Employee Dependent FAQ
Below are some of the most frequently asked questions about Benefits at Carleton.
Who qualifies as an eligible dependent?
- Employee’s Eligible Spouse
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The employee’s spouse is eligible if he or she is the employee’s legal spouse, common-law spouse, or former spouse when mandated by the family court. A common-law spouse is deemed eligible if they have been cohabitating for 12 consecutive months.
- Employee’s Eligible Children
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A child is eligible if he or she is the employee’s eligible spouse’s unmarried natural, legally-adopted, or step / foster child, for whom the employee or employee’s eligible spouse has been appointed legal guardians, and who are:
- under age 21,
- under age 25, if they are full-time students and depend on the employee for support, or
- of any age, if mentally or physically disabled and incapable of self-support, provided the disability began before they turned 21 or while they were full-time students under age 25, and the disability has been continuous since then, and
- natural children of the employee’s daughter, if she is under age 21 and meets the definition of a dependent as defined above.
Canada Life Admin
- How do I find out if a claim has been paid by Canada Life?
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Access your group benefits and claims information for the past 24 months through GroupNet at Canada Life. You can also sign up for direct deposit claim payments (claims will be paid directly to your bank account).
- I am a new employee. When can I submit a claim to Canada Life?
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Typically, we will ask you as a new employee to wait approximately 3 weeks in order to receive your Canada Life pay direct wallet drug card before submitting any claims. This will ensure that you are set up on the Canada Life system and that your claims will be processed smoothly.
- My spouse also has a benefit plan. How can we claim under both plans?
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This is called Coordination of Benefits (COB). You must notify your Benefits Specialist of any changes regarding coordination of benefits. The following steps will help you submit a COB claim:
- To determine which insurer pays a claim, you and your spouse must submit claims to your own plan first. Children must submit their claims to the plan of the parent with the earlier birth date in the calendar year.
- Take photocopies of your claim and receipts.
- Submit your original claim forms and receipts to the insurer who is the first payer based on the above criteria.
- Once you receive your cheque and statement, complete a new claim form, ensuring you include your spouse’s plan and ID numbers. Attach to this claim the statement from the insurer and photocopies of your original claim and receipts. Submit this information to the coordinating plan.
Notes:
- If your spouse is also insured with Canada Life, submit your claim form indicating both plan numbers. Canada Life will look after coordinating between the plans. You will receive two separate cheques.
- If you and your spouse are both employees of Carleton, you may co-ordinate benefits as of May 1, 2020.
- What is my policy and member ID?
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The policy number for the health and dental plan is 51801. Your member ID is your 9-digit employee ID.
- When do I need predeterminations or estimates approved by Canada Life?
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There are two situations in which a predetermination is required:
- Private Duty Nursing, speech treatment plans and long-term use of medical aids and appliances should be submitted for pre-authorization of benefits.
- When dental treatment will involve the use of crowns, bridges or dentures and is expected to cu_event_cost $300 or more, you must obtain a written estimate from the attending dentist.
- When I submitted a claim, I received a cheque for the health expenses but not for my prescriptions. Why?
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Assure Health handles drug claims for Canada Life and requires a separate claim form, and as a result, you will receive two cheques any time you submit a claim through the mail that has prescriptions and other medical expenses attached. Canada Life’s cheque will usually arrive prior to Assure Health’s cheque.
In future, use the Assure Card Claim Form for prescription drugs and you will receive your reimbursement quicker.
Coverage
- Am I covered for a private hospital room?
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No. The plan pays 100% of the difference in cu_event_cost between standard ward and semi-private room accommodation in a hospital.
- Am I covered for eye examinations?
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Yes, except for members of CUPE 3778 and Visiting Scholars. For members who do have coverage, the eye examination fee is taken into consideration in the total amount payable under the Vision Care plan.
For members of CUPE 3778 and Visiting Scholars, if you are under age 20 or over age 64 you may be covered under the provincial health plan. To find out more, contact the provincial health plan organization in the province where you live.
- Are dentures covered under the dental plan?
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Initial placement of dentures is not covered under the plan. Repairs, rebasing and relining of dentures every twelve months are covered at 100%.
- Are orthotics covered under the plan?
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The plan allows for two pairs of orthotics every twelve months. The plan will reimburse 80% of the cu_event_cost to a maximum of $450.00 every twelve months.
- How do I find out whether a drug, medical or dental treatment will be covered under the plan?
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You can contact Great-West Life directly at 1-800-957-9777. A representative will provide you with information regarding your coverage eligibility. Please note that you will be asked to provide your policy number and member ID.
- Is private duty nursing or nursing in the home covered under the plan?
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Charges for the services of a Registered Nurse (R.N.), Registered Nursing Assistant or Licensed Practical Nurse for private duty nursing are covered when provided in the home; provided such services are certified as medically necessary by the attending physician. Payment for such services shall exclude:
- Charges in excess of the fee level set by the largest nursing registry of Ontario
- Agency fees, commissions or overtime fees
- Charges by a nurse who is related to the patient by birth or marriage or who lives in the home of the covered person
- Charges for the services of a homemaker or any person who is not described above
- Charges incurred by any person while confined in a hospital
Travel
- Are there any clauses that apply to Emergency Travel Insurance?
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If you are planning a trip outside your province of residence and you have a medical condition that required treatment or had a change in medication in the three months prior to your departure, be aware of the following.
Coverage may be denied if a problem related to that condition or change in medication arises while you are away.
You may want to contact Great-West Life to clarify coverage before traveling outside of the province.
- Do I need any additional insurance if I am traveling out of the country?
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Emergency Travel Insurance is included in your Extended Health Care Plan. You and your dependents registered under your policy will be covered up to 180 days. Coverage is for emergency care only.
Note: CUASA members and their eligible dependents traveling on university business or on sabbatical leave are not limited to the 180 day maximum.