Essentials by ashrafp

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									                              Essentials
Your Benefit and Pension Plan Your Benefit and Pension Plan Essentials
Contents

Need Information?                          3
About Essentials                           4
Role of Trustees                           4
Role of Administrator                      4
Your Pension Plan                          5
How to join the pension plan               5
Travel cards                               5
How the pension plan works                 5
Current employer contributions             5
Contribution statements                    6
Pension statements                         6
Your “pension adjustment” (PA)             6
When you may retire                        6
Amount of your pension                     6
How to calculate your pension              6
If you joined Local 67 before 1972         7
If you were a member of Local 674          7
Cash benefit                               8
Pension increases                          8
If you retire before age 62                9
If you retire after age 62                 9
Pension payment options                    10
If you don’t have a spouse                 10
If you have a spouse                       10
Applying for your pension                  11
How your pension is paid                   11
Tax fact                                   11
If you go back to work in the trade        12
If you retired before July 1, 2003         12
If you are age 62 or more and
you retire after June 30, 2003             12
If you are age 62 or more and
you retired before July 1, 2003            12
If you leave the trade before
you are eligible to retire                 12
Leaving the Local 67 pension plan          13
Amount of your pension benefit
if you leave the plan                      13
When you are sick or injured               13
If you are prevented from doing any work   14
If you are prevented from
doing your usual job                       14
If you are terminally ill                  14
If you are separated or divorced             14
If you die before your pension begins        15
If you have a spouse                         15
Who qualifies as your “spouse”               15
If you have children but no spouse           16
Who qualifies as your “child”                16
If you have no spouse or children            16
If you die after you retire                  16
Security of benefits                         17
Government plans                             17
Your Group Benefit Plan                      18
General information                          18
How the group benefit plan works             18
Travel cards                                 18
What benefits are provided                   19
How to join the benefit plan                 19
Covering your family                         19
Keeping your coverage                        20
Direct payment                               21
While you are sick or injured                21
When coverage ends                           21
If you die while covered by the plan         22
When you retire                              22
Income tax                                   23
Keeping us informed                          23
Your beneficiary                             23
Dental                                       24
Dental fee guide                             25
Getting a treatment plan                     25
Alternative treatment                        25
What the plan covers at 100%                 25
What the plan covers at 50%                  27
What the plan doesn’t cover                  27
How to make a dental claim                   28
Payment guide for crowns, inlays,
dentures & fixed bridgework                  29
Extended Health Plan                         31
Medical                                      31
What the plan covers                         31
Assistive Devices Program                    34
Travel coverage for retirees and survivors   34
What the plan doesn’t cover                  34
Prescription drugs                           35
What the plan covers                         35
What the plan doesn’t cover                  35
Vision care                                  36
What the plan covers                        36
What the plan doesn’t cover                 36
How to make medical,
drug or vision care claims                  36
Travel                                      37
Who is covered                              37
What’s covered                              37
GS Travel Assistance Service                42
Here's how GS Travel Assistance Service
Works                                       43
Exclusions                                  45
How to make a travel claim                  46
Life insurance                              47
Naming a beneficiary                        47
If you leave the plan                       47
How to make a life insurance claim          48
Short term disability benefits              48
Length of disability                        49
If you take an approved leave               49
How to make a disability claim              50

Your Supplementary Unemployment

Benefits                                    51
How the SUB plan works                      51
How you get SUB benefits                    51
Amount of your SUB benefits                 52
If you claim again                          52
CCRA rules                                  52
How to make an SUB claim                    52
How to make a group benefit claim           53
Direct payment to the provider of service   53
Green Shield plan member online services    53
What’s covered                              54
What’s not covered                          54
If you are covered under another plan       55
Coordinating claims with your spouse        55
Coordinating claims for your children       56
If you are retired                          56
If another party is liable                  56
Group conversion for
dental and extended health                  57
Key words and definitions                   58
Green Shield Canada
Commitment to Privacy                       63
The last word                               65
To become a Trustee, you must be a union member in good standing and you must be elected by the union
member-ship. Currently, our Board has seven trustees. Their job
is to manage our plans in the best interests of our plan members. Because the Trustees aren’t pension and
benefit experts, one of their key responsibilities is to choose the
professionals they need to run the plans effectively. Once they’ve chosen these professionals, it’s up to the
Trustees to manage them carefully and monitor their performance. Reliable Administrative Services Inc. (the
Administrator) looks after the day-to-day administration of the plans, such as signing up new members,
receiving contributions from employers, administering agreements with other unions, keeping track of bank
hours, collecting union field dues, answering member questions, preparing
statements, etc. The Administrator reports directly to the Board of Trustees.
Need Information 43 Our pension and benefit plans have been around for over 30 years.
During this time, they have protected thousands of Local 67 members from financial hardship and helped our
members to enjoy a comfortable retirement About Essentials
Essentials is made up of three plans that have been created specially for members of
Local 67:
1. Pension plan
2. Group benefit plan (health and welfare plan)
3. Supplementary unemployment benefit (SUB)
These three plans are managed by a Board of Trustees. Each plan has a trust agreement
which spells out how the Board of Trustees must operate – this includes how many
people sit on the Board, how they are elected, their duties, and how long they serve.
Need Information?
That’s where your Administrator comes in. For most questions about your pension or
benefits, you should contact Reliable Administrative Services Inc. But, if your question
is about a claim for life or disability benefits, you should contact Manulife Financial.
If your question is about a claim for extended health or dental you should contact

Green Shield Canada.
Administrator
Reliable Administrative Services Inc.
Telephone: 905-387-5861
Fax: 905-387-4146
Web: www.reliableadmin.com
Email: local67@reliableadmin.com
Address: 195 Dartnall Road, Suite 102
Hamilton, ON L8W 3V9

Manulife Financial
Life Insurance claims
Toll Free: 1-800-565-4710
Address: PO Box 1030, Halifax, Nova Scotia B3J 2X5



Goup Disability claims
Telephone: 416-687-5049 or 1-800-465-2076
Web: www.manulife.com
Address: 2 Oueen Street East, PO Box 4606 Stn A
Toronto, Ontario M5W 4Z2
Green Shield Canada

Extended Health and Dental claims
Toll Free: 1.888.711.1119
Web: www.greenshield.ca
Address: Attn: Medical Items
P.O. BOX 1623, Windsor, Ontario N9A 7B3
Attn: Vision
P.O. BOX 1615, Windsor, Ontario N9A 7J3
Attn: Dental Department
P.O. BOX 1608, Windsor, Ontario N9A 7G1

Our Current Trustees
David Cobb Douglas Llewellyn
Leslie Ellerker (Chair) Peter Stopyn
Ross French Frederick Wilson
Victor Langdon (Secretary)


How the pension plan works

For each hour that you work, your employer makes a contribution to the pension plan. The exact amount of the
contribution is spelled out in the collective agreement. At the end of every month, each employer for whom you
have worked reports your hours and sends a cheque to the
Administrator. Employer contributions are deposited into the pension trust fund, which is held by a trust
company. Professional investment managers invest the trust fund in stocks, bonds and other types of
investments permitted by pension law within guidelines set by the Trustees. All
pension benefits and the expenses of running the plan are paid by the trust fund.

The pension plan is regulated by federal and provincial legislation. It’s registered under the Income Tax Act and
the Ontario Pension Benefits Act (registration #0381525).

Current employer contributions

~ Contribution statements

To help you keep track of employer contributions, the Administrator sends you a benefit statement every three
months showing the activity in your pension bank. Please check your statement as soon as you receive it to
make sure that your employers have reported your hours
correctly. If you find any errors, you must tell the Administrator immediately or you may not receive credit for
unreported hours. Please call: 905-387-5861.

~ Pension statements
The Administrator sends you a pension statement each year. This statement provides information on how much
pension you have earned, your beneficiary, and plan funding.
(For details on naming a beneficiary, please see p.15-16.)

~ Your “pension adjustment” (PA)

You pay no income tax on employer contributions to the Local 67 pension plan. But the amount that you are
allowed to contribute to a registered retirement savings plan (RRSP)
in any year is reduced by total employer contributions to the pension plan for the previous year. The Canada
Customs and Revenue Agency (CCRA – formerly Revenue Canada) calls this reduction a “pension
adjustment.” This amount is reported on the T4s that you get from your employers.

When you may retire

Your normal retirement date is the first of the month following your 62nd birthday. You may also retire as early
as age 52 with a reduced pension, or as late as age 69. (See p.9 for details on how much pension you will
receive.)


Amount of your pension

For each 100 hours that your employer contributes to the pension fund, you receive a certain amount of monthly
pension at retirement. Here’s how it works.

~ How to calculate your pension

Your Pension Plan

Your Local 67 pension may be your most important financial asset!
How to join the pension plan It’s automatic. If you work for an employer who contributes to the pension fund
for you, you’re a member of the plan. The Administrator will provide a pension plan enrolment form which you
must complete and return to the Administrator’s office.
If you pay union dues but you’ve never worked for an employer who makes contributions
to the plan for you, you won’t qualify for a pension from the Local 67 plan.
~ Travel cards
If you’re working on a travel card, please check with the Administrator to see if the local you
are working in has a pension agreement with Local 67. If it does, your pension contributions
will be transferred to the Local 67 plan. If it doesn’t, the Trustees will try to establish one.
You automatically join the plan if you work for an employer who contributes for you. If you work in another
U.A. local, you should check with the Administrator to see if that local has
an agreement with Local 67 that will let you transfer pension contributions.
Dates hours were worked Monthly pension at age 62 January 1, 1972 – June 30, 1987 $2.92 per 100 plan hours
July 1, 1987 – April 30, 1999 $4.92 per 100 plan hours
May 1, 1999 – April 30, 2000 $5.27 per 100 plan hours
May 1, 2000 – April 30, 2002 $6.02 per 100 plan hours
May 1, 2002 – Present $6.44 per 100 plan hours
Any pension you earn as an apprentice after April 1, 2002, is adjusted based on your employer contribution rate.

Your RRSP contribution room is reduced by employer contributions to the pension plan during the previous
year. The normal retirement date is age 62, but you can retire on a reduced pension
as early as age 52. Your Local 67 pension is paid in addition to Canada/Quebec Pension Plan (C/QPP) and Old
Age Security (OAS) benefits. Current employer contributions to the pension plan for each hour that you work
After May 1, 2003 $4.75
After May 1, 2004 $5.50
Rates for apprentices range from 40% of above rates in their first year to 80% of above rates in their fifth year.
65

The Administrator calculates your pension for you and sends you a statement each year showing you how much
it has grown. Your Pension Plan ~ If you joined Local 67 before 1972
If you joined Local 67 before 1972, you might qualify for a “past service” pension equal to $3.74 per month for
each year of past service. This is paid in addition to the pension described on the previous page.

“Past service” means the full amount of time before 1972 when you were a member of Local 67 and working
under Local 67 contracts. If you had a break in your Local 67 membership or worked outside the trade, your
past service starts from the date of your reinstatement or the latest date you returned to work in the trade before
1972.

To qualify for past service, you must have earned at least 400 pension hours during 1972.

~ If you were a member of Local 674

In addition to your Local 67 pension, you will also receive any pension that you earned under the former Local
674 (Brantford) plan before it merged with Local 67 in 1976.

Example 1: Monthly pension at age 62 (2 years of service before 1972)
Member of Local 67 since 1970 Age 62 Past service $3.74 x 2 years = $7.48
January 1, 1972 – June 30, 1987 $2.92 x 340 (34,000 hours)
= $992.80
July 1, 1987 – April 30, 1999 $4.92 x 290 (29,000 hours)
= $1,426.80
May 1, 1999 – April 30, 2000 $5.27 x 26 (2,600 hours)
= $137.02
May 1, 2000 – April 30, 2002 $6.02 x 34 (3,400 hours)
= $204.68
May 1, 2002 – Present $6.44 x 8 (800 hours) = $51.52
Total monthly pension $2,820.30

Example 2: Monthly pension at age 62 (no service before 1972)
Member of Local 67 since 1990 Age 62
January 1, 1972 – June 30, 1987 $2.92 x 0 hours = $0.00
July 1, 1987 – April 30, 1999 $4.92 x 120 (12,000 hours) = $590.40
May 1, 1999 – April 30, 2000 $5.27 x 24 (2,400 hours) = $126.48
May 1, 2000 – April 30, 2002 $6.02 x 25 (2,500 hours) = $150.50
May 1, 2002 – Present $6.44 x 12 (1,200 hours) = $77.28
Total monthly pension $944.66

~ Cash benefit

If your pension qualifies as a “small” pension under Ontario pension law, the full value of your pension will be
paid to you in a single lump-sum payment instead of in monthly pension payments. In 2003, a “small” pension
is anything less than $66.50 per month.

~ Pension increases

Depending on the pension fund’s investment performance, the Trustees may declare a pension increase. In the
past, pension increases have applied to both pensions currently being paid to retired members and pensions
earned by active members.

Although there are no guarantees about how big the pension increases will be, or how often they’ll happen, they
have greatly improved pensions over the years. The following chart compares pension increases to the rate of
inflation for the past 15 years. Increases for active members are more complicated, because there have been
different rates for different periods of membership.
87

From time to time, a pension increase may be added to your pension credits. Your Pension Plan
Pension increase for member retired since 1987 Cumulative pension increase from 1987 to 2002: 65.8% Total
inflation (increase in cost of living) from 1987 to 2002: 46.0% o5Jul 1, 1990Jul 1, 1993Jan 1, 1996Jan 1,
1998Jan 1, 1999Jan 1, 200010152010%4%13.8%15.1%1.5%9%

~ If you retire before age 62

If you retire between ages 52 and 62, your pension will be calculated the same way as a pension at age 62, but
will then be reduced by 6% for each year (1/2% per month) that your retirement date falls before your 62nd
birthday. But, in no event will your reduced pension be worth less
than the current value of your pension if you left the plan (see p.13).

Example 3: Early retirement pension at age 60
Member Age 60
Pension earned starting at age 62 $1,000
Reduction in pension (6% x 2 = 12%) –$120 Total monthly pension $880
~ If you retire after age 62

If you delay taking your pension and continue to work in the trade, your employer will continue to make
contributions to the pension fund for each hour that you work, and your pension will continue to grow. By law,
you must start taking your pension by the end of the year in which you reach age 69. If you work past that point,
our employers will continue to make contributions to the pension fund, but these will not be added to your
personal pension account. Instead, they will help the plan as a whole.
Pension payment options

~ If you don’t have a spouse or dependent children

Option 1

Your pension will be paid for as long as you live and comes with a ten-year guarantee. This means that if you
die within the first ten years after your pension begins, payments continue to your beneficiary for the rest of the
guaranteed period. If you don’t have a beneficiary, your
estate will receive a death benefit equal to total payments remaining in the guaranteed period. If you die after
the end of the guaranteed period, no death benefit is paid.

Option 2

If you don’t wish to leave a death benefit, you can drop the guarantee and receive a higher monthly pension that
is paid for your lifetime only.

~ If you have a spouse or dependent children

Option 1

If you have a spouse when you retire, he or she will automatically receive a lifetime pension equal to 66 2/3%
of the pension you were getting in the event of your death. You can increase your spouse’s pension to 100% of
your pension by taking a slight reduction in your monthly
pension at retirement.

If your spouse dies while your children are still dependent (see definition of “child” on p.58), or if you have
dependent children but no spouse when you die, 66 2/3% of your pension will be paid to your children until
they no longer qualify.

Option 2 (available to members retiring January 1, 2004 or later)

If your spouse doesn’t need a continuing pension after your death, you and your spouse can refuse the spouse’s
pension. This may be of interest if your spouse has a pension from his or her employer. Refusing a spouse’s
pension will also cancel the pension for your dependent
children. To refuse a spouse’s pension, you must both sign
a waiver form and file it with the Administrator before your pension begins. You then have the same choices as
109 you cannot change your pension option once you begin receiving your pension. Refusing a spouse’s
pension is an important decision, and your spouse should first obtain independent legal advice.

It may take up to three months from your last day of work to receive your first pension payment. This payment
will include any amount due to you from your actual retirement date don’t forget to notify the Administrator of
any change in your address or banking information Your pension is paid on the first day of every month. Tax is
deducted first. a member with no spouse or dependent children, including a lifetime pension with a guarantee or
a higher pension paid for your lifetime only.
Applying for your pension

Please contact the Administrator at least two months before you are ready to retire. The Administrator will then
send you your pension application forms. The
Administrator must receive all of your employer contributions in order to process your pension. Your
application may not be back-dated.

It may take up to three months from your last day of work to receive your first pension payment. This payment
will include any amount due to you from your actual retirement date.

Please notify the Administrator immediately if you decide to keep working past your scheduled retirement date.

How your pension is paid

Your pension is paid on the first day of each month for the rest of your life. You can have it deposited directly
to an account in your name or you can have a cheque mailed to you.

If you’re planning to live outside Canada, don’t worry. Your pension is still your pension. But because the
payments must be made to a Canadian bank, you will have to make arrangements with your bank to have it
transferred out.

~ Tax fact

Income tax is deducted from your pension before it is paid to you. How much tax is deducted depends on
government tax tables, as well as any additional tax information that you provide. In some cases, you can
increase or decrease the amount of tax that’s taken off your pension payment. Please contact the Administrator
(see p.3) who will send you the forms you need to do this.
If you go back to work in the trade




~ If you retired before July 1, 2003

Your pension is suspended if you are paid for more than 200 hours in any calendar year. If this happens, you’re
treated just like an active plan member and you earn extra pension based on your employer’s contributions to
the pension fund. When you stop working again, your pension is recalculated to include the extra pension and
the new amount is paid to you starting the first of the following month.

~ If you are age 62 or more and you retire after June 30, 2003

You must sign the retiree list if you plan to work in the trade. When you sign the retiree list, the 200-hour limit
doesn’t apply. You can work any number of hours and your pension will not be suspended. Going on the retiree
list means that you:
1. will be called for work only if requests for manpower cannot be filled from the active list,
2. pay retirement dues instead of full active dues,
3. cannot return to the active list.

~ If you are age 62 or more and you retired before July 1, 2003

You have a choice of staying on the active out-of-work list or signing the retiree list. The decision to sign the
retiree list is final and you can’t go back on the active list.

If you leave the trade before you are eligible to retire

If you leave the trade before age 52, you have two choices:

1. Stay in the plan: you can keep the pension benefits you have earned in the plan to provide a pension when
you retire. You can either take a normal pension at age 62 or a reduced pension starting between ages 52 and
62.
2. Leave the plan (see next page).
Once you reach age 52, you must take a pension starting immediately or anytime up to age 62.


Your pension is taxable income. If you start your pension while you are still working, you may
find that you have to pay hefty taxes on your pension.


Your Pension Plan

1211
The “cash value” is the total cost in today’s dollars to provide the pension that you have earned to date and that
starts when you reach age 62.


Leaving the Local 67 pension plan

You may leave the pension plan if you’re out of the union and no employer contributions have been made for
you for 12 or more months.

~ Amount of your pension benefit if you leave the plan

If you have under two years of plan membership when you leave the plan, you will not receive any pension
benefits. The employer contributions that have been made to the plan for you will remain in the plan.

If you leave the plan after two years of membership, you’ll receive a payment equal to the current “cash value”
of the pension you have earned starting at age 62.

You may take this payment in cash only if it qualifies as a small pension. If you do this, tax will be deducted
from your payment. Otherwise, current pension law gives you the following tax-free choices:

• transfer the payment to a locked-in retirement arrangement, such as a locked-in retirement account (LIRA).
A LIRA works the same way as an RRSP, except that no withdrawals are allowed. A LIRA can only be used to
provide an income at retirement, or a death benefit before retirement;
• use the payment to buy an annuity (a lifetime income) from an insurance company; or
• transfer the payment to another U.A. local in Canada or the U.S., or to another employer’s pension plan, if that
plan allows transfers.

When you are sick or injured

If you are disabled, you may qualify for a disability pension from the pension plan. You must have at least two
years of membership in the pension plan, and you must get approval from the Trustees. This includes providing
medical proof of your disability by a doctor appointed by the Trustees.

~ If you are prevented from doing any work

If you are totally and permanently disabled to the point where you can no longer do any work, you will receive
a disability pension equal to the pension you have earned up to the date of your disability (minimum $50 per
month).



~ If you are prevented from doing your usual job

If you are totally and permanently disabled to the point where you cannot work in the plumbing and pipefitting
industry, but you can still work in another type of job, your disability pension will equal the pension you have
earned up to the date of your disability reduced by 3% for each year that your date of disability falls below the
first of the following:

• your 60th birthday,
• 30 years of service, or
• the date when you have 80 years of combined age plus years of service.

If you are terminally ill

If you are medically certified to have less than two years to live, you may cash some or all of your pension
earned to date.

If you are separated or divorced

If you and your spouse aren’t living together, he or she no longer automatically qualifies as your spouse under
pension law, even if you are still legally married. This means that in order to get any death benefits from the
plan, he or she must be specifically named as your beneficiary. You can name someone else as your beneficiary
by completing a new pension beneficiary form and giving it to the Administrator. (For more information about
death benefits, see p.15-16.)

Usually, the value of the pension you have earned during your marriage is included by law in your shared
family assets. This means that the value of your pension must be taken into account when dividing the family
assets. It also means that payments from the plan may have to be made
because of a court order for support or maintenance. Please check with your lawyer for details.


The “cash value” is the total cost in today’s dollars to provide the pension that you have earned to date and that
starts when you reach age 62.

The value of the pension you have earned during your marriage is included by law in your
shared family assets.

Your Pension Plan

1413

Bereavement counselling is available to all members and their families. Please contact the Administrator.




If you die before your pension begins

When it comes to pension benefits, spouses’ rights are protected by law. Unless your spouse signs a waiver
(before your death) giving up the right to your pension death benefits, he or she is automatically your
beneficiary, even if you name someone else. If you have no spouse, or
your spouse signs a waiver, you can choose anyone you want as your beneficiary(ies).

If you have at least two years of plan membership when you die, the following death benefit will be paid:

~ If you have a spouse

He or she will have a choice of receiving a one-time payment or a lifetime pension whose present value is equal
to the full “cash value” of the pension you have earned.

If your spouse chooses the pension, he or she will have a choice of having the pension start immediately or at a
later date. If your spouse chooses an immediate pension, the amount of his or her monthly pension might be
increased, if allowed by current tax rules, to be at least equal to the
monthly pension you earned up to the date of your death divided by 1.07. If your spouse chooses a one-time
payment, he or she will have the following payment options:

• transfer the money tax-free to an RRSP,
• transfer the money tax-free to a locked-in retirement
arrangement or another pension plan if the plan allows it, or
• take it as a taxable lump-sum payment.
Who qualifies as your “spouse”

According to Ontario pension law, this is a person of either sex who is living with you and is

• married to you, or
• not married to you and has been living with you in a conjugal relationship continuously for at least three years,
or in a relationship of some permanence if you are the
natural or adoptive parents of a child.

~ If you have children but no spouse

Your children will receive a one-time payment equal to the full “cash value” of the pension you have earned up
to the date of your death. This payment will be divided equally among them and will be taxed as income.

Who qualifies as your “child”

A child who is dependent on you for support and

• under age 18 throughout the year of your death, or
• under age 24 and a full-time student throughout the year of your death.
~ If you have no spouse or children

The plan will pay a death benefit equal to one of the following, whichever is less:

• the full “cash value” of the pension you have earned up to the date of your death; or
• 36 times the monthly pension you have earned, but not less than the “cash value” of the pension you have
earned since January 1, 1987. You can name anyone you like as your beneficiary(ies).
If you don’t name a beneficiary, your death benefit will be paid to your estate – unless you make specific
reference to it in your will. In either case, the benefit is taxed and paid in a single payment.

Keep in mind that if the payment is made to your estate, it may be subject to probate fees – which could be
hefty, depending on the size of your estate. Also, pension benefits are protected from creditors only if paid
directly to a beneficiary. If they’re paid to your estate, creditors are allowed to make claims on this money.

If you die after you retire

Death benefits after retirement depend on the form of pension you choose at retirement (see p.10).

If you have provided a continuing pension to your spouse, this pension will be paid for life, even if he or she
remarries. If your spouse dies while your children (see definition of “child” above) are still dependent, this
pension will continue until they no longer qualify.


Death benefits after retirement depend on the form of pension you choose at retirement.


Your Pension Plan

1615

Security of benefits

The Trustees intend to keep the plan running indefinitely

Your Group Benefit Plan and follow prudent practices to help limit any risks. However, any benefits that cannot
be covered by the assets (Health & Welfare) in the fund are not guaranteed. If it became necessary to

Your Local 67

pension is completely separate from any government-paid pensions. The amount you receive from C/QPP and
OAS has no effect on the amount you receive from the Local 67 plan.

OAS provides a basic pension for almost every senior age 65 or older. Wind-up the plan, all assets would be
used to provide benefits for members.

Government plans

Government-paid pensions are a nice supplement to your retirement income, but unfortunately they are just that,
a supplement. Many working Canadians do not realize how little these plans pay. Together, Old Age Security
(OAS) and the Canada/Quebec Pension Plan (C/QPP) are meant to provide only basic retirement income –
replacing no more than 40% of the average industrial wage.
If you would like some information on OAS or C/QPP benefits, or would like to receive an application kit,
contact Human Resources Development Canada at 1-800-277-9914 or go to www.hrdc-drhc.gc.ca/isp, where
you can download the forms directly.

General information

~ How the group benefit plan works

Your employers make a contribution to the benefit plan for each hour that you work. The exact amount of the
contribution is spelled out in the collective agreement. (The contribution rate as of May 2005 is $1.80 per hour.)
At the end of each month, your employer sends a report to the Administrator showing how many hours you
have earned together with a cheque to cover the contribution. These contributions are credited to
your benefit account.

You use the funds in your benefit account to “pay” for your coverage under the plan. The current cost of
coverage is $227.06 per month. This is deducted from Check it out!

your benefit account on the first of each month. The Administrator (see p.3) sends you a benefit statement
every three months showing you the activity in your Please check your benefit benefit account. This includes
employer contributions as statement care-well as monthly deductions to pay for your coverage fully. You must
Employer contributions are deposited to a benefit trust report errors fund, which is used to pay the entire cost of
providing immediately or the Local 67 group benefit plan. The trust fund is you may miss managed by our
Board of Trustees (see p.4) which out on hours that are owed chooses professional investment managers to
invest to you the fund’s assets based on the Board’s guidelines.

~ Travel cards

If you work in another U.A. local, you should check with the Administrator to see if that local has an
agreement with Local 67 that will let you transfer benefit contributions.

Your Pension Plan

1817

Your life insurance is currently insured by Manulife Financial. Your travel coverage is with Green Shield.
All other claims are paid directly from the trust fund.

~ What benefits are provided

Your group benefits include:

• dental;
• extended health plan (including medical benefits, prescription drugs and vision care);
• travel and assistance service;
• life insurance;
• short term disability insurance.
All of your benefits except life insurance and travel are “self-insured” under the trust fund. Claims for short
term disability are administered by Manulife Financial. Claims for extended health and dental are administered
by Green Shield Canada. This means that when you make a claim, it goes to Manulife Financial or Green Shield
Canada for approval, and is then paid directly from the trust fund. Life insurance is insured with Manulife
Financial. Travel coverage is with Green Shield Canada. The cost of this coverage is paid from the trust fund.

~ How to join the benefit plan

To join the plan for the first time, you must either:

1. be a member in good standing with Local 67 and have enough employer contributions in your benefit account
to pay for three months of coverage under the plan, or 2. work full-time as a member of the administrative staff
for Local 67 or the Board of Trustees’ administrative staff. Your coverage starts on the first day of the month
after you meet these requirements. For your claims to be paid by Manulife Financial or Green Shield, you must
complete an enrolment card at the Administrator’s office when you join Local 67.

~ Covering your family

Once you become a member of the plan, your “spouse” and “children” (see below) are covered under the dental,
extended health, and travel plans if they are listed on your enrolment card.

Spouse

“Spouse” refers to your legally married spouse or a common-law partner of either sex.

A common-law partner is covered from the first day of the month following the month in which you notify the
Administrator in writing.

You can cover only one spouse at any one time under the plan. Note that under the pension plan, your partner
must live with you for at least three years before he or she qualifies as your spouse.

Children

You or your spouse’s natural, legally adopted, step or foster children qualify under the plan if they are:

• unmarried, and
• dependent on you or your spouse for financial support, and
• under age 21 (under age 25 if a full-time student at a recognized and accredited educational institution).
You may not cover children from a legal marriage at the same time as children from a common-law relationship
unless they are children who live with you or who don’t live with you but are fully dependent on you for
financial support.

Coverage continues after age 21 for unmarried, disabled children who were covered under the plan before age
21 and are not able to support themselves because of their mental or physical infirmity. You must provide proof
of your child’s disability to the Administrator.
~ Keeping your coverage

If you don’t have enough money in your benefit account to make your monthly payment, the Administrator will
send you a warning notice. At that point, you can either make a direct payment to keep your coverage (pay for it
from your own pocket) or let your coverage stop. If you let your coverage stop, you cannot get it back until you
return to work for a contributing employer and build up enough funds in your benefit account to cover two
months of payments. Your coverage will then start again on the first day of the following month.


Please contact the Administrator right away to report any changes in your address or family status. When
you notify the Administrator of a common-law spouse, you must also provide the names of any children of the
common-law relationship.


Your Group Benefit Plan

2019

Your Group Benefit Plan After 12 months of direct payment at the regular rate, you may continue your
coverage by paying the extended pay-direct rate.

~ Direct payment

To keep your coverage using direct payment, your payment must arrive at the Administrator’s office before the
first of the month to which it applies. Your cheque or money order should be made out to the “U.A. Local 67
Benefit Plan” and should clearly show your name, address and social insurance number.

After 12 months of direct payments at the regular rate (currently $227.06 plus $18.17 RST), you may continue
your coverage by paying the extended pay-direct rate (currently $251.80 plus $20.15 RST). Rates are adjusted
from time to time to reflect the cost of providing coverage.

Direct Payment Category Coverage Rate
Regular Full coverage $227.06 + RST
Extended Full coverage $251.80 + RST
Survivor Dental and Extended Health
$119.42 + RST
Retiree (under age 65)
Extended health and Life (to be determined) Retiree (age 65 or more) Extended health and Life
$ 71.38 + RST
Retiree survivor Extended health $ 71.38 + RST
~ While you are sick or injured

If you are receiving benefits from the Workplace Safety and Insurance Board (WSIB), full coverage under the
Local 67 pension and benefit plans will continue for up to 12 months with contributions paid from the plan.
Your employers contribute to the cost of this coverage by making an hourly contribution required under Bill
162 (currently $0.07 per hour.)

~ When coverage ends

Your membership in the benefit plan ends automatically on the first of the month after:

• you stop being a member in good standing of Local 67, or
• you have insufficient funds in your benefit account to cover the monthly cost of coverage and you don’t make
a direct payment. All extended health and dental claims under the plan must be submitted within 90 days after
your coverage ends. If dental prosthetics (such as bridges or crowns) were ordered while you were covered,
they will be reimbursed if installed within 90 days. For information on what happens to your life insurance if
you leave the plan, please see p.47.

~ If you die while covered by the plan

If you die before retirement, coverage continues as before for your spouse and children until your benefit
account falls below one month’s payment. Your spouse then has the option to continue dental and extended
health coverage by paying the direct payment rate for survivors (currently $119.42). The first payment must be
received by the 25th of the month after your benefit account runs down. Coverage for your survivors ends if
your spouse remarries.

If you die after retirement, but while you were still covered under the regular plan, your surviving spouse
and dependants can continue their full extended health and dental coverage by making direct payments. If you
die while you are covered under the retiree plan, your surviving spouse and dependants can continue their
extended health coverage by making direct payments (currently $71.38).

~ When you retire

When you retire, your membership in the regular benefit plan continues until your benefit account falls below
one month’s payment. If you reach age 65 and you still have enough funds in your benefit account to continue
your coverage, you have a choice of taking regular coverage or retiree coverage.

When your benefit account falls below one month’s payment, you may choose to continue either regular
coverage or retiree coverage by direct payment if:

1. you are a member in good standing with Local 67,
2. you are receiving a pension from the Local 67 pension plan, and 2221 If you die, your spouse has the option
to make direct payments to continue dental, health and life insurance coverage. Bereavement counselling is
available for all members and families. Please contact the Administrator
Your Group Benefit Plan Your monthly benefit payment will be deducted directly from your pension
payment. 3. you were covered by the Local 67 benefit plan immediately before you retired. You may stop your
retiree coverage at any time by contacting the Administrator, but if you do this, you cannot change your mind
and get your coverage back at a later date unless you return to work for a contributing employer and earn the
required contributions.

~ Income tax

Under current tax legislation, employer contributions to group life insurance are included in your taxable
income. You receive a T4A every year showing the amount. Any short term disability benefits paid to you are
also included in your taxable income.

~ Keeping us informed

You must let the Administrator know immediately if there is any change in your personal or family status,
including:

• change of name or address,
• marriage or divorce,
• coverage for a common-law partner,
• birth or adoption of a child,
• death of a spouse or other family member,
• a child who reaches age 21 and is a full-time student (must be updated every year).

~ Your beneficiary

You may change your beneficiary(ies) for life insurance at any time. Change forms are available from the
Administrator. If you don’t name a beneficiary, death benefits will be paid to your estate and may be subject
to probate fees, estate taxes and creditor claims.

The Trustees hope and expect to maintain the group benefit plan for many years. However, they may change
any or all of these benefits at any time.

Dental

Healthy teeth are an important part of our overall physical wellbeing. But as we all know, keeping teeth healthy
can be expensive. That’s where your Local 67 dental plan comes in. It pays a wide range of dental services and
procedures intended to keep you and your family smiling.

The following table provides a summary of your dental coverage. Details are provided on the following pages.

Summary of your dental benefits Treatments covered Amount paid by plan (max. $1,500 per person per year)
Effective January 1, 2005, the maximum shown above will be increased by an additional $300 every 5 years for
full upper and lower replacement dentures Diagnostic: exams, x-rays, 100% Endodontics: root canals 100%
Periodontics: root planing and periodontal surgery 100% Preventive: polishing, scaling, fluoride 100%
Prosthodontics (removable): full or partial dentures (see table on p.29-30) 100% Prosthodontics (fixed): initial
bridges (see table on p.29-30) 100% Restorative: fillings, stainless steel crowns 100% Surgical: extractions,
basic oral surgery 100% Orthodontic treatment 50% (max. $400 per person per year) Restorative: inlays, onlays
and crowns (see table on p.29-30) 50%
23 24

Please show this booklet to your dentist so that he or she will know which treatments and services are covered.
You’re covered for one exam each year and your children under 16 are covered for two (including emergency
and specific exams). You’re also covered for up to two hours of cleaning every year.

Dental treatment resulting from an accident may be covered at 100% under your extended health plan.

If you aren’t sure whether a particular treatment is covered, please show this section of your booklet to your
dentist or contact Green Shield at 1.888.711.1119.

~ Dental fee guide

All payments are based on the previous year’s edition of the Ontario Dental Association Suggested Fee Guide
for General Practitioners and Specialists. If your dentist uses a more recent fee guide, you must pay the
difference. Any applicable lab, drug and other expenses are eligible to a maximum of 40% (60% on bruxism
appliance or 50% on dentures) of the allowable professional fee.

~Getting a treatment plan

It is important to get a treatment plan from your dentist before you start any treatment that will cost more than
$300. This will let you know in advance how much you will have to pay and how much will be covered by the
plan.

Ask your dentist to complete a Green Shield or standard dental form describing the treatment and cost. Return
the form with your x-rays to Green Shield, who will tell you what part of the cost the plan will pay. Please send
in your treatment plan at least one month before treatment begins. Once you receive approval from Green
Shield, you must start your treatment within one year.

~ Alternative treatment

There are many ways to treat a particular dental problem or condition, and the costs can vary widely. Benefits
will be paid based on the least expensive service or supply available to provide satisfactory results. Any
difference between this amount and the actual treatment chosen by you and your dentist is your responsibility.

~ What the plan covers at 100%

• Anaesthetics administered in connection with eligible oral surgery.
• Antibiotics: injection of antibiotic drugs by the attending dentist.
• Bridgework: initial installation of fixed bridgework (including inlays, onlays and crowns to form abutments)
to replace one or more natural teeth extracted while covered under the Local 67 dental plan.
• Check-ups, but not more than one examination in any calendar year if age 16 and over and not more than two
examinations in any calendar year if under age 16 (all types of examinations count toward this limit).
• Consultations required by attending dentist.
• Dentures: initial installation of partial or full removable dentures to replace one or more natural teeth extracted
while covered under the Local 67 dental plan and adjustments to these dentures but separate charges for
adjustments included only if incurred more than three months after initial installation.
• Endodontic treatment, including root canal therapy.
• Extractions.
• Fillings, excluding tooth-coloured fillings on molars.
• Fluoride: topical application of sodium or stannous fluoride.
• Oral surgery, including excision of impacted teeth.
• Periodontics: treatment of periodontal and other diseases of the gums and tissues of the mouth.
• Repair or recementing of crowns, inlays, onlays, bridgework, or dentures, or relining of dentures.
• Replacement of existing partial or full removable denture or fixed bridgework by a new denture or new
bridgework, or the addition of teeth to an existing partial removable denture or to bridgework to replace
extracted natural teeth, but only if: Yearly maximums apply to the calendar year (January-December).

Your Group Benefit Plan

2625

. replacement or addition of teeth is required to replace one or more additional natural teeth extracted after the
existing denture or bridgework was installed while covered under the Local 67 dental plan;
. the existing denture or bridgework was installed at least five years before its replacement and cannot
be made serviceable; or
. the existing denture is an immediate temporary denture replacing one or more natural teeth extracted while
covered under the Local 67 dental plan, and replacement by a permanent denture is required and takes place
within 12 months from the date of installation of the immediate temporary denture.
• Scaling and polishing teeth, subject to a combined maximum of eight units of time in any calendar year
(a unit of time equals 15 minutes of service).
• Space maintainers, including stainless steel crowns, but only if crown is placed on primary tooth which
has several cavities which would otherwise require fillings or is non-restorable using normal restorative
dental material.
• X-rays but not more than once every three calendar years for full mouth services of films and twice per
calendar year for bitewing films.

~ What the plan covers at 50%

• Orthodontic treatment including correction of malocclusion.
• Inlays, onlays and crowns (including precision attachments for dentures).

~ What the plan doesn’t cover

• Periodontal splinting.
• Replacement of lost or stolen dental appliances.
• Services related to implants, personalization or characterization of dentures, temporomandibular joint
dysfunction.
• Services completed after termination of coverage. For general exclusions, please refer to “What’s not
covered”on p. 54–55.

~ How to make a dental claim

Dental claim forms are available from the Administrator, your local union office, or the Green Shield website at
www.greenshield.ca. You may also use a standard dental claim form. Claims may be submitted electronically
by your dentist to Green Shield for payment.

You must use a separate form for each person. Claims must be submitted within 12 months of the date of
treatment. The "assignment" part of the form which allows the plan to pay your dentist directly may only be
signed by you (not your spouse or children). The plan has the right to cancel assignment privileges at any time.


Your Group Benefit Plan

2827

~ Payment guide for crowns, inlays, dentures and fixed bridgework

Your Group Benefit Plan 30 You are covered under the plan when one or more natural teeth are extracted
and the extracted teeth are replaced by the partial denture. You are covered under the plan when one or more
natural teeth are extracted and the extracted teeth are replaced by the partial denture. You are replacing a
temporary partial denture, within 12 months of when it was first installed. You have had your existing
dentures for at least five years and they cannot be made serviceable. You are covered under the plan when one
or more natu-ral teeth are extracted and the extracted teeth are replaced by the full denture. You are replacing a
temporary full denture, within 12 months of when it was first installed. You have had your existing dentures for
at least five years and they cannot be made serviceable. Item Requirements Partial Temporary dentures Not
applicable Initial dentures Replacement dentures Crowns, inlays (including precision attachments for dentures)
Initial fixed bridgework The natural tooth must be extracted while you are covered. Replacement fixed You
have had your existing bridgework bridgework for at least five years and it cannot be made serviceable.
Coverage Full Partial Full Repairs such as relining and recementing
N/A 100% N/A
100% 100% 100%
100% 100% 100%
50% 100%
100% 100%
100% 100%
Services in red can be provided by a Registered Denture Therapist.

29
You are required to pay OHIP health tax based on your taxable income, if more than $20,000 per year.


Extended health plan

Your provincial health plan (OHIP) provides you with basic medical coverage. This includes standard ward
hospital care, in-hospital drugs and services, doctors’ services and some paramedical treatments. You are
required to pay OHIP health tax based on your taxable income if that amount is more than $20, 000 per year.
Your doctor or hospital bills OHIP directly.

The Local 67 extended health plan includes medical benefits, prescription drugs and vision care. You will find
sections on each of these benefits in the following pages. Each section tells you what is covered, what isn’t
covered, any maximums that apply, and how to make a claim.

The plan pays 100% of all eligible expenses listed below charged anywhere in the world if they are medically
necessary and not covered by OHIP or another provincial health plan. Claims are paid based on the actual
charges or what would be charged in Ontario if less.

Medical

~ What the plan covers

• Emergency Transportation – licensed ambulance to the closest hospital if part of the cost is covered by your
provincial health plan (does not include an ambulance home from the hospital).
• Convalescent hospital – up to $10 per day for room,
board and services for a maximum of 120 days per disability if admitted within 14 days of your stay in a general
hospital (periods of disability less than 90 days apart are treated as one period of disability).
• Accidental Dental - treatment to repair natural teeth
damaged by an accidental blow to the mouth while covered under the plan (treatment must be pre-approved
and start within 90 days of the accident and be completed within one year or before age 22 if under age 21 at the
time of the accident).
• Audio - hearing aids, if prescribed by a doctor – up to $500 per person every five calendar years (excludes
hearing/ear tests, repairs and batteries).
• Hospital – charges for diagnostic and outpatient services.
• Medical aids and appliances authorized by a doctor,
including:
. compressor, nebulizer, apnea monitor, aerochamber;
. crutches, cane, standard type walker;
. diabetic appliances – up to $500 per person per calendar year for appliances used to monitor or treat diabetes,
other than those supplies listed under prescription drugs (see p.35);
. hospital bed, wheelchair and scooter repairs, when required as a result of normal wear and tear (excluding
replacement of batteries);
. oxygen and equipment necessary for its administration;
. respirator (for the purpose of providing artificial respiration over a prolonged period of time when respiratory
muscles are non-functioning);
. surgical bandages or dressings;
. rental or pre-approved purchase of standard type manual hospital bed (including mattress) or standard
type manual wheelchair (electric hospital beds, wheelchairs and scooters are excluded unless medically
required and recommended in writing by a doctor).
• Medical alert bracelet if approved by the Trustees.
• Nursing – in-home registered nursing (RN) if pre-approved by Green Shield and approved monthly after
30 days (maximum $10,000 per lifetime). This excludes:
. charges by a nurse who is related by birth or marriage or who lives in the home;
. charges for custodial services or services which could be provided by a homemaker or someone who is not a
registered nurse; . agency fees; . commissions; . overtime.
• Paramedical treatment by a licensed acupuncturist, chiropractor, chiropodist, Christian Science practitioner,
naturopath, osteopath, podiatrist – up to $12 per treatment and up to $25 per disability for x-rays
(maximum $200 per person per year for combined paramedical treatments). You are not covered for semi-
private hospital rooms.


Your Group Benefit Plan

3231

• Physiotherapy – treatment by a registered physiotherapist if prescribed by a doctor in accordance with the
Ontario Physiotherapist Association guidelines.
• Prosthetics authorized by a doctor, including: . braces, splints, trusses, casts, cervical collars (“brace”
means a rigid or semi-rigid supporting device or appliance which fits on and is attached to the body or
any part of the body, excluding braces used to correct dental defect, deficiency or injury);
. breast prostheses – external breast prostheses and up to a maximum of six surgical brassieres per calendar
year when required as a result of mastectomy;
. catheters, urinary kits;
. lenses – corrective prosthetic lenses and frames, once only, following cataract surgery or when a person lacks
an organic lens;
. limb and eye – artificial limbs and eyes (myoelectric or sport prostheses reimbursed based on the amount that
would otherwise be paid for standard type artificial limbs);
. orthopaedic shoes which are attached to and form part of a brace. If shoes do not form part of a brace,
payment is limited to $15 per pair per person per calendar year;
. orthotics – up to $250 per person every two calendar years for custom moulded orthotics excluding
orthotics for sport purposes;
. ostomy supplies (excluding gloves), where a surgical stoma exists;
. repairs to prosthetic appliances, when required as a result of normal wear and tear;
. stockings – six pairs of surgical elastic stockings per calendar year;
. stump socks;
. tracheotomy supplies (excluding gloves);
. wigs, only after radiation or chemotherapy ($500 lifetime maximum per person).
• Psychological assessment – diagnosis or assessment
(excluding treatment) by a registered clinical psychologist if prescribed by a doctor.
~ Assistive Devices Program (ADP)

If you require a medical device, you may be eligible for benefits from the Ontario Ministry of Health Assistive
Devices Program (ADP). Some of the devices covered under this program include wheelchairs, artificial limbs,
braces, hearing aids, voice amplifiers, respiratory equipment, colostomy supplies, and visual aids.

ADP has a list of eligible devices and their approved prices, and will contribute up to 75% toward their
approved cost up to certain limits. If you, or a dependant, require the type of equipment mentioned here, you
should ask your family doctor to assist you in filing a claim with ADP. Please contact Green Shield for more
information.

~ Travel coverage for retirees and survivors

Retirees and survivors are covered for the following emergency services while travelling outside your province
of residence or Canada (maximum $10,000 per lifetime):

• doctor’s services,
• hospital ward accommodation if covered in part by a provincial health plan (maximum $40 per day).
Regular plan members have full coverage under the travel plan (see p.37).

~ What the plan doesn’t cover

• Rest cures, travel for health reasons, periodic check-ups, examinations for use by a third party.
• Services provided in a nursing home, home for the aged, health spa, chronic care or psychiatric facility (or unit
of a general hospital). For general exclusions, please refer to “What’s not covered” on p. 54–55.


Your Group Benefit Plan

3433

Dispensing fees vary widely from one pharmacist to another. It pays to shop around!

You are responsible for payment of the dispensing fees.

Prescription drugs

The drug plan pays 100% of the drug expenses listed below, excluding dispensing fees charged by your
pharmacist.

For covered members over age 65, the plan also pays 50% of the first $100 of prescriptions (excluding
dispensing fees) which are not covered due to the $100 annual deductible under the Ontario Drug Benefit
(ODB) program. These claims should not be made before the end of the ODB program year (currently July 31)
unless the full $100 deductible has already been reached. (Special rules apply for Quebec residents. Please
check with the Administrator.)
There are no dollar limits to the amounts covered, but you cannot buy more than a three-month supply of a
prescription at any one time without the approval of Green Shield.

~ What the plan covers

• Drugs that require a prescription by law.
• Birth control pills.
• Diabetic supplies, including insulin, needles, syringes, chemical testing agents and glucometers (for diabetic
appliances, see medical aids on p.32).
• Injectable allergy sera and some injected vitamins.

~ What the plan doesn’t cover

• Contraceptives (other than oral).
• Fertility drugs.
• Items or products considered to be household remedies.
• Non-injectable vitamins, minerals and other dietary supplements or substitutes.
• Over-the-counter products whether prescribed or not.
• Smoking cessation aids.
For general exclusions, please refer to “What’s not covered” on p. 54–55.

Vision care

~ What the plan covers

The plan covers you for either:

• 100% of the cost of one set of single vision, bifocal or trifocal lenses per person per calendar year (including
one pair of frames) to a maximum of $40, or
• one set of contact lenses per person per calendar year up to a maximum of $150.

~ What the plan doesn’t cover

• Eye exams.
• Non-prescription reading or sunglasses or tinted glasses with a tint other than number one.
• Anti-reflective coatings.
• Industrial safety glasses.
• Repair to glasses.
For general exclusions, please refer to “What’s not covered” on p. 54–55.

How to make medical, prescription drug or vision care claims

Send your medical claim form to Green Shield (address on p.3). Claim forms are available from the
Administrator. Make sure that the form is completed in full and all original itemized paid receipts are attached
(cash receipts or credit card receipts alone are not acceptable). Receipts for prescription drugs must show the
prescription number, drug identification number (DIN), and the name, strength and quantity of the drug or
medicine. For vision claims, the date of service is the date your glasses or contacts are picked up. You should
make a copy of your receipts for your records. If you also have coverage under another plan, please refer to
p.55. All claims must be submitted to Green Shield within 12 months of the date of the expense.
Claims may also be submitted electronically by your pharmacist to Green Shield for payment.


Your Group Benefit Plan

3635

You are covered if you are an active member with full coverage or a retiree paying the regular rate for
full coverage. You are covered for a maximum of 60 days and one million dollars per person per calendar year.

Travel

As residents of Canada, we’re used to having “free” medical care provided by the government. So, when we
travel, it can come as a shock to find out that we may have to pay up front to get the medical help we need.
That’s why having out-of-province medical coverage is so important. Your U.A. Local 67 travel plan provides
three types of coverage:

• Medical emergency benefits including emergency health-care expenses while travelling outside the province,
such as hospital accommodation, doctor’s charges, diagnostic services, paramedical services, prescriptions, etc.
• Non-medical and incidental expenses such as flying a family member to your bedside, meals and
accommodation, returning a deceased family member to Canada, etc.
• Other emergency travel assist services such as helping you find a doctor or hospital, arrangement of local care
of children while you are hospitalized, emergency evacuation, direct billing, transmission of urgent messages to
family and business partners, help with lost documents or contacting a lawyer, etc.

~ Who is covered

You are covered if you are an active member with full coverage or a retiree paying the regular rate for full
coverage. You and your family members must also be residents of Canada and be covered by your provincial
government health plan.

~ What’s covered

Some expenses that are limited under the travel plan may be paid under the Local 67 medical plan. Please check
with Green Shield.

Eligible travel benefits will be paid at 100% based on reasonable and customary charges in the area where they
were received, less the amount payable by your provincial government health plan. “Reasonable and
customary” is defined as the usual charge of the provider for the service or supply, in the absence of insurance,
but not more than the prevailing charge in the area for a like service or supply.
All maximums and limitations stated are in Canadian currency. Reimbursement will be made in Canadian
funds or U.S. funds for both providers and employees, based on the country of the payee. For payments that
require currency conversion, the rate of exchange used will be the rate in effect on the date of service of the
claim.

Emergency services will be paid to a maximum of $1,000,000 per calendar year.

Referral services will be paid to a maximum of $50,000 per calendar year.

Reimbursement of eligible benefits for emergency services will be made only if the services were required as a
result of emergency illness or injuries which occurred while you were vacationing or travelling for other than
health reasons.

Upon notification of the necessity for treatment of an accidental injury or medical emergency the patient must
contact Green Shield within 48 hours of commencement of treatment.

• “Emergency” means a sudden, unexpected occurrence (disease or injury) that requires immediate medical
attention. This includes treatment (non-elective) for immediate relief of severe pain, suffering or disease
which cannot be delayed until you or your dependent is medically able to return to your province of residence.
• Any invasive or investigative procedures must be pre-approved by Green Shield or our Assistance Medical
Team.
Eligible benefits are limited to a maximum of 60 days per trip commencing with the date of departure from your
province of residence. If you are hospitalized on the 60th day, benefits will be extended until the date of
discharge.

1. Hospital services and accommodation up to a standard ward rate in a public general hospital.
2. Medical/surgical services rendered by a legally qualified physician or surgeon to relieve the symptoms of, or
to cure an unforeseen illness or injury. Your Group Benefit Plan 3837
3. Emergency Transportation 8. Medical appliances including casts, crutches, canes,
• Land ambulance to the nearest qualified medical facility. slings, splints and/or the temporary rental of a
wheelchair when deemed medically necessary and required
• Air ambulance - the cost of air evacuation (including due to an accident which occurs, and when the devices
a medical attendant when necessary) between hospitals are obtained outside your province of residence.
Treatment by a dentist only when required due to a health plan or to the nearest qualified medical facility. direct
accidental blow to the mouth up to a maximum of $2,000. Treatments (prior to and after return) must
4. Referral services – (a) hospital services and accommodations will be provided within 90 days of the accident.
Details of dation, up to a standard ward rate in a public general the accident must be provided to Green Shield
along hospital, and/or (b) medical surgical services rendered with dental x-rays by a legally qualified physician
or surgeon.

• Prior to the commencement of any referral treatment, 10. Coming Home - when your emergency illness or
written pre-authorization from your provincial injury is such that:
government health plan and Green Shield must be • our Assistance Medical Team specifies in writing
obtained. Failure to comply in obtaining pre-authoriza-that you should immediately return to your province
tion will result in non-payment. You must provide of residence for immediate medical attention,
Green Shield with a letter from your attending physician reimbursement will be made for the extra cost
stating the reason for the referral, and a letter from incurred for the purchase of a one way economy air-
your provincial government health plan outlining their fare, plus the additional economy airfare if required
liability. Please note that your provincial government to accommodate a stretcher, to return you by the
health plan may cover this referral benefit entirely. most direct route to the major air terminal nearest
the departure point in your province of residence.

5. Services of a registered private nurse up to a maximum
of $5,000 per calendar year, at the reasonable and cus-This benefit assumes that you are not holding a valid
tomary rate charged by a qualified nurse (R.N.) regis-open-return air ticket. Charges for upgrading, departered
in the jurisdiction in which treatment is provided. ture taxes, cancellation penalties or airfares for accom-
You must contact Green Shield for pre-approval. panying family members or friends are not included.

6. Diagnostic laboratory tests and x-rays when prescribed
• our Assistance Medical Team or commercial airline stipulates in writing that you must be accompanied by a
by the attending physician. Except in emergency situated qualified medical attendant, reimbursement will be
tions, Green Shield must pre-approve these services (i.e.made for the cost incurred for one round trip economy
cardiac catheterization or angiogram, angioplasty and airfare and the reasonable and customary fee charged by
bypass surgery). a medical attendant who is not your relative by birth,

7. Reimbursement of prescriptions by Green Shield for adoption or marriage and is registered in the
jurisdicdrugs, serums and injectables which require a prescrip-tion in which treatment is provided, plus
overnight by law and are prescribed by a legally qualified hotel and meal expenses if required by the attendant.
medical practitioner (vitamins, patent and proprietary
11. Cost of returning your personal use motor vehicle drugs are excluded). Submit to Green Shield the origi-to
your residence or nearest appropriate vehicle rental paid receipt from the pharmacist, physician or hos-agency
when you are unable to due to sickness, pital outside your province of residence showing the physical injury or
death, up to a maximum of $1,000 name of the prescribing physician, prescription number, per trip. We require
original receipts for costs incurred, name of preparation, date, quantity and total cost. i.e. gasoline,
accommodation and airfares.

4039

Your Group Benefit Plan

A “traveling companion” is any person who has pre-paid accommodation and/or transportation with you or a
covered family member. Your Group Benefit Plan 12. Meals and accommodation up to $1,500 (maximum of
$150 per day for up to 10 days) will be reimbursed for the extra costs of commercial hotel accommodation
and meals incurred by you when you remain with a travelling companion or a person included in the
"family" coverage, when the trip is delayed or interrupted due to an illness, accidental injury to or
death of a travelling companion. This must be verified in writing by the attending legally qualified physician
or surgeon and supported with original receipts from commercial organizations. 13. Transportation to the
bedside including round trip economy airfare by the most direct route from your province of residence, for any
one spouse, parent, child, brother or sister, and up to $150 per day for a maximum of 5 days for meals and
accommodation at a commercial establishment will be paid for that family member to:
• be with you or your covered dependent when confined in hospital. This benefit requires that the
covered person must eventually be an inpatient for at least 7 days outside your province of residence, plus the
written verification of the attending physician that the situation was serious enough to have required the visit.
• identify a deceased prior to release of the body. 14. Return airfare if the personal use motor vehicle of you
or your covered dependent is stolen or rendered inoperable due to an accident, reimbursement will be made
for the cost of a one way economy airfare to return you by the most direct route to the major airport nearest your
departure point in your province of residence. An official report of the loss or accident is required. 15. Return of
deceased up to a maximum of $5,000 toward the cost of embalming or cremation in preparation for
homeward transportation in an appropriate container of yourself or your covered dependent when death is
caused by illness or accident. The body will be returned to the major airport nearest the point of departure in
your province of residence. The benefit excludes the cost of a burial coffin or any funeral-related expenses,
makeup, clothing, flowers, eulogy cards, church rental, etc. Green Shield Canada Travel Assistance Service
The following services are available 24 hours per day, 7 days per week through Green Shield's international
medical service organization.

These services include:

• Access to Pre-trip Assistance (prior to departure): Canada Direct Calling Codes; information about
vaccinations; government issued travel advisories; and VISA/document requirements for entry into country of
destination
• Multilingual assistance
• Assistance in locating the nearest, most appropriate medical care
• International preferred provider networks
• Our Assistance Medical Team’s consultative and advisory services, including second opinion and review of
appropriateness and analysis of the quality of medical care
• Assistance in establishing contact with family, personal physician and employer as appropriate
• Monitoring of progress during treatment and recovery
• Emergency message transmittal services
• Translation services and referrals to local interpreters as necessary
• Verification of insurance coverage facilitating entry and admissions into hospitals and other medical care
providers
• Special assistance regarding the co-ordination of direct claims payment
• Co-ordination of embassy and consular services
• Management, arrangement and co-ordination of emergency medical transportation and evacuation as
necessary
• Management, arrangement and co-ordination of repatriation of remains
• Special assistance in making arrangements for interrupted and disrupted travel plans resulting from emergency
situations to include:
– the return of unaccompanied travel companions
– travel to the bedside of a stranded person
The plan is not responsible for the availability, quality or results of medical treatment or services. Treatment
must be provided at the nearest facility providing adequate service. If you require general information about
the travel plan please call Green Shield Canada at 1.888.711.1119.

If you need a travel claim form or have a question about a claim that you have filed, call 1.800.936.6226 within
Canada and the United States or call collect 0.519.742.3556 when traveling outside Canada and the
United States. 4241
Your Group Benefit Plan

– rearrangement of ticketing due to accident or illness and other travel related emergencies
– the return of a stranded personal use motor vehicle and related personal items
• Knowledgeable legal referral assistance
• Co-ordination of securing bail bonds and other legal instruments
• Special assistance in replacing lost or stolen travel documents including passports
• Courtesy assistance in securing incidental aid and other travel related services
• Emergency and payment assistance for major health expenses, which would result in payments in excess
of $200.
~Here's how Green Shield travel assistance service works

For assistance dial 1.800.936.6226 within Canada and the United States or call collect 0.519.742.3556 when
traveling outside Canada and the United States. These numbers appear on your Green Shield Identification card.

Quote the Green Shield travel assist group number and your Green Shield Identification Number, found on your
Green Shield Identification card, and explain your medical emergency. You must always be able to provide
your Green Shield Identification Number and your provincial government health plan number.

A multilingual Assistance Specialist will provide direction to the best available medical facility or legally
qualified physician able to provide the appropriate care.

Upon admission to a hospital or when consulting a legally qualified physician or surgeon for major emergency
treatment, we will guarantee the provider (hospital, clinic or physician), that you have both provincial
government health plan coverage and Green Shield travel benefits as detailed above.

The provider may then bill Green Shield directly for these approved services for amounts in excess of $200.

Our Assistance Medical Team will follow your progress to ensure that you are receiving the best available
medical treatment. These physicians also keep in constant communication with your family physician and your
family, depending on the severity of your condition. 43 When calling collect while travelling outside Canada
and the United States, you may require a Canada Direct Calling Code. In the event that a collect call is not
possible, keep your receipts for phone calls made to Green Shield’s Travel Assistance Service and submit them
for reimbursement upon your return to Canada.

~ Limitations
1. Benefits will be eligible only if existing or pre-diagnosed conditions are completely stable (in the opinion of
Green Shield and/or our Assistance Medical Team) at the time of departure from your province of residence.
Green Shield reserves the right to review your medical information at the time of claim.
2. The eligible benefits must be required for the immediate relief of acute pain or suffering as recommended by
a legally qualified physician or surgeon. Eligible benefits will not be reimbursed for treatment or surgery which
could reasonably be delayed until you return to your province of residence.
3. Reimbursement for eligible benefits will be made only if your provincial government health plan covers and
provides payment toward the cost of the services received.
4. Coverage becomes effective at the time you or your dependent crosses the provincial border departing from
their province of residence and terminates upon crossing the border returning to their province of residence
on the return home. If traveling by air, coverage becomes effective at the time the aircraft takes off in the
province of residence and terminates when the aircraft lands in the province of residence on the return home.
5. Upon notification of the necessity for treatment of an accidental injury or medical emergency, Green Shield
Travel Assistance reserves the right to determine whether repatriation is appropriate if the patient’s medical
condition will require immediate or scheduled care. Such return to your province of residence is mandatory
where the attending physician and family or admitting physician determines that the patient is medically fit to
travel and appropriate arrangements have been made to admit the patient into the provincial health care system.
Repatriation will ensure continued coverage under the plan. Should the patient opt not to be repatriated, no
further benefits will be paid under the plan for the resolved emergency. 44

The patient must contact Green Shield within 48 hours of commencement of treatment. Failure to notify
us within 48 hours may result in benefits being limited to only those expenses incurred within the first 48 hours
of any and each treatment/incident or the plan maximum, whichever is the lesser of the two.

6. Air ambulance services will only be eligible if:
• they are pre-approved by Green Shield
• there is a medical need for you or your dependent to be confined to a stretcher or for a medical attendant
to accompany you during the journey, and
• you or your dependent are admitted directly to a hospital in your province of residence, and
• medical reports or certificates from the dispatching and receiving legally qualified physicians are submitted to
Green Shield, and
• proof of payment (including air ticket vouchers or air carrier invoices) is submitted to Green Shield.
7. If planning to travel in areas of political or civil unrest, contact Green Shield for pre-travel advice as we may
be unable to guarantee assistance services.
8. Green Shield reserves the right, without notice, to suspend, curtail or limit its services in any area in the
event of political or civil unrest, including rebellion, riot, military uprising, labour disturbance or strike, act
of God, or refusal of authorities in a foreign country to permit Green Shield to provide service.
9. No services shall be provided during any trip undertaken for the purpose of seeking medical treatment or
advice unless pre-authorized as outlined in referral services.

~ Exclusions
Eligible Benefits do not include and reimbursement will not be made for:

1. Treatment or services required for ongoing care, rest cures, health spas, elective surgery, check-ups or
travel for health purposes, even if the trip is on the recommendation of a physician.
2. Treatment or service which you elect to have performed outside Canada when the medical condition would
not prevent your return to Canada for such treatment.
3. Treatment or service required as a result of suicide, attempted suicide, intentionally self-inflicted injury
by you, a traveling companion, or immediate family member while sane or insane.
4. Hospital and medical care for childbirth occurring within 8 weeks of the expected delivery date from the date
of departure, or deliberate termination of pregnancy.
5. Treatment or service provided in a chronic care or psychiatric hospital, chronic unit of a general hospital,
Long Term Care (LTC) facility, health spa, or nursing home.
6. Services received from a chiropractor, chiropodist, podiatrist, or for osteopathic manipulation.
7. Cataract surgery or the purchase of eyeglasses or hearing aids.
8. Green Shield does not assume responsibility for nor shall it be liable for any medical advice given, but not
limited to a physician, pharmacist or other healthcare provider or facility recommended by Green Shield.

~ How to make a travel claim

Green Shield must be contacted by phone within 48 hours of commencement of treatment. Call our Travel
Assistance Service for assistance or for detailed claims submission instructions. Dial 1.800.936.6226 within
Canada and the United States or call collect 0.519.742.3556 when traveling outside Canada and the United
States. These numbers appear on your Green Shield Identification card.

If you have incurred out of pocket expenses, claims must be submitted together with original supporting
receipts to our Travel Assistance Service who will then co-ordinate reimbursement of approved, eligible
expenses with the provincial government health plan. To make a claim, submit the patient’s name, provincial
government health plan number, address and Green Shield Identification Number with a detailed statement
showing the services rendered and the fees charged for each service.

Your Group Benefit Plan

4645

If you have a terminal illness with less than one year to live, you may request an advance life insurance
payment of up to $5,000. This will be deducted from the final payment.
Under current tax law, employer contributions for life insurance are taxed as income. The exact amount
is shown on the T4A form that you receive every year.

Life insurance

If you die while covered by the plan, your group life insurance will pay $20,000 to your beneficiary or estate.
This is paid tax-free and may be taken by your beneficiary(ies) as a one-time payment or in instalments.

Life insurance applies to your life only. No life insurance benefits will be paid on the death of a spouse or child.

~Naming a beneficiary

When you first join the plan, you should complete a beneficiary form. You may name anyone you wish as your
beneficiary and you may name more than one person. If you name more than one person, your death benefit
will be divided according to your instructions.

You can change your beneficiary at any time. If your beneficiary is a minor, you should consider appointing
a trustee to look after your child’s benefits. Otherwise, your death benefits may be held in trust until your child
reaches age 18.

Any death benefit will be paid to the most recently named beneficiary on file with the Administrator unless you
have a more recent will that makes specific reference to your life insurance. If you don’t name a beneficiary,
death benefits will be paid to your estate and may be subject to probate fees, estate taxes and creditors.
~ If you leave the plan

If you leave the plan before age 65, your group life insurance automatically extends for 31 days from your
termination date. If you’d like to continue your coverage, you may arrange to buy individual life insurance
directly from Manulife Financial. No medical is necessary but you must return your application form and
payment to Manulife Financial within 31 days of the date your coverage ends.

~ How to make a life insurance claim

Your beneficiary or executor should contact the Administrator to complete the forms necessary to file
a life insurance claim with Manulife Financial. The claim must be filed within six years of your death.

(Bereavement counselling is available to all members and families. Please contact the Administrator.)

Short term disability benefits

If you become disabled because of an injury or illness that is not related to work, the disability plan will pay you
weekly benefit of $300.

If you are disabled because of an illness, you must wait seven days for your benefits to begin. You must see a
doctor during these seven days or your benefits will be delayed until you do.

If you are disabled because of an injury, there is no waiting period. Benefits begin from the day you are treated
by a doctor. You must see a doctor within seven days. If you are disabled for less than a full week, the daily
benefit rate is $60.You will not receive disability benefits for any day on which you have worked even part of
the day. Tax is deducted from each benefit payment.

You cannot receive disability benefits from both the Local 67 disability plan and the Employment Insurance
Plan (EI) at the same time. The Administrator will begin to pay your Local 67 disability benefits only if you are
denied EI benefits or your EI benefits run out.

If you’re injured

If you’re injured and see a doctor on the weekend, your benefits start on Monday. If you’re injured on a
Tuesday, miss work on Wednesday, and see a doctor on Thursday,
your benefits start on Thursday.

If you’re sick

If your doctor confirms that you are sick and you have
missed work since Tuesday, your benefits start on the
following Tuesday, if you are still sick.

If your illness or injury is related to work, you should advise your employer. Only regular workdays (Monday to
Friday) count as days of disability. Your Group Benefit Plan 4847
~ Length of disability

Disability benefits will be paid for no more than 26 weeks for each period of disability. To receive benefits, you
must remain completely unable to perform a substantial portion of the duties of your regular job and be under
the care of a doctor. After collecting disability benefits, you can qualify for a new 26-week benefit period if:

• the cause of the latest disability absence is not related to any of the prior disabilities and you have returned to
work for at least one full day; or
• you have returned to active work full-time for at least two consecutive weeks since the prior disability ended.
Your benefits will stop immediately if you:
• are no longer under the continuous care of a physician,
• do any work for which you are paid (except approved rehabilitation),
• do not have proof that you are totally disabled,
• refuse a medical exam,
• retire, or
• are imprisoned.

~ If you take an approved leave

No disability benefits are paid during a leave of absence. If a disability begins during maternity/parental leave,
weekly disability benefits will begin at the end of this leave if you have maintained your coverage.

Maternity leave begins on the day you have chosen or the date the child is born, whichever comes first.
Maternity leave ends on the date you are scheduled to return to work full time or the date when your EI
maternity benefits end, whichever is later.

The Trustees will review each case individually if it is not clearly covered by these guidelines, or if
interpretation of the guidelines is necessary.

~ How to make a disability claim

Disability claim forms are available from the Administrator. Claims must be filed within 90 days of the
first day of disability. Benefits are paid weekly.

You should first make a claim to the Employment Insurance Plan (EI), and notify the Administrator at the
same time that you are filing an EI claim. The EI benefit level is higher, and the period when you are collecting
EI won’t count towards your 26-week maximum.

To be eligible for EI sickness benefits, you must normally have worked at least 600 insured hours in the last 52
weeks or since your last claim as defined under the EI Act. The EI sickness benefit pays 55% of your weekly
earnings for up to 15 weeks, up to a maximum decided by the government each year ($413 per week in 2003).
Your EI benefit will be reduced by:

• any benefits due to you under provincial auto insurance;
• any other income or retirement benefits received by you if, together with your Local 67 disability benefits,
your total disability income is higher than your weekly pre-disability income. Claims must be filed within 90
days following the start of disability. You cannot receive disability benefits from the Local 67 plan and EI at the
same time.

Your Group Benefit Plan

5049

The SUB plan pays you $80 per week until you return to work or your SUB account runs out. The SUB will not
be paid for any week(s) in which jobs remain unfilled by Local 67 members.

Your Supplementary Unemployment Benefits (SUB)

If you are unemployed because of illness, shortage of work or attendance at trade school, your Employment
Insurance (EI) benefits may not be enough to cover your daily living expenses. The Supplementary
Unemployment Benefit plan (SUB) helps you out by topping up your income each week until you return to
work or your SUB account runs out.

~ How the SUB plan works

Your employers make a contribution to the SUB plan for each hour that you earn. The exact amount of the
contribution is spelled out in the collective agreement. (The contribution rate as of December 2002 is $0.20 per
hour.) At the end of each month, your employer sends a report to the Administrator showing how many hours
you have earned together with a cheque to cover the contribution. These contributions are credited to your SUB
account. Whenever you receive an SUB payment, a deduction is made from your SUB account to help pay for
your benefits (see “Amount of your SUB benefits,” p.52).

The Administrator (see p.3) sends you a benefit statement every three months showing you the activity in your
SUB account. This includes employer contributions as well as any deductions that have been made from your
account to help pay for benefits that you have received.

~ How you get SUB benefits

You can get SUB benefits if you:

• have signed the “out-of-work” list at the Local 67 union office and are available for work, or
• are unable to work because of sickness or injury that is not related to work and you are not receiving Local 67
short term disability benefits, or
• are attending trade school or a government-sponsored or J.A.T.C. approved training course (must be trade or
skills related), or
• are taking maternity or parental leave, and
• are receiving Employment Insurance (EI) benefits or you are in the two-week EI waiting period,
• are not receiving WSIB benefits,
• have at least $240 in your SUB account (first claim only). You cannot claim if you were dismissed for any
reason other than shortage of work, illness or attendance at trade school. Benefits are not paid for vacation. You
will not qualify for SUB benefits if you are refused EI benefits or didn’t work enough weeks to claim EI.

~ Amount of your SUB benefits

Your SUB plan pays $80 each week. You may collect your weekly cheque in person at the Administrator’s
office or have it mailed to you. SUB is paid for partial weeks of Employment Insurance (EI). SUB has no
impact on the amount of your EI benefit.

For each $80 of SUB paid to you, your SUB account is reduced by $33.33.When your account drops below
$33.33, your SUB payments stop.

~ If you claim again

You don’t need to build your SUB account back up to $240 to make another claim, but you must have at least
$33.33.

~ CCRA rules

You must report any SUB payments as income on your tax return. You will receive a T4A slip from the
Administrator.

The Canada Customs and Revenue Agency (CCRA) will not allow any SUB payments to be made if the Local
67 SUB fund falls below $150,000. The Administrator will notify all members if this happens.

~ How to make a SUB claim

You must submit your EI payment stub or proof of attendance at training school to the Administrator. EI
payment stubs received after 3:00 p.m. Thursday will be processed for payment the following week. Make sure
to include your name, address and social insurance number on your payment stub.


We are required by law to stop all SUB payments if our fund falls below $150,000.

Your Supplementary
Unemployment Benefit

5251
Claim forms can be downloaded from the Green Shield Canada’s website at.

www.greenshield.ca.

Make sure to follow the claims instructions at the end of each of the benefit sections.

How to make a group benefit claim

Detailed instructions for making a claim are shown at the end of each benefit description. If you are covered
under another plan, please see p.55. All extended health and dental claims must be submitted to Green Shield
within 12 months of the date of the expense. For example, if you have a drug expense dated April 25, 2005, you
must submit your claim before April 25, 2006.

All claims submitted to Green Shield will require the Green Shield Identification Number for the person who
has received the benefit.

You will receive a Green Shield Identification Card(s) showing your Plan Member Identification number to be
used on all claims and correspondence. The applicable Green Shield Identification Number can be found below
the name of the covered person on your Green Shield Identification Card. Your number will appear on the front
of the card and end in -00, while each of your dependents with their numbers will be shown on the back.

~ Direct payment to the Provider of Service

Present your Green Shield Identification Card to your provider and, after you pay any applicable co-payment,
they may bill Green Shield directly and in many cases, payment will be made directly to your provider of
service. Most providers will also have a supply of claim forms.

~ Green Shield plan member online services

For plan members (ID card number ends with -00), this site will answer those questions most often asked and
give online access to the following:

• Print personalized claim forms;
• Find out benefit eligibility information, such as when you can buy your next pair of glasses;
• Instantly view your Explanation of Benefits and claim history;
• Print your own claim history for tax purposes or Co-ordination of Benefits;
• Have claim payments deposited directly into your bank account*;
• And much more!
All you have to do is register online using your unique Green Shield ID number and provide your e-mail
address. Once registered, a password will be mailed to the address Green Shield has on file for you. Register
now at www.greeshield.ca and see what the new website can do for you!

(*Please note that once arrangements have been made for Direct Deposit, claims payments will be deposited
directly into the bank account you have chosen. Statements will no longer be mailed to you but will be available
for online viewing.)
~ What’s covered

Expenses must be reasonable and customary amounts that you are legally required to pay and be:

• medically necessary;
• made while under the active care of a legally licensed doctor (unless otherwise indicated in the plan);
• not normally covered by any government plan or agency, including the Workplace Safety and Insurance Board
(WSIB) or provided free of charge in absence of coverage;
• not prohibited by law;
• supported by written proof.

~ What’s not covered

Claims must not be related to:

• occupational illness or injury;

• self-inflicted injury;
• completion of forms, reports, documentation, assessments, tests or evaluations, unless otherwise indicated;
• failure to keep a scheduled appointment;
• injuries or illnesses due to civil disorder or war (declared or undeclared) or while serving in the armed forces;
• cosmetic services;
• lifestyle choices;
• services or supplies that are experimental or which are not approved by the Health Protection Branch of
Health & Welfare Canada for use in Canada;
• services or supplies that are educational or primarily for research;

Your Group Benefit Plan

5453

Your Group Benefit Plan
• committing or attempting to commit a criminal act;
• services or products that are self-prescribed or prescribed by a family member;
• any eligible service that relates to treatment of injuries arising out of a motor vehicle accident.
Note: Payment of benefits for claims relating to automobile accidents for which coverage is available under a
motor vehicle liability policy providing no-fault benefits will be considered only if:
a) The service or supplies being claimed is not eligible; or
b) The financial commitment is complete. A letter from your automobile insurance carrier will be required.
~ If you are covered under another plan

Many working couples have coverage under more than one benefit program. If you’re one of them, you may be
able to claim some expenses from both your spouse’s plan and the Local 67 plan. For example, if the frames for
your glasses cost more than the $40 allowed by the Local 67 plan, you may be able to submit a claim for the
extra amount to your spouse’s plan. But there are certain rules you must follow. This will help you to get the
biggest possible reimbursement and will ensure that each plan pays its fair share of the cost.

First, you need to check to see if the other plan has rules that permit claiming from more than one plan. Then,
make your claims as follows:

~ Coordinating claims with your spouse

Plan rules For your expenses For your spouse’s expenses If your spouse’s plan has
1. Make the first claim to rules on how to make the Local 67 plan. your spouse’s plan. claims from more than
one plan:
2. Claim any unpaid amount against your spouse’s plan. Local 67 plan. If your spouse’s plan doesn’t have rules
on how to make claims from more than one plan: 56
~ Coordinating claims for your children

~ If you are retired

If you’re a retired member with coverage under more than one plan, you should submit your claims in the
following order:
• To the plan where you are an active member.
• To the plan where you are covered as a dependant.
• To the plan where you have retiree coverage.
You must tell the Administrator if your spouse is covered under another plan or if there is a change in that
coverage. Your combined repayment from all plans cannot be more than the actual amount paid out.

~ If another party is liable

If somebody else is liable for paying some or all of your claim because it resulted from fault or neglect, please
check with the Administrator before you sign any settlements or agreements that might affect the amount
of benefit paid under this plan. Be sure to keep copies of all original receipts. You’ll need them to submit
claims to your spouse’s plan. If you are living with your If you are separated or divorced child’s other parent
1. Claim first to the plan of the parent whose birthday comes earlier in the calendar year.
2. Claim for anything left unpaid to the plan of the parent whose birthday comes later in the calendar year.
Make claims for each child in this order:
1. to the plan of the parent with custody
2. to the plan of the spouse of the parent with custody
3. to the plan of the parent not having custody
4. to the plan of the spouse of the parent not having custody.
55
~ Group conversion for dental and extended health

If you will be terminating from the union plan and there is an active Green Shield group benefits program in
force, you may enroll in the Green Shield Prism™ individual program.
Your dependent children who are no longer eligible for benefits under your Green Shield group benefits
program may also enroll in the Green Shield Prism™ individual program.

Call 416-601-0429 in the Toronto area or toll-free at 1-800-667-0429 for an information package or visit
our website at www.greenshield.ca/ProductsAndServices/Individual. Your application must be received within
60 days of termination of your benefits from your Green Shield group program.

Key words and definitions

Annuity

When you buy an annuity, you make a cash payment in exchange for guaranteed income payments.

Assistive Devices Program

A program run by the Ontario Ministry of Health, which provides personalized assistive devices to Ontario
residents with long-term physical disabilities.

Beneficiary

The person you name to receive your life insurance and pension benefits. You can name anyone you wish to
receive your life insurance. But, in most provinces, if you have a spouse, he or she is automatically the
beneficiary of your pension plan benefits unless a waiver has been signed and filed with the Administrator. If
you don’t have a partner who qualifies as your spouse, you can name anyone you want as your pension
beneficiary. If you don’t appoint a beneficiary, death benefits will be paid to your estate and may be subject to
probate fees, estate taxes and creditors.

Cash value

Also known as the “commuted value” or the “transfer value” of your pension, the cash value is the amount of
money you would need to invest today to pay the pension you have built to date starting at your normal
retirement date.

Child
For pension plan death benefits

A child who is dependent on you for support and

• under 18 throughout the year of your death, or
• under age 24 and a full-time student throughout the year of your death. Key Words & Definitions
5857
For group benefits (health and welfare)

You or your spouse’s natural, legally adopted, step or foster child who is:

• unmarried,
• dependent on you or your spouse for financial support,
and
• under age 21 (under age 25 if a full-time student at a recognized and accredited educational institution).
Coverage continues after age 21 for unmarried, disabled children who were covered under the plan before age
21 and are not able to support themselves because of their mental or physical infirmity. You must provide proof
of your child’s disability to the Administrator.

Coverage limit

This refers to the total amount the Local 67 group benefit plan will reimburse for each member of the plan
within a certain period. Examples include per-visit limits for paramedical treatment, per-year maximums for
dental treatments, and lifetime limits on in-home nursing.

Dental fee guide

The schedule of fees published annually by each provincial dental association that outlines the typical cost of
dental services. All payments under the Local 67 dental plan are based on the previous year’s edition of the
Ontario Dental Association Suggested Fee Guide for General Practitioners and Specialists. If your dentist uses a
more recent fee guide, you must pay the difference.

Doctor

A medical practitioner who is licensed, certified or registered where his or her practice is located.

Family

Family includes only your spouse and child(ren).

Life income fund (LIF)

One of the options available for transfer of funds from a locked-in RRSP. Identical to a RRIF, but with some
additional restrictions, such as minimum and maximum annual withdrawal limits. Funds remaining in a LIF by
the end of the year in which you reach age 80 must be used to buy an annuity.

Locked-in retirement account (LIRA)

Also known as a locked-in RRSP. This is an RRSP from which no funds may be withdrawn except to provide a
lifetime pension or death benefit. Funds in a LIRA must be used to buy an annuity or transferred to a life
income fund (LIF) or locked-in retirement income fund (LRIF) by the end of the year in which you reach age
69.
Locked-in retirement income fund (LRIF)

One of the options for transfer of funds from a locked-in RRSP. An LRIF operates much like a LIF, but allows
unused withdrawal room to be carried forward and does not require conversion to an annuity by age 80.

Lump-sum payment

A one-time payment of the “cash value” of your pension plan.

Member in good standing

A fully paid-up member of Local 67.

Ontario Drug Benefit program (ODB)

A program geared towards the elderly and those who require long-term care or social assistance. ODB covers
most of the cost of many prescription drugs, and is a major source of drug coverage after you reach 65.

Past service

The full amount of time before 1972 when you were a member of Local 67 and working under Local 67
contracts.

Key Words & Definitions

6059

Pension adjustment (PA)

The amount that you are allowed to contribute to a registered retirement savings plan (RRSP) in any year is
reduced by total employer contributions to the pension plan for the previous year. The Canada Customs and
Revenue Agency (CCRA) calls this reduction a “pension adjustment.” This amount is reported on the T4s that
you get from your employers.

Pension plan membership

Membership in the plan is automatic. If you work for an employer who contributes to the Local 67 pension fund
for you, you’re a member of the plan. If you pay union dues but you’ve never worked for an employer who
makes contributions to the plan for you, you won’t qualify for a pension from the Local 67 plan.

Registered retirement savings plan (RRSP)

A savings plan registered under the Income Tax Act that allows you to put aside a portion of your income on a
tax-sheltered basis. Contributions and investment earnings grow tax-free until withdrawn. All RRSP savings
must, by law, be withdrawn in cash, transferred to an annuity, or used to buy a lifetime pension, no later than
the end of the year in which you turn 69.

Spouse

For pension benefits

Under Ontario pension law, this is a person of either sex who is living with you and is:

• married to you, or
• not married to you and has been living with you in a conjugal relationship:
• continuously for at least three years, or
• in a relationship of some permanence if you are the natural or adoptive parents of a child.

Spouse

For group benefits (health and welfare)

Same as for pension benefits, with one exception; you don’t have to wait three years if you’re not married. A
common-law partner is covered from the first day of the month following the month in which you notify the
Administrator in writing.

Transfers

If you were a member of another U.A. local, you may be able to transfer pension or benefit contributions into
the Local 67 plans. Check with the Administrator to see if there is an agreement between your old local and
Local 67.

Treatment plan

A treatment plan is a form your dentist fills out detailing what procedures you are going to have, and how much
they’ll cost. It is recommended that you get this form filled out if you are going to have any dental work over
$300. That way Green Shield can tell you which part of the total treatment it will pay.

Yearly maximums: Yearly maximums listed in the booklet are referring to the calendar year (January –
December).

Key Words & Definitions

6261

Green Shield Canada Commitment to Privacy

The Green Shield Canada Privacy Code balances the privacy rights of our group and benefit plan members and
their dependents, and our employees, with the legitimate information requirements to provide customer service
and to meet our human resource requirements. It consists of the following key principles:
1. We ask for your personal information for the following purposes:
• To establish your identification
• To provide you and/or your dependents with the applicable benefit coverage
• To protect you and us from error and fraud
• To provide ongoing services
2. Consent
When you enrolled in your group benefit plan as a plan member, your personal information was obtained and
used only with your consent. We obtained your consent before we:

• Provided benefit coverage
• Offered you other Green Shield Canada services
• Obtained, used or disclosed to other persons, information about you unless we were obliged to do so by law or
to protect our interests
• Used your personal information in any way we did not tell you about previously
Your consent can be either express or implied. Express consent can be verbal or written.
Consent can be implied or inferred from certain actions. For our existing group and benefit plan members and
their dependents, we will continue to use and disclose your personal information previously collected in
accordance with our current privacy code, unless you inform us otherwise and will infer that consent has been
obtained by your continued use.
3. Withdrawal of Consent
You can withdraw your consent any time after you've given it to us, provided there are no legal or regulatory
requirements to prevent this.
If you don't consent to certain uses of personal information, or if you withdraw your consent, we will
no longer be able to administer your benefit coverage. If so, we will explain the situation to you to help you
with your decision. For further information on our privacy policies and procedures, please refer to the Green
Shield Canada web site at www.greenshield.ca. General Information
6463

The last word

This booklet describes your Local 67 pension and benefit plans in simple terms. It isn’t a legal document and
doesn’t cover every detail, but it does give you the basic facts. We’ve made every effort to make sure this
booklet is accurate, but if there is a difference between the information contained here and the legal plan
documents adopted by the Board of Trustees, including any insurance company policies or group contract,
the plan documents and insurance policies or group contract will apply.

General Information

65
Local Union 67

								
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