Group Benefit Plan Lakeland College - 2010

Your GroupBenefits Booklet

As at May 1, 2010

This document contains the benefits details for the group benefit plan provided to active employees of Lakeland College.

May 1, 2010

Table of Contents Benefits‐At‐A‐Glance .................................................................................................................... 1

General Information ..................................................................................................................... 5

About this booklet ............................................................................................................................ 5

Eligibility ............................................................................................................................................ 5

Who qualifies as your dependent ..................................................................................................... 6

Enrollment ......................................................................................................................................... 7

Employee paid premiums ................................................................................................................. 7

When coverage begins ...................................................................................................................... 8

Changes affecting your coverage ...................................................................................................... 8

Updating your records ...................................................................................................................... 8

When coverage ends ........................................................................................................................ 9

Making claims ................................................................................................................................... 9

Proof of disability .............................................................................................................................. 9

Coordination of benefits ................................................................................................................. 10

Medical examination ...................................................................................................................... 10

Recovering overpayments .............................................................................................................. 11

Definitions ....................................................................................................................................... 11

Extended Health Care ................................................................................................................. 12

General description of the coverage .............................................................................................. 12

Deductible ....................................................................................................................................... 12

Prescription drugs ........................................................................................................................... 12

Hospital benefits ............................................................................................................................. 13

Other services ................................................................................................................................. 14

Out of province Emergency Travel benefits ................................................................................... 15

When coverage ends ...................................................................................................................... 16

When and how to make a claim ..................................................................................................... 16

Overall maximum ............................................................................................................................ 16

What is not covered ........................................................................................................................ 16

Dental Care ................................................................................................................................. 18


Deductible ....................................................................................................................................... 18

May 1, 2010

Time unit ......................................................................................................................................... 18

Basic dental services ....................................................................................................................... 18

Extensive dental services ................................................................................................................ 20

Orthodontic services ....................................................................................................................... 21

When coverage ends ...................................................................................................................... 21


Overall maximum ............................................................................................................................ 22


Health Spending Account (HSA) .................................................................................................. 23


HSA benefit year ............................................................................................................................. 23

HSA allocation ................................................................................................................................. 23

Dependent eligibility ....................................................................................................................... 24

How to make a claim from your HSA .............................................................................................. 24

HSA carry‐forward and forfeiture rules .......................................................................................... 25

Coordination of benefits ................................................................................................................. 26

What is covered by your HSA .......................................................................................................... 26

Basic Life Insurance Benefits ....................................................................................................... 31


Administration Employees .............................................................................................................. 31

Faculty Employees .......................................................................................................................... 31

A.U.P.E. Employees ......................................................................................................................... 31

Basic Life benefit reduction ............................................................................................................ 31

Coverage ends ................................................................................................................................. 31

Who the plan will pay ..................................................................................................................... 31

Basic Life coverage during total disability ....................................................................................... 31

Converting Basic Life coverage ....................................................................................................... 32


Optional Life Insurance Benefits ................................................................................................. 33


Optional Life coverage for you and / or your spouse ..................................................................... 33

Coverage ends ................................................................................................................................. 33

Who the plan will pay ..................................................................................................................... 33

May 1, 2010

Suicide ............................................................................................................................................. 33

Optional Life coverage during total disability ................................................................................. 33

Converting Optional Life coverage ................................................................................................. 34


Long Term Disability Benefits...................................................................................................... 35


Administration Employees .............................................................................................................. 35

Faculty Employees .......................................................................................................................... 35

A.U.P.E. Employees ......................................................................................................................... 35

Definition of disability ..................................................................................................................... 35

Benefit payment reductions ........................................................................................................... 36

Benefit payment schedule .............................................................................................................. 37

Waiver of premium ......................................................................................................................... 37

Rehabilitation .................................................................................................................................. 37

Partial disability ............................................................................................................................... 37

Third party liability .......................................................................................................................... 37

Exclusions and limitations ............................................................................................................... 38

Pre‐existing condition ..................................................................................................................... 38

Termination of benefits .................................................................................................................. 38


Accidental Death and Dismemberment (AD&D) Insurance ......................................................... 40


Basic Accidental Death & Dismemberment Insurance ................................................................. 40

Basic AD&D coverage for Administration employees .................................................................... 40

Basic AD&D coverage for Faculty employees ................................................................................. 40

Basic AD&D coverage for A.U.P.E. employees ................................................................................ 40

Basic AD&D coverage for Casual employees .................................................................................. 40

Basic AD&D benefit reduction ........................................................................................................ 40

Specific Loss Schedule ..................................................................................................................... 40

Repatriation benefit ........................................................................................................................ 42

Education benefit ............................................................................................................................ 42

Day‐care benefit .............................................................................................................................. 42

Rehabilitation .................................................................................................................................. 43

May 1, 2010

Workplace modification and accommodation ............................................................................... 43

Occupational training ...................................................................................................................... 43

Permanent total disability ............................................................................................................... 44

Family transportation ..................................................................................................................... 44

Identification ................................................................................................................................... 44

Seat belt benefit .............................................................................................................................. 45

Home alteration and/or vehicle modification benefit .................................................................... 45

Hospital indemnity benefit ............................................................................................................. 45

Aircraft coverage ............................................................................................................................. 46

Limit on benefit amounts ................................................................................................................ 46

Beneficiary ...................................................................................................................................... 46


Coverage ends ................................................................................................................................. 47



Voluntary Accidental Death & Dismemberment Insurance ......................................................... 48

Employee Only Voluntary AD&D plan ............................................................................................ 48

Employee and Family Voluntary AD&D plan .................................................................................. 48

Specific Loss Schedule ..................................................................................................................... 48

Repatriation benefit ........................................................................................................................ 50

Education benefit ............................................................................................................................ 50

Day‐care benefit .............................................................................................................................. 50

Rehabilitation .................................................................................................................................. 51

Workplace modification and accommodation ............................................................................... 51

Occupational training ...................................................................................................................... 51

Permanent total disability ............................................................................................................... 51

Family transportation ..................................................................................................................... 52

Identification ................................................................................................................................... 52

Seat belt benefit .............................................................................................................................. 53

Home alteration and/or vehicle modification benefit .................................................................... 53

Common disaster benefit ............................................................................................................... 53

Escalation ........................................................................................................................................ 53

Hospital indemnity benefit ............................................................................................................. 53

May 1, 2010

Business venture benefit ................................................................................................................ 54

Aircraft coverage ............................................................................................................................. 54

Limit on benefit amounts ................................................................................................................ 55

Beneficiary ...................................................................................................................................... 55


Coverage ends ................................................................................................................................. 55



Benefits-At-A-Glance Extended Health Care Benefit Provisions… 100% payment of prescription drugs, hospital and other eligible medical

expenses.

Includes out‐of‐province emergency travel benefits.

Paramedical practitioners expenses, including: o $500 maximum per year per practitioner for chiropodist/podiatrist,

chiropractor, Christian Science practitioner, massage therapist, naturopath, osteopath, psychologist, and speech language pathologist.

o Contact Human Resources for physiotherapist coverage details.

For a Claim… For prescription drugs, present your direct‐bill drug card to your pharmacist at the time of purchase.

For all other claims, itemize and attach receipts to the Health Services claim form.

Health Services claim forms are available at: www.ab.bluecross.ca/group_forms.html

Submit to Alberta Blue Cross within 90 days of the end of the benefit year in which the expenses were incurred (August 1 to July 31).

If You Become Disabled…

You have the option of continuing Extended Health Care benefits while receiving disability benefits; you are required to pay for all applicable premiums.

If You Die… Coverage for your eligible dependents continues, premium‐free, for up to two (2) years, commencing the first day of the month following your death.

If You Terminate Employment or Retire…

Coverage ceases.

Dental Care Benefit Provisions… Basic services covered at 100%.

Major/Extensive services covered at 80%.

Combined maximum of $1,500 per person per year for Basic & Major/Extensive services.

Orthodontics covered at 50% to a maximum of $1,500 per lifetime for dependent children less than 19 years of age.

Basis of payment is the 2007 Alberta Blue Cross Usual & Customary Dental Schedule of Fees.

Coverage for Part‐Time employees is equal to one‐half of coverage indicated above: o 50% Basic services o 40% Major/Extensive services o $750 combined Basic and Major/Extensive benefit year maximum o 40% Orthodontic Services to a lifetime maximum of $750 per dependent

child For a Claim… Most dentists can submit claims electronically to Alberta Blue Cross.

If your dentist cannot submit claims electronically, obtain a dental claim form outlining procedures completed from your dentist. o Sign and submit to Alberta Blue Cross within 90 days of the end of the

benefit year in which the expenses were incurred. If You Become Disabled…

You have the option of continuing Dental Care benefits while receiving disability benefits; you are required to pay for all applicable premiums.

If You Die… Coverage for your eligible dependents continues, premium‐free, for up to two (2) years, commencing the first day of the month following your death.


Coverage ceases.

http://www.ab.bluecross.ca/group_forms.html

Health Spending Account Benefit Provisions… You may be eligible to receive an annual Health Spending Account

(HSA) allocation based on your employee classification and dependent status.

You may use your HSA to pay for eligible health, dental or vision expenses not covered by the group benefit plan.

The HSA plan year runs August 1 to July 31 each year.

HSA dollars are allocated monthly. For a Claim… Claims balances for services covered by the College’s group benefit plan will

be transferred automatically to your HSA after the Extended Health Care and Dental Care expenses have been adjudicated by Alberta Blue Cross.

Expenses that fall outside the group benefit plan which are eligible to be covered under the HSA require a claim form to be sent to Alberta Blue Cross. Health Spending Account claim forms are available at www.ab.bluecross.ca/group_forms.html

Payment will be made by Alberta Blue Cross monthly if you have at least $50

of eligible expenses (or $10 at year‐end) and adequate dollars in your account.

Unused HSA dollars can be carried forward for one (1) year only to pay for the following year’s eligible expenses.


Your HSA allocations are suspended during approved disability.

If You Die… Coverage ceases.

Unused allocations remaining in your HAS are forfeited at plan year‐end.

Your beneficiary has 90 days to submit any HSA expenses incurred up to the date of death.


Unused HSA balances are forfeited 90 days after your termination date.

You have 90 days to submit any HSA expenses incurred up to the date of termination.

Life Insurance Benefit Provisions… Administration Employees:

Death benefit of 3 x annual earnings (to a maximum of $200,000).

Faculty Employees:

Death benefit of $75,000.

A.U.P.E. Employees:

Death benefit of 2.5 x annual earnings (to a maximum of $100,000).

Your benefit reduces by 50% on your 65th birthday, and terminates at age 70.

Optional:

Employee & Spouse – units of $10,000 to $250,000 maximum for each covered person (25 units).

Your and/or your spouse’s benefit terminates once you reach age 65.

For a Claim… Beneficiary to notify Human Resources as soon as possible.

Complete claim form and submit original Death Certificate or Medical Examiner’s Report to Sun Life as soon as reasonably possible.

Benefits are paid to named beneficiary, or to Estate if beneficiary is not named.




If you become totally and continuously disabled, your coverage will continue.

For approved disabilities beyond the qualifying period, coverage will be extended without payment of premium until you recover or reach age 65. This includes Basic Life coverage, Optional Employee Life coverage, and Optional Spousal Life coverage.

Medical evidence is required to be submitted to Sun Life in order to prove continuing disability.

If You Die… Death benefit is paid to named beneficiary.

Coverage ceases.

Spouse may convert any Optional Life Insurance to an individual insurance policy within 31 days of date of death.


Coverage ceases.

You may convert your Life Insurance, or you and/or your spouse may convert any Optional Life Insurance coverage to individual policies within 31 days of date of termination/retirement, to a maximum of $200,000 per person (Basic and Optional Life coverage combined).

Accidental Death & Dismemberment Insurance

Benefit Provisions… Administration Employees:

Accident benefit of 4 x annual earnings (to a maximum of $250,000).

Faculty Employees:

Accident benefit of 4 x annual earnings (to a maximum of $250,000).

A.U.P.E. Employees:

Accident benefit of 2.5 x annual earnings (to a maximum of $100,000).

Your benefit reduces by 50% on your 65th birthday, and terminates at age 70.

Voluntary:

Employee only – units of $25,000 to $250,000 (10 units).

Employee & Family Plan – units of $25,000 to $250,000 (10 units); varying percentages of employee coverage for spouse & dependent children.

For a Claim… Notify Human Resources immediately.

Provide written notice of claim to AXA Assurances Inc. within 30 days of date of accident.

You may be asked to provide proof of loss within 90 days of the date of the accident.


If you become totally and continuously disabled, your coverage will continue.

For approved disabilities beyond the qualification period, coverage will be extended without payment of premium until you recover or reach age 65. This includes Basic AD&D coverage and Optional AD&D coverage.

If You Die… Applicable Accidental Death benefits are paid to named beneficiary (if death was caused by accidental means).

Coverage ceases. If You Terminate Employment or Retire…

Coverage ceases.

Long Term Disability (LTD) Benefit Provisions… Administration Employees:

Taxable benefit equal to 75% of monthly earnings up to a maximum monthly benefit of $7,500.

Commences after qualifying period of 130 working days or 6 months (whichever is shorter) of continuous disability.

Faculty Employees:

Non‐taxable benefit equal to 70% of monthly earnings up to a maximum monthly benefit of $3,000.


A.U.P.E. Employees:

Taxable benefit equal to 75% of monthly earnings up to a maximum monthly benefit of $3,000.


For a Claim… Obtain an LTD claim form from Human Resources.

Complete and submit the LTD claim form to Sun Life before your General Illness benefits expire.

You have three (3) months to submit your claim, though it is recommended you submit your completed claim form as soon as possible.


During the qualifying period and the 24 months immediately following it, you have a medical impairment due to injury or disease which prevents you from performing, in any setting, the essential duties of the occupation in which you participated just before the disability started;

After the 24 months period, you are unable, because of the medical impairment, to perform, in any setting, the essential duties of any occupation for which you have at least the minimum qualifications.

Benefits terminate at age 65. If You Die… If you have been receiving disability benefits, benefits cease.

Coverage ceases. If You Terminate Employment or Retire…

Coverage ceases upon attaining age 65, retirement, or termination, whichever is earlier.

LTD benefits in progress are not impacted by termination of employment.

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General Information About this booklet The information in this employee benefits booklet is important to you

and should be kept in a safe place. It provides the information you need about the group benefits available to you as an employee of Lakeland College. If there are any discrepancies between the group contracts and the information in this booklet, the group contracts will take priority. If you have any questions about the information in this employee benefits booklet, or if you need additional information about your group benefits, please contact the College’s Human Resources department or your employee group representative.

Eligibility To be eligible for group benefits, you must be in an eligible employee

category of Lakeland College. You must participate in the benefits as a condition of employment with the College. You must be a resident of Canada and be eligible for benefits under the provincial government health care programs in your province of residence. Lakeland College Full‐Time, Part‐Time, and Temporary employees may be eligible for benefits. Eligible employees include Faculty employees who work at least 14 hours per week, and A.U.P.E. and Administration employees who work at least 18 hours per week. Your coverage under this plan becomes effective on the date you become eligible. If you are a Permanent or Continuing employee, your benefits (excluding Dental Care, Optional Life Insurance, and Voluntary AD&D Insurance) commence on your actual date of hire. Dental Care benefits commence on the first of the month following 12 months of employment; Optional Life Insurance commences on the first day of the month coincident with or next following the date of evidence of insurability is approved by the insurer; and Voluntary AD&D Insurance commences on the first of the month following the College Human Resources receipt of your completed Voluntary AD&D application. If you are a Temporary AUPE employee, your Basic AD&D and Health Spending Account benefits commence on your actual date of hire. Extended Health Care and Long Term Disability benefits commence on the exact date following 12 months of continuous employment; Dental Care benefits commence on the first of the month following 12 months of

May 1, 2010 6

employment; Optional Life Insurance is available following 12 months of employment, and commences on the first day of the month coincident with or next following the date of evidence of insurability is approved by the insurer; and Voluntary AD&D Insurance is available after 12 months of employment, and commences on the first of the month following the College Human Resources receipt of your completed Voluntary AD&D application. If you are a Temporary Administration employee, your benefits (excluding Dental Care, Long Term Disability, Optional Life Insurance, and Voluntary AD&D Insurance) commence on your actual date of hire. Dental Care benefits commence on the first of the month following 12 months of employment; Optional Life Insurance commences on the first day of the month coincident with or next following the date of evidence of insurability is approved by the insurer; and Voluntary AD&D Insurance commences on the first of the month following the College Human Resources receipt of your completed Voluntary AD&D application. You are not eligible for Long Term Disability benefits. Your dependents become eligible for coverage on the date you become eligible or the date they first become your dependent, whichever is later. You must apply for coverage for yourself in order for your dependents to be eligible. You may opt‐out of the Extended Health Care and/or Dental Care benefits if you are already covered for similar benefits through your spouse’s group benefits plan. If you are absent from work on the date your coverage would be effective, then that coverage will not be effective until the date you return to active work.

Who qualifies as your dependent

Your dependent must be your spouse or your child. To be eligible, your spouse must be legally married to you, or your partner must have resided with you for a minimum of 12 months and must have been publicly represented as your spouse. You can only cover one spouse at a time. Your children and your spouse’s children (other than foster children), who are unmarried and under age 21, are eligible dependents. A child who is a full‐time student attending an accredited educational institution is also considered an eligible dependent until the age of 25, as

May 1, 2010 7

long as the child is entirely dependent on you for financial support. If a child becomes permanently handicapped before age 21 (or age 25, if in school), coverage will continue as long as:

• the child is incapable of financial self‐support because of a physical or mental disability, and

• the child depends on you for financial support, and remains

unmarried and unemployed. In these cases, you must notify the College’s Human Resources department within 31 days of the date the child attains the limiting age and re‐declared at the start of each school term.

Enrollment You have to enroll in the plan to receive coverage. To enroll, you must

complete the Employee Benefits Enrollment Form for you and your eligible dependent(s). If you and your dependents are covered for comparable Extended Health Care and/or Dental Care coverage under this or another group plan, you may waive the coverage provided under this plan. If, at a later date, the other coverage ends, you can enroll for coverage under this plan at that time. Benefits would commence on the 1st of the month following request.

Proof of Good Health

Proof of good health is required at the following times:

• when you or your spouse request Optional Life coverage; and

• when you or your spouse request to increase your or your spouse’s current Optional Life coverage.

Cost Sharing Cost sharing information for each of the benefits provided may be found

in the Collective Agreement for your respective employee group. Employee paid premiums

You are responsible for paying premiums associated with the Optional Life and Voluntary Accidental Death & Dismemberment Insurance benefits provided through the plan. Employee payments are made via payroll deduction on each pay cheque. Premium rates are subject to change on an annual basis.

May 1, 2010 8

When coverage begins

For the Optional Life benefit, your and / or your spouse’s coverage begins on the date the provider approves your and / or your spouse’s proof of good health. For all other benefits, your coverage begins on the date you become eligible for coverage, provided you are actively at work on that day. If you are not actively working on the date coverage would normally begin, your coverage will not begin until you return to active work. For all other benefits, dependent coverage begins on the date your coverage begins or the date you first have an eligible dependent, whichever is later. Once you have dependent coverage, any subsequent dependents will be covered automatically once you have completed a positive enrollment form indicating the child as a dependent. If there are additional conditions for a particular benefit, these conditions will appear in the appropriate benefit section in this booklet.

Changes affecting your coverage

From time to time, there may be circumstances that change your coverage. For example, your employment status may change, or the College may change the group contract. Any resulting change in the coverage will take effect on the date of the change in circumstances. The following exceptions apply if the result of the change is an increase in coverage:

• if proof of good health is required, the change cannot take effect before the provider approves the proof of good health.

• if you are not actively working when the change occurs or when

the provider approves proof of good health, the change cannot take effect before you return to active work.

Updating your records

To ensure that coverage is kept up‐to‐date, it is important that you report any of the following changes to the College’s Human Resources department:

• change of dependent(s);

• change of name;

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• change of beneficiary(ies); and

• termination of spousal health benefits coverage. When coverage ends

As an employee, your coverage will end on the earlier of the following dates:

• the date your employment ends or you retire.

• the date you are no longer eligible under the plan.

• the end of the period for which premiums have been paid for your coverage; or

• the date the group contract ends.

A dependent’s coverage terminates on the earlier of the following dates:

• the date your coverage ends;

• the date the dependent is no longer an eligible dependent; or

• the end of the period for which premiums have been paid for dependent coverage.

The termination of coverage may vary from benefit to benefit. For information about the termination of a specific benefit, please refer to the appropriate section of this employee benefits booklet.

Making claims Our benefits providers are dedicated to processing your claims promptly

and efficiently. A number of health and dental claims may be made directly from the service provider. For claims which cannot be made directly, you should contact the College’s Human Resources department to get the proper form to make a claim. There are time limits for making claims, which are discussed in the appropriate sections of this booklet. The Alberta Blue Cross claim forms are available online at www.ab.bluecross.ca/group_forms.html

Proof of disability From time to time, our disability benefits provider can require that you

provide proof of your total disability, if you are collecting disability benefits. If you do not provide this information as soon as possible, your benefits may be suspended or terminated.

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Coordination of benefits

Coordination of benefits exists when you, your spouse and/or dependents are covered under more than one benefit plan. By coordinating benefits, gaps in one plan may be covered by the other (for example, when the eligible amount of the primary plan does not cover all of an expense, the secondary plan may provide coverage for part or all of the balance). If you are covered for Extended Health Care and / or Dental Care under this plan and another plan, your benefits will be coordinated with the other plan following insurance industry standards. These standards determine where you should send a claim first:

• claims you are making for yourself are first claimed from the College’s plan. If you have similar coverage available through your spouse’s benefit plan, unused eligible expenses are then submitted to your spouse’s plan. Unclaimed expenses may then be submitted to your Health Spending Account (HSA) provided by the College, and then to your spouse’s HSA, if applicable.

• if you are claiming expenses for your spouse and the spouse is

covered for those expenses under another plan, you must send the claim to your spouse's plan first. Unused expenses may then be submitted to the College’s plan for reimbursement.

• if you are claiming expenses for your children, and both you and

your spouse have coverage under different plans, you must claim under the plan of the parent with the earlier birthday (month and day) in the calendar year. For example, if your birthday is May 1 and your spouse's birthday is June 5, you must claim under your plan first, and then your spouse’s plan. Claims made from your and / or your spouse’s HSA are made in the same order, if applicable.

• the maximum amount that you can receive from all plans for

eligible expenses is 100% of actual expenses. The College’s Human Resource representatives can help you determine which plan you should claim from first.

Medical examination

Our disability benefits provider can require you to have a medical examination if you make a claim for benefits. The provider will pay for the cost of the examination. If you fail or refuse to have this

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examination, the provider will not pay any benefit. Recovering overpayments

The benefits providers have the right to recover all overpayments of benefits either by deducting from other benefits or by any other available legal means.

Definitions Here is a list of definitions of some terms that appear in this employee

benefits booklet. Other definitions appear in specific benefit sections.

Accident Accident means any unlooked for mishap or untoward event which is not expected or designed.

Earnings Earnings refer to the salary you receive from the College excluding any

bonus, overtime or incentive pay.

Doctor A doctor is a physician or surgeon who is licensed to practice medicine where that practice is located.

Illness An illness is a bodily injury, disease, mental infirmity or sickness. Any

surgery needed to donate a body part to another person which causes total disability is an illness.

Retirement date If you are totally disabled, your retirement date is your 65th birthday,

unless you have actually retired before then.

We, our and us We, our and us mean Lakeland College.

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Extended Health Care General description of the coverage

In this section, you and participant means the employee and all dependents covered for Extended Health Care benefits. Extended Health Care coverage pays for eligible services or supplies for you that are medically necessary for the treatment of an illness. To qualify for this coverage you must be eligible for benefits under a provincial medicare plan or federal government plan that provides similar benefits. An expense must be claimed for the benefit year in which the expense is incurred within 90 days of the benefit year end. You incur an expense on the date the service is received or the supplies are purchased or rented. The benefit year is from each August 1st to the following July 31st.

Deductible There is no deductible for this coverage. Prescription drugs The plan covers 100% of the cost of drugs and supplies that are

prescribed in writing by a licensed Physician, Dentist, or Podiatrist and are obtained from a Pharmacist.

Payment Basis Electronic direct‐pay claims adjudication for prescription drugs; claim

form reimbursement basis for other benefits.

Eligible Drugs Drugs requiring a prescription by Provincial or Federal Law. Diabetic supplies including needles, syringes, blood glucose and urine test

strips. Injectable drugs products, including serums, vaccines, and injectable

vitamins. Hematinic vitamins listed in the compendium of pharmaceuticals and

specialties. Smoking cessation products limited to $330 per participant per benefit

year. Extemporaneous compounds prepared by a pharmacist. Contraceptive products, including oral contraceptives.

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Catheters, urinary kits, and colostomy supplies (where surgical stoma

applies). Selected Over‐The‐Counter products or patent or proprietary drugs with

a Registered Trade Mark (classification R) limited to:

• bronchodilators for treatment of asthmatic states; • anti‐inflammatory analgesics for treatment of rheumatoid

arthritis; • urinary analgesics for treatment of infections; • slow‐K, antiarrhyhmics and nitroglycerine for treating

cardiovascular disease; • antihistamines for treatment of allergic asthma, allergic rhinitis

and sinusitis, but specifically excluding their prescription for the treatment of the common cold;

• insulin for the treatment of diabetes; • medication required to treat disorders of the central nervous

system, such as Parkinsonism or Bell’s Palsy; • antihelmintics; dyscrasias to treat a morbid or toxic condition of

the blood; • antacids for the treatment of ulcerative conditions of the gastro‐

intestinal system, but specifically excluding their treatment for the treatment of gas, heartburn, and general gastric acidity; and

• medicated skin cleaners and skin protectors and inti‐seborrheic agents for of chronic skin disease.

Hospital benefits 100% coverage for private or semi‐private hospital accommodation.

Alberta Blue Cross is billed directly for your hospital accommodation expenses. A hospital is an institution located in Canada which is licensed and operates under any federal or provincial health insurance act or law, with facilities to provide active in‐patient treatment and care.

Auxiliary care The plan provides 100% coverage for up to 180 days per participant for

disability if admitted within 14 days of discharge from an active treatment hospital stay of at least five (5) days. Auxiliary care is defined as the care provided to the participant for long term or chronic illnesses in an auxiliary hospital or a publicly funded general active treatment hospital located in Canada.

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Other services The plan covers 100% of the costs for the medical services listed below:

Accidental dental Repair, extraction, and/or replacement of natural teeth (including braces and splints) occurring within 12 months of the date of accidental injury.

Ambulance services Transportation in a licensed ambulance if medically necessary (including

air ambulance), that takes you to and from the nearest hospital that is able to provide the necessary medical services.

Ancillary services Coverage includes blood and blood plasma, coagulotherapy, laboratory

services, oxygen and administration, radiotherapy, radium and radioactive isotopes, and X‐ray examinations.

Diabetic supplies Needles, syringes, urine and blood glucose testing strips.

Hearing aids $500 per participant in a five (5) consecutive year period.

Home nursing care Out‐of‐hospital home nursing care services when medically necessary.

Services must be for nursing care, and not for custodial care. The private duty nurse must be a Registered Nurse, Registered Nursing Assistant, or Licensed Practical Nurse who is not a relative by blood or marriage. There is a limit of $25,000 per participant in a three (3) consecutive year period. This service must be rendered on the written order of a Health Care Professional.

Mastectomy prosthesis

$200 per participant each benefit year, on the written order of a Health Care Professional.

Medical aids Includes coverage for casts, canes, crutches, cervical collars (on the

written order of a Health Care Professional), diaphragms, ileostomy supplies, colostomy supplies, intrauterine devices, splints, trusses, surgical stockings (to a maximum of $50 each benefit year, on the written order of a Health Care Professional), urinary kits, catheters, and walkers.

Medical durable

equipment On the written order of a Health Care Professional, includes coverage for

hospital beds, wheelchairs, iron lungs, respirators, and other approved medical equipment or supplies. Purchase or rental of the medical durable equipment is at the discretion of the benefits provider.

Orthopaedic shoes One (1) pair each benefit year, on the written order of a Health Care

Professional.

Paramedical practitioners

$500 per participant per year for the services performed by Chiropractors, Speech Language Pathologists, Massage Therapists (on the

May 1, 2010 15

written order of a Health Care Professional), Osteopaths, Naturopaths, Psychologists, and Chiropodists/Podiatrists. Services performed by Physiotherapists are covered with no annual maximum.

Permanent braces Included, on the written order of a Health Care Professional.

Prosthetics Conventional artificial limbs and eyes, excluding myoelectric controlled

prosthesis, on the written order of a Health Care Professional. Out of province Emergency Travel benefits

Benefits are provided as a result of a medical emergency which occurs outside your province of residence. This benefit provides 100% coverage for the following benefits:

• Outpatient charges incurred in a public general active treatment hospital located outside your province of residence.

• Expenses for active treatment care to a bed patient admitted to a hospital located outside your province of residence.

• Doctor’s charges for treatment provided outside your province of

residence where such charges are in excess of the amount paid by the provincial health plan in accordance with the Alberta College of Physicians and Surgeons Schedule.

• Medical evacuation to a hospital in your province of residence if

this is medically possible and in the best interest of the patient.

• Travel Assistance, including the provision of 24 hour telephone and telex services around the world in the event of emergency medical situations, sickness, or accident requiring hospitalization as follows: o Confirming coverage and payment of a doctor and/or

hospital; o Arrangements for medical evacuation by a qualified Physician

and then referral to a medical facility equipped to provide treatment;

o Transfer of the patient to another medical facility, if required; or

o The cost of air transport from the place in which the illness occurs to the home city in Canada (as follows), but only when supported by an order in writing from the attending

May 1, 2010 16

physician: To the maximum cost of one economy seat, return fare,

for an attendant (not a relative). If return by stretcher is required, to the maximum cost of

two seats – one for accommodation of the stretcher, one (return fare) for an attendant (not a relative).

Patient’s fare to the maximum of one economy seat if not previously arranged.

When coverage ends

Coverage terminates for you and your eligible dependents once you reach age 70, retire, or terminate employment with the college, whichever first occurs.

When and how to make a claim

Most prescription drug claims may be direct‐billed by the pharmacy once you present your drug card to your pharmacist. To make a claim for other services or devices, complete the claim form that is available from www.ab.bluecross.ca/group_forms.html. Claims must be submitted no later than 90 days after the end of the benefit year during which the expenses were incurred.

Overall maximum An overall combined maximum of $2,000,000 per participant each

benefit year applies to the Extended Health Care and Dental Care benefits.

What is not covered

The plan will not pay for the costs of:

• services or supplies payable in whole or in part under any government‐sponsored plan or program.

• services or supplies to the extent that their costs exceed the

reasonable and usual rates in the locality where the services or supplies are provided.

• equipment that the provider considers ineligible (examples of this

equipment are orthopaedic mattresses, exercise equipment, air‐conditioning or air‐purifying equipment, whirlpools, humidifiers, and equipment used to treat seasonal affective disorders).

• any services or supplies that are not usually provided to treat an

illness, including experimental treatments.

May 1, 2010 17

The plan will not pay benefits when the claim is for an illness resulting from:

• the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.

• any work for which you were compensated that was not done for

the College. • participation in a criminal offence.

May 1, 2010 18

Dental Care General description of the coverage

In this section, you and participant means the employee and all dependents covered for Dental Care benefits. Dental Care coverage pays for eligible expenses that you incur for dental procedures provided by a licensed dentist, denturist, and dental hygienist while you are covered by this group plan. For each dental procedure, the plan will cover expenses up to the fee stated in the 2007 Alberta Blue Cross Usual & Customary Schedule of Fees for General Practitioners and Specialists in Alberta, regardless of where the treatment is received. The plan will not pay more than the reasonable cost of the least expensive alternate procedure. When deciding what the plan will pay for a procedure, the provider will first determine if other or alternate procedures could have been done. If you receive any temporary dental service, it will be included as part of the final dental procedure used to correct the problem and not as a separate procedure. The fee for the permanent service will be used to determine the reasonable and customary charge for the final dental service. Claims are processed based on the date which the service is incurred. You incur an expense on the date your dentist performs a single appointment procedure or an orthodontic procedure. For other procedures which take more than one appointment, you incur an expense once the entire procedure is completed. The benefit year is from August 1st to the following July 31st.

Deductible There is no deductible for this coverage. Time unit One (1) time unit is equal to 15 minutes. Basic dental services

The plan covers 100% of the reasonable and customary charges for the Basic dental services listed below, up to a maximum of $1,500 per participant per benefit year (combined with Extensive dental services).

Diagnostic services • One (1) complete oral exam per Health Care Professional in any 24

month period. • Two (2) recall/other oral exam per Health Care Professional each

May 1, 2010 19

benefit year. • Emergency dental exams. • One (1) complete set of complete/panoramic radiographs in any 24

month period. • Two (2) sets of bitewing radiographs each benefit year. A bitewing x‐

ray is a routine check‐up x‐ray used to detect decay in molar teeth.

Preventative services

• Two (2) time units of polishing (teeth cleaning) each benefit year. • Two (2) fluoride treatments each benefit year. • Space maintainers included for missing primary teeth when used to

maintain the space for a permanent tooth, but not if the maintainer is used to gain space.

• Habit breaking devices. • Pit and fissure sealants (a coating put on top of any pits or cracks in

teeth to prevent cavities from forming). • Two (2) time units of oral hygiene instruction (how to brush and floss)

each benefit year.

Restorative services You are covered for amalgam, synthetic porcelain and plastic fillings. A stainless steel crown is covered only if the tooth cannot be restored to contour and contact adequately with a filling.

Oral surgery You are covered for extraction procedures and other oral surgery

including pre‐ and post‐operative care.

Endodontics Endodontics is root canal therapy and root canal fillings, and treatment of disease of the pulp tissue. You are covered for diagnostic and treatment procedures for pulpal therapy and root canal therapy once per tooth in any 24 month period.

Periodontics Scaling means removing calcium deposits above and below the gum line.

Root planing is the final smoothing of rough tooth surfaces and removing any remaining calcium deposits. You are covered for 18 time units of scaling and root planing in any 12 month period.

General anesthesia When required in the course of dental treatment.

Denture services • Relines (adding material so that the dentures fit properly).

• Rebasing (fitting dentures with a new base). • Denture repairs (fixing broken or damaged dentures).

Pre‐authorization

amount The plan requires that you send the provider an estimate, before the

work is done, for any major treatment or any procedure that will cost more than $800. You should send the provider a completed dental claim

May 1, 2010 20

form that shows the treatment that the dentist is planning and the cost. Both you and the dentist will have to complete parts of the claim form. The provider will tell you how much of the planned treatment is covered. This way you will know how much of the cost you will be responsible for before the work is done. Dental treatment plan forms are available from the Alberta Blue Cross website www.ab.bluecross.ca/group_forms.html.

Extensive dental services

The plan covers 80% of the reasonable and customary charges for the Extensive dental services listed below, up to a maximum of $1,500 per participant per benefit year (combined with Basic dental services).

Crowns A crown is a fixed restoration that covers a major part of the entire

surface of the natural tooth. Crowns are only covered for teeth which cannot be restored to form with a regular filling. You are covered for one (1) crown per tooth in any five (5) year period.

Inlays and onlays Inlays and onlays are metal or porcelain fillings placed on the surface of

the tooth. Inlays and onlays are only covered for teeth which cannot be restored to form with a regular filling. You are covered for one (1) inlay or onlay per tooth in any five (5) year period.

Pre‐fabricated

veneers, jackets Veneers are white facings put on the front of the tooth's surface.

Veneers are only covered for teeth that cannot be restored with a regular filling as long as they are not used primarily to improve appearance. You are covered for one (1) veneer or jacket per tooth in any five (5) year period.

Fixed bridges You are covered for one (1) fixed bridge per tooth in any five (5) year

period.

Posts and cores You are covered for one (1) post or core per tooth in any five (5) year period.

Gold restorations You are covered for one (1) gold restoration per tooth in any five (5) year

period.

Dentures You are covered for one (1) partial denture in any five (5) year period. You are covered for one (1) upper and/or one (1) lower complete denture in any five (5) year period.

Pre‐authorization

amount The plan requires that you send the provider an estimate, before the

work is done, for any major treatment or any procedure that will cost

May 1, 2010 21

more than $800. You should send the provider a completed dental claim form that shows the treatment that the dentist is planning and the cost. Both you and the dentist will have to complete parts of the claim form. The provider will tell you how much of the planned treatment is covered. This way you will know how much of the cost you will be responsible for before the work is done. Dental treatment plan forms are available from the Alberta Blue Cross website www.ab.bluecross.ca/group_forms.html.

Orthodontic services

Your dental benefits include procedures used to treat misaligned or crooked teeth. Only dependent children under age 19 are covered for these procedures. Coverage includes orthodontic examinations, including orthodontic diagnostic services and fixed or removable appliances such as braces, retainers, and habit‐breaking appliances. The plan covers 50% of the reasonable and customary charges for the orthodontic services listed below, up to a maximum of $1,500 per lifetime per participant. Eligible participants include dependent children under 19 years of age (no adult participant coverage). A treatment plan must be completed for all orthodontic claims.

When coverage ends

Coverage terminates for you and your eligible dependents once you reach age 70, retire, or terminate employment with the College, whichever first occurs.


Dental claims may be direct‐billed to Alberta Blue Cross by your dentist. To make a claim for procedures not billed directly, complete the claim form that is available from your dentist or from the Alberta Blue Cross website www.ab.bluecross.ca/group_forms.html. Claims must be submitted no later than 90 days after the earliest of the following dates:

• the end of the benefit year during which the expenses were incurred; and

• the termination of your coverage.

May 1, 2010 22

Overall maximum An overall combined maximum of $2,000,000 per participant each benefit year applies to the Extended Health Care and Dental Care benefits.

What is not covered

The plan does not pay for services or supplies payable in whole or in part under any government‐sponsored plan or program. The plan does not pay for:

• procedures performed primarily to improve appearance. • the replacement of dental appliances that are lost, misplaced or

stolen. • charges for appointments that you do not keep. • charges for completing claim forms. • supplies usually intended for sport or home use, for example,

mouth guards, night guards, snoring appliances, and sleep apnea appliances.

• procedures or supplies used in full mouth reconstructions

(capping all of the teeth in the mouth), vertical dimension corrections (changing the way the teeth meet) including attrition (worn down teeth), alteration or restoration of occlusion (building up and restoring the bite), or for the purpose of prosthetic splinting (capping teeth and joining teeth together to provide additional support).

• experimental procedures.

The plan also does not pay for dental work resulting from:

• the hostile action of any armed forces, insurrection or

participation in a riot or civil commotion. • teeth malformed at birth or during development. • participation in a criminal offence.

The plan does not pay benefits when compensation is available under a Workers' Compensation Act, Criminal Injuries Act or similar legislation.

May 1, 2010 23

Health Spending Account (HSA) General description of the coverage

Your Health Spending Account (HSA) is a tax‐effective benefit program that complements the College’s group Extended Health Care and Dental benefit plans by providing you with additional choices for managing your health‐related expenses. An HSA is like a bank account into which the College deposits dollars for eligible employees and from which you may be reimbursed for eligible health and dental expenses. HSA dollars may be used to cover expenses not covered by the College’s existing group health/dental plans or to top‐up expenses not fully covered by the College’s group health/dental plans, including co‐payment amounts (the amount of the eligible expense that you have to pay) and out‐of‐pocket expenses. Since your HSA allocations are provided to you by the College as pre‐tax dollars, the HSA is a tax‐effective way of paying for your eligible health‐related expenses. Your HSA differs significantly from your regular group benefit plan. For one thing, the Income Tax Act of Canada establishes the types of expenses eligible for reimbursement and the criteria for determining eligible dependents. In general, these definitions are broader for an HSA than for a traditional benefit plan. As well, unlike many health and dental benefit plans, there is no provision for opting out of an HSA; all eligible College employees must participate.

HSA benefit year Each HSA benefit year begins August 1 and ends the following July 31. HSA allocation Each month, Lakeland College deposits HSA dollars to your personal HSA,

as long as you continue to be eligible for benefits. You use these HSA dollars to claim eligible medical expenses you and/or your dependents incur. The amount of your allocation is based on your employment category at the College and your Extended Health Care dependent status. Your annual HSA allocation is as follows:

May 1, 2010 24

Employee Category EHC Coverage

Annual HSA Allocation Faculty AUPE Admin

CFT FTP FTC Family Single

$800 $400

CPT CRT

PTP PTC Family Single

$480 $240

SFT TEM FTCT

T Family Single

$600 $300

PTCT Family Single

$360 $180

HSA eligibility and allocations commence on your date of hire. Monthly allocations are not prorated. There is a maximum of one family account per family unit.

Dependent eligibility

The Income Tax Act of Canada establishes the criteria for determining eligible dependents. In general, these definitions are broader for an HSA than for a traditional benefit plan; for example, an HSA allows you to cover health‐related expenses for family members not considered dependents under a traditional benefit plan but who qualify as dependents for income tax purposes.

How to make a claim from your HSA

Balances on any claim that has already been adjudicated and paid by Alberta Blue Cross (including paper and electronically‐submitted claims) automatically flow to your HSA – you do not need to submit a claim form for HSA reimbursement for these claim balances. For all other claims (i.e. those not already adjudicated by Alberta Blue Cross), you must complete and submit an Alberta Blue Cross HSA claim form, attaching all original receipts and/or any Explanation of Benefits statements that indicate payment from another benefit provider. Claims may be dropped off at any Alberta Blue Cross office or mailed to the address on the claim form. All claims must be received by Alberta Blue Cross no later than 90 days after the end of the HSA benefit year in which they were incurred. Claim forms are available from the Alberta Blue Cross web site (http://www.ab.bluecross.ca/forms.html). HSA reimbursement cheques are automatically produced as per the following guidelines:

May 1, 2010 25

• The expenses must be eligible according the Canadian Income Tax Act;

• You must have enough eligible claims and HSA dollars in your account to meet the monthly minimum claims threshold amount. Any remaining claims will be paid out following the 90 day claims run‐off period.

Claims cheques for eligible expenses are paid monthly by the HSA administrator (Alberta Blue Cross), provided the eligible claims threshold minimum is reached and your HSA dollar balance exceeds this threshold. The claims threshold amount is $50 for each monthly HSA cheque run, and is $10 for the end‐of‐year run‐off HSA cheque run (made approximately 90 days after each HSA benefit year end).

Automatic vs.

discretionary claims As indicated above, balances on any claims which the HSA administrator

has adjudicated (including paper and electronically‐submitted claims) will flow into your HSA as eligible expenses and automatically be paid out on a monthly basis. If you do not want this automatic payment to occur, you can agree, in writing, to change your claims payment default from automatic to discretionary. This means that the benefit administrator will pay claims if and only if you submit a claim form requesting payment for the eligible expenses to the plan administrator. Note that this action increases the potential for HSA balance forfeitures, which are not recoverable. If you wish to make this change, complete the Health Spending Account Payment Options form (available on Public Folders) and submit it to Alberta Blue Cross.

HSA carry‐forward and forfeiture rules

According to the rules of the Income Tax Act of Canada, an HSA must include an element of risk in order for it to maintain its tax exempt status. Consistent with this, your unused HSA dollar balance will be carried forward for one plan year (August 1 to the following July 31) only. If you do not use these HSA dollars in the second plan year, they will be forfeited back to the College to be re‐allocated to all HSA participants the following year. Eligible expenses incurred during the benefit year must be claimed within 90 days of the end of the benefit year (i.e. prior to October 31); they may not be carried forward to be claimed the following year.

May 1, 2010 26

Coordination of benefits

Coordination of benefits exists when you, your spouse and/or dependents are covered under more than one benefit plan. By coordinating benefits, gaps in one plan may be covered by the other (for example, when the eligible amount of the primary plan does not cover all of an expense, the secondary plan may provide coverage for part or all of the balance). With an HSA, submit expenses to all other potential payers first (i.e. provincial health care and/or other health and dental benefit plans). Doing so enables you to maximize the use of your HSA allocation by ensuring it pays only for expenses these plans do not. If you and your spouse both have a health and/or dental benefit plan, submit your own expenses to your benefit plan first. If you have outstanding uncovered expenses (that you have paid out of your own pocket), submit these expenses, along with an Explanation of Benefits form, to your spouse's plan. Finally, if you still have unpaid expenses remaining after submitting the expenses to your group plan and to your spouse’s group plan, the expenses may be submitted to your HSA. Your spouse's expenses should be submitted first to his or her own benefit plan, then to yours. Any amount remaining after both plans have paid can be submitted to your HSA. If you have children, submit their expenses to the benefit plan of the parent whose birthday is earliest in the year (not the oldest), then to the other parent's plan (for example if your birthday is March 1 and your spouse’s birthday is August 3 your benefit plan pays first). Any remaining amount can be submitted to your HSA.

What is covered by your HSA

Your Health Spending Account may reimburse you for medical related expenses not covered by provincial health care or your group health and dental plan. In general, any medical related expense which could be used to meet requirements for deductibility on your personal income tax return (in accordance with the Canada Income Tax Act) is eligible for reimbursement. For example, deductible and co‐payment amounts may be reimbursed for health and dental benefits along with the cost of other procedures not covered by the supplemental health and dental plans (such as ineligible drugs, vision care expenses, orthodontic procedures, etc.). The definition of eligible expenses is occasionally updated to add or remove eligible expenses. As such, the following information is provided

May 1, 2010 27

by Johnson Inc. as a guideline only. The list of allowable expenses below is not comprehensive and is subject to change at any time without notice. This information does not supersede information or decisions rendered by Canada Revenue Agency. It is in your best interest to review the list of eligible HSA expenses on the Canada Revenue Agency web‐site. This list is available at: http://www.cra‐arc.gc.ca/tx/ndvdls/tpcs/ncm‐tx/rtrn/cmpltng/ddctns/lns300‐350/330/llwbl‐eng.html In addition to deductibles and coinsurance amounts, the expenses covered by the account could include the following items, as long as these are not covered by any other provincial health insurance or supplemental health and dental care plans:

Paramedical practitioners

• Acupuncturists • Chiropodists and/or Podiatrists • Chiropractors • Christian Science Practitioners • Dental Hygienists • Dental Mechanic • Dentist • Dietician • Medical Doctor • Naturopath • Nurses and/or Practical Nurses • Occupational Therapist • Oculist • Ophthalmologist • Optometrist • Osteopath • Pharmacist • Physician • Physiotherapist • Psychoanalysts • Psychologists • Speech Language Pathologists and/or Audiologists • Therapeutists

Dental expenses • Preventive, diagnostic, restorative, orthodontic and therapeutic care

May 1, 2010 28

Facilities • Alcoholism or drug addiction treatment centres, including meals and lodgings

• Care in a nursing home • Care in a self‐contained domestic establishment (e.g. in own home) • Care of a person who has been certified to be mentally incompetent • Care in a special school, institution or other place for a mentally or

physically handicapped individual • Care in an institution • Care of a blind person • Full time attendants or care in a nursing home (for confinement to a

bed or wheelchair) • Payment to a licensed private hospital • Semi‐private, preferred or private charges in a hospital

Devices and

supplies • Artificial eyes or limbs • Crutches • Device or equipment, including replacement part, designed

exclusively for use by an individual who is suffering from a chronic respiratory ailment to assist breathing, but not including an air conditioner, humidifier, dehumidifier, or air cleaner

• Device or equipment designed to pace or monitor the heart of an individual who suffers from heart disease

• Device designed to assist an individual in walking, when the individual has mobility impairment

• Device or equipment, including a synthetic speech system Braille printer and large print‐on‐screen device, designed exclusively to be used by a blind individual in the operation of a computer

• Device to decode special television signals to permit the vocal portion of the signal to be visually displayed

• Device designed to be attached to infants diagnosed as being prone to sudden infant death syndrome in order to sound an alarm if the infant ceases to breathe

• Device designed to enable diabetics to measure blood sugar levels • Diapers, disposable briefs, catheters, catheter trays, tubing or other

products required by the patient by reason incontinence caused by illness, injury or affliction

• Drugs, medications or other preparations or substances prescribed by a medical practitioner and recorded by a pharmacist

• Electronic speech synthesizer that enables a mute individual to communicate by use of a portable keyboard

• External breast prosthesis that is required because of a mastectomy • Hearing aids • Hospital bed, including attachments to it that may have been

May 1, 2010 29

included in a prescription • Ileostomy or colostomy pads • Insulin • Iron lung • Kidney machines • Laryngeal speaking aids • Limb braces • Mechanical device or equipment designed to be used to assist an

individual to enter or leave a bathtub or shower, or to get on or off a toilet

• Needle or syringe • Optical scanner or similar device designed to be used by blind

individuals to enable them to read print • Orthopedic shoe or boot, or an insert for a shoe or boot, made to

order for an individual in accordance with a prescription to overcome a physical disability of the individual

• Oxygen tent or equipment • Power operated lift designed exclusively for use by disabled

individuals to allow them access to different levels of a building or assist them to gain access to a vehicle, or to a place a wheelchair in or on a vehicle

• Reasonable expenses relating to rehabilitative therapy, including training in lip reading and sign language incurred to adjust for hearing or speech loss

• Spinal braces • Auditory feedback devices for the treatment of a speech disorder • Electrotherapy devices for the treatment of a medical condition or a

severe mobility impairment • Standing devices for standing therapy in the treatment of a severe

mobility impairment • Pressure pulse therapy devices for the treatment of a balance

disorder • Teletypewriter or similar device, including telephone ringing

indicator, that enables a deaf or mute individual to receive telephone calls

• Walkers • Wheelchairs • Wigs made to order for individuals who suffer from abnormal hair

loss owing to disease, medical treatment, or accident • On behalf of a patient who is blind, profoundly deaf, autistic, epileptic

or has a severe and prolonged impairment that markedly restricts the use of the patient’s arms or legs, (i) for an animal specially trained to assist the patient in coping

May 1, 2010 30

with impairment and provided by a person or organization whose main purpose is such training of animals

(ii) for the care and maintenance of such an animal, including food and veterinary care

(iii) for reasonable traveling expenses that the patient incurred for the purpose of attending a school, institution or other facility that trains in the handling of such animals, and

(iv) for reasonable board and lodging expenses of the patient incurred for the purpose of maintaining full‐time attendance at a school, institution or other facility referred to in subparagraph (iii).

Other eligible HSA

expenses • Ambulance fees for transportation • Medically necessary or reconstructive cosmetic surgery • Cost of arranging and having a bone marrow or organ transplant • Costs of medical services and supplies out of the province of

residence • Hearing expenses, including hearing aids and hearing‐ear dogs • Laboratory, radiological, or other diagnostic procedures or services • Modifications to a home for individuals confined to a wheelchair • Preventive diagnostic, laboratory, and radiological procedures • Transportation expenses to receive medical care, including:

(i) cost of using public transportation or private vehicle if not available, for distances of 40 kilometers or greater

(ii) costs of meals and accommodation if travel distance is at least 80 kilometers,

(iii) reasonable transportation, meals and accommodation for one accompanying person, if a physician certifies that a person is not capable of traveling alone

• Vision expenses including eyeglasses, contact lenses, laser eye surgery and seeing‐eye dogs

May 1, 2010 31

Basic Life Insurance Benefits General description of the coverage

Your Basic Life coverage provides a benefit for your beneficiary if you die while covered. Basic Life insurance benefits paid are non‐taxable in the hands of the beneficiary(ies).

Administration Employees

Basic Life benefit Your benefit is 3 times your annual earnings, rounded to the next higher $1,000. The maximum amount of coverage is $200,000.

Faculty Employees

Basic Life benefit Your benefit is $75,000.

A.U.P.E. Employees

Basic Life benefit Your benefit is 2.5 times your annual earnings, rounded to the next higher $1,000. The maximum amount of coverage is $100,000.

Basic Life benefit reduction

Your benefit reduces by 50% on your 65th birthday.

Coverage ends Your coverage will end when you retire or reach age 70, whichever is

earlier. Who the plan will pay

If you die while covered, the provider will pay the full amount of your benefit to your last named beneficiary on file. If you have not named a beneficiary, the benefit amount will be paid to your estate. Anyone can be your beneficiary. You can change your beneficiary at any time, unless a law prevents you from doing so or you indicate that the beneficiary is not to be changed without their consent.

Basic Life coverage during total disability

If you become totally disabled before you retire or reach age 65, whichever is earlier, Basic Life coverage may continue without payment of premiums as long as you are totally disabled. This continued coverage is subject to the terms of the contract which were in effect on the date you became totally disabled, including reductions and terminations. Your total disability must continue for an uninterrupted period equal to your Long Term Disability Qualifying period in order for you to be eligible

May 1, 2010 32

for waiver of premium. You must submit a disability claim for waiver of premium along with your claim under the group Long Term Disability insurance to Sun Life. If you are approved for waiver of premium, this coverage will continue without payment of premiums until the date you cease to be totally disabled or the date you fail to give the provider proof of your continued total disability, whichever is earlier. If you continue to qualify for premium waiver while you are disabled, it may continue until you reach age 65, at which point it expires. When your disability benefits terminate, your Basic Life insurance terminates. When you return to active work with Lakeland College, that insurance will be reinstated.

Converting Basic Life coverage

If your Basic Life coverage ends, you may apply to convert the group Basic Life coverage to an individual Life policy with Sun Life without providing proof of good health. The request must be made within 31 days of the reduction or end of the Basic Life coverage. The maximum amount you may convert is the lesser of:

• the amount of the insurance terminated; • the maximum amount of insurance for which you have been

insured under this provision less the total amount of individual insurance still in force on your life which was previously obtained through the Conversion Privilege of this provision, or;

• $200,000 (Basic and Optional Life Insurance combined).

If your insurance terminates while this provision continues in force and you die within 31 days after termination of insurance, the amount of insurance which you could have converted to an individual policy on your life through the Conversion Privilege of this provision will be paid to your beneficiary.


Claims for Basic Life benefits must be made as soon as reasonably possible, but must be within six (6) years from the date of the loss. Claim forms are available from the College.

May 1, 2010 33

Optional Life Insurance Benefits General description of the coverage

In addition to the Basic Life coverage you receive as an employee of Lakeland College, Optional Life insurance is available for you and / or your spouse, subject to medical evidence. All Optional Life insurance benefits paid are non‐taxable in the hands of the beneficiary(ies).

Optional Life coverage for you and / or your spouse

You and / or your spouse can choose Optional Life insurance coverage in units of $10,000. The maximum amount of coverage is $250,000, or 25 units. Proof of good health is required on all Optional Life insurance coverage.

Coverage ends Your coverage and / or your spouse’s coverage will end when you retire

or reach age 65, whichever is earlier. Who the plan will pay

If you die while covered, the provider will pay the full amount of your benefit to your last named beneficiary on file. If you have not named a beneficiary, the benefit amount will be paid to your estate. Anyone can be your beneficiary. You can change your beneficiary at any time, unless a law prevents you from doing so or you indicate that the beneficiary is not to be changed without their consent. If you have elected to participate in the Optional Spousal Life benefit and your spouse dies, the provider will pay you the benefit.

Suicide If you or your spouse have any optional coverage that has been in effect

for less than two (2) years, the plan will not pay benefits if death is by suicide, while sane or insane.

Optional Life coverage during total disability

If you become totally disabled before you retire or reach age 65, whichever is earlier, Optional Life coverage may continue without payment of premiums as long as you are totally disabled. This continued coverage is subject to the terms of the contract which were in effect on the date you became totally disabled, including reductions and terminations. Your total disability must continue for an uninterrupted period equal to your Long Term Disability Qualifying period in order for you to be eligible for waiver of premium. You must submit a disability claim for waiver of premium along with your claim under the group Long Term Disability

May 1, 2010 34

insurance to Sun Life. If you are approved for waiver of premium, this coverage will continue without payment of premiums until the date you cease to be totally disabled or the date you fail to give the provider proof of your continued total disability, whichever is earlier. If you continue to qualify for premium waiver while you are disabled, it may continue until you reach age 65, at which point it expires. When your disability benefits terminates, your Optional Life insurance terminates. When you return to active work with Lakeland College, that insurance will be reinstated.

Converting Optional Life coverage

If your Optional Life coverage ends, you may apply to convert the group Optional Life coverage to an individual Life policy with Sun Life without providing proof of good health. If your spouse's Optional Life coverage ends for any reason other than your request your spouse may apply to convert his or her group Optional Life coverage to an individual Life policy with Sun Life without providing proof of good health. The request must be made within 31 days of the reduction or end of the Optional Life coverage. The maximum amount you and / or your spouse may convert is the lesser of:

• the amount of the insurance terminated; • the maximum amount of insurance for which you have been

insured under this provision less the total amount of individual insurance still in force on your life which was previously obtained through the Conversion Privilege of this provision, or;

• $200,000 (Basic and Optional Life Insurance combined).

If your insurance terminates while this provision continues in force and you die within 31 days after termination of insurance, the amount of insurance which you could have converted to an individual policy on your life through the Conversion Privilege of this provision will be paid to your beneficiary.


Claims for Optional Life benefits must be made as soon as reasonably possible, but must be within six (6) years from the date of the loss. Claim forms are available from the College.

May 1, 2010 35

Long Term Disability Benefits General description of the coverage

Your Long Term Disability (LTD) coverage provides a monthly income benefit if you are unable to work for an extended period due to an illness or injury.

Administration Employees

Monthly benefit Your monthly LTD disability is equal to 75% of your monthly earnings, up to a maximum monthly benefit of $7,500. Any benefit you receive is considered to be taxable income by the Canada Revenue Agency.

Qualifying period Your benefits commence after a qualifying period of 130 working days or

six (6) months, whichever is shorter, of continuous disability. Faculty Employees

Monthly benefit Your monthly LTD disability is equal to 70% of your monthly earnings, up to a maximum monthly benefit of $3,000. Any benefit you receive is not considered to be taxable income by the Canada Revenue Agency.


six (6) months, whichever is shorter, of continuous disability. A.U.P.E. Employees

Monthly benefit Your monthly LTD disability is equal to 75% of your monthly earnings, up to a maximum monthly benefit of $3,000. Any benefit you receive is considered to be taxable income by the Canada Revenue Agency.


four (4) months, whichever is shorter, of continuous disability. Definition of disability

During the qualifying period and the 24 months immediately following it, you have a medical impairment due to injury or disease which prevents you from performing, in any setting, the essential duties of the occupation in which you participated just before the disability started. After the 24 months period, you are unable, because of the medical impairment, to perform, in any setting, the essential duties of any occupation for which you have at least the minimum qualifications. The medical impairment must be supported by objective medical evidence.

May 1, 2010 36

The availability of work for you does not affect the determination of totally disabled or total disability.

Benefit payment reductions

Your monthly disability benefit is reduced by any benefits or payments, before deductions, under any government plan, law or agency, such as the Canada Pension Plan/Quebec Pension Plan, the Quebec Parental Insurance Plan, the Workers’ Compensation Act, Workplace Safety and Insurance Act, or other similar legislation, resulting from your same, subsequent or related disability, excluding benefits or payments on behalf of a dependant. If the benefit payable to you is taxable, the monthly disability benefit will be further reduced so that the total amount of benefits and payments from All Sources does not exceed 85% of your monthly rate of earned income in force on the date you became totally disabled. If the benefit payable to you is non‐taxable, the 85% will be applied to your monthly rate of earned income reduced by income tax deductions. “All Sources” include but are not limited to benefits or payments provided:

• under another group insurance policy (including a policy under which you are insured because you belong to an association)

• under an automobile insurance policy

• under a retirement income plan providing income that becomes payable after you are no longer actively at work, whether or not the retirement income is related to disability

• under any government plan, law or agency, such as the Canada

Pension Plan/Quebec Pension Plan, the Quebec Parental Insurance Plan, the Workers’ Compensation Act, Workplace Safety and Insurance Act, or other similar legislation, resulting from your same, subsequent or related disability, excluding benefits or payments on behalf of a dependant.

Sun Life will not take into account any benefits or payments that began before your disability began. However, increases in those benefits or payments as a result of your disability will be taken into account. Benefits or payments from the following sources will not reduce the monthly disability benefit:

May 1, 2010 37

• a policy which is solely an individual disability policy;

• a disability attachment to an individual life insurance policy; and

• a government plan providing disability benefits or payments if Sun Life receives proof that the initial application and an appeal filed within one year of the original decision to decline those disability benefits, have been declined.

Increases in the disability benefits or payments payable under a government plan may occur because of an automatic adjustment in the cost of living. These increases will not further reduce the amount of the monthly disability benefit. If you are eligible for any of the benefits or payments described above, and do not make satisfactory application for them, Sun Life will still consider them when calculating the monthly disability benefit. Sun Life can estimate those benefits or payments and use them to calculate your monthly disability benefit. Total benefits and payments from all sources will not be less than the amount of the disability benefit for which you are insured.

Benefit payment schedule

Benefits are paid in arrears and will begin one month after you become eligible to receive them. A proportionate amount of your monthly benefit will be paid for each full day you are totally disabled for less than a full month, once you have qualified for benefits.

Waiver of premium LTD premiums will be waived while you are receiving disability benefits. Rehabilitation If your disability prevents you from returning to work, Sun Life may be

able to assist you by providing a rehabilitation program that will help you return to the workforce. A rehabilitation program can involve vocational retraining, educational programs and trial or part time work in a new or related field.

Partial disability A partial disability benefit will be paid to you if you are receiving income

under an approved rehabilitation program. The partial disability benefit is your monthly benefit payable reduced by 50% of your monthly rehabilitation income. Your partial disability benefit will be further reduced so that the total amount of your income from all sources does not exceed 100% of your pre‐disability income.

Third party liability Subrogation is a legal practice giving Sun Life the right to be reimbursed

May 1, 2010 38

for benefits paid to you if you have been compensated by another person who is responsible for your loss. If subrogation applies to your claim, Sun Life will contact you to obtain the information required to proceed. You will be required to sign an undertaking to reimburse Sun Life for any amount recovered which exceeds 100% of income or expenses. Before agreeing to a settlement of your claim, Sun Life’s approval must be obtained.

Exclusions and limitations

No benefit is payable for a disability due to or related to:

• intentionally self‐inflicted injuries;

• civil disorder or war, whether or not war was declared; or

• a pre‐existing condition, if you become disabled within 12 months of becoming insured.

You are not considered totally disabled unless you are under the active, continuous and medically appropriate care of a physician and are following the treatment prescribed by the physician for that disability. You are not considered totally disabled due to the use of drugs or alcohol unless you are being actively supervised by and receiving continuous treatment for that disability from a rehabilitation centre or an institution provincially designated for that treatment.

Pre‐existing condition

A pre‐existing condition is one for which you received medical attention, consultation, diagnosis or treatment, during the 12 months before you became insured. This exclusion does not apply if:

• after becoming insured, you have been actively working for 13 consecutive weeks with no absence related to the pre‐existing condition; or

• you were insured for similar coverage under a previous policy

issued to this group, if the previous policy was replaced by this provision within 31 days of its termination.

Termination of benefits

Benefits are payable until the earlier of recovery, return‐to‐work of any sort (except for rehabilitative employment approved by the provider), retirement, age 65, or death. LTD benefits may cease earlier if you refuse:

May 1, 2010 39

• recommended treatment or therapy;

• an offer of appropriate employment;

• appointments with a rehabilitation consultant;

• a medical examination with an independent physician;

• to participate in a recommended medical coordination program;

or

• to undergo vocational testing and assessment. When and how to make a claim

All claims must be received by Sun Life within three (3) months after the end of the qualifying period. Proof of continuing disability may be required each year. Any proceedings against Sun Life for payment of a claim must be started within one (1) year of Sun Life’s receipt of the proof of the claim. Claim forms are available from the College.

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Accidental Death and Dismemberment (AD&D) Insurance General description of the coverage

Accidental Death and Dismemberment coverage provides benefits if, due to an accident occurring while covered, you die or suffer any of the losses listed in the Specific Loss Schedule. Any death benefit paid under this coverage is in addition to the Life coverage. There are two separate AD&D benefits available – Basic AD&D and Voluntary AD&D. Each is explained below.

BASIC ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE Basic AD&D coverage for Administration employees

Your Principal Sum is 4 times your annual earnings, rounded to the next higher $1,000. The maximum amount of coverage is $250,000.

Basic AD&D coverage for Faculty employees

Your Principal Sum is 4 times your annual earnings, rounded to the next higher $1,000. The maximum amount of coverage is $250,000.

Basic AD&D coverage for A.U.P.E. employees

Your Principal Sum is 2.5 times your annual earnings, rounded to the next higher $1,000 (equal to your Basic Life coverage). The maximum amount of coverage is $100,000.

Basic AD&D coverage for Casual employees

Your Principal Sum is $10,000.

Basic AD&D benefit reduction

Your Principal Sum reduces by 50% on your 65th birthday.

Specific Loss Schedule

When injury results in any of the following losses within 365 days after the date of the accident, the plan pays: Percentage ofFor loss of: Principal Sum Life 100%Entire sight of both eyes 100%Speech and hearing in both ears 100%One hand and the entire sight of one eye 100%One foot and the entire sight of one eye 100%Entire sight of one eye 75%

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Speech 75%Hearing in both ears 75%Hearing in one ear 40%All toes of one foot 33 1/3% For Loss or Loss of Use of: Both hands 100%Both feet 100%One hand and one foot 100%One arm 80%One leg 80%One hand 75%One foot 75%Thumb & index finger or at least four fingers of one hand 40% For Paralysis of: Both upper & lower limbs (Quadriplegia) 200%Both lower limbs (Paraplegia) 200%Upper & lower limbs of one side of body (Hemiplegia) 200%

Loss of life Means the death of the insured person.

Loss Means, with reference to:

• Hand or foot, complete severance through or above the wrist or

ankle joint, but below the elbow or knee joint. • Arm or leg, complete severance through or above the elbow or

knee joint. • Thumb, the complete severance of 1 entire phalanx of the thumb. • Finger, the complete severance of two (2) entire phalanges of the

finger. • Toes, the complete severance of one (1) entire phalanx of the big

toe and all phalanges of the other toes. • Eye, the irrecoverable loss of the entire sight thereof. • Speech, complete and irrecoverable loss of the ability to utter

intelligible sounds. • Hearing, complete and irrecoverable loss of hearing. • Loss of use, the total and irrecoverable loss of use, provided the

loss is continuous for 12 consecutive months and such loss of use is determined to be permanent at the end of such period.

“Loss” as above used with reference to loss of use means the total and

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irrecoverable loss of use, provided the loss is continuous for twelve (12) consecutive months and such loss of use is determined to be permanent at the end of such period.

Paralysis Means the loss of ability to move all or part of the body.

Quadriplegia Means the permanent paralysis and functional loss of use of both upper

and lower limbs.

Hemiplegia Means the permanent paralysis and functional loss of use of upper and lower limbs on the same side of the body.

Repatriation benefit

If you die because of an accident for which an amount of Principal Sum becomes payable, the plan will pay up to $15,000 for reasonable and necessary expenses actually incurred for the return home of your body (including preparation charges for transportation). Such loss must occur more than 50 kilometres from your residence. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Education benefit If you die because of an accident for which an amount of Principal Sum

becomes payable, up to 5% of your Principal Sum (to a maximum of $5,000) is payable for each of your dependent children under 25 years of age already enrolled full‐time in an institution for higher learning (including universities, colleges, CEGEPs and trade schools). The benefit is payable annually for each year (up to four consecutive years) that the dependent child continues his or her education in an institution for higher learning. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Day‐care benefit If you die because of an accident for which an amount of Principal Sum

becomes payable, up to 5% of your Principal Sum (to a maximum of $5,000) is payable for each of your dependent children under 13 years of age, who:

• are enrolled in a legally licensed day‐care centre on the date of your death; or

• will enroll in a legally licensed day‐care centre within 365 days after your death.

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The benefit is payable annually for each year (up to four consecutive years) that the dependent child is enrolled in a legally licensed day‐care centre. If none of your dependent children satisfy either the above requirements or the requirements as shown under the section above entitled “Education Benefit”, then an amount equal to 5% of your Principal Sum or $2,500, whichever is less, is payable to your beneficiary. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Rehabilitation If you suffer a loss covered under the Specific Loss Schedule and as a result,

must participate in a rehabilitation program in order to be qualified to engage in a different employment, the plan will refund the reasonable and necessary expenses actually incurred during the three (3) year period following the date of the accident, to a maximum of $15,000. Payment is not made for room, board or other ordinary living, travelling or clothing expenses. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Workplace modification and accommodation

If you sustain an injury which results in a loss payable under the Specific Loss Schedule and you require special adaptive equipment and/or workplace modifications in order to accommodate your active full‐time work with the College, the plan will reimburse College for the expenses incurred up to $5,000. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Occupational training

If you die because of an accident for which an amount of Principal Sum becomes payable, and your spouse must engage in a formal occupational training program in order to upgrade employment qualifications, the plan will refund the reasonable and necessary expenses actually incurred during the three (3) year period following your death, to a maximum of $15,000. Payment is not made for room, board or other ordinary living, travelling or clothing expenses. In the event your spouse satisfies the requirements indicated above, such spouse will be deemed the beneficiary with respect to the benefits payable under this provision.

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If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Permanent total disability

The Principal Sum for which you are covered will be paid to you in a lump sum, less any other amounts already paid to you as a result of the same accident, if you become totally disabled and the following conditions are met: 1. The disability results from an injury caused by an accident. 2. The disability commences within 365 days of the injury. 3. The disability prevents you from engaging in each and every

occupation or employment for compensation or profit for which you are reasonably qualified by education, training or experience.

4. The disability has continued for a period of 12 consecutive months, and is total and permanent at the end of such period.

Family transportation

If you suffer a loss as a direct result of an accident and are hospitalized at least 150 kilometres from your home, the plans will pay up to $5,000 for the usual and reasonable cost of hotel accommodations close to the hospital while you are hospitalized and for the travel expenses of your immediate family members. An immediate family member means a spouse, parent, child, brother or sister.

The plan will only pay for the usual and reasonable travel expenses. The plan will pay for car travel at a rate of $0.35 per kilometre travelled. Transportation must be by the most direct route to and from the hospital. Payment is not made for board or other ordinary living, travelling or clothing expenses. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Identification If you die as a result of an injury and the police or similar governmental

authority require the identification of your body by an immediate family member or family representative, and indemnity for such loss subsequently becomes payable by the plan, the plan will refund the reasonable and necessary expenses actually incurred by the immediate family member or family representative for:

• transportation to the location of your body by the most direct route, and

• for lodging and board,

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provided the body is located more than 150 kilometres from the immediate family member’s residence. An immediate family member means a spouse, parent, child, brother or sister. Private transportation expenses are limited to $0.35 per kilometre travelled and the total maximum amount refundable for all expenses is limited to $10,000. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Seat belt benefit If you are driving or riding in a vehicle and wearing a properly fastened seat

belt at the time of the accident, and an injury results in a loss payable under the Specific Loss Schedule, the plan will pay an additional sum equal to 10% of the amount payable for such loss, subject to a maximum of $25,000. The driver of the vehicle must hold a current and valid driver's license of a rating authorizing him to operate such motorized vehicle and neither be intoxicated nor under the influence of drugs, unless such drugs are taken as prescribed by a physician, at the time of the accident. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Home alteration and/or vehicle modification benefit

If you suffer a loss or injury which results in you requiring a wheelchair, the plan will pay reasonable and necessary expenses incurred within three (3) years of the date of the accident causing the loss or injury for alteration of your principal residence and / or the costs of modifications to one motor vehicle used by you, to make the residence and / or the vehicle wheelchair accessible. The plan will pay up to $15,000 for the modifications.

Hospital indemnity benefit

If you are injured and are confined to a hospital and you are under the regular care and attendance of a physician for the treatment of the injury, you will receive a daily benefit of 1/30th of 1% of your Principal Sum from the 1st day of hospitalization, up to a maximum of $2,500 per month and for a maximum duration of 365 days per accident. Hospitalization required for treatment of any injury other than for a loss listed in the Specific Loss Schedule is also covered in accordance with the above terms, provided such hospitalization begins within 365 days of the

May 1, 2010 46

date of the accident which caused the injury and coverage is in force. The daily benefit is payable from the 5th day of hospitalization. Hospitalization is either a single uninterrupted confinement in a hospital or several successive confinements in a hospital as a result of the same accident, provided each such confinement is separated by a period of less than 90 consecutive days. All confinements must occur within 730 days of the date of the accident. Only one period of hospitalization will be payable for all injuries sustained as the result of the same accident. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Aircraft coverage You are covered only while flying as a passenger in any aircraft holding a

current and valid certificate of airworthiness (other than an aircraft owned, operated, leased or chartered by or on behalf of the College) and flown by a licensed pilot. Coverage also applies while flying as a passenger in a military aircraft.

Limit on benefit amounts

If more than one person covered by the group contract is eligible for benefits resulting from the same accident, the plan will pay up to a maximum of $5,000,000 for all claims related to the accident. If the total amount of benefits payable for the accident is more than $5,000,000, then the plan will pay for each person a percentage of the $5,000,000 that is equal to the percentage the person would have received of the total payable. This limitation applies only to losses payable under the Specific Loss Schedule and the permanent total disability benefit.

Beneficiary The Accidental Death benefit will be paid to the beneficiary designated

on your Basic Group Life Insurance application, otherwise to your estate. With the exception of the sections entitled “Repatriation benefit”, “Education benefit”, “Day‐care benefit”, “Workplace modification and accommodation benefit“, “Occupational training benefit”, “Family transportation benefit” and “Identification benefit”, all other indemnities payable will be paid to you.

May 1, 2010 47

Waiver of premium If you become totally disabled before you retire or reach age 65, whichever is earlier, AD&D coverage may continue without payment of premiums as long as you are totally disabled as long as you have been approved for waiver of premium for your Basic Life insurance. This continued coverage is subject to the terms of the contract which were in effect on the date you became totally disabled, including reductions and terminations. This coverage will continue without payment of premiums until the date you cease to be totally disabled or the date you fail to give the provider proof of your continued total disability, whichever is earlier. If you continue to qualify for premium waiver while you are disabled, it may continue until you reach age 65, at which point it expires.

Coverage ends Your coverage will end when you terminate employment with the

College, retire, or reach age 70, whichever is earlier. What is not covered

You are not covered for Loss, fatal or non‐fatal caused or contributed to by:

• suicide or intentionally self‐inflicted Injury; • war, whether declared or not;

• participation in a riot, insurrection, civil commotion or disturbance;

• active full‐time, part‐time or temporary service in the armed forces

of any country;

• riding as a passenger or otherwise in any vehicle or device for aerial navigation, other than as provided in the section entitled “Aircraft coverage”.

• medical treatment or surgery, except if the medical treatment or

surgery was needed because of an accident. When and how to make a claim

If you suffer a loss other than death, a claim must be received by the provider within 30 days of the loss. If the claim is the result of a death the claim should be made as soon as possible after the death occurred. Claim forms are available from the College.

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VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE Employee Only Voluntary AD&D plan

Your Principal Sum coverage is an amount of insurance equal to a minimum of $25,000 to a maximum of $250,000, in units of $25,000, as selected by you. The Employee Only plan covers you alone.

Employee and Family Voluntary AD&D plan

Your Principal Sum coverage is an amount of insurance equal to a minimum of $25,000 to a maximum of $250,000, in units of $25,000, as selected by you. The Employee and Family plan covers you and your eligible dependent(s). You are covered for the amount of Principal Sum you select. In addition, your family will automatically be insured for the following:

• Your spouse will be insured for 40% of your Principal Sum if you have dependent children, or 50% if you do not.

• Each dependent child will be insured for 10% of your Principal

Sum if you have a spouse, or 15% if you do not.

Note that only one plan may be purchased if you and your spouse both work for Lakeland College. Your spouse can be covered as an employee and as a dependent under the Employee & Family Voluntary AD&D plan, but the amount of insurance under the Employee Only Voluntary AD&D plan will be limited to the difference between $250,000 and the amount applicable for dependent coverage.

Specific Loss Schedule

When injury results in any of the following losses within 365 days after the date of the accident, the plan pays: Percentage ofFor loss of: Principal Sum Life 100%Entire sight of both eyes 100%Speech and hearing in both ears 100%One hand and the entire sight of one eye 100%One foot and the entire sight of one eye 100%Entire sight of one eye 75%Speech 75%Hearing in both ears 75%Hearing in one ear 40%All toes of one foot 33 1/3%

May 1, 2010 49

For Loss or Loss of Use of: Both hands 100%Both feet 100%One hand and one foot 100%One arm 80%One leg 80%One hand 75%One foot 75%Thumb & index finger or at least four fingers of one hand 40% For Paralysis of: Both upper & lower limbs (Quadriplegia) 200%Both lower limbs (Paraplegia) 200%Upper & lower limbs of one side of body (Hemiplegia) 200%

Loss of life Means the death of the insured person.

Loss Means, with reference to:

• Hand or foot, complete severance through or above the wrist or

ankle joint, but below the elbow or knee joint. • Arm or leg, complete severance through or above the elbow or

knee joint. • Thumb, the complete severance of 1 entire phalanx of the thumb. • Finger, the complete severance of two (2) entire phalanges of the

finger. • Toes, the complete severance of one (1) entire phalanx of the big

toe and all phalanges of the other toes. • Eye, the irrecoverable loss of the entire sight thereof. • Speech, complete and irrecoverable loss of the ability to utter

intelligible sounds. • Hearing, complete and irrecoverable loss of hearing. • Loss of use, the total and irrecoverable loss of use, provided the

loss is continuous for 12 consecutive months and such loss of use is determined to be permanent at the end of such period.

“Loss” as above used with reference to loss of use means the total and irrecoverable loss of use, provided the loss is continuous for twelve (12) consecutive months and such loss of use is determined to be permanent at the end of such period.

Paralysis Means the loss of ability to move all or part of the body.

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Quadriplegia Means the permanent paralysis and functional loss of use of both upper and lower limbs.

Hemiplegia Means the permanent paralysis and functional loss of use of upper and

lower limbs on the same side of the body. Repatriation benefit

If you die because of an accident for which an amount of Principal Sum becomes payable, the plan will pay up to $15,000 for reasonable and necessary expenses actually incurred for the return home of your body (including preparation charges for transportation). Such loss must occur more than 50 kilometres from your residence. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Education benefit If you die because of an accident for which an amount of Principal Sum

becomes payable, up to 5% of your Principal Sum (to a maximum of $5,000) is payable for each of your dependent children under 25 years of age already enrolled full‐time in an institution for higher learning (including universities, colleges, CEGEPs and trade schools). The benefit is payable annually for each year (up to four consecutive years) that the dependent child continues his or her education in an institution for higher learning. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Day‐care benefit If you die because of an accident for which an amount of Principal Sum

becomes payable, up to 5% of your Principal Sum (to a maximum of $5,000) is payable for each of your dependent children under 13 years of age, who:

• are enrolled in a legally licensed day‐care centre on the date of your death; or

• will enroll in a legally licensed day‐care centre within 365 days after your death.

The benefit is payable annually for each year (up to four consecutive years) that the dependent child is enrolled in a legally licensed day‐care centre. If none of your dependent children satisfy either the above requirements or the requirements as shown under the section above entitled “Education Benefit”, then an amount equal to 5% of your Principal Sum or $2,500,

May 1, 2010 51

whichever is less, is payable to your beneficiary. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Rehabilitation If you suffer a loss covered under the Specific Loss Schedule and as a result,

must participate in a rehabilitation program in order to be qualified to engage in a different employment, the plan will refund the reasonable and necessary expenses actually incurred during the three (3) year period following the date of the accident, to a maximum of $15,000. Payment is not made for room, board or other ordinary living, travelling or clothing expenses. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Workplace modification and accommodation

If you sustain an injury which results in a loss payable under the Specific Loss Schedule and you require special adaptive equipment and/or workplace modifications in order to accommodate your active full‐time work with the College, the plan will reimburse College for the expenses incurred up to $5,000. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Occupational training

If you die because of an accident for which an amount of Principal Sum becomes payable, and your spouse must engage in a formal occupational training program in order to upgrade employment qualifications, the plan will refund the reasonable and necessary expenses actually incurred during the three (3) year period following your death, to a maximum of $15,000. Payment is not made for room, board or other ordinary living, travelling or clothing expenses. In the event your spouse satisfies the requirements indicated above, such spouse will be deemed the beneficiary with respect to the benefits payable under this provision. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Permanent total disability

The Principal Sum for which you are covered will be paid to you in a lump sum, less any other amounts already paid to you as a result of the same accident, if you become totally disabled and the following conditions are

May 1, 2010 52

met: 1. The disability results from an injury caused by an accident. 2. The disability commences within 365 days of the injury. 3. The disability prevents you from engaging in each and every

occupation or employment for compensation or profit for which you are reasonably qualified by education, training or experience.

4. The disability has continued for a period of 12 consecutive months, and is total and permanent at the end of such period.

Family transportation

If you suffer a loss as a direct result of an accident and are hospitalized at least 150 kilometres from your home, the plans will pay up to $5,000 for the usual and reasonable cost of hotel accommodations close to the hospital while you are hospitalized and for the travel expenses of your immediate family members. An immediate family member means a spouse, parent, child, brother or sister.

The plan will only pay for the usual and reasonable travel expenses. The plan will pay for car travel at a rate of $0.35 per kilometre travelled. Transportation must be by the most direct route to and from the hospital. Payment is not made for board or other ordinary living, travelling or clothing expenses. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Identification If you die as a result of an injury and the police or similar governmental

authority require the identification of your body by an immediate family member or family representative, and indemnity for such loss subsequently becomes payable by the plan, the plan will refund the reasonable and necessary expenses actually incurred by the immediate family member or family representative for:

• transportation to the location of your body by the most direct route, and

• for lodging and board, provided the body is located more than 150 kilometres from the immediate family member’s residence. An immediate family member means a spouse, parent, child, brother or sister. Private transportation expenses are limited to $0.35 per kilometre

May 1, 2010 53

travelled and the total maximum amount refundable for all expenses is limited to $10,000. If you have similar coverage for this benefit under the plan, this benefit may only be paid once.

Seat belt benefit If you are driving or riding in a vehicle and wearing a properly fastened seat

belt at the time of the accident, and an injury results in a loss payable under the Specific Loss Schedule, the plan will pay an additional sum equal to 10% of the amount payable for such loss, subject to a maximum of $25,000. The driver of the vehicle must hold a current and valid driver's license of a rating authorizing him to operate such motorized vehicle and neither be intoxicated nor under the influence of drugs, unless such drugs are taken as prescribed by a physician, at the time of the accident. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Home alteration and/or vehicle modification benefit

If you suffer a loss or injury which results in you requiring a wheelchair, the plan will pay reasonable and necessary expenses incurred within three (3) years of the date of the accident causing the loss or injury for alteration of your principal residence and / or the costs of modifications to one motor vehicle used by you, to make the residence and / or the vehicle wheelchair accessible. The plan will pay up to $15,000 for the modifications.

Common disaster benefit

If you and your insured spouse both sustain loss of life as a result of a common accident or two separate accidents occurring within the same 24 hour period, and such losses become payable under the program, your spouse’s amount of coverage will be increased to the same level as yours, subject to an overall total for you and your spouse of $500,000.

Escalation If a benefit becomes payable under either Specific loss schedule or the

Permanent total disability benefit, an additional sum equal to 1% of the specific loss or principal sum for permanent total disability will become payable for each year your insurance remains in force without interruption, subject to a maximum of 5%.

Hospital indemnity benefit

If you are injured and are confined to a hospital and you are under the regular care and attendance of a physician for the treatment of the injury, you will receive a daily benefit of 1/30th of 1% of your Principal

May 1, 2010 54

Sum from the 1st day of hospitalization, up to a maximum of $2,500 per month and for a maximum duration of 365 days per accident. Hospitalization required for treatment of any injury other than for a loss listed in the Specific Loss Schedule is also covered in accordance with the above terms, provided such hospitalization begins within 365 days of the date of the accident which caused the injury and coverage is in force. The daily benefit is payable from the 5th day of hospitalization. Hospitalization is either a single uninterrupted confinement in a hospital or several successive confinements in a hospital as a result of the same accident, provided each such confinement is separated by a period of less than 90 consecutive days. All confinements must occur within 730 days of the date of the accident. Only one period of hospitalization will be payable for all injuries sustained as the result of the same accident. If you have similar coverage for this benefit under the plan, this benefit is payable up to the percentage of Principal Sum subject to one combined maximum for similar benefits provided through the plan.

Business venture benefit

If you sustain a specific loss for which an amount of benefit becomes payable under the program and as a result, you 1. are unable to perform your occupation due to total disability; 2. remain totally disabled for one (1) year; 3. provide the carrier with due proof of disability within that year; and 4. submit to the carrier a business plan at the end of that year, the carrier will pay the initial costs applicable to the development of a new independent business enterprise in Canada. The initial costs must be incurred within the 2nd year following the date total disability begins and are subject to a maximum of 20% of your Principal Sum or $50,000, whichever is lesser. The initial costs do not include more than your equitable share of the expenses of facilities if you operate your business in a partnership.

Aircraft coverage You are covered only while flying as a passenger in any aircraft holding a

current and valid certificate of airworthiness (other than an aircraft

May 1, 2010 55

owned, operated, leased or chartered by or on behalf of the College) and flown by a licensed pilot. Coverage also applies while flying as a passenger in a military aircraft.

Limit on benefit amounts

A maximum limit of $10,000,000 is imposed on the total of all losses arising out of any one aircraft accident covered under the program. This means that if you and any other persons insured under the program suffer losses occurring from the same aircraft accident, and the total of all benefits (the benefit you are entitled to added to those which the others are entitled to) is greater than $10,000,000, then the amount payable to each individual will be proportionately reduced so that the total amount of all benefits payable equals $10,000,000.

Beneficiary The Accidental Death benefit will be paid to the beneficiary designated

on your Voluntary AD&D Insurance application, otherwise to your estate. With the exception of the sections entitled “Repatriation benefit”, “Education benefit”, “Day‐care benefit”, “Workplace modification and accommodation benefit“, “Occupational training benefit”, “Family transportation benefit” and “Identification benefit”, all other indemnities payable will be paid to you.

Waiver of premium If you become totally disabled before you retire or reach age 65,

whichever is earlier, AD&D coverage may continue without payment of premiums as long as you are totally disabled as long as you have been approved for waiver of premium for your Basic Life insurance. This continued coverage is subject to the terms of the contract which were in effect on the date you became totally disabled, including reductions and terminations. Total disability must continue for an uninterrupted period equal to your Long Term Disability Qualifying period. This coverage will continue without payment of premiums until the date you cease to be totally disabled or the date you fail to give the provider proof of your continued total disability, whichever is earlier. If you continue to qualify for premium waiver while you are disabled, it may continue until you reach age 65, at which point it expires.

Coverage ends Your coverage will end when you terminate employment with the

College, retire, or reach age 70, whichever is earlier.

May 1, 2010 56

What is not covered

You are not covered for Loss, fatal or non‐fatal caused or contributed to by:

• suicide or intentionally self‐inflicted Injury; • war, whether declared or not;

• participation in a riot, insurrection, civil commotion or disturbance;

• active full‐time, part‐time or temporary service in the armed forces

of any country;

• riding as a passenger or otherwise in any vehicle or device for aerial navigation, other than as provided in the section entitled “Aircraft coverage”.

• medical treatment or surgery, except if the medical treatment or

surgery was needed because of an accident. When and how to make a claim

If you suffer a loss other than death, a claim must be received by the provider within 30 days of the loss. If the claim is the result of a death the claim should be made as soon as possible after the death occurred. Claim forms are available from the College.

May 1, 2010 57

A

Accident ∙ 11 Accidental Death and Dismemberment Insurance ∙ 40 Accidental dental ∙ 14 Aircraft coverage ∙ 46, 54 Ambulance services ∙ 14 Anesthesia ∙ See General anesthesia Artificial limbs and eyes ∙ 15 Auxiliary care ∙ 13

B

Basic Accidental Death & Dismemberment Insurance ∙ 40 Basic AD&D ∙ 40 Basic AD&D benefit reduction ∙ 40 Basic AD&D coverage for A.U.P.E. employees ∙ 40 Basic AD&D coverage for Administration employees ∙ 40 Basic AD&D coverage for Casual employees ∙ 40 Basic AD&D coverage for Faculty employees ∙ 40 Basic dental services ∙ 18 Basic Life benefit reduction ∙ 31 Beneficiary ∙ 8, 31, 33, 46, 55 Benefit Year ∙ 12, 18, See HSA Benefit Year Bitewing x‐ray ∙ 18 Braces ∙ 21 Bridges ∙ 20 Business venture benefit ∙ 54

C

Canes ∙ 14 Casts ∙ 14 Cervical collars ∙ 14 Change in Coverage ∙ 8 Chiropodists ∙ 14 Chiropractors ∙ 14 Claims ∙ 9, 16, 46 claims threshold ∙ 24 Common disaster benefit ∙ 53 Complete dentures ∙ See Dentures Converting Basic Life coverage ∙ 32 Converting Optional Life coverage ∙ 34 Coordination of benefits ∙ 26 Coordination of Benefits ∙ 9 Cores ∙ 20 Cost Sharing ∙ 7 Crowns ∙ 20 Crutches ∙ 14

D

Day‐care benefit ∙ 42, 50 Deductible ∙ 12, 18 Definitions ∙ 11 Dental Fee Schedule ∙ 18 Denture repairs ∙ See Denture services Denture services ∙ 19 Dentures ∙ 20 Dependent ∙ 5, 6, 7, 8, 9, 24 Diabetic supplies ∙ 14 Diagnostic services ∙ 18 Diaphragms ∙ 14 Doctor ∙ 11

E

Earnings ∙ 11 Education benefit ∙ 42, 50 Eligibility ∙ 5 Eligible Drugs ∙ 12 Elimination period ∙ See Qualifying Period Emergency dental exam ∙ 18 Emergency Travel ∙ See Out of province Emergency Travel

benefits Employee and Family Voluntary AD&D plan ∙ 48 Employee Only Voluntary AD&D plan ∙ 48 Endodontics ∙ 19 Escalation ∙ 53 Exercise Equipment ∙ 16 Experimental Treatments ∙ 16 Extensive dental services ∙ 20 Extraction ∙ See Oral surgery

F

Family transportation ∙ 44, 52 Fillings ∙ See Restorative services Fluoride treatments ∙ 19

G

General anesthesia ∙ 19 Gold restorations ∙ 20

H

Habit breaking devices ∙ 19 Health Spending Account ∙ 9, 23 Health Spending Account Payment Options form ∙ 25

May 1, 2010 58

Hearing aids ∙ 14 Hemiplegia ∙ 42, 50 Home alteration ∙ 45, 53 Home nursing care ∙ 14 hospital ∙ 15 Hospital beds ∙ 14 Hospital benefits ∙ 13 Hospital indemnity ∙ 45, 53 HSA ∙ See Health Spending Account HSA Allocation ∙ 23 HSA Benefit Year ∙ 23 HSA claim ∙ 24 HSA forfeitures ∙ 25 Humidifiers ∙ 16

I

Identification ∙ 44, 52 Ileostomy supplies ∙ 14 Illness ∙ 11 Inlays ∙ 20 Iron lungs ∙ 14

L

Loss ∙ 41, 49 Loss of life ∙ 41, 49

M

Massage Therapists ∙ 14 Mastectomy prosthesis ∙ 14 Medical aids ∙ 14 Medical durable equipment ∙ 14 Medical evacuation ∙ 15 Medical Examination ∙ 10, 38 Mouth guards ∙ 22

N

Naturopaths ∙ 14 Night guards ∙ 22 Nurse ∙ See Home nursing care

O

Occupational training ∙ 43, 51 onlays ∙ 20 Optional Life ∙ 7, 33 Oral exam ∙ 18 oral hygiene instruction ∙ 19 Oral surgery ∙ 19 Orthodontic services ∙ 21

Orthopaedic Mattresses ∙ 16 Orthopaedic shoes ∙ 14 Osteopaths ∙ 14 Out of province Emergency Travel benefits ∙ 15 Overall maximum ∙ 16, 22 Over‐The‐Counter products ∙ 13

P

Paralysis ∙ 42, 49 Paramedical practitioners ∙ 14 Partial dentures ∙ See Dentures Partial disability ∙ 37 Periodontics ∙ 19 Permanent braces ∙ 15 Permanent total disability ∙ 44, 51 Physiotherapists ∙ 14 Pit and fissure sealants ∙ 19 Podiatrists ∙ 14 Polishing ∙ 19 Posts ∙ 20 Pre‐authorization amount ∙ 19, 20 Pre‐existing condition ∙ 38 Premium waiver ∙ See Waiver of Premium, See Optional Life

coverage during total disability, See Basic Life coverage during total disability

Prescription Drugs ∙ 12 Preventative services ∙ 19 Principal Sum ∙ 40, 48 Proof of Disability ∙ 9, 31, 33, 47, 55 Proof of good health ∙ 7, 33 Proof of Good Health ∙ 7, 8, 32, 34 Prosthetics ∙ 15 Psychologists ∙ 14

Q

Quadriplegia ∙ 42, 50 Qualifying period ∙ 35

R

Radiographs ∙ 18 Reasonable and Customary Charges ∙ 16, 18 Reasonable and necessary expenses ∙ 43 Rebasing dentures ∙ See Rebasing dentures Recall oral exam ∙ 18 Rehabilitation ∙ 43, 51 Rehabilitation Program ∙ 37 Relining dentures ∙ See Denture services Repatriation ∙ 42, 50 Respirators ∙ 14 Restorative services ∙ 19 Retirement ∙ 11 root canal therapy ∙ See Endodontics

May 1, 2010 59

Root planing ∙ See Periodontics

S

Scaling ∙ See Periodontics Seat belt benefit ∙ 45, 53 Sleep Apnea Appliances ∙ 22 Snoring Appliances ∙ 22 Space maintainers ∙ 19 Specific Loss Schedule ∙ 40, 48 Speech Language Pathologists ∙ 14 Subrogation ∙ 37

T

Taxable Benefit ∙ 35 Teeth cleaning ∙ See Polishing Termination of benefits ∙ 38 Termination of Benefits ∙ 9 Third party liability ∙ 37 Time unit ∙ 18 Travel Assistance ∙ 15

V

Vehicle modification ∙ 45, 53 Veneers ∙ 20 Voluntary Accidental Death & Dismemberment Insurance ∙

48 Voluntary AD&D ∙ 40

W

Waiting period ∙ See Qualifying Period Waiver of premium ∙ 37, 47, 55 Waiver of Premium ∙ 31, 33, 55 Wheelchair ∙ 45, 53 Wheelchairs ∙ 14 Workplace modification and accommodation ∙ 43, 51

X

X‐ray ∙ See Bitewing x‐ray

This booklet was prepared by:

11120 – 178 Street

Edmonton, AB T5S 1P2 1.800.661.1973 www.johnson.ca

In the event of discrepancy between this booklet and the respective carrier contract, the contract will take precedent.

Group Benefit Plan Lakeland College - 2010

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