THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN MESSAGE FROM THE BOARD OF TRUSTEES
The Board of Trustees of The Construction Industry's Benefit Plan is pleased to provide you with a comprehensive benefit plan for you and your family. Your employer has recognized the importance of group insurance coverage and is committed to providing such coverage for their workforce. This plan offers the unique features of portability, banking of hours and self-pay option.
The Construction Industry's Benefit Plan offers life insurance for you, your spouse and your dependent children. It also contains a comprehensive dental package covering such items as cleanings, fillings, extractions, crowns, bridges and dentures, and reimbursement for the cost of braces for dependent children. The extended health package covers prescription drug costs, eyeglasses and out-of-country medical expenses. Also included is a long term disability plan intended to provide income protection if you cannot work due to disability.
The Board of Trustees is constantly monitoring the plan to ensure it meets the needs of open shop contractors and their employees. If you have any comments or questions about your plan do not hesitate to contact them at:
The Construction Industry's Benefit Plan
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SCHEDULE OF BENEFITS.1
GENERAL INFORMATION .3
Benefit Plan Administrator .3
About This Booklet and Plan.3
Enrolment Card.4
Initial Eligibility .4
Continuation of Coverage .5
Termination of Coverage .5
Self-Pay Option.5
Extension of Benefits While Disabled .6
Maternity/Parental Leave of Absence .6
Reinstatement.6
Apprenticeship Training Hours.6
Eligible Dependents .7
Residency Requirement.8
CLAIM INSTRUCTIONS.9
Benefit Claim Submissions .9
Extended Health and Dental Claims .9
Life Insurance, Life Waiver and Disability Claims .16
EMPLOYEE LIFE INSURANCE.13
Benefit.13
Beneficiary .13
Waiver of Premium Due to Disability.18
Conversion of Benefit.18
ACCIDENTAL DEATH & DISMEMBERMENT .14
Covered Losses .14
Amount of Insurance.14
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Critical Disease Benefit.14
Schedule of Losses.14
Surgical Reattachment.16
Seat Belt Benefit .16
Day Care Benefit.16
Family Transportation Benefit .17
Home Alteration and Vehicle Modification Benefit .17
Spousal Occupational Training Benefit .17
Rehabilitation Benefit .18
Repatriation Benefit .18
Continuation of Education Benefit.18
Exposure.19
Disappearance.19
Maximum Benefit .19
Total Disability Waiver of Premium .19
AD&D Definitions .19
Limitations.25
DEPENDENT LIFE INSURANCE.26
Benefit.26
Waiver of Premium .26
Conversion of Benefit.26
EXTENDED HEALTH CARE BENEFITS.27
Benefit Coverage .27
Eligible Expenses.27
Prescription Drug Benefit .27
Medical Services and Supplies .25
Out of Province/Canada Medical Emergency Benefits .28
Coordination of Benefits.35
Survivor Benefit.36
Extended Benefits.36
Limitations.36
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DENTAL CARE BENEFITS.33
Benefit Coverage .38
Eligible Expenses.38
Fee Guide .38
Maximum Benefit .38
Alternate Courses of Treatment .34
Pre-determination of Benefits .34
Basic Dental Services .34
Accidental Dental .37
Major Dental Services.38
Orthodontic Dental Services .39
Dental Expenses Outside of Canada .45
Coordination of Benefits.45
Survivor Benefit.45
Extension of Benefits .45
Dental Examinations of Information .45
Limitations.46
LONG TERM DISABILITY.43
Eligibility .48
Coverage During Apprenticeship Training .48
Benefit.48
Qualifying Period.44
Payment Period .44
Definition of Disability.44
Periods for Which Benefits Are Not Payable.44
Integration With Other Income .45
Recurrent Disability.45
Rehabilitation .46
Survivor Benefits.46
Waiver of Long Term Disability Premiums .46
Limitations.46
Subrogation (Reimbursement for Third Party Liability) .47
Termination of LTD Benefit Payments .47
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Termination of LTD Coverage.47
EMPLOYEE & FAMILY ASSISTANCE PROGRAM.49
Benefit Coverage .49
Accessing the EFAP .49
Confidentiality .49
Services Provided .50
Trauma Response Services.50
Cost of Accessing the EFAP .56
Counseling Sessions Provided .56
Long Term Problems .56
Survivor Benefit.56
QUESTIONS & ANSWERS .52
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SCHEDULE OF BENEFITS Employee Life Insurance Accidental Death & Dismemberment Dependent Life Insurance Extended Health Care for Employees & Dependents Dental Care for Employees & Dependents Long Term Disability Insurance Employee and Family Assistance Program
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Please refer to the benefit description pages for complete details regarding expenses, benefit maximums and other limitations. If you have any questions, please call ICBA Benefit Services Ltd toll-free at 1 (888) 298-7752 or at (604) 298-7752. This booklet outlines your plan in general terms. In the case of inconsistencies between this booklet and the contracts issued by Great- West Life or ACE INA Life Insurance, the terms in the master contracts will prevail.
___________________________________________________________________________ PAGE 2 Benefit Plan Administrator
ICBA Benefit Services Ltd is the administrator of your benefit plan. ICBA Benefit Services Ltd' staff can assist you in a variety of ways, including answering questions about your eligibility for benefits, answering questions about the benefits provided by the plan and helping you complete claim forms.
ICBA Benefit Services Ltd will also record any changes to your address, send you claim forms, help you with any claim problem and tell you the status of your claims.
For assistance or claim forms contact: ICBA Benefit Services Ltd
Toll free at 1 (888) 298-7752 or (604) 298-7752
In addition, you can find valuable information about the benefit plan by going to www.mycibp.ca. You can find out your benefit status, find information about the benefits covered under the plan, obtain copies of claim forms, check on the status of your extended health and dental claims and send an email message to ICBA Benefit Services Ltd, to name a few. Please note that you will need your Username and Password to access your personal information.
About This Booklet and Plan
This booklet contains important information about your eligibility for benefits and the levels of coverage provided under your benefit plan. The types of benefits you are covered for, the percentage amounts that will be paid by the plan and the plan maximums are summarized in the Schedule of Benefits.
As you read through the various sections of this booklet, there are a few key points to remember. First, this booklet outlines your plan in general terms. If there are any inconsistencies between what is contained in this booklet and the contracts issued by Great-West Life and ACE INA Life Insurance, the terms of the contracts will prevail. Second, employee life and disability benefits, and accidental death and dismemberment benefits are insured by Great-West Life and ACE INA Life Insurance, respectively, who are solely responsible for these insured portions of the benefit plan. Dependent life insurance benefits are self-
___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
insured. Great-West Life adjudicates claims on behalf of The Construction Industry's Benefit Plan, for the extended health and dental portions of the benefit plan, which are self-insured. Finally, if any of the insurance providers change, the terms of this booklet will remain the same, unless you are notified otherwise.
Enrolment Card
It is your responsibility, and in your own interest, to fully complete an enrolment card and ensure the information is kept up-to-date. You can obtain an enrolment card from your supervisor or payroll administrator, or ICBA Benefit Services Ltd. You should complete the enrolment card legibly and in black ink and return it immediately to your supervisor. Failure to do so can result in the payment of your claims being delayed or declined. The enrolment card contains information vitally important to both you and the plan administrator, ICBA Benefit Services Ltd. For example, if your current address is not on record, you may not receive notice informing you when benefit coverage begins or advising you that your eligibility for benefit coverage has terminated.
As well, the information on your enrolment card is used in order for Great-West Life to provide you with your pay-direct drug card. If you have not completed the enrolment card in full (including indicating the names and dates of birth for your dependents who will be covered under the extended health and dental portions of the benefit plan) you will not be issued a pay direct drug card, or the card you are issued may not cover all of your dependents.
If you have not provided ICBA Benefit Services Ltd with a current correct address, a pay-direct drug card will not be issued and you will not be able to submit any extended health care claims. You must also advise ICBA Benefit Services Ltd each time your address changes, in order to ensure continuing coverage.
The enrolment card is also used to designate your beneficiaries, for payment of any death benefits under the benefit plan. If the enrolment card is not completed properly, or you have not designated any beneficiary, death benefits will be paid to your estate.
Initial Eligibility
Your employer has agreed to report hours worked and remit payments for all hourly paid field or shop employees in your company. The hours you work each month are reported to ICBA Benefit Services Ltd, who maintain the balance of hours in your hour bank account. Initial coverage under the benefit plan takes effect on the first day of the second month after your hour bank account has accumulated 300 hours (e.g. if your employer has reported 150 hours for each of July and August, you would have accumulated 300 hours at the end of August ___________________________________________________________________________ PAGE 4
and would be eligible for benefits October 1 - the first day of the second month after you had accumulated 300 hours). So long as you work for a company participating in The Construction Industry's Benefit Plan, hours will accumulate in your account. You have up to nine months to accumulate 300 hours. Once your account reaches 300 hours, a letter will be sent to you by ICBA Benefit Services Ltd, advising you of the date your coverage under the benefit plan takes effect. If you fail to reach 300 hours in the nine-month period, your hours will be forfeited. For more details on how the hour bank operates, please see question #2 in Questions & Answers section.
Continuation of Coverage
In order to be eligible for a month of benefit coverage, 150 hours are deducted from your hour bank account. The maximum number of hours that can be left in your account, after the most recent input of hours and monthly deductions, is 900 hours. Hours in excess of 900 are forfeited.
Termination of Coverage
Your coverage under the benefit plan (except coverage for disability benefits) will terminate the last day of the month following the month the balance in your account falls below 150 hours, subject to the self-pay option outlined in the following section. Your coverage for disability benefits will terminate on the last day on which you are at work for a Construction Industry's Benefit Plan company. You cannot receive a refund for any hours that have been reported by your employer, when you terminate employment. All hours reported will remain to your credit and will continue to provide coverage so long as you have a minimum of 150 hours in your hour bank account.
Self-Pay Option
Whenever your hour bank account balance falls below 150 hours, a letter will be sent to your last recorded address advising you of the date your benefits terminate. You may, however, elect to have your benefits, except disability benefits, extended for up to six consecutive months under the self-pay option. The amount of payment required, and the deadlines for submitting payments, will be outlined in the letter. Any period of self-pay will not accumulate hours in your hour bank account.
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Extension of Benefits While Disabled
Should you become disabled while eligible for benefits under this plan, you may continue your benefits (except disability benefits), on a contribution basis, for up to 24 months from the date you become disabled. To be eligible for this extension, you must either be in receipt of Workers' Compensation or Long Term Disability benefits, or be approved for waiver of premium under the Employee Life Insurance benefit. Please contact ICBA Benefit Services Ltd if you wish to continue benefits while you are disabled.
Extension of Benefits While on a Maternity/Parental Leave of Absence
You may continue your benefits under this plan (including disability benefits), on a contribution basis, for up to 52 weeks during a scheduled Maternity or Parental Leave of Absence. However, coverage cannot be continued for more than 52 weeks, including any period during which you elected the Self-Pay Option. Please contact ICBA Benefit Services Ltd regarding the continuation of your benefits during a Maternity or Parental Leave of Absence. They will provide you with a letter outlining the amount of payment required, and the deadline for submitting payment. Reinstatement
If your benefits terminate because you do not have sufficient hours in your hour bank plan, your benefits may be reinstated without having to again satisfy the initial 300-hour eligibility requirement. In order for your benefits to be reinstated, your hour bank account must reach at least 150 hours (including hours on hand at the time your benefits terminated) within eight months. When you have accumulated 150 hours within the eligible eight-month period, your benefits will be reinstated the first day of the second month after the 150th hour is recorded in your account. A letter will be sent to you advising the date your coverage is reinstated.
If you do not satisfy the 150-hour reinstatement provision within eight months, then any remaining hours in your hour bank account will be forfeited and the initial eligibility requirement of accumulating 300 hours within nine months will apply.
Apprenticeship Training Hours
Your employer may, at their discretion, continue to remit hours during a period of apprenticeship training, provided that the apprenticeship training commences within 30 days after the day you last worked for that employer. In this case, you will continue to be credited with hours in your hour bank account during your period of apprenticeship training. ___________________________________________________________________________ PAGE 6
Alternatively, you may self-pay in order to continue coverage during a period of apprenticeship training, as provided for under the Self-Pay Option.
Please contact ICBA Benefit Services Ltd at (604) 298-7752 or 1-888-298-7752 regarding the continuation of coverage during your apprenticeship training. Eligible Dependents
Certain benefits are available to your eligible dependents while you are covered for benefits under this plan. To be covered, your eligible dependents must live in Canada and must be listed on your enrolment card.
A dependent spouse includes either: (a) a person to whom you are legally married, or (b) a person continuously living with you for a period of at least one year and who is represented by you publicly as your spouse. Only one spouse will be eligible for benefits under this plan, and will be as indicated by you on your enrolment card.
A dependent child is eligible if he or she is a natural child, stepchild, or legally adopted child of you or your covered spouse. To be eligible, the dependent child must also be unmarried and fully dependent on you for support. If you are living in a common-law relationship, the child of the common-law spouse will be eligible for benefits so long as he/she is in the care and custody of both you and your spouse and living with you.
Where you are in possession of legal guardianship papers, a dependent child, under the age of 18 for which you are the legally appointed guardian, will also be eligible for dependent benefits.
Dependent children are covered only until age 21. However, coverage may be extended to the 25th birthday when the child is a full-time student and satisfactory proof of attendance is provided.
Unmarried and unemployed children 21 years of age or older can be covered if they are dependent upon you by reason of mental or physical disability, became totally disabled prior to attaining age 21, and have been continuously disabled since that time provided the dependent was insured as a dependent under this plan at the time of the accident or the onset of the illness causing the incapacitation. Unmarried and unemployed children who become totally disabled while attending an accredited educational institution, college or university on a full-time basis prior to their attaining age 25, and have been continuously so disabled since that time shall also qualify as a dependent. Proof of the disability from the dependent's physician must be provided.
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Residency Requirement
You and your dependents will not be covered under this plan if you are residing outside Canada, unless an exception is requested by the employer and approved by ICBA Benefit Services Ltd and the Insurers of the benefit plan.
___________________________________________________________________________ PAGE 8 Benefit Claim Submissions
You can obtain claim forms by contacting ICBA Benefit Services Ltd, as indicated in the previous section. Life and disability claim forms should be returned to ICBA Benefit Services Ltd, who will submit them to the appropriate insurer. Extended Health and Dental claim forms should be sent directly to Great-West Life.
Send completed health & dental claim forms to:
If you are unsure how to complete your claim form, contact ICBA Benefit Services Ltd and they will assist you.
Extended Health and Dental Claims
All claims for eligible drugs can be made directly by your pharmacist at the time that you fill your prescription, if you present your pay-direct drug card issued by Great-West Life. You will not have to pay any amount of the prescription that is covered by the plan, but you will have to pay any amounts that are not covered by the plan.
All other Extended Health and Dental claims should be submitted to Great-West Life as soon as possible. All health and dental claims for a calendar year must be submitted no later than June 30th of the following year in order to be eligible for reimbursement.
If your health or dental claim is sent to ICBA Benefit Services Ltd, it will be forwarded to Great-West Life. This will increase the time you will have to wait for your benefit claim reimbursement.
Be sure that you indicate your Plan Number (56700), Identification Number, full name and complete address on all claim forms or other correspondence sent to Great-West Life. ___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
The following is a step-by-step outline of the procedure you should follow for all extended health and dental claims: Extended Health Care Expenses: • obtain a "Healthcare Expenses Statement"; • itemize the expenses for covered services and supplies for each
family member (which can all be put on the same form);
• keep a copy of the statement and receipts for your records; • attach original paid-in-full receipts and send to Great-West Life; • Great-West Life will mail a cheque for the eligible expenses to you. • If you have made a claim under another plan first (e.g. through your spouse)
you should also attach a copy of the Explanation of Benefits showing any amounts that have been paid by the other plan, or if the claim has been denied by the other plan. Please see Question #8 under the Questions and Answers section of this booklet for an explanation of how to file a claim in the event that you have coverage under your spouse's plan.
Out of Province/Canada Expenses: • obtain a "Statement of Claim Out-of-Country Expenses" and the appropriate
form that allows Great-West Life to coordinate your benefits with the applicable provincial medical plan (available by calling ICBA Benefit Services Ltd or by going to www.mycibp.ca);
• itemize the expenses for covered services and supplies on the form; • keep a copy of the statement and receipts for your records; • attach original paid-in-full receipts and send to Great-West Life; • Great-West Life will either mail a cheque for the eligible expenses to you, or
will pay the health care provider(s) directly, if you have so authorized;
• Great-West Life will coordinate payment of benefits directly with your
provincial health care plan (provided you have completed the appropriate form).
• If you have made a claim under another plan first (e.g. through your spouse)
you should also attach a copy of the Explanation of Benefits showing any amounts that have been paid by the other plan, or if the claim has been denied by the other plan. Please see Question #8 under the Questions and Answers section of this booklet for an explanation of how to file a claim in the event that you have coverage under your spouse's plan.
Dental Expenses: • obtain a Standard Dental Claim Form and have your dentist complete his/her
portion (many dentists also now have these forms available online, and may be able to complete and submit them electronically);
• a separate claim form must be used for each individual; • complete your portion of the form and send directly to Great- West Life; ___________________________________________________________________________ PAGE 10
• Great-West Life will mail a cheque for the eligible expenses to you or to your
dentist (if you assigned payment of your dental expenses directly to your dentist by signing the top right hand corner of the claim form).
• If you have made a claim under another plan first (e.g. through your spouse)
you should also attach a copy of the Explanation of Benefits showing any amounts that have been paid by the other plan, or if the claim has been denied by the other plan. Please see Question #8 under the Questions and Answers section of this booklet for an explanation of how to file a claim in the event that you have coverage under your spouse's plan.
Direct Deposit of Extended Health Care and Dental Claims:
Rather than have Great-West Life mail a cheque to you for your health and dental claims, you can advise Great-West Life that you would like to have your claims directly deposited to your bank account. You can do this by signing up for direct deposit on the Great-West Life website (accessed by clicking on the Great-West Life logo on the Independent Contractors and Businesses Association website at www.icba.ca or by completing a Direct Deposit Authorization form (available from ICBA Benefit Services Ltd)). Once you have authorized Great-West Life to electronically deposit your payments, all future health and dental claim payments will be deposited to your bank account. You will also receive an email notice of payment of the claim. Life Insurance, Life Waiver and Disability Claims
Life Insurance, Life Waiver and Disability claim forms should be returned to ICBA Benefit Services Ltd, who will submit them to the appropriate Insurer. Great-West Life is the Insurer for Employee Life Insurance and Long Term Disability. ACE INA Life Insurance is the Insurer for Accidental Death and Dismemberment Insurance. Dependent Life Insurance is self-insured.
The following is a step-by-step outline of the procedure you should follow for all Life and Disability claims: Employee and Dependent Life Insurance • immediately notify ICBA Benefit Services Ltd, who will provide you with the
• obtain an original death certificate or funeral directors statement; • send the completed forms and documents to ICBA Benefit Services Ltd; • the benefit will be paid as soon as satisfactory proof of death and beneficiary
___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN Waiver of Premium for Life Insurance Benefits Due to Disability • notify ICBA Benefit Services Ltd of your disability as soon as possible; • notice of all waiver of premium claims must be provided to Great-West Life
within 300 days of the onset of your disability;
• ICBA Benefit Services Ltd will provide the necessary forms for completion by
• waiver of premium will be approved as soon as satisfactory proof of your
disability has been provided to Great-West Life.
Accidental Death and Dismemberment Insurance • immediately notify ICBA Benefit Services Ltd, who will provide you with the
• obtain an original death certificate, Medical Examiner's Report or other proof
• send the completed forms and documents to ICBA Benefit Services Ltd; • the accidental death and dismemberment benefits will be paid as soon as
proof of death or loss has been verified by ACE INA Life Insurance;
• if the claim is a result of an accidental death, the claim must be submitted to
ACE INA Life Insurance within six months of the date of death;
• if the claim is for a Critical Disease or Dismemberment benefit,
the claim must be submitted to ACE INA Life Insurance within nine months from the date of total disability or 12 months from the date of the dismemberment;
• failure to furnish proof within this time will not invalidate nor reduce any claim
if it is shown not to have been reasonably possible to furnish the proof and that the proof was furnished as soon as was reasonably possible, but in no event will this be more than 12 months after first becoming eligible for accidental death benefits or Critical Disease benefits or 18 months for dismemberment benefits.
Long Term Disability (LTD) • notify ICBA Benefit Services Ltd of your disability as soon as possible; • notice of all Long Term Disability claims must be provided to Great-West Life
within 180 days after the end of the Qualifying Period;
• ICBA Benefit Services Ltd will provide the necessary forms for completion by
• the LTD benefit will be paid as soon as satisfactory proof of your disability
claim has been provided to Great-West Life.
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You are eligible for $50,000 of Employee Life Insurance. The life insurance benefit insures you for death from any cause.
Beneficiary
Should you die while insured, the Employee Life Insurance benefit is payable to your beneficiary. You designated a beneficiary at the time that you completed your original enrolment card. If a beneficiary has not been properly appointed, then the Employee Life Insurance benefit will be payable to your estate. If you wish to change your beneficiary designation at any time, complete a new enrolment card and forward it to ICBA Benefit Services Ltd.
Waiver of Premium Due to Disability
If you become disabled, you may be eligible for a waiver of Employee Life Insurance premiums. You must apply for the waiver of premiums within 300 days of the onset of your disability. The appropriate form can be obtained by contacting ICBA Benefit Services Ltd. The Insurer will advise you if you have been approved for waiver of premium, which will apply so long as you remain disabled, or to age 65. The Insurer may ask for proof of continuing disability from time to time.
Conversion of Benefit
Should your Employee Life Insurance terminate, you may convert the amount of insurance that you had prior to termination to an individual policy. Your application for an individual policy must be made, and you must pay the premium, within 31 days after your insurance coverage terminates. Should you die within 31 days of the date your Employee Life Insurance has terminated, the amount that could have been converted to an individual policy will be paid to your designated beneficiary or estate (if a beneficiary has not been designated). For complete details on the conversion option, contact ICBA Benefit Services Ltd. Employee Life Insurance ___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
ACCIDENTAL DEATH & DISMEMBERMENT Covered Losses
Accidental Death and Dismemberment benefits are provided as a result of: • your death, as a result of accidental bodily injuries occasioned solely through
external, violent and accidental means without gross negligence on your part;
• your medical diagnosis with one of the covered Critical Diseases; • one of the covered losses outlined in the Schedule of Losses, resulting
directly and independently of all other causes from an injury occasioned solely through external, violent and accidental means, without gross negligence on your part.
Amount of Insurance
The amount of Accidental Death and Dismemberment Insurance you are covered for is $50,000.
Critical Disease Benefit
The Insurer will pay you an amount equal to 10% of the Amount of Insurance provided you: • have been medically diagnosed with one of the covered Critical Diseases
after the effective date of your coverage under this benefit and prior to age 65;
• have been Totally Disabled (from any and all occupations as defined in the
policy) from that Critical Disease for at least nine months.
Benefits are limited to the first covered Critical Disease in your lifetime. Covered Critical Diseases are: Poliomyelitis, Parkinson's Disease, Huntington's Chorea, Multiple Sclerosis, Alzheimer's Disease, Type 1 Diabetes (insulin dependent), Amyotrophic Lateral Sclerosis (ALS), Peripheral Vascular Disease and Necrotizing Fasciitis.
Schedule of Losses An amount equal to 200% of the Amount of Insurance for:
• paraplegia (total paralysis of both lower limbs); • hemiplegia (total paralysis of one side of the body); • loss of use of both arms; ___________________________________________________________________________ PAGE 14
• quadriplegia (total paralysis of all four limbs); • loss of use of both legs; • loss of use of one arm and one leg on the same side of the body. An amount equal to 100% of the Amount of Insurance for:
• loss of life; • loss of both hands or both feet; • loss of both arms or both legs; • loss of sight of both eyes; • loss of one hand and one foot; • loss of use of both hands; • loss of use of both feet; • loss of speech and hearing in both ears; • loss of use of one hand or arm and one leg; • loss of sight of one eye and one hand or one foot. An amount equal to 75% of the Amount of Insurance for:
• loss of one arm; • loss of use of one arm; • loss of one leg; • loss of use of one leg; • loss of one hand; • loss of one foot; • loss of speech; • loss of hearing in both ears; • loss of sight of one eye; • loss of use of one hand; • loss of use of one foot. An amount equal to 33 1/3% of the Amount of Insurance for:
• loss of the thumb and index finger of the same hand; • loss of four fingers of one hand; • loss of hearing in one ear. An amount equal to 25% of the Amount of Insurance for:
___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN Surgical Reattachment
If you suffer the loss of a limb or thumb or index finger that is surgically reattached, the Insurer will pay 50% of the amount that would have been payable as indicated in the Schedule of Losses if the loss had been permanent, regardless of the amount of use regained. The balance of the benefit will be payable if the reattachment fails within one year after the reattachment was performed.
Seat Belt Benefit
If you die or become injured as a direct result of an accident, which results in a benefit payable under the Schedule of Losses, while driving or riding in a vehicle and wearing a properly fastened seat belt, the benefit payable under the Schedule of Losses will be increased by 10%.
At the time of the accident, the driver of the vehicle must hold a valid driver's license and must not have been under the influence of drugs, or have been driving the vehicle with a blood alcohol level in excess of 80 milligrams of alcohol per hundred milliliters of blood or have had his or her capacity impaired as a result of drug or alcohol use.
The person claiming the benefit (whether you or your beneficiary) must establish that you were wearing a seat belt at the time of the accident.
Day Care Benefit
When you die as a direct result of an accident for which an amount of insurance becomes payable under this policy, up to 5% of the amount of insurance, to a maximum of $5,000, will be paid for reasonable and necessary expenses actually incurred for each of your dependent children under 13 years of age who are enrolled in a legally licensed day-care centre or who will do so within 365 days after your death.
The benefit is payable annually, for each year (up to four consecutive years) that the child remains enrolled in a legally licensed day-care centre. Room, board or other ordinary living, traveling or clothing expenses are not covered.
If none of your dependent children satisfy the above requirements or the requirements as shown under the section Continuation of Education Benefit, an amount equal to $2,500 will be paid to your beneficiary. ___________________________________________________________________________ PAGE 16
Family Transportation Benefit
If you sustain a Covered Loss and are confined as an inpatient in an approved hospital located at least 150 kilometers from your residence and you are receiving reasonable and customary treatment from a physician or surgeon, the Insurer will pay the reasonable and customary treatment expenses incurred by all members of your immediate family for hotel accommodation in the vicinity of the approved hospital and return transportation by the most direct route to and from the hospital.
The amount payable under this benefit will not exceed the aggregate amount of $10,000 for all accommodation and transportation expenses. If transportation occurs in a vehicle or device other than one operated under a license for the conveyance of passengers for hire, then reimbursement of transportation expenses will be limited to a maximum of $0.30 per kilometer traveled.
Home Alteration and Vehicle Modification Benefit
If you sustain a Covered Loss and subsequently require the use of a wheelchair to be ambulatory, the Insurer will pay the reasonable and customary treatment expenses incurred for the purpose of making your home and vehicle wheelchair accessible.
Benefits are payable for the cost of alterations to your principal residence and the cost of modifications to one motor vehicle utilized by you, when such modifications are approved by licensing authorities where required.
The expenses must be incurred within three years from the date of the Covered Loss and are subject to a maximum of $10,000 in your lifetime.
Spousal Occupational Training Benefit
If your death occurs as a direct result of a Covered Loss, the Insurer will pay the reasonable and customary expenses actually incurred for tuition and books for your insured spouse to participate in a formal occupational training program to become qualified for active employment in an occupation for which your spouse would not otherwise be qualified.
Expenses must be incurred within three years from the date of your death and are subject to a maximum lifetime payment of $10,000.
___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN Rehabilitation Benefit
If within three years from the date of the Covered Loss you participate in a rehabilitation program in order to be qualified to engage in an occupation in which you would not have engaged except for such Covered Loss, the Insurer will pay the reasonable and customary treatment expenses incurred for the services of a licensed rehabilitation provider.
Payment for the total of all expenses incurred under this provision will not exceed $10,000 as the result of any one Covered Loss. Payment does not include incidental expenses, including without limitation, charges for room and board, ordinary living, traveling or clothing expenses.
Repatriation Benefit
If you die, from any cause outside of Canada, or if in Canada, you die at least 150 kilometers from your normal place of residence, the Insurer will pay your beneficiary the reasonable and customary treatment expenses incurred for the preparation of the body and its transportation to the funeral home or the place of interment in proximity to your normal place of residence. Benefits will not exceed $10,000 for all eligible expenses.
Continuation of Education Benefit
In the event your death occurs as a direct result of a Covered Loss, the Insurer will pay your beneficiary the Education Benefit stated below for each of your dependent children who are, at the time of your death enrolled as full-time students: • in an institution for higher learning above the secondary school level as
defined in the province or territory of residence; or
• at the secondary school level but who will enroll as a full-time student in an
institution for higher learning within 365 days after your death.
The Education Benefit is equal to the reasonable and customary treatment expenses actually incurred for tuition and books, subject to the lesser of a maximum of 5% of the amount of insurance or $5,000, for each year the dependent child continues the education, but not to exceed four years, which must run consecutively, with respect to any one dependent child.
This benefit will be paid each year on receipt of satisfactory proof that the dependent child is enrolled as a full-time student in an institution for higher learning. Payment will not be made for expenses incurred prior to your death or for incidental expenses, including without limitation, room, board or other ordinary living, traveling or clothing expenses.
If none of your dependent children satisfy the above requirements, the Insurer will pay an amount of $2,500 to your beneficiary. ___________________________________________________________________________ PAGE 18
Exposure
If you are exposed to the elements following the disappearance, forced landing, stranding, sinking or wrecking of a conveyance in which you were an occupant, such exposure will be deemed an injury by accidental means.
Disappearance
If your body has not been found within one year of the disappearance, forced landing, stranding, sinking or wrecking of a conveyance in which you were an occupant, then it will be deemed that you have suffered loss of life within the meaning of this coverage.
Maximum Benefit
In no case will an amount greater than the Amount of Insurance indicated in the Schedule of Benefits be paid for all losses identified in the Schedule of Losses sustained by you resulting directly or indirectly from the same accident or Critical Disease with the exception of: paraplegia, hemiplegia, quadriplegia, loss of use of both arms, loss of use of both legs, or loss of use of one arm and one leg on the same side of the body, where the benefit payable is 200% of the Amount of Insurance.
Total Disability Waiver of Premium
If premiums for your basic life insurance coverage are being waived, then premiums for the accidental death, disease and dismemberment benefit will also be waived, but only so long as the policy remains in force.
AD&D Definitions
• loss of a hand will mean complete severance at or above the wrist;
• loss of an arm will mean complete severance through or above the elbow
• loss of a leg will mean complete severance through or above the knee joint;
• loss of a foot will mean complete severance at or above the ankle;
• loss of a thumb will mean complete loss of one entire phalanx of the thumb;
• loss of an index finger will mean the complete loss of two entire phalanges of
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• loss of sight, loss of hearing or loss of speech will mean total and
irrecoverable loss of that faculty. If that faculty can be recovered or partially recovered by the use of some device or rehabilitative program, it will be deemed that there was no loss for the purposes of this provision;
• loss of use must be caused by tendon, nerve or bone damage. Such loss of
use must be total and irrecoverable and must be continuous for a period of 12 months. No benefits will be payable for loss of use if benefits for loss by dismemberment are paid or payable as a result of the same Covered Loss;
• paralysis will mean complete and irreversible paralysis caused by brain,
spine, muscle or nerve damage as a result of an accidental injury or covered Critical Disease which has continued for a period of 12 months from the date of the injury or medical diagnosis of the Critical Disease;
• institution for higher learning for the education benefit includes any university,
• immediate family, for the Family Transportation benefit, means a person who
is the spouse, child, father, mother, brother or sister of the employee. Other relatives may be considered in the event that no "immediate family" is living.
Limitations
No Accidental Death and Dismemberment Benefit will be paid for any loss caused by or resulting from any of the following:
• suicide or attempted suicide or self-inflicted injury, while sane or insane;
• committing, attempting or provoking an assault or criminal offense;
• a situation where the Covered Loss results from injuries sustained in, or
directly or indirectly from, a vehicle accident where you were driving the vehicle involved in the accident and had either:
- alcohol in your blood in excess of 80 milligrams of alcohol per hundred
- your capacity impaired as a result of drug or alcohol usage.
• disease, or bodily or mental infirmity, or medical or surgical treatment of any
• death where there is no visible contusion on the exterior of the body (except
• any drug, poison, gas or fumes, voluntarily taken, administered, absorbed or
inhaled, other than as a result of an occupational accident;
• insurrection or war (whether war be declared or not) or participation in any
riot, or active service in the armed forces of any country;
• travel or flight in any aircraft, or descent from such aircraft, if you are a pilot or
a member of the crew of the aircraft, or if such flight is made for the purpose of instruction, training or testing.
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Your spouse (if any) is covered for $10,000 of Dependent Life Insurance. Each of your eligible children (if any) is covered for $5,000 of Dependent Life Insurance. Your eligible spouse and children are covered for this benefit during the same period that you are covered for Employee Life Insurance. Note that your dependents will be covered under the Dependent Life Insurance benefit only if they are listed as dependents on your enrolment card.
In the event your spouse or an eligible child dies from any cause, the benefit will be paid to you. If you should die prior to the benefit being paid, the benefit will be paid to your estate.
Waiver of Premium
Dependent Life Insurance premiums will be waived if you become disabled and have been approved for waiver of your Employee Life Insurance premiums.
Conversion of Benefit
Should your Employee Life Insurance terminate, your spouse may convert the amount of his/her Dependent Life Insurance to an individual policy. If your spouse dies within 31 days of the date your Employee Life Insurance has terminated, the amount that could have been converted to an individual policy will be paid to you. For complete details on the conversion option, contact ICBA Benefit Services Ltd. Dependent Life Insurance
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The extended health care benefits are self-insured under The Construction Industry's Benefit Plan. Great-West Life adjudicates extended health claims for The Construction Industry's Benefit Plan.
Benefit Coverage
This section outlines the details of your extended health care benefits. The payment of any extended health care expense is subject to reasonable and customary pricing, any benefit levels and maximum benefit amounts indicated.
Eligible Expenses
Eligible expenses are generally charges for services and supplies that are medically necessary and customarily provided in relation to the nature and severity of the illness. Eligible expenses are generally included to the extent that:
• all expenses must occur and be paid for while you and your dependents are
• they are reasonable and customary, professionally recognized and medically
• except where otherwise indicated, they are prescribed by a physician;
• they exceed the amount payable under any other provision of the plan
document or, subject to the Co-ordination of Benefits provision, any other plan that provides similar benefits.
Prescription Drug Benefit
The Construction Industry's Benefit Plan will provide coverage for 80% of the Eligible Drugs and 80% of the Eligible Dispensing Fee.
All claims for eligible drugs and certain diabetes supplies can be made directly by your pharmacist at the time that you fill your prescription, by presenting your pay-direct drug card. You will not have to pay any amount of the prescription that is covered by the plan, but you will have to pay the remaining 20% and any other amounts that are not covered by the plan. Alternatively, you can pay for the drugs at the time you receive them from your pharmacist and submit your paid receipt for reimbursement. ___________________________________________________________________________ PAGE 22
Eligible Drugs: The following are considered Eligible Drugs under The Construction Industry's Benefit Plan when prescribed by a physician or other person entitled by law to prescribe them, and provided in Canada. These drugs are covered if they are listed in the British Columbia PharmaCare Benefits List in effect on the date of purchase:
• drugs which require a written prescription • injectable drugs including vitamins and insulins • extemporaneous preparations or compounds if one of the ingredients is a
• certain other drugs that do not require a prescription by law may be covered
when they are prescribed. If you have any questions, contact your plan administrator before incurring the expense
Unless your doctor has prescribed a drug by its brand name and has specified in writing that the product is not to be interchanged, the plan will cover only the cost of the lowest priced equivalent generic drug. For drugs eligible under a provincial drug plan, coverage is limited to the deductible amount and coinsurance you are required to pay under that plan.
There is a maximum limit of a 100-day supply for each prescription. Some specific drugs may require prior authorization by Great-West Life to determine whether or not they meet clinical criteria for the particular health condition. Please call ICBA Benefit Services Ltd to obtain the necessary form for completion by your physician. Eligible Dispensing Fee: The plan will allow a maximum dispensing fee of $6.50 for all prescriptions. Dispensing fees will vary between pharmacies, so you should shop around when filling your prescriptions. Limitations: The following will not be considered eligible drug expenses, whether prescribed or not:
• Expenses private benefit plans are not permitted to cover by law • Services or supplies for which a charge is made only because you have
• The portion of the expense for services or supplies that is payable by the
government health plan in your home province, whether or not you are actually covered under the government health plan
• Any portion of services or supplies which you are entitled to receive, or for
which you are entitled to a benefit or reimbursement, by law or under a plan that is legislated, funded, or administered in whole or in part by a government ("government plan"), without regard to whether coverage would have
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otherwise been available under this plan
• In this limitation, government plan does not include a group plan for
• Services or supplies that do not represent reasonable treatment • Services or supplies associated with:
o treatment performed only for cosmetic purposes
o recreation or sports rather than with other daily living activities
o the diagnosis or treatment of infertility
o contraception, other than oral contraceptives
• Services or supplies not listed as covered expenses • Extra medical supplies that are spares or alternates • Services or supplies received outside Canada • Services or supplies received out-of-province in Canada unless you are
covered by the government health plan in your home province and benefits would have been paid under this plan for the same services or supplies if they had been received in your home province
• Expenses arising from war, insurrection, or voluntary participation in a riot • Atomizers, appliances, prosthetic devices, colostomy supplies, first aid
supplies, diagnostic supplies or testing equipment
• Non-disposable insulin delivery devices or spring loaded devices used to hold
• Delivery or extension devices for inhaled medications • Oral vitamins, minerals, dietary supplements, homeopathic preparations,
infant formulas or injectable total parenteral nutrition solutions
• Diaphragms, condoms, contraceptive jellies, foams, sponges, suppositories,
contraceptive implants or appliances normally used for contraception
• Any single purchase of drugs which would not reasonably be used within 100
• Drugs dispensed by a dentist or clinic or by a non-accredited hospital
• Drugs administered during treatment in an emergency room of a hospital, or
• Preventative immunization vaccines and toxoids • Allergy extracts • Drugs that are considered cosmetic, such as topical minoxidil or sunscreens,
whether or not prescribed for a medical reason
• Smoking cessation products • Drugs used to treat erectile dysfunction • Drugs used to treat obesity • Fertility drugs, whether or not prescribed for a medical reason
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Medical Services and Supplies
The benefit plan will provide for 100% of the following eligible medical services and supplies, subject to reasonable and customary pricing limitations. Hospital: The difference between the charges for a standard ward and a semi- private room in an active treatment hospital. Convalescent Care: The charge for a standard ward or semi-private room for convalescent care for a condition that is likely to improve as a result of the care, where the eligible person is admitted within 24 days of being hospitalized for acute care. There is a maximum of 180 days per illness. Home Care Nursing: The charges for nursing services provided in the patient's home when certified in writing by the attending physician as medically necessary for the condition of the patient. A registered nurse, licensed practical nurse or registered nursing assistant must provide the nursing services. A relative of the patient or a resident in the patient's home must not provide the nursing services. To establish the amount of coverage available before home nursing begins, you should apply for a pre-care assessment. The maximum amount of expenses that will be paid is $10,000 during any one calendar year per person. Charges for custodial care or any service within the capabilities and competence of a member of the household are not eligible. Ambulance: This plan will pay for ambulance services for transportation to and from the nearest hospital where essential treatment is available in the event of illness or injury. The plan will pay the reasonable and customary charges of the ambulance services. Air ambulance transportation will only be covered if normal ground ambulance is not available or is not in the best medical interests of the patient. Response fees are covered only when treatment is provided. Ambulance charges for job related accidents are not covered. Paramedical Practitioners: Charges for the following services, subject to reasonable and customary pricing limitations. Charges for initial consultation or assessment will not be covered.
• charges by a registered/licensed physiotherapist, to a maximum of $600 per
person per calendar year with a $30 per visit maximum;
• charges by a chartered psychologist for counseling and treatment of a mental
or emotional illness, to a maximum of $500 per person per calendar year with a $30 per visit maximum;
• charges by a registered/licensed chiropractor, to a maximum of $500 per
person per calendar year with a $30 per visit maximum;
• charges by a registered/licensed speech language pathologist, to a maximum
of $500 per person per calendar year with a $30 per visit maximum;
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• charges by a registered/licensed massage therapist for therapeutic
massages, to a maximum of $500 per person per calendar year with a $30 per visit maximum;
• charges for a registered/licensed chiropodist/podiatrist, to a maximum of $500
per person per calendar year (surgical tray fees and facility fees are not covered) with a $30 per visit maximum;
• charges for a registered/licensed osteopath, to a maximum of $500 per
person per calendar year with a $30 per visit maximum;
• charges for a registered/licensed acupuncturist, to a maximum of $500 per
person per calendar year with a $30 per visit maximum;
• charges for a registered/licensed naturopath to a maximum of $500 per
person per calendar year with a $30 per visit maximum;
• charges for a registered/licensed dietician, to a maximum of $500 per person
per calendar year with a $30 per visit maximum;
• charges for one diagnostic x-ray examination in each calendar year for each
eligible person, per specialty, where applicable (chiropractor, osteopath, podiatrist,).
Hearing Aids: Up to $1,000 in any five consecutive calendar years for the purchase or repair of hearing aids (excluding batteries), prescribed by a physician, audiologist or otolaryngologist. The repair of hearing aids does not require a prescription. Orthopedic Footwear and Orthotics:
• the cost of custom made orthopedic footwear, including orthopedic alteration
to standard footwear (prescribed by a physician, chiropractor, physiotherapist, podiatrist or chiropodist) up to a maximum of $400 per person per calendar year;
• the cost of custom made foot orthotics or sandalthotics prescribed by a
physician, podiatrist or chiropodist, up to a maximum of $200 per person per calendar year.
Braces: The purchase or replacement of custom braces which incorporate a rigid support of metal or plastic, prescribed by a physician. The repair of a custom fitted brace does not require a prescription. Prosthetics: Where prescribed by a physician,
• charges for artificial limbs, artificial eyes, artificial nose or artificial larynx.
Myoelectric arms including repairs to a maximum of $10,000 per prostheses (charges for duplicate prostheses are not eligible);
• charges for external prostheses following a mastectomy (to a maximum of
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Medical Aids: Where prescribed by a physician, charges for the following medical aids, subject to reasonable and customary pricing and any maximums indicated:
• splints, trusses, crutches, casts, canes, walkers, cervical collars,
parapodiums, ileostomy and colostomy supplies, urinary kits and catheterization supplies;
• rental or purchase (at the discretion of the plan) of manual wheelchairs,
hospital beds, iron lungs or oxygen tents;
• purchase of an electric wheelchair to a lifetime maximum of $4,000 per
• rental or purchase (at the discretion of the plan) of medical durable equipment
• diaphragms (whether or not prescribed by a doctor); intra-uterine devices, if
• up to two mastectomy bras per person per calendar year and mastectomy bra
pads, when used in conjunction with an external mastectomy prosthesis (no prescription required);
• up to two pairs of custom fitted graduated compression hose per person per
• an aerochamber device, once every two calendar years;
• wigs required as a result of chemotherapy, to a lifetime maximum of $500 per
• laboratory procedures, diagnostic services, radiology, blood and blood
plasma, blood radium treatment, coagulotherapy, x-rays, oxygen and the administration;
• needles, syringes, lancets, lancing devices, infusion sets, urine and blood
glucose testing strips for the monitoring and treatment of diabetes (these items may be billed directly using your pay-direct drug card);
• blood testing monitors, to a lifetime maximum of $700;
• insulin pumps when recommended by a physician once every five years;
• burn pressure gradient garments to a maximum of two pairs per person per
• allergy testing materials, provided the testing is performed by a physician, to a
maximum of $40 per test and a lifetime maximum of $200 per person;
• blood pressure monitors, to a maximum of $150 per person in any three
Vision Care Expenses:
• eyeglass lenses and frames (including tinting, anti-reflective or anti-scratch
coating of prescribed lenses), contact lenses, prescription industrial safety
___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
glasses or laser eye surgery, when prescribed by a doctor, ophthalmologist or optometrist, which are purchased while eligible for benefits, to a maximum of $200 every two calendar years for participants age 19 and over, and $200 each calendar year for participants who have not attained their 19th birthday;
• visual training prescribed by a doctor, an ophthalmologist or optometrist, to a
• contact lenses prescribed by a doctor, an ophthalmologist or optometrist if
considered to be medically necessary (e.g. for severe corneal astigmatism, severe corneal scarring, keratoconus or aphakia) and required to improve vision in the better eye to at least 20/40 if this is not possible to do with conventional glasses, to a lifetime maximum of $500 per person;
• eye exams by a licensed ophthalmologist or optometrist where not covered by
a provincial medical plan, to a maximum of $75 every two calendar years or $75 every calendar year for participants who have not attained their 19th birthday (no payment will be made for eye examinations which are medically required);
• no benefits will be paid for sunglasses whether prescribed or not, any option
added to basic lenses and frames for cosmetic purposes or non-prescription industrial safety glasses.
Out of Province/Canada Medical Emergency Benefits
The Construction Industry's Benefit Plan provides for 100% of the following expenses when you or your eligible dependents are traveling outside of your province of residence or outside of Canada, to a maximum of $2,000,000 in Canadian funds. This coverage is for medical emergencies only and is limited to coverage for 60 days of travel per trip. Coverage for travel within Canada is limited to emergencies arising more than 500 kilometers from the person's home. If you will be working outside of Canada or have an eligible dependent that will be studying outside of Canada, you should consider purchasing additional non- emergency medical coverage. A medical emergency is either a sudden unexpected emergency or a sudden unexpected illness or acute episode of disease that could not have been reasonably anticipated based on the person's prior medical condition. Emergency Outside Canada Medical Treatment: The following expenses for emergency medical treatment are covered:
• hospital accommodation in a standard or semi-private ward or intensive care
unit, if the confinement begins while you or your dependent is covered;
• medical services and supplies provided during a covered hospital
• hospital out-patient services and supplies; ___________________________________________________________________________ PAGE 28
• medical supplies provided out-of-hospital if they would have been covered in
• out-of-hospital services of a professional nurse;
• ambulance services by a licensed ambulance company to the nearest centre
• paramedical services provided during a covered hospital confinement.
If your medical condition permits you to return to Canada, benefits will be limited to the amount payable under this plan for continued treatment outside Canada or the amount payable under this plan for comparable treatment in Canada, plus return transportation, whichever is less. No benefits are paid for expenses incurred more than 60 days after the date of departure from Canada. If you or your dependent is hospital confined at the end of the 60-day period, benefits will be extended to the end of the confinement. Benefit Limitations: No benefit will be paid for:
• any further medical care related to a medical emergency after the initial acute
phase of treatment. This includes non-emergency continued management of the condition originally treated as an emergency;
• any subsequent and related episodes during the same absence from Canada;
• expenses related to pregnancy and delivery including infant care after the 34th
week of pregnancy or at any time due to the pregnancy if the person's medical history indicates a higher than normal risk of an early delivery or complication.
Global Medical Assistance Program: This program provides medical assistance through a worldwide communications network which operates 24 hours a day. The network locates medical services and obtains Great-West Life's approval of covered services, when required as a result of a medical emergency arising while you or your dependent is traveling for vacation, business or education. Coverage for travel within Canada is limited to emergencies arising more than 500 kilometers from home. You must be covered by the government health plan in your home province to be eligible for global medical assistance benefits. The following services are covered, subject to Great-West Life's prior approval:
• On-site hospital payment when required for admission, to a maximum of
• If suitable local care is not available, medical evacuation to the nearest
suitable hospital while traveling in Canada. If travel is outside Canada, transportation will be provided to a hospital in Canada or to the nearest hospital outside Canada equipped to provide treatment.
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• Transportation and lodging for one family member joining a patient
hospitalized for more than seven days while traveling alone. Benefits will be paid for moderate quality lodgings up to $1,500 and for a round trip economy class ticket.
• If you or a dependent is hospitalized while traveling with a companion, extra
costs for moderate quality lodgings for the companion when the return trip is delayed due to your or your dependent's medical condition, to a maximum of $1,500.
• The cost of comparable return transportation home for you or a dependent
and one traveling companion if prearranged, prepaid return transportation is missed because you or your dependent is hospitalized. Coverage is provided only when the return fare is not refundable. A rental vehicle is not considered prearranged, prepaid return transportation.
• In case of death, preparation and transportation of the deceased home.
• Return transportation home for minor children traveling with you or a
dependent who are left unaccompanied because of your or your dependent's hospitalization or death. Return or round trip transportation for an escort for the children is also covered when considered necessary.
• Costs of returning your or your dependent's vehicle home or to the nearest
rental agency when illness or injury prevents you or your dependent from driving, to a maximum of $1,000. Benefits will not be paid for vehicle return if transportation reimbursement benefits are paid for the cost of comparable return transportation home.
Benefits payable for moderate quality accommodation include telephone expenses as well as taxicab and car rental charges. Meal expenses are not covered. GLOBAL MEDICAL ASSISTANCE PROGRAM - GROUP 56700/159990
Toll Free in Canada and USA 1-800-527-0218
Toll Free in the United Kingdom 0-800-252-074
In all other countries call collect 410-453-6330
Coordination of Benefits
If you are also eligible for benefits under another extended health care plan, any claim under this plan will be coordinated and limited to the extent that benefits payable from all plans do not exceed 100% of eligible expenses. ___________________________________________________________________________ PAGE 30
Survivor Benefit
If you die while covered for benefits, extended health care coverage will be continued for your eligible dependents without any further payment of contributions. This extension will terminate 12 months from the date of your death.
Extended Benefits
If you are disabled when coverage would otherwise terminate, payment for medical expenses relating to the disability will be continued for 12 months from the date you become disabled. To be eligible for the extension, you must either be in receipt of Workers' Compensation, Long Term Disability benefits or be approved for waiver of premium under the Employee Life Insurance benefit. Limitations
No Extended Health Care Benefits will be paid for:
• expenses that private benefit plans are not permitted to cover by law;
• service or supplies the person is entitled to without charge by law or for which
a charge is made only because the person has coverage under a private benefit plan;
• the portion of the expense for services or supplies that is payable by the
government health plan in the person's home province, whether or not the person is actually covered under the government health plan;
• service or supplies that do not represent reasonable treatment;
• services or supplies associated with treatment performed for cosmetic
purposes only, except cosmetic surgery as a result of an accidental injury;
• services or supplies associated with recreation or sports rather than with
• services or supplies associated with the diagnosis or treatment of infertility,
except as may be provided under the prescription drug provision;
• services or supplies associated with covered items, unless specifically listed
• extra medical supplies that function as spares or alternates;
• services or supplies received outside Canada except as provided under the
Out of Province/Canada Medical Emergency Benefits;
• services or supplies received out-of-province in Canada unless the person is
covered by the government health plan in his home province or the government coverage replacement plan sponsored by the employer and this plan would have paid benefits for the same services or supplies if they had been received in the person's home province;
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• expenses arising from war, insurrection or voluntary participation in a riot;
• services of physicians and surgeons (except when provided under Out of
• services provided by any other insurance or benefit plan;
• a service or supply which is experimental or investigative in nature;
• medical treatment not approved or recognized by the provincial government
• treatment or services provided by a person who is related to or resides with
• an examination by, or the services of, a physician, if required solely for third
• any services or supplies to which the individual is entitled under any Workers'
Compensation statute or any other legislation;
• charges for missed appointments or the completion of claim forms;
• routine examination or routine general checkup required for the use of a third
• charges for the administration of injectable drugs.
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The dental care benefits are self-insured under The Construction Industry's Benefit Plan. Great-West Life adjudicates dental claims for the Benefit Plan.
Benefit Coverage
This section outlines the details of your dental care benefits. To make sure your dentist or denturist is informed of the details of your dental benefits, you should take your booklet with you whenever you or your dependents require dental care or treatment. You should be aware that there are no specific guidelines for what dentists are permitted to charge for dental services. Some dentists may charge more while other dentists may charge less than what will be paid by the dental plan. Therefore, you should ask your dentist what the charge for dental services would be prior to having any dental work done. Your dental office will also be able to tell you what portion of the dental services will be paid by the dental plan. The payment of any dental expenses is subject to any benefit levels and maximum benefit amounts indicated.
Eligible Expenses
Eligible expenses are defined in the Dental Services sections that follow. All expenses must occur while you or your eligible dependents are eligible for benefits. Only those services that are provided by a health care professional licensed, certified or registered to practice a profession by the appropriate licensing, certification or registration authority will be covered.
Fee Guide
The dental plan will pay up to the lower of the amounts specified in the current Provincial General Practitioners or Denturist Society Fee Guide where the dental service is provided, or the amount charged by your dentist/denturist. If dental services are provided by a specialist, then the applicable specialist fee guide will be used.
Maximum Benefit
The dental plan has maximum amounts that will be paid for dental services. The maximum amount that will be paid for the combination of Basic Dental Services and Major Dental Services, as outlined in the following sections, is $2,500 per
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person per calendar year. The total maximum lifetime amount that will be paid for Orthodontic Dental Services for each participant under age 19 is $2,500.
Alternate Courses of Treatment
When two or more courses of dental treatment are available to correct a dental condition, the dental plan will base reimbursement on the cost of the least expensive treatment that in the opinion of the plan provides a professionally adequate result.
Pre-determination of Benefits
If you will be undergoing extensive dental treatment, it is recommended that your dentist submit the proposed course of treatment, before treatment begins. The plan will not determine the appropriateness of the treatment but will advise you, by mail, of the amount that is payable by the dental plan.
Basic Dental Services
Subject to the Fee Guide and Maximum Benefit provisions outlined earlier, the Benefit Plan will provide coverage for 80% of the following basic dental services. Routine examinations and diagnosis
• complete examinations, once every five years;
• recall examinations, once every calendar year for participants age 19 and
over, and once every six months, for participants who have not attained their 19th birthday (see question #10 under the Questions & Answers section at the end of the booklet for an explanation of the coverage during the year that a participant turns age 19);
• radiopaque dyes used to demonstrate lesions;
• interpretation of radiographs or models from another source;
• microbiological, histological, cytological and pulp vitality tests;
Dental x-rays and interpretation
• full mouth or panoramic, once every two years;
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• bitewings, once every calendar year for participants age 19 and over, and
once every six months, for participants who have not attained their 19th birthday (see question #10 under the Questions & Answers section at the end of the booklet for an explanation of the coverage during the year that a participant turns age 19);
• intra-oral, other than bite-wings, to a maximum of 15 films every 24 months;
• periapical and extra-oral films. Oral hygiene instruction
• lifetime limit of one unit per person. Polishing of teeth
• one unit every calendar year for participants age 19 and over;
• one unit every six months for participants who have not attained their 19th
birthday (see question #10 under the Questions & Answers section at the end of the booklet for an explanation of the coverage during the year that a participant turns age 19).
Topical fluoride treatment • only for participants who have not attained their 19th birthday, once every six
months (see question #10 under the Questions & Answers section at the end of the booklet for an explanation of the coverage during the year that a participant turns age 19).
Habit breaking appliances • for the control of harmful dental habits. Pit and fissure sealants • for participants who have not attained their 19th birthday, for permanent teeth Space maintainers
• for missing primary teeth, for participants who have not attained their 19th
• maintenance of space maintainers. Oral surgery: Covered oral surgery includes but is not limited to:
• surgical exposure of teeth; ___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
• the following procedures for remodeling and recontouring oral tissues;
• surgical excision of tumors, cysts, and granulomas;
• treatment of fractures, including related bone grafts to the jaw;
• treatment of maxillofacial deformities, including related bone grafts to the jaw
Palatal obturators, although not listed with oral surgery in the Canadian Dental Association Uniform System of Coding and List of Services, are also covered under this provision. Cleft palate obturators are not covered.
No benefits will be paid for implantology, surgical movement of teeth, services performed to remodel or recontour oral tissues other than those listed above (services for remodeling and recontouring oral tissues are covered under Major Dental Services), or alveoloplasty or gingivoplasty performed in conjunction with extractions. Fillings
• composite (tooth colored) or amalgam (silver) fillings for teeth one to six only;
• amalgam (silver) fillings for other teeth;
• stainless steel crowns only for participants who have not attained their 19th
• replacement fillings are covered only if the existing filling is at least two years
• retentive pins and prefabricated post for fillings;
Endodontics: Covered endodontic services include but are not limited to:
• root canal therapy for permanent teeth, limited to one course of treatment per
tooth (repeat treatment is covered only if the original therapy fails after the first 18 months);
• periapical services (apicoectomies are covered for permanent teeth only).
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No benefits will be paid for root canal therapy for primary teeth, isolation of teeth, enlargement of pulp chambers or endosseous intra coronal implants. Periodontics
• limited periodontal examinations, once every calendar year for participants
age 19 and over and once every six months for participants who have not attained their 19th birthday (see question #10 under the Questions & Answers section at the end of the booklet for an explanation of the coverage during the year that a participant turns age 19);
• non-surgical treatment of gum disorder;
• occlusal adjustments to a lifetime maximum of eight units;
• scaling and root planing, to a combined maximum of eight units in a calendar
• maintenance, adjustment and repair to appliances, twice in a calendar year;
• general anesthesia and facilities in conjunction with periodontal surgery;
Denture services
• relines and rebasings, limited to once each calendar year;
• denture repairs limited to once each calendar year;
• resilient liner in relined or rebased dentures after the three-month post-
insertion care period has elapsed, once every three years. Adjunctive services • minor remedies for relief of dental pain when provided on an emergency Accidental Dental
Coverage for 100% of the charges for the repair, extraction or replacement of natural teeth damaged by a direct accidental external blow to the mouth. The accidental injury and the expense for the repair, extraction or replacement must occur while the individual is eligible for this benefit. The expense for the repair, extraction or replacement must occur within 12 months from the date the dental accident occurred. The maximum payable is $10,000 per person per accident. ___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
Major Dental Services
Subject to the Fee Guide and Maximum Benefit provisions outlined earlier, The Construction Industry's Benefit Plan will provide coverage for 50% of the following major dental services. Examinations
• general prosthodontic exam, once in a five year period;
• specific prosthodontic exam, once in a calendar year. Crowns, onlays, inlays and veneers: Crowns, onlays, inlays and veneers are covered when a tooth has extensive structural loss that cannot be adequately restored using other procedures, when the existing restoration is at least four years old. The following crowns and related items are covered:
• Metal, plastic, porcelain, and ceramic crowns. Coverage for crowns on molars
is limited to the cost of metal crowns. Coverage for complicated crowns is limited to the cost of standard crowns.
• Onlays. Coverage for tooth-colored onlays on teeth other than teeth 1-6 is
• Inlays. Coverage for tooth-colored inlays on teeth other than teeth 1-6 is
• Posts, cores, and pins related to covered crowns.
• Repairs to covered tooth-colored materials.
• Rebonding, removal and recementation of crowns, onlays and inlays. Dentures and bridgework
• Standard complete dentures, standard cast or acrylic partial dentures or
complete overdentures or bridgework when standard complete or partial dentures are not viable treatment options.
• Coverage for tooth-colored retainers and pontics on teeth other than teeth 1
through 6 is limited to the cost of metal retainers and pontics.
• Replacement appliances are covered only when the existing appliance is a
covered temporary appliance that was placed within the last 12 months, or the existing appliance is at least four years old and cannot be made serviceable. If the existing appliance is less than four years old, a replacement will still be covered if the existing appliance becomes unserviceable as a result of the placement of an initial opposing appliance or the extraction of additional teeth. If additional teeth are extracted but the existing appliance can be made serviceable, coverage is limited to the replacement of the additional teeth.
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• Replacement dentures that are lost, stolen or broken through misuse are not
Denture Related Surgery • Denture-related surgical services for remodeling and recontouring oral Appliance Maintenance
• Denture and bridgework maintenance following the three-month post-insertion
- Denture remakes, once every 36 months.
- Denture adjustments, once every 12 months.
- Denture repairs and additions, tissue conditioning and resetting of denture
- Removal and recementation of bridgework.
Orthodontic Dental Services
Subject to the Maximum Benefit provisions outlined earlier, the Plan will provide coverage for 50% of the following orthodontic dental services. Only participants who have not attained their 19th birthday are eligible for this benefit, which includes coverage for:
• general orthodontic exam, once in a five year period;
Coverage for services that commenced before age 19 will be covered until treatment is complete.
Services rendered for comprehensive orthodontic treatment will not be covered unless a treatment plan and records are submitted for approval in writing. The treatment plan must provide the diagnosis, treatment to be rendered, appliances to be used, length of each phase of treatment, the charges, financial arrangements and commencement date of treatment.
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Dental Expenses Outside of Canada
Expenses incurred for dental services outside Canada will be eligible if:
• they represent the usual, customary and reasonable charges for the
procedures in the locality where they are performed;
• charges for such procedures would have been paid under this plan had the
procedures been performed in your province of residence.
Coordination of Benefits
If you are also eligible for benefits under another dental plan, any claim under this plan will be coordinated and limited to the extent that benefits payable from all plans do not exceed 100% of eligible expenses.
Survivor Benefit
If you die while covered for benefits, dental coverage will be continued for your eligible dependents without any further payment of contributions. This extension will terminate 12 months from the date of your death.
Extension of Benefits
Regardless of whether a treatment plan has been approved, your dental benefits will not extend beyond the date coverage terminates, unless dental treatment is rendered within 31 days of your termination of coverage for the following procedures:
• dental restoration in connection with Major Dental Services for which the tooth
was prepared prior to the termination date;
• root canal therapy where the pulp chamber was opened prior to the
• installation of a denture when an impression for dentures was taken prior to
the termination date and the denture is installed after the termination date.
Dental Examinations of Information
In order to determine benefits payable, the plan is entitled to request and will pay reasonable charges for:
• an examination by a dentist of the plan's choice;
• the submission of diagnostic/evaluative material such as x-rays;
• information required to make a payment involving Coordination of Benefits. ___________________________________________________________________________ PAGE 40
Limitations
No Dental Care Benefits will be paid for or as a result of the following:
• duplicate x-rays, custom fluoride appliances, audio-visual oral hygiene
• the following endodontic services - root canal therapy for primary teeth,
isolation of teeth, enlargement of pulp chambers and endosseous intra coronal implants;
• the following periodontal services - topical application of antimicrobial agents,
subgingival periodontal irrigation, charges for post surgical treatment and replacement of periodontal appliances that have been lost, stolen or broken;
• the following oral surgery services - implantology, surgical movement of teeth,
services performed to remodel or recontour oral tissues (other than minor alveoloplasty, gingivoplasty and stomatoplasty) and alveoloplasty or gingivoplasty performed in conjunction with extractions;
• recontouring existing crowns and staining porcelain;
• crowns, onlays or inlays if the tooth could have been restored using other
procedures. If crown, onlays, inlays or veneers are provided, benefits will be based on coverage for fillings;
• expenses covered under another group plan's extension of benefits provision;
• replacement of dentures, devices or appliances that have been lost, stolen or
• accidental dental injury expenses for treatment performed more than 12
months after the accident, denture repair or replacement, or any orthodontic services;
• expenses private plans are not permitted to cover by law;
• services or supplies the person is entitled to without charge by law or for
which a charge is made only because the person has coverage;
• services or supplies that do not represent reasonable treatment;
• treatment performed for cosmetic purposes only;
• congenital defect or developmental malformation in people 19 years of age or
• temporomandibular joint disorders, vertical dimension correction or myofacial
• expenses arising from war, insurrection, or voluntary participation in a riot.
• services provided by a government funded program;
• charges that normally would not be made if the individual were not covered by
• services provided by any other insurance or benefit plan;
___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
• a service or supply which is experimental or investigative in nature;
• treatment or services provided by a person who is related to or resides with
• any services or supplies to which the individual is entitled under any Workers'
Compensation statute or any other legislation;
• charges for missed appointments or the completion of claim forms;
• oral appliances, other than required periodontal appliances;
• recent duplication of services, whether by the same or different dentist;
• hospital charges for dental services;
• spare or duplicate dentures, devices or appliances; • in all cases in which the patient selects a more expensive plan of treatment
than is customarily provided for necessary and adequate treatment, payment and coverage will be based on the lesser fee;
• where the charge for a particular service includes a fee for the diagnostic
radiograph, no other radiographic charges will be covered for the diagnosis or treatment of that condition;
• fees for polishing and finishing restorations;
• payment in advance of services being rendered (payment for comprehensive
cases will be amortized over the length of active treatment);
• in all cases in which a fee is charged for a complicated or difficult treatment,
payment will be based on the lesser cost of an uncomplicated or standard service.
___________________________________________________________________________ PAGE 42
Eligibility
You are eligible for Long Term Disability (LTD) coverage when the following two conditions are met: • you are in benefit under the Hour Bank Benefit Program; • you are actively at work for a Construction Industry's Benefit Plan employer
who is participating in the LTD program.
You are in benefit if you have accumulated sufficient hours in your hour bank account in order to purchase the current month of coverage.
You are considered to be actively at work if you were working for your employer on your last scheduled shift prior to becoming disabled. Coverage During Apprenticeship Training
You are also eligible for LTD coverage while on an approved apprenticeship training program so long as you remain in benefit and the training begins no more than 30 days after the last day worked as an employee with a company participating in the LTD plan. Please contact the Independent Contractors and Businesses Association regarding the continuation of benefit coverage during your apprenticeship training.
The LTD benefit is $2,200 per month. The LTD benefit is reduced by any disability benefits paid under any Workers' Compensation Act or similar law or from the Canada or Quebec Pension Plan, excluding dependent benefits. The benefit is payable only so long as you remain disabled as provided under the Definition of Disability.
There is a further reduction of your LTD benefit if the total of your income listed under the section Integration With Other Income exceeds 85% of your pre-disability income before you became disabled. If it does, your benefit is reduced by the excess amount.
LTD benefits are taxable when received if your employer pays any part of the LTD premium and the benefits are non-taxable if you pay the entire premium. If, while you are receiving benefits from the Insurer, a cost of living increase is introduced in any governmental plan as a result of an increase in the Consumer ___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
Price Index, your benefits are not decreased by the extra amount you receive. However, a decrease in your LTD benefit will occur in the case of other increases such as a change in the method of establishing the benefit level of the governmental plan.
Qualifying Period
You become eligible for LTD benefits following 120 days of disability.
Payment Period
LTD payments will commence following the later of the Qualifying Period or the date you are no longer entitled to receive any wages, short-term disability benefits or severance payments. LTD payments will continue to be paid until the earlier of the date your disability ceases, or the attainment of age 65.
Definition of Disability
In order to be considered disabled, you must be unable to perform the essential duties of your own occupation during the Qualifying Period and during the first two years immediately following the Qualifying Period. Thereafter, you will be considered to be disabled if you are unable to perform the essential duties of: • any occupation for which you are qualified or may reasonably become qualified,
• any occupation for which you are receiving an income that is equal to or greater
than the amount of monthly disability benefit payable under this provision, adjusted annually by the Consumer Price Index.
The availability of work will not be considered by the Insurer in assessing your disability.
If you are required to hold a government permit or license to perform your duties, you will not be considered disabled solely because such permit or license has been withdrawn or not renewed.
Periods for Which Benefits Are Not Payable
You are not eligible to receive LTD benefits during any period that you are:
• not receiving regular, ongoing care and treatment from a physician
appropriate to the disabling condition, as determined by the Insurer;
• receiving Employment Insurance Maternity or Parental benefits;
• on a lay off during which you become disabled; ___________________________________________________________________________ PAGE 44
• on a leave of absence during which you become totally disabled, unless your
employer is required to pay benefits during this period as required by legislation, regulation or case law;
• receiving benefits under an employer-sponsored salary continuance or short
• working in any occupation, except as provided for under the Rehabilitation
• incarcerated in a prison, correctional facility, or mental institution by order of
Integration With Other Income
The LTD benefit is designed to supplement other benefits that may be available to you during disability. The LTD benefit is reduced if your total income from the following sources, when added to the LTD benefit, exceeds an all source maximum limit of 85% of gross pre-disability income (if LTD benefit is taxable) or 85% of net pre-disability income (if LTD benefit is non-taxable):
• earnings or payments from any employer, including severance payments and
• any government plan, excluding Employment Insurance Benefits;
• Canada or Quebec Pension Plans, including dependent benefits;
• any government motor vehicle automobile insurance plan or policy, unless
• benefits payable under any Workers' Compensation Act or similar law.
Recurrent Disability
If you stop being disabled while satisfying a Qualifying Period, and within 30 days become disabled again from the same or related causes, the Qualifying Period will be extended by the number of days during which the disability ceased.
If you stop being disabled following a disability for which benefits were paid, and within six months become disabled again from the same or related causes, that second disability is considered to be a continuation of the previous disability. If the same disability recurs more than six months after the end of the period for which benefits were paid, such disability will be considered a separate disability.
Two disabilities that are due to unrelated causes are considered separate disabilities if they are separated by a return to work of at least one day.
___________________________________________________________________________ THE CONSTRUCTION INDUSTRY'S BENEFIT PLAN
Rehabilitation
LTD benefits will continue to be paid during a period of approved rehabilitation employment. However, your LTD benefits will be reduced by 50% of earnings from approved rehabilitative employment. In addition, your LTD benefit may be further reduced so that your total income from all sources does not exceed 100% of pre-disability gross income (if the LTD benefit is taxable) or 100% of pre-disability net income (if the LTD benefit is non-taxable).
Survivor Benefits
A survivor benefit, equal to three times the last monthly disability benefit payment received by you, will be paid to your surviving spouse. If you do not have a surviving spouse, the survivor benefit will be paid to your surviving dependent children. If there are no surviving dependents, the benefit will be paid to your estate.
Waiver of Long Term Disability Premiums
LTD premiums will be waived during any period that you are in receipt of LTD benefits.
Limitations
No LTD benefit is payable for any disability directly or indirectly related to:
• a work-related injury when you have not applied for benefits payable under
any Workers' Compensation Act or similar law;
NR. 1 – APRIL 2005 Vorgeblich wird die Debatte unter der Überschrift geführt, Frauen mit sexuellen Problemen besser Studie: Sexuelle „Probleme“ und Beziehungszufriedenheit – As-helfen zu können. Anstatt aber auf das bisher ange-pekte der Medikalisierung sexueller (Un-) Zufriedenheit von Frauen sammelte Wissen über weibliche Sexualität zurück-zugreifen oder wenigstens Unters
O r i g i n a l i a Anthroposophische Therapie bei chronischer Depression:eine vierjährige prospektive KohortenstudieH a r a l d J . H a m r e 1 , C l a u d i a M . W i t t 2 , A n j a G l o c k m a n n 1 , R e n a t u s Z i e g l e r 3 ,S t e f a n N . W i l l i c h 2 , H e l m u t K i e n e 1Dies ist die deutsche Übersetzung der Publikation Hamre HJ, Witt CM, Glockmann A, Ziegler R, Will
Benefit Claim Submissions 
You are eligible for $50,000 of Employee Life Insurance. The life insurance benefit insures you for death from any cause.
Beneficiary 
Your spouse (if any) is covered for $10,000 of Dependent Life Insurance. Each of your eligible children (if any) is covered for $5,000 of Dependent Life Insurance. Your eligible spouse and children are covered for this benefit during the same period that you are covered for Employee Life Insurance. Note that your dependents will be covered under the Dependent Life Insurance benefit only if they are listed as dependents on your enrolment card.
In the event your spouse or an eligible child dies from any cause, the benefit will be paid to you. If you should die prior to the benefit being paid, the benefit will be paid to your estate.
Waiver of Premium 
The extended health care benefits are self-insured under The Construction Industry's Benefit Plan. Great-West Life adjudicates extended health claims for The Construction Industry's Benefit Plan.
Benefit Coverage 
The dental care benefits are self-insured under The Construction Industry's Benefit Plan. Great-West Life adjudicates dental claims for the Benefit Plan.
Benefit Coverage 
Eligibility