Telecommunication Workers Benefit PlanFor employees/ members of TWU and SHAW

as at January 1, 2000

Suite 303 - 4603 KingswayBurnaby, B.C. V5H 4M4

Office: 604 430-3300 Fax: 604 430-5395

Email:general@twplans.com Part D News New Assure Drug Cards-September 2003 TW Benefit Plan-Part D (Shaw)-July 23, 2003 Claim Forms

Download Assure Card Drug Claim Form (PDF format)

Download Dental Claim Form (PDF format)

Download Extended Health Care Claim Form (PDF format)

Note: These forms are for the use of TWU Shaw Members Only.

Completed forms should be sent directly to (note new address):

Great West Life, Health and Dental BenefitsP.O. Box 3050, Winnipeg, Manitoba R3C 4E5

Personal Information Change Forms

Download Address and Beneficiary Change Form (Word format)

Download Co-ordination of Benefits Form (Word format)

Note: These forms are for the use of TWU Shaw Members Only.

Completed forms should be sent directly to:

Telecommunication Workers Benefit Plan, SHAW - Part D CATV Group#303 - 4603 Kingsway, Burnaby, BC V5H 4M4

Plan Table of Contents

BASIC INFORMATION BENEFITS PROCEDURES

1. Important note from our lawyers.

11. Group Life Insurance 12. Dependent Group Life

26. Membership Termination

2. Introduction 3. About the Plan 4. Future of the Plan 5. Identification Cards 6. Plan Participation 7. Class A, B, C and D

Coverage 8. Definition of

Dependents 9. Dependent Benefits

10. Addition/deletion of Dependents

Insurance 13. Accidental Death &

Dismemberment 14. Weekly Indemnity

Benefits 15. Long Term Disability 16. Basic Provincial

Medical and Hospital Plan

17. Extended Health Care Benefits

18. Pharmacare Deductible 19. Low Cost Alternative

Drugs 20. Vision Care 21. Dental Benefits 22. Co-ordination Benefits 23. Survivor Benefits 24. Compassionate

Assistance Program

25. Employee and Family Assistance Program

27. Continuing Coverage 28.o During a Lay-

Off o During a

Strike or Lock-Out

o During an Approved Leave of Absence

o Retired Member Coverage

o While on Weekly Indemnity

o While on Long Term Disability Benefit

29. Claim Procedures

30. Time Limit for Submitting Claims

 

Important note from our lawyers..

This information is intended only as a guide and does not establish any legal rights. It is intended as a summary of the benefits provided at the time of publication. Member's rights to benefit coverage and payments are stated only in the Plan which is available for viewing at the Plan Administration Office. If there is an inconsistency between this booklet and Plan, the terms of the Plan prevail.

Top

Introduction..

The purpose of this Booklet is to outline the benefits for which you and your family are eligible as a Member of the Telecommunication Workers Benefit Plan (TWBP) PART D - CATV Group.

The information provided is intended as a summary of the benefits provided at the time of publication and is not a legal document. Your entitlement to benefits is fully stated in the Telecommunication Workers' Benefit Plan -– PART Part D, which is available for viewing at the Plan Administration Office. If there is a difference between the summary information provided in this booklet and the benefit and its terms as stated in the Plan, the Plan prevails.

Possession of this Booklet alone does not mean that you and your dependents are

insured. You must be a member of the TWBP and satisfy all of the requirements of the Plan to receive benefit payments.

The effective date of this PART D of the Plan is May 1, 1998. This booklet contains the current provisions of PART D of the Plan.

The Insurer: Mail directly to:

Great West Life Health & Dental ClaimsP.O. Box 6055, Station MainWinnipeg, Manitoba R3C 3B2

POLICY 51379 WI, LTD, EHC, Dental POLICY 150447 Life and AD&D

as at May 1, 1998

We suggest that you read this Benefit Booklet carefully, then file it in a safe place with your other important documents for future reference.

Top

About the Plan..

The Telecommunication Workers Benefit Plan (TWBP) and Trust is a non-profit Trust established by the Telecommunications Workers Union (TWU) to provide group insurance coverage for TWU Members at a reasonable cost. The Union appoints a Board of Trustees, comprised of TWU Members, under a Trust Agreement. These Trustees are responsible for receiving the contributions to the Plan and arranging the provision of the Benefits under the Plan. They have the power to appoint professional advisors, enter into underwriting contracts with insurance companies, design and amend the Plan, appoint an administrator, as well as set contribution levels from time to time consistent with the requirements, if any, of the current collective agreements. The Plan is constantly being improved.

In 1998 a two new PARTs was were created to provide benefits for Members of the TWU who are not employed by TELUS (then B.C. Tel) BC Tel. TWU Members employed by SHAW Cablesystems and Campbell Goodell Traynor are now eligible for benefits under the TWBP PARTs D & E respectively. The funding and experience of each PART of the Plan is separately accounted for.

Top

Future of the Plan..

The Trustees are pleased to be able to offer these benefits. To date, the operation of the Plan by the Trustees has generated sufficient reserves in the trust fund to ensure the financial stability of the Plan.

The Trustees review the Plan provisions on a regular basis to identify areas for

improvement and/or to provide added benefits to Members. We welcome your comments and suggestions. The Trustees communicate benefit changes and/or improvements to the Members through booklets, letters, Transmitter articles and the TWBP Internet page. You can link to the Benefit Plan page from the TWU homepage at:

http://www.twu-canada.ca

Top

Identification Indentification Cards..

Upon eligibility, you and your dependents will receive these identification cards:

CareCard

The CareCard is the health care identity card for British Columbia residents. A separate CareCard is issued for each person covered. Each CareCard will display the lifetime Personal Health Number assigned to that card holder. This Personal Health Number will remain the same for each person, regardless of changes to personal status such as leaving home, getting married, change of employer, etc..

The Insurer Member Identification Card

The Insurer Member Identification Card identifies you as a Plan Member. You may be required to present it prior to receiving dental treatment. The Plan name, Policy number and a summary of coverage is shown on the Card.

Emergency Travel Assistance (ETA) Card

Your ETA Card lists the toll-free number to call in case of an emergency, while travelling outside Canada. The Card also lists your Group Policy Number.

Top

Plan Participation..

Who is Eligible?

Members of the Telecommunication Workers Union who are employed by SHAW Cablesystems, are eligible to join PART D of the Plan.

Coverage is also available to retired Members who have retired after December 1, 1989.

Application forms are available from the Plan Administration Office and must be completed at the start of employment.

New application forms must be completed if you have been off the Plan for

more than four months.

Medical Services Plan (MSP) Eligibility

Only residents of British Columbia are eligible for coverage under the Medical Services Plan. "Resident" means a person who:

a. is a citizen of Canada or is lawfully admitted to Canada for permanent residence;

b. makes his or her home in British Columbia; and c. is physically present in British Columbia at least six months in a calendar year;

and includes a person who is deemed under the Regulations to be a resident but does not include a tourist or visitor to British Columbia.

The deeming provision in the Regulations allows us to cover persons who would not otherwise qualify as "residents" because they don't meet all three criteria stated in (a), (b) and (c) above.

These are persons who are temporarily absent from B.C. for more than six months because they are - full-time students attending school or university elsewhere in Canada; full-time students attending school or university in another country (eligible for coverage for a maximum of 60 months); persons on vacation or working outside B.C. (eligible for a maximum of 12 months); persons employed by or under a contract with Canada World Youth, Canadian Executive Services Overseas, Canadian University Services Overseas, Canadian International Development Agency, Department of National Defence Teacher Loan Program (eligible for a maximum of 24 months).

Persons who are not residents of British Columbia lose their eligibility for MSP coverage and other provincial health care benefits. For example, a person who chooses to live in Washington State is not eligible for coverage, regardless of whether he/she commutes to Vancouver to work every day.

When is Coverage Effective?

For Members New to the Plan:

a. If employment commences from the first to the fifteenth of the month, the employer will contribute for the full month's payment and coverage will commence on the first day of the month following three months of employment.

b. If employment commences after the fifteenth of the month, the employer makes no payment to the Plan until the first day of the month following and coverage will commence on the first day of the month following three months of employment.

Coverage will commence on the first day of the month immediately following the month in which employment commences.

For Previously Covered Members:

A Member previously covered by PART D of the Plan, CAN receive coverage on the first day of employment. This is providing the Plan has received the amount of contributions necessary to replenish the Member's required reserve to THREE full months of current contributions.

Otherwise (a) and (b) above will apply.

Coverage Exceptions

If you are not actually at work on the date you would otherwise be eligible for coverage you are not insured until you return to active work. A dependent of a Member is covered by PART D of the Plan at the same time as the Member's effective date.

Top

Class A, B, C & D Coverage..

Class A

Members with more than 18 months of employer contributions within a 24 month period, in the past 5 years.

Full coverage.

Class B

Members with less than 18 months of employer contributions within a 24 month period, in the past 5 years.

Weekly Indemnity benefits will be limited to the current E.I. maximums; Dental benefits will be limited to Plan A & B only. For the initial installation of a

bridge or denture, it will be necessary to have a natural tooth extracted in order to be compensated.

Class C & D

Members age 55 or over who retire on or after December 1, 1989 and who elect to continue:

o Member Life Insurance ($5,000, or $7,500, or $10,000); and/or o Extended Health and Vision Care (including ETA); and/or o Dental:

Class C retirees have Class A coverage; Class D retirees have Class B coverage; and/or

o B.C. Medical.

Members covered under Class B will be notified when they are eligible for Class A coverage and benefits.

Top

Definition of Dependents..

Spouse

With respect to a Member, Spouse has the same meaning as set forth under the Canada Pension Plan, except that a Member's Spouse shall not be required to be an individual of the opposite sex. Once an individual is your Spouse, he or she remains so until you designate a new spouse, or advise the Administration Office that you no longer have one.

Children

Your unmarried natural children, adopted children, or foster or stepchildren living in your home, who are:

o under the care and custody of the Member or his or her Spouse; o under age 19, or under 25 if a full-time student at an accredited

school, college, or university; o not employed on a full-time basis; and o not eligible for insurance as a Member under this or any other Group

Benefit Program. A child who is incapacitated on the date he/she reaches the age when

insurance would normally terminate will continue to be an eligible dependent. However, the child must have been insured under PART D of the Plan immediately prior to that date.

A child is considered incapacitated if he/she is incapable of engaging in any substantially gainful activity and is dependent on the Member for support, maintenance and care, due to a mental or physical handicap.

The Insurer may require written proof of the child's condition as often as may reasonably be necessary.

For Dependent Life Insurance a child will be eligible from birth, unless stillborn.

Top

Definition of Dependents.. Medical Services Plan

your Spouse; and unmarried dependent children, resident in British Columbia, and under the

age of 19 (25 if in full-time attendance at an accredited school, college, or university);

in cases of divorce, children should be covered by the parent who has custody.

Extended Health (including ETA & Vision Care)

your Spouse; and unmarried dependent children, resident in British Columbia, and under the

age of 19 (25 if in full-time attendance at an accredited school, college, or

university).

Dental

your Spouse; and unmarried dependent children, resident in British Columbia, and under the

age of 19 (25 if in full-time attendance at an accredited school, college, or university).

Dependent Life

your Spouse; and unmarried dependent children, resident in British Columbia, and under the

age of 19 (25 if in full-time attendance at an accredited school, college, or university).

A Child Becomes Ineligible For Coverage If He/She:

is employed full-time; is married or in a common law relationship; is 19 years of age or older and not in full-time attendance at an accredited

school, college, or university; is no longer mainly supported by his/her parents; obtains other coverage.

Top

Addition/Deletion of Dependents..

The necessary forms to add or delete dependents may be obtained from the Plan Administration Office. The date of the requested change must be indicated on the forms.

Coverage for a Spouse may become effective from the date of marriage, provided the forms are received by the Plan Administration Office within 30 days of the date of marriage.

Coverage for a common-law Spouse will be effective the first day of the month following the date on which the application card was received providing they have satisfied the twelve month co-habitation period. Proof of twelve month residency must be provided with the application. The ONLY proof that will be accepted will be any one of the following, providing they indicate a date that is at least 12 months prior to the date of application:

driver's license; I.C.B.C. documentation, car registration; utility or telephone bill; top portion of a bank statement; top portion of a credit card statement; B.C. Medical invoice; Property Tax Notice; G.S.T. Rebate;

Income Tax Return acknowledgement.

Coverage for a child may become effective from date of birth, provided the change form is received by the Plan Administration Office within four months of the date of birth. In the case of an adopted child, coverage may become effective from the date of adoption, provided the change form is received by the Plan Administration Office within 30 days of date of the adoption. Specify on the form that the effective date required is the date of adoption.

Change forms not received within the specified time limits will be considered "late". Coverage will then commence the first of the month following receipt of the change forms by the Plan Administration Office.

Making Changes

To ensure that coverage is kept up to date for you and your dependents, it is vital that you report any changes to the Plan Administration Office. Such changes could include:

change in Dependent Coverage; change of Beneficiary; change of Name; applying for coverage previously waived; change of Address.

Top

Group Life Insurance..

In the event of your death from any cause while a covered Member of this PART D of the Plan, your beneficiary will receive the following benefit:

Class A and Class B - $100,000 Class C and Class D - $5,000, $7,500 or $10,000

based upon your initial election

If a Member is not actively at work when an increase in insurance takes effect this increase in insurance will take effect on the next day on which he/she is again actively at work.

Conversion Privilege

If your Group Benefits terminate, you may be eligible to convert your Member Life Insurance to an individual policy, without medical evidence. You must apply for the individual policy, and pay the first monthly premium within 31 days of the termination of your Member Life Insurance. For information on the conversion privilege, please see your Plan Administrator.

The effective date of the converted policy will be 31 days after the date of termination of the Group Insurance under this Benefit.

Death During Conversion Period

If a person dies within 31 days of termination of this benefit, the Insurer will pay the maximum amount the person was eligible to convert. This will be done even if the person did not apply for a converted policy.

Subsequent Eligibility Under This Policy

If a person obtains a converted policy through this privilege and later becomes eligible for Insurance under this Group Policy, the amount for which he/she is eligible will be reduced by the amount of Insurance remaining in force under the converted policy.

Top

Dependent Group Life Insurance..

In addition to the Life Insurance coverage on your own life, your Group Insurance Plan provides coverage for your Spouse and your dependent children as follows:

Spouse $ 25,000.00Dependent Child $ 5,000.00

If one of your dependents should die while insured under PART D of the Plan, the amount of Life Insurance shown above would be payable to you.

Conversion Privilege

The Dependent Life Insurance continues for 31 days following your death, or your termination of coverage. During this 31 day period your Spouse's amount of Dependent Life Insurance may be converted, provided the Spouse is under 65 years of age, to any individual whole life or convertible one-year term or term to age 65 plan without submitting evidence of health. The premium rate will be determined from your Spouse's age and class of risk at the time of conversion.

The maximum amount of insurance that may be converted shall be $25,000 less any amount your Spouse becomes eligible for under a replacing contract of group life insurance.

For information on the conversion, please contact the Plan Administration Office.

Top

Accidental Death and Dismemberment..

Member Accidental Death Benefit

If you were to die as the result of an accident, whether at work, or not, an additional $100,000 will be paid to your beneficiary.

No more than 100% of the Amount of Insurance will be paid for all losses due to any one accident.

Covered Accidental Losses

A loss shown in the Table below is covered if it (a) occurs solely because of accidental injury and within 1 year of the date the injury was sustained, and (b) is total and irreversible or irrecoverable. In the case of loss of speech or hearing, or loss of use of an arm, hand, or leg, the loss must be continuous for 12 months after which time the benefit is payable, provided such disability is determined to be permanent.

COVERED ACCIDENTAL LOSS

DEFINITION OF WHAT CONSTITUTES A LOSS

% OF THE AMOUNT

OF INSURANCE THAT IS

PAYABLELife Accidental death 100%

Each Arm Loss of use, or, severance at or above the elbow 75% Each Leg Loss of use, or severance at or above the knee 75%

Sight in an Eye legal blindness 66 2/3 % Hearing Loss of hearing in both ears

Loss of hearing in one ear only 50%

16 2/3 % Speech Loss of ability to speak intelligibly 50 %

Each Foot Severance between the ankle and the knee 66 2/3 % Each Hand Loss of use, or, severance between the wrist and elbow 66 2/3 %

Thumb and Index Finger only

Severance between the wrist and the inter-phalangeal and proximal interphalangeal joints of one hand, respectively.

33 1/3 %

Exposure

If a loss occurs due to exposure to the elements, after a conveyance in which you were travelling made a forced landing, or was lost, wrecked, stranded, or sank, a benefit will be payable for that loss. The amount payable will be determined in accordance with the previous Table.

Disappearance

If you disappear after a conveyance in which you were travelling made a forced landing, or was lost, wrecked, stranded, or sank, a benefit for loss of life would be payable if your body is not found within one year after the incident occurred.

Losses Not Covered

No benefits are payable for any loss directly or indirectly related to:

suicide or self-inflicted injury, whether the person is sane or insane; war, insurrection or the hostile actions of any armed forces; or

illness or disease, or the medical treatment of any illness or disease.

Top

Weekly Indemnity Benefits (short term disability)..

If you become totally disabled while insured and are unable to work for a short period of time, this benefit will replace a portion of your lost weekly earnings.

Total Disability means that due to sickness or injury, you are unable to perform the regular duties of your own occupation.

You must be under the continual treatment of a qualified and licensed physician. Benefits are as follows:

Class A

58% of weekly earnings in effect immediately prior to the date of disability, up to a maximum benefit of $420.00 per week.

Class B

58% of weekly earnings in effect immediately prior to the date of disability, up to the current E.I. maximum per week.

A doctor's certificate is required for all weekly indemnity or long term disability claims. Be sure your doctor is aware of your first day of sickness. Notification of sickness or accident must be reported, by telephone, to the Plan Administration Office no later than the first working day following the sickness or accident. All claims should be submitted within the 8th day of sickness or accident, to the Plan Administration Office. Claims will not be valid until the day of notification. Claims which are received late, or after the fact, may be held and reviewed by the Trustees at their next meeting. Weekly indemnity claim forms are available from the Plan Administration Office.

Weekly benefit payments will be made in arrears. Any payment for part of a week will be calculated at a rate of 1/7 of the weekly benefit.

This benefit commences on the 8th calendar day of a disability and will be paid for up to a maximum of 17 weeks. In the event that you are still disabled after 17 weeks an application will be made for long term disability benefits.

Third Party Settlements

WI Benefits are not payable for disabilities caused by the fault of a third party, that is someone from whom you may be seeking monetary compensation (for example, a disability resulting from a motor vehicle accident).

If your disability is caused by the fault of a third party a Disability Loan rather than WI benefits may be payable from the Plan. The Trustees may, in their absolute

discretion, provide you with a loan pending settlement of your claim against the third party PROVIDED THAT you sign an agreement to reimburse the Trustees of the Plan. The amount of reimbursement is dependent upon the actual amount of your settlement and takes into account your legal expenses and the amounts you may be required to repay your employer.

If you release a third party of liability, without making a claim for lost wages, you will be required to reimburse the Trustees. Therefore, in order to avoid your having to repay a loan without the offsetting recovery from the third party at fault, it is extremely important that you advise your adjuster or lawyer of your claim for lost wages at the beginning of any disability caused by the fault of a third party.

Disabilities Not Covered

No benefits are payable for any Disability directly or indirectly related to:

self-inflicted injuries or illnesses, whether the person is sane or insane; war, insurrection, the hostile actions of any armed forces or participation in a

riot or civil commotion; or the committing of or the attempt to commit an assault or criminal offence.

Recurrent Disabilities

If you again become totally disabled from the same or related causes within 2 weeks of returning to work, payments for the balance of the benefit period will resume immediately. For benefits to resume immediately, you must see a physician on the date the disability recurs, and advise the Plan Administration Office.

Claim Termination

Payments will terminate prior to the end of the Benefit Period:

if you do not provide the Insurer with satisfactory proof of disability; when you are no longer disabled; when you work in any occupation for wage or profit; in the event of your death.

No Weekly Indemnity Benefits Will Be Payable During Any Period in Which You Are:

not under the care of a physician; working without the approval of the Administrator; on lay-off during which you become totally disabled; on leave of absence during which you become totally disabled, except for the

health related portion of a Maternity Leave of Absence, unless your employer is required to pay benefits during this period as a result of legislation, regulation or case law;

receiving Employment Insurance Maternity or Parental Benefits (except for the health-related portion of Maternity Leave of Absence);

Workers' Compensation wage loss payments will be offset from disability benefit payments.

Receiving benefit payments under an employee –sponsored salary

continuance or a wage-loss replacement plan.

Follow These Steps To Make a Weekly Indemnity Claim

Obtain a claim form from the Plan Administration Office. See a physician. Have a doctor complete his portion of the form. Complete your portion. Forward claim to the Plan Administration Office.

Upon return to work please phone the Plan Administration Office so that the claim can be finalized.

During the progress of the claim you may be requested to submit supplementary medical reports. These will be mailed directly to you and are to be returned directly to the Insurer.

These benefits are non-taxable.

Top

Long Term Disability..

If you continue to be totally disabled after the Weekly Indemnity benefits has expired, you will be eligible to receive 65% of your salary (to a maximum benefit of $1,700 monthly). This benefit commences after 17 consecutive weeks of disability payments and is payable until the earlier of recovery, attainment of age 65, or death.

The amount of the benefit payable is less any amount of disability benefits the Member is entitled to amount of disability benefits you may be entitled to receive from the following sources:

Workers' Compensation or similar coverage; and 65% of any amounts you may receive from Canada or Quebec Pension Plans

as a primary disability payment, excluding dependent benefits; and the Quebec Automobile Insurance Act.

This amount will be further reduced so that the total amount payable does not exceed 85% of pre-disability earnings. All sources include those stated above and any disability benefits received from:

any group, association, or franchise plan; any retirement or pension disability plan; any income payable from any employer; Canada or Quebec Pension Plans, dependent benefits.

Your monthly benefit will not be reduced by a government cost-of-living adjustment occurring after the date on which benefits become payable.

In order to be entitled to this benefit you must be unable to perform the normal duties of your own occupation for the qualifying period and the next 24 months. After this the normal duties are deemed to be those of any occupation for which the

member is or may become suited by education, training, or experience.

These benefits are non-taxable.

Claim Termination

Benefit Payments Will Terminate Prior to the End of the Benefit Period:

if you do not provide the Insurer with satisfactory proof of your disability; if you do not participate in vocational rehabilitation (a retraining or job

placement program) when it is considered appropriate by the Trustees; when you are no longer disabled; when you reach the age of 65; in the event of your death.

Third Party Settlement

LTD Benefits are not payable for disabilities caused by the fault of a third party, that is someone from whom you may be seeking monetary compensation (for example, a disability resulting from a motor vehicle accident).

If your disability is caused by the fault of a third party a Disability Loan rather than LTD benefits may be payable from the Plan. The Trustees may, in their absolute discretion, provide you with a loan pending settlement of your claim against the third party PROVIDED THAT you sign an agreement to reimburse the Trustees of the Plan. The amount of reimbursement is dependent upon the actual amount of your settlement and takes into account your legal expenses and the amounts you may be required to repay your employer.

If you release a third party of liability, without making a claim for lost wages, you will be required to reimburse the Trustees. Therefore, in order to avoid your having to repay a loan without the offsetting recovery from the third party at fault, it is extremely important that you advise your adjuster or lawyer of your claim for lost wages at the beginning of any disability caused by the fault of a third party.

Recurrent Disability

If you again become disabled from the same or related causes within 6 consecutive months of return to work, benefits for the balance of the benefit period will resume immediately. For benefits to resume immediately, you must provide a physician's report.

Periods For Which No Benefit is Payable

No monthly benefit is payable:

during any period in which the person you are is working, except where this work is part of a rehabilitative program; or

during any period in which the person you are is receiving benefits under a salary continuance or short term wage loss replacement plan; or

during the remainder of any leave of absence or temporary lay-off in which

the person you becomes totally disabled; or during any pregnancy leave of absence required by law or fixed by mutual

agreement between the person you and her your employer; or while receiving Employment Insurance Maternity or Parental benefits (other

than during the health related portion of a Maternity Leave of Absence); or during any period in which a Physician is not attending to and providing

regular ongoing care and treatment for the disabling condition; or while absent from your home for more than one month, unless the treating

Physician has approved such an absence in writing to the Plan Administration Office, and has indicated the care and treatment that will be required during such absence, and proof that this care and treatment is being received is submitted during your absence.

Rehabilitation

Trustees may require the disabled person you to participate, with the assistance of his or her your Physician and Employer in a rehabilitation program. If the disabled person you works as part of this program, the monthly benefit will continue to be paid. However, benefit payments will be reduced so that the disabled person's your income from all sources does not exceed 100% of his or her your pre-disability earnings.

Disabilities Not Covered

No benefits are payable for any disability directly or indirectly related to:

self-inflicted injuries or illnesses, whether the person is sane or insane; war, insurrection, the hostile actions of any armed forces or participation in a

riot or civil commotion; the committing of or the attempt to commit an assault or criminal offence; the abuse of addictive substances including drugs and alcohol, unless you are

participating in a treatment program; the insured individual refusing to participate in a rehabilitation program which

is deemed appropriate by the Trustees, the attending physician, or on the advice of independent medical opinion.

Pro Rating

The Monthly Benefit will be reduced, if necessary, so that the combined disability and retirement benefits that the disabled person is eligible to receive from all sources does not exceed 85% of the person's pre-disability earnings.

Follow These Steps to Make an LTD Claim

Obtain claim forms from the Plan Administration Office one month prior to weekly indemnity benefits expiring.

Complete your section of the claim form. Have your physician complete his section of the form. Submit forms promptly to the Plan Administration Office.

Appeal Process for LTD Claims

In the event your Long Term Disability Claim is declined or terminated and you wish

to appeal the decision, please contact the Plan Administration Office for appeal process guidelines.

Notice of intent to appeal must be received in the Plan Administration Office within 15 days of the date of the termination letter from the Insurer.

Top

Basic Provincial Medical and Hospital Plan..

Medical benefits are provided under The Medical Services Plan of British Columbia ("Medicare MSP") as administered by Medical Services Plan of British Columbia.

Briefly, the Plan MSP provides for the full cost of most physicians and surgeons services, including:

home, hospital and office visits; x-ray and laboratory services; surgical procedures (in and out of hospital); anaesthesia; maternity, including prenatal and postnatal care.

Care provided by licensed Specialists is also covered (including that of a psychiatrist) provided your regular doctor refers you to him. In addition, certain limited coverage is provided with respect to physiotherapy, special nursing, orthoptic, and optometric treatment, chiropractic, naturopathic and podiatric care and oral and dental surgery.

Hospital room and board care to the standard ward level is provided by the Hospital Programs. Expenses for semi-private and private room accommodation are provided under the Extended Health benefits.

Coverage Outside Canada - Hospital Benefits

Only emergency in-patient hospital benefits are provided outside Canada. B.C. Medical will pay for hospital charges outside Canada, not to exceed $75 a day (Canada funds) for an adult or child and $41 a day (Canada funds) for a newborn infant.

Coverage Outside Canada - Physician Benefits

Payment of physician's services incurred outside Canada, on an emergency basis, will not exceed the amount payable had you received the same care in B.C. Payment is in Canadian funds.

Out-of-Province claims must be submitted within six months of the date of service. Claim forms are available from the Plan Administration Office. Please notify the Plan Administration Office upon your return and we will assist you with the submission of your claim to B.C. Medical and to the Insurer for any portion not paid by B.C. Medical.

The Following Services Are Not Covered While You Are Absent From B.C.

Chiropractic Orthoptic Physiotherapy Naturopathic Orthodontic Podiatry Optometric Massage Therapy

B.C. Medical Coverage For Temporary Absences

If your absence from B.C. may be for more than six months please advise the Plan Administration Office so that arrangements can be made to provide continuing coverage.

Top

Extended Health Care Benefits..

This Plan supplements the coverage provided by the Medical Services Plan of B.C. and Universal Pharmacare. The following are covered expenses, if medically necessary for the treatment of sickness or injury and recommended by a physician:

Overall Benefit Maximum

Class A and Class B - Unlimited Class C and Class D - $25,000 per lifetime, including

Vision Care Expenses

The maximum benefit is the most that will be payable for covered expenses incurred for the care of an insured person.

When a person in Class C or Class D first becomes insured for this benefit, the maximum benefit is the Overall Benefit Maximum shown above. At the start of each calendar year, the maximum benefit is decreased by the benefits payable for expenses incurred in the previous year and increased by the least of:

10% of the Overall Benefit Maximum; $1,000; and an amount which would bring the maximum benefit to the Overall Benefit

Maximum.

Deductible - Nil.

Benefit Percentage

100% for: - Drugs; Hospital Care; Medical Services and Supplies; Professional Services; Vision Care, excluding visual training and remedial exercises.

The benefit percentage for out of Canada emergency medical treatment is 100%. The benefit percentage for referral outside Canada for medical treatment available in Canada is 50%.

The benefit percentage for:

E.T.A. is 100%. myoelectric prostheses is 80%. visual training and remedial exercise is 50%.

Covered Expenses

The expenses specified are covered to the extent that they are reasonable and customary, provided they are:

medically necessary for the treatment of sickness or injury and recommended by a physician; and

incurred for the care of a person insured under this Group Benefit Program.

Payment of any covered expenses under this benefit which may be purchased in large quantities will be limited to the purchase of up to a 3 month's supply at any one time.

Hospital Care

charges, in excess of the hospital's public ward charge, for semi-private or private accommodation;

confinement in a convalescent care facility or a nursing home which starts within 2 days of discharge from a hospital confinement of at least 5 days, up to a maximum of $20 per day for 120 days per disability for semi-private or private accommodation.

Prescription Drugs

drugs or medicines dispensed by a licensed pharmacist, and which by law or convention require a written prescription of a physician or dentist;

oral contraceptives, intrauterine devices, and diaphragms; injectable medications; life-sustaining drugs; preventative vaccines (oral or injected) and serums; non-prescription drugs and supplies required for the treatment of diabetes.

Automatic jet injectors or similar equipment are not covered.

Charges for the administration of serums, vaccines, or injectable drugs are not covered.

Health Care Practitioners

Services provided by the following licensed practitioners:

Chiropractor (including x-rays) $600 per calendar year

Osteopath (including x-rays) $600 per calendar year

Podiatrist (including x-rays) $600 per calendar year

Masseur or Masseuse $600 per calendar year Naturopath (including x-rays) $600 per calendar year

Speech Therapist $600 per calendar year Acupuncturist $600 per calendar year Physiotherapist Unlimited Psychologist, Psychotherapist, Psychoanalyst, or Master of Social Work (M.S.W.)

$600 per calendar year combined.

B.C. Medical provides coverage, with an annual limit of 12 visits each for the services of Chiropractors, Naturopaths, Physiotherapists, Massage Therapists, and Podiatrists. The patient visit charge, or user fee, may be claimed from the Insurer. When your visits exceed the annual limit set by B.C. Medical you may claim the cost of treatment with the Insurer. User fees at April 1, 1998 have been set by B.C. Medical at $10.00 per visit and are subject to change.

Recommendation by a physician is not required for the licensed practitioners listed above.

Medical Services and Supplies

Private Duty Nursing:

services provided in your home (other than custodial care, homemaking services and supervision) by a Registered Nurse, to a maximum of $25,000 per calendar year;

services provided must be services which are deemed to be within the practice of nursing.

A detailed treatment plan should be submitted to the Plan Administration office before the services begin for a pre-determination of benefits. You will then be advised of any benefit that will be provided.

Charges for the following services are not eligible:

services performed by a nursing practitioner who is related to or lives with the patient;

services performed while the patient is in a hospital, nursing home, or similar institution;

services which can be performed by a person of lesser qualification, a relative, friend, or Member of the patient's household.

Ambulance:

licensed ambulance service, including air ambulance, to and from the nearest hospital where adequate treatment is available.

Medical Equipment:

rental or, at the Insurer's option, purchase of a hospital bed, standard wheelchair, electric wheelchair (if medically necessary), respiratory equipment, oxygen and oxygen equipment, or other such equipment which may be deemed reasonable.

Non-Dental Prostheses, Support, and Hearing Aids:

artificial eyes, limbs, and breast prostheses, the benefit percentage for myoelectric prostheses is 80%;

surgical stockings and surgical brassieres; braces (excluding foot braces), trusses, collars, casts, crutches, and quad

canes; orthopaedic shoes which are made or altered to fit the person's specific

medical needs, and which are prescribed by a physician; orthotic foot appliances (including foot braces) which are made or altered to

fit the person's specific medical needs, up to a maximum of $200 per calendar year (recommendation of a practitioner is required, not necessarily a physician);

cost-installation, repair and maintenance of hearing aids (including charges for batteries), to a maximum of $600 every 5 calendar years;

stump socks, to a maximum of 6 pairs per calendar year; wigs and hairpieces when required as a result of chemotherapy, to a

maximum of $100 per 6 consecutive months.

Other Supplies and Services:

ileostomy and colostomy supplies; oxygen and diagnostic services; charges for the treatment of accidental injuries to natural teeth or jaw,

provided the treatment is rendered within 12 months of the accident, excluding injuries due to biting or chewing.

Out of Province/Out of Canada

Emergency medical treatment of a sickness or injury which occurs while temporarily out of Canada, provided the insured person who receives the treatment is also covered by the Provincial Health Care Plan during the absence from Canada.

A medical emergency is a sudden, unexpected injury which occurs, or an unforeseen illness which begins during the absence from Canada and which requires immediate medical attention.

Medical treatment which is not available in the insured person's province of residence but which is available and provided to that person elsewhere in Canada.

Medical treatment which is not available in Canada.

Out of Canada Referral

Referral outside Canada for treatment which is available in Canada, 50% to a maximum of $3,000 every 3 calendar years.

If, while outside Canada on referral for medical treatment, the insured person requires treatment for a medical condition which is related directly or indirectly to the referral treatment, the total expenses payable for all treatment are subject to the maximum of $3,000 every 3 calendar years, and a benefit percentage of 50%.

The Insurer requires that it be recommended by a Physician practicing in Canada.

Before treatment begins you must submit a detailed treatment plan with cost estimate to the Plan Administration Office. You will then be advised of any benefit that will be provided.

Charges for the following are payable under this expense: o physician's services; o hospital room and board at standard ward rates; o the cost of special hospital services.

The amount payable for these expenses will be the reasonable and customary charges less the amount payable by the Provincial Health Care Plan.

Charges incurred outside Canada for all other covered Extended Health Care expenses are payable on the same basis as if they were incurred in Canada.

Emergency Travel Assistance (ETA)

All members are eligible for ETA.

ETA is a travel assistance program available for insured persons during the first 6 months while travelling outside Canada.

Delivered through an international travel assistance organization, ETA provides medical, personal and financial assistance in case of travel emergency.

Please Refer to Your ETA Brochure for Details:

Providers of medical services outside Canada (i.e. hospitals, physicians, etc.) may require immediate payment or advance deposits. If this occurs and the charge exceeds $200, ETA can assist in settling the bill.

If assistance is requested, the international travel assistance organization will arrange with the provider (hospital, physician, etc.) to send all bills directly to them for payment.

The insured person will have to sign an authorization form, allowing the travel assistance organization to seek reimbursement of the covered expenses from the applicable Provincial Health Care Plan and the Insurer.

If assistance is not requested, the insured person will be responsible for seeking reimbursement of the expenses, first from the Provincial Health Care Plan and then the Insurer.

Upon your return please contact the Plan Administration Office to obtain

the proper forms to make your claim. Out-of-province claims must be submitted to B.C. Medical within 6 months of the date of service.

Exclusions

No Extended Health Care benefits are payable for expenses resulting from:

self-inflicted injuries; war, riot, insurrection or civil commotion; committing or attempting to commit an assault or criminal offence; an illness or injury for which benefits are payable under any government plan

or Workers' Compensation; charges for periodic check-ups, broken appointments, third party

examinations or travel for health purposes; services or supplies provided by an employer's medical or dental department; services or supplies for which no charge would normally be made in the

absence of insurance; services or supplies which are not permitted by law to be paid; services or supplies which are required for recreation or sports; services or supplies which would have been payable by the Provincial Health

Care Plan if proper application had been made; services or supplies which are furnished without the recommendation and

approval of a physician acting within the scope of his license; medical treatment which is not usual or customary, or is experimental or

investigational in nature; charges not specified in the foregoing list of eligible expenses.

Top

Fair Pharmacare

Effective May 1, 2003 the British Columbia provincial government introduced an income-based deductible program for prescription drugs called “Fair Pharmacare”.

All members are asked to register fro Fair Pharmacare. Once your registration is process, you will receive a confirmation letter. A copy of the letter should be forwarded to the insurer (Great West Life) in order for them to determine your deductible limit.

If the insurer receives no confirmation letter, the insurer will pay 100% of your family combined claims up to $2000. If your claims exceed $2000, the insurer will continue to pay claims for an 8 week period to allow time for you to register and will only stop paying claims if the deductible information is not received by the end of the 8 week period.

Pharmacare Deductible..

The annual Pharmacare deductible is $800 per family effective April 1, 1998.

The Insurer will pay 100% of your first $800 of prescription receipts issued in a

calendar year.

When your prescriptions exceed $800 in a calendar year you will pay the pharmacy only the portion of your prescription drug costs not covered by Pharmacare.

These prescription receipts can be submitted to the Insurer for payment. Please keep copies of your receipts as they will not be returned.

The Pharmacare deductible is set annually and is subject to change.

Top

Low Cost Alternative Drugs..

Effective April 21, 1994 Pharmacare introduced a new reimbursement strategy which will only cover low cost alternative drugs (e.g. generic drugs vs. brand name drugs using the same active ingredients).

On October 1, 1995, Pharmacare program introduced a "reference-based" pricing initiative. This program reimburses the low cost drug alternative (which may have different active ingredients) used to treat a particular condition.

Both programs are designed to encourage the use of low cost drugs that have the same therapeutic benefits as higher-priced drugs.

Individuals will still have the option to purchase higher-cost drug alternatives. However, Pharmacare will only provide reimbursement for the actual cost of the low cost drug on its list. A claim may be made to the Insurer for consideration of the balance of the cost.

Top

Vision Care.. Eye exams, once per calendar year for each dependent child and once during

any 2 consecutive calendar years for each of the Member and the Spouse. Purchase and fitting of prescription glasses or elective contact lenses, as well

as repairs, to a maximum of $200 per calendar year for each dependent child and $200 during any 2 consecutive calendar years for each of the Member and the Spouse.

If contact lenses are required to treat a severe condition, or if vision in the better eye can be improved to a 20/40 level with contact lenses but not with glasses, the maximum payable for all vision care expenses will be $200 per calendar year for each dependent child and $200 during any 2 consecutive calendar years for each of the Member and the Spouse.

Visual training and remedial exercises - 50%, to a maximum of $200 per calendar year for each dependent child and $200 during any 2 consecutive calendar years for each of the Member and the Spouse.

Top

Fair Pharmacare

Effective May 1, 2003 the British Columbia provincial government introduced an income-based deductible program for prescription drugs called “Fair PharmaCare”.

All Members are asked to register with Fair PharmaCare. Once your registration is processed you will receive a “Fair PharmaCare Registration Confirmation” letter followed by a letter entitled “Confirmation of your Fair PharmaCare Financial Assistance Level” which outlines your annual deductible amount. A copy of this letter should be forwarded to the insurer, (Great West Life) in order for them to correctly process your extended health care claims.

If the insurer receives no confirmation letter, the insurer will pay 100% of your family’s combinedclaims up to $750. If your claims exceed $750, the insurer will notify you of the need to confirm your family’s registration and deductible amount but will continue to pay claims for an 8 week period to allow time for you to provide proof of registration. If confirmation of registration is not provided to the insurer during this period, your claims payments will continue until the end of the 8 week period at which time you may be delayed.

You can register with Fair PharmCare online at https://pharmacare.moh.hnet.bc.ca/ or by calling toll-free in BC 1-800-387-4977 (8:00 AM to 8:00 PM weekdays, 8:00 AM to 4:00 PM weekends).

Dental Benefits..

The Insurer will pay the benefit percentage of all covered expenses incurred for the dental care of an insured person.

Benefit Percentage

Class A - 100% for Plan A - Basic Services - 75% for Plan B - Major Restorative Services - 50% for Plan C - Orthodontic Services

Class B - 100% for Plan A - Basic Services - 75% for Plan B - Major Restorative Services

Class C - remain in the same Classification "A" as prior to retirement Class D - remain in the same Classification "B" as prior to retirement

Benefit Maximums

Class A - $2000 $1,500 per calendar year combined for Plan A and Plan B

- $2,000 per lifetime for Plan C

Class B - $2000 $1,500 per calendar year combined for Plan A and Plan B Class C - as pertains to the Classification, A above, prior to retirement Class D - as pertains to the Classification, B above, prior to retirement

Dental Fee Guide

current British Columbia Fee Guide for General Practitioners and Specialists; fees of a Specialist will only be considered if the insured person is referred to

the Specialist by a General Practitioner.

Alternate Benefits Treatment

When there are two or more courses of treatment available to correct a condition, the Insurer will reimburse the member for the least expensive form of treatment which provides a professionally adequate result.

Examples of when the Alternate Benefits Provision will be considered:

when there are 5 or more functional teeth missing in an arch, or when bridgework is replacing an existing partial denture, the Insurer's allowance will be that of a partial denture;

when porcelain is used on molar teeth, for crowns or bridgework, the allowance will be that of full cast metal.

Plan A - Basic Services

Class A, B, C and D

one complete oral exam in any 24 consecutive months; full mouth x-rays during any 24 consecutive months; recall exams, bitewing x-rays, light scaling and polishing, and fluoride

treatments, once every 5 months; routine diagnostic and laboratory procedures; one visit for oral hygiene instruction; fillings, and pit and fissure sealants; stainless steel crowns (excluding crowns of porcelain fused to metal, acrylic,

plastic, gold, porcelain and other substances); space maintainers (appliances placed for orthodontic purposes are not

covered); minor surgical procedures and post surgical care; extractions (including impacted and residual roots); periodontal services (treatment of gum disease and other supporting tissues

of the teeth, excluding periodontal prosthesis [splinting] and orthodontic treatment [repositioning]). Three periodontal appliance adjustments are covered while insured under this Policy;

consultations, anaesthesia, and conscious sedation; endodontics (root canal work); onlays and inlays, when the function of a tooth is impaired due to cuspal or

incisal angle damage caused by trauma or decay; denture repairs, relines and rebases (relining and rebasing of dentures is

limited to once every 36 consecutive months). dental mouthguards as prescribed by a dentist.

Plan B - Major Restorative Services

Class A, B, C and D

crowns, when the function of a tooth is impaired due to cuspal or incisal angle damage caused by trauma or decay;

surgical procedures not included in Plan A (excluding implant surgery - allowance for implant surgery, along with other charges related to implants, will be considered under the Alternate Benefits Treatment provision);

initial provisions of fixed bridgework (a detailed treatment plan should be submitted before the work is started. See the Alternate Benefits Treatment provision on Page 42);

replacement of bridgework, provided the new bridgework is required because:

- a natural tooth is extracted and the existing appliance cannot be made serviceable;

- the existing appliance is at least 60 months old; or

- the existing appliance is temporary and is replaced with the permanent bridge within 12 months of its installation;

bridgework required solely to replace a natural tooth which was missing prior to becoming insured under this PART D of the Plan is not covered for Class B Members;

initial provision of full or partial removable dentures; replacement of removable dentures, provided the dentures are required

because:

- a natural tooth is extracted and the existing appliance cannot be made serviceable;

- the existing appliance is at least 60 months old; or

- the existing appliance is temporary and is replaced with the permanent dentures within 12 months of its installation (replacement of dentures within the first 12 months of becoming insured for this covered expense is not covered);

removable dentures required solely to replace a natural tooth which was missing prior to becoming insured under this PART D of the Plan are not covered for Class B and Class D Members.

Plan C - Orthodontic Services

Class A and Class C

orthodontic services for you and your dependents.

Pre-Determination of Benefits

If the cost of any proposed dental treatment is expected to exceed $300, the Insurer suggests that you submit a detailed treatment plan, available from your dentist, before treatment begins. You can then be advised of the amount you are entitled to receive under this benefit.

Exclusions

No Dental Care benefits will be payable for expenses resulting from:

self-inflicted injuries; war, riot, insurrection or civil commotion; committing or attempting to commit an assault or criminal offence; dental care which is cosmetic; missed dental appointments; services which are payable by any government plan; services or supplies provided by an employer's medical or dental department; services or supplies for which no charge would normally be made in the

absence of insurance; treatment rendered solely to correct the vertical dimension or

temporomandibular joint dysfunction; replacement of removable dental appliances which have been lost, mislaid, or

stolen; laboratory fees which exceed reasonable and customary charges.

Top

Co-ordination of Benefits..

If a Member or dependent of a Member who is covered under this contract for Extended Health Care, Emergency Travel Assistance or Dental Care is also covered under another plan which provides similar coverage, any claim will be co-ordinated and/or reduced so that benefits payable from all plans will not exceed 100% of the eligible charges incurred. Benefit payments will be determined as follows:

The Plan which does not contain a Co-ordination of Benefits provision will pay before the plan which does.

Where both plans contain a Co-ordination of Benefits provision, priority is given as follows:

1. the plan where the person is covered as a Member*; 2. the plan where the person is covered as a dependent Spouse; 3. the plan where the person is covered as a dependent child. Where a

dependent child is under two or more plans, priority is given as follows: a. the plan of the parent with the earlier date of birth (month/day)

in the calendar year; b. the plan of the parent whose first name begins with the earlier

letter in the alphabet, if the parents have the same date of birth.

The following order of benefit payment will apply if the parents are separated/divorced:

a. the plan of the parent with custody of the child; b. the plan of the Spouse of the parent with custody of the child; c. the plan of the parent not having custody of the child; d. the plan of the Spouse of the parent in (c) above.

* If a Member is covered as an Employee/Member (not as a dependent) under more

than one plan please notify the Plan Administration Office.

Top

Survivor Benefits..

If you die while you and your dependents are insured under PART D of the Plan, the Plan will continue the Dependent Life Insurance, Extended Health Care, Vision Care, and Dental Care benefits if you are a Member of Class A or B, and Extended Health Care and/or Vision Care and/or Dental if you are a Member of Class C or Class D without payment of premium, until the earliest of:

the date your dependent is no longer a dependent, according to the definition of dependent;

the date which is 2 years from your death; or the date your surviving Spouse remarries.

The maximum period for extended coverage is two years.

Termination of the policy with the Insurer will have no effect on insurance continued under this benefit.

B.C. Medical coverage may also be continued, on a self-pay basis.

Top

Compassionate Assistance Program..

This benefit is a program to meet the special financial needs of Members who are terminally ill.

To be eligible an insured Member must meet these requirements:

is terminally ill (in general, if life expectancy is no more than 12 months); requires financial assistance.

The loan maximum is 50%, to a maximum of $50,000, of the amount of life insurance under our Policy, and interest charges are deducted from the amount of Life Insurance benefit paid to the beneficiary.

Decision on approval of the loan is co-ordinated by the Insurer.

Please contact the Plan Administration Office for additional information and application requirements.

Top

Employee and Family Assistance Program..

An Employee and Family Assistance Program is available to our Members and their

dependents. We are using the services of Warren Sheppell - CONTACT program and they can be reached at:

1-800-387-4765 for general information.

The purpose of the Program is to supply to members and their families a professional and confidential resource to help resolve the personal and/or emotional problems that most of us are faced with from time to time.

A separate brochure is available if more information is required. More detailed information regarding this program can be found on their website - http://www.warrenshepell.com.

Top

Membership Termination..

Your coverage and that of your eligible dependents will cease as described below:

immediately when your employer ceases to be a participating employer; immediately upon termination of the Plan (Medical extends to the end of the

month of termination); the date any required contribution is due but not paid; immediately upon voluntary termination of employment; upon Employer initiated termination of employment as follows:

- IMMEDIATELY - Weekly Indemnity and Long Term Disability;

- at the end of the month immediately following the month in which employment terminated:

o Medical o Dental o Extended Health o ETA o Vision Care o Life o Dependent Life o AD&D

When you are terminated by the Employer or are laid-off, your Employer will make full payment for that entire month regardless of the number of days worked providing you worked in the previous month.

You and your eligible dependents will receive the above mentioned coverage for the following 3 months after termination or lay-off providing you are eligible for benefits. Premium payment for this additional 3 month's coverage comes from your reserve.

Top

Continuing Coverage..

During a Lay-Off

Members may continue coverage during a lay-off. A benefit package is available and provides the following coverage for up to 12 consecutive months provided premium payments are received:

B.C. Medical Life Insurance AD&D Dependent Life Insurance Extended Health ETA

Please contact the Plan Administration Office within 15 days of your lay-off if you elect to self-pay for this coverage. Otherwise coverage will terminate the end of the month following the month in which you were laid-off.

During a Strike or Lock-Out

If the Member ceases to be actively at work due to a strike or lock-out, employment will be deemed to continue, unless the Union makes another arrangement for continuation of benefits as permitted under the Canada Labour Code. Employment will be deemed continuous provided the appropriate premium payments are made; but in no event for more than 12 consecutive months. The Member must reimburse the Plan at the end of the strike to replenish the 3 month reserve.

To qualify for continuing benefits the Members on strike or lock-out must be participating a minimum of 20 hours per week either in picketing or other Union related duties.

If the Trustees agree, based on Plan finances, coverage will be maintained for:

Life Insurance AD&D Dependent Life Insurance Weekly Indemnity Long Term Disability B.C. Medical Extended Health Care ETA

If a Member becomes disabled during the period of strike or lock-out, such Member will not begin to satisfy the Elimination Period for the disability until the date the Member would have returned to work.

During an Approved Leave of Absence

If you are absent from work on a permissible, extended leave of absence, coverage may be maintained for six consecutive months. During the six month period, a benefit package is available:

B.C. Medical

Life Insurance AD&D Dependent Life Insurance Extended Health ETA

Arrangements must be made with the Plan Administration Office prior to the leave of absence.

Premiums must be pre-paid prior to the leave of absence, otherwise all benefits will terminate effective the date the leave of absence becomes effective.

Retired Member Coverage

Coverage is available to Members, and their dependents, taking regular or early retirement. Early retirement can occur from age 55, on:

all coverage, with the exception of weekly indemnity and long term disability, will continue for 3 months following the month in which retirement occurs;

the following benefits will be available after 3 months of retirement, on a self-pay basis. Arrangements must be made with the Plan Administrator within 31 days of retirement:

- B.C. Medical

- Life Insurance in the amount of $5,000, $7,500 or $10,000

- Extended Health (including Vision Care), subject to a lifetime maximum of $25,000 per person insured (as described on page 28)

- Dental

at retirement you may elect to continue your coverage as detailed under Class C & D. If you do not elect to continue your coverage on your date of retirement, you will not have the option to elect the coverage at a later date. Once you have made an initial election of a benefit amount, you will not be eligible to increase this amount at a later date.

While on Weekly Indemnity Benefit

All benefits will continue while you are on a Weekly Indemnity claim. Premiums will be paid by your Employer.

While on Long Term Disability Benefit

While you are on long term disability, the Plan will only pay premiums for B.C. Medical for the first 3 months you are on benefit. Premiums for Long Term Disability, Life Insurance, AD&D, and Dependent Life Insurance will be waived during total disability.

You will be invoiced monthly for any other benefits you may wish to continue.

Top

Claims Procedures..

Weekly Indemnity Benefits

refer to page 21 of this booklet; reimbursement will be made to the Member for any receipt he/she submits for

a physician to complete a Weekly Indemnity or Long Term Disability claim form:

- payment will be to a maximum of $20 per report;

- payment will be to a maximum of $40 per calendar year;

- payment will be issued by the Insurer.

Long Term Disability

refer to page 26 of this booklet; reimbursement as above under Weekly Indemnity Benefits; all claims must be submitted within 6 months of the end of the qualifying

disability period.

Extended Health and Vision Care

claims must be submitted to the Insurer on the forms provided; all claims must be submitted within 18 months after the date the expense was

incurred; be sure to complete the form showing:

- Member's name, address, social insurance number;

- date of service or receipt, etc.

- charges with original receipts.

Mail directly to:

The Great-West Life Health and Dental Claims P.O. Box 6005, Station Main Winnipeg, Manitoba, R3C 3B2

Dental Claims

a dental claim form should be taken to the dentist whenever you or one of your dependents has an appointment;

you must complete the employee section. It is not necessary to have the employer section completed as long as your Group Policy No. 51379 and

social insurance number are shown; when the dentist has completed the form, return it along with any itemized

bills to the Insurer at the address above; all claims must be submitted within 18 months after the date the expense was

incurred.

Life Insurance Claims

your beneficiary must complete the Life Claim form available from the Plan Administration Office and a completed form must be submitted within 90 days from the date of the loss.

B.C. Medical - Out-of-Province

claim forms are available from the Plan Administration Office; out-of-province claims must be submitted to B.C. Medical within six months of

the date of service.

Top

Time Limit for Submitting Claims.. In the event of employment termination, or termination of the policy, all

claims must be submitted within 90 days of the termination date.

Late proof will be accepted by the Insurer up to one year after the benefits first became payable if it can be shown that it was not reasonably possible to submit proof any sooner.