in earnings Any increase or decrease in your annual earnings means a corresponding change in the amount of life and accident, business travel, and disability coverage, depending on the plans for which you are eligible. Life accident and business travel insurance amounts and premiums are revised on the effective date of the change to reflect adjusted insurable earnings changes resulting from earnings rate adjustments, increments, and promotions. If your earnings increase retroactively or decrease before the effective date, coverage changes the first of the month following the month in which the change is authorized. Here is an example of how this works for Basic Life Insurance coverage. Example Annual earnings $39,950 Adjusted insurable earnings 2 X $39,950 = $69,900 (rounded to $70,000) Collective agreement ratified June 17, 2009 Retroactive to January 1, 2009 Coverage increases July 1, 2009 For disability coverage, retroactive salary increases affect your benefits only if the increase date falls before you began to receive disability benefits. Retroactive earnings adjustments for retirees do not affect the adjusted insurable earnings. Traveling on business The Health Care Plan covers health emergencies outside your province of residence. Business Travel Accidental Death and Dismemberment Insurance provides additional medical and other travel emergency coverage, if you are on NAV CANADA business. Basic Life Insurance and Business Travel Accidental Death and Dismemberment Insurance provide life and accident benefits to your beneficiaries in the event of your death. Taking an authorized leave of absence During paid leave, benefits coverage continues as though you were at work. On unpaid leave for: illness or disability, maternity, adoption, paternity, or for care and nurturing up to 52 weeks after the birth or adoption of a child, education, service with an international organization, version: September 1,

51 care and nurturing, beyond 52 weeks after birth or adoption of a child, relocation of your spouse, personal reasons, or service on loan to a union, you must maintain your Basic Life Insurance by paying required premiums either in advance or when you return to work. If you pay once you are back at work, you can spread payment over a period of no more than twice the period of leave. If your leave for: care and nurturing, beyond 52 weeks after birth or adoption of a child, relocation of your spouse, personal reasons, or service on loan to a union, you will have to pay both the employee and employer portion of the required premiums for all the NAV CANADA Benefit Plans you want to maintain (please note that the Basic Life Insurance is not optional) beyond the first three months of leave, as long as you pay the required premiums in advance. You can give post-dated cheques or make a lump-sum payment. If you become disabled while on leave and have maintained your disability coverage, you would be entitled to short-term disability or sick leave benefits (depending on your collective agreement). Long-term disability benefits would begin following a waiting period of 13 weeks or expiration of short-term disability or sick leave benefits, whichever is later. Leaving NAV CANADA In general, coverage ends if you leave NAV CANADA for a reason other than retirement. You cannot continue your coverage under the Dental Care, Long-term Disability Insurance or Business Travel Accidental Death and Dismemberment Insurance Plans once you leave. Health Care Plan If you take a deferred pension or transfer the value of your pension benefits out of the NAV CANADA Pension Plan, coverage ends on the last day of the month following the date you leave NAV CANADA. If you are eligible for Health Care Plan coverage as a retiree, you can apply for coverage anytime after your pension starts. If you do not apply within 60 days of being eligible, a three-month waiting period applies. If you are an employee covered under the Health Care Plan, you will have 90 days after your coverage ends to submit claims for reimbursement to your Health Spending Account. Expenses must have been incurred, that is, they must be dated before your coverage end date; otherwise, they will be rejected. version: September 1,

52 If you are not eligible for the Health Care Plan when you leave NAV CANADA, you may benefit from the My Health Coverage Choice package offered by Sun Life. To be eligible: you and everyone included in your application must be age 75 or less on the date you apply, you must be covered under a provincial health care plan, children age 21 to 25 (26 for Quebec residents) must be full-time students at college or university, you must be a Canadian resident, and you must apply no more than 60 days after your NAV CANADA coverage ends. For more information: Visit You will find everything you need, from plan details to application forms. You can even purchase coverage directly online. Call toll-free SUN LIFE ( ). If you are interested, but do not have Internet access, the Customer Care Centre will send you an application form. Once approved, Sun Life will send you a welcome package with detailed coverage information. Contact Sun Life by at [email protected]. Basic Life Insurance Plan If you leave NAV CANADA and defer your pension, you can maintain your coverage. Just send a written request to your Pension Advisor with a cheque for the first 12-month payment no more than 30 days after your termination date. You will be covered for the same amount as when you left NAV CANADA if you were under age 61; coverage begins to reduce as of your 61 st birthday. If you leave NAV CANADA and transfer the value of your pension benefits out of the NAV CANADA Pension Plan, you can continue coverage by applying for conversion to a private policy with Great-West Life no more than 31 days after you leave. If you choose this option, you pay your premiums directly to Great-West Life. Converting life insurance Within 31 days of leaving NAV CANADA, you can contact Great-West Life directly to buy individual life insurance without a medical examination (regardless of your state of health), subject to certain restrictions. If you die during the 31-day period after you leave NAV CANADA, benefits will be paid as if you had converted coverage, even if you had not. Retiring You cannot continue your coverage under the Dental Care, Long-term Disability Insurance or Business Travel Accidental Death and Dismemberment Insurance Plans once you retire from NAV CANADA. version: September 1,

53 Health Care Plan Supplementary coverage Check the definition of retiree in the benefit dictionary at the end of the booklet to determine if you are an eligible retiree under the Health Care Plan. If you are, you can: continue the coverage you have by completing the Health Care Plan Application Form, or apply anytime by completing the same form, if you were not previously covered.. Any required cost is deducted from your pension. If your premiums are higher than your pension amount, you must send a cheque for the required premium in advance to your Pension Advisor. The following rules apply for coverage at retirement for eligible retirees. If you apply*... Within 90 days of becoming eligible Within 90 days of acquiring a new spouse and/or children To join more than 90 days after: becoming eligible, or acquiring a new spouse and/or children Coverage starts on... The date your completed application is received if that is the first day of a month, or the first day of the next month The date of the change The first day of the fourth month after your application is received *Your application must be submitted with the applicable supporting documents. Only dependents for whom we have supporting documents will have coverage. The Health Spending Account is not offered to retirees, even if you continue your Health Care Plan coverage when you retire. You must submit final claims under your Health Spending Account no more than 90 days after your coverage as an employee ends. Expenses must have been incurred, that is, the receipts must be dated before your coverage end date; otherwise, they will be rejected. Basic Life Insurance Plan If you retire with at least two years of service and take an immediate pension, coverage continues unless you opt out. You will be covered for the same amount as when you retired if you were under age 61. Your coverage reduces by 10% (of your full coverage in effect on your 61 st birthday), on April 1 or October 1 immediately following your 61 st birthday and every year after that, until it reaches $5,000. Coverage reduces to $5,000 on the first reduction date after your 70 th birthday. You can apply for the reduced coverage of $5,000 anytime. You will not be able to increase it later. To take the reduced coverage, complete the Basic Life Insurance Paid-Up Amount Application. You can also cancel anytime and buy an individual policy. Any required cost is deducted from your pension. If your premiums are higher than your pension amount, you must send post-dated cheques for the required premium in advance to your Pension Advisor. version: September 1,

54 Personal/family events Change in marital status Adding a child to my family Child reaching age 21 Child going to school or university Child leaving school or university Both spouses working at NAV CANADA Changing personal information Change in marital status Check the definition of spouse in the benefits dictionary at the end of the booklet to determine when your new spouse is eligible. Apply to change your Health Care Plan coverage to family, if you had single. You must provide the applicable proof of eligibility to your Pay & Benefits Advisor/Pension Advisor. If you are active employee, you must update the NAV Employee Self Serve account to show Family Health Care coverage and add your spouse as a dependant. If you apply within 90 days of your marriage, or your change in status with a common-law spouse after one year of cohabitation, coverage takes effect on the date of the change. If you apply more than 90 days later, coverage takes effect the first day of the fourth month after your application is received. Apply to change your Health Care Plan coverage to single, if you had family and you have no other dependents. Your coverage change takes effect no more than 60 days after you update the NAV Employee Self Serve account to show single Health Care coverage. If you have other dependents, you must update the NAV Employee Self Serve account to uncover your spouse from the Health Care and Dental Care plans. Change your designated beneficiary, if you wish and are permitted to do so by law by submitting the applicable form. Updating your dependants though oracle in no way changes your beneficiary. Adding a child to my family Apply to change your Health Care Plan coverage to family, if you had single. You must provide the applicable proof of eligibility to your Pay & Benefits Advisor/Pension Advisor. If you are active employee, you must update the NAV Employee Self Serve account to show Family Health Care coverage and to add your child as a dependant. If you apply within 90 days of the arrival of the child, coverage takes effect on the date of the change. If you apply more than 90 days later, coverage takes effect the first day of the fourth month after your application is received. Change your designated beneficiary, if you wish and are permitted to do so by law by submitting the applicable form. Updating your dependants under your NAV Employee Self Serve account in no way changes your beneficiaries for Life Insurance. version: September 1,

55 Child reaching age 21 If your child is not attending an accredited school full-time, Health Care and Dental Care coverage ends when he or she reaches age 21. If your child enters a spousal relationship before that date, coverage ends immediately. If your child depends on you for support because of a psychiatric or physical disability and became disabled before age 21, coverage may continue without age limit. You must complete the Handicapped Child Coverage form and submit to Sun Life Financial for approval. NAV CANADA will only be advised if the application has been approved in order to maintain your child s coverage. Information related to the diagnosis of your child will not be released to NAV CANADA. Child going to school or university Coverage continues until age 25 (age 26, for Quebec residents) as long as your child is enrolled in an accredited school full-time and a letter or other confirmation of your child s enrolment is provided to your Pay & Benefits Advisor/Pension Advisor on an annual basis. If you are active employee, you must update the NAV Employee Self Serve account to update the Student Status of your child record. Children who depend on you for support because of a psychiatric or physical disability, who became disabled while still eligible for coverage, may be covered without age limit. You must complete the Handicapped Child Coverage form and submit to Sun Life Financial for approval. Child leaving school or university Coverage ends if your child is older than age 21 and stops attending school full-time. Both spouses working at NAV CANADA Health Care Plan Dental Care Plan Business Travel Accidental Death and Dismemberment Insurance You may both apply for family coverage, and both cover your children. Co-ordination of benefits is permitted You both have family coverage automatically, and both cover your children. Co-ordination of benefits is permitted Your spouse and children are covered during relocation and related house-hunting trip Changing personal information Represented employees Represented retirees Pay & Benefits Advisor Pension Advisor Contact your... version: September 1,

56 Common/other events Buying medical supplies and services Buying prescription drugs Getting eye exams and glasses/contact lenses Buying hearing aids Going to the dentist Going to the doctor Visiting a health practitioner Using my Health Spending Account Buying medical supplies and services What does the plan cover? Represented employees Retirees 80% 80% The Health Care Plan pays reasonable and customary charges for covered services or products, as long as: any provincial plan has paid its maximum for the service or product, and the service or product is prescribed by a physician and medically necessary. You pay the remaining cost. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Artificial limbs, temporary and permanent (to replace temporary) Bandages and surgical dressings required for the treatment of an open wound or ulcer Blood-glucose monitors for insulin-dependent diabetics and for legally blind or colour blind non-insulin-dependent diabetics Including replacement of existing prosthesis, no earlier than: 60 months after the last purchase for patients over age 21, or 12 months after the last purchase for spouse, or child age 21 or less Earlier replacement may be approved if medically proven that growth or shrinkage of surrounding tissue requires replacement at an earlier date Including repair or replacement, no earlier than 60 months following the date of purchase of the monitor version: September 1,

57 Braces that contain either metal or hard plastic Breast prosthesis following mastectomy Colostomy, ileostomy and tracheostomy supplies, catheters and drainage bags for incontinent, paraplegic or quadriplegic patients Durable equipment manufactured specifically for medical use, required for temporary and therapeutic use in the patient s private residence rental, or purchase at Sun Life s option including walkers, hospital beds, apnea monitors and alarm systems for eneuretic patients Elasticised support stockings and elasticised apparel for burn victims Insulin jet-injector device for insulin-dependent diabetics Insulin pumps and associated equipment for insulindependent diabetics, including repair or replacement at least 60 months following the date of purchase Orthopaedic brassieres Orthopaedic shoes that are an integral part of a brace or are specifically constructed for the patient, including modifications to such shoes, prescribed by a physician, chiropodist or podiatrist Orthotics Oxygen and its administration Physician s services, when such services would be eligible for reimbursement under one or more provincial health plans Trusses, crutches, splints, cast and cervical collars in metal or hard plastic Not including dental braces or braces used primarily for athletic use Including 1 replacement for each prosthesis in any 24-month period Reimbursement limited to the cost of non-motorized equipment, unless medically proven that motorized is required Manufactured to individual patient specifications, or with a minimum compression of 30 millimetres Maximum reimbursable expense $760 1 for each covered person every 36 months Reimbursed only if prescribed by a physician associated with a recognized centre for the treatment of diabetes at a university teaching centre Maximum reimbursable expense $100 1 for each covered person in any one calendar year Maximum reimbursable expense for each covered person in any one calendar year of: total charges, less the average cost of regular footwear, as determined by Sun Life, or $150 1, whichever is less Maximum reimbursable expense $300 1 for each covered person in any one calendar year Wheelchair required for therapeutic use in the patient s private residence rental, or purchase at Sun Life s option including repairs and replacement Reimbursement limited to the cost of non-motorized equipment, unless medically proven that motorized is required Replacement no earlier than 60 months after the last purchase Lifetime maximum reimbursable expense $500 1 Wigs, when the patient is suffering from total hair loss as the result of a disease or illness 1 All expenses with a maximum reimbursable amount will be paid at 100% coinsurance. version: September 1,

58 How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. For all expenses outside Canada under the Health Care Plan, you should contact Mondial Assist/World Access Canada, where possible, before incurring the expense. See the Making a claim section for complete details. version: September 1,

59 Buying prescription drugs What does the plan cover? Represented employees Retirees 80% 80% The Health Care Plan pays reasonable and customary charges for covered prescription drugs, as long as the medication is medically necessary for the treatment of disease or injury and approved by Sun Life. The plan will deduct a per script fee of $4.00 for each Drug Identification number (DIN) claimed on an individual receipt. You pay the remaining cost. If you are a full-time or part-time represented employee covered under the Health Care Plan, you have access to the Pay Direct drug card feature. This card can be used for prescription drug expenses for you and your registered dependants (subject to the coordination of benefits rules). Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Aerochambers with masks for the delivery of asthma medication Brand name drugs Compounded prescriptions Drug-delivery devices to deliver asthma medication Drugs identified in the Monographs section of the current Compendium of Pharmaceuticals and Specialties as a narcotic, controlled drug, or requiring a prescription Erectile Dysfunction Drugs Hypodermic needles, syringes, and chemical diagnostic aids for treatment of diabetes Injectable drugs Life-sustaining drugs that may not legally require a prescription, identified in the Therapeutic Guide section of the current Compendium of Pharmaceuticals and Specialties under the following headings: anti-anginal agents antiparkinsonism agents bronchodilators antihyperlipidemic agents hyperthyroidism therapy parasympathomimetic agents For children under six years of age only Reimbursed up to the price of the generic equivalent unless specified by a physician with an inscription no substitution on the prescription Regardless of active ingredients Must be integral to the product Maximum reimbursable expense $1,300 1 for each covered person in any one calendar year Including needles and syringes no earlier than 36 months after purchase of an insulin jet-injector Including allergy serums administered by injection version: September 1,

60 tuberculosis therapy anticholinergic preparations anti-arrhythmic agents glaucoma therapy insulin preparations oral fibrinolytic agents topical ensymatic debriding agents Replacement therapeutic nutrients prescribed by an accredited medical specialist for the treatment of an injury or disease (excluding allergies or aesthetic ailments), provided that no other nutritional alternative exists to support the life of the patient Smoking cessation aids that require a prescription and are not available over the counter Vitamins and minerals that are not available over the counter and that are prescribed for the treatment of a chronic disease, when the customary practice of medicine considers that these products have proven therapeutic value and when no other alternatives are available to the patient Weight loss drugs that require a prescription Lifetime maximum reimbursable expense for each covered person $1,000 1 Covered (including prescribed injectable vitamins/dietary supplements if used in conjunction with a weight loss drug program) if person is considered obese as defined by the World Health Organisation 1 All expenses with a maximum reimbursable amount will be paid at 100% coinsurance. I am trying to stop smoking. Can the plan help? Yes, but only with smoking cessation aids that require a prescription and are not available over the counter, to a lifetime maximum reimbursable expense of $1,000. Does the plan cover Viagra? Yes, the plan covers all erectile dysfunction drugs up to a maximum reimbursable expense of $1,300 for each covered person in any one calendar year. version: September 1,

61 Does the plan cover experimental drugs? Experimental products or treatments are never eligible unless Sun Life is satisfied that substantial evidence exists provided through objective clinical testing of the product s or treatment s safety and effectiveness for the purpose and under the conditions of the use recommended. Certain life-sustaining non-prescription drugs are covered if prescribed by a physician. Does the plan cover an unlimited supply of therapeutic or maintenance drugs? Although there is no maximum limit for drugs, you may only claim what can reasonably be used in three months. The plan will only reimburse a maximum 90-day supply at a time. Does the plan cover supplies for diabetics? Yes, including hypodermic needles, syringes, and chemical diagnostic aids. But, if you buy an insulin jet-injector, you cannot claim needles and syringes for the next 36 months. Does the plan cover contraceptives? Yes, oral and non-oral contraceptives prescribed by a Doctor and dispensed by a licensed pharmacist. Are injectable drugs covered? Yes, including allergy serums administered by injection. Does the plan cover brand-named drugs? Yes, but only in two instances: if no generic drug is approved on the market, or your physician writes no substitution on your prescription and you submit a copy of the prescription with your claim. Otherwise, only the value of the equivalent generic drug will be reimbursed. version: September 1,

62 Can I use a mail-order pharmacy and still get reimbursed? A mail-order prescription program is available through Rexall Direct, and its affiliate XPress Pharm for Quebec residents, for all eligible Health Care Plan members living in Canada. Rexall Direct and XPress Pharm offer a convenient and cost-effective way of purchasing your prescription medications. This service is ideal for people who take medications on a regular basis. Vitamins, minerals, and all general drugstore products are available for delivery along with your prescriptions. Rexall Direct or XPress Pharm will bill Sun Life directly for your eligible prescription drug orders and deliver your prescriptions, right to your door. The only out-of-pocket expense for you is your 20% share of the cost, the $4 per script fee or any non-eligible items (such as regular drugstore items) you choose to purchase. No claims to Sun Life will be necessary other than the unpaid portion of expense claims through your Health Spending Account, or to another plan for coordination of benefits. For further information about Rexall Direct, call or its Quebec affiliate XPress Pharm at Visit their website at or or contact your Pay & Benefits Advisor. How does the per script fee of $4.00 affect me? If you are a represented employee/retiree, in order to administer this cost containment initiative, Sun Life Financial calculates the eligible expense you claim by considering a per script fee of $4.00 for each Drug Identification Number (DIN) indicated on the receipt once the co-insurance has been applied. Claim for 3 different drugs (DINs) on one receipt $100 Reimbursement level Represented employees/retirees 80% X $100 = $80 Per Script fee charge 3 X $4.00 = $12.00 Reimbursement amount Represented employees/retirees $80 - $12 = $68.00 Example How can I claim weight loss drugs? If you are a represented employee/retiree, charges for prescription weight loss drugs (includes injectable vitamins and dietary supplements prescribed by a physician in conjunction with a weight loss drug program) will be considered an eligible expense only if the covered person is deemed obese as defined by the World Health Organization (WHO). To find out more about the BMI and the WHO, refer to their website at: A special authorization form for anti-obesity medication must be submitted to Sun Life Financial and approval received before a claim can be processed. Approval remains on file for 12 months at which time a new form must be submitted for approval. version: September 1,

63 How do I make a claim? It depends on your individual situation if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. If you are using the Pay Direct drug card See the Making a claim section for complete details. version: September 1,

64 Getting eye exams and glasses/contact lenses What does the plan cover? Represented employees Retirees 80% 80% The Health Care Plan pays reasonable and customary charges incurred for the following supplies and services. You pay the remaining cost. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Artificial eyes and replacements Eye examinations by a licensed optometrist Eyeglasses or contact lenses initial purchase required as the direct result of surgery or an accident Eyeglasses and contact lenses needed to correct vision, prescribed by an ophthalmologist or optometrist, and repairs Laser eye surgery Including replacement of existing eye, no earlier than: 60 months after the last purchase, for covered persons over age 21, or 12 months after the last purchase, for spouse, or children under age 21 One examination for each covered person in each two-year calendar period Must be purchased within six months of such surgery or accident, or as soon as is reasonably possible, in Sun Life s opinion Maximum reimbursable expense $200 1 for each two-year calendar period Can be claimed against the same maximum reimbursable expense of $200 1 as eyeglasses and contact lenses in subsequent two-year calendar period (under the regular Health Care Plan, not the Health Spending Account) until the full cost has been claimed. 1 All expenses with a maximum reimbursable amount will be paid at 100% coinsurance. Does the plan cover sunglasses? Yes, as long as they have prescription lenses. version: September 1,

65 How does the two-year claiming period work? If you received a reimbursement of $200 on the purchase of eyeglasses, contact lenses or laser eye surgery during the two-year period that runs from January 1, 2009 to December 31, 2010, you cannot claim again until the new two-year period (January 1, 2011 to December 31, 2012) begins. For laser eye surgery claims, you may re-submit the expense, as long as the person is covered by the plan, in every two-year calendar period until the full cost of the surgery has been claimed. You cannot re-submit the expense under the Health Spending Account for that new calendar year period. How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. See the Making a claim section for complete details. version: September 1,

66 Buying hearing aids What does the plan cover? Represented employees Retirees 100% 100% The Health Care Plan pays reasonable and customary charges for: hearing aids prescribed by an ear, nose, and throat specialist, including repairs but excluding batteries, and the initial purchase of hearing aids required as the direct result of surgery or an accident, as long as they are purchased within six months of the surgery or accident, or as soon as is reasonably possible, in Sun Life s opinion, to a maximum reimbursable expense of $500 for each covered person every 60 months. To be eligible: any provincial plan must have paid its maximum for the service or product, and the service or product must be prescribed by a physician and medically necessary. You pay the remaining cost. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. See the Making a claim section for complete details. version: September 1,

67 Going to the dentist What does the plan cover? The Dental Care Plan reimburses*: 90% of the cost of basic services, such as exams, X-rays, fillings, root canals, and treatment of gum disease, and 50% of the cost of major services, such as crowns, bridges, and dentures, as well as orthodontics. *Payment will not be made for any portion of a charge for treatment over the usual, reasonable and customary charge of the least expensive alternate service or material consistent with adequate dental services when such alternative service or material is customarily provided. The following maximums are applied to the amount of expense: $1,500 for each covered person in any one calendar year for basic and major services combined, other than orthodontics, and $2,500 lifetime maximum for each covered person, for orthodontics. You pay the remaining cost. If you join the plan on or after July 1 in a calendar year, the maximum benefit payable in that year is $750 for services other than orthodontics. If treatment is likely to cost more than $300, Sun Life recommends that you have your dentist submit a treatment plan and expected cost to Sun Life. In return, Sun Life will let you know how much of the cost the plan will pay. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Eligible expense Reimbursed at Anaesthesia in connection with oral surgery and drug injections 90% Bridges/dentures 50% exams, films and diagnostic casts addition of tooth to a removable denture partial and complete dentures pontics (fixed bridges) retainers abutments (fixed bridges) retentive pins in abutments repairs of fixed appliances other prosthodontic services Consultations with another dentist 90% Crowns, inlays/onlays, and other restorative services 50% gold foil gold inlays 50% version: September 1,

68 retentive pins, posts and cores porcelain inlays crowns other restorative services Eligible expense Denture repairs (minor) repairs adjustments relining and rebasing (once every 3 years) Reimbursed at Emergency services not otherwise specified 90% Endodontics (root canals) 90% pulp capping pulpotomy root canal therapy periapical services other endodontic procedures Examination and diagnosis complete oral examination recall oral examination (once every 9 months) specific oral examination emergency oral examination treatment planning Fillings amalgam silicate acrylic or composite pin reinforcements for these restorations House calls, hospital calls and special office visits 90% Oral surgery 90% uncomplicated removal of tooth surgical removal and tooth repositioning alveoplasty, gingivoplasty, stomatoplasty, osteoplasty, tuberoplasty removal of excess mucosa surgical excision removal of cyst surgical incision removal of impacted teeth repair of soft tissue frenectomy, dislocations miscellaneous surgical services 90% 90% 90% version: September 1,

69 Orthodontics orthodontic exam films orthodontic diagnostic casts surgical services observation and adjustments repairs, alterations removable appliances fixed appliances retention appliances appliances to control harmful habits Eligible expense Periodontics (treatment of gum disease) non-surgical, surgical and post-surgical treatment occlusal equilibration (not exceeding 8 units every 12 months) scaling and root planing other periodontic services Preventive services dental cleaning and polishing (once every 9 months) topical application of fluoride (once every 9 months) pit and fissure sealants (for children under age 15 only) caries control enameloplasty space maintainers (not involving movement of teeth) oral hygiene instructions (1 per benefit year) Tests, lab work biopsy of oral tissue pulp-vitality tests X-rays periapical (one complete series every 36 months) occlusal bitewings (once every 9 months) extra-oral sialography, uses of dyes panoramic (once every 36 months) interpretation of radiographs from another source tomography Reimbursed at 50% 90% 90% 90% 90% If you need certain types of oral surgery or treatment of accidental injury of your natural teeth, the Health Care Plan pays 80% of reasonable and customary charges first. version: September 1,

70 How is the amount of the maximum eligible expense determined? If you Live and go to the dentist in Canada Live in Canada, but go to the dentist outside Canada The maximum eligible expense is calculated using The current dental fee guide in the province or territory where the dentist is located Amount that would have been payable in your province of residence Do I need to get pre-approval for expensive dental treatment? If treatment is likely to cost more than $300, Sun Life recommends that you have your dentist submit a treatment plan and expected cost to Sun Life. In return, Sun Life will let you know how much of the cost the plan will pay. What if I need dental surgery or dental treatment after an accident? Dental surgery You claim from the Dental Care Plan first, and any balance, from the Health Care Plan. The Dental Care Plan covers up to 90%. For any remaining balance, the Health Care Plan covers 80% of reasonable and customary charges for the following oral surgical procedures. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. version: September 1,

71 Eligible expense Avulsion of nerve supra or infra-orbital Cysts, lesions, abscesses biopsy soft tissue lesion incision excision hard tissue lesion excision of cysts excision of benign lesion excision of ranula incision and drainage intra oral soft tissue intra osseous (into bone) periodontal abscess incision and drainage Frenectomy labial or buccal (lip or cheek) Fractures and dislocations dislocation temporomandibular joint (or jaw) closed or open reduction fractures mandible no reduction, closed reduction, or open reduction fractures maxillar or malar no reduction, closed reduction, open reduction, or complicated open reduction Gingival and alveolar procedures alveoplasty flap approach with curettage flap approach with osteoplasty flap approach with curettage and osteoplasty gingival curettage gingivectomy with or without curettage gingivoplasty Lingual (tongue) Removal of teeth or roots removal of impacted teeth removal of root or foreign body from maxillar antrum root resection apiectomy or apicoectomy anterior teeth bicuspids molars version: September 1,

72 Repair of antro-oral fistula Sialolithotomy simple Sialolithotomy complicated Sulcus deepening, ridge reconstruction Torus (bone biopsy) Treatment of traumatic injuries repair of soft tissue lacerations debridement, repair, suturing Treatment of dental injury You claim from the Health Care Plan first, and any balance, from the Dental Care Plan. The Health Care Plan covers 80% of reasonable and customary charges for the services of a dentist/dental surgeon (as well as charges for braces and splints) required to treat a fractured jaw or accidental injuries to natural teeth caused by an external, violent injury or blow. Accidents associated with cleaning, chewing, and eating are not covered. The Dental Care Plan covers up to 90% of any remaining balance. Treatment must take place no more than 12 months after the accident (for children under age 17, before the child reaches age 18). Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. For all expenses outside Canada under the Health Care Plan, you should contact Mondial Assist/World Access Canada, where possible, before incurring the expense. See the Making a claim section for complete details. version: September 1,

73 Going to the doctor What does the plan cover? Your provincial health plan covers the cost of seeing a doctor. Simply show your provincial medicare card when you visit your doctor. In addition, where a particular doctor s visit is not eligible for reimbursement under your provincial health plan, but is eligible under another province s health plan, the Health Care Plan covers 80% of reasonable and customary charges for that visit. If you or a covered family member has to go to the doctor outside your province of residence, in certain instances, the plan will cover the cost. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. See the Making a claim section for complete details. version: September 1,

74 Visiting a health practitioner What does the plan cover? Employees Retirees 80% 80% The Health Care Plan covers reasonable and customary charges for the following services, as long as they: are medically necessary for the treatment of disease or injury and within the practitioner s area of expertise, require the skills and qualifications of such a practitioner, and are provided by a practitioner licensed, registered, or certified through the respective provincial licensing body or professional organization. You pay the remaining cost. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Eligible expense Acupuncturist Chiropodist/podiatrist Chiropractor Electrology by an electrologist or a physician, limited to treatment to remove excessive hair from exposed areas of the face and neck (when the patient suffers from severe emotional trauma as a result of the condition) Naturopath Osteopath/Osteopathic practitioners Physiotherapist Psychologist Registered massage therapist Speech-language pathologist Maximum reimbursable expense $300 1 for each covered person in any one calendar year $300 1 for each covered person in any one calendar year $500 1 for each covered person in any one calendar year $20 1 for each visit psychiatrist s or psychologist s prescription required every 12 months $300 1 for each covered person in any one calendar year $300 1 for each covered person in any one calendar year Unlimited Physician s prescription required every 12 months $1,000 1 for each covered person in any one calendar year Physician s prescription required every 12 months $300 1 for each covered person in any one calendar year $500 1 for each covered person in any one calendar year Physician s prescription required every 12 months User fees under the provincial health plan in the Unlimited person s province of residence, where law permits a person to be reimbursed for such charges 1 All expenses with a maximum reimbursable amount will be paid at 100% coinsurance version: September 1,

75 Does the plan cover the cost of any laboratory tests or X-rays? Yes, that is: tests done in a commercial laboratory for diagnosis of an illness, (not including tests in a physician s office or pharmacy, and X-rays ordered by a physician, chiropractor, osteopath or chiropodist/podiatrist. The plan does not cover the cost of laboratory test or X-rays done in a private laboratory. How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. See the Making a claim section for complete details. version: September 1,

76 Using my Health Spending Account How much money do I get in my account each year? If you are a full-time or part-time represented employee covered under the Health Care Plan, you are entitled to $750 each year in a Health Spending Account. This amount can be used to claim eligible expense for yourself, and your registered eligible dependants (one $750 allocation per certificate number). This amount is not transferable to cash, and must be used during the calendar year in which it is credited to your account. If your coverage under the Health Care Plan starts part-way through the year, credits are allocated in the amount of $ for each calendar quarter (January to March, April to June, July to September, October to December). What expenses can I claim from the Health Spending Account? Any expenses that is tax-deductible and listed in the Income Tax Act, its regulations and Interpretation Bulletins, for yourself, your registered eligible dependants. For more information on what is covered, access the Health Spending Account link on your profile homepage of the Sun Life Financial website or contact a Customer Service Representative at Sun Life, at How do I make a claim? To receive maximum benefits, begin by claiming the expenses under the Health Care or Dental Care Plan, depending on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. If you have a balance remaining or for expenses not covered under the plans: complete Part 4 for Health expenses or Part 5 for Dental expenses of the Health Spending Account Claim Form, and mail your claim to Sun Life, or submit your claim electronically. Just go to sign in with your Access ID and PIN, click on My claims and then click on Health Spending Account e-claim under the Submit a claim tab. You can get an Access ID and PIN number by calling Sun Life at Please note that expenses incurred in the previous calendar year must be processed using a paper-based claim. You have until March 31 of the following year to claim expenses incurred during the current year. See the Making a claim section for complete details. version: September 1,

77 Health events Calling an ambulance Going to the hospital Getting private nursing care Illness or injury outside my province of residence Becoming disabled Suffering a permanent accidental injury Death of a family member Death of an employee Death of a retiree Calling an ambulance What does the plan cover? Represented employees Retirees 80% 80% The Health Care Plan covers reasonable and customary charges for ground or air ambulance services, as long as: the service is prescribed by a physician and medically necessary, and the provider is licensed. You pay the remaining cost. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Can I get the ambulance to take me to any hospital I want? No, it must take you to the nearest hospital equipped to provide the required treatment. Does the plan cover the cost of a medical certified attendant to accompany me? Yes if medically necessary. version: September 1,

78 How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. For all expenses outside Canada under the Health Care Plan, call Mondial Assist/World Access Canada, where possible, before incurring expenses. See the Making a claim section for complete details. version: September 1,

79 Going to the hospital What does the plan cover? The Health Care Plan covers 100% of reasonable and customary costs, in Canada or abroad, for semi-private hospital accommodation. If you choose a private hospital room, you must pay the difference in cost between semi-private and private accommodation yourself. The plan will only pay the hospital for the semi-private accommodation costs. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. What if I just want ward accommodation? Your provincial health plan covers 100% of the cost. Can I get higher reimbursement from the plan? No, there is no option to pay more for higher coverage. If you choose a private room when you are hospitalized, you must pay the difference in cost between semi-private and private accommodation yourself. Does the plan cover other types of hospital services? Generally, in Canada, hospital charges are covered by your provincial plan. How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. For all expenses outside Canada under the Health Care Plan, call Mondial Assist/World Access Canada, where possible, before incurring expenses. See the Making a claim section for complete details. version: September 1,

80 Getting private nursing care What does the plan cover? Represented employees Retirees 100% 100% The Health Care Plan covers reasonable and customary charges for a private nurse at home, to a maximum reimbursable expense of $15,000 for each covered person in any one calendar year, as long as: the care is prescribed by a physician and medically necessary, and the person providing nursing care or prescribing it does not live with the patient and is not related to the patient by blood or marriage. You pay the remaining cost. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Do I need Sun Life s approval before I hire a nurse? Contact Sun Life ahead of time to make sure that the plan will cover the expenses. How do I make a claim? It depends on your individual situation: if you are only covered by NAV CANADA Plans, if you also have coverage under another plan, such as where your spouse works, or if you are separated or divorced and are claiming for your children. See the Making a claim section for complete details. version: September 1,

81 Illness or injury outside my province of residence What does the Health Care Plan cover? The Health Care Plan covers 100% of reasonable and customary charges for emergency health care you need: outside your province of residence, and above what is payable by your provincial health plan, to a maximum reimbursable expense of $1,000,000 for each covered person for any one period of travel. The expense must be: prescribed by a physician and medically necessary, incurred no more than 60 days from the date you leave home or any time you are on official travel status (if treatment continues beyond 60 days, related expenses will be covered), incurred because of an emergency (an acute, unexpected condition, illness, disease, or injury that requires immediate assistance) or because the services were not readily available at home, and payable in part by the provincial plan. Eligible expenses include: public-ward accommodation and auxiliary hospital services in a general hospital, the services of a physician, and out-patient services in a hospital. If a treatment or service is not offered in the patient s province and the person is referred to a hospital in another province, in writing, by the attending physician in his/her province of residence, the plan pays 100% for reasonable and customary charges for the same services, up to a maximum of $25,000 per illness. If you are traveling on business, other benefits are also available. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. Is other emergency travel assistance available? Yes, if you have supplementary coverage under the Health Care Plan. You can call a 24-hour help-line to get: one-way economy airfare for the patient and professional attendant, back to the province of residence, when medically necessary, medical evacuation by ambulance, when Sun Life determines that suitable care is not available where the emergency occurs, family assistance, for example, reimbursement of expenses to return dependent children to Canada, subject to certain limits (combined maximum payable $2,500 for any one travel emergency), transportation arrangements to the nearest hospital that provides the appropriate care, or back to Canada, version: September 1,

82 medical referrals, consultation and monitoring, legal referrals, a telephone interpretation service, a message service (messages held up to 15 days for family and business associates), and advance hospital and medical expense payment. Are there any special benefits for business travel? Yes. If you are traveling on NAV CANADA business, the Business Travel Accidental Death and Dismemberment Insurance through ACE INA pays benefits if you die or suffer a permanent injury, as well as the following expenses, above the amount provided by the Health Care Plan. Emergency medical care The plan covers 100% of reasonable and customary charges, to a lifetime maximum of $500,000 for each employee (emergency health benefits are not paid on behalf of your spouse or children) for supplies and services required within 60 days of the emergency for emergency medical treatment, including: drugs and medicines available only by prescription and listed in the current Compendium of Pharmaceuticals and Specialties, private-duty nursing, prescribed by a physician as medically necessary, where the service is provided by a registered nurse not a member of your family or ordinarily resident in your home, to a maximum of $1,000 per person, transportation by local licensed ambulance, diagnostic laboratory and X-ray examinations, administration of anaesthesia, oxygen, blood, and blood transfusions, semi-private hospital room and board charges and related services and supplies, including drugs administered while confined to hospital for up to 30 days, and physician charges for medical or surgical services. Emergency evacuation The plan also covers reasonable and customary charges for transportation, medical services, and medical supplies for an emergency evacuation, to a maximum of $50,000 for each employee, as long as: the attending physician certifies that: your medical condition warrants immediate transportation to the nearest hospital where appropriate medical treatment can be obtained, or after being treated at a local hospital, your medical condition warrants transportation to your Canadian or United States residence for further medical treatment or to recover, or both, travel is by the most direct and economical route, and version: September 1,

83 expenses for special transportation (that is, any land, water, or air conveyance required to transport you during an emergency evacuation, including, but not limited to, air ambulance, land ambulance, and private motor vehicle) are those required by the regulations of the conveyance in which you are transported. Family transportation If you, your spouse, or child sustains a covered injury and is confined to a hospital more than 150 kilometres from home, the plan pays reasonable and customary charges to bring a member of your immediate family (that is, your legal or common-law spouse, parents, grandparents, children over age 18, brother, or sister) by the most direct route by licensed common carrier to be with the person. The attending physician must recommend this visit in writing. The maximum payable is $10,000. How do I make a claim? For all expenses outside Canada under the Health Care Plan, call Mondial Assist/World Access Canada, where possible, before incurring expenses. For all expenses under Business Travel Accidental Death and Dismemberment Insurance, contact ACE INA. See the Making a claim section for complete details. version: September 1,

84 Becoming disabled Short-term disability Am I entitled to these benefits? Yes, if you are a full-time or part-time management employee or an eligible represented employee in: IBEW (effective 24-Aug-98), CFPA (effective 20-Nov-98), SSEA (effective 23-Dec-98) now under PIPSC, PIPSC (effective 5-Oct-98, if hired on or after 5-Oct-98), or ACFO (effective 12-Jun-98), short-term disability benefits are paid from the Disability Income Security Program (DISP). If you are a represented employee not indicated above, you receive sick leave credits to use if you are ill or injured. When am I eligible to get these benefits? When your manager or immediate supervisor is satisfied that you are unable to perform your duties, because of non-occupational illness or injury. A medical certificate may be required. What benefits do I get? For full details on the benefits that apply to you, refer to your collective agreement. Do short-term disability benefits apply if my disability is work-related? No. In that case, NAV CANADA pays your full salary under Injury-on-Duty Leave. These claims are adjudicated by the provincial workers compensation authority. What happens to my other NAV CANADA benefits coverage while I am disabled? Your benefits continue as though you were at work. What happens if I return to work and become disabled again? Refer to your collective agreement. version: September 1,

85 When do short-term disability benefits end? When you have used your total accumulated sick leave or DISP entitlement, but no later than: the date you retire, or the date you leave NAV CANADA, whichever happens first. How do I make a claim? Notify your manager or immediate supervisor as soon as you are absent from work due to a non-work-related injury or illness. If the absence is expected to extend beyond 21 consecutive calendar days, your manager must complete the online Employee Notification Form. For more information, send an to [email protected]. Long-term disability What is considered a disability? During the elimination period and the next 24 months, you are considered disabled if you are unable to perform the essential functions of your own regular job. Thereafter, you are considered disabled if you are unable to perform any reasonably commensurate occupation for which you are qualified by training, education or experience. You must be under the active care of a physician and follow a course of treatment satisfactory to Great-West Life. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. What if my disability is related to a condition I had before starting work with NAV CANADA? Generally, no benefits are paid for disabilities arising from a disease or injury for which you obtained medical care before you became insured. However, if you meet the following criteria, this provision does not apply to you. If you: have been continuously at work for 13 weeks (ignoring absences of 2 days or less), have not received medical care for that disease or injury for a period of 90 days starting before this coverage began or your disability began, whichever is later, and ending on or after the effective date of your insurance under this benefit, or version: September 1,

86 become totally disabled more than one year after this plan begins to cover you (if you are laid off under a workforce adjustment program and re-appointed within one year, periods of work before the lay-off count toward the one year). When do I start benefits? After the elimination period. What benefits do I get? Once your claim is approved by Great-West Life, you receive 70% of your adjusted insurable earnings as long as you remain disabled. This amount is reduced by amounts you receive for the same or a subsequent disability from or under: the Public Service Superannuation Act (PSSA) or NAV CANADA Pension Plan, the Canada/Quebec Pension Plan (C/QPP), excluding benefits payable to, or on behalf of, your dependents because of your disability, workers compensation or similar government legislation, another group insurance plan or policy you have because of membership in an employee union or association, any government legislation, for example, automobile insurance income replacement benefits, disability benefits, or retirement benefits related to any employment, payable after your disability period begins, and compensation or profit for any occupation or business enterprises in which you are actively engaged. If you are eligible for benefits from another source, you must apply for them. Benefits are not reduced by: government or pension plan benefit cost-of-living increases, disability benefits payable to or on behalf of your dependent, return of pension contributions when not entitled to a pension, benefits from retirement plans to which NAV CANADA has not contributed, benefits under a private, personal insurance policy, or a policy you have because of membership in a professional association not restricted to NAV CANADA, severance pay, early departure/retirement incentives, rehabilitation to a maximum of 100% of monthly earnings when combined with long-term disability benefits and other offset, disability payments from a life insurance, or disability benefits to a veteran under the Pension Act, and any subsequent increases. version: September 1,

87 Example Annual earnings $47,925 Adjusted insurable earnings $48,000 Gross annual long-term disability benefits $48,000 x 70% = $33,600 Gross monthly long-term disability benefits $33, = $2,800 Example Gross monthly long-term disability benefits $2, Income from other sources NAV CANADA Pension Plan $1, Canada Pension Plan $ Total income from other sources $1, Monthly net disability payment from the $2, $1, = $966,68 Long-term Disability Insurance Plan If you do not meet the definition of disability after the elimination period and the subsequent 24 months, your benefits end, unless you participate in a rehabilitation plan. Do these benefits apply if my disability is work-related? No. In that case, NAV CANADA pays your full salary under Injury-on-Duty Leave. These claims are adjudicated by the provincial workers compensation authority. Will my benefits increase when the cost of living goes up? Yes. Plan benefits will be adjusted to reflect any cost-of-living increase each January 1 st, to a maximum of 3% a year. What happens if I become disabled while I am on a leave of absence? If you become disabled while on leave and have maintained your coverage, you would be entitled to the short-term disability or sick leave benefits set out in your collective agreement. Long-term Disability Insurance benefits would begin following a waiting period of 13 weeks or expiration of short-term disability or sick leave benefits, whichever is later. version: September 1,

88 What happens to my other benefit coverage while I am disabled? For Basic Life Insurance, you must continue to pay your share of the premiums. Your coverage under the Health Care and Dental Care Plans continues at no cost to you. NAV CANADA will continue to cover 100% of the cost of premiums. What happens if I return to work and become disabled again? If you recover and return to work, and then become disabled again after: one month, if the second disability is due to unrelated causes, six months, if the second disability is due to related causes, or twelve months, if the second disability is due to the same cause, your Long-term Disability Insurance benefits will start again, in the same amount as you were receiving before you returned to work, without a new elimination period. Do I have to participate in a rehabilitation plan? Yes. Great-West Life may stop your benefits if you do not co-operate or participate in a recommended and approved rehabilitation plan. You may be able to engage in such a plan for up to 24 months while receiving long-term disability benefits from Great-West Life. Your total income from an approved plan, plus disability benefits, cannot exceed your pay before you became disabled. When do benefits end? Your benefits end when you: stop being disabled, are no longer under the active care of a physician, are not following a course of treatment satisfactory to Great-West Life, or reach age 65, whichever comes first. version: September 1,

89 How do I make a claim? You need to apply within 12 weeks from the start of disability, so as not to delay payment of your benefits. See the Making a claim section for complete details. Basic Life Insurance advance payment Great-West Life will, as long as they consider the expense reasonable, pay all or a portion of your Basic Life Insurance amount directly to a person or group that has already paid for your maintenance or medical care. Your beneficiary must sign an agreement before the benefit is paid. To be eligible for this benefit, you must be covered under the Basic Life Insurance Plan at the time you make a claim and NAV CANADA must be able to confirm the beneficiary of record to get their agreement. Life Insurance living assistance benefit You can request that up to 50% of your insurance amount under the Basic Life Insurance or $25,000, whichever is less be paid while you are living, provided that: you are suffering from an injury or illness expected to result in death within 12 months, from which there is no reasonable prospect of recovery, based on your physician s medical information, you have not named an irrevocable beneficiary, you submit a written request to Great-West Life, NAV CANADA authorizes the payment, and you and your beneficiary sign an agreement before the benefit is paid. The amount paid (plus accumulated interest) will reduce the Basic Life Insurance benefit your beneficiary receives when you die. version: September 1,

90 Suffering a permanent accidental injury Active employees If you are permanently injured, you may be eligible for Disability Income Security Program (or sick leave, depending on your collective agreement) and Long-term Disability Insurance Plan benefits. If your injury is work-related, you could receive Injury-on-Duty Leave benefits. If your injury happens while you are on NAV CANADA business, other benefits are payable. What if I am injured on a business trip? The Business Travel Accidental Death and Dismemberment Insurance Plan pays benefits if you suffer a permanent accidental loss or loss of use within one year of an accident that happens during the first 60 days of travel and stopover while on NAV CANADA business, away from NAV CANADA premises. It also includes coverage: while a passenger, pilot or crew member, riding in, boarding or alighting from an aircraft, while making a parachute jump from an aircraft for the purpose of self-preservation, or if you are struck by an aircraft. Your spouse (under age 75) and children are also covered in case of any accident during relocation or related house-hunting trip. Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. For... Coverage based on survivor benefit of... Represented employees 3 X adjusted insurable earnings (maximum $350,000) Your spouse and children $100,000 for your spouse $10,000 for each child The amount payable for loss or loss of use is a percentage of that payable in the event of death. This percentage varies depending on the injury s severity. Benefits are also payable if you suffer a covered loss or loss of use because you were exposed to the elements following a covered accident. Only the largest benefit is paid for injuries resulting from one accident. version: September 1,

91 Injury/loss Percentage of amount payable in the event of accident Quadriplegia (total and irreversible paralysis of all 4 limbs) 200% Paraplegia (total and irreversible paralysis of both lower limbs) 200% Hemiplegia (total and irreversible paralysis of one arm and one leg on 200% the same side of the body) Loss of both hands or both feet 100% Loss of entire sight of both eyes 100% Loss of one hand and one foot 100% Loss of one hand and entire sight of one eye 100% Loss of one foot and entire sight of one eye 100% Loss of speech and hearing 100% Loss of use of both arms or both hands 100% Loss of one arm or one leg 75% Loss of use of one arm or one leg 75% Loss of one hand or one foot 66 2/3% Loss of entire sight of one eye 66 2/3% Loss of use of one hand 66 2/3% Loss of speech or hearing 66 2/3% Loss of thumb and index finger of the same hand 33 1/3% Loss of four fingers of the same hand 33 1/3% Loss of hearing in one ear 25% Loss of all toes of the same foot 12 ½% The following additional benefits may be paid from the Business Travel Accidental Death and Dismemberment Insurance Plan. Home and vehicle modification If a person receives benefits for a covered loss or loss of use that requires permanent use of a wheelchair, the plan will pay up to $10,000 for one-time modifications to: the person s principal residence, to make it wheelchair-accessible and habitable, and the person s vehicle, to make it accessible or drivable, when such modifications are required by the vehicle licensing authorities, provided that: home modifications are done by an experienced contractor recommended by a recognized wheelchair support organization, and vehicle modifications are carried out by an experienced provider and approved by provincial licensing authorities. version: September 1,

92 Seat belt benefit If a person receives benefits for a covered loss or loss of use, the amount will be increased by 10% if the person was driving or riding in a vehicle, wearing a properly fastened seat belt (as evidenced in a police report). Life insurance living assistance benefit You can request that up to 50% of your insurance amount under the Basic Life Insurance or $25,000, whichever is less be paid while you are living, provided that: you suffer an injury or illness expected to result in death within 12 months, from which there is no reasonable prospect of recovery, based on your physician s medical information, you have not named an irrevocable beneficiary, you submit a written request to Great-West Life, NAV CANADA authorizes the payment, and you and your beneficiary sign an agreement before the benefit is paid. The amount paid (plus accumulated interest) will reduce the Basic Life Insurance benefit your beneficiary receives when you die. How do I make a claim? Benefits are paid to you. See the Making a claim section for complete details. Represented employees Pay & Benefits Advisor Contact your... version: September 1,

93 Death of a family member Business Travel Accidental Death and Dismemberment Insurance If your spouse or one of your children loses their life in a covered accident during relocation or a related house-hunting trip, the plan pays $100,000 for your spouse and $10,000 for each child. The plan also pays the following additional benefits. Repatriation In case of death more than 150 kilometres from your permanent residence, no more than 365 days after the accident, the plan pays for preparing the family member s body for burial and shipping it to your city of residence, to a maximum of $10,000. Seat belt benefit If a person receives benefits for a covered loss or loss of use, the plan benefits will increase by 10% if the person was driving or riding in a vehicle, wearing a properly fastened seat belt (as evidenced in a police report). Disappearance If the body of your spouse or one of your children has not been found within one year of the disappearance, stranding, sinking or wrecking of the conveyance in which they were riding at the time of the accident, the plan pays benefits for loss of life. How do I make a claim? Benefits are paid to you. See the Making a claim section for complete details. Represented employees Pay & Benefits Advisor Contact your... Are the benefits tax-free? Yes. How are the benefits paid? A lump sum in Canadian dollars. version: September 1,

94 Death of an employee What benefits are payable? Basic Life Insurance In the event of your death from any cause, your beneficiary would receive benefits equal to twice your adjusted insurable earnings. Coverage reduces by 10% (of your full coverage in effect on your 61 st birthday), beginning on the April 1 st or the October 1 st immediately following your 61 st birthday and every year after that. Example Annual earnings at age 61 $29,900 Coverage at age 61 $60,000 Birth date March 15 10% of coverage in effect at age 61 $6,000 If no change in earnings: Coverage effective April 1 after 61 st birthday $60,000 - $6,000 =$54,000 Coverage effective April 1 after 62 nd birthday $54,000 - $6,000 =$48,000 Coverage effective April 1 after 63 rd birthday $48,000 - $6,000 = $42,000 If you are a represented employee and are still at work past your 65 th birthday, NAV CANADA will automatically begin paying 100% of the premiums for the first $5,000 of your coverage. You pay for the rest. If you die while you are still working at NAV CANADA, coverage equals at least: $5,000, or one third of your adjusted insurable earnings on the date of your death, whichever is greater. Business Travel Accidental Death and Dismemberment Insurance If you lose your life while traveling on NAV CANADA business, your beneficiary also receives the following benefit. For... Coverage based on survivor benefit of... Represented employees 3 X adjusted insurable earnings (maximum $350,000) Read what limitations and exclusions apply to this coverage, in the section What the plans do not pay for. version: September 1,

95 The following additional benefits may also be paid from the Business Travel Accidental Death and Dismemberment Insurance Plan. Repatriation In case of death more than 150 kilometres from your permanent residence no more than 365 days after the accident, the plan pays for preparing your body for burial and shipping it to your city of residence, to a maximum of $10,000. Seat belt benefit In case of death, the plan benefit will increase by 10% if you were driving or riding in a vehicle, wearing a properly fastened seat belt (as evidenced in a police report). Education benefit In case of your death, the plan pays an additional education benefit, to a maximum of $5,000 a year, on behalf of any of your children who, on the date of the accident, were enrolled full-time in an institution of higher learning beyond secondary school, or were at secondary school and enrol full-time in an institution of higher learning within 365 days of the accident. This benefit is payable annually for a maximum of four consecutive annual payments, as long as the children continue their education full-time in an institution of higher learning. If none of your children qualify, the plan pays an additional $2,500 to your beneficiaries. Disappearance If your body has not been found within one year of the disappearance, stranding, sinking, or wrecking of the conveyance in which you were riding at the time of the accident, the plan pays benefits to your beneficiaries for loss of life. Basic Life Insurance advance payment Great-West Life will pay all or a portion of your Basic Life Insurance amount directly to a person or group that has already paid for your burial, as long as they consider the expenses reasonable. This benefit is paid when there is no estate, or one with insufficient assets, or where a long delay in settling the estate is expected. version: September 1,

96 Can you show me an example of benefits payable if I die? If you earn $60,000 and die in a covered accident while traveling on NAV CANADA business, your beneficiary would receive the following benefits. Example Basic Life Insurance $120,000 Business Travel Accidental Death and Dismemberment Insurance $180,000 Total payable $300,000 Who should my beneficiary contact to make a claim? Represented employees Pay & Benefits Advisor Contact your... They will provide the necessary forms and assistance to complete them and gather the necessary supporting documents. Are the benefits tax-free? Yes. However, if you do not name a beneficiary or name your estate as beneficiary, probate fees may apply. How are the benefits paid? A lump sum in Canadian dollars. version: September 1,

97 Death of a retiree Basic Life Insurance If you have maintained your coverage, in the event of your death from any cause, your beneficiary would receive benefits equal to twice your final adjusted insurable earnings, less any reduction, if applicable. Your coverage reduces by 10% (of your full coverage in effect on your 61 st birthday), on the April 1 st or the October 1 st immediately following your 61 st birthday and every year after that, until it reaches a minimum coverage of $5,000. Example Coverage as of retirement $60,000 Birth date March 15 10% of full coverage in effect as of retirement $6,000 Coverage effective April 1 after 61 st birthday $60,000 - $6,000 = $54,000 Coverage effective April 1 after 62 nd birthday $54,000 - $6,000 =$48,000 Coverage effective April 1 after 63 rd birthday $48,000 - $6,000 = $42,000 If you retire prior to January 1, 2010, once you reach age 65, NAV CANADA will pay 100% of the premiums for the first $5,000 of your coverage. If your coverage is higher, premiums will be shared in the same way as they were before age 65. If you retire on or after January 1, 2010, you are responsible for 100% of the premium, this includes the first $5,000 after the age of 65. You can reduce coverage to $5,000 anytime; you cannot, however, increase it later. version: September 1,

98 Plan Health tips Simple guidelines like these can protect your health and that of your family. Diet and exercise Keep healthy foods and snacks in your home. Reaching and maintaining a healthy weight will help you avoid many health hazards. No single food will cure all ills, or provide instant energy or make losing weight easy. Use moderation and choose a variety of foods in your daily eating. Drink plenty of water, juice, and non-alcoholic beverages. Make sure you get adequate daily exercise. Wear appropriate protective gear while doing so. When you are going outdoors, use a sunscreen of SPF 15 or more and wear a hat. Excessive sun exposure can lead to the development of skin cancer. Avoid strenuous activity or heavy exertion when temperatures exceed 25 C, combined with high humidity. Staying healthy Be sure to get enough sleep at night. If you cannot live in a smog-free environment, at least avoid smoke-filled rooms, high traffic areas, breathing in highway fumes and exercising near busy streets. Wash your hands as often as possible. Infection spreads very easily from surface to surface and can easily attach to your hands and then wind up in your body via the mouth, eyes, ears, or nose, through cuts, etc. Schedule regular medical check-ups for you and your family. Do not drink and drive a car, watercraft or any motorized vehicle. Conquering stress Set aside quiet time every day to meditate or daydream. Stress is an inevitable part of life but, to function at our best, we need to keep stress from becoming dis-stress. Be flexible in dealing with stress. Anticipate stressful situations and prepare for them. Exercise helps reduce the effects of stress. Maintain your social network: people with a variety of friends may experience reduced stress. version: September 1,

99 Do positive things: negative activities increase stress levels, which may suppress the immune system even more. Contact the Employee Assistance Plan if you need help coping with a work or personal problem. You can reach someone 24 hours a day, seven days a week, by calling (English) or (French). Getting the best care possible from health professionals Instead of going directly to a hospital emergency room if you become ill or are injured, first consider: going to your family doctor, going to a walk-in clinic, calling TeleHealth : / TTY Be sure to ask your health care provider the right questions. Be an informed patient. Know what medical tests you need as your life situation changes. Talk to your doctor about these tests. Follow your doctor s orders in taking any medication as prescribed. When you visit your health care professional, know what is covered and what is not for various supplementary medical expenses. Check What happens if for a life event approach to getting information. version: September 1,

100 Travel tips Things to consider before you leave For detailed travel health information, visit Travel Medicine Program Web site, a Health Canada site that provides: current information on international disease outbreaks, immunization recommendations for international travel, general health advice for international travelers, and disease-specific treatment and prevention guidelines. If you plan to travel off the beaten track, you may need to take extra health precautions. Seek medical advice at least six weeks before you travel, since some vaccinations should not be given together. Review NAV CANADA s out-of-province health coverage and decide whether you need to buy additional insurance. Carry your benefit card as proof of insurance coverage. Know how to contact Mondial Access/World Access Canada for emergency health claims, and make sure that your traveling companion(s), travel agent and someone at home know how to do so as well. Make sure you know about health risks specific to your destination. Take first aid supplies along. Keep prescription medication in its original container, and carry a doctor s prescription for any controlled drug. Do not leave prescription medication in your checked luggage, in case your baggage goes astray. Carry a medical certificate for syringes if you require them for medical purposes. Ensure that you have all required visas. Make photocopies of your visas, and keep them separate from the originals. Photocopy the identification page in your passport. Keep a copy separate from the passport, and leave another copy with someone at home. For travel reports on various countries throughout the world, visit Consular Affairs at and consult the travel report for your destination. version: September 1,

101 Links to useful sites The external links in this section will help you learn more about a range of program-related, health, and other issues of interest. Never has there been more health information available to the public than today. A recent survey of nearly 500 Canadian university students indicated that they prefer to receive health information through magazines, television and brochures more than from a health care practitioner. The internet provides a wealth of information. There are many benefits to having access to health information. People are becoming better health care consumers and taking health matters in hand. Unfortunately, there is a downside. Along with information comes misinformation, misuse of information, or misinterpretation of information. It is important to be vigilant about what you read and how you adapt it to your life. For information on your personal situation, see the right person (for example, physician, dentist, financial planner, etc.). NAV CANADA has no control over the content or performance of the external sites to which you may link. These external sites do not reflect your coverage under the NAV CANADA benefit program, nor are they part of your benefit insurance policies. Administrator/insurer sites Sun Life Great-West Life ACE INA Life Insurance Health-related information Provincial health care plans Alberta Health Care Insurance Plan British Columbia Medical Insurance Plan Manitoba Health Services New Brunswick Medicare Newfoundland and Labrador Medical Care Plan Northwest Territories Health Care Plan Nova Scotia Department of Health Nunavut Department of Health and Social Services Ontario Health Insurance Plan PEI Medicare Quebec Health Insurance Plan Saskatchewan Health version: September 1,

102 Yukon Health Care Insurance Plan Information and news on various diseases and conditions Canadian Health Network Coping with stress (English only) Health Canada Mayo Clinic (English only) Santé magazine (French only) Web MD Health (English only) Nutrition National Institute of Nutrition Taxation and assistance abroad Taxation Canada Revenue Agency Minister of Revenue Quebec Information and assistance for Canadians abroad Foreign Affairs Canada version: September 1,

103 Do Find the right form Enrol in a plan Make coverage changes Opt out of a plan Make a claim Register a personal change Get emergency travel assistance while traveling Speak to someone about a claim version: September 1,

104 Forms Basic Life Insurance Plan Basic Life Insurance Beneficiary Designation Form Basic Life Insurance Paid-Up Amount Application (retirees only) Business Travel Accidental Death and Dismemberment Insurance Plan Business Travel Accidental Death and Dismemberment Beneficiary Designation Form (employees only) Dental Care Plan Health Spending Account Claim Form Health Care Plan Retirees Claim Form Health Spending Account Claim Form Handicapped Child Coverage Form Short-term disability Employee Notification Form Long-term Disability Insurance Plan Employee Statement Form NAV CANADA Pension Plan Pension Plan Beneficiary Designation Form version: September 1,

105 Important legal notice outlines and highlights general provisions and coverage under NAV CANADA Benefit Plans. This information is as accurate and reliable as possible. There is no guarantee, however, that it is complete or current at all times. Final interpretation is governed by the terms of official contracts. In case of conflict between the content of this booklet and the relevant contract, the contract will prevail. Eligibility criteria and/or plans, programs, practices, and processes may be changed or terminated anytime without notice to participants. This booklet does not constitute a contract of employment between you and NAV CANADA, or an obligation by NAV CANADA to maintain any particular benefit program, practice, or policy. NAV CANADA is not responsible for decisions you make based on this information. NAV CANADA collects, uses and discloses personal information and personal health information (Information) about you and your dependents to arrange for the benefits described in. Service, insurance, and benefit providers, consultants, plan administrators, and auditors may change from time to time and receive your personal information, as required. Protecting your privacy is important to NAV CANADA. NAV CANADA and its service and insurance providers who have job-related need to do so, collect, use, disclose, and share personal information. This Information may be used for the purpose of: assessing eligibility, providing benefits coverage to you and your dependents, managing and administering the plans described, determining which service and insurance providers to retain, and determining and maintaining appropriate financial terms. Privacy policies for our insurance providers can be found at the following websites: Sun Life: Great West Life: ACE-INA: Access to your Information is limited to people who need to see it to achieve these purposes, or any other person whom you authorize in writing. NAV CANADA agrees to protect and maintain the confidentiality of your information through appropriate security measures and safeguards. NAV CANADA ensures all such parties enter into confidentiality agreements to protect and appropriately safeguard your information. You are entitled to review your information and, if appropriate, have it corrected. To do so, submit a written request to [email protected] or [email protected] or [email protected]. For questions on premium deductions, eligibility and coverage dates, application procedures, or claims procedures, contact your Pay & Benefits Advisor or Pension Advisor. version: September 1,

106 Contact us Telephone Toll-free number Payroll Jeanne d'arc (JD) Crowe (613) Payroll Operations Manager Pay & Benefits Advisors Monique de Medeiros (613) Management and unionized Pay and Benefits: New Brunswick/HQ/Quebec/NAV CENTRE Saima Ahmad (613) PIPSC (all) Jacqueline Desjardins (613) IBEW (BC, QC, ON, NCR, NB, NAV Centre - Bilingual sites) Céline Lefebvre [email protected] (613) ACFO (all), CAW 2245 (PEI, NF, QC, NS, Nunavut, NB, NAV Centre, NCR, ON - Bilingual sites) Carole Poirier [email protected] (613) CATCA (ON, QC, NAV Centre - Bilingual sites) Heather Walker Team Lead Ontario, Western and Atlantic [email protected] (613) Sue Barclay [email protected] (613) CATCA (AB, SK, YU, NWT - English sites) Valerie Bowie CATCA (BC, NCR, NB - Bilingual sites) [email protected] (613) John Dintino IBEW (AB, NF, NS. ON, Nunavut, BC, SK [email protected] (613) English sites) Robin Palmer [email protected] (613) CATCA (NF, MB English sites) Melissa Parsons [email protected] (613) CATCA (BC English sites), CAW 1016 (all) Margaret Sutton [email protected] (613) CAW 2245 (MB, BC, AB, ON, SK (English sites) Julie Tremblay CFPA (all), PSAC (all), Students (all) [email protected] (613) Heather Webster Union Executives (all), CATCA (NS, ON English sites) [email protected] (613) version: September 1,

107 Pension Telephone Lee Robinson (613) Manager, Pension Administration Michelle Sibley (613) Pension Advisor Benefits Myreille Campeau Benefits Programs Manager Melanie Lauzon Benefits Specialist Sarah Levesque Benefits Advisor (613) (613) (613) version: September 1,

108 How works Finding your way around Using the buttons across the top of the screen, from any page of the booklet, you can review: the complete Benefits dictionary, an alphabetic listing of important definitions of benefits terms and acronyms, the list of forms you can download and print, and various benefits-related publications you can download and print. To return to reviewing, just click any where on the page. The Benefits dictionary, Forms, Publications, and this page are also accessible via the Bookmark pane. The best way to find what you re looking for is to jump in and give it a try. We ve designed to make it as easy as possible to find what you re looking for. Remember... Click the + sign beside entries in the Bookmark pane Learn, Plan, or Do, for example to see the topics covered in that section. Words that are in blue type within the text lead to the top of the page where you can find more information or a definition. Use the grey Previous button anytime to revisit a previous view. Two buttons appear at the bottom of each page, one called Contact us, which lists addresses and telephone numbers of benefits personnel, and another that provides an Important legal notice. Bookmark pane Use the Adobe Reader Bookmark pane on the left side of your screen to link to different sections of the booklet. Click the Bookmark tab to open the pane. Then, leave it open while you navigate, or click the tab again to close it. How to print information Click the Print button at the top of the screen. The dialogue box that opens gives you a choice to print the information you want: the whole text, selected pages only, or just the page you are now on. version: September 1,

109 Acupuncturist A person licensed, registered or certified through the respective provincial licensing body or professional organization, or in the absence of such an association, person with comparable qualifications determined by Sun Life. Adjusted insurable earnings Your annual earnings, rounded up to the next higher multiple of $250, if not already such a multiple. All life insurance coverage that must be multiplied by two will be rounded after the multiplication. Annual earnings include: Aviation Weather Briefing Allowance Base Salary Bilingual Bonus Competency Premium Educational Allowance Flying Allowance Maintenance of Radio Equipment Meteorology Training Allowance On-the-job Training Allowance Operational Facility Premium/ATC premium Supervisory Differential Technical Certification Premium Chiropractor A member of the Canadian Chiropractic Association, or of a provincial association affiliated with it or, in the absence of such an association, person with comparable qualifications determined by Sun Life. Child/children Your unmarried children, and children in the custody of your spouse who lives with you, including adopted children, stepchildren, foster children, or children for whom you are or your spouse is the legal guardian, and who are: under age 21, age 21 or older and dependent on you for support because of a psychiatric or physical disability, provided they become disabled while eligible (or while they would have been eligible if you had been covered) under the benefit program, or if older, while full-time students in a school or a university up to age 25 (26 in Quebec). Chiropodist/podiatrist A person licensed by the appropriate provincial licensing authority or, in those provinces where there is no licensing authority, a member of the Canadian Association of Foot Professionals or, in the absence of such an association, a person with comparable qualifications as determined by Sun Life. Chronic disease A condition that exists beyond the usual course of an acute disease or beyond a reasonable time for tissue damage to heal. Any such condition that lasts longer than six months may be considered chronic. Commensurate occupation A position for which the rate of pay is at least twothirds of the current rate of pay of the position you occupied when you became disabled. version: September 1,

110 Continuous employment Under the Health Care Plan For the purpose of completion of six months of continuous employment, two periods of employment, provided that the break (termination of employment) between the two periods is less than seven working days. Under the Basic Life Insurance Plan For the purpose of completion of six months of continuous employment, two periods of employment, provided that the break (termination of employment) between the two periods is less than one day. Under the Dental Care and Long-term Disability Insurance Plans For the purpose of completion of six months of continuous employment, two periods of employment, provided that the break (termination of employment) between the two periods is less than five working days. Deferred pension A pension based on service and earnings on the date you leave NAV CANADA that becomes payable at a later date. When you leave before being entitled to an immediate pension, your NAV CANADA pension can be deferred. Dental fee guide Dentist A person licensed to practice dentistry by the provincial licensing authority or, in the absence of such an authority, a person with comparable qualifications as determined by Sun Life. Disabled/disability The inability, for the elimination period and the next 24 months, to perform the essential functions of your regular job (your own occupation); thereafter, the inability to perform any reasonably commensurate occupation for which you are qualified by training, education or experience (any occupation). Electrologist A person who, as determined by Sun Life, qualifies as a certified electrologist. Elimination period The waiting period before you are eligible to receive Long-Term Disability benefits. Represented employees Period during which you receive Disability Income Security Program benefits Your total accumulated sick leave, or 13 weeks whichever is longer This time counts even if you retire before the full period expires Charges established by provincial dental associations for specific services provided by dentists in their provinces. version: September 1,

111 Full-time employee A person who is employed for an indeterminate period or for a term of more than six months, or who has completed six months of continuous employment and works an average of at least 30 hours a week. Hospital A legally licensed hospital that provides facilities for diagnosis, major surgery and the care and treatment of persons suffering from disease or injury on an in-patient basis, with 24-hour services by registered nurses and physicians. This includes legally licensed hospitals providing specialized treatment for mental illness, drug and alcohol addiction, cancer, arthritis and convalescing or chronically ill persons. This does not include nursing homes, homes for the aged, rest homes or other places providing similar care. Loss Losses of must be suffered within one year of the date, and occur as a direct result, of the accident, and include: hand or foot actual severance through or above the wrist or ankle joint, arm or leg actual severance through or above the elbow or knee joint, eye the total and irrecoverable loss of sight, speech the total and irrecoverable loss of speech that does not allow audible communication in any degree, hearing the total and irrecoverable loss of hearing that cannot be corrected by any hearing aid or device, thumb and index finger actual severance through or above the first phalange, fingers the actual severance through or above the first phalange of all four fingers of the same hand, toes the actual severance of both phalanges of all toes of the same foot, or quadriplegia (paralysis of both upper and lower limbs), paraplegia (paralysis of both lower limbs) and hemiplegia (paralysis of upper and lower limbs of one side of the body) the complete and irrecoverable paralysis of such limbs. Loss of use The total and irrecoverable loss of function of an arm, hand or leg, provided such loss of function is continuous for 12 consecutive months and such loss of function is thereafter determined on evidence satisfactory to ACE INA to be permanent. Medical care Care obtained when you consult a physician, use medication on the advice of a physician, or receive other medical services or supplies. Naturopath A member of the Canadian Naturopathic Association or any provincial association affiliated with it or, in the absence of such an association, a person with comparable qualifications as determined by Sun Life. Nurse A registered nurse or nursing assistant, licensed, registered, or certified through the respective provincial licensing body or professional organization or, in the absence of such a registry, a nurse with comparable qualifications as determined by Sun Life. version: September 1,

112 Ophthalmologist A doctor of medicine (M.D.) licensed to practice ophthalmology. Physician A doctor of medicine (M.D.) legally licensed to practice medicine. Optometrist A member of the Canadian Association of Optometrists or of a provincial association affiliated with it or, in the absence of such an association, a person with comparable qualifications as determined by Sun Life. Physiotherapist A member of the Canadian Physiotherapy Association or of a provincial association affiliated with it or, in the absence of such an association, a person determined by Sun Life to have comparable qualifications. Osteopath A person licensed, registered or certified through the respective provincial licensing body or professional organization or, in the absence of such an association, a person determined by Sun Life to have comparable qualifications. Part-time employee A person who is employed for an indeterminate period or for a term of more than six months, or who has completed six months of continuous employment and is assigned to work more than one-third of the normally scheduled hours of work for a particular occupational group but less than 30 hours a week. Pension eligibility service Membership in the NAV CANADA Pension Plan, used to determine when you can retire, that is, the time elapsed from the date you joined the plan, including periods of absence. Psychologist A permanently certified psychologist who is listed in the appropriate provincial registry in the province where the service is rendered or, in the absence of such a registry, a person determined by Sun Life to have comparable qualifications. Reasonable and customary Within the general level of charges for a specific service or product in the locale where the expense is incurred, determined by Sun Life after consulting published fee guides of associations of practitioners. Recurrence An absence is considered to be continuous if it is due to a recurrence of the same or related illness within any thirty (30) day period. version: September 1,

113 Registered massage therapist A person licensed by the appropriate provincial licensing body or, in the absence of a provincial licensing body, a person determined by Sun Life to have comparable qualifications. Registered pharmacist A person who is licensed to practice pharmacy and who is listed in the pharmacists registry of the licensing body for the jurisdiction in which such person is practising. Rehabilitation Vocational training, a program, or a period of work approved in writing by Great-West Life as a means of facilitating your return to work following disability. A NAV CANADA represented employee who leaves NAV CANADA on or after September 1, 2005 but prior to January 1, 2010, and who, on his or her retirement date: is eligible for an immediate pension benefit, or has at least 15 years of pension eligibility service. Must be in receipt of NAV CANADA pension benefits. Speech-language pathologist A person who holds a Master s degree in speech language pathology and is a member, or is qualified to be a member, of the Canadian Association of Speech-Language Pathologists and Audiologists or any provincial association affiliated with or, in the absence of such an association, a person determined by Sun Life to have comparable qualifications. Retiree Under Basic Life Insurance A NAV CANADA employee who had at least two years of service with NAV CANADA on his or her retirement date and is receiving NAV CANADA pension benefits. Under the Health Care Plan A NAV CANADA employee who leaves NAV CANADA before September 1, 2005, with at least two years of service on his or her retirement date, and is receiving NAV CANADA pension benefits. Spouse Your legal spouse of either gender, or the person who has lived with you as your spouse in a permanent, exclusive relationship for a continuous period of at least one year and continues to live with you as such. Your spouse must be under age 75 to be covered under Business Travel Accidental Death and Dismemberment Insurance. Supplementary coverage Coverage under the Health Care Plan that supplements provincial health care coverage for eligible NAV CANADA employees and retirees who are eligible for coverage under a provincial plan. version: September 1,

114 Transportation Any land, water, or air conveyance required to transport you during an emergency evacuation. Vehicle A private passenger car, station wagon, van, or jeep-type automobile. version: September 1,