IBEW Local 894 - Benefit Plan

Health and Welfare Trustees

Forms

• Supplementary Health Expense Claim
  

  Use this form for all claims other than dental and prescription drugs. The member's signature is required to process the claim. Submit original invoices with the claim. Claims sent by fax can not be processed, as the insurance company will only accept original receipts and paperwork. Make all submissions to the Union Office.
  Open Form
  
  

• Dental Claim
  

  Use the standard dental claim form available at your dentist's office, or download this one from Manulife. The member's signature is required to process the claim. Make all submissions to the Union Office. Please note that this is a two-page document. You need only print the first page.
  Open Form
  
  

• Short Term Disability - Physician's Statement
  

  This form is required to file for Weekly Indemnity (Short Term Disability) benefit. The form must be completed by the physician, signed by the member, and submitted to the Union Office, along with the Member Statement, below.
  Open Form
  
  

• Short Term Disability - Member Statement
  

  This form is required to file for Weekly Indemnity (Short Term Disability) benefit. The form must be completed and signed by the member, and submitted to the Union Office, along with the Physician's Statement, above.
  Open Form
  
  

• Claimsecure Drug Claims Transmittal Form
  

  Use this form to submit prescription drug expenses for which you require reimbursement. Please note that the Group # is 5881, and the Certificate Number is the member's Social Insurance Number.
  Open Form
  
  

• Claimsecure Over-Age Dependant Form
  

  Your Spouse and your unmarried Children, including adopted, foster and step-children, who are less than 21 years of age, and who reside in Canada, are eligible. Unmarried Children over the age of 21 who are full-time students and dependent upon you for support are also eligible. You are required to complete the Claimsecure Over-Age Dependant Form for each year of extended eligibility. Submit the completed form to the Union Office. The $5.00 fee is only payable if the dependant requires his/her own drug card.
  Open Form
  
  

• Claimsecure Special Authorization Drug Form
  

  This form must be completed for drugs requiring special authorization. The completed form must be faxed or mailed to Claimsecure, according to the instructions on the form.
  Open Form
  
  

Group Benefits Booklet

View an online copy of the Group Benefits Booklet. Booklets are currently being printed and will be mailed to all plan members.

Benefit Summary for Active Members

• Life Insurance - $50,000
  
• Survivor Income - Spouse - $200/month, Children - $100/month
  
• Accidental Death and Dismemberment Insurance - $35,000 principal sum
  
• Weekly Indemnity - $500/week (integrated with EI)
  
• Long Term Disability - $2,000/month
  
• Major Medical
  
• Vision Care - $225 toward the purchase of prescription glasses once every 24 months
  
• Emergency Outside Canada Travel Assistance
  
• Prescription Drugs
  
• Dental Plan - $1,500 annual maximum per person
  
• Semi-private Hospitalization
  
• Eye Exams - Maximum $50 one exam in two calendar years
  

UPDATES

January 2010

The Health & Welfare Trustees are pleased to announce the dental benefit will be increasing from the year 2007 dental fee guide to the year 2008 dental fee guide effective with services received on or after January 1, 2010.

June 2008

Effective August 1, 2008, the monthly Dollar Bank Drawdown and Pay Direct charge will be increased.

Currently an Active Member's Dollar Bank Draw Down is $310.00 per month. Effective August 1st, 2008 the monthly Draw Down will be $350.00. This increase partially takes into account the recent increase in the Contribution Rate. The increase in the Contribution Rate also allows the Member's Dollar Bank to continue to grow.

Effective August 1st, 2008 the maximum a Member can hold in his Health & Welfare Dollar Bank will increase to $4,200.00

The current charge for Active Members who are on Pay Direct is $267.00, plus taxes. Effective August 1st, 2008 the Pay Direct charge will be $275.00. Provincial Sales Tax of $22.00 and $1.18 of Ontario Premium Tax will be added to the monthly Pay Direct charge for a total monthly Pay Direct charge of $298.18. Since this increase is effective for the benefit month of August 2008 the first payment would be due September 10th, 2008.

The Trustees have decided to leave all other Pay Direct charges the same and to continue to subsidize these costs out of the Unallocated Reserve. If you have any questions regarding these changes you may contact Sue O'Neill at the Union Office.

Revised Member Information Cards

The Health and Welfare Trustees are pleased to inform you there are new revised “Member Information Cards” available at the Union Office. These cards are used to record your beneficiary information for the Benefit Plan’s Life Insurance coverage.

Please be aware the insurance company will not issue a cheque for life insurance to beneficiaries under the age of 18. On the new “Member Information Cards” a member can name beneficiaries younger than 18 as long as they name a Trustee. It would then be the Trustee named on the card that would receive the life insurance payment.

Also, if a member wishes, he/she may name a primary and a contingent beneficiary on the revised card. An example of this would be to name the husband or wife as primary beneficiary and the children as contingent beneficiaries, and if husband and wife both die at the same time, the contingent beneficiaries would receive the life insurance benefit.

If you wish to review or update your beneficiary information please contact Sue O'Neill at the Union Office.