--- exp Canadian flex benefits plan your enrolment guide
Make it your plan, your way. Our flex benefits plan is a truly flexible plan; you choose the levels of benefit coverage based on what’s right for you and your circumstances. With this flex program comes a responsibility to find out all you can about the choices you have to get what you need for you and your family, now and in the future. Read the contents of this package carefully, and discuss, with your family, the choices you’re considering to ensure they meet your particular needs. To help you, there’s a dedicated, toll-free line staffed by trained customer service representatives and a secure website just for exp employees. Plus, you enroll online which allows you to explore different scenarios to get the plan that’s just right for you. Call them at +1.855.350.5592 from 8 am to 8 pm Eastern Time. You can depend on Manulife to give you the help you need, when you need it. The health and well-being of our employees and their families is very important. We hope you will take advantage of this opportunity to build a plan that’s best for you. It’s your plan, your way.
2
July 2015
Step one
Learn about your plan
A flex plan is all about choice. You’re in charge, because you know your situation best. Use this guide to start thinking about the two types of choices you will make when you enrol: • How much health, dental, life, and disability coverage will you/your family need? • How will you use your credits or payroll deductions to pay for coverage?
What kind of coverage do you need? When choosing your coverage, think about the following: • If you have a spouse and/or dependent children, does your spouse have group benefits coverage too? If so, you can coordinate benefits under both plans to get up to 100% of your eligible expenses covered. • What are your financial priorities at this stage in your life? You can apply unused credits to your Health Care Spending Account (HCSA) or Group RRSP.
July 2015
3
Your benefits at a glance Health Benefit Details Benefit Plan year
July 1st to June 30th Option 1
Option 2
Option 3
Option 4
Deductible
None
$50 Single, $100 Family per plan year
$50 Single, $100 Family per plan year
$50 Single, $100 Family per plan year
Termination Age
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
Out-of-province / Travel Assistance only
70% unless stated otherwise
80% unless stated otherwise
95% unless stated otherwise
Maximum of $6,000 (Single) and $12,000 (Family) per plan year of paid expenses and 100% thereafter
Maximum of $4,000 (Single) and $8,000 (Family) per plan year of paid expenses and 100% thereafter
Maximum of $1,000 (Single) and $2,000 (Family) per plan year of paid expenses and 100% thereafter
Unlimited except for: $5,000 lifetime maximum on fertility drugs, $300 lifetime maximum on anti-smoking prescription drugs
Unlimited except for: $5,000 lifetime maximum on fertility drugs, $300 lifetime maximum on anti-smoking prescription drugs
Unlimited except for: $5,000 lifetime maximum on fertility drugs, $300 lifetime maximum on anti-smoking prescription drugs
No coverage for antiobesity drugs or sexual dysfunction drugs
No coverage for antiobesity drugs or sexual dysfunction drugs
No coverage for antiobesity drugs or sexual dysfunction drugs
Covered Expenses Amount Reimbursed for Drugs Only Drug Out of Pocket Annual Maximum
Prescription Drugs – Mandatory Generic Substitution (legally requiring a prescription)
No Coverage
Dispensing Fee Maximum
No Coverage
No Coverage
$10
$15
Amount Reimbursed for all Other Medical Coverage
No coverage
70% Reimbursement (unless otherwise indicated)
85% Reimbursement (unless otherwise indicated)
100% Reimbursement (unless otherwise indicated)
Vision
No coverage
70% of Prescription Glasses, Contacts and Laser Surgery and Eye Exams to a maximum of $200 per 24 months
85% of Prescription Glasses, Contacts and Laser Surgery to a maximum of $200 per 24 months
100% of Prescription Glasses, Contacts and Laser Surgery to a maximum of $250 per 24 months
Eye Exams – $75 per 24 months
Eye Exams – $75 per 24 months
Hospital Coverage
No Coverage
70% for Semi-private
85% for Semi-private
100% for Private
Out-of-province Medical Emergency
100% with a lifetime maximum of $5,000,000
100% with a lifetime maximum of $5,000,000
100% with a lifetime maximum of $5,000,000
100% with a lifetime maximum of $5,000,000
Emergency Travel Assistance
Included
Included
Included
Included
Medical Supplies and Services Amount Reimbursed
No Coverage
70% Reimbursement
85% Reimbursement
100% Reimbursement
Private Duty Nursing
No Coverage
$10,000 per plan year
$20,000 per plan year
$25,000 per plan year
Hearing Aids
No Coverage
$500 per 36 months
$500 per 36 months
$500 per 36 months
Orthopaedic Shoes/Orthotics
No Coverage
No Coverage
$300 every 4 years for custom made shoes only
$500 every 4 years for custom made shoes only
In the event there is a discrepancy between this document and the formal plan or policy documents, the formal plan or policy documents will take precedence. The details of the plan may be modified by exp at any time.
4
July 2015
Health Benefit Details
Benefit Plan year
July 1st to June 30th Option 3
Option 1
Option 2
Option 4
Deductible
None
$50 Single, $100 Family per plan year
$50 Single, $100 Family per plan year
$50 Single, $100 Family per plan year
Termination Age
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
70% Reimbursement
85% Reimbursement
Paramedical Services Amount Reimbursed
No Coverage
100% Reimbursement
Acupuncturist, Audiologist, 70% reimbursement, 85% reimbursement, 100% reimbursement, Chiropractor, Naturopath, maximum of $300 per maximum of $500 per maximum of $750 per Occupational Therapist, practitioner per plan year, practitioner per plan practitioner per plan Osteopath, Physiotherapist up to an overall maximum year, up to an overall year, up to an overall and Rehabilitation Therapist, No Coverage of $600 per plan year for maximum of $1000 per maximum of $1500 per Podiatrist/Chiropodist, all practitioners combined plan year for all plan year for all Psychologist and practitioners combined practitioners combined Psychotherapist, Registered Massage Therapist, Speech Therapist Exp offers an Employee Assistance Program (EAP). This service provided by Shepell-fgi is completely confidential, and is free for you and your immediate family members. For immediate support with your health, well-being and work-related issues, call toll-free 24 hours a day, seven days a week: +1.800.387.4765. Please contact your HR Representative for any questions concerning your EAP or consult the information brochure on explore.
Dental Benefit Details
Benefit Plan year
July 1st to June 30th Option 2
Option 3
Option 4*
Termination Age
Option 1
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
Earlier of age 65 or Retirement
Deductible
$50 Single, $100 Family per plan year
$50 Single, $100 Family per plan year
$50 Single, $100 Family per plan year
Current fee guide for General Practitioners in Province of residence
Current fee guide for General Practitioners in Province of residence
Current fee guide for General Practitioners in Province of residence
Dental Fee Guide
No Coverage
Recall Examination Frequency
Once per 9 months for adults, Once every 9 months for Once every 6 months for adults. Once every 6 months children under age 19. for children under 19.
Once every 9 months for adults. Once every 6 months for children under 19.
Covered Expenses Basic Services
No Coverage
100%
100%
100%
Endodontics/Periodontics
No Coverage
60%
80%
100%
Dentures
No Coverage
No Coverage
50%
50%
Bridges, Crowns, Inlay/Onlay
No Coverage
No Coverage
50%
50%
$1,000 per plan year (combined for Basic and Endodontics/Periodontics)
$1,500 per plan year (combined for Basic, Endodontics/Periodontics, Dentures, Bridges, Crowns, Inlay/Onlay)
$2,500 per plan year (combined for Basic, Endodontics/Periodontics, Dentures, Bridges, Crowns, Inlay/Onlay)
No Coverage
No Coverage
50% up to a lifetime maximum of $2,000 (for children under age 19 only)
Annual maximum
No Coverage Orthodontics
In the event there is a discrepancy between this document and the formal plan or policy documents, the formal plan or policy documents will take precedence. The details of the plan may be modified by exp at any time. * When you elect Option 4 for dental, you must remain covered under this option for at least 2 years before you will be able to change your dental coverage. July 2015
5
Health Care Spending Account (HCSA) Coverage
The HCSA allows you to use excess flex credits to cover expenses with before-tax dollars. Any amount not used in the current plan year can be carried over for one additional plan year. Any previous year's amount remaining at the end of the second year will be forfeited. The HCSA has a grace period and claims must be submitted by December 31st following the end of the Plan Year in which the expense was incurred.
Short-Term Disability (STD) – This benefit will be paid as Salary Continuance by exp Benefit
100% of weekly earnings for the first week; 75% for the next 15 weeks
Elimination Period
7 consecutive calendar days of absence
Maximum Benefit Period
17 weeks (including the Elimination Period)
Termination Age
Earlier of age 65 or retirement
Long-Term Disability (LTD) Option 1
Option 2
Benefit
50% of first $2,500 of gross monthly earnings, 42% of next $3,500 and 35% of the balance
62% of first $2,250 of gross monthly earnings, 54% of next $3,000 and 40% of the balance
Maximum Benefit
$10,000 per month
$10,000 per month
Qualifying Period
17 weeks
17 weeks
Approximate net income replacement ratio1
60% -65%
75%- 80%
All Source Maximum2
80% of net earnings
85% of net earnings
Cost Of Living Adjustment (COLA)
CPI up to a maximum of 3% following 5 years of disability
CPI up to a maximum of 3% following 2 years of disability
Definition of Disability
Unable to do own occupation for 2 years and any occupation after
Unable to do own occupation for 2 years and any occupation after
Tax Status of any Disability Payments
Non-taxable
Non-taxable
Termination Age
Earlier of age 65 or retirement
Earlier of age 65 or retirement
Varies by province. The All Source Maximum allows LTD benefits to be further reduced if the total income the plan member receives from All Sources of Income exceed 80% (Option 1) and 85% (Option 2) of the plan member’s pre-disability income.
1 2
Basic Life Note: Evidence of Insurability is required for all increases in coverage after initial enrolment.
Option 1
Option 2
Option 3
Coverage
1 x annual earnings
2 x annual earnings
3 x annual earnings
Maximum
$1,000,000
$1,000,000
$1,000,000
Termination Age
Earlier of age 65 or retirement
In the event there is a discrepancy between this document and the formal plan or policy documents, the formal plan or policy documents will take precedence. The details of the plan may be modified by exp at any time.
6
July 2015
Employee Optional Life Note: Only available to employees who elect Option 3 under the Basic Life benefit. You must complete an Evidence of Insurability form to qualify for this coverage. Coverage
Available in units of $10,000
Maximum
$500,000 (50 units)
Termination Age
Earlier of age 65 or retirement
Spousal Optional Life Note: Your spouse must complete an Evidence of Insurability form to qualify for this coverage. Coverage
Available in units of $10,000
Maximum
$500,000 (50 units)
Termination Age
Earlier of Spouse’s age 65, Employee's age 65 or retirement
Child Optional Life Coverage
Available in units of $5,000
Maximum
$25,000 (5 units)
Termination Age
Earlier of Employee's age 65 or retirement
Please note that all Accidental Death & Dismemberment (AD&D) coverage listed on this page is provided to you by another carrier. Manulife Financial does not insure these benefits. Please contact your HR Representative for any questions concerning AD&D coverage or claims.
Employee Optional AD&D Option 1 Coverage
Available in units of $10,000
Maximum
$500,000 (50 units)
Termination Age
Earlier of age 65 or retirement
Spousal Optional AD&D Option 1 Coverage
Available in units of $10,000
Maximum
$500,000 (50 units)
Termination Age
Earlier of Spouse’s age 65, Employee's age 65 or retirement
Child Optional AD&D Option 1 Coverage
Available in units of $5,000
Maximum
$25,000 (5 units)
Termination Age
Earlier of Employee’s age 65 or retirement
In the event there is a discrepancy between this document and the formal plan or policy documents, the formal plan or policy documents will take precedence. The details of the plan may be modified by exp at any time. July 2015
7
Your dependents and beneficiary Who’s covered under your plan? Unless you choose single coverage, you can cover the following categories of family members. Spouse A spouse is your legal spouse or a person living with you in a role like that of a marriage partner for at least 12 months. Child A dependent child is your natural child, adopted child or stepchild (a stepchild must be living with you) who is: • unmarried; • under the age stated below: • for Dental coverage - under age 21, or under age 26 if a full-time student; • for Extended Health Care coverage - under age 21, or under age 26 if a full-time student • not employed on a full-time basis • not eligible for insurance as an employee under this or any other Group Benefit Program A child who is incapacitated on the date he or she reaches the age when insurance would normally terminate will continue to be an eligible dependent. However, the child must have been insured under this Benefit Program immediately prior to that date. A child is considered incapacitated if he or she is incapable of engaging in any substantially gainful activity and is dependent on the employee for support, maintenance and care, due to a mental or physical disability. Manulife Financial may require written proof of the child's condition as often as may reasonably be necessary. For Dependent Life Insurance a child must be at least 24 hours old to be eligible.
Designating your beneficiary When you are enrolling online, you will be asked to designate beneficiaries. Please keep in mind that it is a legal requirement to have a document on file stating your beneficiary and with your original signature. Therefore, you must complete a paper beneficiary form and return it to Manulife Financial in order to officially designate your beneficiary. If you do not officially designate a beneficiary, any applicable benefit payments will be made to your estate.
8
July 2015
Your Health Care Spending Account Your group benefit plan includes a Health Care Spending Account (HCSA). With an HCSA, you have extra benefits to cover unexpected health or dental expenses – and even pay amounts that your plan doesn’t pay.
What’s covered? Your HCSA covers three types of expenses: 1. The amount left over after Manulife has paid your health or dental claim. For example if your plan covers 60% of prescription drug costs, then you can use your HCSA to pay the other 40%. 2. Any health service or supply that’s covered by a benefit plan, so you can use it to pay for health or dental expenses when you don’t have health or dental coverage. For example, even if you’ve opted out of your dental plan, you can use your HCSA to pay for dental work. 3. Any other health-related, insurable expenses that you could claim for the health tax credit on your tax return. These expenses don’t need to be covered by your health or dental plan to be covered by your HCSA. If you’re in doubt, call Manulife Financial Customer Service. Some examples of items that your regular plan may not cover, but your HCSA does: • Some medical equipment (must be prescribed by a doctor) • Cosmetic surgery • Expenses related to sight or hearing guide dogs • Optical scanners for people with visual impairments Some common health-related expenses not covered by your HCSA: • Earplugs • Medic-AlertTM bracelets • Toothbrushes/toothpaste
Who’s covered? You can use your HCSA for any family member considered dependent on you under your plan.
July 2015
9
Your Health Care Spending Account How your HCSA works 1. You transfer your unused credits to your HCSA at enrolment. 2. You use your regular health or dental claim form to make an HCSA claim. If the expense can be paid from your regular health or dental plan, we’ll consider it under that benefit first before using your HCSA money. If you have coverage under a second health or dental plan, you should submit the claim there before using your HCSA. 3. Along with your payment, we’ll send you a claim statement (called an explanation of benefits or EOB) that shows how much money you have left in your HCSA. If there isn’t enough money in your HCSA to pay the full amount of your claim when you submit it, we will consider as much as possible using your available funds. Your HCSA money is available as of the date your plan year begins – July 1. After a year from that date, if you have money left in your HCSA, you can still use it the next year – this is called Credit Carryover. You can only keep unused HCSA money for one extra year, so if you still haven’t used up the first year’s money at the end of next year, it will no longer be available.
Example of how credit carryover works: June 2013: You allocate $250 to your HCSA. By the end of June 2013, you’ve only used $50 so you have $200 left. July 2013: You allocate another $250 to your HCSA. You now have a total of $450. When we pay your claim for $100 in December, it’s taken from the 2012 money. By June 2013, you still have $100 from 2012 and $250 from 2013. July 2014: You have to give up the unused $100 from 2012, but you still have access to the $250 from 2013. Your plan sponsor deposits another $250 into your account, so you have a total of $500. You have some cosmetic dental work done in June of 2014, and you use $450. July 2015: You still have $50 from 2014, and your plan sponsor deposits another $250.
The grace period gives you extra time The grace period means extra time to send in your HCSA claims after your plan year ends. Your grace period starts at the end of your plan year – June 30. That means you have until December 31st to submit the expenses you’ve had for that benefit year. (This corresponds to the claim period under the plan)
10
July 2015
Paying for your benefits A flexible benefits plan assigns a cost — sometimes referred to as a "price tag“ — to each type of benefit. The plan gives you company-paid "credits" with which you can purchase the benefit coverage that best suits your needs. Credits: The credits allocated to you represent the portion of the benefits cost that exp is paying. If you don’t use all of your credits, you can use the remaining credits by putting them into your HCSA. Payroll deduction: If you use all of your credits and they do not entirely cover the cost of the benefits you have selected, then you must pay the balance through payroll deductions. Your online enrolment makes this process easy. It calculates everything for you, and lets you change your selections and view the financial implications as many times as you wish until you submit your choices. Once you submit, your selections will remain in effect for the plan year unless you have a life event.
Applying for additional coverage Group Benefits are designed to ensure that every member of your organization has access to a basic amount of health, life, and disability coverage without being required to provide proof of good health. However, some people feel more secure with additional life insurance coverage. That’s why your plan includes options for buying extra insurance for you and your family. However, depending on the additional coverage you choose, you may be required to provide “evidence of insurability.” In other words, health information. If you select options that require this step, the enrolment site will prompt you to complete a paper Evidence of Insurability form, which requires your signature. After we receive the form, Manulife will contact you with a decision and/or any additional details regarding your application. Please note that this health information is for Manulife only, and will not be shared with exp.
A note about costs Your flex plan is intended to give you choice in how you spend exp’s contribution towards the cost of your benefits, and provides choices for buying additional coverage. As you are making these choices, it’s easy to see that a group benefit plan doesn’t mean ‘free’ health or dental care. The cost of coverage is a direct result of the number and amounts of claims made by plan members during the year. So choose — and use — your benefits wisely. After all, it’s your plan, your way!
July 2015
11
Step two
How to Enrol
Once you have completed the online registration process and accessed the enrolment tool, you will be able to simulate different benefit selection scenarios and see the associated costs on screen. You will also be able to view the details of each benefit option by clicking on the benefit name and viewing the Benefits-at-a-Glance chart. The site is very intuitive and will walk you through each selection you need to make. Once you have completed your enrolment, you will be able to print a coverage statement that summarizes your selections or save it to your desktop. Default Coverage If you choose not to enrol, you will be given the default coverage (Option 2, single coverage for Health and Dental, Option 1 for Basic Life (1 X salary) and Option 1 for LTD). You will not be able to adjust your coverage until the next re-enrolment period, unless you experience a life event (e.g. birth of child, marriage). IMPORTANT NOTE: It is at this step that you also make your selection of contribution to your Registered Retirement Savings Plan (RRSP). You select the percentage of your base salary you wish to contribute on the same page you choose your benefits Options. Your contribution will be made through a payroll deduction (in a RRSP) and exp will start matching your contribution up to 3% (in a DPSP), 2 years from the date you first elect to contribute. If you elected to contribute, later on in the enrolment process you will automatically be led to make your investment selections and beneficiary designation for both RRSP and DPSP plans. Please refer to the Retirement Enrolment Guide for full details on these last steps and both exp Retirement plans. If you do not select a payroll deduction to go towards your RRSP, you will not be contributing to the plan, therefore you will not be receiving exp’s matching contributions. New Benefits Card After you complete your enrolment, you will receive a package from Manulife containing your new benefits card. Extra cards will be included for your eligible dependents. The card will contain your new plan contract number (i.e. policy number) and your plan member certificate number. Your card also contains important Emergency Travel Assistance contact numbers for when you travel outside the province. Health Care Spending Account (HCSA) You will be able to allocate any unused credits, after you have made your benefit selections, to your HCSA.
12
July 2015
When can you change your coverage? When you enrol in your flex plan, you are choosing benefits for the duration of your benefit plan year (July 1st to June 30th). You can change your benefit selections only at the next annual re-enrolment period. There are some exceptions, however. If you experience a life event and wish to modify your coverage, you have 31 days to apply through Manulife's secure website. A change in Life Event occurs when: • you acquire a dependant • you have a change in marital status • change in spouse's coverage under another plan, ie. your spouse’s coverage ceases, your spouse gains coverage or there is a significant reduction of your spouse’s benefit • any dependant ceases to qualify as a dependant •
any dependant dies
You will be required to provide details about the life event. If your application is approved, any payroll deductions will be adjusted accordingly. IMPORTANT NOTE: You can change the amount you allocate to your RRSP anytime throughout the year. You simply need to log back into the Benefits website, select the “Manage my plan” Quick Link. Click the box next to the Retirement Savings Program change then “Continue”. You will now be able to change the amount of your contributions. Continue to follow the steps on-screen. If you are contributing for the first time to this plan, be sure to look for this link: https://gsrs1.manulife.com/passport/english/login/loginselfenrol.jsp
to make your fund selection and beneficiary designation. Consult the Retirement Enrolment Guide for further details, namely on investment selections and beneficiary designation.
Questions If you need more information, please contact Manulife’s Customer Centre at +1.855.350.5592 from 8 a.m. until 8 p.m. Eastern Time.
July 2015
13
Step How to get more information three Descriptions of your flex options While you are enrolling online, you can see the details of each flex option by clicking on the benefit name.
Coverage statement At the end of your online enrolment, you can get a statement outlining your selections. If you need a copy of this statement later, it will be available on Manulife’s secure site.
Other details about your flex plan Just visit Manulife’s secure site, and click on “forms and brochures” to see a variety of information about your plan.
Other online support After your enrolment period closes, you will continue to have access to the plan member secure site. It’s a convenient and confidential way to take care of your benefit needs. Change your coverage … • Apply for life event coverage changes Manage your claims … • Sign up to have your medical and dental claims deposited directly to your bank account, and get online claim statements • Get claim forms pre-filled with available information Find out your … • Claims history • Details of previous claims (including pay-direct drug claims) • Coverage amounts
You’ll never have to memorize your plan and certificate numbers to make a claim If you print your claim forms from the site, they’ll be pre-filled with your personal identifying information.
• HCSA balance
Customer service You can contact Manulife Financial Customer Service in one of two ways: • Phone toll-free at +1.855.350.5592, 8:00 a.m. to 8:00 p.m. Eastern Time. Please have your benefit plan identifying information ready when you call. • Visit the Plan Member Secure Site to send a confidential e-mail.
14
July 2015
Step four
Using your benefit card and coordination of benefits
Paying for prescriptions with your benefit card When you choose a Health coverage option, you will have the convenience of immediate payment for eligible prescriptions. And you won’t have to fill in any claim forms. It’s simple to use: • Most pharmacies in Canada are linked to our drug plan electronic payment network. • When you use your card for the first time, your pharmacist will enter your plan information into his or her computer. He or she will then enter your prescription information, and the system will tell him or her the payment amount. Your pharmacist will only ask you to pay at the pharmacy for amounts that aren’t covered under your plan (such as deductibles, co-payments, or amounts over any plan limits, depending on your plan). • You’ll receive a receipt, which you should keep with your other claim statements. • The card works for all of your eligible dependents. To help ensure your safety: When you use your benefit card, you’re protected against potentially dangerous drug interactions as well because most pharmacies are linked to the network. The system will check your prescription against any previous, active prescriptions — regardless of the pharmacy where they were filled. If there’s potential for a dangerous interaction, the system will warn the pharmacist so that he or she can contact your doctor to verify the new prescription. While your pharmacist is a trusted professional, this extra step is a valuable extra level of security.
Emergency Travel Assistance If you get sick or are injured while travelling outside of your home province, your Emergency Travel Assistance (ETA) plan is there to protect you – wherever you happen to be in the world! When you phone the number on the back of your benefit card, a Representative will be able to provide you with immediate assistance and coordinate a wide variety of services. Here are just a few examples*: • Help you find a doctor or hospital • Arrange and pay for your flight home for health care • Make necessary arrangements for other family members travelling with you • Coordinate claims for all medical services between your provincial health plan, your Manulife health plan, and any other group or individual health plans Our ETA provider; Allianz Global Assistance can provide assistance in a variety of languages.
ETA Health Advice and Assistance Your ETA plan includes a telephone health advice service that can be invaluable in an emergency, or even if you just have a question. You can phone the toll-free number on the back of your benefit card to speak directly to a registered nurse about your health concerns. In urgent situations, the nurse can advise you whether you should go immediately to hospital, or whether it can wait until you can see your doctor. It’s confidential, it’s free, and it’s convenient.
*Some limitations apply. Your benefits booklet will contain details about all limitations.
July 2015
15
Coordination of Benefits (COB) Getting the most from all of your health and dental coverage Did you know that if you have health or dental coverage under another plan, then you can get up to 100% of an expense reimbursed? Through coordination of benefits (COB), you’re allowed to submit the unpaid part of a claim to another plan for payment. In other words, if 80% of your claim is paid by Manulife, you can have the other 20% paid by your other plan. If the other plan doesn’t pay the full 20%, then you can use your HCSA to recover the rest. Follow these instructions to help make the most of COB. [If you have dependents, you’ll also need to read the box called “COB rules.”] Step 1: Send the claim to your Manulife health/dental plan. This is your primary plan. Step 2: After you receive your cheque and/or explanation of benefits, then submit a claim to the other plan to cover any amount that wasn’t paid. This is your secondary plan. Step 3: If there are still some expenses not paid after submitting to both plans, and you have a balance in your HCSA, use the regular health or dental claim form and submit it to your Manulife plan, checking the HCSA box on the claim form.
When you’re using COB, • always attach a copy of your claim statement, or a copy of the receipt, to your claim. • if you use your benefits card, keep the pharmacy receipt to attach to your claim for the secondary plan.
16
July 2015
COB rules If your family has two health or dental plans, how do you know which one to use first?
For you: • Send claims to your Manulife plan, then submit any unpaid portion to your spouse’s plan.
For your spouse: • Send claims to your spouse’s plan, then submit any unpaid portion to your Manulife plan.
For your eligible dependent children: • If the month of your birthday falls earlier in the year than your spouse’s, send claims to your Manulife plan first. Then submit any unpaid portion to your spouse’s plan. • If the month of your spouse’s birthday falls earliest in the year, send claims to your spouse’s plan first. Then submit any unpaid portion to your Manulife plan. • If your spouse’s plan is also with Manulife, we will automatically coordinate claims between the two plans so you don’t have to re-submit.
July 2015
17
Your Notes:
18
Questions? Contact Manulife You can contact Manulife Financial Customer Service in one of two ways: • Phone toll-free at +1.855.350.5592, 8:00 a.m. to 8:00 p.m. Eastern Time. Please have your benefit plan identifying information ready when you call. • Visit the Plan Member Secure Site to send a confidential e-mail.
19
