Summary of Benefits. Unifor - Local 2107

Transcription

1 Summary of Benefits Unifor - Local 2107

2 TABLE OF CONTENTS Introduction Employee and Family Assistance Program Health Plan Life Insurance Long Term Disability Voluntary Accidental Death & Dismemberment Insurance

3 INTRODUCTION The St. Francis Xavier University employee benefits program is designed to provide you and your family with basic income protection in the event of accident, illness, disability or death. This Summary of Benefits has been prepared to give you a summary of the main features of your group insurance programs. It is not an insurance policy, and does not grant or confer any contractual rights. All rights under this program shall be governed by the provisions of the Master Policy and by applicable law. This Summary of Benefits is for your reference. Please read it carefully and keep it for future use. 2

4 EMPLOYEE AND FAMILY ASSISTANCE PROGRAM (inconfidence) What is an Employee and Family Assistance Program? An Employee and Family Assistance Program (EFAP) is a voluntary, confidential, short term counseling service that connects employees and their eligible family members to a network of dedicated professionals who are able to provide assistance 24 hours a day, 7 days a week. This network includes psychologists, social workers, addiction and career counselors, childcare and elder care specialists and legal and financial specialists. Practical, relevant support will be provided fast and in a way that is most suited to your employee s preferences and learning approach. Caring professionals can help select a support option that works best for them, such as telephonic, in-person, on-line, and through a variety of issue based health and wellness resources. An EFAP enables employees to resolve personal, family or job concerns before they begin to affect other areas of their lives. Employees with sound psychological health, such as the ability to concentrate, are able to achieve greater personal and professional success. Who is covered under the EFAP? All employees of StFX and their eligible family members, excluding student employees. What is covered under the EFAP? Medavie Blue Cross has partnered with Shepell fgi in order to offer the inconfidence program to help Saint FX employees meet strategic health and wellness objectives. Both Medavie Blue Cross and Shepell fgi are recognized and trusted by employers, employees and their families. Exemplifying quality, confidentiality and accessibility, our assessment, counselling and referral services are a direct route to problem resolution and employee wellness. Delivered by qualified and caring clinicians the inconfidence EFAP provides professional assistance for a wide range of issues, including: MAINSTREAM COUNSELLING W ork Issues Addiction Issues Relationship Issues Parenting Issues Personal / Emotional Issues Acute Situations Situational Stressors WORK-LIFE SUPPORT Legal Financial Health Support Family Support Homecare Access Nutritional Services Smoking Cessation TRAUMA SERVICES Non-Urgent Urgent Life-Threatening W orkplace Accidents Robbery Downsizing W orkplace Violence Corporate Fraud This short-term counselling model is very flexible and offers as many sessions as required within inconfidence s brief, solution-focused model to successfully resolve the individual s problem. We only refer out to community resources for long-term or very specialized circumstances. 3

5 How do I access the EFAP? To learn more about the services available and to access any of the counselling or work/life consultation services including child, elder and dependent care; legal and financial support; nutritional counselling and a health information service, call: toll-free 7/24/365 service crisis counselling English- or French-language service Confidentiality and privacy are assured, within the limits of the law, to each employee and family member who uses inconfidence. You are contacting Shepell-fgi directly, and they do not share any information on any individual case with StFX or with Medavie Blue Cross. 4

6 HEALTH and DENTAL PLAN Policy Number: Medavie Blue Cross administers the following benefits on behalf of St. Francis Xavier University: - Hospital Benefit - Extended Health Benefit - Vision Benefit - Drug Benefit - Dental Benefit The information contained in this booklet summarizes the important features of your group program; is prepared as information only; and does not, in itself, constitute an agreement. The exact terms and conditions of your group benefit program are described in the group policy held by your employer. The information contained in this booklet is important, and we suggest it be kept in a safe place. This booklet replaces any previously issued booklet. To access a wealth of savings on medical, vision care and many other products and services, visit HOSPITAL BENEFIT If you (or your dependents, if applicable) incur charges in Canada for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, co-insurance or maximum amount shown below, less the amount allowed under any government health program. Benefit maximums are applied on a per person basis. Co-insurance: 100% HOSPITAL ROOM The difference between standard ward accommodation and semi-private room accommodation. TERMINATION Hospital benefit ceases at the earlier of retirement, termination of employment or the end of the month you turn age 65. WHEN AND HOW TO MAKE A CLAIM Hospital benefit is paid directly to the hospital. Your identification card should be shown at the hospital who will arrange to bill Medavie Blue Cross directly. Claims must be submitted within 12 months of receiving services or supplies. No claims will be paid by Medavie Blue Cross after the termination date of this plan. 5

7 EXTENDED HEALTH BENEFIT - IN CANADA If you (or your dependents, if applicable) incur charges in Canada for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, co-insurance or maximum amount shown below, less the amount allowed under any government health program. Benefit maximums are applied on a per person basis. Co-insurance: 100% OXYGEN Charges for oxygen on the written authorization of the attending physician. PHYSICIAN SERVICES Charges outside the covered person's province of residence in excess of the allowance under a government health plan. PRIVATE DUTY NURSING Maximum: $5,000 in a calendar year Provided you do not reside in a convalescent nursing home and the nurse is not a relative, charges for medically necessary home nursing care performed by a registered nurse, registered nursing assistant or certified nursing assistant are eligible. Written authorization of the attending physician is required. All nursing services must be pre-approved by Medavie Blue Cross in order to be considered for reimbursement. PROFESSIONAL AMBULANCE Maximum: $50 in a calendar year Charges for licensed ground ambulance services required to transport a stretcher patient to and from the nearest hospital able to provide essential care. EXTENDED HEALTH BENEFIT - WORLDWIDE If you (or your dependents, if applicable) incur charges for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, coinsurance or maximum amount shown below, less the amount allowed under any government health program. Benefit maximums are applied on a per person basis. Co-insurance: 100% ACCIDENTAL DENTAL Dental treatment when natural teeth have been damaged by a direct accidental blow to the mouth or jaw. Services must be rendered or approved for payment by Medavie Blue Cross within 180 days of the accident. Benefits will be paid up to the usual and customary fee of the current Dental Association Fee Guide for general practitioners in your province of residence at the time of treatment. DIABETIC EQUIPMENT Maximum: $700 every five consecutive calendar years Charges for the following equipment on the written authorization of the attending physician for treatment and control of diabetes: preci-jet, glucometer or equipment that performs similar functions and approved by Medavie Blue Cross. DIAGNOSTIC AND X-RAY SERVICES Charges for laboratory service and X-ray examinations HEARING AIDS Maximum: $400 in any seven consecutive calendar years. 6

8 Charges for hearing aids (excluding batteries and exams) when prescribed by an otolaryngologist, otologist and/or registered audiologist. MEDICAL SUPPLIES AND EQUIPMENT Charges for the following medical supplies and equipment, when prescribed by an authorized physician: - purchase of burn pressure garments is limited to a maximum of $500 in a calendar year; - rental (or purchase, if approved by Medavie Blue Cross) of a wheelchair or hospital-type bed; - equipment for the administration of oxygen; - insulin pump; - compression pump; - lymphoedema sleeves (limited to 2 in a calendar year); - transcutaneous electrical nerve stimulator (TENS machine) is limited to a maximum eligible expense of $300 every 5 consecutive calendar years. Once the original equipment purchase is approved, the rental or approved purchase of another piece of similar equipment will be limited to once every 5 consecutive calendar years. MOLDED ARCH SUPPORTS Maximum $100 every 36 consecutive months Charges for molded arch supports when prescribed by the attending physician, excludes replacement except when due to a pathological change. ORTHOPEDIC FOOTWEAR & SUPPLIES Maximum: $200 in a calendar year Charges for orthopedic footwear when the footwear has been customized with special features to accommodate relieve or remedy some mechanical foot defect or abnormality. A prescription from an orthopedic surgeon, physiatrist, rheumatologist, chiropodist/podiatrist or the attending Physician is required along with a copy of the biomechanical or gait analysis from the health care professional. Also, charges for footwear modifications, adjustments, and supplies when prescribed by one of the health care professionals noted above to accommodate, relieve or remedy some mechanical foot defect or abnormality. OSTOMY SUPPLIES Charges for essential ostomy supplies on the written authorization of the attending physician. CHIROPRACTOR Maximum: $500 in a calendar year $35 for X-rays in a calendar year Charges for treatment, except when performed in a hospital, by a licensed chiropractor PHYSIOTHERAPIST Maximum Frequency: 20 treatments in a calendar year 7

9 Charges for treatment, except when performed in a hospital, by a licensed physiotherapist PROSTHETIC APPLIANCES Charges for the following remedial appliances or supplies, when authorized by the attending physician: - artificial limbs (limited to one prosthetic appliance to each limb in a lifetime); - breasts (limited to a left and a right prosthesis every two consecutive calendar years); - eyes (limited to one left and one right prosthesis in a lifetime); - canes or crutches (limited to two in a lifetime); - splints; - casts; - trusses (limited to one truss every five consecutive calendar years); and - braces (limited to one cervical collar in a calendar year and all other braces are limited to one in a lifetime). Replacement must be due to pathological or physiological change. Repairs and/or adjustments are provided to a maximum eligible expense of $50 in a calendar year. Hair prosthetics (wigs), when hair loss is due to an underlying pathology or its treatment, to a maximum eligible expense of $300 in a lifetime. Hair prosthetics, replacement therapy and other procedures for physiological hair loss are excluded (i.e., male pattern baldness). WARD ACCOMMODATION Charges for ward accommodations in a licensed general hospital outside Canada which are in excess of the allowance under a government health plan. TERMINATION 8

10 VISION BENEFIT If you (or your dependents, if applicable) incur charges for any of the following while insured, Medavie Blue Cross will pay the usual, customary and reasonable charges for these eligible expenses, based on any deductible, co-insurance or maximum amount shown below. Benefit maximums are applied on a per person basis. Co-insurance: 100% LENSES, FRAMES AND CONTACT LENSES Maximum: $200 every 24 consecutive months for adults and every 12 consecutive months for dependent children less than 18 years of age Charges for corrective eyeglasses, including lenses, frames and contact lenses, but excluding safety glasses or glasses/contacts for cosmetic purposes. EYE EXAMINATIONS Maximum: $50 every 24 consecutive months for adults and every 12 consecutive months for dependent children less than 18 years of age Charges of a licensed optometrist or ophthalmologist for eye examinations. TERMINATION Vision benefit ceases at the earlier of retirement, termination of employment or the end of the month you turn age 65. WHEN AND HOW TO MAKE A CLAIM Vision benefit is reimbursed to the employee. The employee must pay the provider of service, obtain an official paid in full receipt and submit to Medavie Blue Cross for processing. Some services may require a completed claim form to accompany the receipt. Claims must be submitted within 12 months of receiving services or supplies. No claims will be paid by Medavie Blue Cross after the termination date of this plan. 9

11 DRUG BENEFIT If you (or your dependents, if applicable) incur charges for certain prescription-requiring drugs, the eligible drug may be subject to quantity maximums, dollar maximums, deductibles, co-payments or other maximums as approved by Medavie Blue Cross. Benefit maximums are applied on a per covered person basis. Co-payment: Co-insurance: Method of payment: $5 for each eligible drug on the prescription 100% of the remaining eligible expense paid directly to the pharmacy Includes prescription drug items approved by Medavie Blue Cross and many commonly prescribed over-thecounter items approved by Medavie Blue Cross. Charges for the following are also included: - diabetic supplies - preventive vaccines - smoking cessation benefit to a maximum of $350 in a calendar year Eligible drug expenses include medically necessary items that, by law, can only be obtained with a prescription of a physician or dentist, which are authorized as benefits by Medavie Blue Cross, and are dispensed by an approved provider. Preventive vaccines, approved by Medavie Blue Cross are eligible when submitted in a reimbursement basis only. Your submission must be accompanied by an official receipt indicating the drug identification number (DIN) or the name, strength and quantity of the vaccine purchased. Medavie Blue Cross will reimburse only for the lowest priced interchangeable drug when prescribed by a physician and dispensed by a pharmacist, unless the physician indicates no substitution. TERMINATION Drug benefit ceases at the earlier of retirement, termination of employment or the end of the month you turn age 65. WHEN AND HOW TO MAKE A CLAIM The Medavie Blue Cross Identification Card should be shown and the provider will arrange to bill Medavie Blue Cross directly. 10

12 GENERAL EXCLUSIONS AND LIMITATIONS Medavie Blue Cross does not cover the following expenses: 1. Medical examinations or routine general checkups required for use by a third party. 2. Elective services obtained outside the covered person s province of residence. 3. Charges which normally would not be made if the covered person was not covered under the plan. 4. Any item or service not listed as a benefit in this plan. 5. Medications restricted under federal or provincial legislation. 6. Registration charges or non-resident surcharges in any hospital. 7. Services performed by an unqualified practitioner. 8. Charges for missed appointments or the completion of forms. 9. Charges for health care planning assessments. 10. Any health care services and supplies that are not provided by a Medavie Blue Cross approved provider. 11. Convalescent, custodial or rehabilitation services, unless otherwise specified. 12. Conditions not detrimental to health. 13. Services that are not medically required, that are given for cosmetic purposes or that exceed the ordinary services given in accordance with current therapeutic practice. 14. Benefits the covered person receives or is entitled to receive from Workers' Compensation. 15. Mileage or delivery charges. 16. Any injury or illness resulting from the covered person s active participation in or related to civil unrest, riot, insurrection or war. 17. Participation in the commission of a criminal offense. 18. A service or supply that is experimental or investigative in nature. 19. A service or supply that is not medically necessary or proven effective. 20. Services for which the government prohibits the payment of benefit. 21. Services provided without charge or normally paid for directly or indirectly by the employer. 22. Services for which the employee or dependent is entitled to indemnity from any government plan, or any plan or arrangement. 23. Services as a result of self-inflicted injuries or any suicide attempt, whether the covered person is sane or not. 11

13 HEALTH INFORMATION TERMINATION OF INSURANCE Coverage for you and your dependents will cease on the earliest of: - the contract termination date, - the date you terminate employment, - the date you cease to be eligible due to retirement, death, leave of absence, age limitation, change in classification, etc., - Class A - Unless an employee is eligible for Class B, the benefits terminate at the earlier of retirement, termination of employment or at the end of the month the employee reaches age 65, - Class B - The benefits terminate at the end of the month the early retiree reaches age 65. ALTERNATIVE BENEFIT Where more than one form or alternative form of treatment exists, Medavie Blue Cross, in consultation with its Health Care Consultants, reserves the right to make payment for eligible services and supplies based on an alternate procedure or supply with a lower cost, when deemed appropriate and consistent with good health management. CO-ORDINATION OF BENEFITS In the event that benefits may be claimed under more than one section of the health care plan, the claim will be assessed in a manner that provides the greatest benefit to the employee. If you are eligible for similar benefits under another group benefit plan the amount payable through this plan shall be co-ordinated with all benefit plans and will not exceed 100% of the eligible expense. Where both spouses of a family have coverage through their own employer benefit plans, the first payer of each spouse s claim is their own employer s plan. Any amount not paid by the first payer can then be submitted for consideration to the other spouse s benefit plan (the second-payer). Claims for dependent children should be submitted first to the benefit plan of the spouse who has the earlier birth month in the calendar year, and then to the other spouse s benefit plan. When submitting a claim to a second payer, be sure to include payment details provided by the first payer. Benefit payments will be co-ordinated with any other plan or arrangement, in accordance with the Canadian Life and Health Insurance Association (CLHIA) guidelines. CONVERSION PRIVILEGE If you should terminate employment, you may convert to an Individual Health plan currently issued by Blue Cross provided that application is made within 31 days following your date of termination. 12

14 ADDITIONAL BENEFIT INFORMATION ELIGIBLE EMPLOYEES To be eligible for group benefits, you must be a permanent employee who is a resident of Canada, covered under your provincial government plan, actively at work and working a minimum of 20 hours per week on a regular basis. Coverage commences immediately upon employment. Unifor Facilities Management Early Retirees are eligible if they have reached the age of fifty-five (55) and have completed twenty-five (25) years of service at the date of termination of employment and who take retirement through the Defined Benefit Pension plan for Employees of St. Francis Xavier University. Employees may elect coverage, within 31 days of becoming eligible following the waiting period, by completing an application. Coverage is effective on the date of eligibility, except when: (a) the employee is not actively at work on the day that coverage would otherwise become effective, or (b) the application is made after the 31 day period. If not actively at work when you would normally have become eligible, your coverage will commence when you return to work on a full-time basis. ELIGIBLE DEPENDENTS Dependents are defined as your legal spouse (as described below), and unmarried, unemployed dependent children including natural, legally adopted or step-children. Children of a common-law spouse may be covered if they are living with the employee. All dependents must be residents of Canada and be eligible for benefits under the provincial government health care programs in the province of residence in order to be eligible for coverage. The term spouse is defined as a person of the opposite or same sex who is legally married to the employee, or has continuously resided with the employee for not less than one full year having been represented as members of a conjugal relationship (common law). In the event of divorce, legal separation, or discontinuance of cohabitation ("common law" spouse), you may elect to continue membership of the former spouse or to provide notice to Medavie Blue Cross to terminate coverage for the spouse. Medavie Blue Cross will at no time provide coverage for more than one spouse under the same plan. Dependent children are eligible for benefits if they are less than 21 years of age* or, if 21 years of age* but less than 25 years of age**, they must be attending an accredited educational institution, college or university on a full-time basis. Unmarried, unemployed children 21 years of age* or older qualify if they are dependent upon the employee by reason of a mental or physical disability and have been continuously so disabled since the age of 21*. Unmarried, unemployed children who became totally disabled while attending an accredited educational institution, college or university on a full-time basis prior to the age of 25** and have been continuously disabled since that time also qualify as a dependent. * Benefits cease on December 31 st of the year the dependent children turn age 21. ** Benefits cease on December 31 st of the year the dependent children turn age 25. Dependent coverage begins for your eligible dependents on the same date as your coverage, or as soon as they become eligible dependents if added later, provided that dependent benefits were applied for within 31 days of their becoming eligible. If coverage is not applied for within this 31 day period, evidence of health on the dependents may have to be submitted and approved before coverage begins. EVIDENCE OF HEALTH Proof of good health is not required if application is made within 31 days of first becoming eligible. If coverage is not applied for within this 31 day period, evidence may be requested for the employee and his dependents, if any, before benefits commence. Certain other situations may require the submission of evidence of health before coverage will be approved. The cost of obtaining evidence of health is to be provided at your own expense if you or your dependents do not apply for coverage within 31 days of becoming eligible. 13

15 CARDHOLDER SITE INSTRUCTION FOR MEMBERS Medavie Blue Cross is continually developing its Web technology to respond to the needs of our customers. One such innovation, the Cardholder Site, will help you better understand, manage and co-ordinate your benefit plan. The Cardholder Site is simple to use and is delivered in a secure environment. Now, when you want to access general information about your plan, view your claims and payment history, or print generic claim forms, you just have to click your mouse. The Cardholder Site is available 24 hours a day, seven days a week from home or work, all you need is an Internet connection. The Cardholder Site makes life easier for you. ON THE CARDHOLDER SITE There are a variety of options available to you on the Cardholder Site. Coverage Inquiry: Detailed information about the member s Blue Cross benefit plan Forms: Printable versions of generic Medavie Blue Cross claim forms Member Information Members can view and/or update address information (where access is available) Request new identification cards Add/update banking information for direct deposit of claim payments (where applicable) Member Statements Members can view claims history for member and dependents View record of payments issued to member and/or the service provider View Health Spending Account balances (where applicable) FIRST-TIME ACCESS TO THE CARDHOLDER SITE 1. Log on to the Medavie Blue Cross Web site at 2. Select English 3. Select For Cardholders / Member Services from the e-service Centre menu on the right 4. Select Go to Secure Site 5. Select First Time, Register Now 6. Complete the online registration form 7. A temporary password will be ed to the address entered during registration 8. Return to the Cardholder Site and enter the user ID and temporary password 9. The member will be prompted to change the password. Click Submit to save the new password 10. Click Done once the changes are saved, you will be directed to the Welcome Page **Please ensure you make note of your user ID and password for future reference** PLEASE NOTE For security reasons, the Cardholder Site is for use of the cardholder only. We look forward to helping you take advantage of our online technology. For further information on the Cardholder Site, or for any questions about your Medavie Blue Cross benefit plan, please contact our Customer Information Center toll free at the number on the back of your identification card or [email protected]. DUAL COVERAGE EXCLUDED Eligible children shall be covered as dependents of only one employee even though both parents may be covered as eligible employees. A spouse cannot be covered for supplementary health expense coverage as a dependent if also covered as an employee. 14

16 GROUP LIFE INSURANCE Eligibility All regular, full-time union staff must participate in the Group Life Insurance Plan as a condition of employment. Life Insurance for Members The amount of your Life Insurance benefit will be $25,000. paid to your beneficiary upon your death, regardless of the cause. When you enroll in the plan, you should name a beneficiary to whom you wish your Life Insurance proceeds paid. Your estate will be your beneficiary if you do not name one. Subject to provincial laws, you may change your beneficiary at any time. Claims Procedure Life claim forms will be provided by Human Resources. Keep this summary in a place where your beneficiary may refer to it. Taking a lump sum settlement is only one of the ways of settling a Life claim. A settlement option such as a life income should be considered. If you do not make a settlement option election, your beneficiary may do so at the time of claim. Make sure that your beneficiary knows that these options are available. Life claims must be submitted within three months of the loss

17 LONG TERM DISABILITY Benefit Summary Income Benefit - 75% of regular monthly earnings Maximum Income Benefit - $2,500. Elimination Period days Maximum Benefit Duration - To age 65 Commencement and Termination of Coverage You are required to participate in the plan after three months of employment if you are a full-time employee. If you are a part-time employee you are eligible to participate in the plan after six months of employment. You will be covered as soon as you become eligible. You must be actively at work when coverage takes effect, otherwise the coverage will not be effective until you return to work. Increases in your benefits while you are covered by this plan will not become effective unless you are actively at work. Temporary, seasonal and part-time employees who work less than 20 hours per week may not join the plan. You coverage terminates when you employment ends, you are no longer eligible, or the policy terminates, whichever is earliest. Income Benefits The plan provides you with regular income to replace income lost because of a lengthy disability due to illness or injury. Benefits begin after the waiting period is over, and continue until you are no longer disabled as defined by the policy or you reach age 65, whichever is earlier. Check the Benefit Summary for the benefit amount and waiting period. If disability is not continuous, the days you are disabled can be accumulated to satisfy the waiting period as long as no interruption is longer than 2 weeks and the disabilities arise from the same disease or injury. If your employer provides short term disability or sick leave benefits that are still being paid when the waiting period ends, the waiting period will be extended to the date the short term disability or sick leave benefits end, but no longer than one year after your disability starts. After the waiting period, successive disabilities are considered to be in the same disability period if they arise from the same disease or injury and the later disability starts within 6 months after the previous disability ends. LTD benefits are payable for the first 24 months following the waiting period if injury or disease prevents you from doing your own job. You are not considered disabled if you can perform a combination of duties that regularly took at least 60% of your time to complete. After 24 months, LTD benefits will continue only if your disability prevents you from being gainfully employed in any job. Gainful employment is work you are medically able to perform, for which you have at least the minimum qualifications, and provides you with an income of at least 60% of your indexed monthly earnings before disability. Because your employer contributes to the cost of LTD coverage, benefits are taxable. Your LTD insurance terminates when you reach age

18 Other Income Your monthly LTD benefit is reduced by other income to which you are entitled during disability. Your LTD benefit is first reduced by: Disability or retirement benefits you are entitled to on your own behalf under the Canada or Quebec Pension Plan Benefits under any Workers Compensation Act or similar law. Your LTD benefit is then reduced to the extent that it together with the other income listed below exceeds 80% of your indexed monthly earnings before disability. Benefits another member of your family is entitled to on the basis of your disability under the Canada or Quebec Pension Plan Loss of income benefits available through legislation which you and nay other member of your family are entitled to on the basis of your disability, including automobile insurance benefits where permitted by law Disability benefits under a plan of insurance available through membership in an association Employment income, disability benefits, or retirement benefits related to any employment except an approved rehabilitation program. Rehabilitation Benefit If you are disabled, the rehabilitation benefit is designed to help you return to gainful employment and a more productive lifestyle. Great West Life will approve a program that facilitates your earliest possible return to work. Contact your employer for more information about this aspect of the plan. Earnings received from an approved rehabilitation program are not used to reduce your monthly LTD benefit unless those earnings, together with your income from this plan and the other income listed above, would exceed your indexed monthly earnings before disability. Limitations No benefits are paid for: Disability that begins before you insurance starts or after it ends. Disability arising from a disease or injury for which you received medical care before your insurance started. This limitation does not apply if your disability starts after you have been continuously insured for one year, or you have not had medical care for the disease or injury for a continuous period of 90 days ending on or after the date of your insurance took effect. The scheduled duration of a temporary lay-off or leave of absence, including maternity leave. Disability arising from war, insurrection, or voluntary participation in a riot. Any period of prison confinement. Any period in which you do not cooperate with an approved rehabilitation program. Any period in which you do not cooperate with a reasonable treatment program. Depending on the severity of the condition, the plan my require you to be under the care of a specialist. For substance abuse, treatment must include participation in a recognized substance abuse withdrawal program. Any 12-month period during which you do not live in Canada for at least 6 months. Conversion Privilege If you change jobs, you may apply for an individual LTD policy without any medical tests. You must apply and pay the first premium no later than 31 days after you start your new job, and you must start your new job no later than 6 months after you leave your present one. See your employer for details. How to Make a Claim Forms on which to make claim will be sent to you. For assistance with all claims contact Human Resources

19 OPTIONAL ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE Eligibility All permanent, active, full-time (minimum 15 hours per week) employees of St. Francis Xavier University and their spouses under the age of 65 and dependent children who are unmarried, dependent upon the Employee for maintenance and support and: (a) under 21 years of age (b) under 25 years of age and are in attendance at an institution for higher learning on a full-time basis, or (c) by reason of mental or physical infirmity, are incapable of self-sustaining employment and are totally dependent upon the Employee for support within the terms of the Income tax Act. Coverage All accidents resulting in Death, Dismemberment, Loss of Speech, Loss of Hearing or Paralysis are covered - anywhere in the world - anytime - 24 hours per day. Schedule of Insurance Benefits If within one year after the date of an accident, an Insured Person suffers a loss listed below, the Insurer will pay: For Loss or Percentage of Loss of Use of: Principal Sum Life % Both Hands % Both Feet % Entire Sight of Both Eyes % One Hand and One Foot % One Hand and the Entire Sight of One Eye % One Foot and the Entire Sight of One Eye % Speech and Hearing in Both Ears % One Arm... 75% One Leg... 75% One Hand... 66% One Foot... 66% Entire Sight of One Eye % Speech... 66% Hearing in Both Ears... 66% Thumb and Index Finger or at Least Four Fingers of One Hand... 33% For Loss of: All Toes of One Foot... 25% Hearing in One Ear... 25% For Total Paralysis of: Both Upper and Lower Limbs (Quadriplegia) 200% Both Lower Limbs (Paraplegia) % Upper and Lower Limbs of One Side of Body (Hemiplegia) % Only one benefit, the largest to which you are entitled, is payable for all losses resulting from any one accident to a maximum of $1,000,

20 Repatriation Benefit If you or your insured dependents die as the result of a covered accident occurring at least 50 kilometers from home, the Insurer will pay up to $10,000. for expenses incurred for the return home of the body (including preparation charges for transportation). Child Education Benefit In the event of your accidental death, up to 5% of the principal sum (to a maximum of $5,000.) will be payable for each insured qualifying child for post-secondary education expenses (provided the child is already in the program or will soon be entering the program). This is payable annually for each year for up to four consecutive years. Rehabilitation Benefit The Insurer will pay for your approved occupational training, up to a maximum of $10,000., within three years of the accident. Spouse Occupational Training Benefit The Insurer will pay up to $10,000., within three years of your accidental death, for formal occupational training for your spouse. Extended Family Benefit Coverage for your dependents will be continued without further payment of premiums for six months following the date of your death from any cause. Amount of Principal Sum a) The employee may purchase, in units of $10,000., any amount of insurance between a minimum of $10,000 and a maximum of $300,000. b) An employee's spouse and dependent children may be covered as follows: 1) The amount of insurance on the spouse is 50% of the Principal Sum of the employee and for each dependent child it is 10% of the Principal Sum of the employee. 2) For an employee who has no dependent children the amount of insurance on the spouse is 60% of the Principal Sum of employee. 3) For an employee who has dependent children but no spouse the amount of insurance for each dependent child is 20% of the Principal Sum of the employee

21 Monthly Cost The rate for an employee is $ monthly for each $1,000 of Principal Sum and the rate for an employee and family is $ monthly for each $1,000 of Principal Sum of the employee. Your premiums are paid through payroll deductions. Examples of Cost (Per Pay) Amount of Employee Employee & Principal Sum Only Plan Family Plan $ 10, , , , , , , , , , How May I Enroll You may enroll by completing an application card and returning it to Human Resources. The Accidental Death and Dismemberment Application form can be found on the StFX HR website. Insurance as to each eligible person who makes or for whom application is made shall become effective as follows: a) On the effective date of this Policy with respect to those employees whose application for insurance is received by the policyholder on or before the effective date of this Policy; b) On the first of the month coincident with or next following the date their application for insurance is received by the policyholder, with respect to those employees who apply after the effective date of this Policy. Termination of employment, non-payment of premium, attainment of age 65 or retirement automatically terminates insurance at the end of the month in which the event occurred. The Family Option terminates on the same date that the Employee's insurance terminates. Limitations No coverage will apply: a) While on service in the armed forces of any country; b) As the result of declared or undeclared war or act thereof; c) As the result of air travel, except as a passenger in any aircraft having a current and valid certificate of airworthiness; d) As the result of flying in any aircraft owned, operated or leased by your employee. e) In case of suicide or self-destruction or any attempt thereat while sane or insane

22 Beneficiary The employee Loss of Life Benefit will be paid to the beneficiary designated on the application or revision card. All other employee benefits and all dependent benefits will be paid to the employee. Claims Procedure Written notice of claim must be given to the Insurer, within 30 days after the occurrence of the accident or as soon thereafter as it is reasonably possible. Forms on which to make claim will be sent to you. For assistance with all claims contact Human Resources. Extended Health benefit ceases at the earlier of retirement, termination of employment or the end of the month you turn age 65. WHEN AND HOW TO MAKE A CLAIM Extended Health benefit is reimbursed to the employee. The employee must pay the provider of service, obtain an official paid in full receipt and submit to Medavie Blue Cross for processing. Some services may require a completed claim form to accompany the receipt. You may obtain claim forms from your employer or provider of service as appropriate. To make a claim, complete the claim form that is available. Claims must be submitted within 12 months of receiving services or supplies. No claims will be paid by Medavie Blue Cross after the termination date of this plan