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,