Human Resources A GUIDE TO SHELL CANADA S GROUP BENEFIT PLANS

Transcription

1 Human Resources A GUIDE TO SHELL CANADA S GROUP BENEFIT PLANS May 2016

2 INTRODUCTION This guide provides information on Shell Canada s group benefits coverage health and dental plans and life and accident insurance plans including claims procedures and other relevant information such as tax and eligibility provisions. While every effort has been made to include as many details as possible, the descriptions in this document are only a summary of the major provisions of each of Shell Canada s group benefit plans. In the event of any discrepancy between this information and applicable benefit documents, benefits will be paid in accordance to the official plan documents and any prevailing legislation. Shell Canada expects all Shell in Canada (Shell) eligible employees and covered dependents to participate in any government health and dental programs for which they are eligible. Government plans and coverage vary by province. Many provinces also provide specific benefits for residents age 65 and over. Shell Canada s plans supplement government coverage, where applicable. Shell Canada reserves the right to amend any provision (including but not limited to premiums, deductibles, HSA credit amounts and coverage) or to discontinue any of these plans at any time. Amendments will be made from time to time. Protecting Your Privacy Shell Canada is committed to protecting your personal information. We collect personal information about you and your dependents for the purpose of providing and administering the group benefits plans. We may share your personal information with third parties, as necessary, to determine eligibility for coverage and to administer the group benefits. Where third parties are located in jurisdictions outside of Canada they are required to protect the confidentiality of your personal information in a manner that is consistent with Canadian privacy laws and our privacy policy and practices. Information respecting individual claims is held by Shell Canada s plan administrators and is not accessible by Shell Canada. Read our Privacy Policy on HR Online. If you have any questions about our privacy practices, contact our Privacy Officer at privacyincanada@shell.com. A Guide to Shell Canada s Group Benefit Plans

3 TABLE OF CONTENTS CONTACT INFORMATION AND GETTING HELP...1 All Plans...1 Health and Dental...1 Emergency Travel Assistance...2 Unresolved Benefit Questions...3 Long Term Disability...3 Life Insurance...3 Accident Insurance...3 HEALTH AND DENTAL...4 Overview...4 $1,500 HEALTH SPENDING ACCOUNT (HSA)...5 Overview...5 About Your HSA...5 Family Members Eligible for HSA...5 Two Years to Use It...5 Funding...5 Eligible HSA Expenses...6 Ineligible HSA Expenses...10 Tax Considerations...11 BUSINESS TRAVEL EMERGENCY TRAVEL ASSISTANCE...12 Overview...12 Coverage While Travelling on Company Business...12 Emergency Services...12 Referred Services...13 Eligible Travel Medical Expenses...13 Emergency Travel Assistance...13 Emergency Services Excluded from Coverage...15 Emergency Services Outside Canada...16 Limits on Emergency Travel Assistance Coverage...16 Liability of Sun Life Financial or Europ Assistance...16 EXTENDED HEALTH CARE PLAN...17 Overview...17 Summary of Extended Health Care Options...17 Eligible Extended Health Care Expenses...18 Annual Out-of-Pocket Maximum...24 Limitations...25 Exclusions...25 Pre-Authorizing New Treatments...26 Tax Considerations...26 A Guide to Shell Canada s Group Benefit Plans

4 TABLE OF CONTENTS continued DENTAL PLAN...27 Overview...27 Summary of Dental Options...27 Eligible Dental Expenses...28 Limitations...29 Exclusions...30 Pre-Authorizing New Treatments...31 Tax Considerations...31 HEALTH SPENDING ACCOUNT PLUS (HSA PLUS)...32 Overview...32 Additional $1,500 HSA Credit...33 Health Support...33 Annual Deductible...33 Eligible Health Support Expenses...33 Emergency Travel Assistance for Personal Travel...38 Limitations...38 Exclusions...39 Pre-Authorizing New Treatments...40 Tax Considerations...40 PROVINCIAL HEALTH CARE...41 Overview...41 Moving Between Provinces and Territories...41 Tax Considerations SUBMITTING CLAIMS FOR HEALTH AND DENTAL EXPENSES...42 Electronic Drug Claims...42 Sun Life Mobile Application...42 Electronic Dental Claims...42 Paper Claims...43 E-claims...43 Claim Deadlines...45 Claims Processing and Payment...45 Sign Up for Direct Deposit to Get Your Claims Payments Faster...46 Coordinating Benefits with Government Plans...46 Coordinating Benefits with Another Group Plan...47 Coordinating Extended Health Care and Dental with Your Spouse s Plan...48 Coordinating HSA Plus with Your Spouse s Plan...48 A Guide to Shell Canada s Group Benefit Plans

5 TABLE OF CONTENTS continued LIFE AND ACCIDENT INSURANCE...50 Overview...50 BASIC AND OPTIONAL LIFE INSURANCE...51 Overview...51 Coverage...51 Basic Life Insurance...51 Shortened Life Expectancy...51 Optional Life Insurance...51 Medical Evidence of Insurability...52 Beneficiaries...52 Changing Your Beneficiaries...52 Exclusions...53 Tax Considerations...53 Making a Life Insurance Claim...53 BASIC AND OPTIONAL ACCIDENT INSURANCE...54 Overview...54 Coverage...54 Basic Accident Insurance...54 Optional Accident Insurance...54 Beneficiaries...55 Changing Your Beneficiaries...55 Benefits Payment Schedule...55 Specific Coverage...57 Additional Benefits...57 Exclusions...60 Tax Considerations...60 Making an Accident Insurance Claim...60 GOVERNMENT DEATH AND INJURY BENEFITS...61 Canada/Quebec Pension Plan (C/QPP)...61 Workers Compensation...61 DISABILITY INCOME...62 Overview...62 SHELL INCOME CONTINUANCE (SIC)...63 Overview...63 Payments...63 LONG TERM DISABILITY (LTD)...64 Overview...64 Payments...64 Exclusions...64 A Guide to Shell Canada s Group Benefit Plans

6 TABLE OF CONTENTS continued ELIGIBILITY...65 Eligible Employees...65 Eligible Dependents for Shell Canada Plans...66 MAKING CHANGES TO BENEFITS...67 Health and Dental Enrollment Every Two Years...67 Changes Permitted for Qualifying Life Events...67 Changes Permitted Anytime...68 PREMIUMS AND COST SHARING...69 Health and Dental...69 Disability Income...69 Life and Accident Insurance...69 SPECIAL SITUATIONS...70 New Employees...70 Part-Time Employees...71 Employees on Parental Leave...71 Leave of Absence (Other Than Parental Leave)...73 Employees Moving to and from Quebec...75 Employees Moving Elsewhere in Canada...75 Local Non-National Expatriates...76 Expatriates...76 Resignations or Termination...77 In the Event of Your Death...78 GLOSSARY...80 CONTACT...81 A Guide to Shell Canada s Group Benefit Plans

7 CONTACT INFORMATION AND GETTING HELP All Plans The Shell Benefits Centre (SBC) provides a detailed description of all benefit plans and provides information on your current benefits participation and beneficiaries. To view your coverage, find information about the plans and make changes when appropriate, go to the Shell Benefits Centre. To access the Shell Benefits Centre: n Go to For assistance with any of the plans, contact the Shell Benefits Centre: n Toll-free at ( if you re outside Canada and the U.S.) from 6 a.m. to 6 p.m. Mountain Time, or n Go to and click Help. Health and Dental Sun Life Financial administers the health and dental benefits. For assistance with health and dental claims, contact the Sun Life Financial Customer Care Centre: n Toll-free at ( if you re outside Canada) 6 a.m. to 6 p.m. Mountain Time any business day, or n Go to the Sun Life Financial Member Services website New joiners will receive a welcome letter from Sun Life Financial approximately two to four weeks after your date of hire. The letter will contain an Access ID, Password and instructions on activating your Sun Life Financial account. To access the Sun Life Financial Member Services website: n Go to n Enter your Access ID n Enter your Password n Select Sign In COVERAGE SHELL CANADA CONTRACT NUMBER Extended Health Care/Dental HSA Plus Your Sun Life Financial member ID number is 100 followed by the last six digits of your Shell People personnel number. For example, if your Shell People personnel number is , your Sun Life Financial member ID number will be Sun Life Financial Member Services website If you don t know your Access ID, go to the sign in page and click Forgot your Access ID? Follow the steps to receive your Access ID online. Then return to the sign-in page and click Forgot your password? Follow the steps to receive a password. When you access the Sun Life Financial Member Services website you will be able to: n Submit claims online n Sign up for direct deposit of your claim payments n Check your HSA balance n View your latest claims statement n View your claims history n Check when your plan will cover your next purchase of glasses or contact lenses n Look up when you or your family members are eligible for your next dental check up n View customized information about what s covered in your plan n Print an all-in-one wallet coverage card summarizing your benefits A Guide to Shell Canada s Group Benefit Plans 1

8 CONTACT INFORMATION AND GETTING HELP continued n Use the online Wellness Centre to discover tools to help manage your health including health assessments, drug and medical libraries, calculators and more n Send a secure message. If you have a confidential question, you can send a secure message through Sun Life Financial Member Services website the Sun Life Financial Member Services website. Simply select Secure messages from above the blue navigation bar and follow the instructions. Your message and Sun Life Financial s response will remain completely confidential. SNAP THIS TAG TO CONNECT TO SUN LIFE FINANCIAL If you have a smart phone, you can snap this image to connect to our Customer Care Centre. First, get the free app for your phone at then aim your phone s camera at the tag and snap it. You can then call the Sun Life Financial Customer Care Centre or save the phone number on your phone. Emergency Travel Assistance Sun Life Financial provides emergency travel assistance in association with Europ Assistance USA, Inc. (Europ Assistance). If a medical emergency occurs while travelling, it is important that you or, if you are unable, someone close to you or a hospital employee, call the Europ Assistance operations centre before receiving medical care. Europ Assistance must pre-authorize any invasive or investigative procedures (e.g., surgery, angiogram, MRI), except in extreme circumstances. If you don t contact Europ Assistance your claim could be reduced or declined. For assistance while traveling, contact Europ Assistance. Country Number Instructions Canada and the U.S Call toll-free Cuba Call for an international operator. Ask for (collect call). Toll-free dialing or calls from public phones are not available. Elsewhere call Call collect You will be required to provide the following information: n Your Shell Canada contract number n Your Sun Life Financial member ID number n Your provincial health care insurance number Europ Assistance will confirm your eligibility for coverage and if possible arrange direct payment. The Europ Assistance contact information is also shown on your travel card and you can print the travel card by going to the Sun Life Financial Member Services website. 2 A Guide to Shell Canada s Group Benefit Plans

9 CONTACT INFORMATION AND GETTING HELP continued Unresolved Benefit Questions If you have a benefit question, please follow the steps below: 1. Review the benefit documents available on the SBC under the Forms and Documents section. 2. If you cannot find the information on the SBC, contact the SBC: n Toll-free at ( if you re if you re outside Canada and the U.S.) from 6 a.m. to 6 p.m. Mountain Time, or n Go to and click Help. 3. If your question is in regard to a health or dental claim or coverage information, contact Sun Life Financial at ( if you re outside Canada (6 a.m. to 6 p.m. Mountain Time) 4. If you have completed all of the above actions and do not believe your situation has been resolved, send an to SCAN-Unresolved-Pension-and-Benefits-Issues@shell.com for review. You will be contacted within 48 hours. Long Term Disability Desjardins Financial Security (Desjardins) provides the Long Term Disability plan under Policy Life Insurance Desjardins Financial Security provides the Basic Life Insurance plan under Policy Sun Life Financial provides the Optional Life Insurance plan under Policy To view your Life Insurance coverage, find and link to information about the plan, and make changes when appropriate (including beneficiary changes), contact the Shell Benefits Centre: n Go to n Select mybenefits Accident Insurance Desjardins Financial Security provides the Basic Accident Insurance plan under Policy ia Financial Group provides the Optional Accident Insurance plan under Policy To view your Accident Insurance coverage, find and link to information about the plan, and make changes when appropriate (including beneficiary changes), contact the Shell Benefits Centre: n Go to n Select mybenefits A Guide to Shell Canada s Group Benefit Plans 3

10 HEALTH AND DENTAL Overview As a regular active employee, you start with company-paid coverage: n Emergency medical coverage while on company business outside of your home province or outside of Canada n $1,500 Health Spending Account (HSA) credit (Quebec employees may decline each year), and n HSA Plus for you (employee only coverage) Instead of HSA Plus, you have the choice of enrolling for a different health and dental coverage within 45 days from your date of hire that best meets your needs: n Any combination of Extended Health Care and Dental coverage (Basic, Enhanced or Decline) for you, for you plus one dependent, or for you plus two or more dependents, or n HSA Plus for you plus one or more dependents, or n Decline all optional health and dental coverage YOU START WITH... Emergency Travel Assistance while on company business + 1 HSA is a Health Spending Account you can use to pay for almost any health or dental expense not reimbursed by another plan. 2 Health Support is a limited extended health plan that provides financial protection against some of the costs of a major illness, injury or emergency travel assistance. $1,500 HSA 1 + HSA Plus (additional $1,500 HSA and Health Support 2 ; employee only coverage) OR YOU CHOOSE... ONE EXTENDED HEALTH CARE OPTION Basic OR Enhanced AND ONE DENTAL OPTION Basic OR Enhanced OR YOU CHOOSE... Decline health care and/or dental coverage Add dependents Add dependents 4 A Guide to Shell Canada s Group Benefit Plans

11 $1,500 HEALTH SPENDING ACCOUNT (HSA) Overview As a regular active employee, you automatically receive a credit of $1,500 to your HSA on January 1 of each year or at the time of hire, regardless of other Shell Canada health and dental coverage you choose. Shell Canada automatically provides this benefit at no cost to you. About Your HSA A HSA is an account you use to pay for eligible health and dental expenses (or portions of those expenses) that are not covered by any other plan. Reimbursements from your HSA are tax-free, except in Quebec. See Tax Considerations at the end of this section for more information. There are no maximums or per visit limits; you are limited only by the balance in your account. Eligible expenses are governed by the Canada Revenue Agency (CRA). See Eligible HSA Expenses in this section for more information. Family Members Eligible for HSA Your HSA may be used to reimburse eligible health and dental expenses for you, your spouse and other eligible family members who are dependent on you for financial support as defined by the Canada Income Tax Act including: n The child or grandchild of you or your spouse, or n The parent, grandparent, brother, sister, uncle, aunt, niece or nephew of you or your spouse, if the dependent is resident in Canada at any time in the year However, only your spouse and eligible dependent children may be covered by Health Support. Two Years to Use It Eligible expenses you incur between January 1 and December 31 may be reimbursed from your HSA credit for that year. If you do not submit enough expenses to use your full $1,500 HSA credit during the year, the balance is automatically carried forward to the next year. You may use this balance in addition to the new $1,500 credit you receive the next year to pay for eligible expenses incurred during the next year. Current year credits cannot be used to reimburse expenses incurred in the previous year. CRA rules state that a credit can be carried forward for only one year, and, if it is not used within that year, it is forfeited. This means if you do not incur sufficient expenses to use up the carried forward credit, the unused amount is forfeited. You have 90 days from the end of the second year to submit eligible expenses to be paid from the carried forward amount. Forfeiture of any carried forward credit occurs on March 1 following the end of the second year. Funding Shell contributes the amount required to fund your HSA. You are neither required nor permitted to contribute to your HSA. A Guide to Shell Canada s Group Benefit Plans 5

12 $1,500 HEALTH SPENDING ACCOUNT (HSA) continued Eligible HSA Expenses HSA utilizes the list of items that are eligible for the Medical Expense Tax Credit as defined by the CRA with the exception of premiums for the Shell Canada Extended Health Care and Dental plans. Medical Practitioners Expenses for the services of the following medical practitioners are eligible for reimbursement from your HSA if the practitioner is licensed by the province to perform the service provided: n Acupuncturist n Chiropodist or podiatrist n Chiropractor n Christian Science nurse or practitioner n Dental hygienist n Dentist n Dietician n Master of social work (MSW) (outside Quebec) n Medical doctor n Naturopath n Nurse (RPN, RN) n Occupational therapist n Optometrist, oculist or ophthalmologist n Osteopath n Physiotherapist n Psychoanalyst n Psychologist n Registered massage therapist n Speech therapist, speech language pathologist or audiologist n Therapist or therapeutist Eligible Prescription Drugs n Drugs, medications or other preparations or substances which are manufactured, sold or represented for use in the diagnosis, treatment or prevention of an illness, disorder, abnormal physical state or symptoms, or in modifying an organic function when prescribed by a medical practitioner or dentist, and dispensed and recorded by a pharmacist n Insulin test tapes and tablets n Oxygen n Vitamin B 12 and liver extract injectable for pernicious anemia Dental Care n Preventive, diagnostic, restorative, orthodontic and therapeutic care n The making or repairing of an upper and lower denture, or for the taking of impressions, bite registrations and insertions for the denture by a person who is authorized under the laws of a province to carry on the business of a dental mechanic 6 A Guide to Shell Canada s Group Benefit Plans

13 $1,500 HEALTH SPENDING ACCOUNT (HSA) continued Vision Care n Eyeglasses or other devices (contact lenses) for the treatment or correction of a defect of vision, prescribed by a medical practitioner n Laser eye surgery Care and Facilities n Public or licensed private hospital (including hospitals located outside Canada) n A full-time attendant or full-time care in a nursing home for a person who has a severe and prolonged mental or physical impairment n A full-time attendant in a self-contained domestic establishment if a qualified medical practitioner certifies that the patient is likely to be dependent on others for his or her personal needs and care for a prolonged and indefinite period of time because of a mental or physical infirmity. The attendant must be at least 18 years of age and not the spouse of the patient. n Full-time care in a nursing home for a person who, because of a lack of normal mental capacity, is and will continue to be dependent on others for his or her personal needs and care. The certification of a qualified medical practitioner is required to support the need for this care. n Care and/or training at a school, institution or other place (nursing home) when the person has been certified to be someone who, because of a physical or mental disability, requires the equipment, facilities and personnel specially provided by that school, institution or other place. An appropriately qualified person must certify that the person s disability requires such special care. This also includes care of a person who suffers from behavioural problems and is attending a school specializing in this type of problem. Assistance Devices, Supplies and Equipment n Artificial eye n Artificial limbs n Crutches n Iron lung/portable chest respirator n Rocking bed for poliomyelitis victims n Wheelchair, including scooters and wheel-mounted geriatric chairs n Spinal brace/support n Brace for a limb n Ileostomy or colostomy pad, including pouches and adhesives n Truss for hernia n Laryngeal speaking aid n Aids to hearing, including hearing aids, Cochlear implant, and devices that produce extra loud signals n Artificial kidney machine, including costs for reasonable and necessary alterations to a home to accommodate the kidney machine and the costs of housing the machine (e.g., insurance, heating, maintenance, repairs) n Oxygen tent or other equipment necessary to administer oxygen for medical purposes n Cloth diapers, disposable briefs, catheters, catheter trays, tubing or other products required for incontinence caused by illness or injury A Guide to Shell Canada s Group Benefit Plans 7

14 $1,500 HEALTH SPENDING ACCOUNT (HSA) continued Medical Devices and Equipment PRESCRIBED FOR CHRONIC CONDITIONS n Device or equipment to assist in breathing, including a replacement part, designed exclusively for use by a person suffering from a severe chronic respiratory ailment or a severe chronic immune system disregulation, but not including a humidifier, dehumidifier, heat pump, or heat or air exchanger n Air or water filter or purifier for use by a person who is suffering from a severe chronic respiratory ailment or a severe chronic immune system disregulation to cope with or overcome that ailment or disregulation n Electric or sealed combustion furnace acquired to replace a furnace that is neither an electric furnace nor a sealed combustion furnace, where the replacement is necessary solely because of a severe chronic respiratory ailment or a severe chronic immune system disregulation n Air conditioner for use in coping with a severe ailment, illness or disorder, to a maximum of 50% of the cost of the air conditioner or $1,000, whichever is less PRESCRIBED FOR IMPAIRED MOBILITY n Power-operated guided chair installation that is designed to be used solely in a stairway n Mechanical device or equipment designed to be used to assist a person to enter or leave a bathtub or shower or to get on and off a toilet n Device that is designed to assist a person in walking when they have a mobility impairment n Power-operated lift or transportation equipment designed exclusively for use by a disabled person to allow access to different areas of a building or to assist the person to gain access to a vehicle or to place the person s wheelchair in or on a vehicle n Device designed exclusively to enable a person with a mobility impairment to operate a vehicle PRESCRIBED FOR OTHER IMPAIRMENTS n Teletypewriter or similar device, including a telephone ringing indicator, that enables a deaf or mute person to make and receive telephone calls n Optical scanner or similar device designed to enable a blind person to read print n Device or equipment, including a synthetic speech system, Braille printer and large print on-screen device, designed exclusively to be used by a blind person in the operation of a computer n Electronic speech synthesizer that enables a mute individual to communicate by use of a portable keyboard n Device used to decode special television signals to permit the script of a program to be displayed visually n A visual or vibratory signaling device, including a visual fire alarm indicator, for a person with a hearing impairment 8 A Guide to Shell Canada s Group Benefit Plans

15 $1,500 HEALTH SPENDING ACCOUNT (HSA) continued PRESCRIBED FOR MISCELLANEOUS REASONS n Custom-made wig for a person who has suffered abnormal hair loss due to an illness, medical treatment or accident n Needles and syringes for injections n Device or equipment designed to pace or monitor the heart of a person suffering from heart disease n Orthopedic shoe or boot or an insert for a shoe or boot custom made for a person to overcome a physical disability n Hospital bed including the necessary attachments n External breast prosthesis that is required because of a mastectomy n Device designed to be attached to infants diagnosed as being prone to Sudden Infant Death Syndrome (SIDS) in order to sound an alarm if the infant stops breathing n Infusion pump, including disposable peripherals, used in the treatment of diabetes or a device designed to enable a diabetic to measure blood sugar levels n Electronic or computerized environmental control system designed exclusively for the use of a person with a severe and prolonged mobility restriction n Extremity pump or elastic support hose designed exclusively to relieve swelling caused by chronic lymphedema n Inductive coupling osteogenesis stimulator for treating non-union of fractures or aiding in bone fusion Transportation, Meals and Accommodation n Transportation of a patient by ambulance to or from a public or licensed private hospital n Transportation of a patient by a person engaged in the business of providing transportation services from the locality where the patient lives to a place more than 40 kilometers from that locality where medical services are normally provided (or from that place to that locality), provided: substantially equivalent medical services are not available in that locality the route travelled by the patient is reasonably direct, and it is reasonable for the patient to travel to that place to obtain medical services This also includes the transportation of one other person to accompany the patient when the patient has been certified by a medical practitioner to be incapable of travelling without the assistance of an attendant. n Reasonable expenses for meals and accommodation for the patient and, if necessary, the accompanying person, provided the conditions for the above transportation expenses are satisfied and the distance travelled to obtain medical services is more than 80 kilometers from the locality where the patient lives A Guide to Shell Canada s Group Benefit Plans 9

16 $1,500 HEALTH SPENDING ACCOUNT (HSA) continued Other Medical Expenses n Cost of laboratory, radiological and other diagnostic procedures or services for maintaining health and preventing illness or assisting in the diagnosis or treatment of an injury, illness or disability when prescribed by a medical practitioner n Acupuncture treatment when performed by a qualified medical practitioner n Whirlpool or hot tub treatment, if prescribed by a medical practitioner (does not include cost of equipment) n Reasonable expenses for rehabilitative therapy, including training in lip reading and sign language, in order to adjust to the patient s hearing or speech loss n Reasonable expenses for renovations or alterations to a dwelling of a patient who lacks normal physical development or who has a severe and prolonged mobility impairment, to enable the patient to gain access to, or to be mobile or functional within, the dwelling n For a patient who requires a bone marrow or organ transplant: reasonable expenses, including legal fees, to locate a compatible donor and to arrange for the transplant reasonable travelling, board and lodging expenses of the donor and the patient This also includes the expenses of one person who accompanies the donor and another person who accompanies the patient. n For a patient who is blind or profoundly deaf or who has a severe and prolonged impairment that markedly restricts the use of arms or legs: costs of acquisition, care and maintenance, including food and veterinary care, of an animal specially trained to assist the patient in coping with the impairment and provided by a person or organization whose main purpose is the training of such animals reasonable travel, board and lodging expenses while in full-time attendance at a school, institution or other facility that trains persons with disabilities in the handling of such animals Ineligible HSA Expenses HSA utilizes the list of items that are eligible for the Medical Expense Tax Credit as defined by the CRA with the exception of premiums for the Shell Canada Extended Health Care and Dental plans. 10 A Guide to Shell Canada s Group Benefit Plans

17 $1,500 HEALTH SPENDING ACCOUNT (HSA) continued Tax Considerations Your HSA credit and reimbursements you receive from your HSA are not subject to federal income tax or provincial income tax except in Quebec. No tax means more money for you to spend on health and dental expenses. In Quebec, the HSA is a taxable benefit. The taxable benefit amount is equal to the average reimbursement from the HSA per participating employee plus the average expenses, premium tax and sales tax. The taxable benefit amount for the HSA, as well as other health and dental benefits, is included in Box J on the Relevé 1 (RL-1). Every Shell employee participating in the $1,500 HSA in Quebec is subject to the same taxable benefit regardless of the amount of reimbursement you personally receive. For example, at a 24% marginal tax rate, you would pay approximately $360 in Quebec provincial income tax on a $1,500 taxable benefit. However, making use of your HSA is still beneficial because you pay no federal income tax on your reimbursement. Due to the tax implications, Quebec employees may decline the $1,500 HSA. If you choose to decline, you cannot participate in $1,500 HSA until the next calendar year. If you participate in HSA Plus you cannot decline the $1,500 HSA. To decline the $1,500 HSA benefit, contact the Shell Benefits Centre: n Toll-free at ( if you re outside Canada and the U.S.) from 6 a.m. to 6 p.m. Mountain Time, or n Go to and click Help. You must decline this benefit by December 15 each year in order to decline coverage for the next calendar year. A Guide to Shell Canada s Group Benefit Plans 11

18 BUSINESS TRAVEL MEDICAL EMERGENCY TRAVEL ASSISTANCE Overview This benefit provides emergency medical coverage when you travel on business outside your home province or outside Canada. It pays for eligible emergency hospital or medical expenses that are in excess of your provincial health care coverage. The coverage also includes emergency travel assistance with Sun Life Financial emergency travel assistance provider, Europ Assistance USA, Inc. (Europ Assistance), a 24-hour world travel assistance service that provides help in most languages for both medical and non-medical emergencies that occur while you are travelling almost anywhere in the world. Coverage While Travelling on Company Business Shell automatically provides this benefit at no cost to you. No enrollment is necessary. However, you must be covered under provincial health care to be eligible for this benefit. Eligible emergency hospital or medical expenses that are in excess of your provincial health care coverage are reimbursed at 100%. Coverage is in effect for 72 hours before and 72 hours after your scheduled business activities. If you are not enrolled in Shell Canada s Extended Health Care or HSA Plus plans, you should buy personal travel insurance if your personal travel will extend beyond the 72 hours covered under business travel insurance. Your dependents are not included in your business travel coverage. If you are planning an out-of-province business trip and you have a medical condition that is not stable (e.g., you have received treatment or had a change in medication in the last three months), you should obtain clearance from your doctor or Shell Health, Occupational Health before travelling (although this does not guarantee a claim will be paid). Emergency Services Europ Assistance will pay 100% of the cost of covered emergency services. Europ Assistance will only cover emergency services obtained within 120 days of the date you leave the province where you live if you are covered under Extended Health Care and within 60 days if you are covered under HSA Plus. If hospitalization occurs within this period, in-patient services are covered until the date you are discharged. Emergency Services mean any reasonable medical services or supplies, including advice, treatment, medical procedures or surgery, required as a result of an emergency. When a person has a chronic condition, emergency services do not include treatment provided as part of an established management program that existed prior to the person leaving the province where the person lives. Emergency means an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by a doctor. At the time of an emergency, you or someone with you must contact Europ Assistance. All invasive and investigative procedures (including any surgery, angiogram, MRI, PET scan, CAT scan), must be pre-authorized by Europ Assistance prior to being performed, except in extreme circumstances where surgery is performed on an emergency basis immediately following admission to a hospital. If contact with Europ Assistance cannot be made before services are provided, contact with Europ Assistance must be made as soon as possible afterwards. If contact is not made and emergency services are provided in circumstances where contact could reasonably have been made, then Sun Life Financial has the right to deny or limit payments for all expenses related to that emergency. An emergency ends when you are medically stable to return to the province where you live. 12 A Guide to Shell Canada s Group Benefit Plans

19 BUSINESS TRAVEL EMERGENCY TRAVEL ASSISTANCE continued Referred Services Referred services must be for the treatment of an illness and ordered in writing by a doctor located in the province where you live. 80% of the costs of referred services will be paid. Your provincial medicare plan must agree in writing to pay benefits for the referred services. All referred services must be: n Obtained in Canada, if available, regardless of any waiting lists, and n Covered by the medicare plan in the province where you live. However, if referred services are not available in Canada, they may be obtained outside of Canada. Eligible Travel Medical Expenses Europ Assistance will cover emergency services while you are outside the province where you live and they will also cover referred services. For both emergency services and referred services, Europ Assistance will cover the cost of: n A semi-private hospital room n Other hospital services provided outside of Canada n Out-patient services in a hospital n The services of a doctor Expenses for all other services or supplies eligible under this plan are also covered when they are incurred outside the province where you live, subject to the reimbursement level and all conditions applicable to those expenses. Emergency Travel Assistance Medical Emergency Assistance AROUND-THE-CLOCK ACCESS Assistance in almost any language, through a toll-free/call-collect telephone hotline and fax line, is available 24 hours a day, seven days a week. INFORMATION ON LOCAL MEDICAL CARE Europ Assistance will refer you to a local physician, dentist, pharmacist or appropriate medical facility. MONITORING YOUR MEDICAL CARE Medical care and services will be monitored by medical staff who will maintain contact as frequently as necessary with you, your attending physician, your personal physician and your family. Medical Transportation If Europ Assistance determines, in consultation with an attending physician, that it is medically necessary for a covered member/dependent to be transported under medical supervision to a different hospital or treatment facility or to be sent home, they will arrange, guarantee, and if necessary, advance the payment of the transportation. Return Home of Dependent Children If dependent children, under sixteen, are left unattended due to the hospitalization of a companion, transportation will be arranged to return them to their normal place of residence. Cost of transportation will be paid less any redeemable portion of original ticket. If necessary, round-trip transportation for a qualified escort to accompany the children will be arranged. A Guide to Shell Canada s Group Benefit Plans 13

20 BUSINESS TRAVEL EMERGENCY TRAVEL ASSISTANCE continued Visit by a Family Member If, while travelling alone or under sixteen, you or one of your covered dependents become hospitalized and are expected to remain in the hospital for more than seven consecutive days, expenses for one round-trip economy transportation will be paid for one member of the immediate family to visit. Reimbursement will be made for the cost of accommodation and meals, subject to a maximum of $150 Canadian per day per person for up to seven consecutive days. The visit must be approved in advance by Europ Assistance. Return of Deceased If you die while out of the province where you live, Europ Assistance will arrange for all necessary government authorizations and for the return of your remains, in a container approved for transportation, to the province where you live. Europ Assistance will pay a maximum of $5,000 Canadian per return. Expenses related to the burial are not eligible. Vehicle Return Europ Assistance will arrange and, if necessary, advance funds up to $500 Canadian for the return of a private vehicle to the province where you live or a rental vehicle to the nearest appropriate rental agency if death or a medical emergency prevents you from returning the vehicle. Meals and Accommodation For Companion Reimbursement will be made for the cost of accommodation and meals, subject to a maximum of $150 Canadian per day per person for up to seven consecutive days if the return trip is delayed due to illness of the covered person. Meals and Accommodation For Covered Person(s) Reimbursement will be made for the cost of accommodation and meals, subject to a maximum of $150 Canadian per day per person for up to five consecutive days if released from the hospital but not able to travel yet. A maximum of $150 Canadian per day will be paid for the convalescing covered individual and accompanying covered family member s meals and accommodation at a commercial establishment up to a maximum of five consecutive days. Lost or Stolen Luggage or Travel Documents If your luggage or travel documents become lost or stolen while you are travelling outside of the province where you live, Europ Assistance will attempt to assist you by contacting the appropriate authorities and by providing directions for the replacement of the luggage or documents. Translation Services This service provides translation services in major languages. Emergency Message Service Europ Assistance will transmit an urgent message from you to your home, business or other location. Europ Assistance will keep messages to be picked up in its offices for up to 15 days. 14 A Guide to Shell Canada s Group Benefit Plans

21 BUSINESS TRAVEL EMERGENCY TRAVEL ASSISTANCE continued Claims Payment Service If your medical expenses are greater than $200 Canadian, Europ Assistance arranges for the payment of medical expenses, provided you contact them before the expense is incurred. You will be asked to sign an authorization form, allowing Europ Assistance to coordinate payment of the claim on your behalf through your provincial government health insurance plan and Sun Life Financial. If required, Europ Assistance will forward an advance deposit to the hospital before medical services are rendered. If payments made on your behalf are subsequently determined to be for ineligible services or amounts, Sun Life Financial reserves the right to recover the overpayment from you. If you do not contact Europ Assistance before expenses are incurred or if your medical expenses are less than $200 Canadian, you are responsible for paying the expense and submitting the itemized bills to Europ Assistance upon your return. Also include your dates of travel (departure and return) and the details regarding the emergency. You do not have to send claims for doctors or hospital fees to your provincial medicare plan first. This way you receive your refund faster. Sun Life Financial and Europ Assistance coordinate the whole process with most provincial plans and all insurers, and send you a cheque for the eligible expenses. Europ Assistance will ask you to sign a form authorizing them to act on your behalf. If you are also covered under other plans, Europ Assistance will coordinate payments with the other plans in accordance with guidelines adopted by the Canadian Life and Health Insurance Association. The plan from which you make the first claim will be responsible for managing and assessing the claim. It has the right to recover from the other plans the expenses that exceed its share. Emergency Services Excluded from Coverage COVERAGE Any expenses related to the following emergency services are not covered: SHELL CANADA CONTRACT NUMBER Extended Health Care/Dental HSA Plus Your Sun Life Financial member ID number is 100 followed by the last six digits of your Shell People personnel number. For example, if your Shell People personnel number is , your Sun Life Financial member ID number will be n Services that are not immediately required or which could reasonably be delayed until you return to the province where you live, unless your medical condition reasonably prevents you from returning to that province prior to receiving the medical services n Services relating to an illness or injury which caused the emergency, after such emergency ends n Continuing services, arising directly or indirectly out of the original emergency or any recurrence of it, after the date that Sun Life Financial or Europ Assistance, based on available medical evidence, determines that you can be returned to the province where you live, and you refuse to return n Services which are required for the same illness or injury for which you received emergency services, including any complications arising out of that illness or injury, if you had unreasonably refused or neglected to receive the recommended medical services n Where the trip was taken to obtain medical services for an illness or injury, services related to that illness or injury, including any complications or any emergency arising directly or indirectly out of that illness or injury A Guide to Shell Canada s Group Benefit Plans 15

22 BUSINESS TRAVEL EMERGENCY TRAVEL ASSISTANCE continued Emergency Services Outside Canada Expenses incurred for emergency services outside Canada are subject to a lifetime maximum of $1,000,000 Canadian per person or, if lower, any other applicable lifetime maximum. Limits on Emergency Travel Assistance Coverage There are countries where Europ Assistance is not currently available for various reasons. For the latest information, please call Europ Assistance before your departure. Europ Assistance reserves the right to suspend, curtail or limit its services in any area, without prior notice, because of: n A rebellion, riot, military up-rising, war, labour disturbance, strike, nuclear accident or an act of God n The refusal of authorities in the country to permit Europ Assistance to fully provide service to the best of its ability during any such occurrence Liability of Sun Life Financial or Europ Assistance Neither Sun Life Financial nor Europ Assistance will be liable for the negligence or other wrongful acts or omissions of any physician or other health care professional providing direct services covered under this group plan. To get the most up-to-date emergency travel assistance information access the Sun Life Financial Member Services website: n Go to n Select my coverage from the my health and well-being section n Select Print travel card from the Take me to menu Sun Life Financial Member Services website 16 A Guide to Shell Canada s Group Benefit Plans

23 EXTENDED HEALTH CARE PLAN Overview The Extended Health Care plan helps you pay for many health expenses not covered by provincial health care. You may choose Basic or Enhanced coverage, or you may decline Extended Health Care coverage. You may remain in HSA Plus instead of choosing Extended Health Care and Dental benefits. Summary of Extended Health Care Options The following table summarizes the eligible expenses and helps you compare the coverage provided under each Extended Health Care option. This is a summary only review the Eligible Extended Health Care Expenses section for specific plan details. EXTENDED HEALTH CARE OPTIONS... ELIGIBLE EXPENSES BASIC ENHANCED DECLINE Eligible Prescription Drugs 80% 80% No Drug card provided Drug card provided coverage Does not include drugs that do not legally require a prescription (i.e., over-the-counter drugs) Includes drugs that do not legally require a prescription if they are prescribed by a doctor and dispensed by a pharmacist Vision Care 80% of cost of one eye exam every 80% of cost of one eye exam every 24 months (every 12 months for 24 months (every 12 months for children under 19) children under 19) 80% of cost for prescribed glasses 80% of cost for prescribed glasses or contact lenses to a maximum or contact lenses to a maximum of $100 every 24 months (every of $200 every 24 months (every 12 months for children under 19) 12 months for children under 19) Hearing Aids 80% to a maximum of $300 every 80% to a maximum of $500 every 60 months 60 months Licensed Health Practitioners 80% up to $20 per visit and a 80% up to $30 per visit and a Acupuncturist, chiropodist/ maximum of $400 per calendar maximum of $600 per calendar podiatrist, chiropractor, year per type of practitioner year per type of practitioner massage therapist, Provincial restrictions may limit Provincial restrictions may limit naturopath, osteopath, eligibility and reimbursement eligibility and reimbursement physiotherapist, speech therapist Psychological Counseling 80% up to $100 per visit to a 80% up to $100 per visit to a maximum of $750 per calendar year maximum of $900 per calendar year Registered Nursing 80% to a maximum of $10,000 80% to a maximum of $20,000 per calendar year per calendar year Hospital Accommodation 100% for semi-private 100% for semi-private Ambulance 100% 100% 80% of the cost to upgrade to a private room to a maximum of $100 per day Medical Services 80% 80% and Equipment Maximums apply to specific items Maximums apply to specific items Accidental Dental 80% 80% Emergency Travel 100% of eligible expenses for trips of 100% of eligible expenses for trips of Assistance up to 120 days to a lifetime maximum up to 120 days to a lifetime maximum of $1,000,000 Canadian of $1,000,000 Canadian All maximums listed are per covered person. A Guide to Shell Canada s Group Benefit Plans 17

24 EXTENDED HEALTH CARE PLAN continued The Basic and Enhanced options cover many of the same eligible expenses but may have different reimbursement limits. You choose the eligible dependents you want to cover. You may cover different dependents under Extended Health Care than you cover under Dental. Your premiums are based on the option you choose (Basic or Enhanced or Decline) and the number of dependents you cover (employee only, employee plus one dependent, or employee plus two or more dependents). Eligible Extended Health Care Expenses The Extended Health Care plan covers expenses that are reasonable and customary, as determined by Sun Life Financial, provided they are: n Medically necessary for the treatment of an illness and recommended by a doctor n Incurred for the care of a person insured under this program n Reasonable, taking all factors into account n Not covered under provincial health care or any other government-sponsored program n Legally insurable under provincial or federal law or regulation Specific limitations and exclusions may affect the eligibility of an expense. Review Limitations and Exclusions in this section before you incur the expense. Eligible Prescription Drugs Basic 80% reimbursement Reimbursement will be made for medically necessary drugs that are appropriate for treatment of a health condition and legally require a prescription in order to be dispensed. All drugs must have a Drug Identification Number (DIN) and be prescribed by a physician or a dentist and dispensed by a pharmacist. In addition, the following drugs are eligible: n Injectible drugs and vitamins, insulin and allergy extracts n Compounded prescriptions, if one of the ingredients is an eligible expense n Needles, syringes and chemical diagnostic aids for the treatment of diabetes n Oral and non-oral prescribed contraceptives n Prescription drugs used in the treatment of sexual dysfunction (maximum $1,200 per covered person per calendar year) n Prescription drugs used in the treatment of obesity (maximum $1,800 per covered person per calendar year) n Smoking cessation drugs that require a prescription, e.g., Zyban (lifetime maximum $500 per covered person). Nicotine gum and patches are not eligible, as these items can be purchased without a prescription n Oral and injected preventive vaccines and medicines n Sclerotherapy medications (maximum $15 per visit) n Drugs for the treatment of infertility Some drugs that do not legally require a prescription are covered if they are life sustaining and have been prescribed by a doctor, such as insulin preparations and anti-anginal agents like nitro-glycerine. The maximum reimbursement for an advance supply of any prescribed drug is between one and three months depending on the type of drug. Enhanced 80% reimbursement Coverage includes the prescription drug coverage described under Basic plus drugs that are necessary for day-to-day functioning that do not legally require a prescription but have been prescribed, have a DIN, and are dispensed by a pharmacist. 18 A Guide to Shell Canada s Group Benefit Plans

25 EXTENDED HEALTH CARE PLAN continued FOR RESIDENTS OF QUEBEC Coverage includes the prescription drug coverage described above plus additional drugs to meet the requirements of the Régie de l assurance maladie du Québec (RAMQ) formulary for mandatory drug coverage. If RAMQ requirements change, Shell Canada s plan will change accordingly. Ineligible Drugs The following are not eligible for reimbursement under Basic or Enhanced coverage even if prescribed by a physician: n Experimental drugs or investigational treatments that are not approved for treatment of a specific condition by Health Canada or other regulatory body for the general public n Household remedies n Contraceptives other than prescribed oral and non-oral n Vitamins, minerals, protein supplements, therapeutic nutrients, diets and dietary supplements, infant foods, sugar or salt substitutes and natural health products n Lozenges, mouthwashes, non-medicated shampoos, contact lens care products, skin cleansers, protectives and emollients n The cost of giving injections, serums and vaccines n Muscle relaxants which do not require a prescription n Hair growth stimulants n Drugs for cosmetic purposes n Drugs, biologicals and related preparations which are intended to be administered in hospital on an in-patient or out-patient basis and are not intended for a patient s use at home If you have any question as to whether or not a drug expense is eligible for reimbursement, obtain the DIN and contact Sun Life Financial or use the Sun Life Financial Member Services website. Vision Care Basic 80% reimbursement for the cost of one eye exam every 24 consecutive months and 80% reimbursement to a maximum of $100 every 24 months for glasses or contact lenses per covered person (eye exams and glasses or contact lenses every 12 months for covered children under age 19) Enhanced 80% reimbursement for the cost of one eye exam every 24 consecutive months and 80% reimbursement to a maximum of $200 every 24 months for glasses or contact lenses per covered person (eye exams and glasses or contact lenses every 12 months for covered children under age 19) Eligible vision care expenses include: n An eye examination by an optometrist n Prescription eyeglasses and contact lenses that are necessary for the correction of vision, including charges for fitting and repairs SUN LIFE FINANCIAL PAY-DIRECT DRUG CARD You will receive a Sun Life Financial pay-direct drug card if you participate in either the Basic or Enhanced Extended Health Care options. See the Submitting Claims for Health and Dental Expenses section for more information on how to use the drug card. Sun Life Financial Member Services website n Prescription eyeglasses and contact lenses that are certified by an ophthalmologist as necessary due to a surgical procedure or the treatment of keratoconus are limited to a lifetime maximum reimbursement of $250 for the non-surgical treatment of keratoconus and $250 per covered person for expenses incurred within six months of each surgical procedure A Guide to Shell Canada s Group Benefit Plans 19

26 EXTENDED HEALTH CARE PLAN continued As a Sun Life Financial benefits plan member, you can save up to 20 per cent on prescription lenses, frames and contact lenses through the Preferred Vision Services (PVS) network. Many locations also apply the discount to non-prescription eyewear and accessory items. Through the PVS network you can also save 10 per cent of the cost of laser eye correction surgery (Lasik MD ) and prescription eyewear purchased online through ClearlyContacts.ca. In addition, discounts are available from selected Hearing practitioners. PVS network providers are all independent practitioners. To find a provider near you, visit or call toll-free Tell the practitioner that you are covered under a Sun Life Financial benefits plan and pay the reduced price. Non-prescription glasses or sunglasses are not an eligible expense. Safety glasses required for work may be reimbursed in accordance with your local safety program. Please refer to your local safety policy and procedures. Hearing Aids Basic 80% reimbursement to a maximum of $300 per covered person every 60 consecutive months Enhanced 80% reimbursement to a maximum of $500 per covered person every 60 consecutive months Reimbursement will be made for the purchase, installation, maintenance or repair of hearing aids, including the cost of batteries. Health Practitioners Basic 80% reimbursement up to $20 per visit and a maximum of $400 per calendar year per type of practitioner per covered person Enhanced 80% reimbursement up to $30 per visit and a maximum of $600 per calendar year per type of practitioner per covered person Reimbursement will be made for the services of eligible licensed health practitioners recognized in your province including: n Acupuncturist n Audiologists n Chiropodist/podiatrist n Chiropractor n Dieticians n Massage therapist n Naturopath n Occupational therapist n Osteopath n Physiotherapist n Speech therapist The plan also pays the cost of one X-ray per calendar year for each of the following practitioners: n Chiropractors n Osteopaths n Podiatrists/chiropodists 20 A Guide to Shell Canada s Group Benefit Plans

27 EXTENDED HEALTH CARE PLAN continued Psychological Counseling Basic 80% reimbursement to a maximum of $100 per visit and $750 per calendar year per covered person Enhanced 80% reimbursement to a maximum of $100 per visit and $900 per calendar year per covered person Psychological counseling includes therapeutic counseling by a licensed psychologist or social worker. A physician s referral is not required. Other counseling practitioners such as pastoral counselors and family therapists, may be eligible under this benefit with a referral before treatment begins. Reimbursement for services obtained as a result of Employee Assistance Program referrals is included in the annual maximum. For further information, contact Shell Health, Occupational Health. Registered Nursing Basic 80% reimbursement to a maximum of $10,000 per calendar year per covered person Enhanced 80% reimbursement to a maximum of $20,000 per calendar year per covered person Coverage includes the in-home services of a registered nurse, registered nursing assistant, certified nursing assistant or licensed practical nurse. Treatment must require the level of expertise of the practitioner. The prescribed services must be for a temporary period only and not available through provincial health care, community health programs, nursing homes or similar institutions. Before registered nursing begins you should submit a detailed treatment plan with cost estimates to Sun Life Financial to confirm coverage. See Pre-Authorizing New Treatments near the end of this section for more information. The following are not eligible expenses under this benefit: n Services provided primarily for custodial care, homemaking duties or supervision n Services performed by an immediate family member or someone who lives with the patient n Services performed while the patient is confined in a hospital, nursing home or similar institution Hospital Accommodation in Canada Acute Care Basic 100% reimbursement for the difference in cost between ward and semi-private accommodation in hospital Enhanced 100% reimbursement for the difference in cost between ward and semi-private accommodation in hospital and 80% of the difference in cost between semi-private and private accommodation in hospital to a maximum of $100 per day Reimbursement will be made for accommodation at a legally licensed acute care institution operated for the care and treatment of sick and injured persons as in-patients, and that: n Provides facilities for diagnosis, major surgery or rehabilitation n Provides 24-hour nursing service by registered nurses and has a physician in regular attendance, and n Is eligible to receive payments under a provincial hospital plan The following are not eligible for reimbursement: n Expenses for nursing homes, rest homes, homes for the aged, blind or deaf n Expenses for institutions operated primarily for the care and treatment of alcoholics, drug addicts, or the mentally ill, unless the institution is eligible to receive payments under a provincial hospital plan n Charges for any portion of the cost of ward accommodation, user fees or similar charges A Guide to Shell Canada s Group Benefit Plans 21

28 EXTENDED HEALTH CARE PLAN continued Hospital Accommodation in Canada Rehabilitative, Convalescent or Chronic Care Basic 80% reimbursement to a maximum of $50 per day Enhanced 80% reimbursement to a maximum of $100 per day Reimbursement is limited to 180 days for each period of confinement. Eligible expenses include room and board charges for semi-private accommodation for rehabilitative, convalescent and chronic care (not custodial care) in a licensed hospital in Canada. Confinement must occur immediately following the patient s discharge from a legally licensed acute care institution and be certified by a physician as medically necessary. Eligible facilities include: n A legally licensed hospital with beds or units designated for convalescent care and that provides diagnosis, care and treatment of a person suffering from illness or injury on a 24-hour basis, with 24-hour services by registered nurses and physicians n Specialized treatment licensed hospital facilities, such as for mental illness, cancer or arthritis when approved by Sun Life Financial The following are not eligible for reimbursement: n Expenses for nursing homes, rest homes, homes for the aged, blind or deaf n Expenses for institutions operated primarily for the care and treatment of alcoholics, drug addicts, or the mentally ill, unless the institution is eligible to receive payments under a provincial hospital plan n Charges for any portion of the cost of ward accommodation, user fees or similar charges Ambulance in Canada Basic 100% reimbursement Enhanced 100% reimbursement Ambulance service in Canada including on-site medical treatment and licensed ground ambulance service or emergency air ambulance service to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation. This is limited to one trip to and from the hospital for any one period of confinement. Medical Services and Equipment Basic 80% reimbursement Enhanced 80% reimbursement Eligible expenses include: n Trusses, crutches, plaster of paris or fiberglass casts, splints n Medically necessary equipment rented or purchased at Sun Life Financial s request, that meets your basic medical needs. If alternate equipment is available, eligible expenses are limited to the cost of the least expensive equipment that meets your basic medical needs. For expenses incurred for a wheelchair, coverage is limited to the use of a manual wheelchair, except if the person s medical condition warrants the use of an electric wheelchair. n Wigs and hairpieces for temporary or permanent hair loss due to illness or medical treatment to a maximum of $200 per covered person every two years Before purchasing orthotics, check with Sun Life Financial for detailed information about the documentation Sun Life Financial requires in order to process your claim. See the All Plans section for contact information. 22 A Guide to Shell Canada s Group Benefit Plans

29 EXTENDED HEALTH CARE PLAN continued n Prostheses and supports (non-dental): artificial limbs or other prosthetic appliances Before you purchase, repair or rent medical supplies and/or equipment, contact Sun Life braces (other than foot braces) Financial to find out what documents they orthopedic shoes, orthopedic modifications to shoes, will require in order to process your claim, and custom-made orthotics when prescribed by a e.g., prescription, test results or proof of licensed supplier. Sun Life Financial reserves doctor or podiatrist for the correction of deformity the right to limit benefits. of the bones and muscles provided they are not primarily for athletic use (limited to a combined maximum of one pair per covered person per calendar year) n Support stockings, stump socks and pressure gradient hose (maximum four pairs per covered person per calendar year) n Surgical brassieres (maximum four per covered person per calendar year) n Ileostomy, ostomy, colostomy supplies n Surgical dressings n Joint lubrication therapy for osteoarthritis (e.g., Synvisc or Orthovisc) n Oxygen, plasma and blood transfusions n Blood glucose monitors for insulin-dependent diabetics n Insulin pumps n Radiotherapy or coagulotherapy n Incontinence supplies such as diapers, pads and disposable briefs required as a result of an illness n Diagnostic laboratory and X-ray examinations (except MRIs and CAT scans) n Insurable utilization fees which are imposed by the government under the provincial health care plan in your province of residence for the use of a service which is an eligible expense To be eligible for reimbursement, the rental or purchase of medical services and equipment must be pre-approved by Sun Life Financial. See Pre-Authorizing New Treatments near the end of this section for more information. Accidental Dental Basic 80% reimbursement Enhanced 80% reimbursement Charges for the treatment of accidental injuries to natural teeth or jaw provided the treatment is rendered within 12 months of the accident. Services required in conjunction with such a fracture or injury due to a condition that existed before the accident are excluded. Expenses for an injury caused by biting or chewing are not eligible under this benefit. A physician s recommendation is not required. Before treatment begins you should submit a detailed treatment plan with cost estimates to Sun Life Financial to confirm coverage. See Pre-Authorizing New Treatments near the end of this section for more information. A Guide to Shell Canada s Group Benefit Plans 23

30 EXTENDED HEALTH CARE PLAN continued Emergency Travel Assistance for Personal Travel You and your covered dependents have emergency travel assistance for personal travel as described under Business Travel Emergency Travel Assistance to a lifetime maximum of $1,000,000 Canadian per person. If you have declined all optional Shell Canada health coverage, you do not have emergency travel assistance for personal travel. You should consider buying personal travel insurance anytime you are travelling outside your home province for personal reasons. Basic 100% reimbursement to a lifetime maximum of $1,000,000 Canadian per covered person; covers personal travel for trips of up to 120 days Enhanced 100% reimbursement to a lifetime maximum of $1,000,000 Canadian per covered person; covers personal travel for trips of up to 120 days Coverage is in effect for trips up to 120 days, beginning from the date you leave your home province. You should make personal travel insurance arrangements before you leave your home province if you will be travelling for longer than 120 days. If you have been out of your home province for more than 120 consecutive days you must return to your home province for at least 24 hours to qualify for coverage again. See the Business Travel Emergency Travel Assistance section for information on eligible travel medical expenses and emergency travel assistance. Non-emergency expenses are not eligible for coverage under the Emergency Travel Assistance benefit. The Extended Health Care plan reimburses you for eligible expenses incurred outside of your home province or outside of Canada as though the expense had been incurred in your home province. For example, if you fill an eligible prescription after leaving the hospital where you were treated for an emergency, the expense is reimbursed under the prescription drug category. Annual Out-of-Pocket Maximum If eligible expenses for you or a covered dependent exceed $10,000 Canadian in a single calendar year, any further eligible expenses for that person in that same calendar year are reimbursed at 100% instead of 80%. This helps protect you in the event that you or a covered family member has unusually high health expenses in one year. It means the maximum out-of-pocket cost for eligible expenses for any covered person is $2,000 Canadian per calendar year. Sun Life Financial keeps track of expenses for each covered person and automatically begins 100% reimbursement of claims when someone reaches the annual out-of-pocket maximum. Specific per-item maximums and limits continue to apply. For example, even if you reach the out-of-pocket maximum, reimbursement for glasses and contact lenses is still limited to $100 Canadian every 24 months under Basic and $200 Canadian every 24 months under Enhanced. The out-of-pocket maximum does not include or apply to hospital, ambulance, or emergency out-of-province expenses, since these expenses are already reimbursed at 100%. 24 A Guide to Shell Canada s Group Benefit Plans

31 EXTENDED HEALTH CARE PLAN continued Limitations n Reimbursement for all eligible prescription drugs will be limited to the cost of the generic drug unless your physician prescribes a brand name drug and writes no substitution on the prescription. If your physician does not explicitly prohibit substitution, you may still purchase the brand name drug, but the plans will only pay based on the cost of the generic equivalent n Some provincial health care plans prohibit reimbursement for certain items until the maximum payable under the provincial plan has been reached n Where applicable, the plan will pay only after the annual maximum under your provincial health care plan has been reached, even if the provincial plan allows an insurance company to pay while the provincial plan is reimbursing n Provincial restrictions may limit eligibility and reimbursement of health practitioner expenses contact Sun Life Financial for details n A physician s referral is not required to receive reimbursement for the services of eligible licensed health practitioners n You and your eligible dependents must be covered under a provincial health care plan to be eligible for coverage under the Extended Health Care plan n Benefits are paid only for those eligible expenses that are considered by Sun Life Financial to be reasonable and medically necessary. When available, the fee guide established by a recognized professional association or the payment limit set by the provincial medical authority will be used in determining the reasonable and customary charge n A physician s prescription is required for an eligible expense, unless noted otherwise n Sun Life Financial may require evidence or additional information in addition to a prescription from a physician or other practitioners to establish the eligibility of the claim before reimbursement is made n If you receive benefits under the Extended Health Care plan for an injury or illness for which a third party is or may be liable for damages, Sun Life Financial may request completion of a subrogation agreement. The agreement means that, where permitted by law, you will be required to reimburse Sun Life Financial for those amounts which, when added to the payments received from Sun Life Financial, exceed 100% of your incurred expenses Exclusions No benefit is payable from this plan for: n Out-of-province expenses for the regular treatment of an injury or illness which existed before the patient s departure from his or her province of residence n Items purchased primarily for athletic use n Coverage that is prohibited by the government n Any appliance not listed as an eligible expense n Services of a homemaker n Services performed or provided by the covered person, an immediate family member or a person who lives with the covered person n Dental expenses except those described under the Accidental Dental benefit n Expenses for elective, cosmetic or experimental medical treatment or surgery, including supplies and other expenses associated with the treatment or surgery n Transportation and accommodation expenses n Services provided by telephone n Expenses for services or supplies provided while confined in a hospital on an in-patient basis A Guide to Shell Canada s Group Benefit Plans 25

32 EXTENDED HEALTH CARE PLAN continued n Expenses payable under provincial health care, Workers Compensation or any government plan n Expenses incurred due to intentionally self-inflicted injuries or illnesses n Expenses incurred due to civil disorder or war, whether war was declared or not n Services required as a result of committing or attempting to commit a criminal offence n Charges for missed or cancelled appointments n Charges for the completion of claim forms or other forms n Expenses incurred as a result of injury sustained while operating a motor vehicle while under the influence of an intoxicant, including alcohol n Expenses for periodic checkups or third-party examinations n Expenses for services or supplies provided by an employer s benefit department n Expenses that are not permitted by law to be paid n Charges for services and supplies when there would have been no charge in the absence of private insurance Pre-Authorizing New Treatments It is recommended that you send a treatment plan to Sun Life Financial and obtain pre-authorization before incurring any significant health or dental expense, to confirm what will be covered under the plan. For example, expenses incurred under the registered nursing and accidental dental benefits are often significant amounts. A treatment plan is a written description of the proposed course of treatment prepared by your doctor or health professional. A pre-authorization will tell you how much of the expense will be covered by the plan and how much you are responsible for paying. To obtain a pre-authorization, mail the completed treatment plan along with any supporting documentation such as X-rays or DIN, to Sun Life Financial. You will be required to provide the following information: n Your Shell Canada contract number n Your Sun Life Financial member ID number n The patient s name n If the patient is a student child over 21, the name of the school he or she attends Tax Considerations COVERAGE SHELL CANADA CONTRACT NUMBER Extended Health Care/Dental HSA Plus Your Sun Life Financial member ID number is 100 followed by the last six digits of your Shell People personnel number. For example, if your Shell People personnel number is , your Sun Life Financial member ID number will be Shell s contribution to the Extended Health Care plan and reimbursements you receive from the plan are not subject to federal income tax or provincial income tax except in Quebec. In Quebec, Shell s contribution to the Extended Health Care plan is a taxable benefit for provincial income tax purposes. The taxable benefit is equal to the average cost per participant including reimbursements, administrative expenses, premium tax and sales tax, minus your individual premium. The taxable benefit amount for the Extended Health Care plan, as well as other health and dental benefits, is included in Box J on the Relevé 1 (RL-1). 26 A Guide to Shell Canada s Group Benefit Plans

33 DENTAL PLAN Overview The Dental plan helps you pay for many treatments to maintain or restore healthy teeth and gums. You may choose Basic or Enhanced coverage, or you may decline Dental coverage. You may remain in HSA Plus instead of choosing Extended Health Care and Dental. Summary of Dental Options The following table summarizes the eligible expenses and helps you to compare the coverage provided under each Dental option. This is a summary only review the Eligible Dental Expenses that follow for specific plan details. DENTAL OPTIONS... ELIGIBLE EXPENSES BASIC ENHANCED DECLINE Preventative Services 100% 100% No (recall exams every coverage 9 months, and cleaning) Minor Restorative Services 90% 90% (X-rays, fillings, extractions, endodontics) Major Restorative Services 50% to a maximum of $1,500 60% to a maximum of $2,500 (crowns, inlays, onlays, per calendar year per calendar year implants, gold fillings, dentures, bridges) Orthodontics 50% to a lifetime maximum of $1,500 60% to a lifetime maximum of $2,500 per covered person under age 21 per covered person (under age 25 for full-time students), Adults and eligible children of any provided the treatment commenced age are covered prior to age 19 All maximums listed are per covered person. You choose the eligible dependents you want to cover. You may cover different dependents under Dental than you cover under Extended Health Care. Your premiums are based on the option you choose (Basic or Enhanced or Decline) and the number of dependents you cover (employee only, employee plus one dependent, or employee plus two or more dependents). A Guide to Shell Canada s Group Benefit Plans 27

34 DENTAL PLAN continued Eligible Dental Expenses Eligible expenses are reimbursed up to the recommended fee in the current dental association fee guide in the province in which the expense was incurred. Specific limitations and exclusions may affect the eligibility of an expense. Review Limitations and Exclusions in this section before you incur an expense and for more information about the dental fee guides. Preventive Services Basic 100% reimbursement Enhanced 100% reimbursement Eligible expenses include: n One recall visit per covered person every nine months, including: a recall examination one set of bite wing X-rays topical application of fluoride phosphate one unit of light scaling and one unit of polishing, or prophylaxis n Root planing and scaling in excess of that covered by a recall visit up to a maximum of 16 combined time units per calendar year per covered person n Consultation required by an attending dentist n Pit and fissure sealants Minor Restorative Services Basic 90% reimbursement Enhanced 90% reimbursement It is recommended that you submit a treatment plan before incurring any major dental expense. See Pre-Authorizing New Treatments near the end of this section for more information. Eligible expenses include: n Full mouth X-rays or a panoramic film once every two calendar years per covered person n Space maintainers that replace permanently lost teeth n Amalgam, acrylic and composite fillings n Veneers provided for dental health reasons n Stainless steel crowns on primary teeth n Surgical procedures such as extractions n Periodontic treatment (excluding alveoplasty and surgical services) n Endodontic treatment, including root canal therapy n Repair or recementing of crown, inlays, onlays or bridgework n Repair of dentures n Relining or rebasing of dentures once every 36 months and only after six months have elapsed since the installment of an initial or replacement denture n Tissue conditioning 28 A Guide to Shell Canada s Group Benefit Plans

35 DENTAL PLAN continued Major Restorative Services Basic 50% reimbursement to a maximum of $1,500 per covered person per calendar year Enhanced 60% reimbursement to a maximum of $2,500 per covered person per calendar year It is recommended that you submit a treatment plan before incurring any major dental expense. See Pre-Authorizing New Treatments near the end of this section for more information. Eligible expenses include: n Inlays, onlays, gold fillings or crowns to restore diseased or accidentally broken teeth provided the tooth is functionally impaired by incisal angle or cuspal damage n Replacement of inlays, onlays or crowns every five years n Partial and complete dentures, adjustments to dentures within the six months following installation, and replacement of temporary dentures n Fixed bridgework and replacement of temporary bridgework n Replacement of denture or fixed bridgework or addition of teeth to bridgework, if necessary due to extraction of a natural tooth, if denture or bridgework cannot be made serviceable n Dentures or bridgework more than five years old n Dental implants, crowns on implants, and other structures attached to implants n Periodontal splinting n Diagnostic casts n Alveoplasty and periodontal surgical services Orthodontic Services Basic 50% reimbursement to a lifetime maximum of $1,500 per covered person under age 21 (under age 25 for full-time students), provided the treatment commenced prior to age 19. Enhanced 60% reimbursement to a lifetime maximum of $2,500 per covered person (no age restrictions) It is recommended that you submit a treatment plan before incurring any orthodontic expense. See Pre-Authorizing New Treatments near the end of this section for more information. Eligible expenses include braces and other treatments for improperly aligned teeth. Limitations n Eligible expenses are reimbursed up to the recommended fee in the current dental association fee guide in the province in which the expense was incurred. It is important to note that each dentist sets their own rates for the services they provide. You are responsible for paying any amount the dentist charges above the fee guide. In Alberta, a fee guide has not been published since Reimbursement is based on the 1997 fee guide adjusted for inflation. n If the expense was incurred outside Canada, reimbursement is made according to Sun Life Financial s reasonable and customary fee schedule n Services provided by denturists are reimbursed according to the denturist fee guide n Charges by dental specialists are reimbursed according to the dental specialist fee guide, up to a maximum of 120% of the charges established for general dental practitioners in the dental association fee guide A Guide to Shell Canada s Group Benefit Plans 29

36 DENTAL PLAN continued n If an eligible dental procedure is listed in the current fee guide but no fee is specified, reimbursement is limited to the reasonable and customary amount as determined by Sun Life Financial n To be eligible for reimbursement, anaesthesia and laboratory procedure charges must be completed in conjunction with other services and submitted with the procedure code of the actual dental work n If you receive benefits under the Dental plan for an injury or illness for which a third party is or may be liable for damages, Sun Life Financial may request completion of a subrogation agreement. This agreement means that, where permitted by law, you will be required to reimburse Sun Life Financial for those amounts which, when added to the payments received from Sun Life Financial, exceed 100% of your incurred expenses. Exclusions No benefit is payable from this plan for: n Cosmetic services n Charges for surgical facilities or suites n Permanent splinting n Crowns or onlays placed on a tooth that is not functionally impaired by incisal angle or cuspal damage n Any expense incurred for full mouth restorations, vertical dimension correction or correction of temporamandibular joint dysfunction n Anti-snoring or sleep apnea devices n Prosthetic devices ordered before the patient was covered under this plan, or ordered while the patient was covered under this plan but installed after coverage ceased n Any service which, in Sun Life Financial s opinion, is experimental or is not required to maintain or restore dental health n Expenses for lost, stolen or mislaid dentures, orthodontic appliances or space maintainers n Approved expenses for continued orthodontic treatment if the treatment takes place after coverage stops n Charges for services and supplies when there would have been no charge in the absence of private insurance n Services performed by a person who is ordinarily a resident in the patient s home n Expenses payable under provincial health care, Worker s Compensation or any government plan n Expenses incurred due to intentionally self-inflicted injury or illness n Expense incurred due to civil disorder or war, whether the war was declared or not n Services required as a result of committing or attempting to commit a criminal offence n Charges for missed or cancelled appointments n Charges for the completion of claim forms or other forms n Expenses incurred as a result of injury sustained while operating a motor vehicle while under the influence of an intoxicant, including alcohol n Expenses for periodic checkups or third-party examinations If alternative methods of treatment are available which, in Sun Life Financial s opinion, provide a professionally adequate result, reimbursement will be based on the least expensive treatment. 30 A Guide to Shell Canada s Group Benefit Plans

37 DENTAL PLAN continued Pre-Authorizing New Treatments It is recommended that you send a treatment plan to Sun Life Financial and obtain pre-authorization before incurring any significant health or dental expense, to confirm what will be covered under the plan. For example, expenses incurred under the registered nursing and accidental dental benefits are often significant amounts. A treatment plan is a written description of the proposed course of treatment prepared by your doctor or health professional. A pre-authorization will tell you how much of the expense will be covered by the plan and how much you are responsible for paying. To obtain a pre-authorization, mail the completed treatment plan along with any supporting documentation such as X-rays or DIN, to Sun Life Financial. You will be required to provide the following information: n Your Shell Canada contract number n Your member ID number n The patient s name n If the patient is a student child over 21, the name of the school he or she attends Tax Considerations COVERAGE SHELL CANADA CONTRACT NUMBER Extended Health Care/Dental HSA Plus Your Sun Life Financial member ID number is 100 followed by the last six digits of your Shell People personnel number. For example, if your Shell People personnel number is , your Sun Life Financial member ID number will be Shell s contribution to the Dental plan and reimbursements you receive from the plan are not subject to federal income tax or provincial income tax except in Quebec. In Quebec, Shell s contribution to the Dental plan is a taxable benefit for provincial income tax purposes. Your taxable benefit is equal to the average plan costs per participant including reimbursements, administrative expenses, premium tax and sales tax, minus your individual premium. The taxable benefit amount for the Dental plan, as well as other health and dental benefits, is included in Box J on the Relevé 1 (RL-1). A Guide to Shell Canada s Group Benefit Plans 31

38 HEALTH SPENDING ACCOUNT PLUS (HSA PLUS) Overview With HSA Plus, you receive an additional $1,500 annual credit to your HSA, plus Health Support for specified eligible expenses. You may remain in HSA Plus or you may add dependents or you may decline HSA Plus coverage. You may also choose Extended Health Care and Dental benefits instead of HSA Plus. HSA Plus includes the basic $1,500 HSA credit provided to all employees and an additional credit of $1,500, for a total of $3,000. You use the HSA to reimburse your day-to-day health and dental expenses. You must have provincial health care coverage to submit claims for health expenses to a HSA. The Health Support portion of HSA Plus covers eligible emergency out-of-province and out-of-canada medical expenses and after you reach the annual deductible, Health Support covers 100% of eligible prescription drugs, registered nursing, semi-private hospital room, ambulance services and medical services and equipment (some limits apply). HERE S WHAT IT LOOKS LIKE HSA $1,500 credit + additional $1,500 credit Pays for Health Support premium and reimburses all eligible health and dental expenses up to the balance in your account + HEALTH SUPPORT Covers 100% of: n eligible emergency out-of-province medical expenses AND n after you reach the annual deductible: eligible prescription drugs*, registered nursing, semi-private hospital, ambulance and medical services and equipment (some limits apply) Annual Deductibles $2,000 per individual to a maximum of $3,000 per family * For Quebec residents, Health Support covers 100% of RAMQ formulary drugs after you reach the annual RAMQ out-of-pocket maximum. HERE S HOW IT WORKS STEP ONE You Receive... Two credits to your HSA on January 1: The $1,500 that all regular active employees receive AND The additional $1,500 for HSA Plus participants For a total of $3,000 STEP TWO Your HSA pays... Your annual premium for Health Support AND All eligible health and dental expenses up to the balance in your account STEP THREE After you use up the balance in your HSA, you pay... All dental expenses AND All health expenses until you reach the Health Support deductible* STEP FOUR After you reach the annual deductible, Health Support pays % of eligible prescription drugs, registered nursing, semi-private hospital, ambulance and medical services and equipment expenses up to annual maximums And you pay... All expenses not covered by Health Support Health Support pays % of eligible emergency out-of-province medical expenses for trips of 60 days or less (regardless of the balance in your HSA or whether you have reached the Health Support deductible) to a lifetime maximum of $1,000,000 Canadian * Expenses for eligible prescription drugs, registered nursing, semi-private hospital, ambulance and medical services and equipment count towards the Health Support deductible, whether you use your HSA to pay for them, you pay for them yourself, or they are paid by another non-government plan (as long as you submit the statement of reimbursement). The following do not count towards the Health Support deductible: emergency out-of-province medical expenses, expenses that are not covered by Health Support (such as dental treatments, vision care and medical practitioners), and any amount reimbursed from a government plan. 32 A Guide to Shell Canada s Group Benefit Plans