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Health Benefit FAQs |
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The following are the most commonly asked questions by
Members regarding the Health & Welfare 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. |
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How do I establish
coverage?
- You must be a Member
in good standing of the Heat and Frost Workers’ Local Union
118. (For H&W Plan purposes, Members
working for non-union
contractors who refuse to co-operate in Local 118 organizing
efforts are not in good standing.)
You must be enrolled
in the Plan by completing the Life Insurance beneficiary designation
and the enrolment forms for MSPBC.
You must have earned,
and your employer(s) must have reported and paid into the Plan,
the number of hours required to qualify for coverage according
to the Hour Bank table above.
Hours worked but not
reported or paid by your employers do not qualify you for
coverage.
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When does coverage
begin?
If you have filled out
the application forms, your coverage will start on the first day
of the month following the month in which enough hours are
reported to the Plan by your employer(s).
EXAMPLE:
| Month Worked: |
Hours Reported: |
| June |
0 |
| July |
150 |
| August |
150 |
| September |
Lag Month |
| October |
Coverage Starts |
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How does coverage
continue?
Once you are covered,
the hours your employers report for you are added to your Hour
Bank. Each month, a fixed number of hours are deducted to “pay”
for your coverage (the “cover charge”) and you will continue to be
covered as long as your Hour Bank contains sufficient hours.
You may accumulate hours
in your Hour Bank to carry you through periods of poor
employment or vacation. Any hours in excess of the “Hour Bank
maximum” go into the general fund of the Plan.
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What if the Hour Bank
falls short?
When your Hour Bank has
too few hours to pay the cover charge, you are no longer
covered by the Plan. However, you have the option of paying for the
coverage yourself.
When do not have enough
hours to continue coverage, the Administrator sends you
a shortage notice telling you how many hours you are short and
the amount required to maintain coverage. If you make payment of
the amount requested by the deadline specified on the Notice,
your coverage will be continuous.
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What coverage do I have for Dependents?
Your eligible Dependents
will be covered for Extended Health Care and Dental Benefits
and for Basic Medical (MSP-BC), but you must register them in
the Plan for this coverage to take effect. Your eligible
Dependents are:
- your Spouse; and
- your Dependent
children to age 21 (age 19 for MSP-BC); and
- your Dependent
children to any age (age 25 for MSP-BC) who
are attending a
recognized school or college full time (you must be prepared to prove
dependency); and
your Dependent
children to any age who are physically or mentally disabled who are
dependent on you for support and for whom you are entitled to
an income tax exemption, provided each child was covered
by the Plan immediately prior to his or her 21st birthday.
“Spouse” means your
legal Spouse or a person who has been living with you in a common-law
relationship for at least one full year and who is publicly
represented as your Spouse.
Dependents are not
covered for Short Term
Disability, Life Insurance, and Accidental Death
& Dismemberment coverage.
New Dependents are not
covered until you register them.
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What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to
receive similar benefits simultaneously under the Health &
Welfare 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.
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