GROUP PLANS
What Is Covered?
Your group insurance plan will provide you with a certificate and/or a booklet
that outline the key features of your coverage, including covered expenses,
eligible dependents, deductibles and coinsurance, limits and exclusions, and claim
procedures. Your human resources officer and/or benefits administrator can help
you obtain additional information. The complete details of the plan are contained in
the master contract that is issued to the plan sponsor by the insurer.
For a list of typical benefits provided by group extended health and dental plans,
please see page 3. Bear in mind that benefits vary widely from one plan to another.
For a description of other kinds of health-related coverage your employer may
provide, such as disability, travel, critical illness and long-term care benefits, please
see Section 4, Individual Plans.
Who Is Covered?
To be eligible for coverage you typically must be a member of the sponsoring
association or union, or – in the case of employer-sponsored plans – a permanent,
full-time employee. Under some employer-sponsored plans, you must also have
been at work for a specified period such as one month or three months. Check
your plan to find out what the enrolment requirements are, for yourself and your
dependents.
Under most group plans, you are insured only as long as you remain part of the
group. In general, if you leave your job, or cease to be a member of the
association, your coverage ends.
However, if you are laid off or leave because of a downsizing program, your benefits
may be continued for a period of a few weeks. And in some instances, replacement
coverage may be available if you apply within a specified time period, such as 90
days. Your benefits administrator or the OmbudService for Life and Health
Insurance (please see page 14) may be able to provide more information about
replacement coverage and how to get it.
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