Group Benefits Eligibility

Eligibility Rules: who qualifies and when?

A new Plan Member becomes eligible for coverage in accordance with the waiting periods outlined in the benefit summary pages for his or her classification.

To be eligible, a plan member must:

Be in an eligible class
Work the minimum number of hours per week
Have completed the waiting period
Be "actively at work" when he or she becomes eligible for coverage

Premiums become payable on the first of the month coincident with or next following the eligibility date. For example, if the Plan Member’s effective date is February 10th, the Plan Member becomes eligible to submit claims on the 10th but premium payments do not start until March 1st. If the Plan Member’s effective date is February 1st (rather than February 10th) then the eligibility date would be February 1st and premium payments would also start on February 1st.

Spousal Eligibility

A Plan Member may cover only one spouse at a time:

A legal spouse
A Common-Law spouse: A Common-Law spouse is eligible for coverage under this agreement when living together in a conjugal relationship with the Plan Member continuously for a period of not less than one year.

Dependent Children

Generally, Dependent Children are eligible for coverage up to the end of the year following their 21st birthday or to the end of the year following their 25th birthday, if enrolled and in full-time attendance at an accredited college or university.

Children over 21 years of age may qualify for coverage if they are dependent upon the covered Plan Member by reason of a mental or physical disability.

Eligibility of Unmarried Dependent Children

Dependent Children are eligible for benefits up to the age restrictions noted on the benefit summary pages provided they are not married (or living in a Common-Law relationship) and they are financially dependent on the Plan Member or the Plan Member's spouse. Dependent Children are automatically terminated upon reaching the age restrictions outlined in the Benefit Summaries.

Eligibility for Over-Age Dependent Children – Student

An over-age Dependent Child is eligible for benefits provided he or she is enrolled and in full-time attendance at an accredited college or university on a full-time basis. Full-time attendance means more than ten hours of classroom instruction per week.

Eligibility of Over-Age Dependent Children – Physically or Mentally Disabled

A mentally or physically disabled dependent may be covered provided the dependent is incapable of self-sustaining employment and is wholly dependent upon the Plan Member or the spouse for support and maintenance.

At the time of enrolment, the Plan Member should indicate any applicable information regarding a dependent's disabled status. Please note the insurer may require additional information at a later date to verify a dependent's status. If required, the insurer will request the additional information directly from the Plan Member.

If a dependent becomes disabled at a later date, please contact Morneau Shepell for more information.

Survivor Benefits

In the event that the Plan Member dies while covered under this agreement, the level of health and dental benefits provided to that Plan Member may continue to cover survivors until the earlier:

24 months not to exceed the date of the second anniversary of death; or,
The date on which the spouse remarries or the Plan Member's children are no longer eligible for coverage (i.e., age 21 or age 25, if enroled and in full-time attendance at an accredited college or university or over if they are dependent upon the Plan Member by reason of a mental or physical disability)

Premium may or may not be required.