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General Information |
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Employee Eligibility
Q.C.C.C. MEMBERS will initially become covered on the
1st day of the month following the
month in which 120 hours are earned, provided the employer
makes the appropriate
contributions to the Plan. Example: 120 hours earned in April
provide coverage for May. If an Employee working under the Q.C.C.C. Agreement
earned less than 120 hours or is not a Union Member, and the employer has not
contributed on his/her behalf for the Full Benefit Plan, please refer to
the section regarding the
Mini Plan. For continued coverage after initial
qualification, the Employee must earn at least 90 hours per
month. If a lapse in coverage occurs, the Employee must
re-qualify with 120 hours.
NOTE: An enrolment card must be completed and
forwarded to the Administrator’s office before any claims
payment will be made. If dependents or a beneficiary changes, a revised
card must be completed.
OFFICE PERSONNEL will be initially
covered the 1st of the month following the date of becoming a permanent
employee*, provided he/she is actively at work on that day. Employees absent
from work on their effective date, with the exception of statutory holidays
or paid vacations, will become effective on the date they return to active
full-time work.
*However, if the coverage is not requested on
the eligible effective date, or if application for coverage has not been made
within 31 days of that date, then any application for coverage will require
submission of evidence of insurability. The Insurance Company will then determine the
effective date of coverage and if approved, Dental benefits will be
limited during the 1st 12 months, as outlined in the group policy.
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Dependent Eligibility
Eligible dependents are:
Spouse
- The person to whom the Employee is married or a
person with whom they reside and who is represented as husband or
wife. Only one person may qualify at any one time.
Children
- Unmarried children under 21 years of age.
- Unmarried children age 21 or over are also
eligible provided they depend wholly upon the Employee for support and maintenance
and are full-time students in an educational institution.
- Stepchildren, foster children and legally
adopted children may be included the same as the Employee's own children, provided they
depend upon the Employee for support and maintenance.
- A child who is physically or mentally
incapable of self-support upon attaining age 21 may be continued under the
Extended Health and Dental benefits while remaining incapacitated and
unmarried, subject to the Employee's own coverage continuing in effect. This privilege
also will apply to a child who has remained in the Plan beyond his
or her twenty-first birthday if he or she later ceases to be a qualified
dependent and is physically or mentally incapable of self-support and is not
married. To continue coverage under this provision, proof of incapacity must
be received by the Plan Administrator within 31 days after coverage would
otherwise terminate. Additional proof will be required from time to
time.
Children are eligible for the Health Insurance
from birth. If a dependent, with the exception of a new-born child, is
confined for medical care or treatment in any institution or at home when
coverage would normally start, the dependent will not be covered until given
a final release by the doctor from all such confinement.
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Medical Examination
No medical examination will be required
providing coverage commences on the eligibility date.
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Termination of Dependent Insurance
Dependent coverage terminates the same day as the Employee’s,
except in the event of the Employee’s death while
covered. Upon the death of an Employee, Extended Health
and Dental benefits will be continued for a period of twelve
months for the spouse and eligible dependents of the deceased
Employee.
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Extended Coverage on Termination/Layoff
Any Q.C.C.C. Member who has been in the employ of a
Participating Employer and who was on the Full Benefit Plan,
shall receive upon layoff, one month’s
coverage for each 520 earned pension contribution hours, to a maximum of six
months of coverage, provided they are registered and available
for work under the Q.C.C.C. agreement. The Lay-off Plan will not include Wage
Indemnity.
An Employee’s coverage (with the exception of Wage Indemnity
and Long Term Disability) will be extended to the last day of
the month following the month in which Full or Lay-off
coverage, provided through employment, terminates (due to
firing, quitting or leave of absence). See also Mini
Plan.
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Absence Due to Disability
If an Employee is eligible for Wage
Indemnity benefits on any premium due date, the employer will continue premium
payment for all benefits while the Employee is collecting benefits.
If an Employee is entitled to Worker’s
Compensation, he or she is not eligible for the Wage Indemnity benefit.
However, all other benefits will be maintained as in the previous paragraph to a
maximum of 52 weeks.
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When the Employee is Unemployed
Self-pay: The Plan includes a six months’ self-pay
provision* for an Employee who is a Member in good standing of
Q.C.C.C. (for all benefits except Wage Indemnity and Long Term
Disability) effective on the first of the month coinciding
with or next following:
- cessation of the extended coverage allowed after coverage
provided by the employer terminates as above.
- expiry of an Employee's Wage Indemnity benefits.
- when Wage Indemnity benefits would have expired had the
Employee not been in receipt of Worker’s Compensation
benefits.
* For Employees who are totally disabled, this self-pay
provision will be extended until the earlier of (i) the date
the Employee ceases to be totally disabled and (ii) the
Employee’s attainment of age 65.
WHEN REQUIRED, A SELF-PAY NOTICE WILL BE
MAILED TO YOU AT THE ADDRESS ON FILE. IF PAYMENT IS RECEIVED,
SUBSEQUENT NOTICES WILL BE SENT ON A MONTHLY BASIS.
PAYMENT IS DUE ON THE 15TH OF THE MONTH.
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Reinstatement
If an Employee, who is a Q.C.C.C. Member, returns to work and earns 90 hours (either with a previous employer or a new employer) before
his or her coverage terminates (either from extended coverage or self-pay
coverage), the Employee’s coverage will be deemed to be continuous.
If an Employee should incur a claim prior to
the receipt of a self-pay contribution, the claim will be considered
eligible, provided the self-pay contribution is received within the time limit
given. In the event of a Life Insurance claim, prior to the receipt of the self-pay
contribution, the required self-pay premium is automatically deducted from the
Death Benefit.
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Coordination of Benefits
The purpose of Extended Health Care and Dental insurance is to
help meet actual expenses. In line with that purpose, the Plan
contains a non-profit provision. As a result, benefits under
this Plan may be reduced so that benefits from all plans do
not exceed the actual expenses. “Plans” includes medical
and Dental care benefits under a law or government program,
group insurance or other coverage for a group of individuals,
including student coverage obtained through an educational
institution above the high school level.
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