AM I ELIGIBLE FOR BENEFIT COVERAGE?

• How do I continue Health Care Benefits and Dental Benefits for an Incapacitated Child?
• Do Health Care Benefits and Dental Care Benefits Continue after My Death?

AM I ELIGIBLE FOR BENEFIT COVERAGE?

Eligibility is determined by the current International Alliance of Theatrical Stage Employees, (I.A.T.S.E.), Local 667/669 Trust Agreement and the current Eligibility Regulations established by the Plan Trustees as summarized in this booklet.

All Members who are in good standing with the International Alliance of Theatrical Stage Employees (I.A.T.S.E.), Local 667 or Local 669 as shown in this booklet are eligible for benefit coverage.

Member and Family Coverage

To become, and remain, eligible for benefit coverage under this Plan, Members must meet, and continue to meet, the conditions summarized. Members and their families may receive benefits provided the Members are eligible to receive a benefit level, which provides for spousal and dependent child coverage.

Union Membership in I.A.T.S.E., Local 667 or Local 669

The basic requirement to become eligible, and continue to be eligible, for benefit coverage is Union membership "in good standing" in either I.A.T.S.E., Local 667 or Local 669 as determined by the respective Constitution and By-Laws of each Local Union and the supreme Constitution and By-Laws of the International Alliance.

Determining Union Members who are "in good standing" is the responsibility of each Local Union Office. The membership lists are to be up-dated monthly and provided to the Trustees and the Plan Administrator.

The benefit coverage for each Member will be decided at the start of each Plan Year (April 1 to March 31) and will be based on the total contributions in the Member's Individual Health and Welfare account to the end of the previous Plan Year.

Residency and Provincial Medicare Coverage Required

Members and eligible dependents will receive full Plan coverage only as long as they continue to be residents of Canada. Partial plan coverage as shown in the Benefit Summary in the Schedule of Benefits is provided for non-residents.

Members and dependents must be insured for and retain Provincial Medicare coverage in a Province or Territory of Canada to receive Health Care Benefit coverage as outlined in this booklet.

Annual Benefit Level Classification

Members will receive the highest benefit level for the Plan Year beginning April 1 based on their individual Health and Welfare account balances as of December 31 of the preceding year.

Each Member will be eligible for the highest level of benefits that his/her individual account balance can support. The account balance must be able to support at least 12 months of benefit costs and administration service charge requirements in effect at the start of the Plan Year (April 1).

There will be no opting out of the Plan coverage by a Union Member or by the Member's spouse and/or dependent children.

There will be no voluntary opting to elect a lower benefit level than that determined based upon the Member’s account balance at the end of the previous calendar year.

Benefit Level 01 Coverage

A Member in good standing of I.A.T.S.E., Local 667 or Local 669 will be covered for the minimum benefit, or Benefit 01, as determined by the Trustees from time to time.

The premiums for the Benefit 01 coverage for all Members in good standing may be paid from the Health and Welfare Trust Fund reserves.

When a person becomes a Member of I.A.T.S.E., Local 667 or Local 669, Benefit 01 coverage will be provided from the first of the month following the effective date of Union membership. Any producer contributions made in the year before becoming a Plan Member will be applied to the account balance for the next Plan Year. An Application for Plan Membership will be sent to each new Member which must be completed and returned to the Union or Health & Welfare Administration Office.

Any Member who has a Health and Welfare account balance at the beginning of the Plan Year that will provide only the Benefit 01 coverage, will have that account balance pay the Benefit 01 coverage costs and administration service charges in full for one complete Plan Year. If the account balance is less than the benefit costs and administration service charges for one complete Plan Year, the balance will be funded through the Trust Fund reserves.

A Member will continue to be covered for Benefit 01 until the account balance at the end of the previous calendar year is sufficient to provide a higher level of benefit (or until termination of Plan membership occurs).

Benefit Level 02, 03, 04 Coverage

A Member in good standing of I.A.T.S.E., Local 667 or Local 669 will be eligible for Benefit 02, 03, 04 for a Plan Year if the Health and Welfare account balance at December 31 of the preceding year is at least equal to 12 months of deductions for 02, 03, 04. The account balance includes the producer contributions, if any, received in the year prior to becoming a Plan Member.

The account balance will then be reduced each month by the deduction amount as long as the Member continues to meet the requirements in this booklet.

Each deduction will equal a month of Benefit Level 02, 03, 04 coverage costs plus administration service charges.

A Member who is eligible for Benefit Level 04 and whose account balance exceeds 36 months of deductions, will have excess deductions transferred to a Health Spending Benefit. The maximum amount that can be transferred for any one year, is limited to 12 months of the current year’s Benefit Level 04 deduction amount. The Member’s account balance will immediately be reduced by the amount transferred. Unused amounts cannot be transferred back. Reimbursement of expenses from the Health Spending Benefit are administered by Manulife and are payable from the funds allocated to your Health Spending Benefit.

Eligibility for Benefit Payments

Benefits, or the reimbursement of expenses, will be paid to a Member from this Benefit Plan after the Member has sent a completed Application for Plan Membership to the Union or Health & Welfare Administration Office.

Benefits, or the reimbursement of expenses, will be paid to a Member on behalf of a qualifying spouse or dependent child only if the spouse or child has been designated by the Member on the Application for Plan Membership on file at the Union or Health & Welfare Administration Office.

Eligible family members (dependents) include:

• your spouse, if a resident of Canada, (or residing with you outside of Canada for qualifying benefits only), and,
• your unmarried children (natural, step, adopted, or if proof is submitted, any child under your legal guardianship, primarily dependent on you for support) under the age of 21 (or 25, if they are students regularly attending school) provided they are primarily dependent on you for financial support and they are residents of Canada (or residing with you outside of Canada for qualifying benefits only).
• your spouse is either your husband or wife if you are legally married, or a person who you are living with and who is currently, and has been for a continuous period of at least 12 months, publicly maintained and represented as your husband or wife or same sex spouse.

You may apply for coverage for a dependent child who is a student regularly attending school (under the age of 25) and who resides elsewhere, but within Canada, during the academic term. Proof must be submitted at the beginning of each academic year for coverage to apply

Any mentally or physically handicapped children primarily dependent on you for support are eligible provided they became so incapacitated prior to attaining the limiting age specified above while covered under this Plan.

You must designate your spouse and children in writing before they can become your dependents under this Plan.

Coverage is terminated when a person ceases to be a Member in good standing of I.A.T.S.E., Local 667 or Local 669; whether that person takes Honourable Withdrawal, is Suspended, is Expelled or Resigns. That person and his/her dependents will no longer be covered for any benefits of the Plan as of the first of the month following Union membership termination. The coverage for a dependent will cease earlier if the dependent no longer qualifies as a spouse or a dependent child.

How Do I Continue Medical Benefits and Dental Benefits for an Incapacitated Child?

Medical and Dental Benefits will continue beyond the date an unmarried dependent child reaches the limiting age for coverage, provided proof is submitted to Manulife within 31 days after the child:

• Is incapable of self-sustaining employment because of mental retardation or physical handicap,
• became so incapacitated before reaching the limiting age, and
• is chiefly dependent on you for support and maintenance.

Thereafter, proof must be submitted to Manulife, as required, but not more often than annually.

Do Medical Benefits and Dental Care Benefits Continue After My Death?

If you die while your dependents are insured under the Medical and/or Dental Benefits, your dependents will continue to be insured for such benefits until the earliest of:

• 2 years after the date of your death,
• the termination of the Group Policy,
• the remarriage of the spouse (children will continue to be insured for up to a total of 2 years),
• the date the dependent child ceases to qualify as a dependent,
• the date coverage for your dependents terminates for any reason.

Upon your death, benefits will be payable to your spouse, if living, or to your dependent child(ren) (or legal guardian).

If a person returns to become a Member in good standing of I.A.T.S.E., Local 667 or Local 669, benefit coverage will begin as shown above under the heading "Am I Eligible for Benefit Coverage?" - "Benefit Level 01 Coverage".

However, if the person returns within 12 months of the date the membership was originally terminated, then the previous Health and Welfare account balance including any Health Spending Benefit, will be restored to the Member's credit. Coverage for the remainder of the Plan Year will be based upon the value of the restored account balance.

The Health Spending Benefit limitation dates, regarding the 24 month maximum cannot be extended once they are established. This is a requirement under The Income Tax Act.

Life Insurance and Accidental Death & Dismemberment 
(AD & D) Insurance

Life Insurance:

If, for any reason, your group life insurance or any part of it terminates, the terminated amount (up to a maximum of $200,000) may be converted to a plan of individual life insurance offered by Manulife Financial. No evidence of insurability is required. The amount may not be greater than the amount of coverage you were insured for under the Group Policy. Your Plan Administrator or a Manulife Service Representative can be contacted for details.

• Written application and the first month's premium payment must be received by Manulife within 31 days of termination of the Member Life Insurance, subject to limitations as outlined in the Group Policy.
• Conversion application forms may be obtained through your Plan Administrator.

Accidental Death & Dismemberment (AD&D) Insurance:

• No conversion option is available.
• Claims incurred while covered must be reported within 60 days of your termination date.

Medical Benefits

If you are totally disabled on the date coverage under this benefit terminates, expenses which would have been payable had your insurance not terminated will be payable provided:

• the expenses are incurred within 90 days of the termination of your insurance,
• you remain continuously and totally disabled,
• you do not become covered under any other group-type plan providing similar coverage, and
• the Group Policy remains in force.

Totally Disabled means: For a Member, that such person cannot, because of illness or injury, engage in such person’s regular occupation, and is not working for pay or profit; and

For a dependent, that such person cannot, because of illness or injury, engage in most of the normal activities of a person of the same age and gender.

Manulife Financial: Pay Direct Drug Card

Manulife Financial: Pay Direct Drug Card - You will not be able to use your Drug Card after your coverage terminates.

Dental - Benefit Level 02, 03 & 04

Eligible expenses relating to treatment, which had been initiated before the termination of your insurance, are covered for 90 days for an identifiable multiple course of endodontic or periodontic treatment, provided the Group Policy remains in force.

Eligible expenses relating to treatment, which had been initiated before the termination of your insurance, are covered for:

• 90 days for an identifiable multiple course of endodontic or periodontic treatment, or
• 31 days if an impression for a prosthodontic appliance had been taken, provided the Group Policy remains in force.

Critical Condition Benefit

Claims incurred while covered must be reported within 60 days of your termination date.

Member and Family Assistance Program

Coverage will continue through the normal course of a treatment that began before termination.