Member Eligibility

Member Eligibility

To qualify for coverage you, and your eligible Dependents, must be insured under a provincial health plan.  The plan’s administrator keeps an account for you of the hourly contributions made by your employer on your behalf.   This account is called a Dollar Bank Account.  The balance in this account determines your eligibility for benefits. 

You become eligible for coverage under the Trust Fund when you have accumulated three monthly deductions in your dollar bank.  Your coverage is effective on the first day of the month following that accumulation.  Your coverage continues for each month your dollar bank contains the required monthly deduction.  The maximum dollar bank balance is twelve monthly deductions.   If you earn an excess of twelve deductions, these funds will be transferred to the general reserve of the Trust Fund.

If you are absent from work because of disability due to illness or injury on the date your coverage, or any increase in your coverage, would otherwise become effective, such coverage will not become effective until the date you return to active full-time work for 1 full day.

Change of Your Status

As advised in the website section entitled On the Importance of Being Registered, it is your responsibility to notify the administrator of any change of your status (married, separated, divorced, new Dependents, etc.) to ensure that proper coverage is maintained.

Dependent Eligibility

Your Dependents becomes eligible for coverage when you become eligible or, if acquired later, upon becoming your Dependent. To qualify for coverage your eligible Dependents must be insured under a provincial health plan.  Newborn Children are eligible for coverage from birth, provided you advise the administrator within 31 days of the birth.
You must be a covered Member of the Plan and eligible for benefits in order for your Dependents to be covered.

Coverage or any increase in coverage, for your Dependent who is confined for medical treatment in any institution or at home on the date such coverage would otherwise become effective, will not become effective until given a final release by the Physician from all such confinement.  This shall not postpone the effective date for a Child born while your Dependents are insured under the plan.

Dependent means a Spouse or unmarried Child who is under 21 years (under 25 years, if regularly attending school and solely Dependent upon the Member for support).
 
Spouse means a person married to the Member as a result of a valid religious or civil marriage ceremony; except that, a person living with the Member in a common-law relationship for a minimum period of twelve consecutive months will be deemed to be the Member's Spouse, if such person is publicly represented as the Member's Spouse.  
Spouse may include a former Spouse of the Member for whom insurance protection for some of the benefits available under the Member’s benefit program is mandated by a court order; however a Member can only insure one Spouse at a time and that Spouse must be the same person for all spousal benefits provided under this plan.

Child means:

1. Your unmarried Children under 21 years of age provided they are not employed on a regular full-time basis.
2. Your unmarried Children under 25 years of age provided they are not employed on a regular full-time basis and they are in full-time attendance at a university or similar institution. Annual proof of student registration is required after the Child attains age 21.
3. Your legally adopted Children, step Children, or Children of your common-law Spouse, provided your Spouse or common-law Spouse lives with you and has custody of the Child, and provided they meet the requirements set out above.
4. Children outlined above must be solely Dependent upon the Member for support.

Continuation of Coverage for Functionally Impaired Children

Extended Health Care and Dental Care coverage will continue beyond the date an unmarried Child attains the limiting age for coverage, provided proof is submitted to the Insurance Company within 31 days after such date that such Child:

1. is incapable of self-sustaining employment by reason of functional impairment;
2. became so incapacitated prior to attainment of the limiting age; and
3.  is wholly dependent upon you for support and maintenance.

Thereafter, such proof must be submitted to the Insurance Company, as required.