Benefit Resources & General Information - Postdoctoral Associates

Manulife Financial

For Extended Health, Dental, Life Insurance, and Health Care Spending Account

Group Benefits – Health Claims
PO Box 1653
Waterloo, Ontario. N2J 4W1

Group Benefits – Dental Claims
PO Box 1654
Waterloo, Ontario. N2J 4W2

Phone: 1-866-896-8515

Go to the Manulife Website

For all correspondence with Manulife Financial please include your plan contract number (87220) and your certificate number found on your Manulife card.

Global Excel Management

For Emergency Travel Assistance

Phone: 1-800-265-9977 (Canada/United States)

Country Code + 800-9221-9221 (International)

If you can’t get through using the international toll-free number, please call the Canada/United States number or call 519-741-8450 collect.

Voluntary Personal Accident Insurance

Sun Life Assurance Company of Canada
Group Life Claims
1155 Metcalfe St.
Montreal QC H3B 2V9

Phone: 1-877-893-9893

Employee Assistance Program

Your Employee (and family) Assistance Program is provided by TELUS Health (formerly LifeWorks)
Phone:1-844-880-9142 (24/7)

Go to the Western EAP Website
TELUS Health One website

Mobile app: Download the TELUS Health app at your app store or scan the QR code.

Western University

Pension Plan, Benefit Plans provisions and Other Benefits

Human Resources
Support Services Building, Room 4159
London, ON N6A 3K7

Use ASK HR to contact Human Resources

Phone: 519-661-2194 (Monday to Friday, 8:30 a.m. to 4:30 p.m., ET)
Fax: 519-661-4104

Go to the Human Resource Benefit Website Homepage

To be covered by the Western active group benefits program, you and your dependents must reside in Canada, and meet the following eligibility requirements:

Employee Definition

An employee who is actively employed as a Postdoctoral Associate is eligible for coverage.

Spouse Definition

Spouse means: the legally married spouse of the Employee; or a person of the opposite or same sex who has continuously lived with the Employee for a period of at least one year in a conjugal relationship outside marriage. Only one Spouse will be considered as being covered at any time.

Note: The person you designate as your spouse is recognized until such time you advise otherwise. Any dissolution of a marriage through divorce, or in the case of common-law marriage, actual separation for more than 90 days, results in the loss of status of spouse. Contact Human Resources to remove your ex-spouse from your benefits.

Dependent Children Definition

Children that are natural, legally adopted, step or foster children of the Employee or Spouse, who are unmarried, not engaged in full-time employment, dependent on the Employee or Spouse for financial support and under age 21.

A child age 21 and older who meets all other requirements of this definition will continue to be eligible for coverage provided the Child is:

• Under age 25 and enrolled and in full-time attendance at an accredited educational institution which provides a recognized certificate of accreditation on completion
• Incapable of self support due to mental or physical infirmity which began while the Child was covered as the Employee's Dependent.

Dependent Children Studying Outside Canada

We recommend that medical coverage be purchased through the academic institution your child is attending. Some schools will not accept the Canadian plan's travel coverage when there are dollar limits (annual or lifetime) on essential benefits.; It is typically a minimum requirement of the school that foreign students purchase their student insurance plan.

Health and Dental Coverage Options When No Longer Eligible

The insurance provider offers a full line of individual and family health and dental plans specifically designed for employees and/or their dependents that no longer have group health and dental coverage. Application for coverage must be made within 60 days of termination of benefits from your group health or dental plan. Further information including the application can be found on the Manulife CoverMe website or by contacting Human Resources at 519-661-2194.

Please visit the Western Benefits webpage Making a Claim.

Remember, there is a cost to your benefits, and you may change your coverage at any time.

Read the PDF document Benefit Costs for Postdoctoral Associates.

Read more about how to make changes to your benefits.

Changes to Coverage

To ensure that coverage for you and your eligible dependents is up to date, it is vital that you advise us of any family changes in writing within 31 days.  If the change is a result of a life event (such as birth or adoption of a child, getting married or divorced), the coverage will become effective on the date of the change without providing proof of good health, provided:

• Written application for the change is submitted within 31 days of the life event, and
• Provided additional requests for coverage have not been previously declined (life insurance)

After the 31-day window has closed, coverage may be subject to a medical questionnaire and approval from our benefit provider.

Necessary forms to make changes such as increasing/decreasing life insurance coverage, adding/removing dependents, updating beneficiaries can be found on the Human Resource Benefits website. Call Human Resources for assistance with making changes to your benefits and completion of forms.

Death Before Retirement - Survivor Benefit

If you die while you are an active employee and participating in the Health Care, Emergency Travel Assistance plan and Dental Care benefits, Western continues coverage for your surviving covered dependents until the earliest of the following occurs:

• 12 consecutive months from the date of your death
• The date your spouse remarries
• The date the person no longer qualifies as a dependent
• The date the dependent becomes eligible for similar coverage under another group contract

Working Beyond Your Normal Retirement Date

Life Insurance

Your life insurance (Optional, Dependent Life and the Voluntary Personal Accident Insurance) plans end at your Normal Retirement Date (NRD).

At your Normal Retirement Date, you may convert your present life insurance coverage or the coverage of your spouse, up to a maximum of $200,000, to a private policy without providing evidence of good health provided you make application within 31 days of your Normal Retirement Date.

You may convert the Voluntary Personal Accident Insurance benefit (if applicable) to a private policy (maximum of $100,000) within 60 days of your Normal Retirement Date.

Health Care and Dental

Health Care and Dental benefits continue.

Leaving Western Before Retirement

This information will help those who leave Western before retirement to understand what happens to benefits. Included is information about converting some benefits to a plan that you would pay for privately.

Life insurance benefits terminate the end of the month that employment with Western terminates. Life insurance coverage or the coverage of your spouse, up to a maximum of $200,000, may be converted to a private policy without providing evidence of good health provided application is made within 31 days of the date that group life insurance terminates. Premiums are based on private policy rates.

Voluntary Personal Accident Insurance benefits terminate the end of the month that employment terminates. Coverage, up to a maximum of $100,000, may be converted to a private policy within 60 days of the date that coverage terminates. Premiums are based on private policy rates.

Extended Health and Dental terminate the end of the month that employment terminates for any services received prior to the termination date.The insurance provider offers individual and family health and dental plans specifically designed for people that no longer have group health and dental coverage. Application must be made within 60 days of termination of benefits from the group plans.

Read more at Converting/continuing your benefits after leaving Western.

Any outstanding eligible medical and dental expenses must be submitted to the benefit carrier within 90 days after coverage ends.

Actively Employed

Means the employee reports for work at his or her usual place of employment with the employer, or such other location as may be required, and is able to perform the Essential and Material Duties of his or her regular occupation on a permanent full-time and full-pay basis for a minimum of 25 hours per week, unless specified otherwise. If an employee is not required to report for work on a specified date, he or she will be considered to be Actively Employed if he or she is not disabled to the degree that he or she could not have reported for work at his or her usual place of employment and performed the Essential and Material Duties of his or her regular occupation.

Active Treatment

Means the ongoing and continuous medical or surgical inpatient treatment of a sickness or injury in the acute phase, including active treatment of a chronic sickness.

Due Diligence

Means a process the insurance provider follows to assess new drugs, existing drugs with new indications, services or supplies to determine eligibility under the plan. This process may use Pharmacoeconomics, cost effectiveness analysis reference information from existing federal or provincial formularies, recognized clinical practice guidelines, or an advisory body.

Essential and Material Duties

Means the duties which are required for the performance of an occupation and which cannot be reasonably omitted or modified.

Government Plan

Means any plan or arrangement provided by or under the administrative supervision of any government, including any provincial health insurance plan, workers’ compensation act or any workplace safety and insurance act.

Lower Cost Alternative

Means if two or more drugs, supplies or services result in therapeutically similar results, the Lower Cost Alternative will be considered.

Medically Necessary

Means accepted and recognized by the Canadian medical profession and the insurance provider as effective, appropriate and essential treatment of a phase of an illness or injury. The insurance provider has the right after Due Diligence has been completed to determine whether the drug, service or supply is eligible.

Non-Emergency Treatment

Means treatment received outside of the covered person's province of residence that requires immediate attention, but is not considered emergency or life threatening.

Normal Retirement Date

The first day of the month next following a staff member's sixty-fifth birthday.

Prior Authorization

Means a claims management feature applied to a specific list of drugs, supplies or services to determine eligibility based on predefined clinical criteria and a Pharmacoeconomic or cost effectiveness evaluation.

Proof of Good Health

Means all statements of medical evidence of a person's health and other information as required by the insurance provider. All Proof of Good Health must be submitted to the insurance provider for approval.

Reasonable and Customary

Means a charge which is usually made in the absence of this or any similar coverage, for a specific type of care, service or supply, based on representative fees and prices in the geographic area in which the charge for the care, service or supply was incurred, as determined by the insurance provider.

The insurance provider has the right to recover any overpayment of benefits from the person or organization who received payment that was not covered under the plan.  If the overpayment cannot be recovered directly, the insurance provider has the right to reduce future benefit payments until the overpayment has been recovered in full.