Co-operative Housing Federation of Canada

Basic Life Insurance

CHF Canada and HUB International have developed a framework of Group Life Insurance coverage to meet the needs of staff. This cost-effective insurance allows each employee to ensure their financial security and their family's well being.

Features of the Basic Life Insurance benefit:

• Two times salary to a maximum benefit of $100,000
• Coverage reduces by 50% at age 65 and terminates at age 75
• Premiums are waived after nine months of total and continuous disability

Living assistance benefit is available as an advance payment of your Basic Life Insurance in cases of terminally ill employee under age 65.

Optional Life Insurance

Employees' circumstances and therefore their life insurance needs will vary. Optional Life Insurance allows an employee to purchase additional protection at their own expense through payroll deductions, which is a low cost alternative to personal insurance policies or mortgage insurance. Optional Life Insurance is available with the following plan features:

• Coverage can be purchased for the employee and/or their spouse
• Coverage is available in units of $10,000 to a maximum of $100,000 (i.e., 10 units)
• Coverage terminates at age 70

Optional Life Insurance Rates

Rates for Optional Life Insurance can be obtained by contacting HUB International.

The volume purchasing arrangement available through the CHF Canada group plan enables members to obtain competitive rates for this benefit.

Note: The Employee Family Assistance Program benefit will be available to all employees and their dependents, regardless of option selected.

This summary is intended to provide a brief description of the benefits available under the CHF Canada group insurance program. This material does not create or confer any rights. The exact terms and conditions of your benefits are outlined in the applicable group benefits agreements or policies. Some restrictions and/or limitations may apply to all benefits mentioned above.

Please contact HUB International for full details.

Short Term Disability Insurance

Short Term Disability, provides plan members with protection against short-term loss of income due to injury or illness. The CHF Canada group plan offers Short Term Disability Insurance at affordable group rates.

Some of the features of the Short Term Disability program include:

• 66.7% of your weekly salary, the maximum weekly benefit is the lesser of $642 or the amount calculated using the formula for the All Source Maximum.
• Benefit payments begin after the 7^th day for accident or sickness
• Maximum benefit duration is to the end of the 15^th week from the date of total disability, upon reaching age 75 or retirement, or the date you engage in any work or occupation

Short Term Disability Insurance Rates

Rates for Short Term Disability Insurance can be obtained by contacting HUB International.

The volume purchasing arrangement available through the CHF Canada group plan enables members to obtain competitive rates for this benefit.

Note: The Employee Family Assistance Program benefit will be available to all employees and their dependents, regardless of option selected.

This summary is intended to provide a brief description of the benefits available under the CHF Canada group insurance program. This material does not create or confer any rights. The exact terms and conditions of your benefits are outlined in the applicable group benefits agreements or policies. Some restrictions and/or limitations may apply to all benefits mentioned above.

Long Term Disability Insurance

CHF Canada’s Long Term Disability (LTD) program provides protection against an extended loss of income due to injury or illness. This benefit is designed to integrate with CHF Canada’s Short Term Disability, Employment Insurance Benefits, or temporary salary continuance that your co-op provides to employees if they are disabled or sick.

The taxability of any LTD benefit received by a disabled employee is determined by whoever initially paid the premiums for the coverage. If the employee pays 100% of the premium, then any eventual benefit payment will not be taxable to the employee if the employee is disabled. If the employer pays any portion of the LTD premium then any benefit received is taxable.

Features of the Long Term Disability benefit:

The disability definition is commonly based on the ‘12-month own occupation’ definition. This means that the employee is disabled from his or her own occupation during the first 12 months of disability and thereafter is disabled for any occupation that is suitable by virtue of past training, education or experience. Some restrictions apply with respect to pre-existing medical conditions.

Note: The Employee Family Assistance Program benefit will be available to all employees and their dependents, regardless of option selected.

This summary is intended to provide a brief description of the benefits available under the CHF Canada group insurance program. This material does not create or confer any rights. The exact terms and conditions of your benefits are outlined in the applicable group benefits agreements or policies. Some restrictions and/or limitations may apply to all benefits mentioned above.

Extended Health Care Benefits

This benefit provides additional medical coverage for the treatment of illness or injury which are not assumed under a province’s basic medical plan. Coverage is provided to both you and your eligible dependents, with no deductible.

Coverage Maximum:

The maximum reimbursement per insured person per calendar year will be unlimited, except as defined for each specific service.

Some available features include:

• Vision Care
• Paramedical Practitioner coverage
• Therapeutic Equipment 50%
• Emergency Out-of-Country Travel Insurance and Assistance

Paramedicals

The CHF Canada health plan charges by the following licensed and qualified practitioners for treatment of injury or sickness in excess of amounts allowed under the covered employee’s provincial health care benefits, to a maximum of $700 per practitioner per covered person:

• Acupuncturist
• Chiropractor
• Massage Therapist
• Naturopath
• Osteopath
• Physiotherapist
• Podiatrist/Chiropodist
• Psychologist/Psychotherapist
• Speech Therapist

Prescription Drugs

The CHF Canada prescription drug plan covers charges for drugs or medicines required for medical treatment of injury or sickness, prescribed by a licensed physician or dentist. The plan also features a pay-direct drug card administered by The Co-operators. The co-payment amount is equal to the pharmacy dispensing fee.

Vision Care

The Vision Care benefit covers charges for lenses, frames or contact lenses when prescribed by a licensed Optometrist or Ophthalmologist. The maximum reimbursement will be $200 in any 24 consecutive months per covered person, with a $50 maximum reimbursement for frames.

Note: This benefit is only available if your co-op has selected this option.

Out-of-Country/Province Coverage (100% coverage)

This benefit is limited to the first thirty (30) days of travel by the covered person outside his/her province of residence. These charges are not subject to any deductible or co-insurance amounts.

Note that your provincial health care plan covers emergency care while temporarily absent from your home province, but often will not pay the full cost of these services. This supplementary health plan covers these additional hospital and medical costs up to the reasonable and customary charges.

Covered charges include those listed below for emergency medical care or emergency hospitalization incurred by a covered person while traveling outside their province of residence.

The plan covers emergency medical expenses required as the result of a sudden and unexpected illness or injury which occurs while temporarily outside your home province.

Emergency Medical Travel Assistance Service

The emergency medical travel assistance service provides you and your eligible dependents with 24-hour access to medical assistance in the event of an emergency covered by your Extended Health Care benefit.

If a medical emergency arises while traveling, notify the emergency travel medical assistance service within 48 hours following your emergency: Canada and U.S.A. 1-888-440-2667 From other Countries 1-416-340-1316 (call collect)

For more information on your Emergency Medical Travel Assistance service, please refer to your handbook.

Termination Age

Your Extended Health Care benefits terminate at age 75.

Note: The Employee Family Assistance Program benefit will be available to all employees and their dependents, regardless of option selected.

This summary is intended to provide a brief description of the benefits available under the CHF Canada group insurance program. This material does not create or confer any rights. The exact terms and conditions of your benefits are outlined in the applicable group benefits agreements or policies. Some restrictions and/or limitations may apply to all benefits mentioned above.

Please contact HUB International for full details.

Dental Insurance

The Dental benefit is designed to promote good dental care at a reasonable cost. Benefits are based on the current dental association fee guide for your province of residence. There is no deductible on any covered charges incurred.

Coverage Maximums

The maximum reimbursement per calendar year for Basic and Major Restorative services combined will not exceed $1,600 per person.

Some available features include:

Basic Services

• Cavity revealing (Bite Wings) X-rays
• Cleaning of teeth
• Either radiographs or panoramic films (not both)
• Extractions
• Fillings
• Pit and fissure sealant (covered for Dependent Children under 14 years of age)
• Routine examinations
• Topical application of fluoride
• Relining and rebasing of removable dentures
• Root canal therapy (endodontics)
• Treatment of the gums (periodontics)

Major Restorative Services (50% reimbursement)

• Addition of teeth to existing dentures or fixed bridgework
• Initial installation of full or partial removable dentures or fixed bridgework
• Initial provision of crowns, gold inlays or onlays if tooth broken due to injury
• Placement of veneers on anterior teeth only (but not for cosmetic purposes)
• Replacement of existing crowns, inlays and onlays after a period of 5 years since placement of the restoration
• Replacement of existing full or partial removable dentures or fixed bridgework

Termination Age

Your Dental Insurance terminates at age 75.

Note: The Employee Family Assistance Program benefit will be available to all employees and their dependents, regardless of option selected.

This summary is intended to provide a brief description of the benefits available under the CHF Canada group insurance program. This material does not create or confer any rights. The exact terms and conditions of your benefits are outlined in the applicable group benefits agreements or policies. Some restrictions and/or limitations may apply to all benefits mentioned above.

Please contact HUB International for full details.

Accidental Death & Dismemberment (AD&D)

AD&D Insurance provides an added element of protection if you suffer a severe accident which causes death or a loss listed in the Loss Schedule described below.

Features of the AD&D benefit:

1. Pays an additional amount equal to the Basic Life Insurance benefit in the event of accidental death
2. Pays an equal or lesser portion of the death benefit for dismemberment or paralysis due to an accident
3. Coverage for AD&D Insurance matches the level of Basic Life Insurance
4. Coverage reduces by 50% at age 70, and terminates at age 75

Note: The Employee & Family Assistance Program benefit will be available to all employees and their dependents, regardless of whether or not they have AD&D coverage.

This summary is intended to provide a brief description of the benefits available under the CHF Canada group insurance program. This material does not create or confer any rights. The exact terms and conditions of your benefits are outlined in the applicable group benefits agreements or policies. Some restrictions and/or limitations may apply to all benefits mentioned above.

Please contact HUB International for full details.

The CHF Canada’s Employee and Family Assistance Program (by Telus Health, formerly LifeWorks) provides a variety of professional services to support your total well-being. Total well-being can include mental, financial physical, and social well-being, all of which EFAP services can address.

How do I know if EFAP is the right support for me?
A large misconception is that we must be experiencing a crisis in order to reach out to EFAP. It is designed to support you at any point on your well-being journey, from prevention to intervention, and can help you:

• Seek clarity in some areas of life
• Work through complex emotions
• Process a traumatic experience
• Challenge negative thinking patterns
• Learn new techniques to cope with difficult situations
• Move through a big life transition
• Develop new, positive habits
• Focus on personal growth

Confidentiality:
The EFAP program is a confidential service within the limits of the law, the CHF Canada and its co-op member employees will not know you accessed the service unless you choose to share that information.

Services available to:
CHF Canada full-time employees on the Co-operators Group Employee Benefit plan

Modalities include:

Face-to-face Telephonic Video Text Based

Accessible 24 hours a day, 7 days a week:

When calling the EFAP number, you will be connected with a client care representative who can help direct you to the best service for you and your concerns.

Please contact HUB International for full details.

Eligibility Rules: who qualifies and when?

To be eligible, a plan member must:

• Work for a CHF Canada member
• Be a full-time employee who works a minimum of 15 hours per week and has completed the probationary period of 3 months of continuous service. Be a resident of Canada; and
• Not have attained the age of 65 upon receiving application for insurance.

Coverage begins the first day following the 3 months of continuous employments. Premiums are pro-rated to the
date the employees benefits are effective and will appear on the next billing. For example, if the plan member's coverage is effective February 10, premiums will appear on the March bill.

Eligibility Medical Evidence Requirements

Groups with fewer than 3 employee participants:

• All new members need to submit the Co-operators’ Group Health Evidence Questionnaire with their application and be medically approved by the insurer;

Groups with 3 or more employee participants:

• Only require the Co-operators’ Group Health Evidence Questionnaire for amounts over the Guaranteed Issue limits, applying for Optional Life or any Late Applicants applying 31 days after their eligibility grace off period

Additional Provisions

A plan member may cover only one spouse at a time:

• A legal spouse
• A common-law spouse: a common law spouse is eligible for coverage under this agreement when living together in a conjugal relationship with the plan member continuously for a period of not less than one year

Eligibility of Dependent Children

• Dependent children are eligible for coverage as defined in master policy up to their 21^st birthday provided they are not married (or living in a common law relationship) and they are financially dependent on the plan member or the plan member's spouse, or
• Up to 25^th birthday if enrolled and in full-time attendance at an accredited college or university (up to 26^th birthday in Quebec)
• Children over 21 years of age, if they are considered dependent upon the covered plan member by reason of a mental or physical disability (Note: If a dependent child becomes mentally or physically disabled at a later date, please contact HUB International for more information).
• Dependent children are automatically terminated upon reaching the age restrictions outlined in the benefit summary pages of the provision.

Over-age dependent children are eligible for benefits provided he or she is attending a recognized school, college or university on a full-time basis. Full-time attendance means more than ten hours of classroom instruction per week.

Survivor Benefits

In the event of an employee's death, The plan allows for the Spouse and Dependents already covered for Extended Health and/or Dental to maintain the protection. This coverage will be continued without payment of premium but terminates on the earliest
of the following circumstances:

• Upon the termination of the Master Policy; or
• Upon the completion of 24 months from the date of the plan member's death; or
• Upon ceasing to be an eligible Dependent for any reason other than there not being an eligible insured member or insured employee living.

Note: Request for Survivorship should be indicated at the time the death claim is submitted to The Co-operators via toll-free at 1.866.889.9925 or by mail.

For more information contact The Co-operators toll free at 1.800.667.8164 or email [email protected]

Adding Coverage

New Employees

The Plan Administrator should have the new hire complete the appropriate application for group coverage.

Once the Plan Administrator provides details on the plan to the employee, the employee has three options:

• Enrol in the program for ALL benefits; or
• Enrol in ALL benefits except health/dental if comparable coverage is available through a spouse’s plan; or
• Refuse ALL benefits offered under the program

In order to maintain the participation levels outlined in your contract, The Co-operators recommends that enrolment in the program be a condition of employment. Should employees choose to decline benefits, remember that the participation level requirement cannot be compromised.

During the Waiting Period

1. Plan Administrator completes Section 1 of the Group Enrolment or Sections 1 and 2 of the Change Form
2. Employee completes Section 2 to 7 of the Group Enrolment or Sections 3 and 4 of the Change Form
3. Plan Administrator must review the form to ensure that:
   • All sections are complete
   • The new hire has signed up for the correct benefits
   • The application is signed and dated
4. The form must be completed and submitted within 31 days of the end of the waiting period. If there is a discrepancy between this time period and the effective date, please attach a memo to the application card outlining the reason.
5. Mail the original application to The Co-operators at the following address:
   Co-operators Life Insurance Company
   Group Administration Department
   1920 College Ave
   Regina, Saskatchewan S4P 1C4
6. Plan Administrator retains a file copy

After the Expiration of the Waiting Period - "Late Applicant"

An employee who does not complete and sign a Group Enrolment or Change Form within 31 days from the eligibility date will be considered a late applicant.

An employee who is considered a late applicant must submit the Group Health Evidence Questionnaire to The Co-operators for approval. The Co-operators will then advise the Plan Administrator of the carrier’s decision to grant or deny coverage. Coverage commences only when formal written approval is received from the insurance carrier. Dental coverage will also be restricted in the first year of coverage.

The same procedure for late enrolment of employees applies for late enrolment of dependents. An employee must enrol eligible dependents in the plan within 31 days from the date the dependents became eligible for dependent benefits.

1. Plan Administrator completes Sections A and F of the Group Enrolment or Change Form within 31 days from the eligibility date will be considered a late applicant.
2. Employee completes Sections B to E of the Group Enrolment or Change Form
3. Employee completes a Group Health Evidence Form
4. Mail the original application and the original health evidence form to The Co-operators
5. Plan Administrator retains a file copy of each form
6. Plan Administrator will receive a letter advising of The Co-operators’ decision (approval or declination) or of any additional requirements
7. Once approved, the new coverage will be added to your premium statement and an Employee Benefits Program handbook should be provided for the employee. Contact HUB International for a supply of employee handbooks.

For more information contact The Co-operators toll free at 1.888.761.7851 or email [email protected]

Adding or Deleting Dependents

Loss of Spousal Coverage

If an employee initially waives health and dental benefits because he/she had comparable coverage under a spousal plan and his/her spouse subsequently loses coverage, the employee must apply for benefits within 31 days of losing his/her spousal coverage. If an employee does not apply for coverage within 31 days of losing spousal coverage, he/she will be considered a “late applicant” and will have to submit satisfactory evidence of medical health before The Co-operators accepts the employee and dependents onto the plan.

Within 31 days:

1. Plan Administrator completes Section 1 and 2 of the Group Benefits Plan Member Change form. Employee completes Sections 3 and 4 of the Group Benefits Plan Member Change form. Send a copy of the original form via email to: [email protected]
   
   OR 
   
   Via Fax: (306) 761-7373
   
   OR
   
   Via Mail: Co-operators Life Insurance Company
   1920 College Avenue
   Regina, SK
   S4P 1C4
   
   
2. Plan Administrator retains the original in the employee a file

After 31 days:

1. Plan Administrator completes Section 1 and 2 of the Group Benefits Plan Member Change form within 31 days from the eligibility date will be considered a late applicant.
2. Employee completes Sections 3 and 4 of the Group Benefits Plan Member Change form
3. Employee completes a Group Health Evidence form
   
   Send the original Group Benefits Plan Member Change form and the original Group Health Evidence form via mail to:Co-operators Life Insurance Company
   
   1920 College Avenue
   
   Regina, SK
   
   S4P 1C4
   
   
4. Plan Administrator retains a file copy of the Group Benefits Plan Member Change form
5. Plan Administrator will receive a letter advising of The Co-operators’ decision (approval or declination) or of any additional requirements

Gain of Spousal Coverage

An employee can waive his/her right to health and/or dental benefits under CHF Canada’s program if comparable spousal coverage is available.

1. Employee completes Group Benefits Plan Member Change form
2. Send a copy of the original form via email to: [email protected]
   
   OR
   
   Via Fax: (306) 761-7373
   
   OR
   
   Via Mail: Co-operators Life Insurance Company
   1920 College Avenue
   Regina, SK
   S4P 1C4
   
   
3. Plan Administrator retains the original in the employee a file

Note: If the other coverage terminates, plan members can opt back into this plan without providing evidence of good health, provided they notify The Co-operators within 31 days of the termination of the other coverage. If there is a lapse in coverage or we receive notice after 31 days, the plan member and dependents will be considered late applicants.

Any questions or for more information contact The Co-operators Group Client Service Team toll free at 1-800-667-8164 or email [email protected]

Changing Name or Beneficiary

Changing Beneficiary

1. Employee completes the Plan Member Change form
2. Mail the original form to The Co-operators

Note: It is important to keep an employee’s beneficiary designation up-to-date as the insurance carrier will pay life benefit proceeds to the last named beneficiary only.

Changing Name

1. Plan Administrator completes Section 1 and 2 of the Group Benefits Plan Member Change form. Employee completes Sections 3 and 4 of the Group Benefits Plan Member Change form.
2. Send a copy of the original form via email to: [email protected]
   
   OR
   
   Via Fax: (306) 761-7373
   
   OR
   
   Via Mail: Co-operators Life Insurance Company
   1920 College Avenue
   Regina, SK
   S4P 1C4
   
   
3. Plan Administrator retains original in employee a file

Any questions or for more information contact The Co-operators Group Client Service Team toll free at 1-800-244-3184 or email [email protected]

Changing Salary

Note: Failure to submit salary changes within 31 days could result in a reduced benefit in the event of a life or disability claim.

Individual Salary Changes

1. Plan Administrator completes Section 1 of the Group Benefits Plan Member Change form. Send the copy of
   the form via email to: [email protected]
   
   OR
   
    Via Fax: (306) 761-7373
   
   OR
   
   Via Mail: Co-operators Life Insurance Company
   1920 College Avenue
   Regina, SK
   S4P 1C4
2. Plan Administrator retains original in employee a file

Mass Salary Changes

1. If there are several salary changes to be made in a given period, the Plan Administrator completes the Group Policy Change Form
2. Submit the form to The Co-operators via fax at (306) 347-6812 or by mail.

Any questions or for more information contact The Co-operators Group Client Service Team toll free at 1-800-667-8164 or email [email protected]

Terminating Employment

Individual Terminations

1. Plan Administrator immediately completes Sections 1 and 2 of the Group Benefits Plan Member Change form
2. Send a copy of the original form via email to: [email protected]
   
   OR
   
   Via Fax: (306) 761-7373
   
   OR
   
   Via Mail: Co-operators Life Insurance Company
   1920 College Avenue
   Regina, SK
   S4P 1C4 
   
   
3. Plan Administrator retains original in employee file

Mass Terminations

1. If there are several terminations to be made in a given period, the Plan Administrator completes Group Policy Change Form
2. Submit the form to The Co-operators via fax at (306) 761-7373 or by mail.

Any questions or for more information contact The Co-operators Group Client Service Team toll free at 1-800-667-8164 or email [email protected]

Maternity Leave

An employee on maternity or parental leave may be eligible to keep all benefits. Contact your local Labour Standards office for details. The employee must keep all of the coverages that were in force prior to the maternity or parental leave OR opt out of all of these coverages until his/her scheduled return to work date.

1. If the employee elects to continue all benefits while on a maternity leave, there are no forms to complete
2. If the employee elects to discontinue all benefits while on a maternity leave, the Plan Administrator terminates the employee by completing the Plan Member Change Form
3. Submit the form. Send a copy of the original form via email to:

[email protected]

OR

Via Fax: (306) 761-7373

OR

Via Mail: Co-operators Life Insurance Company
1920 College Avenue
Regina, SK
S4P 1C4

Any questions or For more information contact The Co-operators Group Client Service Team toll free at 1-800-667-8164 or email [email protected]

Transfers

A transfer is when an employee moves to a different account within the same group

1. Account transfers must be reported by BOTH the employer who the individual is transferring TO and the employer that the individual is transferring FROM.
   • Transferring FROM - should be reported as a termination, the Plan Administrator must complete the Plan Member Change Form
   • Transferring TO - should be reported as an addition, the Plan Administrator Both employers must complete the Plan Member Enrolment.
2. Submit the form. Send the original form via email to:

[email protected]

OR

Via Fax: (306) 761-7373

OR

Via Mail: Co-operators Life Insurance Company

1920 College Avenue

Regina, SK

S4P 1C4

Any questions or for more information contact The Co-operators Group Client Service Team toll free at 1-800-667-8164 or email [email protected]

Severance Package

In certain circumstances, The Co-operators will agree to extend coverage for severed employees providing The Co-operators receive a request from the employer to do so prior to the severance taking effect.

1. Plan Administrator completes the Group Benefits Request for Coverage Extension
2. Send via email to: [email protected]
3. Plan Administrator reatins the original request in the employee file

The Co-operators will not agree to extend short term disability, long term disability, or out-of-country coverage.

For further assistance regarding Request for Extensions, please contact The Co-operators toll free at 1.888.761.7851 or email [email protected]

Converting Benefits

It is very important that you inform the terminating (or retiring) employee of their right to convert benefits.

The employee is eligible to convert Group Life Insurance to an individual policy. The Co-operators must receive the conversion application within 31 days of the termination date. Plan Member can find a list of Co-operators advisors on www.cooperators.ca. the advisor will help the plan member assess his or her needs and choose a suitable policy.

The employee is also eligible to convert extended health and dental care benefits to an individual policy within 60 days of termination under the group plan. Please note that the individual policies do not provide coverage that is identical to the group plan. For more information regarding the application process please contact HUB International.

Applying for Optional Life and Optional Spousal Life Insurance

Under your group insurance program, an employee is eligible to apply for optional life and optional spousal life insurance at any time.

1. Employee completes an Optional Life Insurance Application indicating the additional amount of insurance for which the employee wishes to apply
2. Submit the form. Send the original form

Via Fax: (306)-347-6180 or toll-free: 1-866-889-9924

OR

Via Mail: Co-operators Life Insurance Company
Attn: Group Medical Underwriting Department
1920 College Avenue
Regina, SK
S4P 1C4

1. Employee should retain a photocopy for his/her files
2. Employee will receive a letter advising of The Co-operators’ decision (approval or declination) or of any additional requirements. The Plan Administrator will receive a carbon copy of that letter
3. Once approved, the new coverage will be added to your premium statement from The Co-operators

Any questions or for more information contact The Co-operators Group Client Service Team toll free at 1-800-244-3184 or email [email protected]

Pay-Direct Drugs

Note: All adjudication is provided by Co-operators.

This plan is made available as part of the benefit package through The Co-operators. The plan allows employees to pay only their portion of the drug cost directly to the pharmacist. The rest of the cost is billed directly to the plan. This eliminates the need for employees to pay the full cost of the prescription and then submit a claim form to The Co-operators for reimbursement.

If, for any reason, the employee’s pay-direct drug card was not used at the point of sale, simply have the employee complete the Extended Health Care Claim Form and attach the original receipt(s). Please send the claim form along with the receipt directly to the Co-operators.

Health and Vision Care Claims

Plan Members have the option to submit claims online through Benefits Now(R) for Plan Member or through the Benefits Now Mobile App for iPhone and Android(TM)

or

1. The Co-operators provides an Extended Health Care Claim Form for all non-drug health claims (e.g., paramedical practitioners, supplies, services etc.)
2. Employee completes and signs Parts 1 and 2 of this form
3. Employee attaches original receipts when submitting a claim (photocopies are not accepted)
4. Employee may submit claims directly to The Co-operators Note: For orthotics and certain paramedical practitioners, an authorization from a physician is required – please refer to the employee handbook for additional details.

Dental Claims

Plan Members have the option to submit claims online through Benefits Now(R) for Plan Member or through the Benefits Now Mobile App for iPhone and Android(TM)

or

1. Dental claims are submitted using The Co-operators’ Dental Claim Form (a standard dental claim form available at most dental offices may also be used)
2. Employee completes and signs this form
3. Employee attaches original receipts when submitting a claim (photocopies are not accepted)
4. Employee may submit claims directly to The Co-operators

Note: For any extensive course of treatment involving crowns, bridgework, etc., which may exceed $300, a detailed treatment plan must be submitted to the Insurance Company for assessment before any treatment, other than necessary emergency treatment, commences. The Covered Person will then be advised of the estimated amount payable by the Insurance Company for the Covered Dental Expense. Send estimates to The Co-operators, attention of Dental Claims Department, to determine how the expenses will be reimbursed prior to incurring the expense.

Disability Claims

Please refer to The Co-operator’s Disability Claims Guide for complete details of the requirements of a disability claim as well as answers to some frequently asked questions.

Short Term Disability

1. The employee must complete an Application for Short Term Disability
2. There are three forms which must be completed for a short term disability claim:
   • Section I: Physician's Statement
   • Section II: Employer Statement
   • Section III: Employee Statement
3. Once completed by the appropriate individuals, the employee mails all forms to The Co-operators

Note: Claims should be submitted as soon as possible after the date of disability for a short term disability claim. Benefits commence on the 15^th calendar day of disability.

Long Term Disability

1. The employee must complete an Application for Long Term Disability. Benefits start on the 120th day of continuous disability.
2. There are three forms that must be completed for a long term disability claim:
   • Section I: Employee Statement
   • Section II: Physician's Statement
   • Section III: Employer Statement
3. Once completed by the appropriate individuals, the employee mails all forms to The Co-operators
4. Claims should be submitted six to eight weeks before the end of the elimination period for a long term disability claim
5. If the employee is eligible for WSIB benefits, the employee will receive a Worker's Compensation claim form from his/her physician

Employee Or Spousal Life Insurance Claims

1. In the event of the death of an insured employee or spouse, the employer and claimant complete the required statements of the Notice of death for The Co-operators Life Insurance Company
2. For claims of $25,000 and over: submit a Proof of Death – Physician’s Statement
3. For claims of under $25,000: a certified copy of the Funeral Director’s Statement is sufficient
4. If the deceased was over the age of 60, a photocopy of the Birth Certificate is also required (if available)
5. Once all completed forms and supporting documents are collected, forward them to The Co-operators

Note: Upon approval of a claim, the claim settlement cheque is sent directly to the beneficiary – the services of a lawyer are no usually required in submitting a claim for death benefits. If the beneficiary is the estate, The Co-operators will require a notarized copy of the will and the certificate of appointment of Estate Trustee.

Total Disability Waiver Of Premium For Life Insurance Benefits

Consult your contract regarding the waiting period that is specified (e.g., the disability must be continuous for a period of nine months before a waiver claim can be submitted). Arrange to have claim forms provided to the disabled employee around the end of the waiting period.

Note: If an employee is receiving long term disability benefits with The Co-operators, a separate application will not be required.

1. The employee must complete an Application for Long Term Disability
2. There are three forms that must be completed for a long term disability claim:
   
   • Section I: Employee Statement
   • Section II: Physician's Statement
   • Section III: Employer Statement 
3. Once completed by the appropriate individuals, the employee mails all forms to The Co-operators

Living Assistance Benefit

The living assistance program is made available as an advanced life insurance payment to help meet the expenses of terminally ill individuals who are covered by the group life insurance plan. Please refer to your employee handbook for further information regarding this benefit.

1. The employee must complete an Application for Living Assistance
2. The Co-operators will contact the individual’s doctor requesting medical information regarding his/her condition
3. The decision made by The Co-operators is final and binding and cannot be appealed. However, if his/her condition worsens, he/she may re-apply

Accidental Death Claims

1. In the event of the accidental death of an insured employee or spouse, the employer and claimant complete the required sections of the Notice to Co-operators Life Insurance Company
2. The claimant also completes a Claim for Accidental Death Benefit Form
3. Accidental death claims should be submitted with the following supporting documents:
   1. A certified copy of the Funeral Director’s Statement or a Medical Examiner’s Report
   2. A copy of the police investigation report
   3. An autopsy report
   4. If the deceased was over the age of 60, a photocopy of the Birth Certificate is also required (if available)
4. Once all completed forms and supporting documents are collected, forward them to The Co-operators

Note: The outcome of an accidental death claim will also depend on the findings of a Coroner’s Report, which The Co-operators will request from the Coroner directly. The Co-operators’ decision may take up to six months. Upon approval of a claim, the claim settlement cheque is sent directly to the beneficiary – the services of a lawyer are not usually required in submitting a claim for death benefits. If the beneficiary is the estate, The Co-operators will require a notarized copy of the will and the certificate of appointment of Estate Trustee.

Accidental Dismemberment Claim

1. In the event of an accidental dismemberment claim for an insured employee or spouse, the employer and claimant complete a Dismemberment Statement form
2. There are three sections that must be completed on a Claim for Accidental Dismemberment Benefit form:
   • Section I: Statement of Group Employer/Group Policyholder
   • Section II: Statement of Claimant
   • Please include the Dismemberment Physician Statement form
3. Note: Please ensure that the specific loss suffered is clearly indicated.
4. Once completed by the appropriate individuals, mail all sections of the claim to The Co-operators

Note: Settlement of accidental dismemberment claims will be sent directly to the claimant.

For further assistance regarding any aspect of a claim, please contact The Co-operators Group Client Service Team toll free at 1-800-667-8164 or email [email protected]

Becoming a member

Q: HOW DO I BECOME A MEMBER OF CHF CANADA?
A: Housing Co-ops of all sizes, and other organizations and individuals that support housing co-operatives are eligible for membership. Interested candidates should contact the Co-operative Housing Federation of Canada.

Q: HOW DO I BECOME ELIGIBLE FOR PARTICIPATION IN THE CHF CANADA EMPLOYEE BENEFITS GROUP?
A: Participation in CHF Canada’s Volume Purchasing Program is an exclusive membership privilege offered by CHF Canada. All members of CHF Canada are eligible to participate in CHF Canada’s Employee Benefits Program. Interested members or prospective members should contact HUB International.

Billing

For all billings inquiries, please call The Co-operators at 1-800-667-8164.

Eligibility

Q: WHO IS CONSIDERED AN ELIGIBLE EMPLOYEE?
A: Employees are eligible for benefits if they are under age 65 and work at least 15 hours per week.

Q: WHO IS CONSIDERED AN ELIGIBLE DEPENDENT?
A: Eligible dependents include spouses (legally married or common-law partners, including same-sex partners) and children up to age 21, or age 25 if a full-time student. A student must be taking at least 10 credit hours of classroom instruction at an accredited educational institution to be considered a full-time student.

Q: IS MEDICAL APPROVAL REQUIRED IN ORDER TO JOIN THE PLAN?
A: No medical approval will be required in order to join the plan if employees sign up for coverage within 31 days of being eligible. Only Optional Life Insurance and Long Term Disability coverage over $2,780/month, or groups with 1-2 employees require medical approval.

Travel Insurance

Q: AM I COVERED FOR MEDICAL TREATMENT AWAY FROM MY PROVINCE OF RESIDENCE?
A: Yes, if you are covered under the Extended Health Care benefit. The emergency medical travel assistance service provides you and your eligible dependents with 24 hour access to medical assistance in the event of an emergency covered by your Extended Health Care benefit

If a medical emergency arises while traveling, notify the emergency travel medical assistance service within 48 hours following your emergency:

Canada and U.S.A. 1-888-440-2667

416-340-1316 (call collect) outside Canada or U.S.A

In an effort to continually improve the glossary, we welcome all suggestions. If you need help with a particular word and cannot find it in the glossary, please let us know

A

• Accidental Death & Dismemberment - A lump sum payment if the insured dies as a result of an accident or loses eyesight, hearing, or appendages (i.e. arms, legs, feet and hands).
• Acupuncture - Services provided within their specialty by acupuncturists authorized to practice acupuncture in Canada or in the province where the services are provided.
• Administrator - Individual or company responsible for administering the group insurance contract including the accounting and enrollment.
• Adverse Selection - Persons poorer-than-average health (or health expectations) tend to apply for greater insurance coverage than do persons in average or better health.
• Age Reduction - A reduction in the amount of insurance when a person reaches a certain age. See Termination age
• Aggregate - When referring to a family deductible or out-of-pocket maximum, aggregate implies that the family charges may total up to the maximum, as long as one member-  meets the individual amount.
• Allowable Expense - Any claims that meet the criteria of the insurance policy which you are covered by.
• Annual Maximum - The maximum amount any one individual may receive, per year, under an insurance contract.
• Anti-selection - The selection of coverage beneficial to the employee but not beneficial to the plan itself.
• Association Group Plans Health - plans designed for members of an association.
• Audiology - Services provided within their specialty by audiologists authorized to practice audiology in Canada or in the province where the services are provided.

B

• Basic Life Coverage The base (core) life insurance plan, offered either as a lump sum or in multiples of salary. If desired, additional life coverage can be added to Basic Life to increase the coverage: see Optional Life Coverage.
• Beneficiary The person designated by the insured to receive Group Life and/or Accidental Death Benefits upon the death of the insured.
• Benefit The amount payable by the insurance company to the holder, assignee or beneficiary of the insurance policy when a loss covered by the policy occurs.

C

• Canada Pension Plan (CPP) - Government plan that pays a monthly pension to eligible individuals. See Offsets.
• Carrier - The insurer who agrees to underwrite the group contract and provide certain types of coverage and service.
• Child, Handicapped - Specific provision in contract for the continuing coverage of dependent child regardless of age, if handicapped and unable to provide for themselves.
• Chiropractic - Services provided by a member the Canadian Chiropractic Association or an affiliated provincial association.
• Claim - A demand by the insured person to the insurer for the payment of benefits. See Notice and Proof of Claim.
• Claimant - A plan beneficiary exercising his/her right to receive benefits.
• Claims Paid - Cheques paid out to claimants by the insurance company. The checks are considered Paid Claims if they either are dated within the policy year or are cleared by the banks within the policy year.
• Class - A categorical listing of insurance coverage which an individual is placed into to determine eligible coverage under the policy.
• Co-ordination of Benefits - A policy which will determine how benefits will be calculated if the claimant is insured under several group contracts insuring the same event.
• Coinsurance - The insured and the insurer share the cost of the claim within a specified ratio. For example, the insurer pays 80%, the insured pays 20% of the claim expense. The amount paid by the Insurer is the Coinsurance, and the amount paid by the Insured is the co-pay.
• Common-Law Marriage - Two persons who have been cohabiting and residing with each other for a continuous period of at least one year, and who’s spousal relationship has been publicly recognized.
• Consumer Price Index - Price index produced by Statistics Canada that measures the percentage variation over time of the cost of purchasing a specific list of goods.
• Consultant - A person or firm specializing in the design, sale and service of employee benefit plans.
• Contributory - A portion of the premium paid by the employee is required.
• Contributory Plan - A plan which requires employees to pay part of the cost for the benefit plan.
• Convalescent Hospital - Facility that provides rehabilitative care and is eligible under the provincial hospital insurance legislation.
• Conversion - The individual has the right to convert group insurance coverage to an individual plan without presenting evidence of insurability if converted within 31 days of termination.
• Coverage - A classification of benefits provided under a group policy or the amount of insurance or benefits stated in the group policy for which an insured is eligible.

D

• Deductible - An amount of expenses that must be paid by the insured before any benefits become payable.
• Definition of Disability - See Permanent and Total Disability and Two Year Own Occupation.
• Dependent - The employee's spouse or children.
• Dependent Life - Life Insurance issued for the spouse and children with the employee as the beneficiary.

E

• Effective Date - The date a policy becomes effective. If the hour is not specified, the effective time is 12:01 a.m. on the appropriate date.
• Eligible Employees - Employees who have met the requirements under the group policy for insurance.
• Employee Benefit Program - A program through which various benefits are offered to employees by their employer to cover such contingencies as medical expenses, disability income, retirement and death; usually paid for wholly or in part by the employer. Such benefits frequently are referred to as "fringe benefits" because they are separate from wages and salaries.
• Evidence of Insurability - Proof presented through written statements on an application form, and/or through a medical examination, that an individual is eligible for a certain type of insurance coverage.
• EOB - Once a claim has been processed, the subscriber will receive an Explanation Of Benefits statement. The following information is detailed on the EOB actual charges, allowed charges, deductible and coinsurance amounts, total benefits payable and the claimant responsibility

F

• Family - Two spouses who are legally married or living common-law, or one or two adults (legally married or living common-law) and their dependent children.

G

• Group Insurance - Insurance issued, usually without medical examination, on a group of people under a master contract. It is usually issued to an employer for the benefit of employees. The individual members of the group hold certificates as evidence of their insurance.
• Group Insurance Change Form - A form used to submit additions, changes and terminations for processing by the premium administrators.
• Group Life - Insurance covering a group of employees under one life insurance policy.
• Guaranteed Issue - Maximum amount of benefit that will be provided without the need for evidence of insurability.

H

I

• Insured - The member who is covered by the policy.
• Insurer - The insurance carrier who agrees to underwrite the group contract and provide certain types of coverage and service.
• Indemnity Plan - Plan which restores or reimburses one to the extent of their loss.

J

K

L

• LTD - Long Term Disability insurance provides income protection in the event of time lost due to sickness or accident of long term nature. Generally monthly payments commence after a specified waiting period and continue while the employee remains disabled usually up to a specified age. See Definition of Disability, Permanent and Total Disability, Period of Disability, Two Year Own Occupation and Offsets.

M

• Massage Therapy - Services provided within their specialty by individuals authorized by a recognized provincial association to practice massage therapy. (Where such an association does not exist, individuals who, in the insurer’s opinion, have similar qualifications.)
• Maximum Benefit - The maximum amount any one individual may receive under an insurance contract. See Annual Maximum.

N

• Naturopathy - Services provided within their specialty by members of the Canadian Naturopathic Association or an affiliated provincial association.
• Non-Evidence Maximum (NEM) - The maximum amount of insurance coverage one may receive before Evidence of Insurability is required.
• Notice and Proof of Claim - The policy will specify time limits for giving notice, and then proof of claim. It also specifies the manner in which the proof of loss must be submitted.
• Nursing Home - Facility housing (elderly) individuals who, due to a reduction in their physical or psychological autonomy, must live in a sheltered environment.

O

• Occupational Therapy - Services provided within their specialty by occupational therapists authorized to practice occupational therapy in Canada or in the province where the services are provided.
• Offsets - Reductions to one’s Long Term Disability benefit in order to offset other sources of income such as Worker’s Compensation, CPP, QPP, etc.
• Old Age Security (OAS) - A federal retirement income program providing pension benefits to those 65 or older, with residence in Canada for at least 10 years.
• Optional Life Coverage - Option to purchase additional life insurance over and above Basic or core life insurance coverage. Optional Life frequently requires applicants to provide additional personal information. See Evidence of Insurability.
• Orthotherapy- Services provided within their specialty by orthotherapists authorized to practice orthotherapy in Canada or in the province where the services are provided.
• Osteopathy - Services provided within their specialty by holders of a doctorate in osteopathy conferred by a college of osteopathy approved by the Canadian Osteopathic Association.
• Out-of-Country Expenses - Expenses incurred by an insured or insured dependent for emergency services and treatment of bodily injury or disease while travelling outside Canada.
• Out-of-Pocket Expenses - Those medical expenses which an insured is required to pay because they are not covered under the group contract.
• Out-of-Pocket Maximum - The maximum amount of coinsurance an insured is required to pay before the plan will pay 100% .
• Over-the-Counter Drug - Drug that can be purchased without a prescription.

P

• Payroll Deduction - The amount taken from the employee's earnings with their consent, as contribution toward the cost of the group insurance plan.
• Period of Disability - The period during which an employee is prevented from performing the usual duties of his/her occupation or employment or during which a dependent is prevented from performing the normal activities of a healthy person of the same age or sex. More than one cause (accident or sickness) may be present during or contribute to a single period of disability. See Two Year Own Occupation.
• Permanent and Total Disability - A disability that will presumably last for the insured's lifetime and prevents engagement in any occupation for which the insured is reasonably fitted. See Offsets.
• Physiotherapy - Services provided within their specialty by members of the Canadian Physiotherapy Association or an affiliated provincial association..
• Podiatry - Services provided for foot health by individuals authorized to practice.
• Pooling - The combination of all premiums, claims, expenses for certain size cases, types of coverage or excess classes in order to spread the risk.
• Pre-Existing Condition - Any physical and/or mental condition or conditions that existed prior to the effective date of coverage under a contract.
• Premium - The amount paid to the insurer for the insurance protection.
• Prescription Drug - Drug that cannot be obtained without a prescription from a physician or dentist.
• Provision - A part of a group insurance contract that explains or describes a feature, benefit, condition, requirement, etc., of the insurance protection afforded by the contract.
• Psychology - Services provided within their specialty by permanently recognized psychologists whose names appear in the registry of psychologists of the province where the services are provided.

Q

• QPP Québec Pension Plan. See Offsets.
• Québec Pension Plan - Government plan that pays a monthly pension to eligible individuals.

R

• Reasonable and Customary - This term refers to limiting benefit payments to fees which are reasonable and representative for the service rendered, under the circumstances rendered, by the physician rendered.
• Recurring Disability - A case where if a second disability occurs related to the first disability within a specified period of time, the second disability will be a continuation of the first disability claim.
• Rehabilitation - Refers to a provision in many long-term disability (LTD) plans that enables the insured claimant to receive at least partial benefits while undergoing retraining and seeking new employment.
• Rehabilitative Employment - Any occupation or work for compensation or profit approved by the Insurer and undertaken by the insured while unable to work on a full-time basis usually in conjunction with a LTD plan.
• Renewal Date - The date when the insurance policy is to be reviewed for experience and the rates are adjusted.
• Retention - The portion of the premium retained by the insurance company to cover expenses and provide profits.
• Retirement - Permanent withdrawal from the labor force.

S

• Salary - Base salary, excluding bonuses.
• Secondary Payer - The plan that pays second when you have coverage through two benefit plans (yours and your spouse's plan). This is known as co-ordination of benefits where you can be reimbursed up to 100% (but not more) when you submit your claim to both benefit plans.
• STD - Short-Term Disability benefit provided to employees who are absent from work due to illness or disability. Short Term Disability (also known as Weekly Indemnity or Sick Leave) usually has a maximum amount of time the benefit will last.
• Sickness - Illness not arising from accident or injury. Usually the sickness causing disability must be contracted by the insured while the policy is in effect. Some policies require that the sickness need only manifest itself while the policy is in effect.
• Single - An unmarried person with no dependent children.
• Smoker - A smoker is defined as someone who has smoked cigarettes at least once in the last 12 months.
• Speech Therapy - Services provided within their specialty by holders of a master’s degree in speech therapy who are a member of the Canadian Association of Speech-Language Pathologists and Audiologists or an affiliated provincial association or who satisfies the conditions for membership in this association.
• Spouse - The person to whom you are lawfully married; or a person who has been cohabiting and residing with you for a continuous period of at least one year, and has been publicly represented by you as your spouse.
• Subject to Insurability - A statement of proof of a person's physical condition, occupation or other factor affecting his or her acceptance for insurance is required.
• Survivor Benefits - Allows dependent family members of a deceased employee to have continued coverage for a specified period; premiums are often waived during this period. See Waiver of Premium.

T

• Term Life Insurance - Life insurance plan that terminates when employment ceases. Conversion policies are available.
• Termination - An employee who terminates employment with the employer or withdraws from a group plan offered by the employer.
• Termination Age - Specified age when an employee loses insurance coverage. See Age reduction.
• Total Disability - Inability to perform all of the duties of one's regular occupation or the duties of any occupation for which the individual may become fitted due to education, training or experience.
• Twenty-Four Hour Coverage - Insurance providing benefits for an accident or sickness incurred either on the job or off the job.
• Two-Year Own Occupation - Common disability definition stating that the employee is disabled for his or her own occupation during the first two years of disability and thereafter is disabled for any occupation that is suitable by virtue of past training, education or experience.

U

• Underwriting - The process by which an insurance company determines whether or not it will accept an application for insurance.

V

• Voluntary - Chosen by one's own consent. Often refers to lack of minimum enrollment requirements.

W

• Waiting Period - A period of time that must pass in order for an individual to become eligible for benefits under a group insurance policy.
• Waiver - An agreement attached to a policy which exempts from coverage certain disabilities normally covered by the policy.
• Waiver of Premium - A provision that under certain conditions a person's insurance will be kept in full force by the insured without further payment or premiums. It is used most often in the event of permanent and total disability.
• Worker's Compensation Act - A statute imposing liability on employers to pay benefits and furnish care to employees injured and to pay benefits to dependents of employees killed, in the course of and because of their employment. See Offsets.

X

Y

Z

It's as easy as a click. The following forms are available to print, fill out, and fax or mail in. They are provided in Adobe Acrobat PDF format. If you do not have Acrobat Reader, download it free of charge from Adobe's web site.

Plan Descriptions
CHF Canada Benefit Option Brochures for Co-ops for 1-2 Employee Co-ops
CHF Canada Benefit Option Brochures for Co-ops for 3 or more employees
EFAP Brochure
Standard Employee Benefits Program for 1-2 Employee Co-ops
EFAP website

Enrolment & Changes
Group Benefits Plan Member Enrolment Form
Group Benefits Plan Member Change Form
Optional Life Insurance Application Form - Employee & Spouse
Policy Change Form
Payment by Monthly Pre-Authorized Chequing Form
Health Evidence Form
Group Benefits Student Eligibility Form
Request to Waive Waiting Period
Request to Waive Waiting Period (FR)
Notice of Return to Work Claim for Group Disability Benefits

Life Claims
Notice of Death – Claimant Statement
Notice of Death – Plan Sponsor Statement
Proof of Death – Physician's Statement

Disability Claims
Employer Guide to Disability claims
Living Assistance Benefit – Plan member agreement and application
Long Term Disability – Attending Physician's Statement
Long Term Disability – Plan member guide and application
Long Term Disability – Plan Sponsor Statement
Short Term Disability – Attending Physician's Statement
Short Term Disability – Plan member guide and application
Short Term Disability – Plan Sponsor Statement

Health & Dental Claims
Standard Dental Claim Form
Claim Form for Extended Health Benefits
Request for Brand Name Drug Coverage

AD&D Claims
Dismemberment – Physician Statement
Dismemberment Statement

Corporate Sites
Telus Health Corporate Site
Co-operative Housing Federation of Canada

Benefits Sites
The Co-operators
Benefits Now for Plan Sponsor
Benefits Now Plan Member
Canadian Dental Association

Government Sites
Canada Customs and Revenue Agency (formerly Revenue Canada)
Canada Pension Plan (CPP)
Employment Insurance
Health Canada
Human Resources Development Canada
Old Age Security
Quebec Pension Plan (QPP)
Workers Compensation

Provincial and Territorial Health Care Links
Newfoundland & Labrador (MCP)
Prince Edward Island
Nova Scotia
New Brunswick
Quebec - RAMQ
Ontario (OHIP)
Manitoba
Saskatchewan
Alberta (AHCIP)
British Columbia (MSP)
Yukon
Northwest Territories
Nunavut

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