ADMINISTRATION

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					        ADMINISTRATION
                        Guide



The National Financial Co-operatives Benefit Plan




              (Last update - February 2011)
Introduction
The purpose of this Group Insurance Administration Guide is to simplify your part in the administration of your Group
Insurance program. The Guide has been designed to outline the administrative procedures of your plan.

The Guide reflects the administrative procedures of your plan, however, this information in no way modifies the
provisions of your master policy. In determining the rights and obligations of both the employer and the employees,
the provisions of your master policy apply.

Although the administrative procedures of your plan have been documented as fully as possible, certain situations
may arise which require further explanation. Contact your local Great-West Life Group Office if you need help.




                                                          2
Table of Contents
Contacts                                      Page 4
Ordering Supplies                             Page 6

Forms                                         Page 7

Definitions                                   Page 8

Employee Additions                            Page 10

Late Applicants                               Page 12

Beneficiary Designations                      Page 14

Excess Insurance                              Page 16

Employee Changes                              Page 17

Terminations and Life Conversion              Page 19

Health & Dental Claims                        Page 21

HCSA                                          Page 26

Survivor Benefits                             Page 31

Life Claims                                   Page 32

Accidental Death & Dismemberment Claims       Page 34

Life Waiver of Premium                        Page 35

Disability Claims                             Page 36

Best Doctors                                  Page 39

Critical Illness Claims                       Page 40

CONTACT/EAP                                   Page 41

Optional Benefits (Life and AD&D)             Page 42

Plan Direct – Early Retirees                  Page 44

Premium Statement                             Page 45

Policy Number Summary                         Page 47




                                          3
Contacts
Group Sales and Service Office

       Calgary Group Sales (for MB, SK, AB Credit Unions)
       Stock Exchange Tower, Suite 1400, 300 - 5th Avenue S.W.
       Calgary, AB, T2P 3C4
       Carrie Versfeld, Senior Specialist, Client Service
       carrie.versfeld@gwl.ca
       Phone: (403) 515-5911
       Fax: (403) 234-0011

       Toronto Group Sales (for ON Credit Unions)
       330 University Ave. Suite 400
       Toronto, ON M5G 1R8
       Louise Meacoe, Senior Representative, Client Service
       louise.meacoe@gwl.ca
       Phone: (416) 552-5759
       Fax: (416) 552-5020

       Atlantic Provinces Group Sales (for NS, NL Credit Unions)
       1900 - 1801 Hollis St.
       Halifax, NS, B3J 3N4
       Darci Fisher, Associate Manager, Client Service
       darci.fisher@gwl.ca
       Toll Free: 1-888-260-4440
       Phone: (902) 496-3594
       Fax: (902) 429-0998

       Atlantic Provinces Group Sales (for NB Credit Unions)
       1900 - 1801 Hollis St.
       Halifax, NS, B3J 3N4
       Natasha Tremblay, Client Service Representative
       natasha.tremblay@gwl.ca
       Toll Free: 1-888-260-4440
       Phone: (902) 429-8427
       Fax: (902) 429-0998

Administration:
Member Administration (Applications for Late Applicants, Excess Insurance and Optional Life):

       Member Administration
       P.O. Box 6000
       Winnipeg, MB, R3C 3A5
       Fax: (204) 946-8603
       Email: memberadmin@gwl.ca
       8am - 4pm Central

Premium Payment

       Group Insurance Payment Administration
       P.O. Box 1053
       Winnipeg, MB, R3C 2X4




                                                    4
Claims
Life Claims and AD&D Claims

        Group Life Claims
        P.O. Box 6000
        Winnipeg, MB, R3C 3A5
        Phone: (204) 946-4096

Disability Management Services Office (DMSO)
For Disability Claims including Early Referral and Waiver of Premium Claims:

        Calgary Disability Management Services Office
        P.O. Box 1707 Station M
        Calgary, AB, T2P 2L7
        Phone: (403) 515-5900
        Toll Free: 1-866-221-8524
        Fax: (403) 234-7565
        Case Manager - Tracy R. extension #5936.

Benefit Payment Office

Health and Dental (in Canada)

        London Health and Dental Benefit Payment Office
        255 Dufferin Avenue
        London, ON, N6A 4K1
        Dedicated Toll Free Line for Plan Members: 1- 877 538-5496
        Plan Administrator Access Line 1-877-421-5032

Out-of-Country Claims

        Out-of-Country Claims Winnipeg
        P.O. Box 6000
        Winnipeg, MB, R3C 3A5
        Phone: (204) 942-3589
        Dedicated Toll Free Line: 1-877-538-5496
        (select option for medical benefits while traveling outside of Canada)



Helplines:
        GroupNet Helpline
        Toll Free: 1-800-665-2648, Phone: (204) 946-7607

Ordering Supplies
1.      Great-West Life Supply Department
        P.O. Box 6000
        Winnipeg, MB, R3C 3A5
        * Please fax Forms Requests to (204) 946-4137
        http://www.greatwestlife.com/web5/groups/group/@public/documents/web_content/s7_001253.pdf

        * For CONTACT/EAP and booklets, please contact the local Group Sales and Service Office.




                                                        5
Ordering Supplies
2.      Complete the self addressed Request for Supplies form.
        http://www.greatwestlife.com/web5/groups/group/@public/documents/web_content/s7_001253.pdf

3.      Include the form number(s) (see bottom left of form) and quantity needed. Clearly print your return address
        and policy number on the request form.

4.      Send or fax form to Great-West Supply Services:

        Great-West Life Supply Department
        P.O. Box 6000
        Winnipeg, MB, R3C 3A5
        Fax: (204) 946-4137

Please allow approximately two weeks for delivery

Re-Ordering Booklets
If you require changes or a reprint of employee booklets, please contact your local Great-West Group Office below:

        Calgary Group Sales (for MB, SK, AB Credit Unions)
        Stock Exchange Tower, Suite 1400, 300 - 5th Avenue S.W.
        Calgary, AB, T2P 3C4
        Carrie Versfeld, Senior Specialist, Client Service
        carrie.versfeld@gwl.ca
        Phone: (403) 515-5911
        Fax: (403) 234-0011

        Toronto Group Sales (for ON Credit Unions)
        330 University Ave. Suite 400
        Toronto, ON M5G 1R8
        Louise Meacoe, Senior Representative, Client Service
        louise.meacoe@gwl.ca
        Phone: (416) 552-5759
        Fax: (416) 552-5020

        Atlantic Provinces Group Sales (for NS, NL Credit Unions)
        1900 - 1801 Hollis St.
        Halifax, NS, B3J 3N4
        Darci Fisher, Associate Manager, Client Service
        darci.fisher@gwl.ca
        Toll Free: 1-888-260-4440
        Phone: (902) 496-3594
        Fax: (902) 429-0998

        Atlantic Provinces Group Sales (for NB Credit Unions)
        1900 - 1801 Hollis St.
        Halifax, NS, B3J 3N4
        Natasha Tremblay, Client Service Representative
        natasha.tremblay@gwl.ca
        Toll Free: 1-888-260-4440
        Phone: (902) 429-8427
        Fax: (902) 429-0998




                                                          6
Forms Listing

On-Line Forms                                                                 For online claim submission or to
         Always up-to-date.                                                   obtain printable claim forms pre-

         No waiting for supply deliveries.                                    filled with employee’s name, plan
                                                                              information, and claim centre
         Download forms for use on your own Intranet.
                                                                              mailing address, please direct
         All forms may be printed and sent in by regular means, and the
                                                                              employees to our GroupNet for
         supply request form can be filled out on-line and mailed or faxed.
                                                                              Plan Members site at
Note: Customized National Benefits Plan forms can be found at
                                                                              www.greatwestlife.com
www.NationalPlan.ca You will need the Adobe Acrobat Reader to view and
print Great-West forms. The reader is available for free download at:

http://www.adobe.com/products/acrobat/readstep2.html




Forms for Plan Administrators
http://www.greatwestlife.com/001/Client_Services/Group_Plan_Administrators/Group_Plans/index.htm

Forms for Plan Members
http://www.greatwestlife.com/001/Client_Services/Group_Plan_Members/Forms/index.htm




                                                          7
Definitions


Non-Evidence Maximum
The Non-Evidence Maximum (NEM) is the amount of insurance for which an employee can be covered without
approval of insurability by Great-West Life.


Employee
An individual in the service of the employer on an active, permanent, full-time or part-time basis. This excludes
employees who work less than specified number of hours per week, as noted in the benefit booklet.

To satisfy “actively at work” requirement, an employee must not be disabled according to this policy’s definition of
disability; and be either: (a) actually working at the employer’s place of business or a place where the employer’s
business requires him to work; or (b) absent due to vacation, weekends, statutory holidays, or shift variances.


Spouse
The employee’s legal spouse, common-law spouse or former spouse.

A common-law spouse means a person who is living with the employee in a conjugal relationship. For cohabitation
period requirements, please refer to the benefit booklet.

A former spouse means a divorced or ex-common-law spouse for whom insurance protection for some of the benefits
available under the employer’s benefit program is mandated by court order. The employee can only insure one
spouse at a time for all benefits.


Average Hours Worked Per Week
Please refer to the benefit booklet for the average number of hours worked per week. This is used to convert an
employee’s hourly rate of pay to annual earnings.




                                                            8
Dependent Children
Unmarried children who are:

         From live birth to under 21 years of age

         Under 28 (unless specified otherwise in your benefit booklet) years of age and registered in full-time
         attendance at university or a similar institution.

         Any age and incapable of supporting themselves due to a continuous physical or mental disorder which
         begins before the age of 21, or while they are students and under the age of 28 (unless specified otherwise
         in your benefit booklet).

The child must be chiefly dependant on the employee for support and maintenance. The child must be unmarried.
Child includes step child, adopted child, or any other child for whom the employee or the insured spouse has been
appointed legal guardian. If the employee or the insured spouse is the legal guardian of the child, they must provide
a copy of the "order of court". Children under age 21 are not covered if they are working more than 30 hours a
week, unless they are full-time students. A child is considered a full-time student if he or she has been in registered
attendance at an elementary school, high school, university, or similar educational institution for at least 15 hours
(including class and lab time) per week sometime in the last 6 months. Child may take a period of time off from
schooling without coverage and would be covered again upon their return to full-time studies, provided the child is
under age 28. Dependants taking self-study or correspondence courses would not be considered a full-time student.




Family Status or Lifestyle Changes
These include

         Birth or adoption by the employee of a child

         The employee’s marriage (legal or common-law). For cohabitation requirements, please refer to the booklet.

         Divorce or termination of a common-law relationship by the employee

         Death of an employee’s spouse

         Death of the employee’s only insurable child

         The employee’s spouse losing benefits coverage elsewhere

         The employee no longer has any children eligible for dependant coverage


Earnings
Refer to the benefit booklet.


Excess Insurance
The amount of Life or Long Term Disability insurance an employee is eligible for that is greater than the non-
evidence maximum. Please refer to the booklet for the Life and Long Term Disability non-evidence maximums.




                                                              9
Add New Employees
All employees and their eligible dependants must participate in your plan on completing the eligibility waiting period.
Please refer to the benefit booklet for the waiting period.


Steps to Add New Employees
1.       Give the employee an Application for Group Coverage form and have them complete it in ink.

2.       Have employee complete all sections of the Application for Group Coverage except those marked “To be
         completed by Plan Administrator,” and then return the form to you.

3.       Ensure that the form is:

              fully completed and legible

              signed and dated by the employee.

4.       Complete the “To be Completed by the Plan Administrator” section of the form

              Update your employee records

              Enter the employee information on GroupNet according to the GroupNet Enrolment Guide

              If your Credit Union has portion of the contribution to pension paid by the employer, see the
              Contribution to Pension Handling below

6.       File the original of the Application for Group Coverage form in the employee’s file. Great-West Life does
         not require a copy of the form.

7.       Give the employee the following if applicable:

         *Personalized ID Card
         *Global Medical Assistance brochure
         Contact Employee and Family Assistance Program (if applicable)
         Benefit Statement
         Best Doctors Brochure / Card
         Employee Benefit Plan booklet
         *GroupNet for Plan Members brochure
         Optional Life Brochure
         Optional AD&D Brochure

         *These items would not be provided to employees who waive their health and dental benefit.

Note:    See Beneficiary Designation section for further information.


Contribution to Pension Handling
If your Credit Union has a portion of the contribution to pension paid by the employer, you will need to request a
Great-West Assisted Change through GroupNet, in addition to adding the employee.

Please generate an email through Great-West Assisted Change, requesting that “this employee be added under
the employer paid pension plan division using the same ID number as their core benefit with a prefix of
PP in front”.

An additional billing division will be listed under your policy number.




                                                              10
Applying for Coverage More Than 12 Months After Becoming Eligible
If the employee did not complete the Application for Group Coverage form before the expiry of the waiting period
and you discover it:

Within 12 months of the date the employee became eligible:

Have the Application for Group Coverage form completed now. Premium will be charged retroactive to the date that
the employee should have been added to the plan.

12 months or more after the date the employee became eligible:

They will be considered as a late applicant. See Late Applicant Section for instructions on how to enrol a late
applicant.


Conditions for Waiving Benefits
Health and Dental benefits may be waived only if the employee and/or their eligible dependants are covered by a
spousal plan.




                                                          11
Late Applicants
Employees must apply for coverage within 12 months of being eligible. Otherwise, they are considered late
applicants.


New Employees
1.       Complete the first part of both the Application for Group Coverage form and the Evidence of
         Insurability form for the employee who is applying as a Late Applicant.

2.       Give the employee the forms along with the sealed Confidential Return Envelope. Advise them of the
         following:

                Each form must be fully completed in ink and legible.

                Each form must be signed and dated.

                If the employee requires single coverage only, they should only complete the “employee” questions.

                For Family coverage, the employee should complete both the “employee” and the “spouse and children”
                questions. Both the employee and the spouse must sign the Evidence form to obtain family coverage.

3.       The employee is to keep a copy of the Evidence of Insurability form.

4.       Have employee return the original Evidence of Insurability form to you in a sealed Confidential Return
         Envelope (form number - 1028E) along with the Application for Group Coverage form.

6.       Send the original Evidence of Insurability form in the sealed confidential envelope with a copy of the
         Application for Group Coverage form to Member Administration:

         Member Administration
         P.O. Box 6000
         Winnipeg, MB, R3C 3A5
         Phone: (204) 946-7096
         Fax: (204) 946-8603
         Email: memberadmin@gwl.ca
         8am - 4pm Central

         NOTE: Keep the original Application for Group Coverage form for your records

7.       Great-West may ask for more information while reviewing the application. Great-West will let you know in
         writing if the application has been approved or declined. If approved, the coverage will be effective on the
         date of approval.

8.       Great-West adds the new employee. Do not add the employee on GroupNet since Great-West will do it for
         you.

Note:   If your plan includes Dentalcare, all employees applying as late applicants will have limited Dentalcare

coverage. See the following page, and your benefit booklet or contract for details.




                                                           12
Current Insured Employee with Family Status or Lifestyle Changes
1.       Complete the first part of the Evidence of Insurability form for the employee who is applying as a Late
         Applicant.

2.       Give employee the Evidence of Insurability form and Confidential Return Envelope and the Group
         Coverage Change Form. Advise them of the following:

              Each form must be fully completed in ink and legible.

              Each form must be signed and dated.

              If the employee requires single coverage only, they should only complete the “employee” questions.

              For Family coverage, the employee should complete both the “employee” and the “spouse and children”
              questions. Both the employee and the spouse must sign the Evidence form to obtain family coverage.

3.       The employee is to keep a copy of the Evidence of Insurability form.

4.       Have employee return the original Evidence of Insurability form to you in a sealed Confidential Return
         Envelope along with the Group Coverage Change Form.

5.       Send the Evidence of Insurability form in the sealed confidential envelope (form number - 1028E)
         with a copy of the Group Coverage Change Form to Member Administration (see contact information
         above).

6.       Great-West will let you know if the application has been approved or declined. If approved, the coverage
         will be effective on the date of approval.

7.       Great-West makes the employee changes. Do not update the employee’s information on GroupNet since
         Great-West will do it for you.

NOTE: Keep the original Application for Group Coverage form for your records.



If your plan includes Dentalcare, all employees applying as late applicants will have limited Dentalcare coverage.
When approved as a Late Applicant, Dentalcare benefits will be subject to the following restrictions:

         Routine (Basic) Treatment expenses are limited to a maximum of $250 during the first 12 months.

         No benefits will be paid for Major Treatment expenses during the first 12 months.

         No benefits will be paid for Orthodontic Treatment expenses during the first 24 months.

These limitations do not apply to expenses that are solely the result of an accident that occurred after the employee’s
Dentalcare Insurance took effect.

Please see your contract for details.




                                                          13
Beneficiary Designations
All employees are required to properly and adequately designate a beneficiary on their application form.


New Employee Designating a Beneficiary
Make sure the employee completes the Beneficiary Designation section on the application form. The employee
must give full given names, surnames and the relationship to the employee.


Crossed Out Designation
If the employee crosses out any portion of the designation, they must initial the crossed-out portion.


Minor Children
If the beneficiary is a minor child, a trustee designation is recommended. The employee may wish to appoint a
trustee by completing the Trustee Appointment Form.


Québec Residents
If the employee resides in Québec and designates their spouse as beneficiary on or after October 20, 1976, the
spousal beneficiary is irrevocable unless the employee makes the designation revocable. All other designations (other
than the spouse) made on or after this date are revocable unless stated otherwise.


Beneficiary Designations and Divorce
In Quebec, divorce automatically cancels the irrevocable beneficiary. In this situation an employee can make a
change of beneficiary without any written consent from the previous irrevocable beneficiary.


Existing Employee Changing a Beneficiary
To make a Beneficiary Designation change, the employee must complete the Change of Beneficiary section of the
Group Coverage Change Form. Make sure the Group Coverage Change Form is signed and dated by the
employee and you.




                                                          14
Changing Irrevocable Beneficiary
An employee cannot change an irrevocable beneficiary without the written consent of the irrevocable beneficiary. If
the employee wants to change the irrevocable beneficiary, they must have the irrevocable beneficiary complete the
Consent to Change of Irrevocable Beneficiary form. If the employee has named a minor child as the
irrevocable beneficiary, the child cannot give a valid consent to the change until he/she reaches the age of majority.


Revocable Beneficiary
An employee can change a Revocable Beneficiary at any time without the written consent of the revocable
beneficiary. Keep the Group Coverage Change Form with the employee’s original application form at all times.
Please note that Great-West will require the original application form and any subsequent change of beneficiary form
at the time of a claim.


Beneficiary Designation Examples
To avoid any legal complications that may result from an unclear or vague designation, here are sample designations
that are considered satisfactory and will present no problem in the payment of claims:

One Beneficiary:                              Doe, Jane (Spouse) or

                                              Smith, William (Friend)

Estate:                                       The Insured’s Estate

Contingent Beneficiary:                       Doe, Jane (Spouse) if living

                                              otherwise Doe, Janet (Daughter)

Two Beneficiaries:                            Doe, Jane (Spouse) and

                                              Doe, Janet (Daughter) in

                                              equal shares or the survivor

Multiple Beneficiaries:                       Doe, Jane (Spouse) and

                                              Doe, David (Son) and Doe, Janet (Daughter)

                                              equally or the survivors of them equally,

                                              or the survivor.




                                                          15
Excess Insurance
Great-West will let you know if an employee must submit an Evidence of Insurability form before their excess
insurance becomes effective. A completed Evidence of Insurability form is required for any of the following
situations:

           New employees who are eligible for excess insurance when they are hired and the amount for which they
           are eligible is over the Non Evidence Maximum; or

           The employee receives an increase in benefits of more than 10 percent (due to a salary increase) and is
           already over the Non Evidence Maximum; or

           Employees who were previously declined for excess insurance and now wish to increase their coverage; or

           Employees over the age of 65 applying for increased amounts of Excess Life Insurance; or

           Employees over age 60 applying for increased amounts of Excess Long Term Disability Insurance.

If evidence of insurability is required:

1.         Complete the first section of the Evidence of Insurability form.

2.         Give the employee the form and Confidential Return Envelope (form number - 1028E). Tell them the
           following:

               The form must be fully completed in ink and legible.

               The form must be signed and dated.

3.         The employee is to keep a copy of the Evidence of Insurability form. Employee returns the original
           Evidence of Insurability form in a sealed Confidential Return Envelope (form number - 1028E) to you.

4.         Send the Evidence of Insurability form in the sealed envelope to Member Administration:

           Member Administration
           P.O. Box 6000
           Winnipeg, MB, R3C 3A5
           Fax: (204) 946-8603
           Email: memberadmin@gwl.ca
           8am - 4pm Central

Great-West may ask for more information while reviewing the application. Great-West will let you know in writing if
the application has been approved or declined. If approved, the excess coverage will be effective on the date of
approval.

NOTE: Keep the original Application for Group Coverage form for your records.



If an employee is declined for excess insurance and the non-evidence maximum is increased at a later date, that
employee will not be eligible for increased coverage unless they submit satisfactory evidence of insurability.

Great-West processes the increase. You do not need to update your records on GroupNet since Great-West will do it
for you.




                                                          16
Employee Changes
Changes in Earnings
Update all of your records on GroupNet with the new earnings as soon as they occur, since volume based benefits
are impacted in the event there is a claim for life or disability.

Increases in insurance (life and disability coverage) apply only if a plan member is actively at work. "Actively at work"
refers to plan members that are not disabled who are actually working, either at their plan sponsor’s place of
business or where they’re required to work. Plan members absent due to vacation, weekends, statutory holidays,
employer paid leaves of absence or shift variances are considered actively at work as well. Decreases in coverage
take effect as they occur.

It is also important to note that "changes" include adjustments in coverage due to salary increase. A salary increase
that takes place while a plan member is not actively at work should not be reported until the disability is over to
avoid an overcharge in premium. A salary decrease while a plan member is not actively at work should be reported
immediately.

Should there be a claim while a plan member is not actively at work, the benefit will be based on the plan member’s
reported salary as of the last day worked.

Note:    An employee must be actively at work to be eligible for any increase in benefits coverage. If not, the

change will not become effective until the employee returns to work.

Mass salary changes can be done on GroupNet or submitted to your local service contact, by providing an excel
spreadsheet including names, ID numbers and revised earnings along with the effective date.


Changes in Family Status (Single/Couple/Family)
Your plan requires that 100 percent of eligible dependants be enrolled. Single employees must enroll for couple or
family coverage as soon as they become eligible for dependant coverage (i.e. date of marriage, date common-law
spouse is eligible or, if no spouse, date of birth of first child).

If enrolment is overlooked and you discover it:

         Within 12 months of the date the dependant(s) should have been enrolled, add the dependant(s) now.
         Premium will apply retroactive to the dependant’s original effective date. Process the change through
         GroupNet

         After 12 months, Great-West will consider them late applicants. See Late Applicant section. Great-West
         makes the employee changes. Do not update the employee’s information on GroupNet since Great-West
         will do it for you


Changes in Division, Class, Province of Residence and Province of
Employment
Process the change through GroupNet.




                                                               17
Early Retirees and Changes at Age 65
You must move active employees who reach age 65 (minus the LTD waiting period) to the over age 65 benefit class
that mirrors their previous benefits. Refer to Benefit Class description information on GroupNet. Diary action on this
task is useful.

When an active employee elects early retirement and is eligible under the terms of the contract, have them complete
the Early Retiree Form within 31 days of their last day of work. Once the form is returned to you, process the class
change through GroupNet. If the early retiree has elected a lower amount of insurance from their amount in-force
immediately prior to retirement, send an email through Great-West Assisted Change revising the lower amount of life
insurance.

Terminate Early Retiree coverage on GroupNet on the last day of the month when the member turns age 65. Set up
a Diary on GroupNet (for date when they turn 65) when the member retires early.

When plan member or spouse’s group life insurance coverage is reduced or terminated, they may be entitled to
convert all or part of their coverage to a Great-West or Freedom 55 individual life insurance policy without providing
medical evidence of insurability. Please refer to “Terminations” section in this Administration Guide.


Changes in Employee Name, Dependants, Waiver of Health and Dental
Benefits
1.       Have the employee complete and sign the Group Coverage Change Form.

2.       Keep form with the employee’s Application for Group Coverage form.

3.       Process the change through GroupNet.



Change from Child to Student
Great-West will mail you the Child Maximum Report prior to any child’s 21st birthday. If a child qualifies as a student,
process the change on GroupNet from Child (CH) relationship to Student (ST), within 5 days of the birth date.

If dependent child that is a student no longer satisfies the full-time student requirement, you may terminate that
dependent using GroupNet. The effective date of termination in this instance is 6 months from the date the
student last attended school. Terminations can be future dated.


Reinstatements
You may reinstate a terminated employee within the reinstatement period.

1.       Complete the reinstatement section of the Group Coverage Change Form

2.       Keep form with the employee’s Application for Group Coverage form.

3.       Process the change through GroupNet.

Note:    If an employee does not return to work within the reinstatement period, the employee is considered a new

employee. See Add New Employee section.



                                                           18
Terminations
Process the termination through GroupNet.

If your Credit Union has a portion of the contribution to pension paid by the employer, you will need to
terminate employee under both divisions. First division being core benefits, and the second the
contribution to pension.

For individual product information please refer employee to the following website where they could access Sonata
Health located under the Health & Dental Insurance section of the site:
http://www.greatwestlife.com/001/Home/Individual_Products/index.htm

Note: Terminations due to death should not be processed through GroupNet. Great-West will perform the update.


Life Conversion
When a plan member or spouse’s group life insurance coverage is reduced or terminated, they may be entitled to
convert all or part of their coverage to a Great-West or Freedom 55 individual life insurance policy without providing
medical evidence of insurability.

Plan members and spouses will be required to consult with a financial security advisor at Great-West or Freedom 55
to convert their group life coverage. This will help ensure they receive the professional advice required to make
informed decisions when applying for individual life insurance.

When a plan member or spouse’s group life insurance coverage is reduced or terminated, provide them with the
following documents/information:

         Group Life Conversion Privilege Plan Member Fact Sheet: This piece provides basic information
         about the conversion privilege. It instructs the plan member/spouse to obtain a Group Life Conversion
         Privilege Notification Form from their plan administrator should they wish to convert their group life
         coverage.

         http://www.greatwestlife.com/web5/groups/group/@public/documents/web_content/s6_000292.pdf

         Completed applications for individual insurance and the first premium must be received within 31 days after
         the group insurance terminates or reduces.

         Group Life Conversion Privilege Notification Form: For plan members living outside of Quebec, use
         the below form to convert group life insurance to an individual life insurance policy. When complete, give
         one copy of the form to the plan member/spouse and keep one copy for your files.
         http://www.greatwestlife.com/web5/groups/group/@public/documents/web_content/s7_001251.pdf

         Please contact the local Resource/Financial Centre office at
         http://www.freedom55financial.com/locations/english/default.asp



During the conversion period, the group life coverage in effect prior to the date of termination or reduction will be
extended.
NOTE: All Forms for Plan Administrators including the Life Conversion Forms can be located at the following
website: http://www.greatwestlife.com/001/Client_Services/Group_Plan_Administrators/Group_Plans/index.htm



                                                          19
Coverage During Lay-off, Unpaid Leave of Absence, Illness or Injury
Benefits for employees who are laid off, on leave, ill or injured, should be continued in accordance with your written
company policy.

If the plan member is on a temporary layoff or a leave of absence (other than maternity or parental leave), disability
insurance may be continued until 31 days after the date the layoff or leave starts. All other insurance may be
continued until six months after the date the layoff or leave starts. If you, as the plan sponsor, are required by law
to continue insurance beyond these dates, the insurance will be continued until the end of the period required by
law. Please have your extension of benefits approved by contacting your GWL Group Sales Office. Once approved,
the extension will be handled by Great-West Life’s member administration department. This benefit is not available
to employees who resign or retire.

For unionized credit unions, there may be provisions to extend health and dental benefits beyond 6 months during a
layoff or as part of termination clauses in their agreements. If this is your situation, please contact your GWL Group
Sales Office for approval.

There would be no benefit adjustments during lay-off or unpaid leave of absence, and coverage would be based on
the plan member’s reported salary as of the last day worked.

Important Note: Disability coverage, Optional Life, or Optional AD&D coverage cannot be extended beyond
Employment Standards Requirements.

1.       If an extension of benefits is approved by GWL, process the extension through Great West Assisted changes
         and notify your local Group Sales Office.

2.       Make note to terminate the extended benefits at the end of the severance period.



Severance
Benefits should be extended in accordance with Employment Standards requirements.

For extension of coverage beyond the Employment Standards requirements, you must first email the request to your
local Great-West Group Office for approval before offering it to the employee. Great-West will consider extending
coverage for basic life and AD&D dependent life, healthcare and dentalcare for a limited period of time, providing the
extension applies to all employees in similar circumstances. Please note that any severance agreements would not
include, Disability, Global Medical Assistance, out-of-country coverage, or any elective benefits such as Optional Life
or Optional AD&D.

Once extension is approved by GWL, request system update through your local GWL Group Sales and Service Office.




                                                           20
Maternity or Parental Leave
Employee must either maintain all coverages offered by the employer at the start of the leave, or opt out of all
coverages. Once an employee has opted out of the plan and started their leave, they cannot change their mind.

During maternity or parental leave, insurance will be continued until the end of the leave provided you, as the plan
sponsor offers extension of coverage to plan members during these types of leaves, and the plan member has
elected to take this extension. If so, the extension applies to all coverages offered by you, as the plan sponsor, for
which the plan member was covered on the last day of work prior to the leave.

1.   Have the employee complete and sign the Group Coverage Change Form, if they choose to terminate all
     their benefits while on maternity leave. Have the member add a note that this is due to maternity/parental
     leave. You may choose to have member provide you with a letter requesting the refusal in lieu of the Group
     Coverage Change Form.

2.   Process the termination through GroupNet.

3.   Make a note to reinstate benefits through Great-West Assisted changes on GroupNet, within 31 days of return to
     work otherwise late application applies.




                                                           21
Healthcare Claims (including Visioncare Claims)
Claim Submission
1.       For on-line claim submission or printable forms pre-filled with employee’s name, plan information, and claim
         centre mailing address, please direct employees to our GroupNet Online Services for Plan Members site at
         www.greatwestlife.com

2.       If the employee is sending the claim in electronically, direct them to keep receipts for audit purposes should
         they be selected.

3.       For paper claim submission, employee sends completed claim form along with the original receipt(s) to the
         Benefit Payment Office address:

                  London Health and Dental Benefit Payment Office
                  255 Dufferin Avenue
                  London, ON, N6A 4K1
                  Dedicated Toll Free Line: 1-877-538-5496
4.       Encourage employees to keep a copy of the claim form and receipt(s).

All claims must be submitted within 15 months of the date the expense is incurred.

Great-West will process the claim and send any eligible payments and an Explanation of Benefits (EOB) directly to
the employee.

Hospital claims - The hospital generally sends the claim directly to Great-West. Great-West then reimburses the
hospital and sends the employee an EOB. If a claimant is billed by the hospital, the above Claim Submission
procedure should be followed.

Provider Electronic Claim Submission (Physiotherapist, Chiropractor or Vision Providers). Providers who
want to learn more about eClaims technology, or get details on how to register can call 1-866-240-7492 on online at
www.telushealth.com.


Out-of-Country Claims Submission
Have the employee contact the out-of-country claims office:

         Out-of-Country Claims Winnipeg
         P.O. Box 6000
         Winnipeg, MB, R3C 3A5
         Phone: (204) 942-3589
         Dedicated Toll Free Line: 1-877-538-5496
         (select option for medical benefits while traveling outside of Canada)
Great-West will send the employee the appropriate claim and provincial authorization form. Have the employee
complete the forms and return them along with receipts to the address indicated in point one above.

Their claim will be processed, and any eligible payments and/or an Explanation of Benefits (EOB) will be sent directly
to the employee at the address indicated on their claim form.

Their claim will be submitted to the appropriate provincial plan for reimbursement on behalf of the insured employee.
This process allows us to process the claim in a more timely fashion then waiting for the provincial reimbursement.




                                                          22
Coordination of Benefits
In some situations, an employee and their dependants may have similar benefit coverage under another group
insurance plan. Your plan contains a Coordination of Benefits (COB) provision, which is designed to share the cost
between plans and ensure that the employee receives the maximum overall benefit. COB also ensures the employee
is not reimbursed for more than the actual expenses incurred.

The order of claims submission is as follows:

1.       The employee sends the claim to their own plan first.

2.       The spouse sends the claim to their plan first.

3.       Claims for dependent children are sent to the plan of the parent who has the earlier birthday in the year.
         For example, if the employee’s birthday is April 8th, and the spouse’s birthday is March 12th, the claim must
         be sent to the spouse’s plan first.

4.       Any claims not paid in full by the first plan should be sent to the other plan together with a copy of the EOB
         and receipt.


Claim Inquiries
Any claim inquiries should be directed to: 1- 877-538-5496

To ensure prompt response, the claimant must give:

         the policy number

         the employee’s name and identification number

         the patient’s name

         type of claim

         date of service; and

         any other particulars relating to the claim.




                                                           23
Prescription Drug Card Benefits
Great-West makes prescription drug card benefits available through Emergis Inc – eHealth Solutions Group. Great-
West handles the administration, eligibility information and claims inquiries for you and all employees.

Emergis Inc. provides a network that will receive, adjudicate and pay prescription drug card claims. They accept
electronic claims directly from pharmacies. Paper claims from employees who have not used their drug card to
purchase their prescription drugs or who are claiming for coordination of benefits can be sent directly to Great-West
for assessment.

The card contains the following information needed to process a drug claim:

         The first two digits identify Great-West as the carrier

         The next six digits identify your group policy number

         The next 10 digits is the employee’s identification number

         The final two digits identify the current issue number of the card. The issue number changes each time an
         employee’s card is replaced due to its being lost or stolen. It makes the previous card inoperative.


Electronic Drug Card Claims Procedure
1.       Claimants present their 3-in-1/Assure prescription drug card to the pharmacist each time a prescription drug
         is purchased.

2.       They will be required to pay for any deductibles, coinsurance, and any other out-of-pocket amounts
         resulting from their plan design at the time of purchase.




                                                           24
Dentalcare Claims
Paper Claim Submission
1.       The dentist completes Part 1 of the Dentalcare form.

2.       The employee completes Part 2 (Employee Information) and Part 3 (Patient Information).

         For help filling in claim forms, or for printable forms pre-filled with employee’s name, plan information, and
         claim centre mailing address, please direct employees to our GroupNet Online Services for Plan Members
         site at www.greatwestlife.com.

3.       Employee sends form to the Benefit Payment Office address:

                  London Health and Dental Benefit Payment Office
                  255 Dufferin Avenue
                  London, ON, N6A 4K1
                  Dedicated Toll Free Line: 1- 877 538-5496
4.       Encourage employees to keep a copy of the claim form.

All claims must be submitted within 15 months of the date the expense is incurred.

Great-West will process the claim and send any eligible payments and an Explanation of Benefits (EOB) directly to
the employee at the address indicated on their claim form.

If the dental office has electronic claim submission capabilities, the dentist may be able to submit the claim
electronically to Great-West for processing.




Assignment of Payments
If the employee would like Great-West to reimburse the dentist directly, the employee must sign the assignment
authorization section in Part 1 of the Dentalcare form. When an assignment is authorized for a particular claim, the
assignment is irrevocable.




Treatment Plan
For any larger Dentalcare claims (e.g. over $200) including all orthodontic claims, the employee should send a
treatment plan to Great-West for consideration. The claim form should clearly indicate that this is a treatment plan
and not an actual claim. X-rays showing policy number and employee identification number should be submitted
with the form if applicable.

Great-West will give the employee a written estimate of the amount that would be paid by the plan if claimed. The
dentist will receive a copy of the estimate along with the X-rays submitted.




                                                           25
Coordination of Benefits
In some situations, an employee and their dependants may have similar benefit coverage under another group
insurance plan. Your plan contains a Coordination of Benefits (COB) provision, which is designed to share the cost
between plans and ensure that the employee receives the maximum overall benefit. COB also ensures that the
employee does not receive reimbursement from both plans that exceeds the actual expenses incurred.

The order of claims submission is as follows:

1.       The employee or the dentist sends the claim to the employee’s plan first.

2.       The spouse or the dentist sends the claim to the spouse’s plan first.

3.       Claims for dependent children are sent to the plan of the parent who has the earlier birthday in the year.
         For example, if the employee’s birthday is April 8th, and the spouse’s birthday is March 12th, the claim must
         be sent to the spouse’s plan first.

4.       Any claims not paid in full by the first plan should be sent to the other plan together with a copy of the
         Explanation of Benefits (EOB) and receipt.


Claim Inquiries
Any claim inquiries should be directed to: 1- 877-538-5496. To ensure prompt response, the claimant must give:

         the policy number

         the employee’s name and identification number

         the patient’s name

         type of claim

         date of service; and

         any other particulars relating to the claim.




                                                          26
Health Care Spending Account (HCSA) – If Applicable
Your plan includes a Health Care Spending Account (HCSA) that allows employees to be reimbursed for health-
related expenses using pre-tax benefit dollars. Funds are allocated to the employee’s HCSA at the beginning of each
plan year. Employees are reimbursed for expenses not fully covered or not covered at all under the plan, including
expenses such as deductibles and coinsurance. All expenses must qualify as medical expenses under the Income Tax
Act.

In order for the employee to assign credits to their HCSA, the employee’s total credit amount must be made available
in full to them prior to the start of each HCSA plan year (at each HCSA plan anniversary date). An employee’s credits
cannot be built up throughout the year. To find out more regarding the allocation of HCSA credits, do not hesitate to
contact your local Great-West Group Office.


Definitions
Employee, Spouse, Dependant

The definitions for eligible employees, spouse and dependent children are the same as those, which apply under your
basic Group benefit plan. See Administrative Detail Summary.

In addition, the HCSA eligible dependants refer to any person the employee is entitled to claim a medical expense tax
credit under the Income Tax Act.

HCSA Plan Year

Your HCSA plan year is January to December.

HCSA Year-End Benefit Provision

Your plan has a Credit Roll-Over year-end benefit provision. At the end of the plan year an employee’s unused
credits are rolled over for use in the next plan year. If, in the next plan year those credits remain unused, the
employee loses the credits at the end of the plan year.


Add New Employees
1.       Once the employee’s enrolment is completed under the basic plan, enrol the employee in the HCSA by
         completing the Group Insurance Adjustment form using the Great-West Assisted Changes function.


Changes to Employee Credits
Adjustments to annual HCSA credits due to a family status or lifestyle change (e.g., marriage, divorce, separation,
birth of a child, death etc.) are allowed if the employee applies within 31 days of that change. Otherwise, the credit
amount change can only be made at the next re-enrolment date.

Report changes by sending an email through the Great-West Assisted Changes function on GroupNet.




                                                          27
Terminations

You must report HCSA changes by sending an email through the Great-West Assisted Changes function on GroupNet,
or you may report the termination to Member Administration of all employee terminations as they occur:

         Member Administration
         P.O. Box 6000
         Winnipeg, MB, R3C 3A5
         Phone: (204) 946-7096
         Fax: (204) 946-8603
         Email: memberadmin@gwl.ca
         8am - 4pm Central

Claims will be processed as described in the Claims Submission section of this guide. The expense must have been
incurred before the employee terminated and received by Great-West before the next plan anniversary date.

Note: Any unused credits after this period will automatically be lost.

To terminate, use the procedures outlined in the Terminations section.


Reinstatements
When reinstating an employee under the basic employee plan, you must also reinstate under the HCSA. If an
employee is reinstated within your Group Benefit’s Reinstatement Period, the employee’s HCSA balance is reinstated.
Confirm through Great-West Assisted Changes the amount to be reinstated.

Report changes by sending an email through the Great-West Assisted Changes function on GroupNet.


Annual Re-Enrollment of Employees
1.       At least 10 days before every HCSA plan’s anniversary date complete the Group Insurance Adjustment
         form indicating employees eligible for HCSA, allocation amount by employee, and send it to Member
         Administration.


Billing Statements
At the end of each month, Great-West will send you a HCSA Statement showing the number and amounts of HCSA
claims processed as well as the administration fees due.

The HCSA statements are billed in arrears.

1.       Pay amount due as billed. Include a copy of the HCSA statement.

2.       Send your payment to Group Insurance Payment Administration:

         Group Insurance Payment Administration
         P.O. Box 1053
         Winnipeg, MB, R3C 2X4

Payment must be sent within 31 days or your coverage will be terminated.




                                                           28
Health Care Spending Account Claims Procedures
1.       Have employee complete the HCSA claim form.

2.       The employee sends the HCSA claim form to the Benefit Payment Office as indicated on the form, together
         with the following documentation:

             a copy of the Explanation of Benefits where there is an unpaid balance

             a record of the purchase (e.g. sales receipt, pharmacy dispensing record); and

             a copy of the doctor’s prescription for any over-the-counter medications dispensed by a pharmacist.

         Note: Send original receipts or photocopies if originals are not available.

3.       Tell employees to keep a copy of the claim form and any receipt(s) or documentation.

4.       Great-West will process the claim and send any eligible payments and an Explanation of Benefits (EOB)
         directly to the employee at the address indicated on their claim form.


Credit Roll-Over Claim Submission Limit
HCSA claims can be submitted at any time during a plan year.

All HCSA claims must be submitted no later than 31 days immediately following the end of that plan year in which
the claim was incurred. HCSA claims submitted after this time are not covered under the terms of your plan.

Example:

Each plan year the employee receives a HCSA credit amount of $200. (December 31st is the end of the plan year). In
2006, the employee submits a total of $150 in claims. After reimbursement, the balance remaining in the employee’s
account is $50.

The employee had forgotten to submit a $45 dental claim incurred in 2006. On January 21st, 2007, the employee
submits this 2006 claim.

Since the employee sent the claim before January 31, 2007, the claim can be paid from the 2006 credit balance.
After reimbursement of the $45 claim, the employee’s 2006 balance is $5.

The remaining $5 is rolled over to the 2007 credit balance.




                                                          29
Coordination of Benefits
In some situations, an employee and their dependants may have similar benefit coverage under another group
insurance plan. Your plan contains a Coordination of Benefits (COB) provision, which is designed to share the cost
between plans and ensure the employee receives the maximum overall benefit. COB also ensures that the
employee does not receive reimbursement from both plans that exceeds the actual expenses incurred.

The order of claims submission is as follows:

1.       The employee sends the claim to their own plan first.

2.       The spouse sends the claim to their plan first.

3.       If there is a HCSA, claims are paid out on the balance remaining after both your plan and your spouse’s plan
         have been paid out.

4.       Claims for dependent children are sent to the plan of the parent who has the earlier birthday in the year.
         For example, if the employee’s birthday is April 8th, and the spouse’s birthday is March 12th, the claim must
         be sent to the spouse’s plan first.

5.       Any claims not paid in full by the first plan should be sent to the other plan together with a copy of the EOB
         and receipt.


Claim Inquiries
Any claim inquiries should be directed to 1- 877-538-5496. To ensure prompt response, the claimant must give:

         the policy number

         the employee’s name and identification number

         the patient’s name

         type of claim

         date of service; and

         any other particulars relating to the claim.




                                                           30
Survivor Benefits
Dependant Eligibility
If dependant coverage is in effect when an employee dies, the surviving dependant(s) will continue to receive
coverage for Health and Dental benefits until the earliest of:

         24 months from the employee's death

         The date that the survivor no longer qualifies as an insurable dependant.

         Insurable dependants also include an employee's child who is born after the employee's death.

If you have Life coverage with Great-West, contact your local Great-West Life Service Representative when an
insured employee dies for assistance in submitting the Life claim and Survivor Benefits claim. If you do not have Life
coverage with Great-West, provide Member Administration with the date of the employee's death.

This will ensure that benefits are transferred at the appropriate date and benefit cheques are issued to the surviving
spouse. If there is no surviving spouse, benefits are paid to the child of majority age or in the case of a minor, to
their legal guardian.


Coverage and Premium
Coverage will be provided even if your group plan terminates after the employee's death. Premium will not be
required for the surviving dependant(s) after the employee dies. Survivor Benefit coverage is intended to provide
surviving dependant(s) with the same coverage they would have received if the employee were still living. As such,
Survivor Benefit coverage may be subject to the same changes as the rest of the group plan, should it be amended
after the employee's death.




                                                           31
Life Claims
Employee Life (or Paid-Up Life) Claim Submission
1.       Complete Part 1 – Plan Sponsor’s Statement of the Group Life Claim Report.

2.       Give the Group Life Claim Report to the beneficiary (or beneficiaries if more than one) to complete Part
         2. Please also provide them with A Helping Hand: Financial Considerations when making a Life
         Claim.

3.       Have the beneficiary provide completed claim form with proof of death. One of the following is acceptable:

             copy of the Funeral Director Statement of death

             a copy of Provincial Death Certificate

             Attending Physician’s Statement

             Paid Up Life Certificate (if applicable)

4.       Send all documents, including the employee's original Application form and any beneficiary changes (if you
         maintain these records) to Group Life Benefits:

         Group Life Claims
         P.O. Box 6000
         Winnipeg, MB, R3C 3A5
         Phone: (204) 946-4096

         Keep copy of the Application and beneficiary change forms.
         If the employee’s eligibility period had been waived, send the supporting written documentation with the
         above information. If the estate is named as the beneficiary, and the claim is over $25,000, refer to the
         Group Life Claim Report for additional required documents.

5.       Great-West will send you the claim cheque unless you request otherwise.

Note: Do not update the record on GroupNet since Great-West will do it for you.



Dependant Life Claim Submission
For dependant life claims (from live birth), use the claim forms and procedure outlined for Employee Life Claims.

In all cases, the employee is the designated beneficiary for Dependant Life benefits.

The employee’s original application form will be returned to you once the Dependant Life claim has been processed.

Name of insured is the name of the deceased dependant. Do not complete: date of employment, date last worked,
salary at last date worked, reason for leaving and occupation.

Do not update the record on GroupNet since Great-West will do it for you.




                                                           32
Paid-Up Life Handling

Who is eligible to the benefit:


         Participants are eligible or start contributing to premium at the same time as they are eligible to the Basic
         Life Benefit;
         Active Participants who are not eligible to the Basic Life Benefit are not eligible to Paid-up Life;
         Active Participants will pay premium until they either leave or retire (see next note for retirees under age
         65) or turn age 70 whichever comes first;
         Early Retirees (individuals under age 65 who maintain early retiree life coverage) pay premium until they
         turn age 65, or until they terminate the early retiree life benefit.


When will GWL issue a certificate:
Since the eligibility to receive a Paid-up Life certificate is a combination of age and years or service, GWL will only
issue a certificate when they receive the application form, from the plan administrators. This application for qualifying
individuals would be submitted within 31 days after the employee terminates or retires. The form is found on the
National Plan website www.nationalplan.ca


The same application process will apply to Early retirees (as defined above) but the certificate will only be issued at
the end of the month they reach age 65, or at the time they terminate the early retiree life coverage.




Accidental Death Claims
For accidental death claims, use the claim form and procedures outlined for Employee Life Claims. Include details of
accident – such as a police and/or coroner's reports or autopsy report. Where available, send newspaper accounts of
the accident or a copy of the company accident report if the accident occurred at work.

If Occupational Training Benefit for Spouses or Education Benefit for Children is also being claimed as a result of the
employee's death, give the spouse the Accidental Death, Dismemberment & Specific Loss Supplementary Benefits
Claim Form to complete.

Note: Do not update the record on GroupNet since Great-West will do it for you.




                                                            33
Accidental Dismemberment or Loss
1.   If accidental dismemberment or injury is being claimed, give the employee the following forms:

         Group Life Benefits Claim for Accidental Dismemberment or Specific Loss for their completion of
         Part 2.

         Group Life Benefits Certificate of Attending Physician Dismemberment or Loss form for the
         physician to complete.

     If Family Transportation Benefit, Wheelchair Benefit, or Education Benefit is also being claimed
     as a result of the person's accidental injury, give the employee the Accidental Death,
     Dismemberment & Specific Loss Supplementary Benefits Claim Form to complete.

2.   Have employee return both forms to you, along with the Police report or workplace accident report and a
     Coroner’s report or Autopsy report (in death related cases).

3.   Complete Part 1 of the Group Life Benefits Claim for Accidental Dismemberment or Loss.

4.   Send all documents, including the employee's original Application for Group Coverage form (if you
     maintain these records), to Group Life Claims:

     Group Life Claims
     P.O. Box 6000
     Winnipeg, MB, R3C 3A5
     Phone: (204) 946-4096

     Keep copy of the Application and beneficiary change forms.

     If the employee’s eligibility period had been waived, include the supporting written documentation with the
     other documentation.

5.   Great-West will send you the claim cheque unless you request otherwise.




                                                      34
Life Waiver of Premium
Great-West Long Term Disability
Accidental Death & Dismemberment (AD&D) and all Basic and Optional Life coverage will continue without premium
payment after 9 months of the claimant being approved for LTD benefits. Disability premium is waived effective the
date of approval of the claim and premium during the qualifying period is not refunded.

NOTE:    For 2011 calendar year only, Health & Dental premiums are also waived
         when a claimant has been on LTD for 9 months.




                                                         35
Disability
Early Referral Services - for Credit Unions without Short-Term Disability

1.   Complete and sign the front page of the Early Referral Services – Employer’s Statement M5469A
     BIL form. This benefit provides salary continuance to plan members who have been absent for a 10 day
     period.
     http://www.greatwestlife.com/web5/groups/group/@public/documents/web_content/s7_002737.pdf

2.   Give the employee the Early Referral Services – Employee’s Statement M5469B (which contains
     Physician’s Statement form), to complete and return to Great-West Life Disability Office. Due to privacy of
     the medical information, you may want to provide your employee with a self-addressed envelope, so that
     it’s returned directly to Great-West Life.
     http://www.greatwestlife.com/web5/groups/group/@public/documents/web_content/s7_002735.pdf

3.   The completed Early Referral Services form must be submitted to the Disability Management Services Office
     (DMSO) on the 10th day of the employee’s date of disability:

     Calgary Disability Management Services Office
     P.O. Box 1707 Station M
     Calgary, AB, T2P 2L7
     Phone: (403) 515-5900
     Toll Free: 1-866-221-8524
     Fax: (403) 234-7565
     Case Manager - Tracy R. extension #5936

4.   If more detailed medical information is required, the DMSO will contact the attending physician directly.

5.   A letter explaining the recommendation for payment of benefits will be provided.




                                                      36
Disability
For Credit Unions with Long-Term Disability Only

You must notify Great-West in writing of the employee’s disability within three months after the end of the disability
waiting period. Otherwise, the claim will be declined.

If the employee has qualified for worker’s compensation benefits or automobile accident benefits, send the DMSO a
LTD claim within the time frame stated above. Otherwise, the claim will be declined.


1.       Give employee the Long Term Disability Income Benefits Employee’s Statement to be completed by
         them and their physician.

2.       Have the employee return the guide to you in a sealed envelope.

3.       Complete the Application for Group Long Term Disability – Employer’s Statement.

4.       Send the sealed envelope and the employer submission guide to the Disability Management Services Office
         (DMSO):

         Calgary Disability Management Services Office
         P.O. Box 1707 Station M
         Calgary, AB, T2P 2L7
         Phone: (403) 515-5900
         Toll Free: 1-866-221-8524
         Fax: (403) 234-7565
         Case Manager - Tracy R. extension #5936

         If the employee’s eligibility period was also waived, send the written documentation confirming the waiver.
         (i.e. a copy of the offer of employment including immediate benefit coverage)

5.       The DMSO will process the claim and advise you of our decision in writing.

6.       Disability premium will be waived on approval of the LTD claim retroactive to the date of the eligibility of the
         LTD claim (i.e. after the end of the waiting period). Premiums must continue to be paid until the DMSO
         advises that premiums will be waived.

7.       When the employee returns to work, complete a Notice of Return to Work form and send it to the DMSO
         with a copy to Member Administration.

8.       Do not update the employee record on GroupNet since Great-West will do it for you.

9.       Keep the notification with the employee’s application.




                                                          37
Disability
For Credit Unions with Short-Term Disability (STD) and Long Term
Disability (LTD)

You must notify Great-West in writing of the employee’s disability within three months after the end of the disability
waiting period. Otherwise, the claim will be declined.

If the employee has qualified for worker’s compensation benefits or automobile accident benefits, send the DMSO a
LTD claim within the time frame stated above. Otherwise, the claim will be declined.

1.       Give employee the Short Term Disability Income Benefits Employee’s Statement to be completed
         by them and their physician.

2.       Have the employee return the guide to you in a sealed envelope.

3.       Complete the Application for Group Short Term Disability Benefits – Employer’s Statement.

4.       Send the sealed envelope and the employer statement to the Disability Management Services Office (DMSO)
         within 10 days of the employee’s date of disability.

         Calgary Disability Management Services Office
         P.O. Box 1707 Station M
         Calgary, AB, T2P 2L7
         Phone: (403) 515-5900
         Toll Free: 1-866-221-8524
         Fax: (403) 234-7565
         Case Manager - Tracy R. extension #5936

         If the employee’s eligibility period was waived also send the written documentation confirming the waiver.

5.       The DMSO will process the claim and advise you of our decision.

If employee returns to work:

1.       Complete a Notice of Return to Work form and send it to the DMSO.

If disability extends into a long-term disability claim:

1.       Complete the Employment and Insurance Information form before the STD benefit period is complete.

2.       Send it to the DMSO. See contact information above for address.

3.       The DMSO will process the claim and will advise you in writing of their decision.

4.       When the employee returns to work, complete a Notice of Return to Work form and send it to the DMSO.

5.       Do not update the employee record on GroupNet since Great-West will do it for you.

Keep the notification with the employee’s application.




                                                           38
Best Doctors®
Have the employee call Best Doctors® at the toll free number in their brochure.

Please remember that employees that waived health & dental benefits need to be enrolled in the benefit class that
allows for Best Doctors coverage only. For list of benefit classes, please refer to GroupNet.




                                                          39
Critical Illness Claims
1.    Have employee obtain the claim form from the Great-West website by visiting:
      http://www.greatwestlife.com/001/Client_Services/Group_Plan_Members/Forms/Group_Critical_Illness_Clai
      m_Forms/index.htm

     If the person does not have access to our website, they can request a claim form by calling 1-866-907-2395
     Ext. 5045. Note that there are evidence forms as well as separate forms for each type of condition.

2.    Have the employee complete and send the evidence form and the claim form for the applicable condition
      to the address shown on the form.




                                                    40
CONTACT (Employee Assistance Program) - If Applicable
Great-West, along with Shepell-fgi provides CONTACT, Great-West’s Employee and Family Assistance Program (EAP).

Great-West handles member and plan administration, including billing, rates and renewals. All inquiries should be
directed to your local Great-West representative. To ensure privacy and confidentiality, no identifying employee or
dependant data is shared between Great-West and Shepell-fgi.

         It is very important that you report company name changes, or the addition or deletion of an affiliated or
         subsidiary company, immediately to Great-West so that Great-West can update their systems and report the
         change to Shepell-fgi. This will ensure employees are not denied access to the services.

         Employees cannot waive the CONTACT benefit.

         Waiver of premium does not apply to the CONTACT benefit.

Shepell-fgi provides the EAP services. A Shepell-fgi Senior Account Manager/Service Manager will guide you in
developing, implementing and maintaining the EAP. For information or assistance at anytime, please call Shepell-fgi
@ 1-800-461-9722.

Promotional materials (i.e. supervisor's guide, brochure including wallet card, magnets or posters), can be ordered
by:

         E-mail gwlmaterials@warrenshepell.com,

         online www.warrenshepell.com/gwlmaterials, or

         calling Shepell-fgi @ 1-800-461-9722 ext. 5353

The HealthQuest (newsletter) is produced four times a year and is available in paper and/or electronic (PDF) format.
To change delivery from paper and/or PDF format, change mailing information, or adjust the quantities required,
please e-mail eapnewsletter@gwl.ca, or fax (204) 946-7305. Please be sure to include your name, policy number,
and organization name and address.




                                                          41
Optional Benefits
Optional Life
Your Optional Life policy number is:           Refer to page 47 of this guide

Coverage is chosen by employees on an individual basis and is available to the employee, spouse and child.
Insurance for employee and/or spouse is available in units of $10,000. The maximum for children is $50,000 per
child. Note: There is one rate billed for children, regardless of the number of children the member has listed.


New Applications and Increases in Coverage
1.       Give the Optional Group Term Life Insurance brochure to all employees.

2.       Give the Evidence of Insurability form and Confidential Return Envelope to employees who wish to apply
         for coverage.

3.       Complete the Coverage Detail portion of Evidence of Insurability form.

4.       Instruct the employee to complete the Evidence of Insurability form and return it to you in the
         Confidential Return Envelope.

5.       Send the envelope to Member Administration:

         Member Administration
         P.O. Box 6000
         Winnipeg, MB, R3C 3A5
         Fax: (204) 946-8603
         Email: memberadmin@gwl.ca
         8am - 4pm Central

Great-West will advise in writing as to the approval date and the amount of coverage. Approval is subject to the
employee being actively at work on the approval date. If the employee is absent from work on the coverage
effective date, insurance will become effective on the date the employee returns to work.

If Great-West declines the employee's or the spouse's application, we will send a letter to the employee or spouse
advising of our decision. You will also be sent a letter outlining our decision.

Do not update your records on GroupNet since Great-West will do it for you. Do update your employee records to
ensure premiums are charged to your employee.


Decreases or Terminations in Coverage
An employee’s or spouse’s amount of insurance may be decreased or terminated at any time.

1.       Have the employee give you written notification of change.

2.       Enter the change on GroupNet and in your payroll/HRIS system.

3.       Keep the notification with the employee’s application.




                                                           42
Applying for Non-Smoker Rates
An employee or their spouse may apply to have Optional Life premiums reduced to non-smoker rates. To be
considered a non-smoker, an employee or spouse must not have smoked for a continuous 12-month period.

1.       Have the employee complete the Application for Non-Smoker Rates. If the employee answered yes to
         any of the questions, you must decline the request for non-smoker rates.

2.       Update your records on GroupNet and your payroll/HRIS system.

3.       Keep the notification with the employee’s application.


Optional Accidental Death and Dismemberment (AD&D)
Coverage is chosen by employees on an individual basis. There are no minimum participation requirements.
Coverage is effective on the date the employee signs the application, provided the employee is actively at work.
Employees may increase or decrease coverage by completing another application.

1.       Give employee the Optional AD&D Insurance brochure.

2.       Have employees who wish to apply for coverage complete the Application for Optional Group AD&D
         form and return it to you.

3.       Send application to Member Administration:

         Member Administration
         P.O. Box 6000
         Winnipeg, MB, R3C 3A5
         Phone: (204) 946-7096
         Fax: (204) 946-8603
         Email: memberadmin@gwl.ca
         8am - 4pm Central

Do not update GroupNet since Great-West will do it for you. Update your payroll/HRIS premiums for that employee.




                                                         43
Plan Direct – Early Retirees
For early retirees terminating their Group Benefits coverage, coverage Plan Direct can be obtained. To apply, you
must be age 50 and over and must be covered by the provincial health plan in your province of residence. Please
note that preferred rates have been arranged.

Please visit the National Plan site for the Application Form www.nationalplan.ca (attached for your convenience)



 Application M6179
      Eng.pdf

General information about Plan Direct can be found at

http://www.greatwestlife.com/001/Home/Individual_Products/Insurance/Health___Dental_Insurance/index.htm

Inquiries may be directed by contacting PDAdmin Group at 1-800-565-4066 or by email questions@plandirect.com



Please Note: Application for some of the Individual Products is time sensitive. Therefore, please provide this
information to plan members at the time of termination of their employment.




                                                         44
GroupNet Billing
Each month before the premium due date, Great-West prepares your premium statement and emails you to tell you
that it is available on-line.

          The billing will be prepared four to six days from the end of the month.

          Your policy limits retroactive credits to four months therefore it is important that you review your billing
          carefully.

          Premium credits or debits are made for complete months of coverage and are not pro-rated.

          Premiums are due and payable on the first of each month.

          You have 31 days to send in your premium.

          Your coverage will be terminated if Great-West doesn’t receive your premium within 31 days. Claims
          incurred on or after this date will not be accepted.

Note: Health Care Spending Accounts are billed in arrears and payable by cheque. See Health Care
Spending Accounts for further billing information.



Details on your Billing Statement:
          The “Adjustments for Prior Period” on your bill, include changes that were processed prior to the billing run
          date.

          “Detailed Information for Current Period” shows the premium amount per employee. In the “Total Cost”
          column additionally breaks down the premium contribution by the Employer (ER) and Employee (EE).

          “Change Detail Report” will list all the changes that have been made since the last bill’s cuff-off date, that
          will affect the current billing amount owing.


Premium Payment
1.        Print bill using the “Print” feature in GroupNet Billing.

2.        Pay total amount due, less any payments sent to Great-West but not appearing on your statement.

3.        Include your Premium Remittance form with your payment and send to Group Insurance Payment
          Administration:

          Group Insurance Payment Administration
          P.O. Box 1053
          Winnipeg, MB, R3C 2X4




                                                              45
Billing (Self-Accounting)
Each month, you prepare your premium statement.

        Premiums are due and payable on the first of each month.

        Your policy limits retroactive credits to four months.

        Premium credits or debits are made for complete months of coverage and are not pro-rated.

        You have 31 days to send in your premium.

        Your coverage will be terminated if Great-West doesn’t receive your premium within 31 days. Claims
        incurred on or after this date will not be accepted.


Premium Payment
1.      Pay total amount due.

2.      Include your payment with your premium statement and send to Group Insurance Payment Administration:

        Group Insurance Payment Administration
        P.O. Box 1053
        Winnipeg, MB, R3C 2X4




                                                          46
POLICY NUMBER SUMMARY
ATLANTIC CENTRAL (NB)
Basic                   160604
Optional Life           163714
ASO                     57141
Early Referral Services 58083
Paid-Up Life            163728


ATLANTIC CENTRAL (NS, NL)
Basic                   160607
Optional Life           163717
ASO                     57143
Early Referral Services 58084
Paid-Up Life            163727

CREDIT UNION CENTRAL OF SASKATCHEWAN
Basic                   163705
Optional Life           163706
Early Referral Services 58085 and 58089 Self-Acc
Self-Admin              163707 and 163708 Optional Life

CREDIT UNION CENTRAL OF MANITOBA
Basic                   163711
Optional Life           163712
Early Referral Services 58086
Paid-Up Life            163713

CREDIT UNION CENTRAL OF ALBERTA
Basic                   163720
Optional Life           163721
Early Referral Services 58087 and 58090 Self-Acc
Paid-Up Life            163722 and 163725 Self-Acc
Self-Admin              163723 and 163724 Optional Life

CENTRAL 1
Basic                   156647
Optional Life           163730
Early Referral Services 58088
Paid-Up Life            163731

Directors
Basic                  163709

Paid Up Life Master - Policy 163626




                                                 47

				
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