Benefit Summary for Level 04 Members
This summary must be read together with the benefits described in this booklet.
|Life Insurance||$300,000, reducing to $20,000 at age 70|
|Accidental Death, Dismemberment and Specific Loss (Principal Sum)||$100,000, reducing by 50% at the end of the plan year (March 31st), coinciding with or next following your 65th birthday and terminating when you reach age 70|
|Weekly Disability Income Benefits|
|Waiting Period||14 days|
|Maximum Benefit Period||26 weeks|
|Amount||$700 per week|
|Benefit Integration||Plan payments will be made for occupational disabilities only if the member is denied Workers Compensation Benefits|
|Termination||At the end of the plan year (March 31st) coinciding with or next following your 75th birthday|
If you become disabled, contact your Plan Administrator ASAP who will provide information concerning Weekly Disability benefit claims and required documentation. Satisfactory written proof of claim must be submitted within 6 months of the date you become disabled.
To be eligible for Weekly Disability Income Benefits, you must have been actively at, or available for work, or have been actively looking for work with a contributing employer. You must also have:
NOTE: Members cannot voluntarily upgrade for Weekly Disability Benefit. This benefit is based on Producer Contributions only.
Covered expenses will not exceed reasonable and customary charges
|In-Canada Prescription Drug Expenses||An amount equal to the dispensing fee portion of the drug charge|
|All Other Expenses||Nil|
|Out-of-Country Emergency Care Expenses||100%|
|Global Medical Assistance Expenses||100%|
|All Other Expenses||90%|
|Basic Expense Maximums|
|Hospital||Semi-private room to a maximum of $10,000 each plan year|
|Home Nursing Care||$5,000 each plan year|
|Victorian Order of Nurses||$450 each plan year|
|Medical Travel in Canada||Included|
|In-Canada Prescription Drugs
Vaccines – all vaccines approved by Health Canada
|Medical Cannabis||up to $2,500 per year has been included for the treatment of multiple sclerosis, cancer, HIV/AIDS and palliative care. In all cases, Canada Life will determine if you qualify based on diagnosis and will require dispensing from an authorized supplier.|
|Smoking Cessation Products
|$500 lifetime or as otherwise required by law
$5,000 lifetime or as otherwise required by law
|Hearing Aids||$1,000 per ear every 5 plan years|
|Custom-fitted Orthopedic Shoes||$300 each plan year|
|Custom-made Foot Orthotics||$450 each plan year|
|Splints (including shoes attached to a splint)||Included|
|Mechanical or Hydraulic Patient Lifters||$2,000 per lifter once every 5 years|
|Outdoor Wheelchair Ramps||$2,000 lifetime|
|Blood-glucose Monitoring Machines
Continuous Glucose Monitor and Flash Glucose Monitor for Type 1 diabetes only. Prior authorization by CL is required.
|1 every 4 years
|Transcutaneous Nerve Stimulators||$700 lifetime|
|Extremity Pumps for Lymphedema||$1,500 lifetime|
|Custom-made Compression Hose||4 pairs each plan year|
|Wigs or hairpieces for permanent hair loss as a result of an injury or disease, or temporary hair loss as result of medical treatment for any disease||$1,000 every 3 plan years|
|Intrauterine Devices (IUDs)||2 each plan year|
|Colostomy and Ileostomy Supplies, Oxygen, Medicated Dressings and Custom-made Burn Garments||Included|
|Prosthetic Equipment including:|
|External Breast Prosthesis||1 every 12 months|
|Surgical Brassieres||2 each plan year|
|All prosthetic equipment is limited to a lifetime maximum of $10,000|
|Paramedical Expense Maximums|
|Acupuncturists||$700 each plan year|
|Audiologists||$700 each plan year|
|Chiropractors||$700 each plan year
$25 for x-rays each plan year
|Christian Science Practitioners||$700 each plan year|
|Dieticians||$700 each plan year|
|Registered Massage Therapists||$700 each plan year|
|Naturopaths||$700 each plan year|
|Osteopaths||$700 each plan year
$25 for x-rays each plan year
|Physiotherapists/Athletic Therapists||$700 each plan year combined|
|Occupational Therapists||$700 each plan year|
|Podiatrists||$700 each plan year
$25 for x-rays each plan year
|Chiropodists||$700 each plan year|
|Psychologists/Psychotherapists/Social Workers/Registered Clinical Counselor (for BC residents only)/Psychoanalysts (for QC residents only)
*(Includes Intensive Behavioral Intervention and Applied Behavior Analysis treatment for children on the autism spectrum disorder (must be supervised by a psychologist).
|$2,000 each plan year combined|
|Speech Therapists/Speech Language Pathologists||$700 each plan year combined|
|Visioncare Expense Maximum|
|Eye Examinations||$75 every 24 months|
|Glasses, Contact Lenses and Laser Eye Surgery|
|- for your spouse or a dependent child||$250 every 24 months|
|- for members||$750 every 24 months|
|Global Medical Assistance Program (GMA)||Included|
|Out-of-Country Emergency Care Expense Maximums||$1,000,000 lifetime|
|- under age 70||Unlimited|
|- age 70 and above||$5,000 each plan year|
|Plan year is April 1st to March 31st|
|Covered expenses will not exceed reasonable and customary charges|
|Payment Basis||The dental fee guide on the date treatment is rendered for the province in which treatment is rendered|
|Orthodontic Coverage||50% (eligible dependents under age 19)|
|Accidental Dental Injury Coverage||90%|
|Basic Treatment||$1,500 each plan year|
|Major Treatment||$1,500 each plan year|
|Orthodontic Treatment||$2,500 lifetime (eligible dependents under age 19)|
|Accidental Dental Injury Treatment||$5,000 per accident|
|Plan year is April 1st to March 31st|
|Other carriers' coverage not underwritten by Canada Life|
|Member & Family Assistance||Counseling available through FSEAP for you and your family|
|Critical Condition Benefit (Members Only)||$50,000 for eligible members under age 65 (Underwritten by Blue Cross)|
Information About Your Benefit Plan
You cannot elect a lower benefit level than the benefit level based on your Health and Welfare Account at the end of the calendar year before the start of the plan year, unless you opt down one level with a Health Care Spending Account.
Annual Benefit Level Classification
You will receive the highest benefit level for the plan year beginning April 1 based on your individual Health and Welfare account balances as of December 31 of the preceding year.
You will be eligible for the highest level of benefits that your individual account balance can support. The account balance must be able to support at least 12 months of benefit costs and administrator service charge requirements in effect at the start of the plan year (April 1).
There will be no voluntary opting to elect a lower benefit level than that determined based upon your account balance at the end of the previous calendar year.
Benefit Level 01 Coverage
If you are in good standing of I.A.T.S.E., Local 667 or 669, you 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, if you are in good standing, may be paid from the Health and Welfare Trust Fund reserves.
When you become a member of I.A.T.S.E., Local 667 or 669, Benefit 01 coverage or the benefit level you will qualify for through producer contributions, 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.
If you have a Health and Welfare account balance at the beginning of the plan year that will provide only the Benefit 01 coverage, you 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 for one complete plan year, the balance will be funded through the Trust Fund reserves.
You 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 Golden Level, QC Drugs, 02, 03 or 04 Coverage
If you are in good standing of I.A.T.S.E. Local 667 or 669, you will be eligible for Benefit QC Drugs, 02, 03 or 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 QC Drugs, 02, 03 or 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 you continue to meet the requirements in this booklet.
Each deduction will equal a month of Benefit Level QC Drugs, 02, 03 or 04 coverage costs plus administration service charges.
If you are eligible for Benefit Level 04 and your account balance exceeds 36 months of deductions, you will have excess deductions transferred to a Health Care Spending Account. 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. Your account balance will immediately be reduced by the amount transferred. Unused amounts cannot be transferred back. Reimbursement of expenses from the Health Care Spending Account are administered by Canada Life and are payable from the funds allocated to your Health Care Spending Account.
If you voluntarily upgrade to a higher benefit level and later downgrade to a lower benefit level, you forfeit the right to voluntarily upgrade to a higher benefit level for 36 months.
Members Who Reside Outside of Canada
If you or your dependents are eligible to receive Benefits Level 01, QC Drugs, 02, 03 or 04 coverage but you are a member who resides outsides of Canada, your coverage is modified as follows (qualifying benefits):
You and your dependents are not eligible to receive coverage for: