LEMAY EMPLOYEES ENROLMENT GUIDE WELCOME Welcome to the Lemay modular program. In this guide, you ll find everything you need to understand the plans, the applying rules and to make the necessary choices.
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LEMAY EMPLOYEES ENROLMENT GUIDE WELCOME Welcome to the Lemay modular program. In this guide, you ll find everything you need to understand the plans, the applying rules and to make the necessary choices. This new program was designed specifically to give you more flexibility, to reflect the different needs of each employee, and to evolve with you. ELIGIBILITY All Lemay employees become eligible for the Group Benefits program after three (3) months of continuous service, for all plans. GENERAL OVERVIEW Mandatory coverage: Basic Life insurance, Accidental Death and Dismemberment insurance (AD&D), Critical Illness insurance, Long Term Disability insurance, Health and Dental Care insurance. Coverage of your dependents is mandatory in Basic Life Insurance, Health and Dental Care insurance. Optional coverage: Additional Life insurance for the employee and the spouse. GENERAL OVERVIEW You have no choice to make for the following plans: Basic Life Insurance Dependent Life insurance Accidental death and dismemberment insurance Critical Illness insurance Short-term disability insurance Long-term disability insurance For Health Care and Dental Care, two Benefit Plans are available: the Basic Plan or the Enriched Plan. Your selection will apply for both Health and Dental. For example, you cannot choose the Basic plan for Health Care and the Enriched Plan for Dental Care. The employer pays 60% of the cost of Health and Dental Care according to the Basic plan, and the cost of Short-term disability insurance plan. You pay the remaining cost. In addition, the employer also provides an additional envelope $1,000 per employee, which can be used in one of the following ways: Reduce the cost of the Enriched plan Deposit in a Health Spending Account (HSA) 1 Deposit in a Wellness Account Deposit in your Group Retirement Savings Plan Additional explanations on each of these choices are given below. RULES The chosen plan (Basic or Enriched) must be the same for Health Care and Dental Care. There are four possible statuses: single, single parent, couple or family. The status may be different in Health and Dental. For example, you can have a single status for Health care coverage and a family status for Dental Care. You can opt out if you want to be covered by your spouse s Health and Dental Care plans instead. You can opt out from only one of the plans (Health or Dental) if you wish. Proof of spousal coverage will however be required for the opting out to be accepted. In Health and Dental, your dependents (spouse and children) have to be covered either by the Lemay program or by your spouse s program, as these two plans are compulsory for all the family. For example, you cannot take a single Dental Care Plan if your dependents are not covered by the Dental plan of your spouse. You will be able to modify your choices (Basic or Enriched plans and distribution of the additional envelope) on November 1 st, 2017 and every two years thereafter. Change of plan and/or status are possible at all times in the case of a Life event : o Marriage, civil union or common-law spouse o Separation or divorce o Death of a dependent o Birth or adoption of a first child o Last dependent child no longer eligible to coverage o Involuntary loss of spousal coverage In all Life event cases, you have 31 days after the date of the event to modify your choice, which will be retroactive to the date of the event. At any time during the year, you can make the following changes (Please note that these changes do not allow you to change status or plan) : o Change of beneficiary o Add or remove a dependent child (excluding the first and last) o Enter or terminate the student status of your children o Change your address o Sign up for direct deposit Default Plan: if you do not make a selection (Basic or Enriched), you will be placed in the Basic plan according to your current coverage (single, family, etc.) and the additional envelope will be deposited in the HSA. You will not be allowed to modify these choices before the next enrolment. 2 HOW TO USE THE ADDITIONAL ENVELOPPE PAY THE COST OF THE ENRICHED PLAN You have the possibility to use your additional envelope to reduce the cost of the Enriched Health and Dental Care plans. In this regard, please note the following: You absolutely must use the cost simulator (available on to determine the maximum amount that can be used to pay the Enriched plan. o The maximum amount allowed is the difference between the cost of the Basic Health and Dental Care and the cost of the Enriched plans, depending on your status. The amounts used for this purpose will be taxable benefits at the provincial level. A taxable benefit is an amount added to your income on which you pay tax. HEALTH SPENDING ACCOUNT You can use the funds deposited in this account to pay for health or dental care expenses which are not covered by the plan you have chosen, such as: Eyeglasses, dental visits or massage therapist costs, non-reimbursed drugs costs, or any expense over the maximum amounts permitted, etc. Here are some rules applying to the Health Spending Account: The HSA can be used to pay your health and/or dental care expenses and your dependents health and/or dental care expenses, even if you have a single status or if you are covered by the Health Care and Dental Care plan of your spouse. The definition of dependents is also extended for the HSA. Anyone you can declare as your dependent on your tax return may be a dependent for your HSA. You will have a maximum period of 60 days after the end of the contract year (November 1 st ) to claim fees incurred during the previous contract year. Unused money can be carried over to the following period only. The amounts not used afterwards will be lost. The amounts used will be added to your provincial taxable income. IMPORTANT NOTE: The contractual year being from November 1 st to October 31 st, the first application of the Health Spending Account will be from July 1 st, 2015 to October 31 st, One-third of the amount you choose will be initially deposited on July 1 st, The total amount will then be deposited again on November 1 st, 2015 and For instance, if you choose to deposit $1, 000 into your HSA: Deposit on July 1 st, 2015 = $1,000 $ / 3 = $333 Deposit on November 1 st, 2015 = $1,000 Deposit on November 1 st, 2015 = $1,000 3 On November 1 st, 2017, if you wish, you will be able to reselect your choice and change the amount deposited into your HSA. Example of use An amount of $1,000 is deposited in your HSA on November 1 st, In 2016, you request a reimbursement from your Health Spending account of $300 for a pair of glasses. The remaining $700 will be carried over after November 1 st, 2016, in addition to your new amount of $1,000. If you do not make any other request before October 31 st, 2017, the $700 carried over will be automatically forfeited on November 1 st, To claim from your Health account, you proceed in the same manner as you do for any insured claims, by submitting receipts online through the AGA portal for members, or by filling out a paper form. WELLNESS ACCOUNT You can use the funds deposited in the Wellness Account to pay for the following expenses: Monthly Titles for public transits Membership Fees for structured physical activities such as training centers, yoga, Pilates, dance classes, etc. Exclusions: sport equipment like running shoes, treadmill, bicycle, etc Here are some rules applying to the Wellness Account: Unused amounts may be carried forward to the next period only and will be lost thereafter. The amounts used in the Wellness Account are considered as salary and added to your taxable income at both levels of government IMPORTANT NOTE: The contractual year being from November 1 st to October 31 st, the first application of the Wellness Account will run from July 1 st, 2015 to October 31 st, One-third of the amount you choose will be initially deposited on July 1 st, The total amount will then be deposited again on November 1 st, 2015 and To claim expenses from your Wellness Account, bring your receipts to your Human Resources department, twice a year (October and April). GROUP RETIREMENT SAVINGS PLAN Deposits in your Group Retirement Savings Plan will be monthly. The amounts will be deposited in a deferred profit sharing plan (DPSP). A DPSP is simply a way for an employer to contribute to your retirement plan in a way more fiscally advantageous for you. You can also make additional contributions to your retirement savings. Your deposits will be made in a Group RRSP. 4 Please note the following: A minimum annual deposit of $50 is required in the Group Retirement Savings Plan. If you have less than $50 after the distribution of your $1,000 envelope, you will have to assign it to one of the other three alternatives (Cost of enriched plan, HSA, Wellness Account). You get immediate tax savings on all amounts deposited, either in the DPSP or Group RRSP. To find further information about your Group Retirement Savings Plan, please visit the website 5 PLANS DESCRIPTION PLAN BASIC ENRICHED ELIGIBILITY Conditions Period LIFE INSURANCE & AD&D Member Amount Reduction Exemption Termination 30 hours / week 3 months of service 1 X salary 50% at 65 years Up to 65 years 70 years or retirement LIFE INSURANCE - Dependents Amount (Spouse) $5,000 Amount (Children) $2,500 Termination CRITICAL ILLNESS INSURANCE Amount (Member) Moratorium Period OPTIONAL LIFE INSURANCE Amount (Member & Spouse) 70 years or retirement 6000$ (Stroke, heart attack, kidney failure, cancer) 90 days By $10,000 increments Minimum $20,000 Maximum $500,000 Termination Life, AD&D, and Critical Illness Insurance Member s 65 th year PLAN BASIC ENRICHED Short-term Disability Benefit Qualifying period Fiscal status Duration of benefits Long-term Disability Benefit Fiscal Status Employment Insurance plus additional benefits = 60% of salary None Taxable 15 weeks 66,67% of the first $2,250 of the monthly salary plus 50% of the excess Non-taxable Non-evidence Maximum $7,500 Maximum with evidence $15,000 Qualifying period Payment period Maximum of all sources Termination Short-Term and Long-Term Disability Insurance 15 weeks Up to 65 years 85% of net wages 65 years 6 Health Care Insurance PLAN BASIC ENRICHED HEALTH CARE Hospitalization 100% semi-private 100% semi-private Short-term No limit No limit Long-term (convalescence, rehabilitation) $20 / day, 90 days $20 / day, 90 days Travel 100% 100% Duration of trip 180 days 180 days Assistance Included Included Lifetime Maximum $5,000,000 / insured $5,000,000 / insured Drugs Franchise $5 / prescription $5 / prescription Payment card Direct Direct Co-insurance 80% 90% Generic substitution Compulsory Compulsory Drug List Regular list Regular list Co-insurance on all other costs 80% 90% Other covered expenses Paramedical Psychologist and social worker $800 / year Chiropractor (1) $800 / year (2) Physiotherapist $800 / year Speech therapist $800 / year (3) Naturopath $800 / year (2) Acupuncturist $800 / year Audiologist Not covered $800 / year (3) Dietitian Occupational Therapist n.a. $800 / year Osteopath (1) $800 / year (2) Podiatrist Massage Therapist Orthotherapist Detox cure Not covered n.a. $800 / year (2) $80 / day $2,500 lifetime Diagnostic services Not covered $1,000 / year Nursing services $10,000 / year $10,000 / year Visual Care Eye examination Glasses and lenses or laser surgery Other Expenses Support stockings Orthopedic shoes Artificial lens Conventional wheelchair Glucometer Not covered Not covered n.a. $300 / 24 months $100 / year $300 / year $200 / year $1,500 lifetime $200 / 36 months 7 Other Expenses (continued) Sclerosing injections Neurostimulator T.E.N.S. Orthotic or podiatric plantar support Hearing Aid Hair prosthesis Breast prosthesis $20 / visit $700 lifetime $300 / year $500 / 36 months $150 / year $150 / 24 months IUD $50 / year Ambulance Included Included Termination Retirement Retirement (1) Including $50 / year for imagery technique (2 or 3) Combined for all indicated specialists Dental Care PLAN BASIC ENRICHED DENTAL CARE Deductible None None Preventive care (exams, cleanings) Not covered 80% Basic care (filling, canal treatment, gum treatment, etc.) Not covered 80% Major treatments (bridges, crowns, dentures) 60% 60% Orthodontic Not covered Not covered Annual Maximum $1,500 $1,500 Recall exam s.o. 6 months Schedule Current year Current year Termination Retirement Retirement COSTS A cost simulator (Excel file) is available to help you calculate your cost depending on the choices made. You will find it on AGA s website at IMPORTANT: You must absolutely use this cost simulator before distributing your additional envelope as it is the only place you can get the maximum amount allowed to pay the enriched plan. HELPFUL TIPS Examine the benefits and cost of the coverage offered by your spouse s employer. Add up the amounts claimed in Health Care and Dental Care of the last 12 months for the entire family. Consider taking a smaller coverage and use the Health Spending account to cover certain expenses (glasses, dentist s visits, etc.) 8 How to enroll? Visit the website : Download the enrolment form and fill it. The following information must be absolutely be included in the form : o Your choice of protection (opting out, single, couple, single parent or family) o If you have dependents, their information (name, relationship and confirmation that they are covered or not under another plan) must be provided even if you opt out or choose a single status. o Your beneficiary designation for your Life insurance. Use the cost simulator to help you make your choice and indicate the maximum amount of the $1,000 envelope which can be used to reduce your contribution to the Enriched plan. Use the Internet tool to indicate your plan choice (Basic or Enriched) and indicate where you want your dollars to be deposited. Send the original completed form to: o Julie D. Rivard for employees located in the Brewster and St-Joseph offices. o Aude Robert for employees located in Peel, Grande-Allée and Saguenay offices. If you request an Optional Life Insurance amount, you must also complete the evidence of insurability form of the insurer. This form can also be found on the website, and must be sent to AGA Benefit Solutions (view address in the Contacts section). If you do not send us your choices, you will be automatically be placed in the Basic Plan depending on your current status (initial enrolment of July 1 st, 2015), or in the single status (future employees) and the additional envelop of $1,000 will be deposited into the Health Spending account. You will not be able to change the plan and choose another envelope distribution before the next reenrolment. What happens if? 1. I have a Life event allowing me to modify my choices: Go to the website download and complete the Change of Status and Plan form. It will not be possible to change the distribution of your additional $1,000 envelope during the year, even if you have a Life event. You will have to wait until the next re-enrolment to do so. 2. I am on maternity, paternity or parental leave: If a Life event or are-enrolment period occurs during maternity, paternity or parental leave, you can proceed in the same way as if you were at work, by filling the Change of Status / plan form or the Re-enrolment form found on the website 3. I am on disability: During disability periods of short or long-term, only status changes caused by Life events will be permitted. You can modify your choices within 31 days upon your return to work. 9 4. I want to add or remove a dependent, or change their student status: Fill in the appropriate sections of Change of Status and Plan form. IMPORTANT: i. Claims for dependents will not be accepted as long as their information has not been sent. ii. You must also send evidence of full-time student status for your children over 21 years of age every year. Claims will not be accepted as long as evidence of student status has not been sent. 5. I have a change of address, I would like to request a direct deposit for my refunds, I would like to verify the balance of my Health Spending account or submit my claims electronically: Go to the website and register to the members portal, where you can perform all of these transactions. Forms must be sent at the following locations. In all cases, only original forms should be sent. Enrolment form (initial enrolment, new employee or re-enrolment) : o Human Resources Change of Status/Plan form : o Human Resources Change of Beneficiary form : o Human Resources Evidence of Insurability form : o AGA Benefit Solutions TRANSITION BETWEEN THE OLD AND THE NEW PROGRAM Expenses incurred prior to June 30 th, 2015 You have 90 days to claim your health care and dental care expenses incurred prior to June 30 th, 2015 to your former insurer. Lemay employees: send claims to Desjardins Financial Security. IBI Group employees: send claims to Green Shields. Expenses incurred as of July 1 st, 2015 Your new insurer is Great West Life. However, all claims must be submitted to AGA who administers your insurance program. You will receive your insurance certificate and your direct payment card in the first weeks of June. The numbers written on the card are the ones you need to give your pharmacist and your 10 dentist for the covered cost to be paid directly by the insurance plan you have chosen (see illustration). For all other fees, you can send your receipts electronically by registering on the AGA members portal Paper forms are also available on the AGA members portal. CONTACTS Your new insurer is Great West Life. However, AGA Benefit Solutions is the administrator who manages the contract and pays the Health Care and Dental Care claims. All requests for information should be addressed to AGA Benefit Solutions at the following numbers: The opening hours are from 8:30 a.m. to 8:00 p.m., Eastern Time. The service is available in English and in French. You can also contact AGA Benefit Solutions by or by mail at the following address: AGA Benefit Solutions 3500 de Maisonneuve Blvd. West Suite 2200 Westmount (Québec) H3Z 3C1 11
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