HEALTH AND WELFARE TRUST AGREEMENT

Transcription

1 1 HEALTH AND WELFARE TRUST AGREEMENT This agreement is made effective on between (dd/mm/yr) 1. (company name) Referred to as "the Employer" - and - 2. BeneCo+ Referred to as "the Agent" 1.0 Appointment of Agent 1.1 The Employer hereby appoints BeneCo+ as Agent for the Employer, for the establishment of a health and welfare trust pursuant to the provisions of the Income Tax Act, Canada. 2.0 Duties of Agent 2.1 The Agent shall establish and maintain a health and welfare trust on behalf of the Employer and for this purpose may: a) establish the terms of the trust in writing, b) change the terms of the trust from time to time as the Agent sees fit, by giving 60 days notice to the Employer. c) appoint one or more trustees, and change trustees, from time to time as the Agent sees fit, b) enter into agreements with the trust, to provide and be paid for services to the trust, which services may include any services required by the trust to properly provide the benefits for which the trust is established. 2.2 The Agent shall act reasonably and in good faith in carrying out its duties. 3.0 The Trust

2 2 3.1 The trust shall administer, directly or through the agent and other agents, an employee health and welfare benefit plan, pursuant to the provisions of the Income Tax Act. 3.2 The Agent may, if requested, assist the Employer in creating an employee health and welfare benefit plan, and shall be paid for its services, as may be agreed between the parties at the time. 3.3 The Employer shall establish, and the trust shall administer, the plan hereto attached and marked as Plan "A" (Client Master File) unless the parties otherwise agree in writing. 4.0 Fee 4.1 The Employer shall pay to the Agent: a) an initial fee of $ to establish the trust and b) an annual maintenance fee to keep the trust in effect, on the anniversary date of the trust, of $ The trust may use the Agent to provide administrative services on behalf of the plan, for the benefit of the Employer and the Employee, and the Employer shall pay for such services a processing fee for each claim, of 10% (Min. $25.00) 4.3 The Agent may change the annual maintenance fee and the processing fee, for any subsequent trust year, by giving notice to the Employer at least 60 days prior to the end of a trust year. 5.0 Termination 5.1 Either party may terminate this agreement at any time by giving 30 days notice to the other. 5.2 Upon termination, and in regard to any employee health and welfare benefit plan administered on behalf of the Employer, a) the trust shall finalize the administration of any funds or claims under its jurisdiction to the date of termination, b) the trust shall account for and make available to the employees, listed as

3 3 beneficiaries of the trust, any funds under its administration, c) the trust shall otherwise cease to be responsible to the Employer and it's employees, and d) the plan shall terminate on the date of termination, unless transferred to another trust by the Employer. 6.0 Notice 6.1 Unless otherwise specified, all notices given under this Agreement shall be in writing. 6.2 Notices need not be personally served, and may be delivered to the address for service. 6.3 Service shall be deemed to be made if notice is sent by single registered mail. The date of service shall be deemed to be seven days after the date of mailing, subject only to any interruption of postal service reasonably apparent to the person giving notice, in which case notice shall require proof of actual delivery to the address for services. 6.4 Each party may notify the other of a change in address for service, in the manner set out herein. 6.5 The address for service of the parties shall be as follows: Agent: 1131 Ranchlands Blvd N.W. Calgary, Alberta T3G 1G4 Employer: (legal company name) THIS AGREEMENT WAS EXECUTED BY THE PARTIES ON THE DATES SET OUT BELOW. Company Authorizing Signature: Witness: Date: BeneCo+ Per: Witness: Date:

4 4 HEALTH & WELFARE TRUST AGREEMENT FOR "Child" - means: a child of the Employee or his spouse, and shall include a step-child, adopted child or foster child. 1.2 "Dependent - means: a) a person of the opposite or same sex of the Employee, who is either: i) legally married to the Employee; or ii) living with the Employee, and who is publicly represented as the employee's spouse; b) an unmarried child under the age of 18; c) an unmarried child who is registered and attending as a fulltime student at an institute of higher learning, and who is under the age of 25; d) an unmarried child who is incapable of supporting himself because of a mental or physical handicap. e) dependent parent(s) and/or grandparent(s). 1.3 "Employee" - means a person who is: a) employed by the Employer, b) a Director of the Employer, or c) retired from the service of the Employer, and who has received notice from the Employer that coverage shall continue and who s EMPLOYEE NOTIFICATION OF COVERAGE is hereto attached. 1.4 "Hospital - means a lawfully operated institution under the supervision of a staff of physicians. 1.5 Illness means a bodily or mental disorder of any kind including an illness related pregnancy. 1.6 "Injury" - means an accidental injury.

5 5 1.7 "Physician" - means a licensed doctor or dentist practising within the scope of his license 1.8 "Plan" - means the provisions of this document. 1.9 "Service" - means the Trustee appointed to administer the BeneCo+ Health and Welfare Trust for the purpose of this plan. 2.0 Plan Administration 2.1 This plan shall be administered by an Employee Health and Welfare Benefit Trust established by or on behalf of the Employer, pursuant to the provisions of the Income Tax Act. 2.2 The Employer shall keep a record of Employees covered by the plan, and shall make copies of those records available to the covered Employees and the trustee, at all reasonable times. 2.3 This is a "Cost Plus" plan and the Employer shall make contributions to the plan only as required to fund the cost of each claim as it is presented plus the processing fee. 2.4 The Employer shall make contributions as determined by the trustees of the plan, within 15 days of notification of the required amount by the trustees, and these shall include: a) the claims amount, and b) administration fees and expenses. 2.5 All funds shall be paid in Canadian dollars. 3.0 Eligibility 3.1 An Employee and their dependents shall be covered by this plan after: a) the parameters set out in the Employee Master File (i.e. Appendix A) 4.0 Claims Procedure 4.1 When a claim arises, a covered Employee shall provide documentation to the Employer:

6 6 a) as required to reasonably prove the claim, b) as required by the Taxation authorities under the Income Tax Act, and c) the Employer will submit a claim form to the trustees certifying that the claim submitted complies with the terms of this agreement as amended from time to time. 4.2 An Employee shall make a claim, and shall submit written proof of all expenses claimed, within 365 days of the date on which the expense was incurred, failing which a claim for that expense shall not be covered, unless accepted by the Employer at its absolute discretion. 4.3 If a claim is not allowed, any action by an Employee against the Employer or the trustees shall be brought within 365 days of the date that the claim was denied. 6.0 Health Coverage 5.1 All services and supplies reasonably necessary for the health care of an Employee are covered by this plan, except as listed under "exclusions". Covered expenses include, but are not limited to, the following: a) hospital charges; b) physician's and surgeon's charge c) prescribed drugs; d) ambulance service; e) services by a licensed psychologist; f) chiropractors' services; g) naturopath's services; h) private duty professional nursing services; i) treatment by a physiotherapist; j) treatments by x-ray, radium of radioactive isotopes; k) blood transfusions, including blood and blood plasma; l) oxygen, and rental of equipment for its use; m) purchase and repair of artificial limbs, artificial eyes, splints, trusses, braces, crutches and casts, and other prosthetic devices; n) rental of wheel chair, hospital bed or iron lung; o) services re-entered in the treatment of Temporal Mandibular Joint Dysfunction (TMJ);

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8 8 8.0 General Provisions 8.1 This plan shall be effective from the date on which it is adopted. 8.2 This plan may be amended by the Employer at any time by giving 14 days notice to the Employee affected by the change. No change shall affect a claim arising prior to the expiry of the notice. 9.0 Adoption of Plan 9.1 This plan is hereby adopted by the company for the benefit of its Employees, to be administered by a Health and Welfare Trust established by the company pursuant to the provisions of the Income Tax Act, Canada. Company authorizing signature: Date: Witness: Acknowledgment BeneCo+ hereby acknowledges receipt of a copy of this plan, and that it will deliver a copy of the plan to the trustees of BeneCo+ Employee Health and Welfare Benefit Trust", pursuant to its Agency Agreement with the Employer. Per: Date: Witness: