October 14, 2019  
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Eligibility Rules (i.e., who qualifies and when)

A new Plan Member becomes eligible for coverage in accordance with the waiting periods outlined in the benefit summary pages for his or her classification.

To be eligible, the Plan Member must:

  • Be in an eligible class
  • Work the minimum number of hours per week
  • Have completed the waiting period
  • Be "actively at work" when he or she becomes eligible for coverage

Premiums become payable on the first of the month coincident with or next following the eligibility date. For example, if the Plan Memberís effective date is February 10th, the Plan Member becomes eligible to submit claims on the 10th but premium payments do not start until March 1st. If the Plan Memberís effective date is February 1st (rather than February 10th) then the eligibility date would be February 1st and premium payments would also start on February 1st.

Additional Provisions

Spousal Eligibility

A Plan Member may cover only one spouse at a time:

  • A legal spouse
  • An estranged spouse (separated)
  • An ex-spouse (divorced)
  • A Common-Law spouse: A Common-Law spouse is eligible for coverage under this agreement when living together in a conjugal relationship with the Plan Member continuously for a period of not less than one year.

Dependent Children

Generally, Dependent Children are eligible for coverage up to the end of the year following their 21st birthday or to the end of the year following their 25th birthday, if enroled and in full-time attendance at an accredited college or university.

Children over 21 years of age may qualify for coverage if they are dependent upon the covered Plan Member by reason of a mental or physical disability.

Eligibility of Unmarried Dependent Children

Dependent Children are eligible for benefits up to the age restrictions noted on the benefit summary pages provided they are not married (or living in a Common-Law relationship) and they are financially dependent on the Plan Member or the Plan Member's spouse. Dependent Children are automatically terminated upon reaching the age restrictions outlined in the Benefit Summaries.

Eligibility for Over-Age Dependent Children - Student

An over-age Dependent Child is eligible for benefits provided he or she is enroled and in full-time attendance at an accredited college or university on a full-time basis. Full-time attendance means more than ten hours of classroom instruction per week.

Eligibility of Over-Age Dependent Children Ė Physically or Mentally Disabled

A mentally or physically disabled dependent may be covered provided the dependent is incapable of self-sustaining employment and is wholly dependent upon the Plan Member or the spouse for support and maintenance.

At the time of enrolment, the Plan Member should indicate any applicable information regarding a dependent's disabled status. Please note the insurer may require additional information at a later date to verify a dependent's status. If required, the insurer will request the additional information directly from the Plan Member.

If a dependent becomes disabled at a later date, please contact Morneau Shepell for more information.

Survivor Benefits

In the event that the Plan Member dies while covered under this agreement, the level of health and dental benefits provided to that Plan Member will continue to cover survivors until the earlier:

  • 24 months not to exceed the date of the second anniversary of death; or,
  • The date on which the spouse remarries or the Plan Member's children are no longer eligible for coverage (i.e., age 21 or age 25, if enroled and in full-time attendance at an accredited college or university or over if they are dependent upon the Plan Member by reason of a mental or physical disability).

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If you have any further questions, please contact us; we'll be glad to help you.


Last updated on:  Tuesday, July 10, 2012  Page: 

This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.

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