Copyright © 1997 Brotherhood of Locomotive Engineers - National Legislative Board - Canada
Q.1 As a unionized employee, who am I covered with for dental benefits?
A.1 All unionized employees are covered with Great West Life under Policy 51078.
Q.2 How do I become eligible for these dental benefits?
A.2 Employees are covered from the first of the month following the completion of 12 months of compensated service (252 CCS days).
Q.3 Do I have to have a permanent job to qualify?
A.3 No. As long as you have completed 12 months of compensated service, you are eligible from the first of the following month provided you continue to have compensated service each month.
Q.4 Are members of my family also covered?
A.4 Coverage extends to your spouse and children.
Q.5 What is the definition of "spouse"?
A.5 A spouse is the person who is legally married to you or forms a common-law relationship with you, provided the common-law spouse is publicly represented as a spouse and has been residing continuously with you for at least one (1) year and both of you are free to marry; or at least three (3) years if either of you is not free to marry the other.
Q.6 At what age are my children no longer covered?
A.6 Once your child turns 21, s/he is no longer covered unless s/he is a full-time university student. If your child is a full-time university student, s/he is covered until the age of 25.
Your child must also be unemployed. If s/he is holding a full-time job, or any job that has dental benefits, s/he is not covered.
Q.7 I am getting divorced. Does my spouse keep her coverage under my dental plan?
A.7 No. Once you are divorced, your spouse is ineligible for coverage.
Q.8 I am divorced and my ex-spouse has custody of the children. Are the children still covered under my dental plan?
A.8 No. The children are not covered because they live with the ineligible spouse.
Q.9 I am divorced and have partial custody of my children. Are they covered under my dental plan?
A.9 No. The children must be living with you full time to have coverage.
Q.10 I am separated from my spouse, not divorced. Is my spouse still covered?
A.10 Yes.
Q.11 Do I have to pay a deductible when I submit my claim?
A.11 Yes. The deductible amount is $35 per family, annually.
Q.12 What is the reimbursable rate?
A.12 Basic dental care is reimbursed at 100% up to the maximum limit. Major dental care is reimbursed at 50% up to the maximum limit.
Q.13 Do I have a yearly maximum?
A.13 Yes. The yearly maximum is $1,000 per family member.
Q.14 Is there any orthodontic coverage under my plan?
Q.14 Yes. The lifetime maximum for orthodontics is $1,500 per family member with reimbursement of 80% up to the maximum.
Q.15 I want to get cosmetic work done on my teeth. Is this covered under my plan?
A.15 No. Cosmetic treatment is not covered.
Q.16 The dentist has recommended that my child get sealant treatment on his teeth to prevent future problems. Is this covered?
A.16 No. Sealant treatment is not covered.
Q.17 Do I have co-ordination of benefits?
A.17 The dental plan does have a co-ordination clause. The employee must submit his expenses to Great West first, and then to the spouse's plan.
Q.18 My spouse and I are both unionized employees working with CPR. Does the co-ordination of benefits still apply?
A.18 No. Married employees both covered under Great West cannot use the co-ordination of benefits clause as they are both eligible employees.
Q.19 If I am laid off, how long does my coverage continue for?
A.19 In the case of lay off, coverage terminates on the last day worked.
Q.20 Is there any way I can continue to pay my dental coverage after I am laid off?
A.20 No.
Q.21 At the time of my lay off I am in the middle of a root canal. Will I be covered for the remainder of the work?
A.21 Yes. Where dental work has been started on a particular tooth or area of the mouth prior to termination of active service, coverage will continue for 30 calendar days from the last day worked for employees and dependents provided that treatment actually commenced while you were an eligible employee.
Q.22 If I am off sick, how long does my coverage continue for?
A.22 Coverage continues for 12 weeks from the date of illness.
Q.23 I am on Workmen's Compensation. Do I have any dental coverage?
A.23 Yes. Your dental coverage is continued while you are on Workmen's Compensation.
Q.24 I am on maternity leave and then taking parental leave. Do I have any dental coverage during these leaves?
A.24 Yes. While an employee is on maternity leave and/or parental leave, dental coverage is continued.
Q.25 If I am laid off or on leave of absence, when do my dental benefits get reactivated?
A.25 In order to have dental benefits reactivated, an employee must return to active work.
Q.26 If I am rejected by Great West because of ineligibility, who should I contact if I think I should be covered?
A.26 Employees should contact the Crew Management Centre.
Q.27 If I am rejected by Great West because the treatment is not covered, who should I contact if I think the treatment should be covered?
A.27 Within 60 days of receiving the rejection, employees should contact Great West directly, providing particulars to support the claim.
Q.1 As a unionized employee, who am I covered with for health & vision care benefits?
A.1 All unionized employees are covered with Sun Life of Canada under Policy 25040.
Q.2 How do I become eligible for these health benefits?
A.2 Employees are covered from the first of the month following the completion of 12 months of compensated service (252 CCS days).
Q.3 Do I have to have a permanent job to qualify?
A.3 No. As long as you have completed 12 months of compensated service, you are eligible from the first of the following month provided you continue to have compensated service in each month.
Q.4 Are members of my family also covered?
A.4 Coverage extends to your spouse and children.
Q.5 What is the definition of "spouse"?
A.5 A spouse is the person who is legally married to you or forms a common-law relationship with you, provided the common-law spouse is publicly represented as a spouse and has been residing continuously with you for at least one (1) year and both of you are free to marry; or at least three (3) year if either of you is not free to marry the other.
Q.6 At what age are my children no longer covered?
A.6 Once your child turns 21, s/he is no longer covered unless s/he is a full-time university student. If your child is a full-time university student, s/he is covered until the age of 25.
Your child must also be unemployed. If s/he is holding a full-time job, or any job that has health benefits, s/he is not covered.
Q.7 I am getting divorced. Does my spouse keep her coverage under my health care plan?
A.7 No. Once you are divorced, your spouse is ineligible for coverage.
Q.8 I am divorced and my ex-spouse has custody of the children. Are the children still covered under my health plan?
A.8 No. The children are not covered because they live with the ineligible spouse.
Q.9 I am divorced and have partial custody of my children. Are they covered under my health plan?
A.9 No. The children must be living with you full time to have coverage.
Q.10 I am separated from my spouse, not divorced. Is my spouse still covered?
A.10 Yes.
Q.11 Do I have to pay a deductible when I submit my claim?
A.11 Yes, the deductible is $100 per family, annually.
Q.12 What is the reimbursable rate?
A.12 The reimbursable is 100% of eligible expenses up to a hospital's average cost of semi-private room accommodation for an unlimited number of days and 100% of eligible expenses for major medical benefits, except for drugs which is 80%.
Q.13 Do I have a lifetime maximum?
A.13 No.
Q.14 Does my health plan cover expenses incurred when I go to the United States?
A.14 There is a maximum amount of coverage of $1,000,000. This is for charges for emergency treatment of an illness contracted while outside Canada, up to 180 days of confinement; up to the hospital's semi-private rate for room and board; for other hospital services and for hospital out-patient services.
Q.15 Are chiropractors covered under my plan?
A.15 Yes, chiropractors are covered with a yearly maximum of $500.
Q.16 Do I have co-ordination of benefits?
A.16 The health plan does have a co-ordination clause. The employee must submit his expenses to Sun Life first, and then to the spouse's plan.
Q.17 My spouse and I are both unionized employees working with CPR. Does the co-ordination of benefit still apply?
A.17 No. Married employees both covered with Sun Life are both eligible employees.
Q.18 If I am laid off, how long does my coverage continue for?
A.18 Health coverage continues until the last day of the month in which laid off.
Q.19 Is there any way I can continue to pay my health coverage after I am laid off?
A.19 Yes. A laid off employee may pay direct for 12 months.
Q.20 If I am off sick, how long does my coverage continue for?
A.20 Health coverage continues for six months from the last day of the month in which employee became ill.
Q.21 Is there any way I can continue to pay my health coverage after the initial six months are over?
A.21 Yes. An employee can pay direct for another six months.
Q.22 I am on Workmen's Compensation. Do I have any health coverage?
A.22 Yes. Your extended health and vision care coverage is continued while you are on Workmen's Compensation.
Q.23 I am on maternity leave and then taking parental leave. Do I have any health coverage during these leaves?
A.23 Yes. While an employee is on maternity leave and/or parental leave, extended health and vision care coverage is continued.
Q.24 If I am laid off, and return to work for a two-week period, what health coverage do I have?
A.24 A laid off employee who returns to active work is covered for that whole month. EG. An employee is laid off and gets recalled on April 9 for four days. He is covered for the whole month of April for health benefits.
Q.23 I have taken a leave of absence. What health coverage do I have?
A.23 An employee who takes a leave of absence has health coverage continued until the end of the month in which the leave was taken. S/he then has the option of paying direct for health coverage for 12 months. An employee returning from leave of absence will automatically be covered from the date of return to active work.
Q.24 Is the Extended Health Plan and the Vision Care Plan two separate plans?
A.24 No. It is one plan called the Extended Health and Vision Care Plan. There is only one deductible of $100 per family per year.
Q.25 What is the maximum amount I can get back from Sun Life for vision care and how often can I make a claim?
A.25 The maximum amount is $175. For persons under age 18, a claim can be made once a year from date of purchase. For persons age 18 and over, a claim can be made once every two years from date of purchase. EG. Glasses are purchased on April 1, 1997. A person 18 or over can only make another claim on or after April 1, 1999.
Q.26 Can I make a claim on vision care just for cosmetic reasons?
A.26 No. The prescription must change from one claim to the next in order to be eligible for any reimbursement.
Q.27 If I am rejected by Sun Life because of ineligibility, who should I contact if I think I should be covered?
A.27 Employees should contact the Crew Management Centre.
Q.28 If I am rejected by Sun Life because of ineligible expenses, who should I contact if I think the expenses should be covered?
A.28 Within 60 days of receiving the rejection, employees should contact Sun Life directly, providing particulars to support the claim.
Q.1 As a unionized employee, who am I covered with for weekly indemnity?
A.1 Employees are covered with National Life under Policy 9097.
Q.2 How do I become eligible for these benefits?
A.2 Employees become eligible on the first of the month following the month in which you have rendered compensated service as a Running Trades employee.
Q.4 How long do the benefits last?
A.4 The maximum an employee can collect on a claim is 41 weeks; the first 15 weeks are paid by National Life, the following 15 weeks are paid by Employment Insurance and topped off by National Life, and the last 11 weeks are paid by National Life. (It should be noted that if an employee does not qualify for EI, the maximum entitlement becomes 26 weeks.)
Q.5 When do I apply for the disability benefits?
A.5 It is important that you file your claim as soon as you are entitled to disability benefits. The claim form must be submitted within 30 days of the commencement of your disability.
Q.6 When do I apply for the EI benefits?
A.6 Application for EI sickness benefits should be filed in the 14th week of your first 15 weeks.
Q.7 How much money do I receive each week on WIB?
A.7 You will receive one-seventh (1/7) of 70% of your weekly base pay for each day that you are entitled to benefits, up to a maximum of $700/week. (The first $500 is the company maximum; the additional $200 maximum is covered by the deduction made monthly on pay cheques.)
Q.8 Do I pay income tax on disability benefits?
A.8 Disability benefits are considered taxable income and income tax will be deducted from any benefits you receive.
Q.9 When do I start to get paid when I go on WIB?
A.9 The disability benefit will commence on the first day if the disability is due to accidental injury or from the first day of sickness if you are hospitalized. In other cases of sickness, benefits will be paid from the fourth day, provided you are being seen and treated by a licensed doctor.
Q.10 If I am on vacation and get sick, can I apply for disability benefits?
A.10 Yes. You may terminate your vacation and apply for disability benefits.
Q.11 I am on Workmen's Compensation. Can I collect disability benefits if I get a sickness which is unrelated to the reason why I am on WC?
A.11 No. An employee cannot collect Workmen's Compensation and disability benefits at the same time.
Q.12 I am on lay off status and get sick. I know I am not entitled to disability benefits but what happens if I get recalled?
A.12 If you are unable to resume work because you are disabled, you will be entitled to make application to National Life effective from the date you are due to resume work.
Q.13 I have been collecting disability benefits for 6 weeks. My doctor indicated on the form that I would be able to return to work at the end of the 6-week period. However, I am still unable to work. What happens?
A.13 You will have to provide the insurance company with additional medical information to justify the payment of further benefits.
Q.14 I have collected the first 15 weeks from the insurance company, and I am almost at the end of the 15 weeks with Employment Insurance, how do I notify the insurance company that I want to collect the remaining 11 weeks?
A.14 Another weekly indemnity form must be completed and your doctor must supply additional medical information to justify the payment of further benefits.
Q.15 My disability benefit coverage has been terminated, when do I have coverage again?
A.15 Your coverage is reinstated upon return to full-time active work.
Q.16 Will the insurance company call me about a claim if there is a problem?
A.16 No. The insurance company deals with the Crew Management Centre. Information regarding your claim will be passed on to you from that offices.
Q.1 As a unionized employee, who am I covered with for life insurance?
A.1 Employees have coverage with National Life under Policy G86-9876.
Q.2 How do I become eligible for life insurance?
A.2 Employees become eligible for the life insurance on the first of the month following the month in which the employee renders compensated service.
Q.3 What is the amount of the coverage?
A.3 $25,000, which doubles in the event of accidental death.
Q.4 If I get laid off, how long do I keep my coverage?
A.4 For laid off employees, coverage ends 31 days after the end of the month during which such lay off occurs. However, you can pay direct for life insurance coverage for 12 months.
Q.5 If I get sick, how long do I keep my coverage?
A.5 Employees keep their coverage for ten months from the end of the month in which the disability occurs. After that period, the employee can pay direct for another two months. Therefore, the total coverage is 12 months.
Q.6 What if after the 12-month period mentioned in Q.5, I am still sick?
A.6 If you are totally disabled and under age 60, you should apply to National LIfe for Extended Insurance on Disability (Waiver of Premium). You must show proof of total disability to National Life, and that the disability has continuously existed for nine months. This proof must be furnished within one year of the last day of the month in which you last worked.
You should apply for Waiver of Premium between the ninth and twelfth months of your disability.
It should be understood that the rules are interpreted strictly by National Life and you must be "totally disabled".
Q.7 If I apply for the Waiver of Premium, and I am accept, what is the amount of the coverage?
A.7 The amount of coverage is $5,000.
Q.8 If I was laid off and did not pay direct for life insurance coverage, when I returned to work, when does my coverage start again?
A.8 Coverage begins again on the first of the month following the month during which you have returned to full-time active work.
Q.9 What happens if I am laid off or sick for longer than 12 months and have continued to pay direct for the time I am allowed to do so?
A.9 If you have five or more years of service you can apply for conversion of your life insurance to an individual policy with the insurance company.
If, while sick, you have applied for the Waiver of Premium and been accepted for the extended insurance of $5,000, you would only be able to convert a total of $20,000 to a personal policy.
Q.10 What happens to my life insurance if I quit?
A.10 If you terminate your employment, and have at least five years of service, you can, within 31 days from the last day of the month during which you terminated, convert your life insurance to an individual policy.
Copyright © 1997 Brotherhood of Locomotive Engineers - National Legislative Board - Canada