Inc. & Partnership Flex Plan

Inc. & Partnership Flex Plan BENEFIT DETAILS Great-West Life is a leading Canadian life and health insurer. Great-West Life's financial security adv...
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Inc. & Partnership Flex Plan

BENEFIT DETAILS Great-West Life is a leading Canadian life and health insurer. Great-West Life's financial security advisors work with our clients from coast to coast to help them secure their financial future. We provide a wide range of retirement savings and income plans; as well as life, disability and critical illness insurance for individuals and families. As a leading provider of employee benefits in Canada, we offer effective benefit solutions for large and small employee groups. Great-West Life Online Visit our website at www.greatwestlife.com for:     

information and details on Great-West Life's corporate profile and our products and services investor information news releases contact information claim forms and the ability to submit certain claims online

Great-West Life Online Services for Plan Members As a Great-West Life plan member, you can also register for GroupNet™ for Plan Members at www.greatwestlife.com. To access this service, click on the GroupNet for Plan Members link. Follow the instructions to register. Make sure to have your plan and ID numbers available before accessing the website. This service enables you to access the following and much more, within a user friendly environment twenty-four hours a day, seven days a week:    

your benefit details and claims history personalized claim forms and cards online claim submission for many of your claims, as outlined in the Healthcare, Dentalcare and Health Care Spending Account sections of this booklet extensive health and wellness content

Using our GroupNet Mobile app, you can access certain features of GroupNet for Plan Members to:    

submit many of your claims online – part of our industry-leading GroupNet online services access personalized coverage information about benefits, claims and more – quickly and easily, any time view card information locate the nearest provider who has access to Provider eClaims, through a built-in GPS mapping tool

In addition, by using GroupNet Text, you can get immediate information that is specific to your benefits. GroupNet Text allows you to use your mobile device to access detailed plan information, including:    

plan and member identification numbers coverage details (details available depend on your plan design) reimbursement amounts benefit maximums, balances and more

You can sign up for GroupNet Text on GroupNet for Plan Members under the Your Profile tab. To use GroupNet Text, go to GroupNet for Plan Members and select the Your Profile tab, then text certain keywords to 204-289-1667. You will receive an instant text back providing information on your coverage. For a complete list of keywords, text Help. For a brief description of the type of information that a keyword provides, text Help along with the specific keyword. Compatibility of GroupNet Text may vary by mobile device or operating system.

Great-West Life’s Toll-Free Number To contact a customer service representative at Great-West Life:  

for assistance with your medical and dental coverage, please call 1-800-957-9777. for assistance with your Health Care Spending Account, please call 1-877-883-7072.

This booklet describes the principal features of the group benefit plan sponsored by your employer, but Group Policy Nos. 160751 and 160752 and Plan Document No. 57486 and 58842 issued by Great-West Life, and Group Policy No. CI10450101 issued to your employer by ACE INA Life Insurance and Group Policy Nos. 9907-60-21 and 9907-60-23 issued to your employer by Chubb Insurance Company of Canada are the governing documents. If there are variations between the information in the booklet and the provisions of the policies or plan document, the policies or plan document will prevail. This booklet contains important information and should be kept in a safe place known to you and your family.

The Plan is administered by

and ACE INA Life Insurance and Chubb Insurance Company of Canada

xx-03-16

Access to Documents You have the right, upon request, to obtain a copy of the policy, your application and any written statements or other records you have provided to Great-West Life as evidence of insurability, subject to certain limitations. Legal Actions Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act or other applicable legislation (e.g. Limitations Act, 2002 in Ontario, Quebec Civil Code). Appeals You have the right to appeal a denial of all or part of the insurance or benefits described in the contract as long as you do so within one year of the initial denial of the insurance or a benefit. An appeal must be in writing and must include your reasons for believing the denial to be incorrect. Benefit Limitation for Overpayment If benefits are paid that were not payable under the policy, you are responsible for repayment within 30 days after Great-West Life sends you a notice of the overpayment, or within a longer period if agreed to in writing by Great-West Life. If you fail to fulfil this responsibility, no further benefits are payable under the policy until the overpayment is recovered. This does not limit Great-West Life’s right to use other legal means to recover the overpayment.

Protecting Your Personal Information At Great-West Life, we recognize and respect the importance of privacy. Personal information about you is kept in a confidential file at the offices of Great-West Life or the offices of an organization authorized by Great-West Life. Great-West Life may use service providers located within or outside Canada. We limit access to personal information in your file to Great-West Life staff or persons authorized by Great-West Life who require it to perform their duties, to persons to whom you have granted access, and to persons authorized by law. Your personal information may be subject to disclosure to those authorized under applicable law within or outside Canada. We use the personal information to administer the group benefits plan under which you are covered. This includes many tasks, such as:        

determining your eligibility for coverage under the plan enrolling you for coverage investigating and assessing your claims and providing you with payment managing your claims verifying and auditing eligibility and claims creating and maintaining records concerning our relationship underwriting activities, such as determining the cost of the plan, and analyzing the design options of the plan preparing regulatory reports, such as tax slips

Your employer has an agreement with Great-West Life in which your employer has financial responsibility for some or all of the benefits in the plan and we process claims on your employer’s behalf. We may exchange personal information with your health care providers, your plan administrator, any insurance or reinsurance companies, administrators of government benefits or other benefit programs, other organizations, or service providers working with us or the above when relevant and necessary to administer the plan. As plan member, you are responsible for the claims submitted. We may exchange personal information with you and a person acting on your behalf when relevant and necessary to confirm coverage and to manage the claims submitted. You may request access or correction of the personal information in your file. A request for access or correction should be made in writing and may be sent to any of Great-West Life’s offices or to our head office. For a copy of our Privacy Guidelines, or if you have questions about our personal information policies and practices (including with respect to service providers), write to Great-West Life’s Chief Compliance Officer or refer to www.greatwestlife.com. Liability for Benefits Your employer has entered into an agreement with The Great-West Life Assurance Company whereby your employer will have full liability for Healthcare (excluding Global Medical Assistance) and Dentalcare benefits outlined in this booklet. This means your employer has agreed to fund these benefits and they are, therefore, uninsured. All claims will, however, be processed by Great-West Life.

TABLE OF CONTENTS

Page Benefit Summary

1

Commencement and Termination of Coverage

9

Dependent Coverage

10

Beneficiary Designation

10

Employee Basic Life Insurance

11

Optional Life Insurance

11

Basic Accidental Death & Dismemberment Insurance

12

Voluntary Accidental Death & Dismemberment Insurance

23

Critical Illness Program

35

Long Term Disability (LTD) Income Benefits

46

Healthcare

49

Preferred Vision Services (PVS)

58

Dentalcare

59

Health Care Spending Account Benefits (HCSA)

64

Wellness Account

66

Coordination of Benefits

68 ®

Diagnostic and Treatment Support Services (Best Doctors Service)

69

Benefit Summary This summary must be read together with the benefits described in this booklet. You are only covered for benefits that apply to the option that you choose.

Employee Basic Life Insurance

100% of annual earnings to a maximum of $2,000,000 Any amount of Employee Basic Life Insurance over $1,500,000 is subject to approval of evidence of insurability

Optional Life Insurance Employee Spouse

Available in units of $10,000 to a maximum of $1,000,000, subject to approval of evidence of insurability Available in units of $10,000 to a maximum of $500,000, subject to approval of evidence of insurability If you are covered under this plan as both an employee and a spouse, you are limited to the $1,000,000 maximum.

Basic Accidental Death & Dismemberment Insurance See benefit description

(Underwritten by Chubb Insurance Company of Canada)

Voluntary Accidental Death & Dismemberment Insurance See benefit description

(Underwritten by Chubb Insurance Company of Canada)

1

Critical Illness Program (Underwritten by ACE INA Life Insurance)

See benefit description

Option 1 Long Term Disability Income Benefits

Option 2

Waiting Period Amount

Cost-of-living Adjustment (COLA) Tax Status

Not covered

26 weeks 70% of the first $2,500 of your monthly earnings plus 60% of the next $2,500 plus 55% of the remainder to a maximum benefit of $15,000 or 85% of your pre-disability take-home pay, whichever is less Not covered

Taxable

Non-taxable

60% of your monthly earnings to a maximum benefit of $15,000

2

Option 3

70% of the first $2,500 of your monthly earnings plus 60% of the next $2,500 plus 55% of the remainder to a maximum benefit of $15,000 or 85% of your pre-disability take-home pay, whichever is less

The lesser of CPI or 3%, whichever is less Non-taxable

OPTION 1

OPTION 2

OPTION 3

OPTION 4

80% of the first $2,500 of covered expenses incurred in a calendar year and 100% for the remainder of the calendar year

100%

Healthcare Deductible Reimbursement Levels In-Canada Prescription Drug Expenses

Nil

Not covered

80%

Out-of-Pocket Maximum for Quebec Residents An out-of-pocket maximum is applied to in-province expenses for drugs listed in the Liste de médicaments published by the Régie de 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 provincial formulary drug expenses incurred for you and your dependent children or for your spouse in a calendar year reaches the maximum out-of-pocket level established by law, the amount payable for provincial formulary drug expenses incurred for the same individuals for the rest of the calendar year will be adjusted as follows: 1. reimbursement will be made at 100% 2. no further out-of-pocket amounts will apply The out-of-pocket maximum does not apply to drug expenses incurred outside Quebec Chronic Care Visioncare Expenses (subject to maximums) Out-of-Country Emergency Care Expenses Medical Supplies Paramedical Expenses (subject to maximums) All Other Expenses

Not covered Not covered

Not covered Not covered

100% 100%

100% 100%

100% Not covered Not covered

100% 80% Not covered

100% 80% 100%

100% 100% 100%

100%

100%

80%

100%

Not covered Not covered

Not covered Not covered

Included Semi-private room to a maximum of $200 per day

Included Semi-private to a maximum of $200 per day or a private room to a maximum of $300 per day

Basic Expense Maximums Ambulance Hospital

3

OPTION 1

OPTION 2

OPTION 3

OPTION 4

Hospital Beds Home Nursing Care

Not covered Not covered

Not covered Not covered

Chronic Care

Not covered

Not covered

In-Canada Prescription Drugs Smoking Cessation Products

Not covered Not covered

Fertility Drugs

Not covered

Vaccines and Toxoids

Not covered

Hearing Aids

Not covered

Included $250 lifetime or as otherwise required by law $15,000 lifetime or as otherwise required by law $250 each calendar year Not covered

Incontinence Supplies

Not covered

Not covered

Custom-fitted Orthopedic Shoes Custom-made Foot Orthotics

Not covered

Not covered

Not covered

Not covered

External Breast Prosthesis

Not covered

Not covered

Surgical Brassieres

Not covered

Not covered

Mechanical or Hydraulic Patient Lifters

Not covered

Not covered

Outdoor Wheelchair Ramps Insulin Infusion Pumps Blood-glucose Monitoring Machines Transcutaneous Nerve Stimulators Extremity Pumps for Lymphedema Custom-made Compression Hose Wigs for Cancer Patients

Not covered Not Covered Not covered

Not covered Not covered Not covered

$1,500 lifetime $15,000 every 36 months per condition $1,000 each calendar year Included $250 lifetime or as otherwise required by law $15,000 lifetime or as otherwise required by law $250 each calendar year $1,000 per unit to a maximum of 2 units every 4 years $1,200 each calendar year $250 every 12 months $300 every 12 months $200 each calendar year 2 every 12 months $2,000 per lifter once every 5 years $2,000 lifetime 1 every 5 years

$1,500 lifetime $15,000 every 36 months per condition $1,000 each calendar year Included $250 lifetime or as otherwise required by law $15,000 lifetime or as otherwise required by law $250 each calendar year $1,000 per unit to a maximum of 2 units every 4 years $1,200 each calendar year $250 every 12 months $300 every 12 months $200 each calendar year 2 every 12 months $2,000 per lifter once every 5 years $2,000 lifetime 1 every 5 years

1 every 4 years

1 every 4 years

Not covered

Not covered $700 lifetime

$700 lifetime

Not covered

Not covered

Not covered

Not covered

Not covered

Not covered

Diagnostic X-Rays and Lab Tests Accidental Dental Injury All Other Medical Supplies

Not covered

Not covered

$1,500 lifetime 2 pairs each calendar year $250 every 60 months Included

$1,500 lifetime 2 pairs each calendar year $250 every 60 months Included

Not covered Not covered

Not covered Not covered

Included Included

Included Included

4

OPTION 1

OPTION 2

OPTION 3

OPTION 4

Acupuncturists

Not covered

Not covered

Chiropractors

Not covered

Not covered

Dietician

Not covered

Not covered

Massage Therapists

Not covered

Not covered

Physiotherapists

Not covered

Not covered

Podiatrists/Chiropodist

Not covered

Not covered Chiropodists

Naturopaths

Not covered

Not covered

Osteopaths

Not covered

Not covered

Psychologists/Social Worker

Not covered

Not covered

Speech Therapists

Not covered

Not covered

$250 each calendar year $250 each calendar year $250 each calendar year $250 each calendar year $250 each calendar year $250 each calendar year $250 each calendar year $250 each calendar year $250 each calendar year $250 each calendar year

$500 each calendar year $500 each calendar year $500 each calendar year $500 each calendar year $500 each calendar year $500 each calendar year $500 each calendar year $500 each calendar year $500 each calendar year $500 each calendar year

Paramedical Expense Maximum

Paramedical expenses are not subject to the reasonable and customary charge limitation Visioncare Expense Maximums Eye Examinations - dependent children under age 14 - all others Eye Examinations, Glasses, Prescription Sunglasses, Contact Lenses and Laser Eye Surgery - dependent children under age 14 - all others

Not covered

Not covered

Not covered

Not covered

Not covered

Not covered

Not covered

Not covered

5

Once every 12 months Once every 24 months

Once every 12 months Once every 24 months

$250 every 12 months $250 every 24 months

$350 every 12 months $350 every 24 months

Global Medical Assistance Program

Included

Out-of-Country Emergency Care

Included

Accidental Dental Chiropractors, Physiotherapists and Podiatrists/Chiropodists

Lifetime Healthcare Maximum

$2,000 per accident

$300 per trip each practitioner Expenses for Out-of-Country Emergency Care cannot exceed a combined maximum of $2,000,000 per incident N/A

$1,000,000

$1,000,000

$1,000,000

The lifetime Healthcare maximum does not apply to Global Medical Assistance and Out-of-Country Emergency Care expenses Covered expenses will not exceed customary charges Note: Option 1 is for employees only

6

OPTION 1

OPTION 2

OPTION 3

OPTION 4

Not covered

The dental fee guide in effect in your province of residence on the date treatment is rendered

The dental fee guide in effect in your province of residence on the date treatment is rendered

The dental fee guide in effect in your province of residence on the date treatment is rendered, plus an additional 10%

Dentalcare Payment Basis

Deductible Reimbursement Levels Basic Coverage Major Coverage Orthodontic Coverage

Nil

Not covered Not covered Not covered

75% 50% Not covered

85% 60% Not covered

100% 75% 50%

Basic Treatment

Not covered

$1,500 each calendar year combined with Major treatment

$2,000 each calendar year combined with Major treatment

$3,000 each calendar year combined with Major treatment

Major Treatment - implants

Not covered

Plan Maximums

-

all other major treatment

Orthodontic Treatment

Healthcare Spending Account and Wellness Spending Account

$750 once $750 once $750 once every 5 years every 5 years every 5 years combined with combined with combined with Basic and Major Basic and Major Basic and Major treatment treatment treatment Not covered $1,500 each $2,000 each $3,000 each calendar year calendar year calendar year combined with combined with combined with Basic treatment Basic treatment Basic treatment Not covered Not covered Not covered $3,000 lifetime Covered expenses will not exceed customary charges

Unused credits at the end of any plan year are rolled over to your account for the following plan year. If they are not used by the end of the following year, they are automatically forfeited.

Diagnostic and Treatment Support Services (Best Doctors® Service)

See benefit description

7

Information About Your Flex Plan 

Each year at annual enrollment you may change your elections effective the following January 1, unless the change results from a change in family status. If it does, the option change will take effect on the date the application for the change is made, as long as it is made within 31 days of the status change. Otherwise, you will not be allowed to change your elections until the next annual enrollment.



If you experience a change in family status during a plan year that affects your coverage needs, you may make changes to your benefit options that directly relate to your status change without waiting for the next January 1st re-enrollment period. Any of the following is considered a change in family status: -

acquiring a dependent (spouse or child) involuntary loss of similar coverage through your spouse’s group benefit program (for example, because of a change in your spouse’s employment status) death of your spouse or child your spouse or child ceasing to qualify for coverage (for example, through divorce or your child’s attainment of a limiting age – see Dependent Coverage in this booklet)

Note: Contact the Agrium HR Shared Service Center for details no later than 31 days after a change in family status occurs. Certain conditions apply.

8

COMMENCEMENT AND TERMINATION OF COVERAGE You are eligible to participate in the plan on the date your employment begins. 

You and your dependents will be covered as soon as you become eligible. If you lose spousal coverage you must notify the Agrium HR Shared Service Center within 31 days of loss of such coverage. If you do not notify the Agrium HR Shared Service Center within 31 days you will not be able to make changed to your benefit coverage until the next annual enrollment.



You must be actively at work when coverage takes effect, otherwise the coverage will not be effective until you return to work. Increases in your benefits while you are covered by this plan will not become effective unless you are actively at work.



Temporary and seasonal employees, and part-time employees who work less than 15 hours per week may not join the plan.

Your coverage for Long Term Disability terminates when your employment ends, or when you are no longer eligible, or the plan terminates, whichever is earliest. Your coverage for all other benefits terminates on the last day of the month in which your employment ends, or when you are no longer eligible, or the plan terminates, whichever is earliest. 

Your dependents' coverage terminates when your coverage terminates or your dependent no longer qualifies, whichever is earlier.



When your coverage terminates, you may be entitled to an extension of benefits under the plan. Your employer will provide you with details.

Survivor Benefits If you die while your coverage is still in force, the health and dental benefits for your dependents will be continued for a period of 2 years or until they no longer qualify, whichever happens first.

9

DEPENDENT COVERAGE Dependent means: 

Your spouse, legal or common-law. A common-law spouse is a person who has been living with you in a conjugal relationship for at least 12 months or, if you are a Quebec resident, until the earlier birth or adoption of a child of the relationship.



Your unmarried children under age 21, or under age 25 if they are full-time students. Note: If you are a Quebec resident, full-time students are covered for prescription drug benefits until age 26. Children under age 21 are not covered if they are working more than 30 hours a week, unless they are full-time students. Children who are incapable of supporting themselves because of physical or mental disorder are covered without age limit if the disorder begins before they turn 21, or while they are students under 25, and the disorder has been continuous since that time. BENEFICIARY DESIGNATION

You may make, alter, or revoke a designation of beneficiary as permitted by law. You should review any beneficiary designation made under this policy from time to time to ensure that it reflects your current intentions. You may change the designation by completing a Beneficiary Designation form which can be found on AgRoutes.

10

EMPLOYEE BASIC LIFE INSURANCE On your death, Great-West Life will pay your life insurance benefits to your named beneficiary. If you have not named a beneficiary or there is no surviving beneficiary at the time of your death, payment will be made to your estate. Your employer will explain the claim requirements to your beneficiary. 

Your life insurance terminates when you reach age 75.



If any or all of your insurance terminates on or before your 65 birthday, you may be eligible to apply for an individual conversion policy without providing proof of your insurability. You must apply and pay the first premium no later than 31 days after your group insurance terminates. See your employer for details.

th

OPTIONAL LIFE INSURANCE Optional Life Insurance allows you to choose additional coverage for yourself and your spouse. Check the Benefit Summary for the amount of Optional Life Insurance available. When you apply for Optional Life Insurance, you must provide proof of insurability, and the application must be approved by Great-West Life. If you or your spouse dies within two years after applying for Optional Life Insurance, Great-West Life has the right to verify any medical information you or your spouse provided. If any inconsistencies are discovered, the claim will be denied and any premiums paid will be refunded. On your death, Great-West Life will pay your life insurance to your named beneficiary. If you have not named a beneficiary or there is no surviving beneficiary at the time of your death, payment will be made to your estate. Your employer will explain the claim requirements. If your spouse dies you will be paid the amount for which he or she was insured. 

If your optional life insurance terminates, you may be eligible to apply for an individual conversion policy without providing proof of your insurability. You must apply and pay the first premium no later than 31 days after your group insurance terminates. See your employer for details.



Your optional life insurance terminates when you reach age 75. Your spouse's coverage terminates at the same time, or when he or she reaches age 75 or is no longer your spouse, whichever comes first.

Limitation No benefit is paid for suicide within the first two years of initial or increased optional life coverage. In such a situation, Great-West Life refunds the premiums that have been received.

11

BASIC ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (Underwritten by Chubb Insurance Company of Canada) Policy No. 9907-60-21 Scope of Insurance The Chubb Insurance Company of Canada Basic Accidental Death and Dismemberment Plan provides accident insurance 24 hours a day, anywhere in the world. Eligibility All active, non-union regular and temporary full-time and part-time employees of the Wholesale/Corporate business units under the age of 70 are automatically covered on the date of hire. Your Benefits All employees are automatically covered for a principal sum of one (1) times annual earnings, subject to a maximum of $1,500,000. The following benefits are provided if the loss occurs as a result of an accident within one year from the date of the accident: Accidental Death & Dismemberment, Loss of Use and Paralysis Percent of Principal Sum

For Accidental Loss of:

Life Both Arms or Both Legs Speech and Hearing Both Hands, Both Feet or Sight of Both Eyes or a combination of any two of a Hand, a Foot or Sight of One Eye One Arm or One Leg One Hand, One Foot or Sight of One Eye Speech or Hearing Thumb and Index Finger of Same Hand Hearing in One Ear All Toes of One Foot

100% 200%* 100%

100% 80% 75% 75% 40% 40% 33%

For Accidental Loss of Use of: Both Arms or Both Legs or a Combination of An Arm and a Leg Both Hands or Both Feet or a Combination of A Hand and a Foot One Arm or One Leg One Hand or One Foot Thumb and Index Finger of Same Hand

200%* 100% 80% 75% 40% Percent of Principal Sum

Paralysis Quadriplegia Paraplegia Hemiplegia

200%* 200%* 200%*

* to a maximum of $1,500,000 12

Brain Damage This benefit will pay 100% of the principal sum for brain damage, if an accidental bodily injury results in brain damage to you. The benefit amount for brain damage will be paid if: 1) brain damage begins, and is diagnosed by a physician, within 30 days after the accident; 2) you are in a hospital or other licensed facility, to receive medically necessary treatment for brain damage, prescribed and supervised by a physician, within the first 30 days following the accident; 3) brain damage continues for 12 consecutive month; and 4) a physician determines brain damage is permanent, complete and irreversible at the end of the 12 consecutive months. If you die within 365 days after the accident, then the benefit will pay a lump sum equal to your principal sum, less any benefit amount for brain damage already paid. Coma This benefit will pay 1% of the principal sum if accidental bodily injury causes you to: 1) lapse into a coma within 30 days after the accident; 2) remain in a coma for 30 consecutive days; and 3) be confined to a hospital or other licensed facility to receive medically necessary treatment for coma, prescribed and supervised by a physician, within the first 30 days following the accident. The benefit amount for coma is payable monthly up to 100% of the principal sum. Brief lapses from a coma will not be considered an interruption of the consecutive 30 day period, or cause a discontinuance in payment, if the lapses and subsequent coma recurrences are due to the same accident. The coma monthly payment will be made until the earliest of the date: 1) you die; 2) you are no longer in a Coma; or 3) total payments equal 100% of the principal sum. If you die within 365 days after the accident, then the benefit will pay a lump sum equal to your principal sum, less any benefit amount for coma already paid. Maximum Payment for Multiple Losses and Multiple Benefits If you are entitled to receive payment of multiple benefit amounts as a result of one (1) covered accident, then the maximum we will pay for all benefits shall not exceed the principal sum with the exception of Loss of Both Arms or Both Legs, Loss of Use of Both Arms or Both Legs or a Combination of an Arm and a Leg, Quadriplegia, Paraplegia or Hemiplegia. In no event will the maximum amount payable exceed 200% of the principal sum.

13

Aggregate If more than one (1) employee suffers a loss in the same accident in an employer owned or leased aircraft, then we will not pay more than $15,000,000, combined with the voluntary and business travel accident plans). If an accident results in benefit amounts becoming payable, which when totalled, exceed $15,000,000, then the aggregate limit of insurance will be divided proportionally among the employees, based on each applicable benefit amount. Definitions: “Loss” with reference to speech means the permanent, irrecoverable and total loss of the capability of speech without the aid of mechanical devices; with reference to hearing means the permanent, irrecoverable and total deafness, with an auditory threshold of more than 90 decibels in each ear which cannot be corrected by any aid or device; and with reference to sight means the permanent loss of vision, remaining vision must be no better than 20/200 using a corrective aid or device. “Loss” with reference to hand or foot means complete severance through or above the metacarpal phalangeal joint of at least four fingers or three fingers and a thumb or the ankle joint; with reference to arm or leg means complete severance through or above the elbow or knee joint; with reference to thumb and index finger means complete severance through the metacarpal phalangeal joints of the thumb and index finger of the same hand; and with reference to toes means complete severance of all toes on a foot. We will consider such severance a loss even if the specified body part is later reattached. If the reattachment fails and amputation becomes necessary, then we will not pay an additional amount for such amputation. “Paralysis” means complete and irreversible loss of all motion and all practical use of an arm or leg provided the loss is continuous for 365 days. “Loss of Use” means the permanent and total inability of the specified body part to function. Exposure & Disappearance If you have not been found within one (1) year of the disappearance, stranding, sinking, or wrecking of any conveyance in which you were an occupant at the time of the accident, then it will be assumed, subject to all other terms and conditions of the policy, that you have suffered Loss of Life insured under the policy. Accident includes unavoidable exposure to elements. Beneficiary Designation You have the right to designate a beneficiary. All beneficiary designations must be: 1) in writing; 2) filed with the administrator; and 3) provided to the insurance company at the time of claim or at such other time as they may require. You, and no one else, unless there is an irrevocable assignment, have the right to change the beneficiary except as set forth above. You do not need the consent of anyone to do so. All beneficiary changes must be: 1) in writing; 2) filed with the administrator; and 3) provided to the insurance company at the time of claim or at such other time as they may require. The benefit amount for covered loss of life will be paid to the beneficiary designated by you. 14

If you have not chosen a beneficiary or if there is no beneficiary alive when you die, then the insurance company will pay the benefit amount for loss of life to the first surviving party in the following order: 1) your spouse; 2) in equal shares to your surviving children; 3) in equal shares to your surviving parents; 4) in equal shares to your surviving brothers and sisters; 5) your estate. Additional Benefits Child Care Expense This benefit will reimburse child care expenses up to $5,000 annually for each eligible dependent child if accidental bodily injury causes your covered loss of life. This insurance applies only if you have a dependent child under the age of 13 years for whom child care expenses are incurred within 365 days of your covered loss of life. This benefit will reimburse child care expenses for each eligible dependent child. However, the total payment will not exceed $25,000 regardless of the number of dependent children for whom payment is made. Child care expenses shall be paid to the natural person who incurs such expenses for the dependent child. Education Expense This benefit will reimburse education expense up to $7,500 annually for each eligible dependent child if accidental bodily injury causes your covered loss of life. This insurance applies only if you have a dependent child at the time of a covered loss of life who: 1) is enrolled as a full-time student at an institution of higher learning on the date of your covered loss of life; or 2) subsequently enrols as a full-time student at an institution of higher learning within 2 years following the date of your covered loss of life; and 3) incurs education expense. This benefit will reimburse education expenses for each eligible dependent child. However, the total annual payment for each dependent child will not exceed $7,500. The education expense payment is limited to 4 consecutive years for each dependent child. In no event will the total payment exceed $50,000. The benefit amount for education expense shall be paid to the natural person who incurs the expense.

15

Family Travel Expense This benefit will reimburse expenses up to $15,000 for the actual costs incurred by an immediate family member for temporary lodging, transportation and meals while travelling to and from visits with you, if within one (1) year of an accidental bodily injury which causes you to suffer a covered loss: 1) you are confined in a hospital not less than fifty (50 km) kilometres from your city of permanent residence; and 2) the attending physician recommends the personal attendance of an immediate family member. The benefit amount for family travel expense will be paid to the natural person who incurs the expense. Funeral Expense This benefit will reimburse funeral expense up to $5,000 if accidental bodily injury causes your covered loss of life. The benefit amount for funeral expense will be paid to the natural person who incurs the expense. Home Alteration or Vehicle Modification This benefit will reimburse charges up to $15,000 for home alteration and up to $15,000 for vehicle modification if a covered loss due to an accidental bodily injury requires you to incur expenses for home alteration or vehicle modification. The expenses for home alteration or vehicle modification must be incurred within 24 months after the accidental bodily injury. The benefit amount for home alteration or vehicle modification is payable if: 1) a physician certifies that the home alteration or vehicle modification is needed to accommodate your physical disability; 2) the home alteration or vehicle modification is made by people experienced in such home alteration or vehicle modification; 3) the home alteration or vehicle modification is in compliance with any applicable laws or requirements for approval by the appropriate governmental authority in the jurisdiction where the services are rendered; and 4) the home alteration or vehicle modification expenses do not exceed the usual level of charges for similar alterations and modifications in the jurisdiction where the expenses are incurred. The benefit amount for home alteration and vehicle modification is payable to the natural person who incurs the expense. In no event will the total payments for home alteration and vehicle modification exceed $15,000. Home Health Care This benefit will reimburse charges up to $5,000 if a covered loss due to an accidental bodily injury causes your confinement to home after a hospital stay of 15 days. The expenses that are the subject of the benefit amount for home health care must be incurred within 18 months after the accidental bodily injury. The benefit amount for home health care is payable on an excess basis. The insurance company will determine the charges for home health care. It will then reduce that amount by amounts already paid or payable by any other plan and it will pay the resulting benefit amount. In no event will the insurance company pay more than $5,000.

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No benefit amount for home health care shall be paid if: 1) treatment is educational, experimental or investigational or does not constitute accepted medical practice; or 2) services are provided by a person who is an immediate family member. Identification Expense This benefit will reimburse expenses up to $15,000 for the reasonable transportation and accommodations costs incurred by an immediate family member, if accidental bodily injury causes your covered loss of life within one (1) year of an accidental bodily injury and: 1) the presence of an immediate family member is requested by the police or a similar governmental authority; and 2) the loss of life occurs not less than one hundred and fifty (150 km) kilometres from your city of permanent residence. The benefit amount for identification expense will be paid to the natural person who incurs the expense. In-Hospital This benefit will pay $150 after an elimination period of 3 days for each day you are in-hospital, if an accidental bodily injury causes you to suffer a covered loss which results in you being in-hospital. The inhospital benefit amount will not be paid for more than 30 days. The in-hospital benefit amount will be paid until the earliest of the date: 1) you die; 2) you are no longer in-hospital; or 3) 30 days has elapsed. If you are discharged from the hospital and the same accident causes you to be in-hospital again within 3 days after discharge, then any time in the hospital will count to satisfy the elimination period. However, in no event will total payment of the in-hospital benefit amount exceed 30 days. Parent Care This benefit will pay $5,000 in equal shares to each of your dependent parents who is receiving support and care provided by you (as evidenced by income tax returns showing such parent as a dependent), to a maximum of $20,000, if you suffer an accidental bodily injury resulting in a covered loss of life. Psychological Therapy Expense This benefit will reimburse the reasonable and customary expenses up to $5,000 for medically necessary counselling for a mental or nervous disorder by a physician, whether on an out-patient basis, in a hospital or any other medical facility licensed to provide such treatment if an accidental bodily injury causes you to suffer a covered loss resulting in a physician’s determination that psychological therapy is required for: 1) you; or 2) your dependent. The benefit amount for psychological therapy expense is s payable on an excess basis. The insurance company will determine the charge for the psychological therapy expense and will then reduce that amount by amounts already paid or payable by any other plan. The insurance company will pay the resulting benefit amount, but in no event will it pay more than $5,000. 17

The benefit amount for psychological therapy expense will be paid to the natural person who incurs the expense. The benefit amount for psychological therapy expense will be paid until the earlier of the date on which: 1) $5,000 has been paid; or 2) 2 years have elapsed from the date of a covered loss. Rehabilitation Expense If an accidental bodily injury causes you to suffer a covered loss which: 1) prevents you from performing all the duties of your regular occupation; and 2) requires you to obtain Rehabilitation, as determined by a physician then this benefit will reimburse the reasonable and customary charges up to $15,000 for treatment, other than psychological therapy, intended to prepare you for work in any gainful occupation, including your regular occupation that is: 1) provided by a therapist licensed, registered, or certified to perform such treatment; or 2) provided in a hospital or other facility, which is licensed to provide such treatment. The rehabilitation must take place under the direction of a physician. The benefit amount for rehabilitation expense is payable on an excess basis. The insurance company will determine the charge for the rehabilitation expense and will then reduce that amount by amounts already paid or payable by any other plan. The insurance company will pay the resulting benefit amount, but in no event will it pay more than $15,000. The benefit amount for rehabilitation expense will be paid to the natural person who incurs the expense. The benefit amount for rehabilitation expense will be paid until the earlier of the date on which: 1) $15,000 has been paid; or 2) 2 years have elapsed from the date of the accidental bodily injury. Repatriation This benefit will reimburse expenses up to $15,000 for the actual costs for preparation of the body for burial or cremation and shipment of the body to your city of permanent residence, if within one (1) year of an accidental bodily injury you suffer a covered loss of life not less than fifty (50 km) kilometres away from your city of permanent residence. The benefit amount for repatriation expense will be paid to the natural person who incurs the expense.

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Seat Belt & Occupant Protection Device This benefit will pay 10% of the principal sum if you suffer an accidental bodily injury resulting in a covered loss of life while you are operating or riding in a private passenger automobile, and using a seat belt. The seat belt must have been properly secured and used in accordance with the recommendations of its manufacturer. This benefit will also pay 10% of the principal sum if you suffer an accidental bodily injury as set forth above and you are positioned in a seat protected by a properly deployed occupant protection device. Occupant protection device means either an air bag, which inflates for added protection to the head and chest areas, or any other personal safety restraint system other than a seat belt. The benefit amount for an occupant protection device will only be paid if a benefit amount for seat belt is paid. Verification of the actual use of the seat belt and proper operation of the occupant protection device at the time of the accident must be part of an official report of such accident or be certified, in writing, by an investigating police officer. In no event will a benefit amount for seat belt be paid if you are operating or riding as a passenger in any vehicle used for a race or contest of any type. In no event will the total payments for seat belt and occupant protection device exceed 20% of the principal sum. Spouse Employment Training Expense If an accidental bodily injury causes your covered loss of life then this benefit will reimburse the actual costs incurred by your spouse for tuition, fees, room and board, required books and course supplies billed by an institution of higher learning that are incurred for the purpose of your spouse obtaining or refreshing skills needed for employment. This insurance applies only if your surviving spouse incurs employment training expense within three (3) years following the date of your covered loss of life. In no event will the total payment for this benefit exceed $15,000. The benefit amount for spouse employment training expense will be paid to the natural person who incurs the expense. Vocational Training Expense If you suffer a covered loss due to an accidental bodily injury then this benefit will reimburse the actual costs incurred for tuition, fees, room and board, required books and course supplies, billed by an institution of higher learning for training that is intended to prepare you for work in any gainful occupation. The benefit amount for vocational training expense will be paid to the natural person who incurs the expense. The benefit amount for vocational training expense will be paid until the earlier of the date on which: 1) $15,000 has been paid; or 2) two (2) years have elapsed from the date of the accidental bodily injury.

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Workplace Modifications/Accommodations This benefit will reimburse charges up to $5,000 for workplace modification/accommodation if a covered loss due to an accidental bodily injury requires you to incur expenses workplace modification/accommodation. The expenses for workplace modification/accommodation must be incurred within 24 months after the accidental bodily injury. The benefit amount for workplace modification/accommodation is payable if: 1) a physician certifies that the workplace modification/accommodation is needed to accommodate your physical disability; 2) the workplace modification/accommodation is made by people experienced in such home workplace modification/accommodation; 3) the home workplace modification/accommodation is in compliance with any applicable laws or requirements for approval by the appropriate governmental authority in the jurisdiction where the services are rendered; and 4) the workplace modification/accommodation expenses do not exceed the usual level of charges for similar alterations and modifications in the jurisdiction where the expenses are incurred. The benefit amount for workplace modification/accommodation is payable to the natural person who incurs the expense. In no event will the total payments for workplace modification/accommodation $5,000. Termination of Insurance Your insurance automatically terminates on the earliest of: 1) the termination date of the policy; 2) the expiration of the period for which required premium has been paid for such you; 3) the date on which you no longer meets the eligibility criteria. Upon termination, your insurance may continue, subject to your employer’s employment policy, as follows: 1) if you are on temporary lay-off, then insurance may continue for the full period of such lay-off but not for more than three hundred and sixty-five (365) days after the date on which such lay off begins; 2) if you are on a leave of absence, then the insurance may continue for the full period of the leave of absence but not for more than three hundred and sixty-five (365) days after the date on which such leave begins; 3) if you are absent from work due to an authorized family or medical leave, then insurance may continue for the full period of the leave but not for more than three hundred and sixty-five (365) days after the date on which such leave begins unless a longer period is agreed to. Continuation of insurance is subject to the payment of premium.

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Conversion Privilege In the event your insurance under the policy ceases for any reason other than termination of the policy, you are eligible to purchase an individual accident insurance policy. In order to convert this insurance to an individual accident insurance policy, you must submit to us or our authorized representative: 1) a completed, written application; and 2) the required premium for the individual accident insurance policy within thirty-one (31) days after your insurance ended. The individual accident insurance policy will: 1) be issued without evidence of insurability; 2) provide insurance only for loss of life and dismemberment that is most similar to, but not greater than, the terminated insurance; 3) not pay for the same loss for which benefits have already been paid under the policy; 4) provide a benefit amount which will be equal to your benefit amount under the policy, subject to a maximum benefit amount of $200,000; and 5) be subject to individual policy terms and conditions. Exclusions There are certain situations we do not cover in our policy. These include: Owned or Leased Aircraft Loss caused by or resulting from, directly or indirectly, you being in, entering, or exiting any aircraft owned, leased or operated by your employer or on your employer’s behalf; or operated by an employee of your employer on your employer’s behalf. This exclusion does not apply to owned aircraft, leased aircraft or operated aircraft listed when piloted by a certified pilot licensed to operate such aircraft. The owned aircraft, leased aircraft or operated aircraft must have an unrestricted airworthiness certificate from a governmental authority with competent jurisdiction. Pilot or Crew Loss caused by or resulting from, directly or indirectly, you riding as a passenger in, entering, or exiting any aircraft while acting or training as a pilot or crew member. This exclusion shall not apply to you riding as a passenger in, entering, or exiting the employer’s owned aircraft, leased aircraft or operated aircraft while you are acting or training as a pilot or crew member by or on behalf of the employer, but only if you are certified and licensed by a governmental authority with competent jurisdiction to operate or serve as crew on such owned aircraft, leased aircraft or operated aircraft or to passengers who temporarily perform pilot or crew functions in a life threatening emergency. Disease or Illness Loss caused by or resulting from, directly or indirectly, your emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions or medical or surgical treatment thereof. This exclusion does not apply to bacterial infection caused by an accident or accidental consumption of a substance contaminated by bacteria. 21

Incarceration Loss caused by or resulting from, directly or indirectly any occurrence while you are incarcerated after conviction. Service in the Armed Forces Loss caused by or resulting from, directly or indirectly, you participating in military action while in active military service with the armed forces of any country or established international authority. However, this exclusion does not apply to the first sixty (60) consecutive days of active military service with the armed forces of any country or established international authority. Suicide or Intentional Injury Loss caused by or resulting from, directly or indirectly, your suicide, attempted suicide or intentionally selfinflicted injury. Trade Sanctions Loss when the government of Canada has imposed any trade or economic sanctions prohibiting insurance of any accident, accidental bodily injury or loss; or there is any other legal prohibition against providing insurance of any accident, accidental bodily injury or loss. War Loss caused by or resulting from, directly or indirectly, a declared or undeclared war in Iraq and your country of permanent residence. Declared or undeclared war does not include acts of terrorism. This description is a summary of the principal features of the Plan, which is governed by the terms of the insurance contract with Chubb Insurance Company of Canada under policy 9907-60-21.

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VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (Underwritten by Chubb Insurance Company of Canada) Policy No. 9907-60-23 Scope of Insurance This Voluntary Accident Insurance Plan provides accident coverage 24 hours a day...365 days a year...worldwide...on or off the job. The insurance applies to accidental bodily injury occurring anywhere on land, water and during air travel (except as limited by the exclusions explained below). Eligibility All active, non-union regular full-time and part-time employees of the Wholesale/Corporate business units under the age to 70 and all spouses of these employees excluding temporary employees under the age of 70 are eligible on date of hire. Plan Benefit Amounts & Options Principal Sum: An eligible employee may select benefit amounts in multiples of $10,000, subject to a maximum of $1,000,000 for himself or herself. An eligible employee may select benefit amounts in multiples of $10,000, subject to a maximum of $500,000 for his or her spouse. The following benefits are provided if the loss occurs as a result of an accident within one year from the date of the accident: Accidental Death & Dismemberment, Loss of Use and Paralysis For Accidental Loss of:

Percent of Principal Sum

Life Both Arms or Both Legs Speech and Hearing Both Hands, Both Feet or Sight of Both Eyes or a combination of any two of a Hand, a Foot or Sight of One Eye One Arm or One Leg One Hand, One Foot or Sight of One Eye Speech or Hearing Thumb and Index Finger of Same Hand Hearing in One Ear All Toes of One Foot

100% 200%* 100%

100% 80% 75% 75% 40% 40% 33%

For Accidental Loss of Use of: Both Arms or Both Legs or a Combination of an Arm and a Leg Both Hands or Both Feet or a Combination of a Hand and a Foot One Arm or One Leg One Hand or One Foot Thumb and Index Finger of Same Hand

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200%* 100% 80% 75% 40%

Paralysis Quadriplegia Paraplegia Hemiplegia

200%* 200%* 200%*

* to a maximum of $1,500,000 Brain Damage This benefit will pay 100% of the principal sum for brain damage, if an accidental bodily injury results in brain damage to an insured person. The benefit amount for brain damage will be paid if: 1) brain damage begins, and is diagnosed by a physician, within 30 days after the accident; 2) the insured person is in a hospital or other licensed facility, to receive medically necessary treatment for brain damage, prescribed and supervised by a physician, within the first 30 days following the accident; 3) brain damage continues for 12 consecutive month; and 4) a physician determines brain damage is permanent, complete and irreversible at the end of the 12 consecutive months. If the insured person dies within 365 days after the accident, then the benefit will pay a lump sum equal to the principal sum, less any benefit amount for brain damage already paid. Coma This benefit will pay 1% of the principal sum if an accidental bodily injury causes the insured person to: 1) lapse into a coma within 30 days after the accident; 2) remain in a coma for 30 consecutive days; and 3) be confined to a hospital or other licensed facility to receive medically necessary treatment for coma, prescribed and supervised by a physician, within the first 30 days following the accident. The benefit amount for coma is payable monthly up to 100% of the principal sum. Brief lapses from a coma will not be considered an interruption of the consecutive 30 day period, or cause a discontinuance in payment, if the lapses and subsequent coma recurrences are due to the same accident. The coma monthly payment will be made until the earliest of the date: 1) the insured person dies; 2) the insured person is no longer in a coma; or 3) total payments equal 100% of the principal sum. If the insured person dies within 365 days after the accident, then the benefit will pay a lump sum equal to the insured person’s principal sum, less any benefit amount for coma already paid.

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Maximum Payment for Multiple Losses and Multiple Benefits If the insured person is entitled to receive payment of multiple benefit amounts as a result of one (1) covered accident, then the maximum we will pay for all benefits shall not exceed the principal sum with the exception of Loss of Both Arms or Both Legs, Loss of Use of Both Arms or Both Legs or a Combination of an Arm and a Leg, Quadriplegia, Paraplegia or Hemiplegia. In no event will the maximum amount payable exceed 200% of the principal sum. Aggregate If more than one (1) insured person suffers a loss in the same accident in an employer owned or leased aircraft, then we will not pay more than $15,000,000, combined with the basic and business travel accident plans). If an accident results in benefit amounts becoming payable, which when totalled, exceed $15,000,000, then the aggregate limit of insurance will be divided proportionally among the insured persons, based on each applicable benefit amount. Definitions: “Loss” with reference to speech means the permanent, irrecoverable and total loss of the capability of speech without the aid of mechanical devices; with reference to hearing means the permanent, irrecoverable and total deafness, with an auditory threshold of more than 90 decibels in each ear which cannot be corrected by any aid or device; and with reference to sight means the permanent loss of vision, remaining vision must be no better than 20/200 using a corrective aid or device. “Loss” with reference to hand or foot means complete severance through or above the metacarpal phalangeal joint of at least four fingers or three fingers and a thumb or the ankle joint; with reference to arm or leg means complete severance through or above the elbow or knee joint; with reference to thumb and index finger means complete severance through the metacarpal phalangeal joints of the thumb and index finger of the same hand; and with reference to toes means complete severance of all toes on a foot. We will consider such severance a loss even if the specified body part is later reattached. If the reattachment fails and amputation becomes necessary, then we will not pay an additional amount for such amputation. “Paralysis” means complete and irreversible loss of all motion and all practical use of an arm or leg provided the loss is continuous for 365 days. “Loss of Use” means the permanent and total inability of the specified body part to function. Exposure & Disappearance If the insured person has not been found within one (1) year of the disappearance, stranding, sinking, or wrecking of any conveyance in which the insured person was an occupant at the time of the accident, then it will be assumed, subject to all other terms and conditions of the policy, that the insured person has suffered Loss of Life insured under the policy. Accident includes unavoidable exposure to elements. Beneficiary Designation The insured person has the right to designate a beneficiary. The employee shall have the sole right to designate a beneficiary for any dependent child who is a minor. All beneficiary designations must be: 1) in writing; 2) filed with the administrator; and 3) provided to the insurance company at the time of claim or at such other time as they may require.

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The insured person, and no one else, unless there is an irrevocable assignment, has the right to change the beneficiary except as set forth above. The insured person does not need the consent of anyone to do so. All beneficiary changes must be: 1) in writing; 2) filed with the administrator; and 3) provided to the insurance company at the time of claim or at such other time as they may require. The benefit amount for covered loss of life will be paid to the beneficiary designated by the insured person. Any benefit amount payable due to the loss of life of a dependent child will be paid to the employee, absent any beneficiary designation by the dependent child. If the insured person has not chosen a beneficiary or if there is no beneficiary alive when the insured person dies, then the insurance company will pay the benefit amount for loss of life to the first surviving party in the following order: 1) the insured person’s spouse; 2) in equal shares to the insured person’s surviving children; 3) in equal shares to the insured person’s surviving parents; 4) in equal shares to the insured person’s surviving brothers and sisters; 5) the insured person’s estate. Additional Benefits Child Care Expense This benefit will reimburse child care expenses up to $5,000 annually for each eligible dependent child if accidental bodily injury causes the insured person’s covered loss of life. This insurance applies only if the insured person has a dependent child under the age of 13 years for whom child care expenses are incurred within 365 days of the insured person’s covered loss of life. This benefit will reimburse child care expenses for each eligible dependent child. However, the total payment will not exceed $25,000 regardless of the number of dependent children for whom payment is made. Child care expenses shall be paid to the natural person who incurs such expenses for the dependent child. Education Expense This benefit will reimburse education expense up to $7,500 annually for each eligible dependent child if accidental bodily injury causes the insured person’s covered loss of life. This insurance applies only if the insured person has a dependent child at the time of a covered loss of life who: 1) is enrolled as a full-time student at an institution of higher learning on the date of the insured person’s covered loss of life; or 2) subsequently enrols as a full-time student at an institution of higher learning within 2 years following the date of the insured person’s covered loss of life; and 3) incurs education expense.

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This benefit will reimburse education expenses for each eligible dependent child. However, the total annual payment for each dependent child will not exceed $7,500. The education expense payment is limited to 4 consecutive years for each dependent child. In no event will the total payment exceed $50,000. The benefit amount for education expense shall be paid to the natural person who incurs the expense. Family Travel Expense This benefit will reimburse expenses up to $15,000 for the actual costs incurred by an immediate family member for temporary lodging, transportation and meals while travelling to and from visits with the insured person, if within one (1) year of an accidental bodily injury which causes the insured person to suffer a covered loss: 1) the insured person is confined in a hospital not less than fifty (50 km) kilometres from the insured person’s city of permanent residence; and 2) the attending physician recommends the personal attendance of an immediate family member. The benefit amount for family travel expense will be paid to the natural person who incurs the expense. Funeral Expense This benefit will reimburse funeral expense up to $5,000 if accidental bodily injury causes the insured person’s covered loss of life. The benefit amount for funeral expense will be paid to the natural person who incurs the expense. Home Alteration or Vehicle Modification This benefit will reimburse charges up to $15,000 for home alteration and up to $15,000 for vehicle modification if a covered loss due to an accidental bodily injury requires the insured person to incur expenses for home alteration or vehicle modification. The expenses for home alteration or vehicle modification must be incurred within 24 months after the accidental bodily injury. The benefit amount for home alteration or vehicle modification is payable if: 1) a physician certifies that the home alteration or vehicle modification is needed to accommodate the insured person’s physical disability; 2) the home alteration or vehicle modification is made by people experienced in such home alteration or vehicle modification; 3) the home alteration or vehicle modification is in compliance with any applicable laws or requirements for approval by the appropriate governmental authority in the jurisdiction where the services are rendered; and 4) the home alteration or vehicle modification expenses do not exceed the usual level of charges for similar alterations and modifications in the jurisdiction where the expenses are incurred. The benefit amount for home alteration and vehicle modification is payable to the natural person who incurs the expense. In no event will the total payments for home alteration and vehicle modification exceed $15,000.

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Home Health Care This benefit will reimburse charges up to $5,000 if a covered loss due to an accidental bodily injury causes the insured person’s confinement to home after a hospital stay of 15 days. The expenses that are the subject of the benefit amount for home health care must be incurred within 18 months after the accidental bodily injury. The benefit amount for home health care is payable on an excess basis. The insurance company will determine the charges for home health care. It will then reduce that amount by amounts already paid or payable by any other plan and it will pay the resulting benefit amount. In no event will the insurance company pay more than $5,000. No benefit amount for home health care shall be paid if: 1) treatment is educational, experimental or investigational or does not constitute accepted medical practice; or 2) services are provided by a person who is an immediate family member. Identification Expense This benefit will reimburse expenses up to $15,000 for the reasonable transportation and accommodations costs incurred by an immediate family member, if accidental bodily injury causes the insured person’s covered loss of life within one (1) year of an accidental bodily injury and: 1) the presence of an immediate family member is requested by the police or a similar governmental authority; and 2) the loss of life occurs not less than one hundred and fifty (150 km) kilometres from the insured person’s city of permanent residence. The benefit amount for identification expense will be paid to the natural person who incurs the expense. In-Hospital This benefit will pay $150 after an elimination period of 3 days for each day the insured person is inhospital, if an accidental bodily injury causes the insured person to suffer a covered loss which results in the insured person being in-hospital. The in-hospital benefit amount will not be paid for more than 30 days. The in-hospital benefit amount will be paid until the earliest of the date: 1) the insured person dies; 2) the insured person is no longer in-hospital; or 3) 30 days has elapsed. If the insured person is discharged from the hospital and the same accident causes the insured person to be in-hospital again within 3 days after discharge, then any time in the hospital will count to satisfy the elimination period. However, in no event will total payment of the in-hospital benefit amount exceed 30 days. Parent Care This benefit will pay up to 10% of the principal sum, maximum of $10,000 in equal shares to each of the insured person’s dependent parents who is receiving support and care provided by the insured person (as evidenced by income tax returns showing such parent as a dependent) to a maximum of $20,000, if the insured person suffers an accidental bodily injury resulting in a covered loss of life.

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Psychological Therapy Expense This benefit will reimburse the reasonable and customary expenses up to $5,000 for medically necessary counselling for a mental or nervous disorder by a physician, whether on an out-patient basis, in a hospital or any other medical facility licensed to provide such treatment if an accidental bodily injury causes the insured person to suffer a covered loss resulting in a physician’s determination that psychological therapy is required for: 1) the insured person; or 2) the insured person’s dependent. The benefit amount for psychological therapy expense is s payable on an excess basis. The insurance company will determine the charge for the psychological therapy expense and will then reduce that amount by amounts already paid or payable by any other plan. The insurance company will pay the resulting benefit amount, but in no event will it pay more than $5,000. The benefit amount for psychological therapy expense will be paid to the natural person who incurs the expense. The benefit amount for psychological therapy expense will be paid until the earlier of the date on which: 1) $5,000 has been paid; or 2) 2 years have elapsed from the date of a covered loss. Rehabilitation Expense If an accidental bodily injury causes the insured person to suffer a covered loss which: 1) prevents the insured person from performing all the duties of the insured person’s regular occupation; and 2) requires the insured person to obtain rehabilitation, as determined by a physician then this benefit will reimburse the reasonable and customary charges up to $15,000 for treatment, other than psychological therapy, intended to prepare the insured person for work in any gainful occupation, including the insured person’s regular occupation that is: 1) provided by a therapist licensed, registered, or certified to perform such treatment; or 2) provided in a hospital or other facility, which is licensed to provide such treatment. The rehabilitation must take place under the direction of a physician. The benefit amount for rehabilitation expense is payable on an excess basis. The insurance company will determine the charge for the rehabilitation expense and will then reduce that amount by amounts already paid or payable by any other plan. The insurance company will pay the resulting benefit amount, but in no event will it pay more than $15,000. The benefit amount for rehabilitation expense will be paid to the natural person who incurs the expense. The benefit amount for rehabilitation expense will be paid until the earlier of the date on which: 1) $15,000 has been paid; or 2) 2 years have elapsed from the date of the accidental bodily injury.

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Repatriation This benefit will reimburse expenses up to $15,000 for the actual costs for preparation of the body for burial or cremation and shipment of the body to the insured person’s city of permanent residence, if within one (1) year of an accidental bodily injury the insured person suffers a covered loss of life not less than fifty (50 km) kilometres away from the insured person’s city of permanent residence. The benefit amount for repatriation expense will be paid to the natural person who incurs the expense. Seat Belt & Occupant Protection Device This benefit will pay 10% of the principal sum if the insured person suffers an accidental bodily injury resulting in a covered loss of life while the insured person is operating or riding in a private passenger automobile, and using a seat belt. The seat belt must have been properly secured and used in accordance with the recommendations of its manufacturer. This benefit will also pay 10% of the principal sum if the insured person suffers an accidental bodily injury as set forth above and the insured person is positioned in a seat protected by a properly deployed occupant protection device. Occupant protection device means either an air bag, which inflates for added protection to the head and chest areas, or any other personal safety restraint system other than a seat belt. The benefit amount for an occupant protection device will only be paid if a benefit amount for seat belt is paid. Verification of the actual use of the seat belt and proper operation of the occupant protection device at the time of the accident must be part of an official report of such accident or be certified, in writing, by an investigating police officer. In no event will a benefit amount for seat belt be paid if the insured person is operating or riding as a passenger in any vehicle used for a race or contest of any type. In no event will the total payments for seat belt and occupant protection device exceed 20% of the principal sum. Spouse Employment Training Expense If an accidental bodily injury causes the insured person’s covered loss of life then this benefit will reimburse the actual costs incurred by the insured person’s spouse for tuition, fees, room and board, required books and course supplies billed by an institution of higher learning that are incurred for the purpose of the insured person’s spouse obtaining or refreshing skills needed for employment. This insurance applies only if the insured person’s surviving spouse incurs employment training expense within three (3) years following the date of the insured person’s covered loss of life. In no event will the total payment for this benefit exceed $15,000. The benefit amount for spouse employment training expense will be paid to the natural person who incurs the expense.

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Vocational Training Expense If the insured person suffers a covered loss due to an accidental bodily injury then this benefit will reimburse the actual costs incurred for tuition, fees, room and board, required books and course supplies, billed by an institution of higher learning for training that is intended to prepare the insured person for work in any gainful occupation. The benefit amount for vocational training expense will be paid to the natural person who incurs the expense. The benefit amount for vocational training expense will be paid until the earlier of the date on which: 1) $15,000 has been paid; or 2) two (2) years have elapsed from the date of the accidental bodily injury. Workplace Modifications/Accommodations This benefit will reimburse charges up to $5,000 for workplace modification/accommodation if a covered loss due to an accidental bodily injury requires the insured person to incur expenses workplace modification/accommodation. The expenses for workplace modification/accommodation must be incurred within 24 months after the accidental bodily injury. The benefit amount for workplace modification/accommodation is payable if: 1) a physician certifies that the workplace modification/accommodation is needed to accommodate the physical disability of the insured person; 2) the workplace modification/accommodation is made by people experienced in such home workplace modification/accommodation; 3) the home workplace modification/accommodation is in compliance with any applicable laws or requirements for approval by the appropriate governmental authority in the jurisdiction where the services are rendered; and 4) the workplace modification/accommodation expenses do not exceed the usual level of charges for similar alterations and modifications in the jurisdiction where the expenses are incurred. The benefit amount for workplace modification/accommodation is payable to the natural person who incurs the expense. In no event will the total payments for workplace modification/accommodation $5,000. Termination of Insurance The insured person’s insurance automatically terminates on the earliest of: 1) the termination date of the policy; 2) the expiration of the period for which required premium has been paid for such the insured person; 3) the date on which the insured person no longer meets the eligibility criteria.

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Upon termination, the insured person’s insurance may continue, subject to the employer’s employment policy, as follows: 1) if the employee is on temporary lay-off, then insurance may continue for the full period of such lay-off but not for more than three hundred and sixty-five (365) days after the date on which such lay off begins; 2) if the employee is on a leave of absence, then the insurance may continue for the full period of the leave of absence but not for more than three hundred and sixty-five (365) days after the date on which such leave begins; 3) if the employee is absent from work due to an authorized family or medical leave, then insurance may continue for the full period of the leave but not for more than three hundred and sixty-five (365) days after the date on which such leave begins unless a longer period is agreed to. Continuation of insurance is subject to the payment of premium. Family Continuation If the employee suffers a covered loss of life, then we will continue insurance for a period of twelve (12) months beyond the date that insurance would otherwise terminate as to such the employee’s surviving dependents. Conversion Privilege In the event the employee’s insurance under the policy ceases for any reason other than termination of the policy, the employee is eligible to purchase an individual accident insurance policy. In order to convert this insurance to an individual accident insurance policy, the employee must submit to us or our authorized representative: 1) a completed, written application; and 2) the required premium for the individual accident insurance policy within thirty-one (31) days after the employee’s insurance ended. The individual accident insurance policy will: 1) be issued without evidence of insurability; 2) provide insurance only for loss of life and dismemberment that is most similar to, but not greater than, the terminated insurance; 3) not pay for the same loss for which benefits have already been paid under the policy; 4) provide a benefit amount which will be equal to the insured person’s benefit amount under the policy, subject to a minimum benefit amount of $200,000; and 5) be subject to individual policy terms and conditions. Waiver of Premium If the employee suffers an accidental bodily injury or sickness which causes a disability that continues for 90 days, we will waive the premium due at the end of the 90 days. The waiver of premium ends at the earliest of (a) the day the employee attains age 65 or (b) the date the policy ends or (c) the day the employee ceases to be disabled.

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Exclusions There are certain situations we do not cover in our policy. These include: Owned or Leased Aircraft Loss caused by or resulting from, directly or indirectly, the insured person being in, entering, or exiting any aircraft owned, leased or operated by the employer or on the employer’s behalf; or operated by an employee of the employer on the employer’s behalf. This exclusion does not apply to owned aircraft, leased aircraft or operated aircraft listed when piloted by a certified pilot licensed to operate such aircraft. The owned aircraft, leased aircraft or operated aircraft must have an unrestricted airworthiness certificate from a governmental authority with competent jurisdiction. Pilot or Crew Loss caused by or resulting from, directly or indirectly, the insured person riding as a passenger in, entering, or exiting any aircraft while acting or training as a pilot or crew member. This exclusion shall not apply to the insured person riding as a passenger in, entering, or exiting the employer’s owned aircraft, leased aircraft or operated aircraft while such insured person is acting or training as a pilot or crew member by or on behalf of the employer, but only if such insured person is certified and licensed by a governmental authority with competent jurisdiction to operate or serve as crew on such owned aircraft, leased aircraft or operated aircraft or to passengers who temporarily perform pilot or crew functions in a life threatening emergency. Disease or Illness Loss caused by or resulting from, directly or indirectly, the insured person’s emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions or medical or surgical treatment thereof. This exclusion does not apply to bacterial infection caused by an accident or accidental consumption of a substance contaminated by bacteria. Incarceration Loss caused by or resulting from, directly or indirectly any occurrence while the insured person is incarcerated after conviction. Service in the Armed Forces Loss caused by or resulting from, directly or indirectly, the insured person participating in military action while in active military service with the armed forces of any country or established international authority. However, this exclusion does not apply to the first sixty (60) consecutive days of active military service with the armed forces of any country or established international authority. Suicide or Intentional Injury Loss caused by or resulting from, directly or indirectly, the insured person’s suicide, attempted suicide or intentionally self-inflicted injury.

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Trade Sanctions Loss when the government of Canada has imposed any trade or economic sanctions prohibiting insurance of any accident, accidental bodily injury or loss; or there is any other legal prohibition against providing insurance of any accident, accidental bodily injury or loss. War Loss caused by or resulting from, directly or indirectly, a declared or undeclared war in Iraq and the insured person’s country of permanent residence. Declared or undeclared war does not include acts of terrorism. This description is a summary of the principal features of the Plan, which is governed by the terms of the insurance contract with Chubb Insurance Company of Canada under policy 9907-60-23.

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CRITICAL ILLNESS PROGRAM (Underwritten by ACE INA Life Insurance) Policy No: CI10450101 Eligibility You will be eligible for coverage if you are an active, permanent, full-time and part-time employee of the Policyholder working a minimum of 20 hours per week, under age 65. Coverage can also be purchased by your spouse (legally married or a person who co-habits with you and has been represented as your domestic partner for a period of 1 year or longer in the community in which you reside and continues to be so represented) under age 65. Insured Conditions 

Alzheimer’s Disease



Aorta Surgery



Benign Brain Tumour



Blindness



Cancer



Coma



Coronary Artery Bypass Surgery



Deafness



Dismemberment



Heart Attack



Heart Valve Replacement



Loss of Speech



Major Organ Failure



Major Organ Transplant



Motor Neuron Disease



Multiple Sclerosis



Occupational HIV Infection



Paralysis



Parkinson’s Disease



Severe Burns



Stroke

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Additional Benefits 

Ductal Carcinoma in situ (DCIS) Benefit



Early Stage Prostate Cancer (T1a or T1b) Treatment



Loss of Independence Benefit



Second Event Benefit

Benefits Optional Guaranteed Issue* Employee: $10,000, $15,000, $20,000 or $25,000 Spouse: $10,000, $15,000, $20,000 or $25,000 Benefit amounts are not subject to satisfactory evidence of insurability. Optional Evidence* - Minimum $10,000 Employee: $25,000 to $150,000 in units of $5,000 Spouse: $25,000 to $150,000 in units of $5,000 Maximum combined coverage is $150,000 per person Benefit amounts are subject to satisfactory evidence of insurability. Coverage ceases upon the earlier of termination, retirement or the attainment of age 65. Smoking Provisions (Applicable To Optional Coverage Only) If the Insured Person is covered on the basis that they are a non-smoker and subsequently begin smoking, then the following will apply: a) The Insured Person must notify Agrium HR Shared Service Center within 30 days of beginning to smoke that they have begun smoking. In this event they must pay a higher premium applicable to a smoker as calculated by ACE INA Life Insurance; or b) Where such notification as is referred to in paragraph (a) above has not been provided to ACE INA Life Insurance or the Insured Person is a smoker but has been paying non-smoker premium rates, then, in the event of a claim ACE INA Life Insurance will reduce the benefits by 50%. If the Insured Person is covered on the basis that they are a smoker and subsequently cease smoking for 12 consecutive months, then ACE INA Life Insurance may be notified that the lower premium applies.

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Payment Terms If, while coverage is in effect: a) but only after coverage has been in effect on the Insured Person for a period of 90 days, the Insured Person, for the first time in their lifetime (applicable to Optional Coverage only), is then diagnosed with DCIS or Cancer, or undergoes Early Stage Prostate Cancer (T1a or T1b) Treatment, whether included or excluded in the policy, or if any symptoms or medical problems manifest themselves which, or the persistence or recurrence of which, subsequently results in an investigation leading to the diagnosis of cancer, and the Insured Person survives for a period of 30 days thereafter, ACE INA Life Insurance will pay the applicable benefit; or b) the Insured Person, for the first time in their lifetime (applicable to Optional Coverage only), is then diagnosed with Alzheimer’s Disease, Benign Brain Tumour, Blindness, Coma, Deafness, Dismemberment, Heart Attack, Loss of Independence, Loss of Speech, Major Organ Failure, Major Organ Transplant, Motor Neuron Disease, Multiple Sclerosis, Occupational HIV, Paralysis, Parkinson’s Disease, Severe Burns or Stroke, and the Insured Person survives for a period of 30 days thereafter (180 days for Paralysis), ACE INA Life Insurance will pay the applicable benefit; or c) the Insured Person, for the first time in their lifetime (applicable to Optional Coverage only), undergoes Aorta Surgery, Coronary Artery Bypass Surgery or Heart Valve Replacement and the Insured Person survives for a period of 30 days thereafter, ACE INA Life Insurance will pay the applicable benefit. Partial Benefits Ductal Carcinoma In Situ(DCIS) Benefit Or Early Stage Prostate Cancer (T1a or T1b) Treatment Subject to the terms, conditions and other provisions of the policy, ACE INA Life Insurance will pay the Insured Person 20% of the principal sum up to a maximum of $20,000 if, while insured, the Insured Person is diagnosed with DCIS or undergoes Early Stage Prostate Cancer (T1a or T1b) Treatment and survive 30 days thereafter. This benefit is payable only once. Payment of this benefit reduces the principal sum the Insured Person selected on the Critical Illness enrolment form. Payment of this benefit will represent full and final discharge of all claims under this benefit. Loss Of Independence Benefit Subject to the terms, conditions and other provisions of the policy, ACE INA Life Insurance will pay the Insured Person 25% of the principal sum if, while insured, the Insured Person is diagnosed with Loss of Independence. The Loss of Independence Benefit is payable only once, without interest. Payment of the Loss of Independence Benefit reduces the principal sum the Insured Person selected on the Group Critical Illness enrollment form. Payment of the Loss of Independence Benefit will represent full and final discharge of all claims under the Loss of Independence Benefit.

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Second Event Benefit (Applicable To Insured Employee Or Insured Spouse Only) If an Insured Person is diagnosed with either of the following: Category of Conditions a) Cancer, or b) Cardiovascular Condition (defined as Heart Attack, Stroke, Coronary Artery Bypass, undergoes Aorta Surgery or Heart Valve Replacement)for which the Principal Sum has been paid and the Insured Person is thereafter considered (by the treating Physician) fully recovered and has returned to work for a period of at least 90 days and is then diagnosed with another Insured Condition, the Second Event Benefit payable will be equal to the Principal Sum (less any partial payment benefit paid after the first principal sum was fully paid). The Second Event Benefit is subject to the Insured Person surviving 30 days after the diagnosis of such Insured Condition. In order to be considered an eligible second event condition, the first and second event cannot fall into the same Category of Conditions. The Second Event Benefit is payable only once. Payment of the Second Event Benefit will represent full and final discharge of all claims under the Second Event Benefit. Following Payment of the Second Event Benefit, coverage under this policy will terminate. Partial Benefits are not considered an event and therefore are not included in the above definition of Second Event. Any benefit payment made will reduce the amount payable under either a First or Second Event. Pre-Existing Medical Condition Provision If you or your covered dependents suffer a sickness or sustain an injury for which medical advice, consultation, investigation, or diagnosis was sought or received, or for which treatment was required or recommended by a licensed medical practitioner during the 24 months immediately prior to you or your covered dependent’s effective date of insurance or prior to any increase in the amount of insurance and, which directly or indirectly causes the specified covered condition to occur within the first 24 months from you or your covered dependent’s effective date of insurance or from any increase in the amount of insurance, a benefit will not be payable. The pre-existing medical condition provision does not apply to Optional Evidence coverage. Definitions Alzheimer’s Disease: means the diagnosis that the Insured Person has Alzheimer’s Disease, which is a progressive degenerative disease of the brain. The diagnosis must be supported by medical evidence that the Insured Person exhibits the loss of intellectual capacity resulting in impairment of their memory and judgment, which results in a significant reduction in their mental and social functioning, such that they require permanent daily personal supervision for the activities of daily living. All other dementing organic brain disorders and psychiatric illnesses are excluded from this insured condition definition. A physician who is certified as either a neurologist or a psychiatrist must confirm diagnosis in writing. Aorta Surgery: means surgery to the aorta that is medically required to treat disease of the aorta and that involves the excision and surgical replacement of the diseased aorta with a graft. The Aortic Surgery must be performed on the prior written advice of a physician certified as a cardiovascular surgeon. Aorta includes the thoracic and abdominal aorta but does not include any of the branches of the aorta. Benign Brain Tumour: means a benign neoplasm in the brain or meninges with histologic confirmation. Cysts granulomas, malformations of intracranial arteries or veins, and tumours or lesions of the pituitary are specifically excluded. The diagnosis must be confirmed neuro-radiologically by a specialist trained in the interpretation of radiological investigations.

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Blindness: means the total and irrecoverable loss of sight in both eyes due to injury or sickness. Corrected visual acuity must be 20/200 or less in both eyes and the field of vision must be less than 20 degrees in both eyes. A physician certified in ophthalmology, must clinically confirm the diagnosis in writing. Cancer: means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue. This includes Leukemia, Hodgkin’s Disease and invasive melanoma but does not include: 

Carcinoma in situ



Kaposi's Sarcoma (or other AIDS related cancers) and cancer in the presence of human immunodeficiency virus (HIV).



Skin cancer or melanoma that is not invasive and has not exceeded .75 millimeters in depth.



Prostate cancer diagnosed as T1 N0M0 or equivalent staging.



A recurrence or metastasis of a cancer which was originally diagnosed prior to the effective date of coverage.

A physician certified as an oncologist must confirm diagnosis in writing. Cerebral Palsy (applicable to Optional Coverage only): means a definite diagnosis of definite cerebral palsy, a non-progressive neurological defect characterized by spasticity and uncoordinated movements. A physician who is certified as a neurologist must confirm the diagnosis in writing. Coma: means you have been in a state of unconsciousness for a continuous period of at least 96 hours, during which external stimulation produced no more than primitive avoidance reflexes. A physician who is certified as a neurologist must confirm diagnosis in writing. Coronary Artery Bypass Surgery: means surgery performed by a physician who is certified as a cardiovascular surgeon to correct narrowing or blockage of one or more coronary arteries with bypass grafts. Non-surgical techniques such as balloon angioplasty, laser relief of an obstruction, or other intraarterial techniques will not be considered to be a covered Critical Illness. Cystic Fibrosis (applicable to Optional Coverage only): means a definite diagnosis of cystic fibrosis which is a hereditary disorder affecting the exocrine glands, resulting in chronic lung disease and pancreatic insufficiency. A physician who is specialized in Medical Genetics must confirm the diagnosis in writing. Deafness: means the diagnosis of permanent loss of hearing in both of your ears, with an auditory threshold of more than 90 decibels in each ear. A physician, who is certified as an otolaryngologist must confirm diagnosis in writing. Dismemberment: means a definite diagnosis of the complete severance of two or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation. The diagnosis of Loss of Limbs must be made by a Specialist. Down’s Syndrome (applicable to Optional Coverage only): means a definite diagnosis of Down’s syndrome supported by chromosomal evidence of Trisomy 21. A physician who is specialized in Medical Genetics must confirm the diagnosis in writing. Ductal Carcinoma in situ (DCIS): means the diagnosis by a licensed physician, of the presence of ductal carcinoma in situ of the breast, as confirmed by a biopsy. A physician certified as an oncologist must confirm the diagnosis in writing.

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Early Stage Prostate Cancer (T1a or T1b) Treatment: means the diagnosis must be made by a specialist. No benefit will be payable unless the specialist has recommended one of the following treatments: 

Prostate Surgery



Radiation Therapy



Chemotherapy



Hormone Therapy

Heart Attack: means a definite diagnosis of the death of heart muscle due to obstruction of blood flow that results in the rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least one of the following: a) heart attack symptoms; or b) new electrocardiogram (ECG) changes consistent with a heart attack; or c) development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty. The diagnosis of Heart Attack must be made by a Specialist. Exclusions: No benefit will be payable under this condition for: a) elevated biochemical cardiac markers with a: (i) Troponin Level of less than 1 (ii) CK-Mb Level of less than 4, or b) ECG changes suggesting a prior myocardial infarction, which do not meet the Heart Attack definition as described above. Heart Valve Replacement: means undergoing surgery to replace any heart valve with either a natural or mechanical valve. The surgery must be determined to be medically necessary by a Specialist. Exclusion: No benefit will be payable under this condition for heart valve repair. Loss of Speech: means the definite diagnosis of the total and irreversible loss of the ability to speak as the result of physical injury or disease, for a period of at least 180 days. The diagnosis of Loss of Speech must be made by a Specialist. Loss of Independence: means the definitive diagnosis by a licensed physician of either: 

Being totally and permanently unable to perform, by oneself, at least 2 of the 6 activities of daily living or,

 Cognitive impairment. A mental or nervous disorder without a demonstrable organic cause is not covered. Loss of Independence must persist for at least 90 days from the date of the diagnosis. Major Organ Failure: means the irreversible failure of the entire heart, entire liver, entire pancreas (pancreatic islet cell transplants are excluded) both lungs, both kidneys or bone marrow, in which the affected organ is unresponsive to any treatment and for which the Insured Person medically required to become enrolled in a recognized Canadian transplant program to become the recipient of a heart, a liver, a pancreas, a lung, or a kidney or to receive a bone marrow transplant. 40

Major Organ Transplant: means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under Major Organ Transplant, the Insured Person must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities. The diagnosis of the major organ failure must be made by a Specialist. Motor Neuron Disease: means a definite diagnosis of one of the following: 

Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)



Primary lateral sclerosis



Progressive spinal muscular atrophy



Progressive bulbar palsy



Pseudo bulbar palsy

The diagnosis of Motor Neuron Disease must be made by a Specialist. Multiple Sclerosis: means the unequivocal written diagnosis by a physician who is certified as a neurologist confirming at least one of the following: 

two or more separate clinical attacks, confirmed by magnetic resonance imaging (MRI) of the nervous system, showing multiple lesions of demyelination; or



well-defined neurological abnormalities lasting more than 6 months, confirmed by MRI imaging of the nervous system, showing multiple lesions of demyelination; or



a single attack, confirmed by repeated MRI imaging of the nervous system, which shows multiple lesions of demyelination which have developed at intervals at least one month apart.

Muscular Dystrophy (applicable to Optional Coverage only): means a definite diagnosis of muscular dystrophy, characterized by well-defined neurological abnormalities, confirmed by electromyography and muscular biopsy. A physician who is certified as a neurologist must confirm the diagnosis in writing. Occupational HIV Infection: means a definite diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the Insured Person’s normal occupation, which exposed the person to HIV contaminated body fluids. The accidental injury leading to the infection must have occurred after the later of the effective date of the policy, the effective date of last reinstatement of the policy, or the Insured Person’s effective date of coverage. Payment under this condition requires satisfaction of all of the following: a) The accidental injury must be reported to the insurer within 14 days of the accidental injury; b) A serum HIV test must be taken within 14 days of the accidental injury and the result must be negative; c) A serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive; d) All HIV tests must be performed by a duly licensed laboratory in Canada or the United States of America; e) The accidental injury must be reported, investigated and documented in accordance with current Canadian or United States of America workplace guidelines. The diagnosis of Occupational HIV Infection must be made by a Specialist. 41

Exclusion: No benefit will be payable under this condition if: 

The Insured Person has elected not to take any available licensed vaccine offering protection against HIV; or,



A licensed cure for HIV infection is available prior to the accidental injury; or,



HIV infection has occurred as a result of non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use.

Paralysis: means the total and irrecoverable loss of function of two (2) or more limbs through neurological damage due to injury or sickness, provided such loss of function continually lasts for 180 consecutive days and such loss of function is thereafter determined on evidence satisfactory to ACE INA Life Insurance to be permanent. A physician certified as a neurologist must confirm diagnosis in writing. Parkinson’s Disease: means unequivocal diagnosis of primary idiopathic Parkinson’s Disease resulting in the inability to perform 3 of the 6 activities of daily living without assistance. Diagnosis should show signs of progressive impairment and must be confirmed in writing by a physician who is certified as a neurologist. Severe Burns: means the Insured Person has third degree burns covering at least 20% of the surface area of their body. A physician who is certified as a plastic surgeon must confirm diagnosis of this condition in writing. Stroke: means that the Insured Person has suffered a cerebrovascular incident, excluding transient ischemic attack (TIA), producing infarction of brain tissue due to thrombosis, hemorrhage from an intracranial vessel or embolization caused by an extracranial source. There must be evidence of permanent neurological deficit persisting for 30 consecutive days, supported by evidence that the deficit is resulting from the stroke, confirmed in writing by a physician who is certified as a neurologist. Continuance Of Coverage If you are (1) laid-off on a temporary basis, (2) temporarily absent from work due to short-term disability, (3) on leave of absence, or (4) on maternity leave, coverage shall be extended for a period of 12 months following the beginning of any such event subject to continued payment of premium. Waiver Of Premium If an Insured Person, under age 65, becomes Totally Disabled for 6 consecutive months, while the policy is in force and the Insured Person provides evidence of Total Disability satisfactory to ACE INA Life Insurance, ACE INA Life Insurance will then waive the payment of each premium which falls due with respect to the Insured Person and any insured dependents. Subject to all the terms and conditions of the policy, waiver of any premium as herein provided will continue with respect to the Insured Person until age 65 or earlier termination of the policy. If the Insured Person ceases to be disabled and he/she returns to employment with the Policyholder and is a member of an eligible class, insurance with respect to the Insured Person may be continued upon resumption of premium payments by the Insured Person or the Policyholder. If after 120 days, an Insured Person receives approval of any Long Term Disability claim provided under a policy of group insurance through the Employer, ACE INA Life Insurance will then waive the payment of each Critical Illness insurance premium subject to the terms stated above.

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Recurrent Disabilities When an Insured Person becomes Totally Disabled again from the same or related causes within 6 months of cessation of the Waiver of Premiums, then all such recurrences will be considered a continuation of the same disability and ACE INA Life Insurance will waive the 6 month qualification period. If the same disability recurs more than 6 months after cessation of the Waiver of Premiums, such disability will be considered a separate disability. Two disabilities which are due to unrelated causes are considered separate disabilities if they were separated by a return to work of at least 1 day. Termination of Waiver of Premium Waiver of Premiums will cease on the earliest of: a) the date the Insured Person ceases to meet the policy’s definition of Totally Disabled; b) the date the Insured Person does not supply ACE INA Life Insurance with appropriate medical evidence as deemed necessary by ACE INA Life Insurance; c) the date the Insured Person is no longer receiving regular, ongoing care and treatment of a physician appropriate for the disabling condition, as determined by ACE INA Life Insurance; d) the date the Insured Person does not attend a medical, psychiatric, psychological, functional, educational and/or vocational examination evaluation by an examiner selected by ACE INA Life Insurance; e) the date the Insured Person turns 65; f)

the date the policy terminates; or

g) the date the Insured Person dies. Coverage During Waiver of Premium While premiums are being waived, Critical Illness Insurance under the policy on the Insured Person and their dependents will continue to be in force. The amount of such Critical Illness Insurance will be the amount of insurance that was in effect on the date of commencement of the disability, subject to any age reduction or termination shown in the policy. “Totally Disabled or Total Disability” with respect to waiver of premium means disability resulting from injury or sickness which prevents engagement in the Insured Person’s regular occupation for 6 consecutive months. Conversion On the date of termination of employment or during the 31 day period following termination of employment, you may convert your insurance to an individual insurance policy of ACE INA Life Insurance. The individual policy will be effective either as of the date that ACE INA Life Insurance receives the application or on the date that coverage under the group policy ceases, whichever occurs later. The premium will be the same as a person would ordinarily pay when applying for an individual policy at that time. Application for an individual policy may be made at any office of ACE INA Life Insurance. The amount of insurance benefit converted to shall not exceed that amount issued during employment up to an all policies combined maximum of $25,000.

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Limitations & Exclusions The plan does not provide benefits for any of the specified coverages caused directly or indirectly by or resulting from intentionally self-inflicted injury, suicide or any attempt thereat, while sane or insane; declared or undeclared war or any act thereof; injury or sickness, other than one of the specified coverages, even though such injury or sickness may have been complicated by one of the specified coverages; a complication of Human Immunodeficiency Virus (HIV) infection or any variance thereof including AIDS and AIDS Related Complex; the use, existence or escape of nuclear weapons, material or ionizing radiation from or contamination by radioactivity from any nuclear fuel or waste from the combustion of nuclear fuel; the commission or attempted commission by the Insured Person of any act which if adjudicated by a court would be an illegal act under the laws of the jurisdiction where the act was committed; misuse of medication or the abuse of drugs or intoxicants; or a pre-existing medical condition except where coverage has been in effect for a period of 24 months following your or your covered dependent’s effective date of coverage. How To Claim In the event of a claim, claim forms can be obtained from the Plan Administrator. Notice of claim must be given to ACE INA Life Insurance within 30 days from the date of the accident, the beginning of the disability or after the survival period, and subsequent proof of claim must be submitted to ACE INA Life Insurance within 90 days from the date of the accident or after survival period. Failure to give notice of claim or furnish proof of claim within the time prescribed in the policy condition will not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible and if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed. In no event, will ACE INA Life Insurance accept notice of claim beyond one (1) year. General Provisions Beneficiary An employee or any spouse has the right to name a beneficiary when he applies for insurance. It is understood that the beneficiary designation made under the Policyholder’s Group Life Insurance Policy shall be recognized as the beneficiary under the policy, unless a further designation has been made that specifically identifies the policy. Failing such designation, all benefits will be paid to the estate of the insured person. All other indemnities of the policy will be payable to the insured person. An insured person can change his beneficiary at any time, where permitted by law. The Company assumes no responsibility for the validity of such designation or change of beneficiary. The beneficiary designation made by the insured person (if any) under the replaced policy has been retained. The insured person should review the existing designation to ensure it reflects his/her current intention. The policy contains a provision removing or restricting the right of the insured person to designate persons to whom or for whose benefit insurance money is to be payable.

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Legal Actions No action at law or in equity shall be brought to recover on the policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with requirements of the policy. For residents of Alberta and British Columbia: Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act. For residents of Manitoba: Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in The Insurance Act. For residents of Ontario: Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002. Otherwise, every action must be brought within one year from the date of loss or such longer period as may be required under the law applicable in the insured person’s province of residence. Change of Insurer An insured person under a former policy may not be excluded from the new policy or be denied benefits solely because of a pre-existing condition limitation that was not applicable or that did not exist in the former policy, or because the person is not at work on the date of coming into force of the new policy. The insured person and any claimant under the policy has the right, as determined by law applicable in the insured person’s province of residence, to obtain a copy of his/her application, any written evidence of insurability (as applicable) and the Policy, on request, subject to certain access limitations.

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LONG TERM DISABILITY (LTD) INCOME BENEFITS The plan provides you with regular income to replace income lost because of a lengthy disability due to disease or injury. Benefits begin after the waiting period is over and continue until you are no longer disabled as defined by the policy or you reach age 65, whichever comes first. You are only covered for the option that you choose as shown in the Benefit Summary. Check the Benefit Summary for the benefit amount and waiting period. 

If disability is not continuous, the days you are disabled can be accumulated to satisfy the waiting period as long as no interruption is longer than 2 weeks and the disabilities arise from the same disease or injury.



LTD benefits are payable for the first 24 months following the waiting period if disease or injury prevents you from performing the essential duties of your regular occupation, and, except for any employment under an approved rehabilitation plan, you are not employed in any occupation that is providing you with income equal to or greater than your amount of LTD insurance under this plan, as shown in the Benefit Summary.



After 24 months, LTD benefits will continue only if your disability prevents you from being gainfully employed in any job. Gainful employment is work you are medically able to perform, for which you have at least the minimum qualifications, and which provides you with an income of at least 50% of your indexed monthly earnings before you became disabled.



Loss of any license required for work will not be considered in assessing disability.



After the waiting period, separate periods of disability arising from the same disease or injury are considered to be one period of disability unless they are separated by at least 6 months.



If you choose the non-taxable plan, you will pay the entire cost of LTD coverage through payroll deduction. If you choose the taxable plan, you will pay the premium with flex credits.



Your LTD insurance terminates when you reach age 65.

Other Income Your LTD benefit is reduced by other income you are entitled to receive while you are disabled. Your benefit is first reduced by: 

disability or retirement benefits you are entitled to on your own behalf under the Canada Pension Plan or Quebec Pension Plan



benefits under any Workers' Compensation Act or similar law



employer sponsored short term disability or sick leave benefits



loss of income benefits under an automobile insurance plan, to the extent permitted by law



50% of earnings received from an approved rehabilitation plan

46

There is a further reduction of your LTD benefit if the total of the income listed below exceeds 80% of your monthly earnings before you became disabled if your benefit is taxable or 85% of your monthly takehome pay before you became disabled if your benefit is non-taxable. If it does exceed this, your benefit is reduced by the excess amount. 

your income under this plan



loss of income benefits available through legislation, except for Employment Insurance benefits and automobile insurance benefits, which you or another member of your family is entitled to on the basis of your disability



the wage loss portion of any criminal injury award



disability benefits under a plan of insurance available through an association



employment income, disability benefits, or retirement benefits related to any employment except for income from an approved rehabilitation plan, or employer sponsored short term disability or sick leave benefits (termination pay, severance benefits, and any similar termination of employment benefits, including any salary paid in lieu of notice, are included as employment income under this provision)

The balance of any earnings received from an approved rehabilitation plan is not used to further reduce your LTD benefit unless that balance, together with your income from this plan and the other income listed above, would exceed your indexed monthly earnings before you became disabled. If it does, your benefit is reduced by the excess amount. Cost-of-living increases in the other income listed above, that take effect after the benefit period starts, except for income from an approved rehabilitation plan, are not included. Vocational Rehabilitation Vocational rehabilitation involves a work related activity or training strategy that is designed to help you return to your own job or other gainful employment, and is recommended or approved by Great-West Life. In considering whether to recommend or approve a rehabilitation plan, Great-West Life will assess such factors as the expected duration of disability, and the level of activity required to facilitate the earliest possible return to work. Medical Coordination Medical coordination is a program, recommended or approved by Great-West Life, that is designed to facilitate medical stability and provide you with cost effective, quality care. In considering whether to recommend or approve a medical coordination program, Great-West Life will assess such factors as the expected duration of disability, and the level of activity required to facilitate medical stability. Inflation Protection One year after the start of your benefit period and annually after that, the then current amount payable will be adjusted to reflect increases in the Consumer Price Index, to a maximum increase of 3% in any year.

47

Survivor Benefit If you die while LTD income benefits are being paid, Great-West Life will pay 3 times your monthly LTD benefit to your named beneficiary. If you have not named a beneficiary or there is no surviving beneficiary at the time of your death, payment will be made to your estate. Your employer will explain the claim requirements to your beneficiary. Limitations No benefits are paid for: 

Any period after you fail to participate or cooperate in a prescribed plan of medical treatment appropriate for your condition. Depending on the severity of the condition, you may be required to be under the care of a specialist. If substance abuse contributes to your disability, the treatment program must include participation in a recognized substance withdrawal program.



Any period after you fail to cooperate in applying for other disability benefits, reapplying for such benefits, or appealing decisions regarding such benefits, where considered appropriate by GreatWest Life.



Any period after you fail to participate or cooperate in an approved rehabilitation plan.



Any period after you fail to participate or cooperate in a recommended medical coordination program.



Any period after you fail to participate or cooperate in a required medical or vocational assessment.



The scheduled duration of a leave of absence. This does not apply to any portion of a period of maternity leave during which you are disabled due to pregnancy.



Any period in which you are outside Canada. This exclusion does not apply during the first 30 days of an absence, or if Great-West Life pre-authorized the absence prior to your departure.



Any period of incarceration, confinement, or imprisonment by authority of law.



Disability arising from war, insurrection, or voluntary participation in a riot.

Conversion Privilege If you change jobs, you may apply for an individual LTD conversion policy without medical evidence. You must apply and pay the first premium no later than 31 days after you start your new job, and you must start your new job no later than 6 months after you leave your present one. Your application must be acceptable according to Great-West Life’s underwriting rules in effect for individual disability insurance conversion policies at the time of application. See your employer for details. How to Make a Claim Before the end of the short term disability benefit period, Great-West Life will ask your employer to provide information to begin processing your LTD claim. All information must be submitted within 3 months of the request.

48

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 for this information. The plan covers customary charges for the following services and supplies. All covered services and supplies must represent reasonable treatment. Treatment is considered reasonable if it is accepted by the Canadian medical profession, it is proven to be effective, and it is of a form, intensity, frequency and duration essential to diagnosis or management of the disease or injury. You are covered for only the Healthcare benefits that apply to the option that you choose as shown in the Benefit Summary. Covered Expenses 

Ambulance transportation to the nearest centre where adequate treatment is available



Depending on the option you choose, semi-private room or private room and board in a hospital or the government authorized co-payment for accommodation in a nursing home is covered when provided in Canada and the treatment received is acute, convalescent or palliative care, up to the maximum as shown in the Benefit Summary. -

Acute care is active intervention required to diagnose or manage a condition that would otherwise deteriorate.

-

Convalescent care is active treatment or rehabilitation for a condition that will significantly improve as a result of the care and follows a 3-day confinement for acute care.

-

Palliative care is treatment for the relief of pain in the final stages of a terminal condition.

Depending on the option you choose, semi-private room or private room and board in an out-ofprovince hospital is covered when the treatment received is acute, convalescent or palliative care. For out-of-province accommodation, any difference between the hospital's standard ward rate and the government authorized allowance in your home province is also covered. The plan also covers the hospital facility fee related to dental surgery and any out-of-province hospital out-patient charges not covered by the government health plan in your home province. 

Residences established primarily for senior citizens or which provide personal rather than medical care are not covered.



Home nursing services of a registered nurse, a registered practical nurse if you are a resident of Ontario or a licensed practical nurse if you are a resident of any other province, when services are provided in Canada. No benefits are paid for services provided by a member of your family or for services which do not require the specific skills of a registered or practical nurse You should apply for a pre-care assessment before home nursing begins



Chronic care, provided in a hospital, nursing home or for home nursing care in Canada, for a condition where improvement or deterioration is unlikely within the next 12 months

49



Drugs and drug supplies described below when prescribed by a person entitled by law to prescribe them, dispensed by a person entitled by law to dispense them, and provided in Canada. Benefits for drugs and drug supplies provided outside Canada are payable only as provided under the out-ofcountry emergency care provision. -

Drugs which require a written prescription according to the Food and Drugs Act, Canada or provincial legislation in effect where the drug is dispensed, including contraceptive drugs and products containing a contraceptive drug

-

Injectable drugs including vitamins, insulins and allergy extracts. Syringes for self-administered injections are also covered

-

Disposable needles for use with non-disposable insulin injection devices, lancets and test strips

-

Extemporaneous preparations or compounds if one of the ingredients is a covered drug

-

Certain other drugs that do not require a prescription by law may be covered. If you have any questions, contact your plan administrator before incurring the expense.

The plan will also pay for preventative immunization vaccines and toxoids. For drugs eligible under a provincial drug plan, coverage is limited to the deductible amount and coinsurance you are required to pay under that plan. 

Rental or, at the plan’s discretion, purchase of certain medical supplies, appliances and prosthetic devices prescribed by a physician



Custom-made foot orthotics and custom-fitted orthopedic shoes, including modifications to orthopedic footwear, when prescribed by a physician



Hearing aids, including batteries, tubing and ear molds provided at the time of purchase, when prescribed by a physician



Diabetic supplies prescribed by a physician: Novolin-pens or similar insulin injection devices using a needle, blood-letting devices including platforms but not lancets. Lancets are covered under prescription drugs



Blood-glucose monitoring machines prescribed by a physician



External insulin infusion pumps prescribed by a physician



Diagnostic x-rays and lab tests, when coverage is not available under your provincial government plan



Treatment of injury to sound natural teeth. Treatment must start within 60 days after the accident unless delayed by a medical condition A sound tooth is any tooth that did not require restorative treatment immediately before the accident. A natural tooth is any tooth that has not been artificially replaced No benefits are paid for: -

accidental damage to dentures

-

dental treatment completed more than 12 months after the accident

-

orthodontic diagnostic services or treatment

50



Out-of-hospital services of a qualified acupuncturist



Out-of-hospital treatment of muscle and bone disorders, including diagnostic x-rays, by a licensed chiropractor



Out-of-hospital treatment of nutritional disorders by a registered dietician



Out-of-hospital services of a qualified massage therapist



Out-of-hospital services of a licensed naturopath



Out-of-hospital services of a licensed osteopath, including diagnostic x-rays



Out-of-hospital treatment of movement disorders by a licensed physiotherapist



Out-of-hospital treatment of foot disorders, including diagnostic x-rays, by a licensed podiatrist or a qualified chiropodist



Out-of-hospital treatment by a registered psychologist or qualified social worker



Out-of-hospital treatment of speech impairments by a qualified speech therapist

Visioncare 

Eye examinations, including refractions, when they are performed by a licensed ophthalmologist or optometrist, and coverage is not available under your provincial government plan



Glasses, prescription sunglasses and contact lenses required to correct vision when provided by a licensed ophthalmologist, optometrist or optician



Laser eye surgery required to correct vision when performed by a licensed ophthalmologist

For information on available discounts on eyewear and vision care services, refer to the Preferred Vision Services section of this booklet following the Healthcare benefit. Global Medical Assistance Program This program provides medical assistance through a worldwide communications network which operates 24 hours a day. The network locates medical services and obtains Great-West Life's approval of covered services, when required as a result of a medical emergency arising while you or your dependent is travelling for vacation, business or education. Coverage for travel within Canada is limited to emergencies arising more than 500 kilometres from home. You must be covered by the government health plan in your home province to be eligible for global medical assistance benefits. The following services are covered, subject to Great-West Life's prior approval: 

On-site hospital payment when required for admission, to a maximum of $1,000



If suitable local care is not available, medical evacuation to the nearest suitable hospital while travelling in Canada. If travel is outside Canada, transportation will be provided to a hospital in Canada or to the nearest hospital outside Canada equipped to provide treatment When services are covered under this provision, they are not covered under other provisions described in this booklet



Transportation and lodging for one family member joining a patient hospitalized for more than 7 days while travelling alone. Benefits will be paid for moderate quality lodgings up to $1,500 and for a round trip economy class ticket

51



If you or a dependent is hospitalized while travelling with a companion, extra costs for moderate quality lodgings for the companion when the return trip is delayed due to your or your dependent’s medical condition, to a maximum of $1,500



The cost of comparable return transportation home for you or a dependent and one travelling companion if prearranged, prepaid return transportation is missed because you or your dependent is hospitalized. Coverage is provided only when the return fare is not refundable. A rental vehicle is not considered prearranged, prepaid return transportation



In case of death, preparation and transportation of the deceased home



Return transportation home for minor children travelling with you or a dependent who are left unaccompanied because of your or your dependent’s hospitalization or death. Return or round trip transportation for an escort for the children is also covered when considered necessary



Costs of returning your or your dependent's vehicle home or to the nearest rental agency when illness or injury prevents you or your dependent from driving, to a maximum of $1,000. Benefits will not be paid for vehicle return if transportation reimbursement benefits are paid for the cost of comparable return transportation home

Benefits payable for moderate quality accommodation include telephone expenses as well as taxicab and car rental charges. Meal expenses are not covered. Out-Of-Country Emergency Care The plan covers medical expenses incurred as a result of a medical emergency arising while you or your dependent is outside Canada for vacation, business or education purposes. To qualify for benefits, you must be covered by the government health plan in your home province. A medical emergency is a sudden, unexpected injury or an acute episode of disease. 

The following services and supplies are covered when related to the initial medical treatment: -

treatment by a physician diagnostic x-ray and laboratory services hospital accommodation in a standard or semi-private ward or intensive care unit, if the confinement begins while you or your dependent is covered medical supplies provided during a covered hospital confinement paramedical services provided during a covered hospital confinement hospital out-patient services and supplies medical supplies provided out-of-hospital if they would have been covered in Canada drugs out-of-hospital services of a professional nurse ambulance services by a licensed ambulance company to the nearest centre where essential treatment is available dental accident treatment if it would have been covered in Canada

If your medical condition permits you to return to Canada, benefits will be limited to the amount payable under this plan for continued treatment outside Canada or the amount payable under this plan for comparable treatment in Canada, plus return transportation, whichever is less. Other Services and Supplies Services or supplies that represent reasonable treatment but are not otherwise covered under this plan may be covered by the plan on such terms as the plan administrator determines.

52

Limitations A claim for a service or supply that was purchased from a provider that is not approved by the plan administrator may be declined. The covered expense for a service or supply may be limited to that of a lower cost alternative service or supply that represents reasonable treatment. Except to the extent otherwise required by law, no benefits are paid for: 

Expenses private benefit plans are not permitted to cover by law



Services or supplies for which a charge is made only because you have coverage



The portion of the expense for services or supplies that is payable by the government health plan in your home province, whether or not you are actually covered under the government health plan



Any portion of services or supplies which you are entitled to receive, or for which you are entitled to a benefit or reimbursement, by law or under a plan that is legislated, funded, or administered in whole or in part by a government (“government plan”), without regard to whether coverage would have otherwise been available under this plan In this limitation, government plan does not include a group plan for government employees



Services or supplies that do not represent reasonable treatment



Services or supplies associated with: -

treatment performed only for cosmetic purposes

-

recreation or sports rather than with other daily living activities

-

the diagnosis or treatment of infertility, other than drugs

-

contraception, other than contraceptive drugs and products containing a contraceptive drug



Services or supplies not listed as covered expenses unless determined by the plan administrator to be covered expenses



Extra medical supplies that are spares or alternates



Services or supplies received outside Canada except as listed under Out-of-Country Emergency Care and Global Medical Assistance



Services or supplies received out-of-province in Canada unless you are covered by the government health plan in your home province and benefits would have been paid under this plan for the same services or supplies if they had been received in your home province This limitation does not apply to Global Medical Assistance



Expenses arising from war, insurrection, or voluntary participation in a riot



Podiatric treatments for which a portion of the cost is payable under the Ontario Health Insurance Plan (OHIP). Benefits for these services are payable only after the maximum annual OHIP benefit has been paid



Visioncare services and supplies required by an employer as a condition of employment



Prescription safety glasses 53

In addition under the prescription drug coverage, no benefits are paid for: 

Atomizers, appliances, prosthetic devices, colostomy supplies, first aid supplies, diagnostic supplies or testing equipment



Non-disposable insulin delivery devices or spring loaded devices used to hold blood letting devices



Delivery or extension devices for inhaled medications



Oral vitamins, minerals, dietary supplements, homeopathic preparations, infant formulas or injectable total parenteral nutrition solutions



Diaphragms, condoms, contraceptive jellies, foams, sponges, suppositories, contraceptive implants or appliances



Any drug that does not have a drug identification number as defined by the Food and Drugs Act, Canada



Any single purchase of drugs which would not reasonably be used within 34 days. In the case of certain maintenance drugs, a 100-day supply will be covered



Drugs administered during treatment in an emergency room of a hospital, or as an in-patient in a hospital



Non-injectable allergy extracts



Drugs that are considered cosmetic, such as topical minoxidil or sunscreens, whether or not prescribed for a medical reason



Drugs used to treat erectile dysfunction



Drugs used to treat obesity



Drugs or drug supplies not listed in the Liste de médicaments published by the Régie de l'assurancemaladie du Québec in effect on the date of purchase or which are received out-of-province, when prescribed for a dependent child who is a student over age 24 and you are a resident of Quebec

Note: If you are age 65 or older and reside in Quebec, you cease to be covered under this plan for basic prescription drug coverage and are covered under the basic plan provided by the Régie de l’assurancemaladie du Québec, unless you elect to be covered under this plan as set out below. A one-time election may be made to be covered under this plan. You must make this election and communicate it to your employer by the end of the 60-day period immediately following:  

the date you reach age 65; or the date you become a resident of Quebec, within the meaning of the Health Insurance Act, Quebec, if you are age 65 or over.

While your election to be covered under this plan is in effect, you will be deemed not to be entitled to the basic plan provided by the Régie de l’assurance-maladie du Québec. “Basic prescription drug coverage” means the portion of drug expenses that is reimbursed by the Régie de l’assurance-maladie du Québec.

54

Prior Authorization In order to determine whether coverage is provided for certain services or supplies, the plan administrator maintains a limited list of services and supplies that require prior authorization. These services and supplies, including a listing of the prior authorization drugs, can be found on the Great-West Life website as follows: http://greatwestlife.com/001/Client_Services/Group_Plan_Members/Forms/Prior_Authorizations_Forms/in dex.htm Prior authorization is intended to help ensure that a service or supply represents a reasonable treatment. If the use of a lower cost alternative service or supply represents reasonable treatment, you or your dependent may be required to provide medical evidence to the plan administrator why the lower cost alternative service or supply cannot be used before coverage may be provided for the service or supply. Health Case Management If you or one of your dependents apply for prior authorization of certain supplies or services, the plan administrator may contact you to participate in health case management. Health case management is a program recommended or approved by the plan administrator that may include but is not limited to:    

consultation with you or your dependent and the attending physician to gain understanding of the treatment plan recommended by the attending physician; comparison, with the attending physician, of the recommended treatment plan with alternatives, if any, that represent reasonable treatment; identification to the attending physician of opportunities for education and support; and monitoring your or your dependent’s adherence to the treatment plan recommended by the person’s attending physician.

In determining whether to implement health case management, the plan administrator may assess such factors as the service or supply, the medical condition, and the existence of generally accepted medical guidelines for objectively measuring medical effectiveness of the treatment plan recommended by the attending physician. Health Case Management Limitation The payment of benefits for a service or supply may be limited, on such terms as the plan administrator determines, where:  

the plan administrator has implemented health case management and you or your dependent do not participate or cooperate; or you or your dependent have not adhered to the treatment plan recommended by his attending physician with respect to the use of the service or supply.

Designated Provider Limitation For a service or supply to which prior authorization applies or where the plan administrator has recommended or approved health case management, the plan administrator can require that a service or supply be purchased from or administered by a provider designated by the plan administrator, and:  

the covered expense for a service or supply that was not purchased from or administered by a provider designated by the plan administrator may be limited to the cost of the service or supply had it been purchased from or administered by the provider designated by the plan administrator; or a claim for a service or supply that was not purchased from or administered by a provider designated by the plan administrator may be declined.

55

Patient Assistance Program A patient assistance program may provide financial, educational or other assistance to you or your dependents with respect to certain services or supplies. If you or your dependents are eligible for a patient assistance program, you or your dependent may be required to apply to and participate in such a program. Where financial assistance is available from a patient assistance program the plan administrator requires participation in, the covered expense for a service or supply may be reduced by the amount of financial assistance you or your dependent is entitled to receive for that service or supply. How to Make a Claim 

Out-of-country claims (other than those for Global Medical Assistance expenses) should be submitted to Great-West Life as soon as possible after the expense is incurred. It is very important that you send your claims to the Great-West Life Out-of-Country Claims Department immediately as your Provincial or Territorial Medical Plan has very strict time limitations. Access GroupNet for Plan Members to obtain a personalized claim form. You must also obtain the Government Assignment form, and residents of British Columbia, Quebec and Newfoundland & Labrador must also obtain the Special Government Claim form. The Great-West Life Out-of-Country Claims Department will forward the appropriate government forms to your attention when required. You should complete all applicable forms, making sure all required information is included. Attach all original receipts and forward the claim to the Great-West Life Out-of-Country Claims Department. Be sure to keep a copy for your own records. The plan will pay all eligible claims including your Provincial or Territorial Medical Plan portion. Your Provincial or Territorial Medical Plan will then reimburse the plan for the government’s share of the expenses. Out-of-country claims must be submitted within a certain time period that varies by province or territory. For the claims submission period applicable in your province or territory or for any other questions or for assistance in completing any of the forms, please contact Great-West Life’s Out-ofCountry Claims Department at 1-800-957-9777.



Claims for expenses incurred in Canada, for paramedical services and visioncare, may be submitted online. To use this online service you will need to be registered for GroupNet for Plan Members and signed up for direct deposit of claim payments with eDetails. For online claim submissions, your Explanation of Benefits will only be available online. Online claims must be submitted to Great-West Life as soon as possible, but no later than 6 months after you incur the expense. You must retain your receipt for 12 months from the date you submit your claim to Great-West Life as a record of the transaction, and you must submit it to Great-West Life on request.

56



For all other Healthcare claims, access GroupNet for Plan Members to obtain a personalized claim form. Complete this form making sure it shows all required information. Attach your receipts to the claim form and return it to the Great-West Life Benefit Payment Office as soon as possible, but no later than 15 months 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, an Assure Claims check will be done. Assure Claims is a series of seven checks that are electronically done on your drug claim history for increased safety and compliance monitoring. This has been designed to improve the health and quality of life for you and your dependents. Checks done include drug 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 may refuse to dispense the prescribed drug. When your coverage ends, return your direct pay drug identification card to your employer.

57

PREFERRED VISION SERVICES (PVS) Preferred Vision Services (PVS) is a service provided by Great-West Life to its customers through PVS which is a preferred provider network company. PVS entitles you to a discount on a wide selection of quality eyewear and lens extras (scratch guarding, tints, etc.) when you purchase these items from a PVS network optician or optometrist. A discount on laser eye surgery can be obtained through an organization that is part of the PVS network. PVS also entitles you to a discount on hearing aids (batteries, tubing, ear molds, etc.) when you purchase these items from a PVS network provider. You are eligible to receive the PVS discount through the network whether or not you are enrolled for the healthcare coverage described in this booklet. You can use the PVS network as often as you wish for yourself and your dependents. Using PVS: 

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, an eye examination, a hearing assessment or a hearing test, if needed



Present your group benefit plan identification card, to identify your preferred status as a PVS member through Great-West Life, at the time the eyewear or the hearing aid is purchased, or at the initial consultation for laser eye surgery



Pay the reduced PVS price. If you have vision care coverage or hearing aids coverage for the product or service, obtain a receipt and submit it with a claim form to your insurance carrier in the usual manner.

58

DENTALCARE A deductible may be applied before you are reimbursed. 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 for this information. The plan covers customary charges to the extent they do not exceed the dental fee guide level shown in the Benefit Summary. Denturist fee guides are applicable when services are provided by a denturist. Dental hygienist fee guides are applicable when services are provided by a dental hygienist practising independently. All covered services and supplies must represent reasonable treatment. Treatment is considered reasonable if it is recognized by the Canadian Dental Association, it is proven to be effective, and it is of a form, frequency, and duration essential to the management of the person's dental health. To be considered reasonable, treatment must also be performed by a dentist or under a dentist’s supervision, performed by a dental hygienist entitled by law to practise independently, or performed by a denturist. You are covered for only the dentalcare benefits that apply to the option that you choose as shown in the Benefit Summary. Treatment Plan 

Before incurring any large dental expenses, or beginning any orthodontic treatment, ask your dental service provider to complete a treatment plan and submit it to the plan. The benefits payable for the proposed treatment will be calculated, so you will know in advance the approximate portion of the cost you will have to pay.

Basic Coverage The following expenses will be covered: 

Diagnostic services including: -

complete oral examination -

-

If you choose Option 2, 3 or 4, once every 36 months

limited oral examinations -

If you choose Option 2 or 3, once every 9 months (once every 6 months for dependent children under age 19) If you choose Option 4, once every 6 months

except that only one limited oral examination is covered in any 12-month period that a complete oral examination is also performed -

limited periodontal examinations -

-

If you choose Option 2 or 3, once every 9 months (once every 6 months for dependent children under age 19) If you choose Option 4, once every 6 months

complete series of x-rays or panoramic -

If you choose Option 2 or 3, once every 36 months If you choose Option 4, once every 24 months

59

-

intra-oral x-rays (excluding bitewing x-rays) -

If you choose Option 2 or 3, to a maximum of 15 films every 36 months If you choose Option 4, to a maximum of 15 films every 24 months

services provided in the same 12 months as a complete series are not covered -

bitewing x-rays -



If you choose Option 2 or 3, once every 9 months (once every 6 months for dependent children under age 19) If you choose Option 4, once every 6 months

Preventive services including: -

polishing -

-

topical application of fluoride -

-

If you choose Option 2 or 3, one time unit every 9 months (1 time unit every 6 months for dependent children under age 19) If you choose Option 4, one time unit every 6 months

If you choose Option 2 or 3, once every 9 months (once every 6 months for dependent children under age 19) If you choose Option 4, once every 6 months

scaling, limited to a maximum combined with periodontal root planing of 8 time units a year A time unit is considered to be a 15-minute interval or any portion of a 15-minute interval





-

pit and fissure sealants on bicuspids and permanent molars every 60 months for a dependent under age 19

-

space maintainers including appliances for the control of harmful habits

-

finishing restorations

-

interproximal disking

-

recontouring of teeth

Minor restorative services including: -

caries, trauma, and pain control

-

amalgam and tooth-coloured fillings. Replacement fillings are covered only if the existing filling is at least 2 years old or the existing filling was not covered under this plan

-

retentive pins and prefabricated posts for fillings

-

prefabricated crowns for primary teeth

Endodontics. Root canal therapy for permanent teeth will be limited to one course of treatment per tooth every 24 months.

60



Periodontal services including: -

root planing, limited to a maximum combined with preventive scaling of 8 time units a year

-

occlusal adjustment and equilibration, limited to a combined maximum of 4 time units every 12 months A time unit is considered to be a 15-minute interval or any portion of a 15-minute interval



-

periodontal appliances, including adjustments, relines and repairs, once every 36 months

-

temporomandibular joint periodontal appliances, once every 36 months. Relines are limited to once every 12 months.

Denture maintenance, including: -

denture relines for dentures at least 6 months old, once every 24 months

-

denture rebases for dentures at least 2 years old, once every 24 months

-

resilient liner in relined or rebased dentures after the 3-month post-insertion care period has elapsed, once every 36 months

-

denture repairs and additions and resetting of denture teeth after the 3-month post-insertion care period has elapsed, once every 24 months

-

denture adjustments after the 3-month post-insertion care period has elapsed, once every 24 months



Oral surgery



Adjunctive services

Major Coverage 

Crowns. Coverage for crowns on molars is limited to the cost of metal crowns. Coverage for complicated crowns is limited to the cost of standard crowns



Onlays and inlays. Coverage for tooth-coloured onlays or inlays on molars is limited to the cost of metal



Tooth coloured veneers



Gold foil restorations Replacement crowns, onlays, inlays, gold foil restorations and tooth coloured veneers are covered when the existing restoration is at least 5 years old and cannot be made serviceable



Posts and cores related to covered crowns once per tooth every 60 months

61



Implant retained appliances, standard complete dentures, standard cast or acrylic partial dentures or complete overdentures or bridgework when standard complete or partial dentures are not viable treatment options. Coverage for tooth-coloured retainers and pontics on molars is limited to the cost of metal retainers and pontics. Replacement appliances are covered only when: -

the existing appliance is a covered temporary appliance

-

the existing appliance is at least 5 years old and cannot be made serviceable. If the existing appliance is less than 5 years old, a replacement will still be covered if the existing appliance becomes unserviceable as a result of the placement of an initial opposing appliance or the extraction of additional teeth. If additional teeth are extracted but the existing appliance can be made serviceable, coverage is limited to the replacement of the additional teeth



Denture-related surgical services for remodelling and recontouring oral tissues



Denture and bridgework maintenance following the 3-month post-insertion period including: -

denture remakes, once every 36 months

-

tissue conditioning

-

bridgework repairs

-

removal and recementation of bridgework

-

removal and reinsertion of implant-retained appliances for repair

Orthodontic Coverage 

Orthodontics are covered for persons age 6 or over when treatment starts

Limitations No benefits are paid for: 

Duplicate x-rays, custom fluoride appliances, any oral hygiene instruction and nutritional counselling



The following endodontic services - root canal therapy for primary teeth, isolation of teeth, enlargement of pulp chambers and endosseous intra coronal implants



The following periodontal services - desensitization, topical application of antimicrobial agents, subgingival periodontal irrigation, charges for post surgical treatment and periodontal re-evaluations



The following oral surgery services - implantology, surgical movement of teeth, services performed to remodel or recontour oral tissues (other than minor alveoloplasty, gingivoplasty and stomatoplasty) and alveoloplasty or gingivoplasty performed in conjunction with extractions. Services for implantology, remodelling and recontouring oral tissues will be covered under Major Coverage



Hypnosis or acupuncture



Recontouring existing crowns and staining porcelain



Crowns, onlays, inlays, gold foil restorations or tooth coloured veneers if the tooth could have been restored using other procedures. If crowns, onlays, inlays, gold foil restorations or tooth coloured veneers are provided, benefits will be based on coverage for fillings



Expenses covered under another group plan's extension of benefits provision 62



Services or supplies covered under Healthcare. If the amount payable would be greater under this Dentalcare benefit, then benefits will be paid under Dentalcare and not Healthcare



Expenses private benefit plans are not permitted to cover by law



Services and supplies you are entitled to without charge by law or for which a charge is made only because you have coverage



Services or supplies that do not represent reasonable treatment



Treatment performed for cosmetic purposes only



Congenital defects or developmental malformations in people 19 years of age or over, except orthodontics



Temporomandibular joint disorders, vertical dimension correction or myofacial pain



Expenses arising from war, insurrection, or voluntary participation in a riot

How to Make a Claim 

Claims for expenses incurred in Canada may be submitted online. Access GroupNet for Plan Members to obtain a personalized claim form and have your dental service provider complete the form. The completed claim form will contain the information necessary to enter the claim online. To use the online service you will need to be registered for GroupNet for Plan Members and signed up for direct deposit of claim payments with eDetails. For online claim submissions, your Explanation of Benefits will only be available online. Online claims must be submitted to Great-West Life as soon as possible, but no later than 6 months after the dental treatment. You must retain your receipt for 12 months from the date you submit your claim to Great-West Life as a record of the transaction, and you must submit it to Great-West Life on request.



For all other Dentalcare claims, access GroupNet for Plan Members to obtain a personalized claim form or obtain form M445D from your employer. Have your dental service provider complete the form and return it to the Great-West Life Benefit Payment Office as soon as possible, but no later than 15 months after the dental treatment.

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HEALTH CARE SPENDING ACCOUNT BENEFITS (HCSA) A Health Care Spending Account (HCSA) is like a bank account through which you may be reimbursed for health and dental expenses up to a predetermined annual credit amount. Your employer will establish the credits for your account prior to each plan year. These credits may be used to cover expenses not covered by group health plans or to top-up expenses not fully covered by group health plans, including deductibles and co-payment amounts. Also, since annual credits are in the form of before tax dollars, the HCSA is a tax-effective way of paying for your health-related expenses. Eligibility You and your dependents are eligible for HCSA credits through your employer if you are covered for basic health benefits under your or your spouse’s group health plan. In addition to the dependents eligible for coverage under your basic health plan, HCSA benefits are extended to any other person for whom you are entitled to claim a medical expense tax credit under the Income Tax Act (Canada). You may apply for HCSA benefits within 31 days of the date you first become eligible or at your plan’s annual enrolment date. Termination Your HCSA coverage terminates when you elect to discontinue coverage (at any plan enrolment date) or when your employer discontinues the plan. Your dependents’ HCSA coverage terminates when your coverage terminates or when they no longer qualify, whichever is earlier. Covered Expenses The Income Tax Act (Canada) governs the types of expenses that can be reimbursed under the HCSA. Coverage is provided for those expenses that qualify for a medical expense tax credit. For a complete list of covered expenses, contact your Canada Revenue Agency District Office and ask for Income Tax Interpretation Bulletin IT-519R. Benefits will be paid for 100% of covered expenses that are incurred while you and your dependents are covered, up to a maximum annual payment equal to the credits in your HCSA. Dental expenses, other than orthodontic expenses, are considered to be incurred when treatment is completed. Orthodontic expenses are considered to be incurred on a periodic basis throughout the course of treatment. All other expenses are considered to be incurred when they are received. Credits are available for covered expenses incurred in a plan year. Any remaining credits will be carried forward for covered expenses incurred in the following plan year. If they are not used for expenses incurred in that plan year, they are automatically forfeited. The maximum annual payment available under your account will consist of the amount of the credit directed to it for the plan year plus any unused amount from the previous year. Limitations No benefits are paid for: 

Expenses that private benefit plans are not permitted to cover by law



Services or supplies you are entitled to without charge by law or for which a charge is made only because you have coverage under a private benefit plan



Any portion of the expense for services or supplies for which benefits are payable under your basic health plan, another group plan or a government plan

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How to Make a Claim The HCSA will reimburse you for the balance of the expense remaining after all other insurance plans have paid out. You must first submit all claims to any government and private insurance plans under which you or any eligible dependents are covered. Once you have received reimbursement for the expense from all other plans, you may submit a claim against the HCSA. Claims against the HCSA may be submitted on a claim form. Claims for prescription drugs, paramedical services, visioncare and dentalcare expenses incurred in Canada may also be submitted online. 

To submit claims using a claim form, use form M5429A or form M445D (HCSA) for dental claims, and form M5431A or form M635D (HCSA) for all other claims



To submit claims online, you will need to be registered for GroupNet for Plan Members and signed up for direct deposit of claim payments with eDetails. For online claim submissions, your Explanation of Benefits will only be available online You must retain your receipt for 12 months from the date you submit your claim to Great-West Life as a record of the transaction, and you must submit it to Great-West Life on request.

Claims against the HCSA must be submitted to the Great-West Life Benefit Payment Office before the earliest of the following: 

90 days after the end of the plan year in which the expenses are incurred



the date the HCSA contract terminates, if it terminates because your employer fails to make a required payment



31 days after the date the HCSA contract terminates, if it terminates for any other reason

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WELLNESS ACCOUNT A Wellness Account is like a bank account through which you may be reimbursed for the covered expenses listed below, up to a predetermined annual credit amount. Your employer will establish the credits for your account prior to each plan year. Eligibility You and your dependents are eligible for Wellness Account credits through your employer if you are covered for basic healthcare benefits under your or your spouse’s group health plan. Termination Your coverage terminates on the earliest of the following:    

the date your policy terminates; the date your employment ends; the January 1 coinciding with or next following the date you elect to discontinue your participation in the wellness account; or the date your employer advises Great-West Life in writing that your coverage under this policy has terminated.

Your dependents’ coverage terminates when your coverage terminates or when your dependent ceases to qualify as an eligible dependent, whichever comes first. Covered Expenses Benefits will be paid for 100% of covered expenses that are incurred while you and your dependents are covered, up to a maximum annual payment equal to the credits in your Wellness Account. Fees for membership and fitness programs are considered to be incurred on a periodic basis throughout the period of participation. All other expenses are considered to be incurred when they are received. Credits are available for covered expenses incurred in a plan year. Any remaining credits will be carried forward for covered expenses incurred in the following plan year. If they are not used for expenses incurred in that plan year, they are automatically forfeited. The maximum annual payment available under your account will consist of the amount of the credit directed to it for the plan year plus any unused amount from the previous year. The following expenses are covered: 

Smoking cessation programs

  

Weight management program fees



Stress management programs



Nutritional counseling



Fitness centre memberships



Physical activity fees, e.g., gym drop-in fees and lift tickets



Sports league and sports team memberships



Instruction for physical activities and lessons, e.g., personal trainer and yoga classes

Natural health products

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Fitness equipment, e.g., treadmill and elliptical



Sports equipment, e.g., hockey sticks, skates and pads, bicycle helmet



Athletic footwear



Professional membership fees



Course, seminar, conference and class expenses, e.g., fees, books and texts

Limitations No benefits are paid for: 

Expenses that private benefit plans are not permitted to cover by law



Services or supplies you are entitled to without charge by law or for which a charge is made only because you have coverage under a private benefit plan



Any portion of the expense for services or supplies for which benefits are payable under your basic health plan, another group plan or a government plan



Food and weight loss or meal replacement supplements



Equipment purchase or rental



Clothing

How to Make a Claim The Wellness Account will reimburse you for the balance of the expense remaining after all other insurance plans have paid out. You must first submit all claims to any government and private insurance plans under which you or any eligible dependents are covered. Once you have received reimbursement for the expense from all other plans, you may submit a claim against the Wellness Account. Claims against the Wellness Account must be submitted on a claim form available from your employer. Claims against the Wellness Account must be submitted to the Great-West Life Benefit Payment Office before the earliest of the following: 

90 days after the end of the plan year in which the expenses are incurred



the date the Wellness Account contract terminates, if it terminates because your employer fails to make a required payment



31 days after the date the Wellness Account contract terminates, if it terminates for any other reason

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COORDINATION OF BENEFITS 

Benefits for you or a dependent will be directly reduced by any amount payable under a government plan. If you or a dependent are entitled to benefits for the same expenses under another group plan (or as a dependent under this plan) benefits will be co-ordinated so that the total reimbursement from all plans will not exceed the reasonable and customary expenses under this plan.



You and your spouse should first submit your own claims through your own group plan. Claims for dependent children should be submitted to the plan of the parent who has the earlier birth date in the calendar year (the year of birth is not considered). If you are separated or divorced, the plan which will pay benefits for your children will be determined in the following order: 1. 2. 3. 4.

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 for any amount which is not reimbursed by the first plan to any other plan that you or your dependents are covered under in the same order as above.

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DIAGNOSTIC AND TREATMENT SUPPORT SERVICES ® (BEST DOCTORS SERVICE) This service is designed to allow access to the expertise of specialists, resources, information and clinical guidance. You, your dependents and your and your dependent’s physician can access this service if the physician has made a diagnosis of a serious physical illness or condition for which there is objective evidence, or if the covered person or his or her physician suspects that the person has this illness or condition. This service is made up of a unique step-by-step process that may help address questions or concerns about a serious physical illness or condition. This may include confirming the diagnosis and suggesting the most effective treatment plan by drawing on a global database of up to 50,000 peer-ranked specialists. How it works 

Access diagnostic and treatment support services by calling 1-877-419-BEST (2378) toll-free.



The person accessing the service will be connected with a member advocate who will be dedicated to his or her case and will provide support through the process. The member advocate will take the necessary medical history and answer the person’s questions. Any information provided is not shared with either your employer or the administrator of your health plan.



Based on the information provided, the member advocate determines the optimal level of service required.



The member advocate may provide information, resources, guidance and advice individually tailored to meet the covered person’s health needs, and can help identify individual community supports and resources available.



If it is appropriate, the member advocate may arrange for an in-depth review of the covered person’s medical file to assist in confirming the diagnosis and help develop a treatment plan. This review may include collecting, deconstructing and reconstructing medical records, pathology retesting and analyzing test results. A written report outlining the conclusions and recommendations of the specialists will be forwarded to the person accessing the service. Generally, this process takes 6 to 8 weeks. Timeframes may vary depending on the complexity of the case and amount of medical records to collect.



If the covered person decides to seek treatment by a different physician, the member advocate can help identify a specialist qualified to meet his or her specific medical needs. Expenses incurred for travel and treatment are not covered by this service.



If the covered person decides to seek treatment outside Canada, the member advocate can arrange referrals and can help book accommodations. The member advocate can also assist in accessing hospital and physician discounts, arrange for the forwarding of medical information and monitor the treatment process. Expenses incurred for travel and treatment are not covered by this service.



The member advocate may identify a Best Doctors specialist suited to answer basic questions about health concerns and treatment options. Answers will be provided in a written report sent by email to the person accessing the service.

These services are not insured services. Great-West Life is not responsible for the provision of the services, their results, or any treatment received or requested in connection with the services.

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