For Pensioners: Out-of-Province Emergency Treatment is covered (inside Canada only), but there is no out-of-country emergency medical coverage.
For Active employees: Emergency Medical Out-of-Province/Out-of-Country, Travel Assistance Coverage is available for the first six weeks after leaving the province of residence.
Further details can be found in the summary booklet within the document library.
Generally, if you were hired January 1, you will receive the Welcome Package by mid February. Your coverage, and your dependant’s coverage, will start January 1. The Welcome Package will contain the necessary forms to add dependants and elect Optional coverage(s). Coverage in any Optional plan is always future-dated. Therefore, it would become effective on the first of the month following the receipt of the forms.
If you are an active employee you cannot opt out of the core benefits, however, you may waive participation in the Health and Dental part of benefits if you have another privately sponsored plan. Please note, it does not save any premiums because core benefits are assessed as one benefit, fully paid by the employer.
When you apply for your pension you must decide whether to participate in the pensioner health and dental plan. You may choose one of three actions:
Upon retirement you have the option of not joining the retiree health plan. Once you have joined, you cannot opt out at a later date. Qualifying “Life events” provide an opportunity to change status (family/single).
For dependent children, the first payer is the insurance company of the parent whose birthday comes first in the year.
It is advisable for members to always declare their spouse as a dependant to be eligible for Core dependant’s life insurance: a benefit payable to you in the event of your dependant’s death.
At the time of the member’s death, a surviving spouse (the spouse on record at the time the pension began) who is eligible for the United Church of Canada pension may elect to continue with the Pensioners Health and Dental plan, decline the coverage or waive it, if they are currently covered by another plan. If the member only had single coverage (rather than family coverage that included the spouse) the survivor does not have an option to join the plan at the time of member’s death.
The plan currently covers dependants to the age of 25 if they are full time students (in Quebec 26 for drug coverage only). When the dependant turns 18, the plan requires written confirmation that the dependant is a full-time student and asks for the name of the school. Grandchildren, and other children who normally live with members and are fully dependent on them for support, are considered eligible dependants.
Requests for additional coverage, for example eyeglasses, are reviewed annually. The process involves comparison with market experience with the benefit and anticipated cost of claims against the new benefit. Any new benefit cost has to be offset by an increase in premium or an equal value reduction in another benefit.
Benefits that are covered by the plan but not claimed against the plan do not add cost to the plan. The only costs to the plan are the actual reimbursements to members and administration. For example, 80% of fertility drug costs, to a lifetime limit of $3,500, are covered by the pensioner’s plan. This is a holdover from when we purchased an insurance product. Because there have been no claims on record against this benefit, it has not cost the plan anything.
If you leave work due to an illness or injury and are absent for more than two weeks you may qualify to apply for the Restorative Care Plan (RCP). The goal of the RCP is to support members while they recover and prepare to return to work safely. RCP lasts six months and you continue to be covered under the benefits plan. Your Employer will continue to pay you your salary and premiums will continue to be deducted as they were prior to RCP. No action is required from you in this scenario. If you are away from work for longer than six months, you may be eligible for a transition to the long-term disability (LTD) plan. You continue to be covered by the benefits plan if you go onto LTD, but you are not required to pay the premiums for the benefits coverage until you are no longer disabled or reach age 65, at which point the disability program ceases. To learn more about the disability programs, please click here.
Should you go on an unpaid protected leave in accordance with the legislation in your province of employment, such as maternity, parental or compassionate leave, the pension and health benefits can continue, provided you pay any contributions you would normally pay. The employer is obligated to pay at least the same share of contributions as if you were not on leave, however, this does not apply if you choose not to continue paying your share of premiums/contributions. To arrange for benefits coverage to continue please contact the Benefits Centre at firstname.lastname@example.org. The team will provide you with monthly amounts owed and will set up direct billing (a Pre-Authorized Debit Agreement authorizes the United Church of Canada Benefits Centre to debit your financial institution account for a previously defined amount each month to maintain benefits coverage and/or contributions into the pension plan).
For information around any other types of leave, please contact the Benefits Centre at email@example.com.
Our staff works with external consultants to review the plan benefits and industry standards annually. They also go to market with our plan every five years. Competitive bids are assessed against fees, service quality, Canadian-base, and other factors. The next review will be in 2022.
Green Shield Canada is the current administration service provider. It is hired to adjudicate (judge) claims and administer reimbursements. On a monthly basis, the United Church reimburses Green Shield for the amount actually paid out to plan members. This contract was renewed after a market review in 2017, with the next review planned for 2022.
Generally, benefits first paid by the member can be claimed online with the claim usually adjudicated within 48 hours and electronic payment to the members bank account within another 48 hours. Drug claims are usually settled online by the pharmacy at the point of sale, with no further claim, payment or action required by the member.
Unfortunately, claims mailed to Green Shield are subject to the vagaries of Canada Post. However, when specific service complaints are brought to the attention of the benefits team, they are investigated and addressed with Green Shield.
Prescription renewal periods are defined by the prescribing physician and limited by provincial Colleges of Pharmacists to a maximum of 100 days and not determined by the plan terms or by Green Shield.
Members may request that their pharmacist reconcile the renewals to a single cycle or subscribe to the new all-Canadian ‘PocketPills’ on-line pharmacy option which was introduced to plan members in 2021 as a voluntary option. This service not only reconciles the renewal dates but it blister-packs and mails the next 100 days of medication automatically.