YOU AND YOUR BENEFITS

Transcription

1 YOU AND YOUR BENEFITS A Handbook for Salaried Employees in Canada Updated: February 1, /2017

2 INTRODUCTION This booklet presents general information only and is designed to give you a broad picture of some of the benefits that apply to you as a salaried employee of General Motors of Canada Company. Any reference to the payment of benefits is conditioned upon your eligibility to receive them. Each of these programs has its own terms and conditions which in all respects control the benefits provided and which may be amended from time to time pursuant to the power to amend referenced below or any power to amend set out in such terms and conditions. The benefits described in this booklet generally apply to salaried employees of General Motors of Canada Company actively at work. General Motors of Canada Company ( General Motors ) reserves the right to amend, modify, suspend or terminate any of its programs (including benefits) and policies covering employees and former employees, including retirees, at any time, including after employees retirements, without notice, by action of its Board of Directors or other committee expressly authorized by the Board to take such action. The programs, benefits and policies to which an employee or former employee, including retiree, is entitled are determined solely by the provisions of the applicable program, benefit or policy as amended from time to time. Absent an express delegation of authority from the Board, no one has authority to: commit General Motors to: any program, benefit, policy or provision under a program, benefit or policy not provided for under the written terms of applicable programs, benefits or policies; or change the eligibility criteria or any other provisions of such programs, benefits or policies. 01/2017

3 TABLE OF CONTENTS WHO TO CONTACT...1 EVENTS THAT MAY REQUIRE ACTION...2 CONTACTING THE GM CANADA BENEFITS CENTRE...3 Setting Up Your User ID... 3 Establishing Security Questions... 3 Your Password... 3 If You Lose or Forget Your Password... 3 Setting Up Your Address... 4 Contacting the GM Canada Benefits Centre by Telephone... 4 YOUR HEALTH CARE COVERAGES... 5 ELIGIBILITY... 5 BASIC HEALTH CARE COVERAGES... 5 GM CANADA HEALTH CARE COVERAGES... 5 Prescription Drug Benefits... 6 Out-of-Province, Hospital, Surgical and Medical Expense Coverage... 9 Prosthetic Appliance And Durable Medical Equipment Benefits Land and Air Ambulance Coverage Paramedical Coverages Long Term Care Coverage Chronic Care Coverage Dental Benefits Vision Benefits Hearing Aid Benefits Comprehensive Medical Expense Insurance Coverage Health Care Spending Account GENERAL INFORMATION ABOUT YOUR HEALTH CARE COVERAGES REQUIREMENT FOR MONTHLY HEALTH CARE CONTRIBUTION COORDINATION OF BENEFITS SUBROGATION EXCLUSIONS AND LIMITATIONS HOW TO CLAIM BENEFITS PLAN MEMBER ONLINE SERVICES CLAIM FORMS GREEN SHIELD CANADA Online Claims Prescription Drug Claims Out-of-Province Claims Hearing Aid Claims Dental Claims Vision Claims Long Term Care Expense Claims (Limited to those hired prior to January 1, 2007) Chronic Care Claims (Limited to those hired prior to January 1, 2007) Comprehensive Medical Expense Insurance Program (CMEIP) Claims Health Care Spending Account (HCSA) Claims i

4 EXPLANATION OF CERTAIN TERMS APPLICABLE TO HEALTH CARE COVERAGES Approved Facility or Treatment Program Co-payment Dental Predetermination (PDT) Eligible Dependents For Health Care Purposes Participating Provider WHILE YOU ARE DISABLED AND UNABLE TO WORK SICKNESS AND ACCIDENT BENEFITS EXTENDED DISABILITY BENEFITS TOTAL AND PERMANENT DISABILITY OR OCCUPATIONAL DISABILITY BENEFITS YOU MAY BE ASKED TO BE EXAMINED BY ADDITIONAL INSURANCE BENEFITS - FOR ACCIDENTAL INJURY OTHER BENEFIT PROGRAM COVERAGES WHILE ON DISABILITY LEAVE SUPPLEMENTAL BENEFITS FOR PREGNANCY, PARENTAL OR ADOPTION LEAVES OF ABSENCE SAVING WITH GENERAL MOTORS THE GM CANADA SAVINGS PROGRAM HOW THE PROGRAM WORKS DESIGNATION OF BENEFICIARIES ACCOUNT STATEMENT AND TAX INFORMATION WHEN YOU RETIRE FOR ALL ELIGIBLE EMPLOYEES FOR EMPLOYEES HIRED ON OR AFTER JANUARY 1, FOR EMPLOYEES HIRED PRIOR TO JANUARY 1, FOR ALL EMPLOYEES WITH BENEFITS ACCRUED UNTIL DECEMBER 31, 2006: FOR ALL EMPLOYEES WITH BENEFITS ACCRUED FROM JANUARY 1, 2007 TO DECEMBER 31, 2012, UNDER THE CAREER AVERAGE EARNINGS (CAE) FORMULA PROGRAM: FLEXPENSION PLUS PROGRAM (if applicable): ILLUSTRATIVE EXAMPLES: UNDERSTANDING YOUR ACCRUED BENEFITS (WORKING IN QUEBEC) FOR ALL EMPLOYEES IN THE DEFINED CONTRIBUTION PLAN FROM JANUARY 1, 2007 UNTIL DECEMBER 31, 2012 (WORKING IN QUEBEC): GENERAL PLAN PROVISIONS: WHEN YOU ARE ELIGIBLE TO RETIRE: ADDITIONAL BENEFIT PROGRAM COVERAGES POST RETIREMENT ESTIMATING YOUR PENSION IN THE EVENT OF DEATH FOR EMPLOYEES HIRED PRIOR TO JANUARY 1, 2007 GM CANADA INSURANCE PROGRAM BENEFITS GM CANADA RETIREMENT PROGRAM SURVIVOR BENEFITS HEALTH CARE BENEFITS FOR SURVIVORS GM SAVINGS PROGRAM BENEFITS FOR SURVIVORS ii

5 FOR EMPLOYEES HIRED ON OR AFTER JANUARY 1, GM CANADA INSURANCE PROGRAM BENEFITS OTHER SURVIVOR BENEFITS HEALTH CARE BENEFITS FOR SURVIVORS GM CANADA SAVINGS PROGRAM BENEFITS FOR SURVIVORS GENERAL INFORMATION GENERAL MOTORS PAYS FOR CESSATION OF INSURANCE COVERAGE YOUR GM CANADA "LENGTH OF SERVICE" "YEARS OF PARTICIPATION" UNDER THE INSURANCE PROGRAM BENEFITS FOR PART-TIME EMPLOYEES BENEFITS FOR TEMPORARY EMPLOYEES BENEFITS FOR CO-OP STUDENTS BENEFITS FOR JOB SHARE EMPLOYEES BENEFIT PROGRAM COVERAGES WHILE ON A LEAVE OF ABSENCE IF YOU LEAVE GENERAL MOTORS CARRIERS iii

6 WHO TO CONTACT The table below summarizes the carriers for the GM Canada pension and benefits programs, along with their tollfree telephone numbers, websites (if applicable) and some common reasons to contact them: CARRIER/SERVICE PROVIDER PROGRAM(S) SERVICED CONTACT INFORMATION COMMON REASONS TO CALL GM Canada Benefits Centre All benefits Pension For general pension and benefits information (Be prepared to provide your Benefits Centre User ID and Password) International To update benefits enrollment information e.g., insurance eligible dependents, beneficiaries To request forms e.g., dependent tuition To request PIN/Password Green Shield Canada Health Care Benefits To check the status of a claim Sun Life Insurance benefits e.g., Basic Life, Optional Group Life Disability coverage Group Critical Illness Insurance To inquire whether a specific claim is covered under the plan provisions To request claim forms Chubb Personal Accident Insurance For information on general plan details Great-West Life GMCL Savings Plan Defined Contribution Pension Plan (DCPP) Account FlexPension Plus Account To inquire about your personal account (including FlexPension Plus) To get current fund prices For program information (excluding Flex Pension Plus) To change your investment options GM Vehicle Purchase Centre Employee Vehicle Purchase Program To request an authorization number for use in purchasing a vehicle under the provisions of the program

7 EVENTS THAT MAY REQUIRE ACTION If your home address changes, please update your address through My Services on Socrates. For a checklist on how to handle common Life Situations go to Driving My Benefits. New Hires Getting Married Adding a Common Law Spouse Adding/Changing Dependents Short Term and Long Term Disability Terminating Your Employment Travelling Out of Province Getting Ready to Retire Add/Change Beneficiaries Birth and Adoption Substance Abuse Counselling 2

8 CONTACTING THE GM CANADA BENEFITS CENTRE The GM Canada Benefits Centre is your central source for various pension and benefit services. You can contact the GM Canada Benefits Centre for your pension and benefit requests, to access general plan information, request forms, or find out which carrier to contact for claims information. NOTE: To inquire about the adjudication of Health Care claims filed or to obtain Health Care benefit claims forms, contact Green Shield Canada directly or go online You can also refer to the Who To Contact section of this document for more information. The following services are administered through the GM Canada Benefits Centre: Defined Benefit Pension (if applicable) Eligibility for Health Care benefit coverage Insurance benefits (e.g., Basic Group Life, Optional Group Life) Assistance with Employee Vehicle Purchase Program if unable to get authorization number through the Family First contact number Other miscellaneous benefits To access your information, simply log on to the (Your Benefits Resources ) website 24 hours a day, Monday through Saturday, and after 1 p.m. EST on Sunday by going to The Benefits Centre website is fast, efficient and right at your fingertips! Setting Up Your User ID The first time you access the (Your Benefits Resources ) website you will be asked to establish a unique identifier (User ID) that you will use to access the website. You can choose any combination of 8 to 20 letters and/or numbers. (You cannot use your SIN for your password.) Establishing Security Questions For security purposes, you will be prompted to answer a few security questions. (For example, name of the street you grew up on or name of your first pet.) You will be asked to respond to your established questions during future visits to the (Your Benefits Resources ) website if you have forgotten your password. Your Password Your confidential password must be 4 to 20 characters in length (letters and/or numbers) and works the same way as the Personal Identification Number (PIN) that you would use at a bank machine. If You Lose or Forget Your Password If you lose or forgot your password, you will be asked to answer your established security questions. If you answer correctly, you may create a new password and proceed immediately to access your file. If you answer incorrectly or you have not set up your security questions, you will 3

9 be assigned a new, temporary password which will be ed to you the same day if you have previously set up your address on Your Benefits Resources, otherwise a mailed copy will be sent to your home address in 7-10 business days. Setting Up Your Address You can add your address when you login on to Your Benefits Resources website at After logging into the website, click on the Your Profile link, followed by Personal Information, and under Addresses select Add. You have the ability to make changes to your address at any time. When you provide your address on the Your Benefits Resources website you will be able to receive most communications directly to your Secure Participant Mailbox rather than having to wait for a mailed copy sent to you home in 7-10 business days. An will be sent to the address you provide to let you know that a communication is available for you. Contacting the GM Canada Benefits Centre by Telephone To contact the GM Canada Benefits Centre by telephone, call toll-free at Representatives are available from Monday to Friday, 8:30 a.m. to 5:00 p.m. EST. Every time you call the GM Canada Benefits Centre, you will be asked to enter your unique and individual User ID and Password. Note this will be the same User ID and Password when accessing the (Your Benefits Resources ) website. If you are calling from outside North America, you can reach the GM Canada Benefits Centre at (Please note that there will be a charge for this call.) When calling the GM Canada Benefits Centre, access your information by typing the digits of your User ID on the telephone key pad and wait for the next prompt requesting your Password. You will then enter the automated telephone system, where you will be given a full menu of pension and benefit options to select from. You will not be able to access your information on the (Your Benefits Resources ) website until you have set up your UserID and Password. You will also not be able to access your information by calling the GM Canada Benefits Centre until you have a UserID and have received your new Password. 4

10 YOUR HEALTH CARE COVERAGES ELIGIBILITY You are covered for health care coverage on your first day of hire. The Health Care Insurance Program provides protection for you and your eligible dependents against a wide range of Health Care expenses while you are an active employee. BASIC HEALTH CARE COVERAGES Means the hospital/medical benefits and prescription drug plan (if eligible) provided by Federal/Provincial plans or other local government plans. Provincial health services may vary by province, therefore, detailed information about your coverage should be obtained from the Provincial Health Plan in which you are enrolled. Hospital/Medical Coverage May Include... accommodation in a ward, including meals and general nursing services; laboratory, radiological and diagnostic procedures; drugs, biologicals and related preparations if prescribed by your physician; use of operating room and anesthetic facilities; use of radiotherapy and physiotherapy facilities if available; in addition, certain "outpatient" services are provided; physician's services in the home, office, hospital; diagnosis and treatment of illness and injuries; one annual health examination; treatment of fractures and dislocations; surgery; x-rays for diagnostic and treatment purposes; administration of anesthetics; obstetrical care, including prenatal and postnatal care from time of coverage; services of certified specialists; specified dental surgery performed in hospital; laboratory services and clinical pathology. GM CANADA HEALTH CARE COVERAGES This is for general information only. Coverage for any benefit is subject to and conditional upon the provisions of the applicable plans. For any specific questions contact the carrier, Green Shield Canada directly, and when appropriate, submit a pre-determination to ensure that your claim will be reimbursed. No benefits are payable for any amount available under any program funded in whole or in part by any governmental body (ex. Provincial Health Plan). 5

11 Prescription Drug Benefits Subject to the terms below, your Prescription Drug coverage is provided to the extent that such benefits are not provided under Provincial Drug Benefit Programs. Benefits are provided by GM Canada for the purchase of certain drugs as determined by the Controlled Drug Formulary, that require a prescription by a licensed physician. New prescription drug products are reviewed for inclusion into the Controlled Drug Formulary based on their therapeutic value, life-saving ability and cost effectiveness. Included for coverage are certain injectable insulin and disposable syringes and needles when prescribed to inject the insulin. In addition, certain drugs will only be considered a benefit under this Program if the patient meets certain specific conditions. These drugs are known as Conditional Drugs. In order to be considered for coverage of a Conditional Drug, the physician will be required to complete the Prescription Drug Special Authorization Form, detailing the patient s medical conditions including clinical evidence, to support why this specific drug is required. This form, in turn, must be submitted to Green Shield Canada for review and assessment of eligibility. If coverage is approved, you or your dependent will be notified. This form is available from Green Shield Canada. If you have any inquiries regarding the eligibility of certain prescription drugs, please contact the carrier, Green Shield Canada by going online to their website and using the Is My Drug Covered link from the home page. Simply type in the name of your medication or the Drug Identification Number (DIN) to determine if your prescribed medication is covered. Dispensing Fee The dispensing fee is the amount charged by a pharmacy for the professional services of the pharmacist to fill or refill a prescription. The dispensing fee charged by a pharmacy varies by store and location. This fee is posted at the pharmacy. Ensure you understand your pharmacy s dispensing fee and make a consumer-conscious decision when selecting the pharmacy you use to dispense your prescription drugs. The maximum covered dispensing fee is $8.00. You will be responsible for any dispensing fee amount charged in excess of $

12 Co-Payment You are required to pay a 10% co-pay of the drug cost (excludes dispensing fee) for each eligible prescription. Drug Co-Payment Example Drug Prescription Total Cost GM Canada Pays You Pay Dispensing Fee $9.99 $8.00 $1.99 ($9.99-$8.00) Drug Cost $55.00 $49.50 $5.50 (10% of $55.00) Total $64.99 $57.50 $7.49 Annual Maximum Prescription Drug Benefit reimbursement (including dispensing fee and drug cost) is limited to $25,000 per calendar year per family. Any prescription drug costs incurred in excess of the annual maximum will not be covered. If you exceed the limit in any calendar year, most provinces have drug reimbursement programs that will assist in covering these drug costs. The provisions of those plans vary by province and we suggest that you contact your provincial/territorial government health care office for information regarding the relevant drug benefit program that may be available to you. Detailed information is also available on the various government web sites and at Green Shield Canada or your physician may also be of assistance in providing information on how to access these benefits. In Ontario those with high prescription drug costs may be eligible for assistance through the Trillium Drug Program. Currently you can register in the Trillium Drug Program if: you do not have private insurance coverage or if your private insurance does not cover 100% of your prescription drug costs; you have a valid Ontario Health Card and are a resident of Ontario; and you are not eligible for drug coverage as another category of recipient under the Ontario Drug Benefit (ODB) Program (i.e., you are not a senior over 65 years of age, you are not a social assistance recipient, you are not receiving professional Home Care services, or you are not a resident of a Long-Term Care facility or Homes for Special Care). Trillium Drug Program application kits are available at your local pharmacy, or by calling The application form and application guide are also available online at Full Generic Drug Plan Whenever a generic equivalent for a prescribed drug is available, reimbursement will be provided as follows: (a) When a drug prescription or refill has a generic equivalent, the maximum benefit for this drug will be limited to the cost of the lowest priced generic drug less the co-pay 7

13 and any amount in excess of the Plan s dispensing fee limitation. Your personal physician s notation of no substitution on the prescription will not be sufficient for the brand name drug to be reimbursed; (b) In the event that a brand name prescription drug becomes available at a cost less than the lowest priced generic drug, the brand name prescription drug will be the eligible benefit; (c) Should you or your dependent choose the more costly drug, in lieu of the lowest priced generic, you will be responsible for the difference in cost. If you are currently being dispensed or are newly prescribed a drug that has a generic equivalent, the Plan will only pay the cost of the generic drug unless there is a brand at a lower cost. In some instances, the pharmacist can change your prescription to its generic equivalent. In other cases, your physician must authorize the change to the generic drug. It is ultimately your decision as to whether or not you choose to take the brand name/higher cost drug, however if you do you will have to pay the difference in cost between the brand name/higher cost drug and the generic/lower cost brand name drug. If you have taken the generic and suffered an adverse drug reaction, your physician may wish to complete a form called Adverse Drug Reaction Monitoring Program Form, which will be sent to Health Canada and copied to Green Shield Canada. This form would confirm and document that you have experienced an adverse reaction to the generic product. In this instance, the brand name drug will be covered. On an exception basis, in circumstances where your physician has prescribed a drug which is not an eligible drug under the Formulary, and your pharmacist fills the prescription, and neither the physician or the pharmacist inform you of its ineligibility, you may request reimbursement of the initial claim as an inadvertent purchase. You will only be reimbursed to the plan maximums. This means the co-pay and any dispensing fee charged in excess of the Plan s maximum dispensing fee limitation will be deducted and quantity adjustments will be made (e.g. you will only be reimbursed for a maximum of 30 days supply if more than 30 days was dispensed). Maintenance Medication Fill Limits Maintenance medications are medications that are prescribed to manage a disease state, such a high blood pressure or high cholesterol, and are defined by Green Shield Canada (GCS). Maintenance Medication refills will be dispensed at a minimum of ninety (90) day supply after the initial fill. This policy limits the number of refills to five (5) per year for maintenance drugs. The initial fill will be a thirty (30) day supply of the medication to make sure that the medicine is right for you. Subsequent re-fills will be dispensed at a ninety (90) day supply. This process will be managed at the pharmacy when you fill a prescription. To find out what medications qualifies as a maintenance medication contact Green Shield Canada. 8

14 Preferred Pharmacy Network (PPN) Specialty drugs must be obtained from a pharmacy in the GSC Preferred Pharmacy Network (PPN). Specialty drugs are defined as any substance that, is biologic, subsequent-entry biologic, biosimilar, or any medication that requires special handling, administration or monitoring as defined by GSC on the Conditional Drug Formulary. These medications require special authorization from your physician. The selected pharmacies are best equipped to handle specialty drugs. If you obtain a new prescription for a specialty drug, you will be required to complete the Prescription Drug Special Authorization Form prior to receiving the medication. If the authorization is approved, an approval letter will be mailed to your home and you will be notified about the PPN for that medication. A Case Coordinator from Health Forward will contact you to review the PPN and will assist with the selection of a pharmacy that is best for you. A Case Coordinator from Health Forward is assigned when this type of prescription is issued. The Coordinators role is to work with employees and their dependents who are on these specialty drugs during their treatment by offering adherence support services, and work with the health care provider, pharmacy and patient assistance program (if applicable) to coordinate care and treatment. Out-of-Province, Hospital, Surgical and Medical Expense Coverage This coverage provides benefits for covered "Out-of-Province" hospital, surgical and medical expenses incurred as a result of an accident, emergency, or referral by a physician in the employee's province of residence. Coverage is only available when the provincial plan makes a payment toward the cost. Coverage also includes case management in serious medical cases and when appropriate, air or land ambulance services for repatriation of the patient and accompanying spouse. The GM Canada salaried Out-of-Province policy number is #4787. Trip Duration Out-of-Province coverage is limited to periods of not more than 60 days per trip. This means that you can take multiple trips in a year that in total exceed 60 days and you will be covered, but no individual trip beyond 60 days will be covered. Example 1 You are on a trip out of your province of residence for 45 days and have a medical emergency on the 35 th day of your trip. You will be eligible for Out-of-Province coverage. Contact Green Shield Canada Travel Assistance. Example 2 You are on a trip out of your province of residence for 90 days and have a medical emergency on the 65 th day of your trip. You will not be eligible for Out-of-Province coverage. Any claims incurred will not be reimbursed through Green Shield Canada Travel Assistance. 9

15 Lifetime Maximum A maximum Out-of-Province benefit payable is established at $1,000,000 per covered person. Medical Emergency In the event of a medical emergency when Out-of-Province, Green Shield Canada Travel Assistance must be contacted by phone immediately prior to the commencement of any treatment except where advanced notice cannot reasonably be provided due to medical or other exceptional circumstances. You may call 24 hours a day, 7 days a week to: from within Canada and the U.S from all other countries (call collect) These contact numbers are printed on the back of your Green Shield Canada Identification Card for your convenience. When calling, quote your group number and your unique Green Shield identification number found on your Green Shield Canada Identification Card, and explain your medical emergency. You must always be able to provide your Green Shield Identification Number and your Provincial Health Insurance Plan number. If the in-hospital treatment is expected to continue beyond five days, you must contact Green Shield Canada Travel Assistance to determine if repatriation is appropriate. Such repatriation is mandatory, where the attending physician and family or admitting physician determine that the patient is medically fit to travel and appropriate arrangements have been made to admit the patient into the provincial health care system. Reimbursement will be provided (to a maximum of $1,000) for the cost of returning the patient s personal use motor vehicle to their pl of residence or nearest appropriate vehicle rental agency when the patient is repatriated to their province of residence. In addition, special assistance is available through Green Shield Canada Travel Assistance to guarantee a provider (i.e. physician or hospital) that the patient has coverage for emergency medical services and, if necessary, make a payment for hospital and medical expenses when the provider refuses to bill the carrier or Provincial Health Insurance Plan. NOTE: In consideration of these Out-of-Province limitations, you may wish to purchase additional personal travel insurance coverage before travelling outside your province of residence to ensure maximum reimbursement of any hospital and medical expenses, particularly if your trip will be in excess of 60 days. Medical travel insurance is available through a number of sources, including automobile associations (e.g. CAA), banks, insurance companies and credit card companies. Prosthetic Appliance And Durable Medical Equipment Benefits Prosthetic appliances and durable medical equipment are part of GM Canada Health Care coverages. No benefits are payable for any amount available under any program funded in whole or in part by a federal, provincial, municipal, or other governmental body. For example, any items approved under the Assistive Devices Program (ADP) through the Ontario government s Ministry 10

16 of Health and Long-Term Care must be submitted to the government program first and then submitted to Green Shield Canada. Coverages are provided for the purchase, fitting, and repair of certain external prosthetic appliances that replace a body part or the functions of a permanently malfunctioning body part. Reimbursement is provided on a usual, reasonable and customary charge basis when prescribed by a licensed physician and furnished and billed by a hospital, dealer or facility that supplies such appliances. The physician must include a description of the equipment, as well as the reason for use or the diagnosis. Also included are the replacement, repair, fitting and adjustment of such appliances. Contact Green Shield Canada for detailed information regarding what specific prosthetic appliance items are covered. Benefits are provided for the purchase or rental of certain durable medical equipment (e.g. hospital beds, crutches, walkers, wheelchairs) on a usual, reasonable and customary charge basis, when prescribed by a licensed physician. This equipment must be necessary for treatment of a medical condition and be provided and billed by a hospital, dealer or facility which normally supplies such equipment. Contact Green Shield Canada for assistance in determining whether rental or purchase is appropriate. You may also contact Green Shield Canada for detailed information regarding what specific durable medical equipment items are covered. In all circumstances, all applicable provincial and federal government assistance must be applied for prior to consideration for coverage and a re-evaluation of the patient s condition is to be done on a semi-annual basis. Land and Air Ambulance Coverage Land and air ambulance coverage, when medically necessary, will be provided up to the usual, reasonable and customary rate charged for the service as determined by the carrier, in excess of any government funded programs. Paramedical Coverages Paramedical coverages include reimbursement of covered Chiropractic, Chiropody, Podiatry, Naturopathy and Massage Therapy incurred as outlined below. The benefit year for all Paramedical coverages is established from the date of the first approved claim for the service rendered. Chiropractic Benefits are provided for Chiropractic treatment (excluding x-rays). The benefit year maximum for Chiropractic services is $450 per covered person. Chiropractic services are reimbursed at a maximum rate of $25 per visit ($15 per visit until the applicable provincial benefit plan is exhausted in provinces where Chiropractic treatments are covered by a provincial benefit plan). 11

17 Chiropody/Podiatry Benefits are reimbursed at a maximum rate of $11.45 per visit for either Podiatry or Chiropody (Chiropody only when prescribed by a physician), to a combined benefit year maximum of $325 per covered person. Podiatry treatments are eligible when they occur subsequent to the exhaustion of the applicable provincial benefit period maximum. Naturopath Benefits are reimbursed at a maximum of $25 per visit, to a benefit year maximum of $325 per covered person for Naturopath services. Massage Therapy Services of a Registered Massage Therapist, when prescribed by a physician will be reimbursed at a maximum of $45 per visit, to a benefit year maximum of $200 per covered person. The above listed Paramedical coverages do not include and no benefits are payable: 1. For remedies, supplies, vitamins, herbal medications or preparations; 2. Where the service is necessary as the result of a motor vehicle accident, unless there is no such coverage under a motor vehicle insurance policy or such coverage has been exhausted; 3. If the covered person is a resident of a long term care facility, unless such services otherwise provided by the long term care facility have been exhausted. 12

18 Long Term Care Expense Benefits Eligibility for Long Term Care benefits is determined per the schedule below: If eligible, this benefit will provide coverage, as described below, for the patient co-payment expense while the insured person resides in a Long Term Care Home, as an approved resident as determined under the Long Term Care Homes Act Benefits will be payable only on submission of proof satisfactory to the carrier that an eligible person has been approved and a payment of an allowance for such care was made to that Long Term Care Home on behalf of such person by the Province of Ontario for each day benefits are claimed. For those living in a province outside of Ontario, Long Term Care homes must meet the Province of Ontario Standards to be eligible for Long Term Care benefits. Hired Prior to January 1, 2007 Who Were Eligible to Voluntarily Retire as of January 1, The benefit payment toward the patient co-payment expense in any such Long Term Care Facility is limited to $1,724 monthly. Hired Prior to January 1, 2007 and Who Were Not Eligible to Voluntarily Retire as of January 1, The benefit payment toward the patient co-payment expense in any such Long Term Care Facility is limited to $1,400 monthly. Hired After January 1, 2007 Not a benefit. 1 Eligible to Voluntarily Retire as of January 1, 2009 is defined as: a) being at least age 60 with 10 or more years of credited/eligibility service; or b) last hired prior to January 1, 1988, and i. have 30 or more years of credited/eligibility service; or ii. be at least age 55 and age and credited/eligibility service total at least 85 points, as of January 1,

19 Chronic Care Benefit Eligibility for Long Term Care benefits is determined per the schedule below: Hired Before January 1, 2007 Chronic Care coverage is provided when a covered person is in a public chronic hospital or chronic wing facility of a public general hospital. This coverage includes a maximum reimbursement of up to $30 per day for the difference between the charges for a standard ward and the cost of semi-private accommodation when the patient occupies semi-private accommodation and a maximum reimbursement equal to the provincially approved co-pay amount not to exceed $60 per day toward the chronic care co-pay charge following the expiration of the co-pay benefit period paid by the Provincial Health Plan. Hired After January 1, 2007 Not a benefit. Dental Benefits Benefits will be provided up to an annual maximum of $2,500 per person other than for orthodontics (teeth straightening) during any benefit year (October 1 through September 30), and up to a lifetime maximum of $3,000 for orthodontics for covered individuals under 21 years of age. Covered Dental Services Benefits are payable at 80% (100% if eligible to retire as of January 1, ) of the Dentist's or Denture Therapist's usual charge but not more than 80% (100% if eligible to retire as of January 1, ), of the amount specified in the Provincial Dental Association Schedule of Fees in effect one year prior to the date of service (one year lag) or where applicable in the Ontario fee schedule for Licensed Denture Therapists in effect one year prior to the date of service (one year lag) for: recall oral examinations and prophylaxis (cleaning of teeth), but not more than once in any period of nine consecutive months; complete oral exams, not more than once in any period of thirty-six consecutive months; dental x-rays, including full mouth x-rays (but not more than once in any period of 36 consecutive months), and bitewing x-rays (but not more than once in any period of 12 consecutive months); 2 Eligible to Voluntarily Retire as of January 1, 2009 is defined as: c) being at least age 60 with 10 or more years of credited/eligibility service; or d) last hired prior to January 1, 1988, and iii. have 30 or more years of credited/eligibility service; or iv. be at least age 55 and age and credited/eligibility service total at least 85 points, as of January 1,

20 topical application of fluoride for persons under 20 years of age, unless a specific dental condition makes such treatment necessary; space maintainers that replace prematurely lost teeth for children under 19 years of age; emergency treatment for temporary relief of pain; extractions and oral surgery; amalgam, silicate, acrylic, synthetic porcelain, and composite fillings to restore diseased or accidentally injured teeth; porcelain veneers to treat certain conditions; general anesthetics and intravenous sedation when medically necessary and administered in connection with oral or dental surgery; endodontic treatment (nerve and pulp) including root canal therapy, and periodontal (gum) treatment including provisional splinting and one temporomandibular joint appliance as an adjunctive periodontal service; repair or recementing of crowns, bridgework or dentures; and relining or rebasing of dentures more than six months after installation, but not more than one relining or rebasing in any period of 36 consecutive months; inlays, onlays, gold fillings, or crowns, but only when the tooth as a result of extensive caries or fracture cannot be restored with an amalgam or other filling; pit and fissure sealants for permanent molars for persons under 15 years of age; periodontal services are covered when performed by a periodontist for surgical curettage, provisional splinting, occlusal equilibration and scaling and root planing. Benefits are payable at 50% of the Dentist's or Denture Therapist's usual charge but not more than 50% of the amount specified in the Provincial Dental Association Schedule of Fees in effect one year prior to the date of service (one year lag) or where applicable, in the Ontario Fee Schedule for Licensed Denture Therapists in effect one year prior to the date of service (one year lag) for: initial installation of fixed bridgework; initial installation of full or partial removable dentures, including any adjustments during the six-month period following installation; replacement of an existing denture or fixed bridgework, but only when: a) the replacement or addition of teeth is required to replace one or more teeth extracted after the existing denture or bridgework was installed; or, b) the existing denture or bridgework cannot be made serviceable and, if it was installed under this coverage, at least 5 years have elapsed prior to the replacement; or, c) the existing denture is an immediate temporary denture which cannot be made permanent and replacement by a permanent denture takes place within 12 months from the date of initial installation of the immediate temporary denture; initial and replacement of standard implantology including the structure, installation, and crown; orthodontic (teeth straightening) procedures and treatment (including related oral examinations) for individuals under 21 years of age. The remaining charge is a co-payment payable by you. 15

21 Vision Benefits The Vision Plan is provided as a flat fee structure. Individuals will be able to receive new lenses, frames or contact lenses every 24 months, whether or not there is a prescription change, when dispensed by an optometrist, optician or ophthalmologist, up to the following amounts: $200 for single vision lenses, including frames $255 for bifocal vision lenses, including frames $325 for multi-focal vision lenses, including frames OR $210 for contact lenses Vision benefits also include a one-time reimbursement for laser eye surgery. The maximum available to be applied to the cost of laser eye surgery is $325. Any person reimbursed for such laser eye surgery will not be eligible for any other reimbursement under the Vision Plan for a period of 48 months. There are no restrictions as to what the benefit amounts may be used to purchase. For example, individuals may use the benefit amounts towards the purchase of prescription sun glasses, antiscratch coating, high index lenses, etc. Contact lenses will continue to be covered once in each 12 month benefit period when vision cannot otherwise be corrected to at least 20/70 in the better eye, or when medically necessary under certain conditions. Individuals who have a medical condition, such as diabetes, requiring frequent lens changes (as substantiated by an ophthalmologist) are eligible for new lenses (not frames) whenever they have a prescription change. The charge to repair eyeglass frames, such as replacement of arms, nosepads, soldering hinges, temple covers and nylon cord replacement is a covered expense. The cost of the part is the responsibility of the employee. Vision benefits also include a reimbursement to a maximum of $65 for routine eye examination, once in a 24 month period, provided by an optometrist or physician, when this benefit is not provided under the person s Provincial Health Plan. Excluded from this vision examination benefit are individuals who receive this benefit under any government program at any time (e.g. if your Provincial Health Plan provides for eye examinations once every 24 months you are not eligible for this coverage, even in the year the Provincial Plan is not reimbursing). 16

22 Hearing Aid Benefits To obtain benefits you must first be examined by an ear specialist (otologist or otolaryngologist) to determine if your hearing problem is caused by a condition which may be corrected by use of a hearing aid. The cost of this examination is not a covered service. If it is determined that your hearing problem may be corrected by use of a hearing aid, benefits will be provided for the following services once during any period of 36 consecutive months and only when obtained from a participating provider: One hearing aid or binaural hearing aid system (acquisition cost and dispensing fee) including in-the-canal, completely in-the-canal, digital and programmable aids. However, only the particular hearing aid or binaural hearing aid system prescribed as a result of the hearing aid evaluation test will be covered. Covered benefits will include an ear mold, necessary fitting and adjustment of the hearing aid and repairs from the dealer not covered following expiration of the manufacturer's warranty. No benefits are payable for any amount available under any program funded in whole or in part by a federal, provincial, municipal, or other governmental body. If you need the name of a participating provider, contact the carrier Green Shield Canada 17

23 Comprehensive Medical Expense Insurance Coverage Comprehensive Medical Expense Insurance Program (CMEIP) provides major medical benefits through Green Shield Canada. These benefits add to the protection you are provided by the Health Care coverages described earlier. Major Medical Benefits Major medical benefits offer additional protection when the benefits described previously have either been exhausted or are not applicable. Major medical benefits cover reasonable charges, less a deductible amount as described later, for medically necessary services and supplies, including, but not necessarily limited to, those listed below which are not generally covered by your other coverages: in-home nursing care skilled nursing care [provided by a Registered Nurse (RN) or Registered Practical Nurse (RPN)] only when medically necessary, up to the reasonable charge for acute therapeutic care; custodial nursing care [provided by a Registered Practical Nurse (RPN)] only when medically necessary for up to 6 hours per day up to an annual maximum of $7,500; as well as for the services of a Personal Support Worker (PSW), subject to a $25 per day maximum. Custodial care benefits are not subject to the deductibles or co-insurance; prostate-specific antigen (PSA) test once annually; dental work and dentures made necessary by an accident (to the extent not covered under the Dental Plan); co-payments made under basic coverage for prescription drugs (only to be applied to satisfy annual deductible); up to $150 a day, less amounts payable by basic coverages, for confinement for acute therapeutic care in a hospital operated primarily for care of nervous or mental conditions; up to $25 a day for confinement in an approved nursing home or other approved facility, if the confinement is custodial in nature; corrective shoes for infants with congenital foot conditions; physiotherapy, if referred by a doctor and performed by a licensed physiotherapist; psychologist services, recommended by a medical doctor and rendered by a Registered Clinical Psychologist limited to an annual maximum of $4,000; family and marital counseling by a Registered Clinical Psychologist or by a Master of Social Work for up to $50 per visit, limited to an annual maximum of $600 per participant. This $600 annual maximum is part of the $4,000 annual maximum but is not subject to the deductibles or co-insurance; covered expenses for outpatient psychiatric care include only those charges for services rendered after all other benefits have been exhausted. Reimbursement is limited to $4,000 per year for non-psychotic conditions; speech therapy treating speech deficit caused by an accident/illness; 18

24 for any other speech therapy prescribed by a physician limited to an annual maximum of $1,100 per participant, but will not be subject to deductibles or co-insurance; up to two pairs of custom made foot orthotics within the 36-month period limitation, with such total expense not to exceed $400, but not subject to deductibles and co-insurance. Orthotics may only be obtained from a participating provider. Orthotics that are not purchased from participating provider will not be reimbursed. synvisc (or an equivalent viscosupplementation product) limited to a treatment cycle maximum of $300, and a total treatment maximum of $1,200, per 36-month period. This benefit is not subject to deductibles and co-insurance. Contact Green Shield Canada if you have any questions or concerns about what may or may not be covered or allowed before you incur an expense. Deductible Amount and Co-Payment You pay a deductible amount of $50 toward covered expenses under CMEIP that are incurred each calendar year for the same individual. This $50 is called the Individual Deductible Amount. In meeting this amount, you can add up all your CMEIP covered expenses for the same individual, whether they relate to one condition or various conditions. However, if CMEIP covered expenses incurred by two or more family members equal $100 (the family deductible amount), no additional deductible amount will be applied against expenses incurred by any of your other family members for that calendar year. No more than $50 of covered expenses for one family member can be applied toward the $100 family deductible amount. Any covered expenses incurred in October, November or December of any calendar year that are applied to the deductible amount for that year and therefore are not reimbursable will be applied to the deductible amount for the following calendar year. For CMEIP benefits that require co-payment, after you pay the deductible amount ($50 single/$100 family), CMEIP will pay 80% of the first $3,750 of covered expenses incurred during any one calendar year and 100% of covered expenses which exceed $3,750 during that calendar year. Covered expenses for outpatient psychiatric care will continue to be payable at 80%. Example- Once you pay $750 (20% of $3,750) plus the annual deductible in a calendar year toward eligible CMEIP benefits, any further covered expenses incurred in that calendar year will be covered by GM Canada at 100%. Calendar Year Benefit Limitations The maximum reimbursement amount for covered expenses is $50,000 per calendar year for each insured individual. There is no lifetime maximum. 19

25 Health Care Spending Account GM Canada annually credits contributions to your Health Care Spending Account (HCSA), and you have the ability to use that money to reimburse eligible medical and dental expenses not covered by your GM Canada Health Care or Provincial Health Plan. Eligible claims must qualify as a medical expense tax credit as defined by Canada Revenue Agency (CRA) under the Income Tax Act. Additional information is available online by visiting or you can contact Green Shield Canada directly at to check if an expense is HCSA eligible. All executive and classified employees hired before October 1 of the current year who were on the active roll as of December 31 of that same current year will receive a $650 ($325 for job share) credit applied to your HCSA account on January 1 of the following year if still active with GM Canada. For instance, if you are on the active roll December 31, 2017, you will receive a $650 ($325 for job share) credit to your HCSA account on January 1, How the HCSA Plan works: When you incur an expense that is not covered by your GM Canada Health Care or the Provincial Health Plan, you have the ability to file a claim against your available HCSA dollars through Green Shield Canada. If deemed an eligible expense, Green Shield Canada, on behalf of GM Canada, will reimburse you accordingly based on your available HCSA balance. You may only submit claims for your spouse and your eligible dependents if they are actively enrolled in Health Care coverage. You may set up Auto-coordinate My Health Care Spending Account Claims to have any unpaid amount from your health and dental claims be automatically paid under your HCSA. Do not auto-coordinate any benefits that you have coverage for under your spouse s benefit plan. If you opt out of Health Care coverage, HCSA funds will continue to be credited to your account annually; however, HCSA claims dollars can only be used for an employee, not for listed dependents. HCSA reimbursements are tax-free, except if you live in Quebec you will pay tax at your provincial rate on the value of claims reimbursed from this account during the calendar year. Available HCSA funds can be viewed by visiting your account information at When you submit a HCSA claim to Green Shield Canada, you will receive a statement detailing payment and your remaining HCSA balance. Each year, Green Shield Canada will send out a statement to you indicating your HCSA balance. 20