Who Qualifies for Coverage?

Eligibility

You are eligible for group benefits if you:

• are a union or non-union employee of an employer covered by a collective agreement with CLAC or one of its affiliated locals or are a member or an employee of CLAC or one of its affiliated locals
• have the required amount of premium on deposit with the CLAC Health Fund
• have sufficient funds on deposit with the CLAC Health Fund to pay the necessary premium to the benefit providers
• are younger than the termination age
• are covered by the provincial plan (all non-emergency medical treatment must be received in Canada)
• have completed the applicable waiting period

The termination age may vary from benefit to benefit. For this information, please refer to the group insurance plan booklet.

Your dependents are eligible for insurance on the date you become eligible or the date you first acquire a dependent, whichever is first. You must apply for insurance for yourself in order for your dependents to be eligible.

Waiting Period

Hour bank plan members: in no event shall the coverage be effective before the member has accumulated two months' worth of family insurance premiums in his or her account.

Non-hour bank plan members: as specified in the collective agreement.

Late Application

If you apply for benefits that were previously waived because you were covered for similar benefits under your spouse’s plan, your application is considered late when you: 

• apply for insurance more than 31 days after the date benefits terminated under your spouse’s plan
• apply for insurance while benefits under your spouse’s plan have not terminated

Medical evidence to support a late application can be submitted by completing the evidence of insurability form (printable version found under forms or available from the eastern CLAC Benefit Administration office). If required, additional medical evidence may be requested by the benefit providers, at your expense.

Medical evidence is also required for all benefits when you make a late insurance application for any dependent.

Effective Date of Coverage

Entitlement to benefits will be effective on the date you are eligible. You will receive written confirmation of enrolment from the eastern CLAC Benefit Administration office, and you must be actively at work for insurance to become effective. If you are not actively at work on the date your insurance would normally become effective, your insurance will take effect on the first day of the month following the day you are actively at work. Your dependent’s insurance becomes effective on the date the dependent becomes eligible, provided the member meets the eligibility requirement.

Termination of Insurance

Your group insurance will terminate (unless you qualify for an extension of benefits—contact the eastern CLAC Benefit Administration office for further information) when: 

• you cease to be an eligible plan member, or
• any required contribution or payment is due but not paid, or
• you reach the age of 65 and are not actively at work (actively at work is subject to verification of continuing employment), or
• the group policy terminates, or
• you reach the termination age, or
• you have died, subject to survivor benefits

Your dependent’s insurance terminates on the date your insurance terminates or the date the dependent ceases to be an eligible dependent, whichever is earlier.