Frequently Asked Questions

Adding New Employees

Is it possible to waive the Waiting Period?

Which benefits can be waived?

Late Applicants

Employee Changes/ Terminations

Continuation of Benefits during Maternity Leave

Coordination of Benefits

Taxation of Employee Benefits

 Adding New Employees

 We recommend that employees apply for coverage on the first day of employment.  If this is not possible, employees have up to 31 days after the expiry of the waiting period to enrol in the plan.

Steps to Add New Employees:

 Give the employee an Application for Group Coverage form that is to be completed in ink.  Have the employee complete all sections except the one marked “plan sponsor section”.  Ensure that the form is fully completed and legible, and signed and dated by the employee.

 Complete the plan sponsor section of the form.

 Add the employee to the plan using the online system or send to the insurer for processing.

Is it possible to waive the Waiting Period?

If an employee’s offer of employment includes immediate benefit coverage, you may waive the eligibility waiting period.  Written documentation, including the employee’s name and date of hire must be attached to the employee’s Application for Group Coverage form.

Which benefits can be waived?

Health and dental care benefits may be waived only if the employee and/or their eligible dependents are covered by a spousal plan. The employee must provide the plan name and number for the spouse’s coverage.  If the employee loses the duplicate coverage, he/she can add health and dental benefits under the plan within 31 days from the date the other coverage is terminated.

Late Applicants

What is a Late Applicant?

If an employee applies for coverage after the end of the 31-day grace period following the waiting period, she/he is considered a late applicant and will be required to provide a medical evidence of insurability to the insurer.

Complete the first part of both the Application for Group Coverage form and the Evidence of Insurability form for the employee who is applying as a late applicant.  Sign and date the section on the evidence form where the plan administrator’s signature is required

Give the employee the forms to complete the remaining sections:

Each form must be fully completed in ink and legible.

Each form must be signed and dated.

If the employee requires single coverage only, they should only complete the “employee” questions.  For family coverage, the employee should complete both the “employee” and the “spouse and children” questions.  Both the employee and the spouse must sign the Medical Questionnaire form to obtain family coverage.

The employee should keep a photocopy of the form and send the original to the insurer for approval.

The insurer will advise both the employee and the employer in writing of the decision to either approve or decline coverage.  If approved, the coverage will be effective on the date of the approval.

NOTE:  All employees applying as late applicants will have the dental care maximum restricted for the first twelve months of coverage as per the policy contract.

The same process would apply for current employees on the plan who are adding health and/or dental coverage beyond the 31 day window or who are adding dependents after the eligibility period.

Employee Changes/ Terminations

Employee Changes:

Change of name, beneficiary, province or residence or family status:  Employees must complete and sign the Group Coverage Change form within 31 days of the change. 

Salary changes should be reported to the insurer as soon as they occur as they affect the coverage levels for the life and disability benefits.

Terminations:

Benefits cease on the last day of employment or the last day of the statutory notice period when the termination of employment is initiated by the employer.

Severance:

Benefits should be extended in accordance with Employment Standards requirements.  For any extension of coverage beyond the ESA, you must obtain the insurer’s approval.

Continuation of Benefits during Maternity Leave

It is always our recommendation that all benefits continue for an employee who is on maternity leave.  The same premium contribution split applies to an employee on maternity leave and therefore companies are required to work out with the employee how they will continue to collect the necessary premiums (usually done with a series of post-dated cheques).

According to the Employment Standards Act, the employee going on mat leave does have some options available to them (understanding that if the employer pays 100% of any benefit, that benefit must be continued for the duration of the leave).  These options may differ according to the province of residence of the employee.

Attached are drafts of forms you may use internally to help track and document an employee’s decision with regards to the extension of benefits during the maternity leave.

Click here to download the Continuation of Benefits during Maternity Leave form for Ontario Residents.

Click here to download the Continuation of Benefits during Maternity Leave form for Quebec Residents.

Coordination of Benefits

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 both an employee and dependent under this plan or as a dependent of both parents under this plan, benefits will be coordinated so that the total benefits from all plans will not exceed expenses. 

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. The plan of the parent with custody of the child
  2. The plan of the spouse of the parent with custody of the child
  3. The plan of the parent without custody of the child
  4. The plan of the spouse of the parent without custody of the child

 You may submit a claim to the plan of the other spouse for any amount which is not paid by the first plan.

Taxation of Employee Benefits

Taxation of Employee Benefits

Benefits

Taxable?

Taxable Benefit?

Employee Life Insurance Yes (See Appendix 1) No
Dependent Life Yes (See Appendix 1) No
AD&D Yes No
Critical Illness No* No
Short-term Disability No Yes or No (See Appendix 2)
Long-Term Disability No Yes or No (See Appendix 2)
Healthcare No* No
Dentalcare No* No
Visioncare No* No

 

* Quebec Residents

All premiums for those benefits paid by the employer are taxable, and should be reported in their provincial tax return.

Appendix 1

When setting up the plan, the employer has two options:

  1. Pay the employee life and dependent life insurance premium on behalf of the employee, and T4 the employee for the total amount at year end, OR
  2. Deduct the monthly life insurance premium at source (employee's pay cheque)

Appendix 2

Short-Term and Long-Term Disability- these benefits can either be taxable or non-taxable, depending on who pays the premium. In order fo the benefit to be considered non-taxable at time of claim, the employee must pay 100% of the premium. If the employer contributed any portion of the STD or LTD premiums, the beneift will be considered taxable.