Introduction

As an employee of Edmonton Catholic Schools, group insurance benefits are available to you.  The cost of the group insurance benefits is shared between employees and Edmonton Catholic Schools.

The plan benefits are provided through:

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Eligibility

Permanent full-time employees or permanent part-time employees along with their "dependents" are eligible to be covered by the group insurance plan.  Coverage commences on the first day of employment provided the employee is actively at work.  Following is the minimum number of hours per week an employee must be employed in order to be eligible:

Participation in the group insurance plan is compulsory for all eligible employees.  You may opt out of Extended Health, Dental and Vision and Hearing Aid care only if you have coverage through your spouse.

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The term "dependent" means your spouse, either legal or common-law*; and unmarried children (of either your legal spouse or your common-law spouse) who reside with you in a regular parent-child relationship and who are:

• under 21 years of age; or
• under 25 years of age and attending a college or university full-time; or
• mentally or physically handicapped, entirely dependent upon you for support and maintenance and covered under the group insurance plan prior to age 

*Common-law spouse means a person who is publicly represented as your spouse, and who has resided with you for at least two years.

Group insurance plan coverage for dependents you have when you join the plan commences on your effective date.  Group insurance plan coverage for dependents you acquire after you join the plan is effective on the date of birth for new born children, the date of marriage if we have been advised prior to the marriage, or the date we are advised of the marriage.  You must, however, notify Benefits/Human Resource Services within 31 days to add your spouse and each dependent child to avoid late applicant restrictions.

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Group insurance plan coverage for you and/or your dependent(s) ends:

• when you and/or your dependents are no longer eligible (e.g. you are no longer working, or your dependents reach the maximum age); or
• if you are a non-retired employee, on the June 30th immediately following attainment at age 65 (Extended Disability Benefit terminates on the last day of the month following the month in which the employee reaches age 65), or
• if you are a retired employee, at the end of the month in which you have your 65th birthday.

Most group insurance plan coverage may be continued during:

• temporary lay-off, strike or lockout up to the end of the month following the month in which you stopped working.

To continue coverage you must pay the full cost of the group insurance in cases such as:

• maternity leave up to the end of the leave;
• unpaid approved leave of absence, up to one year.

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Retired Employees

Retired employees and their dependents are eligible to be covered by the group insurance plan if they are at least 50 years old with 5 or more years of cumulative employment with Edmonton Catholic Schools.  You must apply for group insurance coverage before retiring and must remain a resident of Canada.

You may, by choosing Option 1, continue the same group insurance plan coverage you had before retiring (except for extended disability which is not available to retired employees), or choose Option 2 which is a reduced level of benefits, or discontinue group insurance plan coverage completely.  The employee will pay the full cost of group insurance plan benefits.

Note: Should you decide to discontinue group insurance you may still convert your life insurance to an individual policy at market rates.

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Claims

Completed claim forms should be sent directly to the insurance carrier at the address shown on the claim form.  You should save all of your original receipts and submit them with the claim form.  If you require return of a receipt, you must inform the insurance company when you submit the claim.  All claim forms are available on the Alberta Blue Cross web site at www.ab.bluecross.ca.  Claim forms are also available at the following locations:

• Extended Health Care and Vision & Hearing (same form) at any Pharmacy in Alberta
• Dental at your dentist's office

All claims must be submitted within 12 months of the date of the service.

Note: Proposed dental treatment exceeding $500 must be pre-approved by the insurance carrier.  Your dentist or orthodontist should complete a treatment plan either on a claim form or attached to one, and submit it to the insurance carrier.  The insurance carrier will review the proposed treatment and advise you how much of the expense will be covered.

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