Benefits Overview (AUT, NSGEU, Professional Staff)

This summary provides an overview of the main provisions of the group insurance program for eligible faculty and staff at St. Francis Xavier University.

This document is not a contract and is subject to change; it is provided for your convenience. If any discrepancies between the contents of this summary and the official plan contract should arise, the terms of the insurance contract will apply in all cases. In no way shall this document confer any contractual rights or obligations.

Eligibility

To be eligible for group benefits, you must be:

  • a permanent employee who is a resident of Canada;
  • covered under your provincial government health plan;
  • actively at work; and,
  • working a minimum of 20 hours per week on a regular basis.

Spouse is defined as:

  • a person of the opposite or same sex who is legally married to you, or
  • has continuously resided with you for not less than one full year having been represented as a common law spouse.

Dependent children are defined as:

Your natural, legally adopted or stepchildren who are dependent upon you for financial care and support. Such children must be:

  • unmarried;
  • unemployed;
  • less than 22 years of age; or,
  • if 22 years of age but less than 26 years of age, they must be attending an accredited educational institution, college or university on full-time basis.

The children of your common-law spouse shall be covered provided the children are living with you.

Unmarried, unemployed children 22 years of age or older shall qualify if they are dependent upon you by reason of a mental or physical disability and became totally disabled prior to attaining age 22, and who have been continuously disabled since that time. Unmarried, unemployed children who became totally disabled while attending an accredited educational institution, college or university on a full-time basis prior to their attaining age 26 and have been continuously so disabled since that time shall also qualify as a dependent.

Health Benefits

Cost Sharing 100% paid by the University
Eligibility
  • Active - when member retires or at end of the calendar year when they reach 71.
  • Faculty Retirees - July 1 following the member's 65th birthday.
  • Faculty Early Retirees - Age 65 or 18 months of coverage, whichever is greater
  • Staff Retirees - the end of the month that the member reaches age 65.

Prescription Drugs

  • Reimbursement:
    • You pay pharmacy dispensing fee + $3 for each drug on the prescription.
    • After the dispensing fee + $3, the program pays 100%.
  • Limitations
    • Mandatory Generic Substitution
    • Prior Authorization may be required.
  • Pay Direct Drug Card
Hospital Care 100% reimbursement for a Semi-Private Room
Vision Care

100% reimbursement

  • Lenses, Frames, Contact Lenses and Laser Corrective Eye Surgery
    • $250 every 24 consecutive months
      • Every 12 consecutive months for dependent children less than 18 years of age
  • Eye Examinations
    • $75 every 24 consecutive months
      • Every 12 consecutive months for dependent children less than 18 years of age
Paramedical Services

100% reimbursement

  • Provided by a licensed: speech therapist, massage therapist, chiropractor, osteopath, acupuncturist, chiropodist/podiatrist, homeopath, dietician, audiologist, occupational therapist, athletic therapist or naturopath
    • 100% reimbursement up to $600 per practitioner in a calendar year.
    • Overall combined maximum of $600 per calendar year.
  • Licensed Physiotherapist
    • $800 per calendar year.
  • Psychological Services
    • $800 per calendar year
    • Eligible practitioners include: clinical psychologist, social worker, registered counselling therapist (does not include RMFT or other specialties)
Private Duty Nursing 100% reimbursement to a maximum of $10,000 per calendar year
Medical Supplies & Prosthetic Equipment

100% reimbursement

  • Repairs and/or adjustments are provided to a maximum eligible expense of $300 in a calendar year.
  • Refer to benefit booklet for more information.
Emergency Travel Coverage 100%
Other Eligible Expenses

100% reimbursement

  • Accidental dental provided treatment is within 180 days of accident.
  • Ambulance services to and from nearest hospital able to provide essential care; max $1,000 per calendar year.
  • Hearing aids to a maximum of $1,000 every three consecutive calendar years; under age 18 every calendar year.
  • Insulin pumps to a maximum of one per five consecutive years.
  • Molded arch supports to a maximum of $300 every two consecutive years.
Reasonable and Customary Expenses are reimbursed based on Medavie Blue Cross' assessment of reasonable and customary fees.

Dental Benefits

Cost Sharing 100% paid by the University
Eligibility
  • Active - when the member retires or at end of the calendar year when they reach 71.
  • Faculty Retirees - July 1 following the member's 65th birthday.
  • Faculty Early Retirees - Age 65 or 18 months of coverage, whichever is greater
  • Staff Retirees - the end of the month that the member reaches age 65.
Reimbursement
  • Preventative Services - oral examinations, x-rays, scaling and other preventative treatments
    • 100% reimbursement to a maximum of $1,500 in a calendar year.
  • Basic Care - endodontic and periodontic related services
    • 80% reimbursement to a maximum of $2,000 per calendar year.
  • Major Restorative Care - inlays/onlays/crowns and implants
    • 80% reimbursement to a maximum of $1,500 per calendar year
  • Orthodontic Care
    • 50% reimbursement to a maximum of $3,000 per lifetime
Fee Guide Current fee guide for general practitioners in the member's province of residence.
Recall Examination
  • One per consecutive 12 months for participants age 19 and over
  • One per six consecutive months for participants under age 19

Life Insurance

Basic Life Insurance

Cost Sharing 50% paid by the University, 50% paid by the employee
Insured Persons Employee Only
Coverage 2 times annual earnings rounded to the nearest $100, if not already a multiple thereof, up to a maximum benefit of $400,000.
Termination of Coverage
  • Staff: coverage terminates the earlier of age 70 or retirement or termination of employment
  • Faculty: coverage terminates at the earlier of retirement or termination of employment.

Optional Life Insurance

Cost Sharing 100% paid by the employee
Insured Persons Employee Only
Coverage 2 times annual earnings rounded to the nearest $100, if not already a multiple thereof, up to a maximum benefit of $400,000. Evidence of insurability is required for all insured amounts over $50,000.
Termination of Coverage
  • Staff: coverage terminates December 31st following attainment of age 65, termination of employment or retirement whichever is earlier.
  • Faculty: coverage terminates the earlier of retirement or termination of employment.

Dependent Life Insurance

Cost Sharing 50% paid by the University, 50% paid by the employee
Insured Persons Employee's spouse and dependants.
Coverage
  • Spouse: $10,000
  • Child: $5,000
Termination of Coverage
  • Staff: coverage terminates the earlier of age 70 or retirement or termination of employment
  • Faculty: coverage terminates at the earlier of retirement or termination of employment.

Accidential Death and Dismemberment

Required Insurance

Cost Sharing 50% paid by the University, 50% paid by the employee
Insured Persons Employee Only
Coverage Amount equal to employee life insurance. In case of an accidental injury, the amount paid to you is based on the nature of your injury.
Termination of Coverage
  • Staff: coverage terminates the earlier of age 70 or retirement or termination of employment
  • Faculty: coverage terminates at the earlier of retirement or termination of employment

Optional Insurance

Cost Sharing 100% paid by the Employee
Insured Persons Employee, Spouse and Dependants
Coverage
  • Employee: $10,000 minimum, in units of $10,000, to a maximum of $400,000.
  • Family Plan:
    • Spouse only: If no dependant children covered, the coverage for the employee's spouse is 60% of the employee's coverage.
    • Spouses and dependant children: Coverage for the employee's spouse is 50% and coverage for dependant children is 10%.
    • Dependant children only: If no spouse is covered, the amount of coverage for each dependant child is 20% of employee's coverage.
Termination of Coverage
  • Staff: coverage terminates the earlier of age 70 or retirement or termination of employment
  • Faculty: coverage terminates at the earlier of retirement or termination of employment

Critical Illness

Cost Sharing 100% paid by the employee
Insured Persons Employee, Spouse and Dependants
Coverage
  • You and your Spouse have the option to buy coverage in units of $10,000 up to a max of $150,000.
  • Coverage is available up to $50,000 with no medical evidence required as long as you apply within 31 days of your hire date.
  • Coverage for dependants is up to $25,000.

Critical Illness insurance provides a non-taxable lump sum benefit to the employee and covers the following conditions:

  • Heart Attack
  • Major Organ Transplant
  • Kidney Failure
  • Loss of Speech
  • Parkinson’s Disease
  • Heart Valve Replacement
  • Coronary Artery Bypass Surgery
  • Major Organ Failure Requiring Transplant
  • Multiple Sclerosis
  • Life Threatening Cancer
  • Benign Brain Tumor
  • Coma
  • Stroke
  • Major Burns
  • Alzheimer's Disease
  • Motor Neuron Disease
  • Blindness
  • Paralysis
  • Loss of Limbs
  • Aorta Surgery
  • Deafness
Termination of Coverage Coverage terminates at the earlier of age 70 or retirement, or termination of employment; or when the covered amount has been paid out.
Note Insurer must be notified within 30 days of diagnosis.

Business Travel Insurance

Cost Sharing 100% paid by the University
Insured Persons Employee
Coverage

Group travel accident insurance provides accident coverage world-wide, provided you are required to travel on the University’s business away from the premises of the University where you are permanently assigned.

The amount of insurance for accidental loss of life is $250,000. In case of an accidental injury, the amount paid to you is based on the nature of your injury; the benefits are outlined in your Policy.

Benefits are payable for the accidental loss of life regardless of any other benefits that you may receive from any other insurance company. Certain other benefits may be coordinated with any similar benefits, or existing benefits payable under other SSQ in-force policies to ensure maximum payment is available.

Termination of Coverage Age 75

Long Term Disability

Cost Sharing 100% paid by employee
Insured Persons Employee only.
Coverage 60% of monthly earnings, plus a contribution of 13% of monthly earnings to the employer-sponsored pension plan (if applicable).
Maximum coverage $15,000 per month
Qualifying Period 105 days
Duration of Benefits To age 65, however, if benefit payments commence during the 12 months immediately preceeding the employee's 65th birthday, benefit payments will continue during the disability to a maximum of 12 months.
Benefits Taxable Payments from the plan are non-taxable because the employee pays the premium.
Definition of Disability

Restriction or lack of ability due to an illness or injury which prevents the employee from performing the essential duties of:

  1. the employee's own occupation, during the Qualifying Period and the 24 months immediately following the Qualifying Period; and,
  2. Any occupation for which the employee is qualified, or may reasonably become qualified, by training, education or experience, after the 24 months specified in part 1 of this provision.
Termination of Coverage

Benefits terminates the earlier of age 65, retirement or termination of employment. Coverage ceases at age 65 less the waiting period.