The following are the most commonly asked questions by Members regarding the Health Benefit Plan. If you would like detailed information on any of these topics, please consult the Group Insurance Plan Booklet. If you still have questions after reading this information, please contact the Plan Administrator.
How can I tell if I’m covered by the Plan?
To ensure that you are indeed covered at the time you incurred or will incur a claim, and to ensure that your employer has submitted the appropriate hours to the Plan on your behalf, you will need to contact the Plan Administrator. Individual Member records are not available on this web site. The Group Insurance Plan Booklet describes how you qualify and maintain coverage. (Please refer to the Eligibility sections, under General Information in the Group Insurance Plan Booklet.)
I’ve been laid off – when does my coverage end?
An Employee’s coverage (with the exception of Wage Indemnity and Long Term Disability) will be extended to the last day of the month following the month in which Full or Lay-off coverage, provided through employment, terminates (due to firing, quitting or leave of absence). The Group Insurance Plan Booklet describes extended coverage on termination/layoff and the Self-pay Plan. Individual Member records are not available on this web site. To check your individual coverage, you will need to contact the PLAN ADMINISTRATOR.
What if I become unemployed?
The Plan includes a six-month self-pay provision* for an Employee who is a Member in good standing of Q.C.C.C. (for all benefits except Wage Indemnity and Long Term Disability) effective on the first of the month coinciding with or next following:
- cessation of the extended coverage allowed after coverage provided by the employer terminates, as above.
- expiry of an Employee’s Wage Indemnity benefits.
- when Wage Indemnity benefits would have expired had the Employee not been in receipt of Worker’s Compensation benefits.
Please refer to the Self-pay section of the Group Insurance Plan Booklet.
What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to receive similar benefits simultaneously under the Health Benefit Plan or any other group insurance plan (including Provincial Plans), to prevent over payment, benefits payable under this Plan would be co-ordinated with the other Plan.
For example: A Member’s wife is covered under her employer’s plan with family coverage. The Member, his spouse and their three children are all covered under both Plans. To determine which Plan would be primarily responsible for the dependent children: Between the Member and the spouse, whomever’s birthday falls first in the calendar year, their plan is responsible for the initial reimbursement of benefits for the dependent children, then, any amounts that are not paid by that Plan are submitted to the other parent’s plan.
In the event that the Member’s birthday is in April and the spouse’s birthday is in January. The spouse’s plan would be primarily responsible for the spouse’s claims and the claims of the children. Any amounts not paid by the spouse’s plan can be submitted to the Member’s Plan for reimbursement. Any amounts for the Member that are not paid by the Member’s Plan, can be submitted to the spouse’s plan for reimbursement.
Please see the Coordination of Benefits section of the Group Insurance Plan Booklet.