Benefit Summary for Level 04 Members

This summary must be read together with the benefits described in this booklet.

Life Insurance $150,000, 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:

  • worked for a contributing employer for a minimum of 5 days in the 30-day period immediately preceding the date of disability;
  • worked for a contributing employer for a minimum of 10 days in the 60-day period immediately preceding the date of disability;
  • become disabled within 30 days of the date you were scheduled to work for a contributing employer for either 5 days in the forthcoming 30 days or 10 days in the forthcoming 60 days (a written proof of such work commitment must be provided), or
  • had patterns of employment with any of the contributing employers for specific calendar months or specific contributing employers during the 24 months immediately preceding the date of disability that demonstrates that you would have been working for a contributing employer if you had not been disabled, in which case your waiting period would begin on the date you would have been so scheduled to work.

NOTE: Members cannot voluntarily upgrade for Weekly Disability Benefit. This benefit is based on Producer Contributions only.

Healthcare

Covered expenses will not exceed reasonable and customary charges

Deductibles
In-Canada Prescription Drug Expenses An amount equal to the dispensing fee portion of the drug charge
All Other Expenses Nil
Reimbursement Levels
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
Included
Included
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, Great-West Life will determine if you qualify based on diagnosis and will require dispensing from an authorized supplier.
Smoking Cessation Products
Fertility Drugs
$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
Orthopedic Equipment 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 GWL is required.
1 every 4 years
$1,500/year
Transcutaneous Nerve Stimulators $700 lifetime
Extremity Pumps for Lymphedema $1,500 lifetime
Custom-made Compression Hose 4 pairs each plan year
Incontinence Supplies Included
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:
Myoelectric Arms Included
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/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).
$1,500 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
Best Doctors Included
Out-of-Country Emergency Care Expense Maximums $1,000,000 lifetime
Healthcare Maximums
- under age 70 Unlimited
- age 70 and above $5,000 each plan year
Plan year is April 1st to March 31st
Dentalcare
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
Deductible Nil
Reimbursement Levels
Basic Coverage 90%
Major Coverage 60%
Orthodontic Coverage 50% (eligible dependents under age 19)
Accidental Dental Injury Coverage 90%
Plan Maximums
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 Great-West 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 Great-West 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):

  • Life Insurance
  • Accidental Death, Dismemberment and Specific Loss (AD&D) Insurance
  • Dentalcare benefits for services incurred outside Canada
  • Member & Family Assistance Counselling

You and your dependents are not eligible to receive coverage for:

  • Weekly Disability Income Benefits
  • Healthcare
  • The Critical Condition Benefit
  • Best Doctors