156241 canadian baptist ministries booklet _22_ baptist…

BAPTIST CONVENTION OF
ONTARIO AND QUEBEC
Retirees who retire on or before their 65th birthday
Great-West Life is a leading Canadian life and health insurer. Great-West Life's financial security advisors work with our clients from coast tocoast to help them secure their financial future. We provide a wide rangeof retirement savings and income plans; as well as life, disability andcritical illness insurance for individuals and families. As a leadingprovider of employee benefits in Canada, we offer effective benefitsolutions for large and small employee groups.
Great-West Life Online
Information and details on Great-West Life's corporate profile, our
products and services, investor information, news releases and contact
information can all be found at our website http://www.gwl.ca.
This booklet describes the principal features of the group benefit plan
sponsored by your employer, but Group Policy No. 156241 issued by
Great-West Life is the governing document. If there are variations
between the information in the booklet and the provisions of the policy,
the policy will prevail.
This booklet contains important information and should be kept in a safeplace known to you and your family.
The Plan is underwritten by
Protecting Your Personal Information
At Great-West Life, we recognize and respect the importance of privacy.
When you apply for coverage or benefits, we establish a confidential fileof personal information. We limit access to personal information in yourfile to Great-West Life staff or persons authorized by Great-West Lifewho require it to perform their duties, to persons to whom you havegranted access, and to persons authorized by law.
We use the personal information to administer the group benefit planunder which you are covered. This includes many tasks, such as: • determining your eligibility for coverage under the plan• enrolling you for coverage • assessing your claims and providing you with payment • verifying and auditing eligibility and claims • underwriting activities, such as determining the cost of the plan, and • preparing regulatory reports, such as tax slips We may exchange personal information with your health care providers,your plan administrator, other insurance or reinsurance companies,administrators of government benefits or other benefit programs, otherorganizations, or service providers working with us when necessary toadminister the plan.
All claims under this plan are submitted through you as plan member.
We may exchange personal information about claims with you and aperson acting on your behalf when necessary to confirm eligibility and tomutually manage the claims.
The personal information in your file will be kept in the offices of Great-West Life or in the offices of an organization authorized by us. You mayrequest to review or correct the personal information in your file. Arequest to review or correct your file should be made in writing and maybe sent to any of Great-West Life’s offices or to our head office at: The Great-West Life Assurance CompanyAttn: Group ComplianceP.O. Box 6000Winnipeg, MB Claims submissions should not be sent to this address. Please use theaddress on the claim form or contact your plan administrator for details.
For more information about our privacy guidelines, please ask for Great-
West Life’s Privacy Guidelines brochure.
TABLE OF CONTENTS
Benefit Summary
This summary must be read together with the benefits described in
this booklet.
Employee Life Insurance
Dependent Life Insurance
Healthcare
In-Canada Prescription Drug Expenses- Dispensing Fee Limit 100%The covered expense for thedispensing fee portion of aprescription drug charge islimited to $5 80% of the first $1,250 ofeligible claims submitted perfamily and 100% thereaftereach calendar year Out-of-Pocket Maximum forQuebec Residents An out-of-pocket maximum is applied to in-province expenses fordrugs listed in the Liste de médicaments published by the Régiede l'assurance-maladie du Québec if you live in Quebec(provincial formulary drug expenses). If the sum of the non-reimbursable amounts you are required to pay for provincialformulary drug expenses incurred for you and your dependentchildren or for your spouse in a calendar year reaches themaximum out-of-pocket level established by law, the amountpayable for provincial formulary drug expenses incurred for thesame individuals for the rest of the calendar year will be adjustedas follows: no further out-of-pocket amounts will apply The out-of-pocket maximum does not apply to drug expensesincurred outside Quebec $5,000 every 3 calendaryears up to age 65After age 65, this maximum isreduced by the amount paidover the previous 3 calendaryears for the remainder ofyour lifetime The covered expense for thedispensing fee portion of aprescription drug charge islimited to $5 Initial plus a replacementevery 2 calendar years COMMENCEMENT AND TERMINATION OF COVERAGE
You are eligible to participate in the plan on the date your retirementbegins.
You and your dependents will be covered as soon as you becomeeligible.
You may waive health coverage if you are already covered for thesebenefits under your spouse's plan. If your coverage under yourspouse's plan terminates, you must apply for coverage under thisplan no later than 31 days after termination. After 31 days, you mustprovide evidence of insurability for you and your dependents beforeyou can participate.
Increases in benefits while you or your dependents are in hospitalwill not become effective until you or your dependents are releasedfrom hospital.
Your coverage terminates when you are no longer eligible or the policyterminates, whichever is earliest.
Your dependents' coverage terminates when your insuranceterminates or your dependent no longer qualifies, whichever isearlier.
If your coverage terminates or in the event of your death, anextension of benefits may be provided under the plan. Details areavailable through your employer.
Survivor Benefits
If you die while your coverage is still in force, the health benefits for yourdependents will be continued on a premium paid basis until they nolonger qualify.
DEPENDENT COVERAGE
A common-law spouse is a person who has been living with you in aconjugal relationship for at least 36 months or, if you are a Quebecresident, until the earlier birth or adoption of a child of therelationship.
Your unmarried children under age 22, or under age 25 if they arefull-time students.
Note: If you are a Quebec resident, full-time students are covered
for prescription drug benefits until age 26.
Children under age 22 are not covered if they are working more than30 hours a week, unless they are full-time students.
Children who are incapable of supporting themselves because ofphysical or mental disorder are covered without age limit if thedisorder begins before they turn 22, or while they are students under25, and the disorder has been continuous since that time.
EMPLOYEE LIFE INSURANCE
You may name a beneficiary for your life insurance and change thatbeneficiary at any time by completing a form available from youremployer. On your death, your employer will explain the claimrequirements to your beneficiary. Great-West Life will pay your lifeinsurance benefits to your beneficiary.
If any or all of your insurance terminates before age 71, you may beeligible to apply for an individual conversion policy without providingproof of your insurability. You must apply and pay the first premiumno later than 31 days after your group insurance terminates. Seeyour employer for details.
DEPENDENT LIFE INSURANCE
If one of your dependents dies, Great-West Life will pay you thedependent life insurance benefit. Your employer will explain the claimrequirements.
Your dependent life insurance terminates when you reach age 70 orwhen you no longer have eligible dependents, whichever comesfirst.
If your spouse's insurance terminates, he or she may be eligible foran individual conversion policy without providing proof of insurability.
You or your spouse must apply and pay the first premium no laterthan 31 days after the group insurance terminates. See youremployer for details.
HEALTHCARE
All expenses will be reimbursed at the level shown in the Benefit
Summary. Benefits may be subject to plan maximums and frequency
limits. Check the Benefit Summary in the front of this booklet for this
information.
The plan covers the following services and supplies if they are notcovered under your provincial government plan and provincial lawpermits the plan to cover them. All covered services and supplies mustrepresent reasonable treatment. Treatment is considered reasonable if itis accepted by the Canadian medical profession, it is proven to beeffective and it is of a form, intensity, frequency and duration essential todiagnosis or management of the disease or injury.
Covered Expenses
Ambulance transportation to the nearest centre where adequatetreatment is available Home nursing services of a registered nurse, licensed practicalnurse or registered nursing assistant who is not a member of yourfamily, but only if the patient requires the specific skills of a trainednurse You should apply for a pre-care assessment before home nursingbegins Drugs and drug supplies described below when provided in Canada.
Drugs which require the written prescription of a physician ordentist, including oral contraceptives Injectable drugs including vitamins, insulins and allergy extracts.
Syringes for self-administered injections are also covered Disposable needles for use with non-disposable insulin injectiondevices, lancets and test strips Extemporaneous preparations or compounds if one of theingredients is a covered drug Certain other drugs that do not require a prescription by law maybe covered when prescribed by your physician or dentist. If youhave any questions, contact your plan administrator beforeincurring the expense.
For drugs eligible under a provincial drug plan, coverage is limited tothe deductible amount and coinsurance you are required to payunder that plan.
Rental or, at Great-West Life's discretion, purchase of certainmedical supplies, appliances and prosthetic devices prescribed by adoctor Custom-fitted orthopedic shoes, including modifications toorthopedic footwear Hearing aids including batteries, tubing and ear molds provided atthe time of purchase Diabetic supplies: Novolin-pens or similar insulin injection devicesusing a needle, blood-letting devices including platforms but notlancets. Lancets are covered under prescription drugs Treatment of injury to sound natural teeth. Treatment must startwithin 60 days after the accident unless delayed by a medicalcondition A sound tooth is any tooth that did not require restorative treatmentimmediately before the accident. A natural tooth is any tooth thathas not been artificially replaced dental treatment completed more than 12 months after theaccident orthodontic diagnostic services or treatment Out-of-hospital treatment of muscle and bone disorders, includingdiagnostic x-rays, by a licensed chiropractor Out-of-hospital treatment of movement disorders by a licensedphysiotherapist Out-of-hospital treatment of foot disorders, including diagnosticx-rays, by a licensed podiatrist Out-of-hospital treatment by a registered psychologist or qualifiedsocial worker Out-of-hospital treatment of speech impairments by a qualifiedspeech therapist Out-of-hospital services of a qualified massage therapist Out-of-hospital services of a licensed osteopath, including diagnosticx-rays Out-of-hospital services of a licensed naturopath Out-of-hospital services of a qualified Christian Science Practitioner Limitations
Except to the extent otherwise required by law, no benefits are paid for: Expenses private insurers are not permitted to cover by law Services or supplies you are entitled to without charge by law or forwhich a charge is made only because you have insurance coverage The portion of the expense for services or supplies that is payableby the government health plan in your home province, whether ornot you are actually covered under the government health plan Services or supplies that do not represent reasonable treatment treatment performed only for cosmetic purposes recreation or sports rather than with other daily living activities the diagnosis or treatment of infertility contraception, other than oral contraceptives Services or supplies not listed as covered expenses Extra medical supplies that are spares or alternates Services or supplies received outside Canada Services or supplies received out-of-province in Canada unless youare covered by the government health plan in your home provinceand Great-West Life would have paid benefits for the same servicesor supplies if they had been received in your home province Expenses arising from war, insurrection, or voluntary participation ina riot Chiropractic or podiatric treatments for which a portion of the cost ispayable under the Ontario Health Insurance Plan (OHIP). Benefitsfor these services are payable only after the maximum annual OHIPbenefit has been paid In addition under the prescription drug coverage, no benefits are paidfor: Atomizers, appliances, prosthetic devices, colostomy supplies, firstaid supplies, diagnostic supplies or testing equipment Non-disposable insulin delivery devices or spring loaded devicesused to hold blood letting devices Delivery or extension devices for inhaled medications Oral vitamins, minerals, dietary supplements, homeopathicpreparations, infant formulas or injectable total parenteral nutritionsolutions Diaphragms, condoms, contraceptive jellies, foams, sponges,suppositories, contraceptive implants or appliances Any drug that does not have a drug identification number as definedby the Food and Drugs Act, Canada Proprietary or patent medicines registered under the Food andDrugs Act, Canada Any single purchase of drugs which would not reasonably be usedwithin 34 days. In the case of certain maintenance drugs, a 100-daysupply will be covered Drugs dispensed by a dentist or clinic or by a non-accreditedhospital pharmacy Drugs dispensed during treatment as an in-patient or an out-patientin a hospital Preventative immunization vaccines and toxoids Drugs that are considered cosmetic, such as topical minoxidil orsunscreens Drugs or drug supplies not listed in the Liste de médicamentspublished by the Régie de l'assurance-maladie du Québec in effecton the date of purchase or which are received out-of-province, whenprescribed for a dependent child who is a student over age 24 andyou are a resident of Quebec How to Make a Claim
Obtain form M635D from your employer. Complete this form makingsure it shows all required information.
Attach your receipts to the claim form and return it to the Great-WestLife Benefit Payment Office as soon as possible, but no later than 15months after you incur the expense.
For drug claims, your employer will provide you with a prescription
drug identification card. Present your card to the pharmacist with
your prescription.
Before your prescription is filled, a Health Assure check will be done.
Health Assure is a series of seven checks that are electronicallydone on your drug claim history for increased safety and compliancemonitoring. This has been designed to improve the health andquality of life for you and your dependents. Checks done includedrug interaction, therapeutic duplication and duration of therapy,allowing the pharmacist to react prior to the drug being dispensed.
Depending on the outcome of the checks, the pharmacist mayrefuse to dispense the prescribed drug.
When your coverage ends, return your direct pay drug identificationcard to your employer.
PREFERRED VISION SERVICES (PVS)
Preferred Vision Services (PVS) is a service provided by Great-
West Life to its customers through Preferred Vision Services.
Preferred Vision Services (PVS) entitles you to a discount on a wideselection of quality eyewear and lens extras (scratch guarding, tints,etc.) when you purchase these items from a PVS network optician oroptometrist. You are eligible to receive the PVS discount through thenetwork whether or not you are enrolled for the healthcare coveragedescribed in this booklet. You can use the PVS network as often as youwish to purchase eyewear for yourself and your dependents at areduced cost.
• Call the PVS Information Hotline at 1-800-668-6444 or visit the
PVS Web site at www.pvs.ca for information about PVS locations
and the program
• Arrange for a fitting or eye examination, if needed • Present your group benefit plan identification card to identify your preferred status as a PVS member through Great-West Life at thetime of purchase • Select your eyewear and pay the reduced PVS price. If you have vision care coverage, obtain a receipt and submit it with a claim formto your insurance carrier in the usual manner.
COORDINATION OF BENEFITS
Benefits for you or a dependent will be directly reduced by anyamount payable under a government plan. If you or a dependent areentitled to benefits for the same expenses under another group planor as both an employee and dependent under this plan or as adependent of both parents under this plan, benefits will beco-ordinated so that the total benefits from all plans will not exceedexpenses.
You and your spouse should first submit your own claims throughyour own group plan. Claims for dependent children should besubmitted to the plan of the parent who has the earlier birth date inthe calendar year (the year of birth is not considered). If you areseparated or divorced, the plan which will pay benefits for yourchildren will be determined in the following order: the plan of the parent with custody of the child; the plan of the spouse of the parent with custody of the child; the plan of the parent without custody of the child; the plan of the spouse of the parent without custody of the child You may submit a claim to the plan of the other spouse for anyamount which is not paid by the first plan.

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