Frequently Asked Questions – Late Application

Essential info

Insured with Canada Life Assurance Company
Policy No. 335645 – Division 10
Toll-free number:
1-800-957-9777
(Select prompt 1 for language preference = English)
(Select prompt 4 for benefit selection = Extended Health 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 personal advice from a representative of the CISVA or any other appropriate professional or medical advisor. You must contact Canada Life directly to confirm eligibility for any eligible benefits under the Extended Healthcare Policy. (Sept. 26/07)

General


Which employees are eligible for coverage under the CISVA, Extended Healthcare 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

Please refer to the Definitions and General Terms section of your benefit booklet for further clarification. Further details on the Benefits Class structure can be found on the CISVA website: CISVA Benefit Plan Overview / Basic Elements of Our Plan.

What general expenses are covered in our Extended Health 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. Extended Healthcare benefits are detailed according to your class status. Please ensure that you are referring to the correct benefit booklet.

How much of our health costs are paid by our plan?

In-Canada expenses = 80% of eligible expenses, up to any benefit plan maximums. There is a $25.00 annual employee/family deductible that must be satisfied before reimbursement.

Out-of-Country, unforeseen expenses = 100% of eligible expenses up to the specified benefit plan maximum that is reflective of your benefit class.

The annual deductible is not applied to any Out-of-Country expenses.

Please refer to your benefit booklet for any annual maximums that may apply for a particular benefit. If there is no financial limit set on a particular benefit, then Canada Life will reimburse eligible expenses up to the reasonable & customary charge.

What are Reasonable & Customary (R&C) charges?

Most benefit plans include coverage for Reasonable and Customary charges for dental and medical services. Generally, this is the lowest of the following:

  • Representative pricing in the area where the treatment is provided.
  • Prices are shown in the applicable professional association fee guide and the maximum prices established by law.

What is Coordination of Benefits?

When two or more plans are involved, one plan is considered to be the primary plan, and the carrier of that plan is the primary carrier (or insurer). The primary carrier pays its eligible amount first. The secondary carrier then reduces its payment by the amount by which total payments would exceed eligible expenses available through both plans. Eligible expenses are as defined in each carrier’s contract before limitations like your annual deductible, co-insurance, fee guides, and maximums are applied.

As a plan member, your claims should be processed through your benefit plan first. Claims for your spouse must be processed through your spouse’s plan first. Any remaining balance can then be processed through the other insurance plan.

When a child is covered under both parents’ plans, the plan of the parent whose birthday (month and day) falls earlier in the calendar year is billed first.

What is a Late Application

Some employees with extended health and dental coverage can waive their coverage through us.

They cannot automatically join the plan if they are not losing the coverage but can join the extended health and dental plan as late applicants.

The approval is not automatic and is based on the employee and their dependents’ medical insurability.

What are the required forms

As a Late Applicant, you must complete the following forms:

The employer or employee must submit the completed, signed forms to the Benefits Administration Office.

DO NOT send the forms directly to Canada Life.

LIMITATIONS AND RESTRICTIONS

Dental coverage for an approved late applicant will be limited.

  • Once approved, the employee and dependents have limited coverage of $250 for the first 12 months after the approval date.

Extended health for an approved late applicant is effective immediately after the approval date, BUT:

  • Approval for extended health coverage is not guaranteed.
  • Canada Life will approve the application based on the employee and the dependents’ medical insurability.

Please refer to our booklet for coverage information.