UNIVERSITY OF NORTHERN
BRITISH COLUMBIA
Terms greater than 6 months but less than 12 months
Great-West Life is a leading Canadian life and health insurer. GreatWest Life's financial security advisors work with our clients from coast to
coast to help them secure their financial future. We provide a wide range
of retirement savings and income plans; as well as life, disability and
critical illness insurance for individuals and families. As a leading
provider of employee benefits in Canada, we offer effective benefit
solutions for large and small employee groups.
Great-West Life Online
Information and details on Great-West Life's corporate profile, our
products and services, investor information, news releases and contact
information can all be found at our website
http://www.greatwestlife.com.
This booklet describes the principal features of the group benefit plan
sponsored by your employer, but Group Policy No. 335856 issued by
Great-West Life is the governing document. If there are variations
between the information in the booklet and the provisions of the policy,
the policy will prevail.
This booklet contains important information and should be kept in a safe
place known to you and your family.
The Plan is underwritten by
and arranged and administered by
D.A. Townley & Associates Ltd.
#101-4190 Lougheed Highway
Burnaby, B.C.
V5C 6A8
Phone: (604)299-7482
Fax: (604) 299-8136
Toll Free: 1-800-663-1356
Protecting Your Personal Information
At Great-West Life, we recognize and respect the importance of privacy.
When you apply for coverage or benefits, we establish a confidential file
of personal information. We limit access to personal information in your
file to Great-West Life staff or persons authorized by Great-West Life
who require it to perform their duties, to persons to whom you have
granted access, and to persons authorized by law.
We use the personal information to administer the group benefit plan
under which you are covered. This includes many tasks, such as:
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determining your eligibility for coverage under the plan
enrolling you for coverage
assessing your claims and providing you with payment
managing your claims
verifying and auditing eligibility and claims
underwriting activities, such as determining the cost of the plan, and
analyzing the design options of the plan
preparing regulatory reports, such as tax slips
We may exchange personal information with your health care providers,
your plan administrator, other insurance or reinsurance companies,
administrators of government benefits or other benefit programs, other
organizations, or service providers working with us when necessary to
administer the plan.
All claims under this plan are submitted through you as plan member.
We may exchange personal information about claims with you and a
person acting on your behalf when necessary to confirm eligibility and to
mutually manage the claims.
For more information about our privacy guidelines, please ask for GreatWest Life’s Privacy Guidelines brochure.
YOUR GROUP INSURANCE PLAN
Current Plan effective date: June 1, 2007
We are pleased to present you with this booklet, which briefly outlines
your group insurance benefits. Please read it carefully and keep it in a
safe place for reference.
All claims for Extended Health Care are adjudicated by D.A. Townley &
Associates Ltd.
TABLE OF CONTENTS
STARTS ON PAGE
ELIGIBILITY PROVISIONS
1
EXTENDED HEALTH CARE
3
GENERAL HEALTH INSURANCE PROVISIONS
19
Your plan administrator will be happy to answer any questions
regarding the details of your group insurance.
ELIGIBILITY PROVISIONS
Employee Insurance
To be eligible for coverage, you must be employed on an active basis,
receive regular earnings, and work at your employer's usual place of
business.
You are eligible if you are working for your Employer for at least 18
hours per week.
You are eligible to enrol for coverage on the date you begin your
employment.
Your coverage will take effect as of the date you become eligible to join
the Plan, provided you apply within 31 days following such date. If you
do not apply within 31 days, or if you had been previously declined for
coverage for reasons other than spousal coverage elsewhere,
satisfactory evidence of insurability will be required.
If you are absent from work (other than for vacation or a legal holiday)
on the day your coverage or any increase in your coverage would
normally take effect, such coverage will not take effect until you return to
work.
Termination of Employee Insurance
Your coverage will terminate on the earliest of:
1. the date you cease to be employed or the date you cease to be a
member of a class eligible for insurance;
2. the end of the period for which premiums have been paid for your
insurance;
3. the date the group policy cancels or the date the class in which you
qualify for coverage as an employee of an employer eligible for
insurance under the Plan cancels;
4. the date you attain age 70 unless otherwise stated.
1
ELIGIBILITY PROVISIONS
Dependent Insurance
You are eligible for dependent insurance on the date you become
eligible to enrol in the Plan if you have eligible dependents on that date.
Otherwise, you become eligible for dependent insurance on the date you
acquire any eligible dependents.
You must apply for dependent insurance within 31 days of the date on
which you are first eligible for it, or satisfactory health evidence will be
required for each dependent.
A hospitalized dependent will not become insured under this Plan, or
eligible for an increase in insurance until released from the hospital
except health coverage for newborn children is effective from birth.
Eligible Dependents include:
1.
your legal or common-law spouse (a person with whom you have
been living for at least one year, and who is publicly represented as
your spouse); and
2.
your unmarried children who are financially dependent on you, who
are under age 19, or age 25 if full-time students at an accredited
college or university. Group health benefits may be continued for a
developmentally or physically disabled dependent child provided
that you submit satisfactory proof of the child's disability within 31
days of the limiting ages, and as required thereafter.
Termination of Dependent Insurance
Coverage for your eligible dependents will terminate on the earliest of:
1.
2.
3.
4.
the date your coverage terminates or the date you cease to qualify
for Dependent Coverage,
the date your eligible dependents cease to qualify for coverage,
the end of the period for which premiums have been paid for your
Dependent Coverage, or
the date Dependent Coverage under the group policy cancels.
2
EXTENDED HEALTH CARE
BENEFIT SCHEDULE
Lifetime Maximum Amount
except:
- Out-of-Canada Referral Benefit
Unlimited
Deductible Amounts Per Calendar Year
Nil
Reimbursement Amount
(Payable by Great-West Life)
- In Canada
- Out-of-Canada
· Emergency
· Referral
$50,000.00
80%
100%
100%
Great-West Life will pay benefits for the Eligible Charges described
below incurred as a result of sickness or accidental bodily injury by you
or your dependents while insured for this benefit. The benefit amounts
we will pay are limited as described under Eligible Charges and are
subject to the Maximum Amount, Deductible Amount, and
Reimbursement Amount shown in the BENEFIT SCHEDULE and all
other provisions of the group policy.
The Deductible Amount shown in the BENEFIT SCHEDULE is the
amount of Eligible Charges you must pay before any benefit is payable
by Great-West Life. Any amounts you pay towards a deductible during
the last 3 months of a calendar year will also be credited as part of the
deductible for the next calendar year.
If two or more members of your family are injured in the same accident,
for all charges resulting from the accident only one Individual Deductible
Amount will apply during the calendar year in which the accident occurs
and during the next year.
The Reimbursement Amount shown in the BENEFIT SCHEDULE is the
percentage of Eligible Charges in excess of the Deductible Amount, if
any, that Great-West Life will pay.
3
EXTENDED HEALTH CARE
Eligible Charges Incurred in Canada
Great-West Life will pay benefits for the following charges incurred in
Canada for necessary medical care, services, or supplies administered
by or ordered by a physician, which are not provided under the
Provincial Medical Plan in your province, and which the Provincial
Medical acts allow us to insure.
1. Prescription Drugs
Fertility drugs and smoking cessations, which can only be obtained
through the prescription of a Physician and which are dispensed by
a Licensed pharmacist are eligible.
The maximum benefit amount payable for any one incurred charge
for a drug or medicine is limited to the charge for a 90-day supply.
Smoking cessation drugs are limited to a lifetime maximum of 3
months supply. Drugs to treat infertility are limited to a lifetime
maximum of 6 months supply.
No amount will be payable for any drug or medicine which is
experimental or which has not been approved for use by the Ministry
of Health and Welfare - Canada (Food and Drugs) for the sickness
or injury for which it was prescribed.
2. Hospital Charges
a. Hospital out-patient charges which are not eligible under your
Provincial Medical Plan; and
b. Hospital daily room and board charges, excluding charges for
chronic care, limited to the difference between the Provincial
Medical Allowance and the hospital's semi-private room charge.
4
EXTENDED HEALTH CARE
Eligible Charges Incurred in Canada (Continued)
3. Convalescent Home or Physical Rehabilitation Facility
Room and board charges made by a convalescent home or physical
rehabilitation facility, excluding charges for chronic care, provided
that residence in the institution:
a. is certified as medically necessary by a physician,
b. occurs within 48 hours after a hospital stay of at least 5
consecutive days, and
c. is due to the same sickness or accidental bodily injury which
was the reason for the hospital stay.
Charges are limited to the difference between the Provincial Medical
Allowance and the institution's semi-private room charge, for up to a
maximum benefit payment period of 180 days.
A new maximum benefit period of 180 days will apply if you (or your
dependent) again must stay in a convalescent home or physical
rehabilitation facility, provided that the same conditions described
above are met, and:
a. the sickness or injury is unrelated to the sickness or injury which
was the reason for the prior stay, or
b. at least 14 consecutive days have passed since the prior stay
during which you (or your dependent) were (was) not a patient in
a hospital, convalescent home, or physical rehabilitation facility.
4. Substance Abuse Rehabilitation
Room and board charges made by a substance abuse rehabilitation
facility in connection with a substance abuse rehabilitation
programme, provided that your Provincial Medical Plan pays a
portion of the charges and Great-West Life has provided its prior
written approval.
Charges are limited to:
a. the difference between the Provincial Medical Allowance and the
institution's semi-private room charge, and
b. a cumulative lifetime maximum payment period of 60 days for
each insured individual.
5
EXTENDED HEALTH CARE
Eligible Charges Incurred in Canada (Continued)
5. Ambulance Service
Charges made by a local licensed ambulance service, or scheduled
airline, railroad, ship, or boat, or air ambulance service, (including
the services of a medical attendant if certified as necessary by the
attending physician), for transporting the insured individual for
medically necessary emergency care to the nearest hospital
qualified to render such care.
6. Nursing Care
Charges made by a registered nurse (R.N.) or a registered nursing
assistant (R.N.A.) for nursing care, excluding charges for nursing
care rendered:
a. in a hospital;
b. by a person who is related to, or lives in the home of the insured
individual; or
c. which does not require the specific skills of a registered nurse or
a registered nursing assistant.
Nursing care charges are limited to a maximum of $10,000.00 per
calendar year for each insured individual.
7. Accidental Dental
Charges made by a dentist for the repair or replacement of sound,
vital, natural teeth or the setting of a fractured or dislocated jaw,
provided that:
a. such services are required as a result of a direct accidental blow
to the mouth and not as a result of an object placed in the
mouth;
b. the accident occurred while the individual is insured under this
benefit; and
c. the charges are incurred within 90 days of the date of the
accident, unless Great-West Life approves a detailed treatment
plan received from the dentist within such 90-day period.
6
EXTENDED HEALTH CARE
Eligible Charges Incurred in Canada (Continued)
8. Medical Supplies
Charges for medically necessary supplies, including but not limited
to the following:
a. artificial limbs and eyes, casts, splints, trusses, braces, crutches,
and surgical supplies;
b. oxygen and the rental of the equipment for its use;
c. foot orthotics, including foot braces, limited in each calendar
year to one pair, up to a maximum benefit of $300.00;
d. wigs, when hair loss is due to chemotherapy treatment, up to a
lifetime maximum benefit of $500.00;
e. the cost of an intrauterine device (IUD);
f. contact lenses, when required as a result of keratoconus or
cataract surgery;
g. blood, blood plasma, when not replaced.
9. Medical Equipment
The cost of rental or purchase (at Great-West Life's option) of a
hospital bed, wheel chair, or other durable medical equipment when
certified as medically necessary by a physician, and the cost of
necessary repairs to purchased equipment, excluding routine
maintenance and batteries.
Equipment may be replaced only once in any 5-year period except
when required due to a worsening of the medical condition or due to
a child's growth. Charges for replacement are eligible only if GreatWest Life agrees that the equipment item cannot be repaired or that
repair is not appropriate.
All amounts payable for rental, purchase, and repair of equipment
are limited to the respective cost for the standard or manual
equipment item unless the special or powered equipment is
approved by Great-West Life.
7
EXTENDED HEALTH CARE
Eligible Charges Incurred in Canada (Continued)
10. Paramedical Services
Charges for paramedical services made by a licensed, certified, or
registered practitioner listed below, up to the maximum amount
shown. User Fees are covered where applicable. However, no
amount is payable for any visit for which any Provincial Medical
Allowance is payable.
Calendar Year
Maximum Amount
$500.00
$500.00
$500.00 (combined maximum)
$500.00 (combined maximum)
$500.00
$500.00
$500.00
$500.00
$500.00
$500.00
Practitioner
Osteopath
Chiropractor
Podiatrist or Chiropodist
Naturopath or Homeopath
Audiologist
Physiotherapist
Psychologist
* Speech Therapist
* Acupuncturist
* Masseur
* Great-West Life may require written certification from a physician
that such services are medically necessary.
Chiropractor, Podiatrist or Chiropodist, Naturopath or Homeopath,
Physiotherapist, and Masseur are limited to a Maximum Amount
payable of $10.00 for the first 12 visits in a Calendar Year.
11. Orthopaedic Shoes
The cost of orthopaedic shoes which are custom-built for an insured
individual, limited to $250.00 per calendar year.
12. Hearing Aids
The cost of purchasing and fitting a hearing aid, limited to $400.00 in
any 5-year period for each insured individual, including the cost of
necessary repairs, but excluding routine maintenance and batteries.
8
EXTENDED HEALTH CARE
Eligible Charges Incurred in Canada (Continued)
13. Eye Examinations
Charges for services performed by a licensed optometrist or
ophthalmologist, limited to one examination and a Maximum Amount
of $65 in each 2-year period.
Eligible Charges Outside Canada
Referral - Charges for services and supplies that are not available in
Canada if:
1. you are referred by two physicians in Canada who are specialists in
the treatment of the sickness or injury involved;
2. you receive written approval of the referral from Great-West Life
before the treatment starts;
3. your provincial medical plan pays a portion of the charges; and
4. the charges are made by a physician, anaesthetist, radiologist,
laboratory or hospital.
The amount payable is reduced by the amount allowed under your
provincial medical plan.
Emergency - Charges for services and supplies required as a result of a
medical emergency that occurs during the first 60 days of travel outside
Canada if:
1. you are or your Dependent is covered under a provincial medical
plan; and
2. treatment could have not been delayed until return to Canada.
9
EXTENDED HEALTH CARE
MedAssist - While you are travelling outside your province of residence
carry the MedAssist card and Travel Passport that have been given to
you. They provide assistance with:
- locating medical or hospital care and evacuation, if necessary;
- communicating with local doctors and hospital staff;
- finding legal or financial assistance;
- sending an urgent message home;
- transferring emergency funds; and
- verifying your insurance coverage.
This assistance will be limited to that required during the first 60 days of
travel outside Canada.
MedAssist coverage also includes charges for the following services if
they are required as a result of a medical emergency that occurs outside
your home province. The maximum amounts stated below are the
maximum amounts payable for each Insured during any one trip and will
be limited to those charges made during the first 60 days of travel outside
Canada.
- accommodation and missed flights to a maximum of $1,000;
- visits by an Insured - airfare to a maximum of $1,000 and
accommodation for 5 days to a maximum of $150 per day;
- child care to a maximum of $1,500;
- return of vehicle to a maximum of $1,000;
- local burial or repatriation to a maximum of $2,000; and
- medical evacuation, once per emergency, based on the most
economical and appropriate transportation.
10
EXTENDED HEALTH CARE
Limitations and Exclusions applicable to Emergency and
MedAssist coverage
The Maximum Amount is $1,000,000 for each Insured Person for all the
Eligible Charges related to any one emergency under the Emergency
and MedAssist provisions. This limitation is not applicable to in-Canada
emergency health care coverage. When emergency treatment for a
condition is completed, any ongoing treatment related to that condition is
not covered.
In the event of a medical emergency, the insured person or someone on
the insured person’s behalf must contact the Assistance Centre
immediately, prior to seeking medical treatment. If it is not reasonably
possible to do so, the Assistance Centre must be contacted as soon as
medically possible. Failure to contact the Assistance Centre will result in
a reduction of benefits and the amount payable for all costs for such
emergency will be limited to the Maximum Amount stated above or
$25,000, whichever is less. Benefits will also be reduced and limited in
this manner if the physician or Travel Assistance provider recommends
the insured person be moved to a different facility and the insured
person chooses not to go.
If the physician or Travel Assistance provider recommends that the
insured person be returned to the person’s home province and the
insured person chooses not to go, the Emergency and MedAssist
coverage will end.
We will not pay for any Emergency or MedAssist charges resulting
directly or indirectly from:
(a) an accident occurring while the insured person was operating a
vehicle, vessel or aircraft, if the insured person:
i) was impaired by drugs or alcohol, or
ii) had a blood alcohol level higher than 80 milligrams of alcohol
per 100 millilitres of blood.
(b) the insured person’s abuse of illegal substances.
(c) pregnancy or the birth of a child outside of Canada:
i) within nine weeks of the expected delivery date, or
ii) after the expected delivery date.
11
EXTENDED HEALTH CARE
Extension of Extended Health Care Benefit
If you are totally disabled (as defined in the Group Policy) due to
sickness or injury on the date your insurance under this benefit would
otherwise terminate, you will be eligible for this extension of coverage
unless the policy or this benefit under the policy is cancelled.
While you remain totally disabled due to the same sickness or injury,
Great-West Life will pay the Eligible Charges under this benefit
resulting from such sickness or injury which are incurred within the
12-month period immediately following the date your insurance would
have terminated.
The same extension of coverage will apply to an insured dependent who
is totally disabled due to sickness or injury on the date his or her
insurance under this benefit would otherwise terminate.
12
EXTENDED HEALTH CARE
Limitations
No amounts will be paid by Great-West Life under this benefit for
charges:
1. in excess of the specific limitations and maximum amounts
described under Eligible Charges;
2. excluded under GENERAL HEALTH INSURANCE PROVISIONS -General Health Limitations;
3. for which the Insured Individual obtains or is entitled to obtain
benefits under any Government Plan;
4. for the cost or fitting of contraceptive devices, except for the cost of
an intrauterine device (IUD);
5. for eye refractions, or for the cost or fitting of eyeglasses;
6. for infertility treatment, such as "in vitro" or "in vivo" procedures;
7. made by a physician in Canada;
8. for medical care or services which are cosmetic, except
reconstructive surgery to restore tissue damaged by sickness or
bodily injury;
9. for dental care or services, other than hospital charges, except as
described under Eligible Charges;
10. incurred for personal comfort items;
11. incurred for a change in gender;
12. for treatment which is experimental;
13. for myoelectric or electric prostheses; or
14. for services or supplies in connection with participation in any sport
or recreational activity if not required for other daily living activities.
For an individual not insured under any Provincial Medical Plan, GreatWest Life will not pay more than the difference between the Eligible
Charges described and the maximum Provincial Medical Allowance for
those charges.
13
EXTENDED HEALTH CARE
Definitions
Government Plan means any plan of insurance provided by or under
the administrative control of any government or agency thereof in
accordance with any law (other than the Unemployment Insurance Act of
Canada) or any plan providing insurance coverage pursuant to the
regulatory power of any government.
Provincial Medical Plan means the hospital and medical insurance
plan created by provincial legislation which is available to the residents
of such province.
Provincial Medical Allowance means the amount allowed or provided
for payment of a hospital charge or a charge for medical care, service, or
supply under:
a. the Provincial Medical Plan under which the insured individual is
insured, or
b. if not insured under any Provincial Medical Plan, then the Provincial
Medical Plan of the province of which the insured individual is a
resident at the time the charge is incurred.
A charge for care, service, or supply is deemed to have been incurred
on the date an insured individual receives such care, service, or supply.
14
PAY-DIRECT DRUG BENEFIT
BENEFIT SCHEDULE
Lifetime Maximum Amount
Unlimited
Deductible Amount
- Individual Deductible Amount
- Family Deductible Amount
$25.00
$50.00
Dispensing Fee Limit
Not Applicable
Reimbursement Amount
(the amount paid by
Great-West Life)
80%
Plan Type
Prescription Brand Name Drugs
Great-West Life will pay benefits for the Eligible Charges described
below incurred as a result of sickness or accidental bodily injury by you
or your dependents while insured for this benefit. The benefits we will
pay are subject to the Lifetime Maximum Amount, Deductible Amount,
and Reimbursement Amounts shown in the BENEFIT SCHEDULE, and
all other provisions of the group policy.
The Deductible Amount shown in the BENEFIT SCHEDULE represents
the portion of each Eligible Charge you must pay before any amount is
payable by Great-West Life.
The Reimbursement Amount shown in the BENEFIT SCHEDULE is the
percentage amount of Eligible Charges in excess of the Deductible
Amount, if any, that Great-West Life will pay.
The Dispensing Fee Limit shown in the BENEFIT SCHEDULE is the
maximum amount payable on your behalf by Great-West Life for each
Prescription of Refill Dispensing Fee charged. No amount will be
payable under this benefit for the portion of the Dispensing Fee which is
in excess of the Dispensing Fee Limit.
15
PAY-DIRECT DRUG BENEFIT
Identification Card
An identification card will be issued to you, indicating you are insured for
this benefit and whether your dependents are also insured.
The identification card is issued for the sole use of employees and
dependents while insured for this benefit. The identification card
remains the property of Great-West Life at all times. Great-West Life
reserves the right to terminate at any time the insurance of any
employee whose identification card has been misused or with respect to
which any false, fraudulent, or fictitious claim has been filed.
Upon termination of your insurance under this benefit, you must return
the identification card to your employer.
Eligible Charges
Eligible Charges are those charges made to an insured individual for
drugs or medicines described below which are dispensed by a licensed
pharmacist.
1. Drugs and medicines which legally require a prescription by a
physician or a licensed dentist.
2. Extemporaneous compounds prescribed by a physician or a
licensed dentist and prepared by a pharmacist.
3. Injectible insulin, serums, vaccines, and vitamins,
- including needles, syringes, and diagnostic test supplies, but
- excluding swabs and rubbing alcohol.
Amounts payable are limited to:
-
the cost to the licensed dispensing pharmacist for any ingredient,
applicable taxes,
a professional or dispensing fee, up to the Dispensing Fee Limit
shown in the BENEFIT SCHEDULE for each prescription or refill.
16
PAY DIRECT DRUG BENEFIT
Claims
To obtain a prescription or a refill from a Member Pharmacy:
a. present your identification card,
b. sign the required claim voucher, and
c. pay to the pharmacy:
- any charges in excess of Eligible Charges;
- any Deductible Amount as shown in the BENEFIT
SCHEDULE; and
- any amount in excess of the Reimbursement Amount as shown
in the BENEFIT SCHEDULE.
To obtain a prescription or a refill from a Non-Member Pharmacy, you
must pay the full amount of the charge for the prescription or refill to the
pharmacy. You may then submit the claim to the Administrator on a
claim form provided by Great-West Life. You will be reimbursed the
portion of the charge in excess of the Deductible Amount or
Reimbursement Amount, but limited to the amount which would be
reimbursed under this Benefit if the drug or medicine were dispensed by
a Member Pharmacy.
A Member Pharmacy is a licensed pharmacy which has agreed to
accept presentation of your identification card in lieu of payment by you
of that part of the prescription charge that is in excess of the Deductible
Amount and/or Reimbursement Amount. Each Member Pharmacy
displays the Administrator's Emblem so you can determine whether or
not a pharmacy is a Member Pharmacy.
17
PAY-DIRECT DRUG BENEFIT
Limitations
No amount will be payable under this benefit for charges:
1. which are excluded under GENERAL HEALTH INSURANCE
PROVISIONS - General Health Limitations;
2. for health or beauty aids, cosmetics, dietary supplements, or
vitamins other than injectible vitamins;
3. for blood or blood plasma;
4. for fertility (or infertility) medication, steroids, or smoking cessation
drugs;
5. for contraceptives, other than orally administered contraceptives;
6. for any prescription or refill in a quantity which exceeds the quantity
normally prescribed for a three month period;
7. for the administration of drugs or medicines; or
8. for any drug or medicine which:
a. does not require the prescription of a physician or a licensed
dentist, (other than injectible medicines included under Eligible
Charges),
b. is a proprietary or patent medicine, defined as a product
registered under Division 10 of the Canadian Food and Drug
Act, which has a General Public (G.P.) number but does not
have a Drug Identification Number (D.I.N.) on its label,
c. is delivered or administered to an individual, in whole or in part,
in the office of the physician or dentist, or while he or she is a
patient in a hospital, extended care facility, rest home or
sanitarium, convalescent home, nursing home, or similar
institution, or
d. the individual is eligible to receive under a Provincial Drug
Benefit Plan.
18
GENERAL HEALTH INSURANCE PROVISIONS
General Health Limitations
No amounts will be paid by Great-West Life under the group policy for
charges:
1. in connection with general health examinations;
2. for which the insured individual is entitled to obtain benefits under
any government plan;
3. for which the individual is entitled to obtain benefits without charge;
4. which result from any self-inflicted sickness or injury;
5. which result from insurrection or war, whether or not war be
declared, any act incident to insurrection or war, or participation in
any riot;
6. which are not medically necessary;
7. which result from any sickness or bodily injury arising out of or in the
course of any employment, other than with UNBC, unless otherwise
stated in the group policy;
8. for time spent travelling, broken appointments, transportation costs
or advice given by telephone or by any other means of
communication; or
9. that are in excess of reasonable and customary charges for the least
expensive treatment that is medically appropriate.
Right to Recover
If Great-West Life makes any payment of benefits to you which you have
the right to recover from any other person, Great-West Life reserves the
right to recover the amount of such payments. You will be expected to
do everything necessary within your power to secure such rights of
recovery.
Co-ordination of Benefits
Benefit payments will be co-ordinated with any other plan or
arrangement so that the total amount received from all sources will not
be greater than the actual expense incurred.
19
GENERAL HEALTH INSURANCE PROVISIONS
Continuation of Health Insurance for Dependent Survivors
If you die, health insurance for your insured dependents will continue
without premiums being required for up to 24 months. However,
coverage under any benefit will end if the benefit or the group policy
terminates.
Insurance continued under this provision will not be increased for any
reason.
If a dependent's insurance would terminate during the 24-month period,
he or she may qualify for an extension of coverage, as described
elsewhere, but not beyond the end of the 24-month period following the
date of your death.
20
GENERAL HEALTH INSURANCE PROVISIONS
Claim Procedures
How to Make a Claim
-
Out-of-country claims (other than those for MedAssist expenses)
must be submitted to your provincial Medicare Plan before you
submit your claims to D.A. Townley & Associates Ltd. at the address
shown below.
-
Obtain a claim form from your employer. Complete this form making
sure it shows all required information.
-
Attach your receipts to the claim form and return it to D.A. Townley
& Associates Ltd. as soon as possible, but no later than 90 days
after you incur the expense:
D.A. Townley & Associates Ltd.
#101-4190 Lougheed Highway
Burnaby, B.C.
V5C 6A8
Phone: (604) 299-7482
Fax: (604) 299-8136
Toll Free: 1-800-663-1356
Upon written direction and at Great-West Life's option, you may
assign all or a portion of the benefits provided by the Plan to be paid
directly to a hospital or person rendering medical services.
NOTE: On all claims or correspondence, please clearly write your
home address and include your certificate number and group
policy number 335856.
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IMPORTANT NOTICE
This booklet is for descriptive purposes only. No rights to any
benefits are created or conferred by this booklet.
The description of or reference to any benefit in this booklet does
not necessarily mean that you are insured for this coverage.
The coverage described in this booklet is subject to the eligibility
requirements and all other terms, conditions, and limitations of the
master policy.
No benefit described in this booklet is effective unless premiums
have been paid for such benefit.
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Print Date: September 2007