A Late Applicant is a person who has not enrolled in the benefit program within 30 days from your eligibility date. At this point, you and your dependents are required to complete a health questionnaire and the insurance company will review this information to determine if you will be approved or declined coverage.

If approved, you will be subject to lower benefit maximums for the first 12 months of coverage.

You must inform your administrator within 30 days of acquiring a new dependent. This means, 30 days after a marriage, birth, adoption or qualifying as common-law, etc. This will ensure that coverage is extended to your new dependent.

If your dependent is not added within the 30 day time frame, completion of a health questionnaire about your dependent will need to be submitted to the insurance company for review. At this point the insurance company can approve or decline coverage.

Your common-law spouse is eligible to join your plan as your dependent, after you have co-habitated for a minimum of 12 months. After 12 months, you have 30 days to add your common-law spouse to your benefit plan.

If you have a change in your marital status, it is important to advise your administrator and complete a form to amend your beneficiary accordingly. This change is often overlooked and Life Insurance claims could be paid to an ex-spouse, if records are not current.

If your children are under the age of 19, it is important to designate a Trustee to receive the insurance claim on their behalf. If no Trustee is assigned, the insurance company will either hold the claim payment until your child reaches the age of 19 or pay it to your estate.

If you do not complete all sections of your claim form, it will be returned to you, along with the original claim receipts. You will must complete the form in its entirety and resubmit to the insurance company.

Note: All claims and correspondence must include your certificate number and group policy number.
Without this information, your claim may be lost.

If both you and your spouse have group insurance coverage, all claims for each person must first be submitted to your own plan. Your children’s claims must be submitted to the parent’s plan whose birthday is first in the calendar year. If there is a portion of the claim not covered by the first insurance company, the remainder can be submitted to the other parent’s plan for payment of the balance.

If you are the only parent in the family with a drug card, the card will only work for your children if your birthday is first in the calendar year.

Some drugs may move from legally requiring a prescription, to an over-the-counter drug. When this occurs, it will no longer be eligible for reimbursement under your benefit plan. Only drugs which legally require a prescription will be covered.

Your insurance company reserves the right to change the formulary. Therefore, there may be instances where a drug was eligible in the past, but is no longer covered under your benefit plan.

There may also be instances where a drug was not properly adjudicated in the past and was paid in error. This would require further investigation.

Employee benefits, provided through your employer, terminate on the same day as your employment terminates. The only exception to this provision is the Basic Life Insurance. You have 30 days from date of termination to convert your Basic Life Insurance into a personal individual policy. You are charged a rate based on your age at the time of your termination. Should you die within the 30 day provision period, benefits will be paid to your beneficiary, as if you were still employed.