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Health Benefit FAQs

The following are the most commonly asked questions by Members regarding the Health & Wellness Plan. If you would like detailed information on any of these topics, please consult the Benefits Plan Booklet. If you still have questions after reading this information, please contact the Plan Administrator.

How do I establish coverage?

  1. 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.)
  2. You must be enrolled in the Plan by completing the Life Insurance beneficiary designation and the enrolment forms for MSPBC.
  3. 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.

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

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.

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.

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.

What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to receive similar benefits simultaneously under the Health & Wellness 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 Benefits Plan Booklet.