INSTRUCTIONS ACTIVE MEMBERS

Transcription

1 INSTRUCTIONS ACTIVE MEMBERS OPP ASSOCIATION GROUP INSURANCE FORM Please read carefully prior to completing the form(s) Mandatory and Optional Group Insurance Benefit Coverage OPP Insurances:! Basic Life Insurance & Long Term Income Protection (LTIP): Mandatory! Health/Vision/Hearing/Dental Plan: Optional! Supplementary Life Insurance: Optional! Dependent Life Insurance (Spouse and/or Child(ren)): Optional OPP Association Insurances:! Basic Life/Accidental Death & Dismemberment: Mandatory for Active Members, Optional for Retirees! Dependent Life (Spouse and / or Child(ren)): Optional! $10,000 Life/Accidental Death & Dismemberment: Optional! $20,000 Life: Mandatory for Active members, Optional for Retirees! Spousal Life $30,000/$60,000: Optional! Voluntary Accidental Death & Dismemberment (Member Only or Family): Optional! Critical Illness (Member, Spouse, Child(ren)): Optional Medical Underwriting Requirements Evidence of Insurability or Medical Application Forms are Medical & Lifestyle Questionnaires that are required by the Insurance Company for Medical Underwriting to approve coverage on specific insurances. Insurances may have an exemption from medical underwriting if the application is received by Target Benefit Administrator within 31 days of a Life Event. Life Events are considered to be: new hire date, common law relationship, marriage, birth or adoption of a child, legal divorce or death of an immediate family member. Another exception is a Guaranteed Issued amount where medical underwriting is only required above a specific amount of Insurance. OPP Insurances:! Basic Life Insurance & Long Term Income Protection (LTIP): Not required! Health/Vision/Hearing/Dental Plan: Not required! Supplementary Life Insurance: Required unless application is received within 31 days of a Life Event! Dependent Life Insurance (Spouse and/or Children): Not required

2 OPP Association Insurances:! Basic Life/Accidental Death & Dismemberment: Not required! Dependent Life (Spouse and / or Child(ren)): Spouse: Required unless application is received within 31 days of a Life Event. Biological/Adopted Child(ren): Not required. Step Child(ren): follow coverage of their biological parent.! $10,000 Life/Accidental Death & Dismemberment: Required unless application is received within 31 days of a Life Event! $20,000 Life: Not required! Spousal Life $30,000/$60,000: Always required! Voluntary Accidental Death & Dismemberment (Member Only or Family): Not required! Critical Illness (Member, Spouse, Child(ren)): Member: Guaranteed Issue up to $50,000. Spouse: Guaranteed Issue up to $25,000. Child(ren): Not required For Life Insurances, the Member Evidence of Insurability and Spouse Evidence of Insurability is available via the OPPA website at by electing the Benefits tab, Member Benefit Services (Target Benefits) and then Forms Library. For Critical Illness Insurances, the Medical Application (applicable to Member and Spouse) is available via the OPPA website at by electing the Benefits tab, Member Benefit Services (Target Benefits) and then Forms Library. The original form(s) must be sent to Target Benefit Administrators. If you require assistance, please contact Target Benefit Administrators at Beneficiary Designation It is recommended that a Primary and Contingent Beneficiary be named. The primary Beneficiary(ies) would make a claim for the insurance in effect on the date of death of the insured member. If the Primary Beneficiary(ies) is not alive on the date of death of the insured member, then the Contingent Beneficiary(ies) would make a claim. A Trustee should be named if any listed beneficiary is under 18 years of age. Effective Date of Coverage New Hires: Insured Benefits (Health/Vision/Hearing/Dental Plan) coverage comes into effect on the first of the month coinciding with the hire date or following two months of continuous service. Direct Hire/Amalgamated members: Insured Benefits coverage and Life & AD&D Policies come into effect on the date of hire. Where approval of the insurance carrier is required the effective date of coverage is the first of the month coinciding with or following the date coverage is approved by the insurance provider.

3 Definition of a Spouse A spouse is a person who is:! Legally married to the insured employee; or! If not legally married to the insured employee, cohabitates with such employee in a conjugal relationship. Effective date for spouse if added at New Hire, a spouse has the same effective date as the member. If addition is after, the effective date for a spouse is the first of the month following receipt of the application at Target Benefit Administrators. Definition of a Dependent Child The child must be unmarried and one of the following:! A natural or legally adopted child of the employee; or! A child living with the employee during the time of adoption probation; or! A step- child residing in the employee s household and for whom the employee is financially responsible; or! A child living with the employee and who is supported solely by the employee, and who is a relative by blood or marriage or is under the employee s legal guardianship. In addition, the dependent child must be:! A child who is under twenty- one (21) years of age; or! A child who is twenty- one (21) years of age or older but not yet twenty- six (26) years of age and in full- time attendance at an accredited educational institution; or! A child who is twenty- one (21) years of age or older who was insured under the plan prior to reaching age 21 years and who is mentally or physically disabled and financially dependent on the employee. For a child to be considered a disabled dependent disability criteria of the insurance company must be met. Effective date for child(ren): if added at New Hire, a child has the same effective date as the member. If addition is after and received within six months of the child s date of birth, the effective date is retro active to the child s date of birth. If the application is received by Target Benefit Administrators past six months from the child s date of birth, the effective date is the first of the months following receipt of the application. Definition of Coordination of Benefits (COB) Benefit coverage under more than one extended health plan and determination of the sequence in which coverage will apply.

4 Forms, Signatures and Mailing The OPP Association Group Insurance Form and Medical Underwriting forms are available via the OPP Association website at by clicking on Member Benefit Services and click on Forms Library (My Benefits). The forms must be printed, completed, signed and the original mailed to Target Benefit Administrators. If you have any questions regarding this process, please contact the Target Benefit Administrators at FORM SECTIONS New Hire Add/Change/Remove Member Beneficiary/ Add/Increase Add/Increase Cancellation TO BE spouse or child Name Trustee Life/AD&D Life Policy of Change Change Policy for for spouse Insurances* COMPLETED Member 1. Member Application 2. Reason for Change/Life Event 3. Plan Member Change of Name 4. Group Insurance Benefits If applicable 5. Dependent Information If applicable 6. Member Life Insurance If applicable If applicable 7. Dependents Life Insurance (if applicable) If applicable 8. Optional Accidental Death and Dismemberment If applicable If applicable If applicable If applicable (AD&D) 9. Optional Critical Illness Insurance (CI) If applicable If applicable If applicable If applicable 10. Appointment or Change of Beneficiary 11. Privacy Read Read Read Read Read Read Read 12. Authorization and Declarations

5 *Cancellation of Insurances may require an additional Cancellation Letter process, contact Target Benefit Administrators.