Medavie Blue Cross is the university’s insurer for Extended Health and Dental Care.
The following benefits are underwritten by Medavie Blue Cross:
– Hospital Benefit
– Extended Health Benefit
– Vision Benefit
– Drug Benefit
– Dental Benefit
For detailed information on specific coverage please click on the Blue Cross Benefits booklet link on this page.
To be eligible for group benefits, you must be a permanent employee who is a resident of Canada, covered under your provincial government plan, actively at work and working a minimum of 35 hours per week if a full-time employee or 25 hours per week if a part-time employee (provided the part-time employee has worked a minimum of nine consecutive months per year) and have completed the plan waiting period. The waiting period for your group plan is one month of continuous employment.
Employees may elect coverage, within 31 days of becoming eligible following the waiting period, by completing an application. Coverage is effective on the date of eligibility, except when: (a) the employee is not actively at work on the day that coverage would otherwise become effective, or (b) the application is made after the 31 day period.
If not actively at work when you would normally have become eligible, your coverage will commence when you return to work on a full-time basis.
Dependents are defined as your legal spouse (as described below), and unmarried, unemployed dependent children including natural, legally adopted or step-children. Children of a common-law spouse may be covered if they are living with the employee. All dependents must be residents of Canada and be eligible for benefits under the provincial government health care programs in the province of residence in order to be eligible for coverage.
The term “spouse” is defined as a person of the opposite or same sex who is legally married to the employee, or has continuously resided with the employee for not less than one full year having been represented as members of a conjugal relationship (common law). In the event of divorce, legal separation, or discontinuance of cohabitation (“common law” spouse), you may elect to continue membership of the former spouse or to provide notice to Medavie Blue Cross to terminate coverage for the spouse. Medavie Blue Cross will at no time provide coverage for more than one spouse under the same plan.
Termination of Insurance:
Coverage for you and your dependents will cease on the earliest of:
– the contract termination date,
– the date you terminate employment,
– the date you cease to be eligible due to retirement, death, leave of absence, age limitation, change in classification, etc.
Coordination of benefits
In the event that benefits may be claimed under more than one section of the health care plan, the claim will be assessed in a manner that provides the greatest benefit to the employee.
If you are eligible for similar benefits under another group benefit plan the amount payable through this plan shall be coordinated with all benefit plans and will not exceed 100 per cent of the eligible expense. Where both spouses of a family have coverage through their own employer benefit plans, the first payer of each spouse’s claim is their own employer’s plan. Any amount not paid by the first payer can then be submitted for consideration to the other spouse’s benefit plan (the second-payer).
Claims for dependent children should be submitted first to the benefit plan of the spouse who has the earlier birth month in the calendar year, and then to the other spouse’s benefit plan. When submitting a claim to a second payer, be sure to include payment details provided by the first payer.
Benefit payments will be coordinated with any other plan or arrangement, in accordance with the Canadian Life and Health Insurance Association (CLHIA) guidelines.
If you should terminate employment, you may convert to an Individual Health and Dental plan currently issued by Blue Cross provided that application is made within 31 days following your date of termination. This conversion privilege is also available to the surviving spouse and/or dependents after the termination of the Survivor Benefit.
In the event of the employee’s death, coverage for surviving eligible dependents under age 65 may be continued in force, provided the subscriber dues continue to be remitted on their behalf, but not beyond:
– the date that the surviving dependent ceases to qualify as a dependent under this contract;
– the date the surviving spouse remarries;
– the date any similar coverage is obtained with respect to a covered dependent;
– 12 months after the employee’s death.