Employees in the following Benefit Class’s are eligible to apply for Short-term disability benefits:
Benefit Class 1: Permanent Full-time and Part-time employees
Benefit Class 2: 1-year contract employees
Benefit Class 4: Priests
There is no termination age for this benefit providing that you continue to be: an insurable employee, actively at work, and meet the definition of disability.
Definition of Disability
This is a wage-loss benefit that is available when eligible employees become disabled due to non-work related injuries, while insured and suffer a loss of earnings as a result. Disability means being unable to perform the essential duties of the employee’s occupation for your or any other employer due to illness or injury. Medical evidence must support this accordingly. The availability of work is not considered when assessing disability.
How is the STD benefit calculated?
The benefit is payable at 66.67% of weekly earnings. STD payments are paid weekly in arrears by the disability office. Weekly earnings are your gross annual earnings divided by the number of weeks that you actually work and are paid for. Examples: 43 weeks (if the employee is a Teacher and/or Teacher Aide), 48 weeks (if a Principal) and 52 weeks for a 12 month employee.
STD which extends into summer periods (July 1st to August 31st) will stop the last day of June for workers on a 10-month work schedule, and resume in September if the disability continues. Workers on a 12-month schedule will have no interruption of payments. Sample benefit calculation (employee is a 10 month employee, earning $45,000/year):
How long is the STD benefit available for? For an approved STD claim, benefits are payable for a 15 weeks period. During this time, the disability office reserves the right to request updated medical information to support your claim. In such cases, the disability claimant is expected to keep in touch with their doctor to be sure such reports are sent promptly and do not delay the payment.
This is a non-taxable benefit; therefore, a T4A will not be issued by the disability office for Income Tax purposes.
Satisfying the STD benefit waiting period
There is a 7 consecutive day waiting period from the last full day worked until the first day payable for disability. Statutory holidays are counted as part of the waiting period and are paid by your employer. It is presumed you will use “sick days” according to your contract to remain at full pay during this waiting period. • If you apply for disability, you CANNOT use banked sick days in excess of the 7 consecutive days waiting period – even if you have them accumulated. This is a contractual stipulation with Canada Life which must be adhered to.
If you have exhausted all of your sick days within the 7 consecutive days waiting period, then any days in excess of your sick days would result in time off, without pay.
The disability office must receive proof of claim within 90 days after the disability begins. Please refer to the Forms/Claim forms/Disability portion of our website to obtain the applicable Employee and Employer Statements.
Within the Employee Statement, there is the Physician Statement that must be completed. The doctor must specify your diagnosis/prognosis and any other applicable information to support your claim.
Continuation of benefits & premium responsibilities
When you are on disability, all of your benefits continue with the exception of the Pension benefit. As a STD claimant, you are still responsible to pay your share of the benefit premiums.
Long-term Disability (LTD)
Who is eligible for LTD benefits?
Employees in the following Benefit Class’s are eligible to apply for Long-term disability benefits, providing that you continue to be an insurable employee, actively at work and meet the definition of disability:
Benefit Class 1: Permanent Full-time and Part-time employees
Benefit Class 4: Priests This benefit terminates at age 65 as you are then eligible to receive Old Age Security (OAS) benefits.
Definition of Disability
LTD continues to be a wage-loss benefit that is available when eligible employees become disabled due to non-work related injuries, while insured and suffer a loss of earnings as a result. Medical evidence must support that during the first 24 months of payments, an employee will be considered disabled if unable to perform the essential duties of the employee’s occupation for your or any other employer due to illness or injury. The availability of work is not considered when assessing disability. After 24 months of payments, the employee will be considered disabled due to illness or injury if unable to perform the essential duties of any occupation for you or any other employer for which the employee is qualified or could reasonably become qualified based on education, training or experience. The availability of work is not considered when assessing disability.
How is the LTD benefit calculated?
The benefit is payable at 67% of pre-disability monthly earnings. This means that there is a lapse of time for a period of 1 month after the last weekly STD payment is issued to the first LTD monthly payment.
Your gross annual salary is divided by 12 (months) to calculate your monthly earnings. Please note that for Teachers and Principals, although you are paid over a 10-month period, your salary represents earnings incurred for a 12 month period.
Unlike STD, LTD payments continue throughout the summer (July 1st to August 31st) so there is no break in coverage. Sample benefit calculation (employee is a 10 month employee, earning $45,000/year):
This is also a non-taxable benefit; therefore, a T4A will not be issued by the disability office for Income Tax purposes.
Satisfying the LTD waiting period
The waiting period before the employee is eligible to receive LTD payments is 119 days. Please note that the 119 days actually represents the 16 week benefit period for STD. Therefore, once you have exhausted the STD benefit, you are eligible to apply for LTD benefits. Canada Pension Plan (CPP) Prolonged disability will prompt Canada Life to ask you to apply for Canada Pension Plan (CPP) disability benefits. If approved, your CPP income is deducted (direct offset) from your LTD benefit. Continuation of benefits & premium responsibilities
When approved for LTD benefits, benefit premiums for the Life, Optional Life (if you’ve applied and been approved), AD&D, STD and LTD benefits are no longer due. However, you are still responsible to pay your share of the benefit premiums for the balance of benefits not listed above (example: Extended Health, Dental and Critical Illness).
The waiver of applicable benefit premiums takes place the first of the month following approval of your LTD claim by the disability office.
Back-to-Work program in conjunction with STD and LTD Benefits
Short-term and Long-term disability insurance plays a valuable role in replacing income lost due to a disability. The best outcome, however, is the return of employees to productive employment. The goal of rehabilitation is to help make that return to employability happens as early and as smoothly as possible, for both the employee and the employer.
Employees engaged in approved rehabilitative employment will have their earnings from rehabilitative employment coordinated with their disability benefits. The employer has the obligation to only pay for the hours/days in which the employee is actually at work.
The disability office will be in contact with your local employer to obtain the following information for the period that the employee worked the previous week:
Specific days that the employee worked
Hours worked per day by the employee
Earnings paid by the local Employer
The disability office will then calculate the appropriate disability benefit payment for you (the employee), based on your earnings through the school/parish. This process will continue until you return to work, FULL-TIME.
It’s important to understand that income from all sources can’t exceed 100% of net pre-disability earnings while on a back-to-work program. This 100% clause does not apply if you are solely on disability.
It is your obligation as an employee to ensure that there is clear communication with your local employer at all times in regards to when you are expected to return to work!
Pension contribution Suspension
Disability, Approved Leave of Absence (LOA) & Maternity Leave
Our Group Policy Contract with the pension department clearly states the following regarding your employer-matched contributions to the Registered Pension Plan (RPP):
“…if a Member is unable to work because of disability (Short-term disability, Long-term disability or WCB), leave of absence or temporary lay-off, all contributions will cease during such periods.”
That being said, the Member may continue to make Voluntary (not matched by your employer) contributions to the Plan, while on disability.
For an expectant mother who goes on disability prior to her official Maternity Leave starting, the Pension contributions must be suspended as well. Only when the Maternity Leave officially starts can the employee request to have her RPP contributions reinstated.
An employee who is on a maternity/parental leave of absence may continue to participate in the CISVA, RPP. This is the only type of leave in which an employee may opt-out of the pension plan, and then resume contributions upon their return to work.
This information is reflected on Page 14 of the CISVA Registered Pension Plan booklet.
Please note that the waiver of Pension contributions takes place the first of the month following disability.
Vacation pay while on disability
An employee usually receives credit for service while on STD for the purposes of vacation and employment security. An employee usually does not receive credit for service while on LTD in regards to Vacation Policy. In general, any vacation outstanding in respect of the employee at the expiry of the STD leave is paid out to the employee at the time they are accepted onto LTD.
LTD Plans or any type of disability insurance plans are considered Income Maintenance Plans/Wage Loss Replacement Plans.
Please refer to your employment contract to confirm if reference is made to your entitlement of vacation time or vacation pay.
CANADA PENSION PLAN DISABILITY
CANADA PENSION PLAN DISABILITY
Canada Pension Plan Disability
The Canada Pension Plan (CPP) has been in effect since 1966. It is a national plan based on contributions from workers and employers in Canada. It is best known for its retirement pension, but also provides survivor, death and disability benefits to CPP contributors and their families.
The CPP Disability program is the largest long-term disability insurance program in Canada. Its primary role is to replace a portion of income for CPP contributors who cannot work because of a disability that is both severe and prolonged (as defined by the CPP legislation).
What is CPP disability
CPP Disability is part of the Canada Pension Plan (CPP). It is designed to provide financial assistance to CPP contributors who are unable to work because of a severe and prolonged disability.
Benefits are paid monthly to eligible applicants and their dependent children. The monthly disability benefit payment includes a fixed amount, plus an amount based on how much and for how long the contributor paid into the Plan. Payments are adjusted once a year in January if necessary, to reflect changes in the cost-of-living index.
How do I qualify for CPP disability benefits?
To qualify you must:
be under 65,
have earned a specified minimum amount and contributed to the CPP while working for a minimum number of years, and
have a severe and prolonged disability as defined by the CPP legislation.
NOTE: To remain eligible, you must continue to have a disability according to the CPP legislation.
The CPP defines “disability” as a condition, physical and/or mental, that is “severe and prolonged”. “Severe” means that you have a mental or physical disability that regularly stops you from doing any type of work (full-time, part-time or seasonal). “Prolonged” means your disability is likely to be long term, or is likely to result in your death.
When should I apply?
(YOU MUST APPLY FOR ALL CPP BENEFITS!) You should apply when you develop a serious long-term or terminal medical condition that prevents you from working regularly at your own or any other job.
The Disability kit includes: Application form, General Information and Guide, Questionnaire, Consent for Service Canada to Obtain Personal Information form, Medical Report and Child Rearing Provision form. Each form must be completed and forwarded to your nearest Service Canada office (see Returning the Form).
Application For Disability Benefits
Questionnaire for Disability Benefits
Consent for Service Canada to Obtain Personal Information / Physician’s copy
Consent for Service Canada to Obtain Personal Information / Service Canada’s copy
Child Rearing Provision form
Information sheet for the Child Rearing Provision
If you are unable to apply on your own, another person may apply for you.
What happens if I die before applying for CPP disability benefits?
CPP disability benefits cannot be paid unless an application is received before the contributor dies. Surviving spouses or common-law partners and dependent children may, however, apply for a CPP death benefit, survivor’s pension, and children’s benefit.
When will my disability benefits start?
Your benefits start four months after the date you become eligible. You may be entitled to benefits dating back a maximum of one year from the date you apply.
Can I volunteer, go to school or work while receiving CPP disability benefits?
Yes. You can:
volunteer or attend school, participate in training or upgrade your skills without affecting your CPP disability benefits;
work – you can earn up to a limited dollar amount without having to report these earnings to the CPP. To verify what amount CPP has designated as a limit on an annual basis, please contact them directly.
Please note: this amount is not a point at which benefits are stopped; it is an opportunity to see if you would benefit.
Do my CPP benefits affect the amount I receive from Great-West Life’s disability programs?
Yes, they will. If you receive disability payments covering the same period of time from both the CPP and the Short-term and/or Long-term disability program, you may be asked to pay back some or all of your CPP disability benefits to the Great-West Life disability office.
If you have questions about how your CPP benefits might affect other benefits you are receiving, you should contact the disability office of Canada Life at 604-455-2700 or 1-877-262-0749.
Are my CPP payments taxable?
Yes. CPP payments are taxable income. If you wish, Social Development Canada can deduct income tax each month. If you do not request monthly tax deductions, you may have to pay income tax in quarterly installments. For more information, contact a tax services office of the Canada Revenue Agency at www.cra.gc.ca.
Disability comes in degrees. At any given time, there may be employees on the job who are at risk for absences and disability. You could be coping with the demands of teenagers or aging parents, trying to manage a medical condition, etc. Other employees could be attempting to return to their normal or work routine after an absence. Any of these situations could escalate into a disability.
The focus of the disability office is on creating opportunities to support recovery and the ability to enable you to return to work.
Employees on short-term disability (STD):
Once an employee is on short-term disability, the focus shifts to recovery and return. Statistics show the longer an employee remains on disability, the less likely they may return to work. Providing the right support for the right problem early on is critical.
Employees on long-term disability (LTD):
Employees facing a serious long-term disability need the most extensive level of support and intervention to realize their potential. By using the same Case Manager throughout, the disability office provides a seamless transition from Short to Long-term Disability and effective support for our employees.
Health & Wellness Library –employees who are participating in our Extended Health or Dental benefits can access a wealth of information to help manage your health, through the Canada Life website for plan members (http://groupnet.greatwestlife.com).
Medical Coordination –provides medical support and expertise from the first report of illness or injury, continuing through treatment. It includes coordinating information between the employees and physician, confirming diagnoses and treatment plans, and faster access to specialists.
Vocational Rehabilitation, Consulting –provides return-to-work planning, education and job search assistance and helps employees adjust on a personal and vocational level.
Exchange – a unique communication process that uses facilitated meetings to bring the employee and the employer together early, to work through issues affecting the employer’s return to work.
STD and LTD Case Management –progressive case management services designed to ensure claims are handed according to the terms of your plan.
At-Work Services – provides vocational or medical rehabilitation and related services while the individual is still at work, to help the employee remain on the job.
Every claim submitted to Great-West Life will be unique, but will follow through a management approach that offers the following key value points:
Timely information gathering and initial assessment
A team approach to management, quarterbacked by a single Case Manager
Regional claim management
Vocational Rehabilitation consultants who focus on the no-medical elements of case management
Medical Coordinators who can add value where medical attention or interpretation is a barrier to return to work
At the heart of the management team is the Case Manager. This person is responsible for a claim from inception until the employee returns to work, or otherwise is no longer eligible for benefits.
Gathering information quickly and making an initial assessment early is critical. For straightforward claims, the value the disability office looks to add is:
To get the employee their income as soon as possible
To minimize the investment in resolving the claim by avoiding the collection and expense of unnecessary reports and documentation
More complex claims can pull in the expertise of specialists to achieve and return to work goal. In most of these cases, early telephone contact will be established with the employee to get a good first hand understanding of the disability, and to set the stage for the process. With these cases, the goal is to apply more resources to the management of the claim where there is good expectation an early return to work may be achieved.
The two primary resources the Case Manager may call upon are their Vocational Rehabilitation consultants and their Medical Coordinators.
All of the Case Managers are trained to recognize situations where employees are suitable candidates for return to work programs. The Case Manager would then engage one of their Vocational Rehabilitation Consultants who will work together with the employee, employer, and the attending physician to implement and monitor the program.
Great-West’s Medical Coordinators are qualified professionals with a medical background and several years of experience managing disabilities. The expertise they bring is important since prolonged waits to access a specialist can otherwise cause unnecessary frustration and uncertainty, as well as delay treatment and jeopardize a successful return to work.
Some of the other resources the Case Manager may use throughout the management of a claim could include:
On-line access to proprietary disability management manuals and medical investigation manuals
Local Medical Consultants, whose primary function is to assist with the interpretation of medical files
Independent Medical Examiners who may be used where the medical information may not be fully available
In extreme and generally rare occasions, surveillance and fraud investigation tolls are available.
Finally, as a part of the financial management of a claim, the disability office will correspond with the employee concerning their application for other income benefits, such as C/QPP and Workers Compensation.
Initial Claim Review:
Before a claim decision can be made, the Case Manager must review the claim to gain insight into its complexity and validity. This step in the process includes gathering information about the claim, and verifying the plan parameters and assessment criteria.
The first pieces of information gathered by the Case Manager will be the claim form and the physician’s statement. If the documentation is straightforward and complete, then the claim decision can be made quickly and accurately. On the other hand, if the information is not straightforward or incomplete, then it is examined more closely.
Canada Life may call the employee to obtain information about their condition and treatment. Then, if additional information is needed, more specific questions can be directed to the employee’s physician. Calling the employee establishes early and personal contact, and sets the stage for potential rehabilitation discussions.
Short-term Disability (STD)
The Case Manager must assess the plan specific criteria before making a decision. This entails reviewing eligibility requirements, plan limitations, and any further plan specific criteria within the CISVA Group Policy Contract. Once these plan parameters are verified, then the disability office can accurately assess the claim against the contractual provisions of the CISVA plan.
Claim Assessment & Decision:
Once the claim has been initially reviewed, the Case Manager can then assess the claim, and determines if it satisfies the plan provision. If the claim is accepted the management of the claim begins. If the claim is declined, then the employee is advised concerning the reasons for the declination. Information is also provided on additional medical facts needed for further review or on how to appeal the decision should the employee disagree with the discussion.
In making an initial assessment of a claim, the disability office reviews all of the information gathered pertaining to the claim. This initial assessment will give direction to the claim, and assist in determining the plan for further handling of the claim.
Maximize Return on Investment
In order to maximize return on investment, the Case Manager must make sure that straight-forward claims are paid accordingly, and only investigate the more complex claims further.
In order for a disability claim to be accepted, the disability must be covered in the CISVA plan provisions; therefore, the Case Manager must check the plan provisions before moving forward with the claim assessment.
Limitations and Exclusions
Limitations are provisions that may result in a claim terminating (temporarily or permanently) if certain criteria have not been satisfied. Exclusions on the other hand, are initial requirements that, if not met will result in a claim being declined (i.e. a pre-existing condition).
Decision-Making Tools Available:
The Case Manager uses many tools when making a decision on a claim. These tools are important in making the right decision in a timely matter.
At Canada Life’s disability offices, they have created proprietary manuals to assist in the assessment and management of disability claims.
Normal Convalescence Periods
Industry recognized reference materials are used in order to establish normal recovery period for disabilities. These reference materials, along with the knowledge of Medical Coordinators and Medical Board Consultants, allow the disability office to determine duration period information. This also enables the Case Manager to make appropriate plans for the employee to return to work.
The Case Manager determines when it is appropriate to use the services of a Medical Consultant. The medical consultant is used to interpret the medical test results and other clinical information. The Case Manager then compares the medical restrictions to the employee’s job abilities to assess if the employee is medically able to do their job.
If a claim is declined or disputed, the employee has the right to an appeal; this right to appeal is outlined to the employee in the decision letter. The review process requires the employee to submit additional information. The employee may also appeal by providing the detailed reasons why the claim should be reassessed. Upon receipt of the additional information, the employee will be provided with the results of our reassessment.
Disability Management (Accepted Claims):
The management of a disability claim is the most detailed part of the disability claim process. In order to manage such detailed claims, Case Managers frequently use the following tools:
The overall objectives to the management of a claim are to:
Maximize non-medical management via Vocational Rehabilitation Consultants 2. include Vocational Rehabilitation and Medical Coordination in detailed claims 3. Have the Case Manager act as the “Gate Keeper”, responsible for the management of the claim from inception until the return to work 4. use other supplemental disability tools to help manage the claim
Disability Management Tools:
Case Managers can use many different tools in order to manage a disability claim. These tools are in place for the Case Manager to get the employee back to work as soon as possible. The main disability management tools are as follows:
Vocational Rehabilitation Referral
Vocational Rehabilitation Consultants are internal specialists that focus on the return to work planning and management.
Canada Life’s Medical Coordinators are qualified professionals with a medical background and several years of experience managing disabilities. The expertise brought is important since prolonged waits to access a specialist can otherwise cause unnecessary frustration and uncertainty, as well as delay treatment and jeopardize a successful return to work.
Ongoing Medical Coordination supports the treatment plan by focusing on realistic return-to-work options. Throughout the duration of the disability, the disability office maintains close contact with the employee, physician(s), and the employer to coordinate medical care and return to work planning.
Disabilities will be reviewed at various times during the claim. The timing depends on the medical condition and the treatment plan. The disability office may contact the employee by phone to determine the appropriate timing of these reviews. This personal approach to the claim review keeps the employee and the Case Manger in constant communication throughout the duration of the claim.
A Medical Consultant may be used at any time in the assessment of a claim. Their expertise can assist in interpretation of test results, reviewing current treatment plans, or other clinical information. Referral to a Medical Consultant may also be an appropriate approach when trying to bring a new treatment direction to the management of a claim. Medical Consultants can provide recommendations in the areas of medication and future treatment that may be more comprehensive than those available from a basic assessment.
Independent Medical Exam
Great-West arranges an Independent Medical Examiner (IME) when the situation is appropriate and the cost of an examination is warranted.
Functional Capacities Evaluation
Canada Life uses Functional Capacity Evaluations to test for abilities in different tasks. This evaluation, often conducted by occupational therapists, verifies the employees’ abilities through medical exams and physician tests.
Great-West has policies and procedures for the identification and investigation of potential fraudulent claims.The Case Managers are in the best position to identify possible fraudulent claims and cases of abuse. Information that does not appear consistent or logical may provide an initial warning of a possible fraudulent claim.
Activity investigations using third party investigators are not a routine part of a disability claim management. However, they can be important in cases where the medical information may support the employee’s entitlement to benefits, but the degree of disability is in question. Under these circumstances an investigation is initiated in order to determine whether the employee’s observable daily activities correspond with the degree of disability claimed. An investigation may also be warranted in response to suggestions that the employee is engaged in other employment, and thus earning income that should be offset from the disability benefit.
Experience has shown that early initiation of rehabilitation is an integral part of effective comprehensive disability management; therefore the possibility of rehabilitation is immediately considered in claim assessment. If appropriate, a telephone interview will be conducted to assist in developing rehabilitation plans and programs for the employees.
Seamless STD/LTD transition:
The disability office strives for a seamless disability approach allowing for an easier transition between Short Term and Long Term disability benefits. The assigned Case Manager is responsible for referrals to Medical Coordination and Vocational Rehabilitation, as well as the claim assessment. Individual claim attention provides consistent and proactive management of the claim, and a personal tough in what is often a difficult time for the employee.
Alternate sources of income, such as CPP, WCB, and auto insurance, act as significant sources of savings to disability benefits. The disability office ensures that any employee who may be entitled to these alternate insurance benefits is notified of their potential entitlement.
Canada Life advises the following individuals to pursue a claim with CPP benefits:
People with degenerative, chronic or terminal conditions.
Where there is no indication that person is medically capable of any work (ie. If it appears improvement is unlikely, benefits may continue until age 65),
Or where the person is over age 60 and not expected to recover from their medical condition and be able to perform any work.
In these situations, benefits could continue beyond the change in definition point, so it is appropriate to advise employees to apply for these CPP benefits.
Canada Life will request a completed CPP option form, a CPP assignment form, and a copy of the CPP/QPP confirmation of application from the employee. The disability office continually assesses claims each time new information is received to determine if the employee should be pursuing a claim with CPP.
The possibility of auto insurance benefits is considered whenever disability is a result of a motor vehicle accident. If alternate benefits are denied, the disability office will assume liability provided other contract requirements have been satisfied.
Once a claim has been approved, the employee is entitled to disability benefits. The following point needs to be taken into consideration to claim payments:
Methods of payment:
Canada Life currently supports two methods of payment – Direct Deposit and Cheque Payment. In order to process an electronic fund transfer, Canada Life requires bank identification and account number for each disability claimant. If the employee chooses cheque payment, the disability office sends the cheque directly to the employee.
Termination & Appeal:
Termination of the claim is the final step in the disability claims process. A claim is considered to be terminated once an employee has returned to work or not longer meets the CISVA plan provisions. For those employees who have been in receipt of Long Term Disability benefits for more than two years, the employee will receive 30 days notice prior to the termination of benefits for those employees whose Long Term Disability benefits are terminating due to a change in the definition of disability. The disability office will advise an employee of their decision as early as possible.If a claimant feels that their claim has been terminated prematurely, they are entitled to an appeal.
REGISTERED PENSION PLAN (RPP)
Policy No. 35169 Managed by Group Retirement Services (GRS), a division of Canada Life Assurance Company
Note: Our Registered Pension Plan (RPP) is a separate policy from the remainder of the Great-West Life benefits. Therefore, you must ensure that the appropriate documentation is completed for any pension changes. Please contact your Benefit Representative for the applicable documents. All originals are forwarded directly to the Benefit Administration Office for processing & record maintenance.
Please call the GRS ACCESS LINE directly if you have lost your PIN, user Access ID and/or Password.
This site is for general information purposes only and is not intended to provide you with any personalized, financial, insurance, legal, accounting or tax advice. You should not rely on this site as a substitute for independent research or for personal advice from an appropriate professional advisor.
Who is eligible to participate in the Registered Pension Plan
If you are a permanent full-time or part-time employee, working a minimum 20 hour work-week, you may join the Registered Pension Plan (RPP) as of your first day of employment. For those individuals who are required to satisfy a probation period, you may join the RPP on the first day after you satisfy your probation period.
If you are a permanent part-time employee working less than 20 hours a week, you may join the RPP on the first day after you complete two years of continuous employment with your employer, provided you have earned 35% of the Year’s Maximum Pensionable Earnings (YMPE) in each of the two consecutive years.
The following eligible Benefit Classes allow for participation in the RPP:
The following contributions are available to CISVA employees:
Contribution levels are based on the following percentages of gross annual earnings:
3% – new or existing employees
7% – new or existing employees
7.5% – is available for Prince George Diocese employees ONLY
8% – employees in their 15th year of service
9% – employees in their 20th year of service
For all other employees participating in the pension plan, subject to benefits offered by your “Employer” in your employment contract, you would contribute to the Plan by payroll deduction an amount as indicated in the chart above.
The “Employer” means the policyholder (Archdiocese of Vancouver) or any affiliated, associated or subsidiary companies listed below:
Catholic Independent Schools of Vancouver Archdiocese
Catholic Independent Schools of Kamloops Diocese
Catholic Independent Schools of Prince George Diocese
Are part-time or casual employees eligible to join the pension plan?
Permanent part-time employees who meet the minimum eligibility requirements of working 20 hours per week may join the plan. Casual or seasonal employees may not.
Employees who work less than 20 hours a week may be eligible to join the RPP providing that the following criteria is met:
an employee for whom a pension plan is maintained is, on application, eligible to become a member of the pension plan after completing 2 years of continuous employment with the employer, with earnings of not less than 35% of the Year’s Maximum Pensionable Earnings (dollar amount set by Revenue Canada) in each of 2 consecutive calendar years.
employees who meet this legislated criterion are placed in Benefit Class 100.
What if I’m absent from work as a result of disability (STD, LTD or WCB)?
If you are temporarily away from work as a result of a disability (Short-term disability, Long-term disability or Worker’s Compensation), you are unable to participate in the employer-matched portion of the pension plan. Contributions will cease as of the first day following the month of disability. Voluntary pension contributions may continue during the period of your disability.
Contributions will be reinstated once you return to your pre-disability employment status.
What happens when I return from my leave of absence or lay-off?
Upon return to active employment, please advise your Benefit Representative accordingly and your benefits will be automatically reinstated and deductions will resume as normal. It is imperative that you check your pay stub to ensure your required pension contributions have been deducted. If the contributions have not been deducted, please advise your employer immediately.
Can I retire before age 65?
Yes. You are entitled to start receiving early retirement benefits as soon as you are age 55 and have been a member of the plan for at least two years. The amount you receive each month, however, may be reduced to compensate for the fact you will likely receive pension payments for a longer period of time.
Can I keep working and contributing past normal retirement age?
Yes, you may continue working if your employer permits you to do so. If you continue working, you will continue to earn pension benefits. Your pension payments must commence no later than the end of the calendar year in which you turn 71.
What are my options if my membership in the plan terminates?
You may leave the benefits in your employer’s pension plan, and start receiving the pension once you get to the age at which you are eligible to commence receiving payments. This option is valuable as it may allow you to participate in future benefit improvements under the plan.
If you quit or lose your job before your pension is vested, you can get back any money you paid into the plan, with interest. You may not be entitled to money your employer has paid into the plan on your behalf.
If, however, you quit or lose your job after your pension is vested you have the option to transfer the value of your vested entitlement out of the pension plan. If you opt to transfer your benefits out of the plan, you can transfer them to your new employer’s plan, as long as your new employer’s plan will accept the transfer. You also have the option to transfer the value of your benefits to a locked-in RRSP, to a life income fund (a “LIF”), or to an insurance company to buy an annuity.
The portion of the benefits resulting from employment before 1993 may be received in a lump sum, by a terminating plan member, if the pension plan does not require that these be locked-in.
If I transfer my benefits out of the pension plan how long do they remain locked-in?
Your benefits will always be locked-in, meaning that the money must only be used for the purposes of providing a stream of retirement income.
If I transfer benefits out of the pension plan, when can I start receiving monthly payments?
If you transfer the money to a locked-in RRSP, in order to start receiving payments it must be further transferred to a life income fund (a “LIF”), used to purchase an annuity, or transferred to another pension plan. In the case of a LIF and an annuity, the payments can start when you reach the age at which you could have started receiving payments under the pension plan the money was transferred out of (age 55 under most plans). If you transfer the money to another pension plan the money becomes subject to the provisions of the new plan.
My spouse and I are separated. Is he/she entitled to any of my pension benefits?
Pensions are a “family asset” under the province’s Family Relations Act. The division of family assets, including pension credits, comes under that legislation. Part 6 of the Family Relations Act provides detailed procedures for valuing and dividing a pension after a marriage breakdown.
What does “VESTED” mean?
If your pension is “vested”, it means that you are unconditionally entitled to receive a pension, either now or in the future, even if you terminate your employment before retirement age. Once you become vested you are entitled to either an immediate or deferred pension, as opposed to simply a return of your own contributions. Being vested also implies that you get the benefit of your employer’s contributions as opposed to just your own contributions.
What does “LOCKED-IN” mean?
Vested pension benefits, resulting from contributions made to the pension plan after 1992, may not be withdrawn as a lump sum, and must be used to provide retirement income.
When are my pension benefits vested?
Legislation requires that pension benefits become vested as soon as the member has completed 2 years of continuous plan membership. Once vested, the member is vested for all periods of plan membership, without regard to whether the contributions or periods of employment were before or after January 1, 1993.
MATERNITY and PARENTAL LEAVE
MATERNITY and PARENTAL LEAVE
Maternity and Parental Leave
Federal and provincial legislation protects an employee’s right to take a maternity leave and outlines the employer’s role in the administration of benefits during such a leave. The Catholic Independent Schools of Vancouver Archdiocese’s maternity leave policy is accountable to employment related legislation and at no time reflects rights that are less than those provided by federal or provincial legislation.
The information that will be provided within this document is held in compliance with the following governing bodies: 1. Employment Insurance (EI) EI website 2. Employment Standards Act (ESA) 3. Human Resources & Social Development Canada (HRDC)
This document provides details of benefit plans, but it is not a legal document. In the event of any conflict between the contents of this guide and the actual plans & contracts or regulations (as outlined by any applicable governing bodies), the provisions outlined in the latter will apply.
Maternity benefits are only available to the person who is away from work because they’re pregnant or have recently given birth. They cannot be shared between parents.
The person receiving maternity benefits may also be entitled to parental benefits.
Maternity (for the person giving birth)
up to 15 weeks
up to $573
If the actual date of birth is different from the expected date of birth, it is very important that you provide this date as soon as possible after the birth of your child. Please contact EI at 1-800-206-7218 from 8:30 am to 4:30 pm and press “0” to speak to a representative. This way they will be able to determine the most advantageous maternity period, in order to receive the maximum maternity benefits you are entitled to.
Eligibility: (Please refer to EI website for the most recent and updated information)
The information below should be used as a guideline. We encourage you to apply for benefits and let a Service Canada agent determine if you’re eligible.
You need to demonstrate that:
you’re pregnant or have recently given birth when requesting maternity benefits
you’re a parent caring for your newborn or newly adopted child when requesting parental benefits
your regular weekly earnings from work have decreased by more than 40% for at least one week
you accumulated 600 insured hours* of work in the 52 weeks before the start of your claim or since the start of your last claim, whichever is shorter
*As an example, 600 hours are equivalent to 20 weeks of work at 30 hours a week.
Parental benefits (as defined by EI)
Parental benefits are available to the parents of a newborn or newly adopted child.
You must choose between 2 options:
Standard parental benefits
Extended parental benefits
Your choice determines the number of weeks and the weekly amount you’ll receive.
If sharing, each parent must choose the same option and submit their own application. Parents can receive their weeks of benefits at the same time or one after another.
Once you start receiving parental benefits, you cannot change options.
You can receive parental benefits within specific periods starting the week after your child’s date of birth or the date your child is placed with you for the purpose of adoption.
These periods are:
Standard parental: within 52 weeks (12 months)
Extended parental: within 78 weeks (18 months)
**Please check EI website for the most recent and updated information**
Maternity Leave refers to the federally legislative leave provided to the biological mother at the time of the birth of a child. Maternity Employment Insurance (EI) benefits are payable to the birth mother for a maximum of 15 weeks.
Supplemental Unemployment Benefit (SUB) – aka: maternity “top-up” benefit refers to the supplemental wage-loss benefit support paid to only teachers and principals of the CISVA, by the local school as the difference between the Employment Insurance payable and 75% of gross salary. This benefit is payable upon the date of birth of the child. This benefit is not paid during the months of July and August as there is no wage-loss during that time.
Waiting Period refers to the 1 week period before Employment Insurance benefits begin to be paid. Generally this period is the first week of the EI claim.
If both parents share parental benefits, only one waiting period needs to be served. If a 1-week waiting period has been served for maternity benefits, the waiting period for parental benefits will be waived.
The basic rate used to calculate maternity and standard parental benefits is 55% of average insurable weekly earnings, up to a maximum amount. In 2020, the maximum amount is $573 a week.
For extended parental benefits, this rate is 33% of average insurable weekly earnings, up to a maximum amount. In 2019, the maximum amount is $344 a week.
Employment Standards Act
Labour standards legislation provides minimum entitlements for employees on maternity leave and states that an employee is entitled to an unpaid maternity leave. While on leave, the individual continues to be in an employee and upon return to work, the employer is required to reinstate the employee in the prior position or to an alternate comparable position.
Increments in salary are to be paid to the employee upon return to work as employees continue to accrue increments on the salary scale grid while on a maternity leave.
Pension and Benefits
The Employment Standards Act (ESA) also requires that when a member of a pension plan is required to make member contributions under the plan (as the pension plan of the Catholic Independent Schools of Vancouver Archdiocese), the member who takes a Maternity leave may continue to participate in and accrue benefits under the pension plan for the duration of the approved leave. Employer contributions will also continue during this leave, unless the member elects in writing (please refer to Waiver section found on the Maternity Leave contract) not to participate in the pension plan for the duration of the approved leave.
Under the Employment Standards Act (ESA), Group Insurance benefits also continue accordingly.
(1) only Teachers & Principals of the CISVA are eligible for this benefit
(2) this benefit is only available to the biological mother
(3) this benefit is not payable during the period the eligible employee may be receiving post-delivery, Short- term disability benefits (for a 4 or 6 week period)
Eligibility requirements & Benefit Calculations
This benefit is only available to teachers and principals of the CISVA who meet the Employment Insurance Regulations, as it forms part of these employees’ compensation package. The benefit is provided to assist employees who experience a wage-loss as of the date of birth of her child. Please note that if the employee is receiving post-delivery, Short-term disability benefits, the top-up benefit is not payable during that 4 or 6 week period.
The benefit requires that each CISVA school provide additional financial support to Teachers and Principals who are on an approved maternity leave by supplementing the standard EI maternity benefit. The school’s financial support increases the standard EI benefit from 55% (EI rate) to 75% for a period of 6 to 15 weeks according to the information provided by the attending physician on the Maternity Leave Medical Report.
A sample calculation of the SUB formula is as follows:
Gross weekly earnings x 75% = max. amount that the Teacher/Principal can receive between EI and the school for the 6-15 week period
Calculation for gross weekly EI benefit = gross weekly earnings x 55%, up to a maximum benefit of $573
Total SUB paid by school: sum of Item 2 minus (–) sum of Item 3 = payable top-up amount
1. Teacher delivers and experiences wage-loss during said year (Sept. 1 – June 30)
Regular gross salary:
Gross weekly salary: $49,082 divided by 52 weeks
75% of gross weekly salary
Gross EI benefit (max is $573)
Amount payable as “top-up” per week (75% Weekly salary – EI benefit)
Please note that this is a taxable benefit; therefore, it will be reflected on your T4 form. As a result, this benefit is subject to CPP contribution deductions.
This benefit is not payable during the months of July and August as there isno wage-lossduring this time.
Registered Pension Plan (RPP)
As required by legislation, pensionable service for a member in the Registered Pension Plan (RPP) of the CISVA will continue to accrue during the approved Maternity leave provided the member indicates in writing that she will continue to make contributions under the plan. Employer contributions to the RPP will also continue during this time.
It is the employee’s responsibility to ensure that they are always adhering to any regulations as it pertains to the Canadian Income Tax Act. The most that an individual can contribute to their RPP is the lesser of 18% of “earned income” for the current year, to the Annual Contribution Limit set by Revenue Canada.
For your purposes, generally speaking, earned income includes a taxpayer’s income (earned while the taxpayer was resident in Canada) from the following:
income earned from employment reported on a T4 slip (including maternity top-up payments for eligible CISVA employees)
It is important that the employee takes the necessary steps to ensure that she doesn’t over-contribute to the RPP for the applicable tax year.
Contributions are based on the amount of employment income at the date the approved leave begins and are paid in regular monthly payments during the leave. Pension contributions must be completely paid before the leave is completed or the ability to contribute will be lost.
Employees of the CISVA must complete a Maternity Leave Contract and sign-off on the applicable waiver (located on page 2) if the employee wishes to suspended their RPP contributions during their maternity leave.
RPP contributions must be reinstated on the employee’s return to work.
Group Insurance Benefits
During maternity leave, the employee shall be entitled to the following benefits providing (1) she was normally entitled to such benefits and (2) she pays her share of premiums:
Life insurance, Accidental Death & Dismemberment, Short-term and Long-term disability
Extended Health, Dental and Critical Illness benefits
Medical Service Plan (MSP)
The aforementioned benefits shall continue uninterrupted during the period of time the employee is on maternity and/or parental leave provided that the employee makes arrangements prior to commencing the leave to pay their share of the benefit premiums for that.
IMPORTANT: Prior to commencing the leave, the employee must provide their employer with post-dated cheques to cover the costs of their portion of the benefit expenses.
Our Short-term Disability (STD) plan now covers the part of maternity leave that the biological mother would not be able to work due to pregnancy and childbirth health-related reasons. While a woman is on maternity leave, there may be a period of time during which she may be unable to work due to the physical demands of pregnancy and childbirth. As a result, there is now the provision of disability coverage during the recovery portion of maternity leave for eligible employees:
Our STD plan has expanded its benefits for disability following childbirth in the following format:
Childbirth by regular delivery: 4 week benefit
Childbirth by c-section: 6 week benefit
These periods reflect the handling of such claims with current normal convalescence periods.
Who is eligible to receive this benefit?
This continues to be an STD benefit. Therefore, the expansion in the STD benefit is made available to all eligible employees (expectant mothers) who are eligible to apply for STD benefits. The employee would need to be actively participating in either one of the following two benefit classes:
Benefit Class 1: Permanent Full-time and Part-time employees
Benefit Class 2: 1-year contract employees
There is no termination age associated with STD benefits providing you continue to be: an insurable employee, actively at work, and meet the definition of disability.
When is this benefit payable?
Even though this benefit is available to eligible employees for a period of 4 or 6 weeks (as of the date of birth of the newborn child), our group STD plan still retains a 7 consecutive-day waiting period. As a result, the post-delivery, recovery benefit is payable for the following two periods:
Type of Birth
* STD Waiting Period
7 consecutive days
7 consecutive days
* If the employee is currently on STD benefits due to pregnancy-related complications, then it’s likely that the STD waiting period has been satisfied. In these cases, this benefit is now payable as of the date of birth of the newborn child.
How are these claims assessed?
These claims are assessed in the exact same manner as any other STD claim.
The employee must be enrolled in the applicable benefit class.
The employee must meet the definition of disability.
The benefit is payable at 66.67% of weekly earnings.
STD payments are paid weekly in arrears by the disability office.
There is a 7 consecutive day waiting period from the date of birth of the newborn until the first day payable for disability.
The Short-term disability claim forms must be completed in full:
The Employee Statement (including the Attending Physician’s Statement)
The Employer Statement
Both of these forms must be completed in full and returned to the Benefit Administration Office for co-ordination with the disability office.
Sample benefits calculation
Sample benefit calculation (employee is paid over a 10 month/43-week period, earning $55,000/year):
Baby is born on January 5th
Baby is born by c-section.
In this example, STD benefits are payable for a 6-week, post-delivery period.
Gross Annual Salary ÷ No. of weeks work per year = STD-maternity benefit amount
Employee is eligible for STD benefits from January 5th to February 16th
– Regular gross annual salary:
– Gross weekly salary: $55,000 divided by 43 weeks
– STD benefit applied at 66.67%. Benefit payable weekly, in arrears.
This is a non-taxable benefit to the employee. Therefore, no T4A will be issued.
What if the employee was already on STD for pregnancy-related complications?
If the employee was previously approved for STD benefits, then the post-delivery, recovery benefit is simply an extension of the existing claim. STD benefits will continue to be paid for 4 or 6 weeks after the date of birth of the newborn (depending on the type of delivery).
Contractually, does this mean that the employee’s official maternity leave is extended?
No, the employee’s official maternity leave is not extended beyond the agreed period of time specified in the employee’s Maternity Leave Contract.
The employee will not receive 1 year and 4 weeks (due to childbirth by regular delivery) of maternity leave. The employee will not receive 1 year and 6 weeks (due to childbirth by c-section) of maternity leave.
The post-delivery, recovery (STD) benefit is simply payable within the existing period of the approved maternity leave.
What happens with the maternity benefits offered through Employment Insurance (EI)?
EI, maternity leave, must start no later than the expected or actual week of childbirth; however, an employee is able to start their maternity leave up to 8 weeks prior to the expected date of delivery. If the employee chose to start the maternity leave early then they would still be eligible for the STD paid, post- delivery period.
STD benefits would be payable for the post delivery period (4 weeks for normal uncomplicated delivery and 6 weeks for a Cesarean section – less the 7 day waiting period).
Please note that EI Benefits are not payable during the period that STD benefits are paid. As our group benefits plan benefits from an EI reduced rate (due to the fact that we offer disability benefits), EI will “offset” any payment that you receive through STD benefits. EI reduces its benefit in the amount paid under the group disability plan. Therefore, employees will not receive full payable benefits under both EI and the STD benefit.
Once the STD benefit is exhausted, then EI will pay the employee (providing that the employee is eligible to receive EI benefits).
Maternity/Parental benefits are limited to a combined period of 52 or 78 weeks. If the employees receives post-delivery STD benefits (4 or 6 weeks minus the 1 week waiting period), then EI’s payable benefit is cut-back.
Note: if the employee starts maternity EI benefits prior to the DOB of the child, the local Employer will need to make note on the employee’s Record of Employment (ROE) that the employee may be eligible for post-delivery STD benefits. After that, EI will follow-up accordingly with the employee.
How is the top-up benefit managed while an employee is receiving STD benefits?
(1) only Teachers & Principals of the CISVA are eligible for this benefit
(2) this benefit is only available to the biological mother
This benefit is available to eligible employees, for a period of 6-15 weeks, as of the date of birth of the newborn child. The period of payable “top-up” benefit is dependent on the information provided by the physician on the Maternity Leave Medical Report.
Please note that “top-up” is not payable during the time that the employee is receiving payment through the post-delivery, recovery STD benefits. The reasons are as follows:
The STD benefit is considered to be the first payor in providing a wage-loss benefit as it’s a system-wide benefit to eligible employees.
EI is the secondary payor; however, EI will suspend any EI payments during the period the claimant is receiving STD benefits.
As the CISVA has an EI reduced plan, EI will “offset” the STD benefit from the EI calculation.
Top-up is also contingent on EI’s approval of the claim.
The employee receives more than 75% of weekly earnings due to the difference in calculations using 43-week formula (STD) versus the 52-week formula (EI).
(A) Example of a top-up calculation:
Jane Doe – Teacher within the CISVA
Jane’s baby is born on January 1st
6-15 week top-up benefit. Payable if:
Employee is Teacher or Principal of CISVA
EI has approved maternity leave
In this example, we’ll say that Jane would have been eligible for top-up for a 15-week period (per her doctor’s recommendation).
Gross Annual Salary ÷ 52 weeks x 75% = 75% of gross weekly salary
75% of gross weekly salary – Gross EI Benefit = Top-up benefits
Jane is eligible for top-up from January 1st to April 14th (52-week formula – EI’s formula)
– Regular gross annual salary:
– Gross weekly salary: $71,407 divided by 52 weeks
– 75% of gross weekly salary
– Gross EI benefit (max is $562)
– Amount payable as “top-up” per week
(75% Weekly salary – EI benefit)
This is the amount that the employee would receive as a combined, taxable income, through EI and the top-up benefit ($537 + $492.92 = $1,029.92)
(B) Example of an approved STD post-delivery, recovery benefit:
Jane Doe – Teacher within CISVA
Jane’s baby is born on January 1st
The baby is born by c-section.
In this example, STD benefits are payable for a 6-week post-delivery period (minus the 7 consecutive day waiting period).
Jane is eligible for STD benefits from January 1st to February 11th (43-week formula – STD formula)
– Regular gross annual salary:
– Gross weekly salary: $71,407 divided by 43 weeks
– STD benefit calculated at 66.67% of the gross weekly earnings. This is a non-taxable benefit to the employee.
Insured with Canada Life Assurance Company
Policy No. 56565 – Division 10 Toll free number: 1-800-957-9777 (Select prompt 1 for language preference = English) (Select prompt 3 for benefit selection = Dental inquires)
This site is for general information purposes only and is not intended to provide you with any personalized financial, insurance,legal, accounting, tax, medical or other professional advice. You cannot rely on this site as a substitute for independent research or for personal advice from a representative of the CISVA or any other appropriate professional or medical advisor.You must contact Great-West Life directly to confirm eligibility for any and all eligible benefits under the Dental Plan.
Which employees are eligible for coverage under the CISVA, Dentalcare Plan?
The eligibility requirements are as follows as defined in our Group Policy Contract:
1. You must be an Insurable Employee 2. You must be Actively at Work 3. You must be in the appropriate Benefit Class
Dental Care coverage pays for eligible expenses that you incur for dental procedures provided by a licensed dentist, denturist, dental hygienist and anaesthetist while you are covered by this group plan. For each dental procedure, we will only cover reasonable expenses. We will not cover more than the fee stated in the current Dental Association Fee Guide for general practitioners in the employee’s province of residence on the date that the treatment is received.
Payments will be based on the current guide at the time the treatment is received. If services are provided by a board qualified specialist in endodontics, prosthodontics, oral surgery, periodontics, paedodontics or orthodontics whose dental practice is limited to that speciality, then the fee guide used will be the specialist’s fee guide as set by the applicable governing authority.
The dental benefit year is from January 1 to December 31.
How much of our dental costs are paid by our plan?
There is no deductible for covered dental costs.
Plan A: Basic treatment
100% coverage of dental fee guide No annual limit
Plan B: Major treatment
50% coverage of dental fee guide $1000 per person, per calendar year maximum
Plan C: Orthodontia
50% coverage of dental fee guide $3,000 lifetime maximum per insured person (Coverage is available for both adults & children)
Pre-authorizations are recommended for anything over $500.00
Pre-authorization is required for dental claims estimated to cost $500 or more. If you or a dependent requires dental treatment that the dentist estimates will cost $500 or more, a Pre-Treatment description (including x-rays) and fee estimate must be obtained from the dentist and submitted to Great-West Life directly for approval before treatment is commenced. If the treatment program is approved you will be notified and reimbursement will be based on the applicable fee guide.
It is strongly recommended to obtain a preauthorization with regards to extensive dental procedures performed. This is to prevent unexpected costs.
What general expenses are covered in our Dentalcare plan?
Please refer to the Booklets section of the CISVA website. The available booklets are reflective of the appropriate Benefit Class that pertains to you. Dental benefits are detailed according to your class status. Please ensure that you are referring to the correct benefit booklet.
Dentists can charge anything they want!
The Fee Guide forms the basis of what insurance companies will pay for dental treatments. The Fee Guide is only a guide for what dentists may charge for any particular treatment. Dentists may set their own fees. Specialists usually charge higher fees than those in the Fee Guide.
For more detailed information on the Fee Guide, please contact the BC Dental Association (www.bcdental.org).
What is coordination of benefits?
If you or your dependents are covered under more than one benefit plan (for example, your spouse’s plan), you can claim up to 100% of an eligible expense (as per the dental fee guide) by coordinating your benefits under both plans. Here’s how:
The plan that covers you as a plan member pays first. Then, the plan that covers you as a dependent pays any remaining eligible balance. Your spouse’s claims should go to his or her plan first, then any remaining balance should be sent to your plan.
Dependent children are covered first by the plan of the parent whose birthday falls earlier in the calendar year. In other words, if your birthday falls in January and your spouse’s birthday is in March, you should submit your children’s claims to your plan first.
Your first benefit plan will send you an explanation of how much of your claim has been covered. You will need to send that explanation, along with copies of your expense receipts, to the second benefit plan in order to claim any remaining balance that’s eligible.
Orthodontic Services will be reimbursed at 50% of the cost with a lifetime maximum benefit of $3,000 per person. Coverage for ongoing treatment requires that the member continues to be eligible for benefits and that a dependent continues to meet the definition of dependent as outlined in the Definitions section of your benefit booklet.
At the start of the orthodontic treatment, the dentist or orthodontist will prepare a written outline of the proposed treatment. This is called a treatment plan. The treatment plan will outline the amount of your initial deposit plus your pro-rated monthly fees. Great-West Life must have a copy of this in the patient’s file before they can reimburse for orthodontic claims.
IMPORTANT: if you wanted to pay for the entire cost of the orthodontic treatment, outright, Great-West Life will not reimburse you for the entirety of the orthodontic expenses. Orthodontia is regarded as an ongoing treatment (claim) therefore; you cannot be reimbursed for a service that is not yet fully completed.
When your orthodontist gives you the completed treatment plan form, forward it to Canada Life. Make sure you indicate on the form:
The member’s plan and ID numbers
Patient’s full name
Patient’s birth date
Information on coverage under any other dental care plans. Refer to narrative on co-ordination of benefits (COB).
The orthodontist or dentist may give you a receipt instead of completing a claim form. Submit your receipt, attached to a completed Dentalcare claim form and forward to Canada Life for processing.
Where do I mail my claims to?
Most general practitioners provide a service to their patients by submitting any incurred dental claims electronically to Canada Life for assessment. In such cases, you don’t need to concern yourself with submitting a paper claim. However, this is a service that is provided to you, your dentist is not obligated to submit your claim electronically. It is your responsibility to verify if this service is provided to you by your dentist.
IMPORTANT: dental specialists (ie: endodontists, prosthodontists, oral surgeons, periodontists, paedodontists or orthodontists) rarely ever submit incurred dental claims electronically to Great-West Life. The reason is typically because when you receive services rendered by one of these professionals, it is generally to satisfy an immediate dental need. You would not be considered a long-term, ongoing, regular patient therefore the service of submitting claims electronically is typically not offered.
Under these circumstances, please submit your dental claim to the following address:
Send to: Canada Life Assurance Co. PO Box 4408 Regina, SK S4P 3W7
Please note that you also have the option of submitting your claims electronically to CL via CL’s E-Claims (aka: Member Portal).
Where can I get blank claim forms?
The following 3 methods are ways in which you can obtain a Dentalcare Expense Statement claim form:
On the CISVA website, refer to the Forms / Claim forms section. This document already includes the plan name, plan number and division number.
On the left-side of the page, refer to Clients & Plan Members
Select Client Services
Select GO under A group benefits plan member?
Select Forms from Basic Forms & Resources
Double-click on the first bullet called, Standard claim forms
Select second bullet called, Dentalcare Claim Form (M445D)
Complete the form accordingly
Regardless of which method you use to obtain a claim form, please ensure that you copy every claim before sending it to Great-West Life. Original documents are always sent to the insurance carrier. Please ensure that receipts are stapled to the back of your claim form.
Is there a claiming deadline for submitting my claims?
Yes. Great-West Life must receive proof of claim no later than June 30th of the year following the date that you incurred your expense.
Example: a porcelain crown was placed on one of your molars in September 2007. As a result, you have until June 30, 2008 for Great-West Life to receive your claim.
Confirmation of this deadline will be found in the tail-end section of the Dental coverage portion of your benefit booklet under the section entitled, Submitting a claim.
What can I do if I disagree with the amounts paid for my claims, or some claims are declined?
Contact the Canada Life Benefit Payment Office (BPO) directly at 1-800-957-9777 to review the assessment of your claim. If still unsatisfied, send the original claim copy, plus the “Explanation of Benefits” that shows amounts paid and reasons, with your reason for disagreement to my office. I will assist you in investigating the matter further.
What is Member Portal ? (Accessing your benefits any time)
Access for your group benefits information has never been easier with Canada Life’s GroupNet for Plan Members (aka: Member Portal).
Register once and you’ll connect to a world of secure, user-friendly services – available online, any time! Available features are as follows:
Sign up for direct deposit claim payments – claim paid directly into your bank account
Access expanded coverage information quickly and easily
View your claim status and Explanation of Benefits for the past 24 months
Check your Extended Healthcare balance and the date that you would next be eligible for a particular benefit
Check when you’re covered for new glasses or contacts
Complete and print personalized claim forms
Access the Health & Wellness Site that includes:
In-depth information on diseases, conditions, drugs and treatment options
Interactive health and wellness tools, including the Personal Health Risk Assessment
Registration is simple and secure.
Follow these easy steps to register and log in for the first time: