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Can Grandparents who are living with the employee be covered?
Unfortunately seniors can not be covered under your group benefit plan. Their prescriptions are covered under the Alberta Government Seniors plan. For more information on the Alberta Seniors plan and what they offer, please see website link.http://www.servicealberta.gov.ab.ca/cps
When do Benefits stop after Termination of Employment?
The benefits stop at midnight on the day the employment is terminated. However, claims incurred prior to termination date may be submitted to claims department for a period of up to 3 months after the termination date. However, you will be charged premium for the month
What additional information is required when submitting claims for eligible over-age Dependent who is attending School?
A copy of the student card or class enrolment card (showing dates) must be submitted along with the regular claim. Some carriers automatically track this and will send you a reminder to see if student status still applies, however most carriers require you to let them know if their status has changed.
How can a person claim a balance owing on a payment made by a spouse's insurer?
First of all when enrolling a member who has coverage through another carrier, please ensure that coordination of benefits are set up. If a person has family coverage, he/she can submit the spouse's claim and have up to the balance paid for any eligible expense. A copy of the Explanation of benefits from the primary carrier should be submitted.
We are a family and we are both covered under different insurance companies; who is the primary carrier?
If you are husband and wife and either of you have a claim, each expense is submitted to the respective insurance carriers and any balance would run through both plans. If you have dependent children and the claims are for one of the children, you would submit the claim under the member who has the earlier birth date in the year. Insurance companies do this so that the company that you work for does not have all the claims pay outs applied to their health and dental experience.
Can I reinstate a former plan member?
If your contract contains re-employment conditions, (e.g. six months), the waiting period is not required if a plan member is re-employed within the number of months indicated in the contract. Coverage would be reinstated on the date of re-employment.
Revocable and Irrevocable Beneficiaries?
Revocable beneficiary means that the plan member is free to change the beneficiary designation at any time. Beneficiary is assumed revocable (unless specifically designated as irrevocable) in all provinces except Quebec.
What if I want to name more than one Beneficiary?
The member must complete the relationship to the member and split by percentage so that it adds up to 100%. If you designate a minor child, the member must designate a trustee.
When no Beneficiary has been Designated?
Proceeds will be paid to member's estate. A properly constituted and current will should be submitted to avoid delays in processing.
Can I continue my Benefits if I leave my Employer?
Each terminated member has an option to convert their current Life Insurance to an individual plan without providing medical evidence (in most cases up to $200,000) if that is the amount they were covered for indicated on your billing statement. You also have the option to convert your health and dental to an individual health and dental plan without medical within 60 days (with most carriers) from the date of termination. Please contact The Benefit Specialist for your options.
Can I terminate an employee who is on Disability?
We recommend that the company has a policy in place for all employees off on disability indicating how long the company will extend benefits for while they are off. Sample wording is provided below. You may want to contact the carrier in this situation or consult an HR Professional to design your HR Policy Manual/Contract.Company Name will maintain insured benefits coverage, subject to eligibility considerations, for up to Length of extension.Where an employee is unable to establish a long term disability claim, he/she may be granted leave of absence without pay for a period not to exceed length of time. If the employee is not able to return to work or establishes a claim within this period, then s/he shall be terminated.
** Group benefits plan are very involved and I have given you some samples of items that come up when administering your group plan** Please contact your carrier or The Benefit Specialists when a concern comes up and we will do our best to provide you with the information requested.**
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