Eligibility and General Information
Below is an overview of some of the Plan’s key eligibility provisions. For complete details regarding establishing and maintaining coverage under the Plan, please refer to the General Information section of the Health Benefits Plan booklet or contact the Administrator.
Establishing Coverage
Eligibility for benefits requires that you:
- Are a QCCC Member in good standing with one of the Affiliated Unions listed in the Quality Control Council of Canada Agreement
- Have a minimum of 180 hours within a period of 12 consecutive months, reported and paid into the Plan by your employer(s)
Coverage will commence on the 1st day of the month following the month in which sufficient hours have accumulated in your Hour Bank as tracked by the Plan Administrator.
How to Enrol in the Plan
To enroll in the Health Benefits Plan you must complete the following forms and send them to the Administrator without delay:
- Benefit Plan Application for Enrolment and Beneficiary Designation
- Common-Law Spouse Declaration Form (if applicable)
Once you are enrolled in the Plan, you will receive a Member ID card. Two cards will be issued if you have dependent coverage.
Coverage for Dependents
Your eligible dependents will be covered for Extended Health and Dental benefits. Please refer to Dependent Eligibility in the General Information section of the Health Benefits Plan booklet for the definition of eligible dependent.
You must advise the Administrator of any change related to your dependents to ensure they have access to benefits.
If your spouse has their own coverage through their employment or union, please refer to the To Make A Claim section of the Health Benefits Plan booklet for information regarding Coordination of Benefits.
Maintaining Coverage
The Plan operates on an hour bank system. Hours are reported monthly by your employer(s) and accumulated in your own personal hour bank. Once you have qualified for coverage, 90 hours are deducted from your hourbank each month to provide your coverage.
You may accumulate up to maximum of 540 hours (6 months of future coverage) in your hour bank in order to continue your coverage through periods of low employment, unemployment or vacation, provided you remain a member in good standing.
If your hour bank falls below 90 hours, you may be eligible to continue your coverage under the self-payment option as described below.
Self-payment
If you are a member in good standing but do not have enough hours for coverage, you may continue your coverage through self-payment for all benefits except Weekly Indemnity and Long Term Disability.
A self-payment notice will be sent to you at the last known address that is on file with the Administrator. You should not ignore this notice if you wish to remain covered. You must pay the amount indicated on the notice by the deadline date in order to maintain your coverage. If you do not respond to the self-payment notice, you will not be sent another notice the following month.
The maximum number of self-payments allowed is 6 consecutive months.
Termination of Coverage
Your coverage will terminate when:
- Your hour bank falls below 90 hours, and you fail to make a self-payment by the specified date, or
- You reach the maximum number of self-payments, or
- You cease to be a QCCC member in good standing
If your coverage terminates, you will have to requalify as described under Establishing Coverage.
