Health Benefits Plan (Dejardins)

Optional Long Term Disability Insurance

In order to be insured under this benefit, you must also be insured under the basic group insurance program and be a member of either the Public Service Pension Plan, Uniformed Services Pension Plan or the Members of the House of Assembly Pension Plan.

This plan is intended to provide a level of income while you are unable to work due to total disability resulting from accident or illness which continues beyond the elimination period of 119 consecutive days. At your option, the elimination period may be extended to the expiration of accumulated sick leave (maximum accumulation 480 days). Benefits are payable through to your recovery, attainment of age 65 or death, whichever occurs first. Regular medical examinations and reports are required throughout your entire period of disability.

Benefits Payable
The monthly income benefit payable will be 66 2/3% of your regular monthly salary at the date of disability, to a maximum monthly benefit of $2,500 on a non-taxable basis.

Definition of Disability
Benefits are payable for the first 12 months following initial receipt of benefits if sickness or accident prevents you from doing your own job. You will be considered disabled if there is no combination of duties you can perform that regularly took at least 60% of your time at work to complete.

After 12 months, benefits continue to be payable if disease or injury prevents you from being gainfully employed in any job. Gainful employment is work you are medically able to perform, for which you have at least the minimum qualifications and which provides you with an income of at least 50% of your pre-disability monthly earnings, adjusted for inflation. The availability of work will not be considered in assessing disability.

Recurrence of Disability
Effective April 1, 2004 the recurrent disability provision will read as follows:

Successive periods of Total Disability occurring while this benefit is in force will be considered to be one period of Total Disability if:

• They result from the same or related causes, and are separated by an interval of less that six months during which the employee was actively at work on a full time basis, or
• They result from entirely unrelated causes, unless they are separated by an interval during which the employee was actively at work on a full time basis.

If a period of total disability is considered under this provision to be a continuation of a previous Total Disability, then benefits will be resumed based on the original benefit period and for the same amount of monthly benefit, but without the application of another elimination period.

Rehabilitation
Provision has been made in the plan to assist you in undertaking rehabilitative employment, however, it is necessary to have the approval of the insurance company prior to commencing rehabilitative employment. The plan allows you to receive increased income in connection with work performed in an approved rehabilitative program, in that your long term disability benefit will be reduced by only the amount of your rehabilitative earnings and other income as outlined below exceed 100% of your pre-disability net earnings.

Benefit Reduction
Your monthly long term disability benefit will be directly reduced by any amount payable under:

• Workers' Compensation
• Canada Pension Plan (excluding any payments for your dependents); or
• Pension benefits from the Public Service Pension Plan, Uniformed Services Pension Plan or the Members of the House of Assembly Pension Plan payable due to the disability. Benefits are automatically assumed to commence after 12 months of disability unless written notice of proof is received confirming benefits were denied.

Long term disability benefits will only be further reduced if your total disability income from all sources, as outlined below, exceeds 85% of your net income at the date of disability.

• Canada Pension Plan dependent benefits;
• Disability benefits through employment or from a group insurance or association plan; and
• Payments from Government plans except those being received prior to effective date of insurance.

Cost of living increases in Canada Pension Plan benefits that take effect after you qualify for benefits are not included as "other income" when your long term disability benefit is calculated.

Termination of Coverage
Long term disability insurance coverage terminates on your attainment of age 65, termination of employment, or the date you cease to be in an eligible classification, whichever is earlier. If you are granted a leave of absence or are on seasonal lay-off, you may continue long term disability insurance for one (1) month from your last day worked.

General Limitations and Exclusions

• No benefits will be payable for disability periods that begin before your insurance starts or after it ends.

• Benefits will not be paid for any period in which you do not participate and co-operate in a reasonable and customary treatment program. If your disability involves a psychiatric disorder, the treatment program must be supervised by a Psychiatrist. If substance abuse contributes to your disability, the treatment program must include participation in a recognized substance withdrawal program. Substance abuse includes alcoholism or drug addiction.

• No benefits will be paid if you fail to participate or co-operate in a recommended or approved rehabilitation program.

• No benefits will be paid during any period for which Employment Insurance maternity benefits are paid.

• No benefits will be paid if disability arises from attempted suicide or intentionally self-inflicted injury while sane or insane.

• No benefits will be paid if the disability arises from active service in the armed forces of any country or in any civilian non-combatant unit that serves with the forces in combat.

• Disabilities arising from war, insurrection, or voluntary participation in a riot are not covered. Benefits will not be paid for any period of confinement in a prison, nor will they be paid for any 12 month period in which the disabled employee does not reside in Canada for at least six of the twelve months.

• If you have received medical care or have taken drugs prior to the effective date of insurance, you will not be covered for that medical condition until you have completed 90 days from the effective date of coverage without any recurrence of medical treatment or taken prescribed drugs for that medical condition. Medical care is considered to be obtained when you consult a doctor, use medication on the advice of a doctor, or receive other medical services or supplies. This limitation expires on the date two years after your effective date of coverage.

Conversion Privilege
Should your insurance terminate on or before the attainment of age 65, you may be eligible to convert the terminated amount to an individual disability income policy without medical evidence subject to the following conditions:

• your insurance terminates at the end of a rehabilitation program that requires you to change employers;

• you start employment with another employer during the rehabilitation program or within six months after its end;

• you apply for conversion in writing within 31 days after your insurance terminates, if you are then employed. If you are not employed, your application must be made within 31 days after employment starts; and

• your application must be acceptable in accordance with the insurer's underwriting rules for individual disability insurance other than medical evidence and length of employment rules.

The individual policy of the type then being offered by the insurer to conversion applicants. Coverage will be effective on the date the insurer approves the application provided the first premium has been paid.
 
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