Plan Member a) Updating the Plan Member s Personal Information... 15

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1 Table of Contents

2 Web Administration INTRODUCTION... 4 WELCOME TO EQUITABLE LIFE OF CANADA... 4 WEB ADMINISTRATION COVERAGE UPDATES... 5 Certificate Summary... 7 a) Terminating the Certificate... 7 b) Updating the Certificate Number... 8 c) Updating the Country/Province... 9 d) Updating the Section ID f) Updating the Division/Subdivision. Transfer g) Viewing the Enrolment Summary Plan Member a) Updating the Plan Member s Personal Information Employment a) Updating the Employment Type b) Updating the Job Title Income a) Updating Income b) Adding a New Income Direct Deposit Override Flags Dependents a) Adding New Dependents b) Updating Dependents c) Terminating Dependents d) Updating Qualification Information: Family Category a) Updating Family Category Benefits a) Benefits Section b) Evidence of Insurability c) Benefit Termination List Volume Amounts Beneficiaries a) Adding a New Beneficiary b) Updating a beneficiary COB (Coordination of Benefits) a) Adding COB to the Certificate b) Updating Existing COB Records c) Terminating COB Records... 46

3 Benefits Cards a) Print Cards b) Order Cards c) Deleting an Existing Card Request Premium Calculator Process Response Rate Summary Health Care Spending Account (HCSA) a) View HCSA Details b) Updating Allocation c) Updating Participation Mass Income and Occupation Changes a) Adding Income b) Editing Income c) Editing Occupation d) Deleting Change Transactions Requiring Contact with Equitable Life Adding a new Plan Member a) Plan Sponsor Information b) Health Care Spending Account (HCSA) c) Employment d) Income e) Plan Member Information f) Direct Deposit g) Selections for Health and Dental h) Dependents i) Coordination of Benefits j) Beneficiary k) Override Flags l) Enroling m) Certificate Enrolment Summary n) Finishing the Enrolment... 78

4 Introduction Welcome to Equitable Life of Canada Thank you for placing your Group Benefits program with Equitable Life of Canada. We value your business and will do our utmost to help you in the smooth administration of your Group Benefits Plan. Equitable Life of Canada offers a full range of Group Life, Health and Disability products, as well as Life Insurance and Annuities for individuals and businesses. Along with your advisor, we will regularly review your benefit requirements to help you assess the appropriate protection for your Plan Members' current and future needs. We have provided this manual to you to use as a guideline when you have Administrative questions. If other questions should arise, do not hesitate to contact us for assistance. Web Administration of your Group Plan: If you have registered for Plan Administrator Web access, you have accepted the following responsibilities: To administer the plan in accordance with the terms of the Group Policy To ensure Plan Members are enrolled and terminated appropriately on the plan and coverage is kept current and accurate, and To maintain enrolment documentation, beneficiary designations and other administrative forms which are described in this Administration Guide, and to maintain records of these in a safe and secure manner. Page 4 of 79

5 Web Administration Coverage Updates As an Equitable Life Web Administrator, you are able to update Plan Member (Certificates) personal information and verify coverage for both Plan Members and their dependents. This guide provides details on some of the most commonly used features on Plan Administrator Web. From the upper navigation bar, select one of the items to review more information. The Policy tab contains detail on your organization s Group Insurance policy with Equitable Life, including details on renewal date, administration type, policy status etc. Select the Division tab to review detail on the division breakdown of the policy, including status and effective dates. You will also find access to the Bills for the division selected. You can select to open bills in either PDF or Excel format. Review the information on billed amount, payment status, etc. Page 5 of 79

6 The Class tab displays information on the class and plan breakdown. Click the Certificates button for quick access to the Certificate list From the Plan grid, click the Benefits button for a summary of Benefits available on the class/plan. In this section, you have access to view and edit Plan Members coverage. Searching and Sorting Certificates You can sort the Certificates in ascending or descending order. The default is ascending by Certificate Number. To change the view to descending, select the arrow located next to the Certificate column. Page 6 of 79

7 From the Certificate List: search for the Plan Member to be updated by using any of the Search Certificate options. The other sorting options include First name, Last name, Birth Date, Division, Section ID, Subdivision, Status, Status Reason and Class. If you only have a partial name or certificate number, use the asterisk (*) as a wildcard character. For example if you were to enter a Last Name as Smi*, this would then display all the certificates of people whose names start with Smi (e.g. Smith, Smithers, Smithson, etc.) Once you have located the Plan Member in the Certificate List, you can select the member by highlighting and then select the View Certificate button. The updates which can be made to a Certificate are found in the Task Center within each of the Certificate Menu items (shown below). Once you select View Certificate, you will have access to the Certificate Info screen. Note: The Health Care Spending Account (HCSA) Certificate Menu item will display only if the Plan Member is enrolled in a class that has HCSA. Certificate Summary This is where you can terminate a Certificate, make updates to the Certificate Number, the Country and/or Province of residence, the Section ID, the Class and/or Plan and the Division and/or Subdivision. This is also where you can view the Enrolment Summary or terminate the Certificate if the Plan Member was enrolled through the Plan Administrator website. a) Terminating the Certificate To terminate a Certificate, select the Terminate Cert. link from the Task Center. Page 7 of 79

8 This will open a screen with the Terminate Date and Status Reason fields enabled. Enter the Certificate s Termination Date. You will not be able to terminate a Certificate more than three months retroactively or in the case where there have been claims paid between the Terminate Date and the current date. Please contact our Group Benefits Administration team at our Head Office if you see the following message. You must select a Status Reason from the drop down box for the termination. Please select the most appropriate Status Reason for the termination. Select the Save button. This will refresh the screen and save the changes. To exit the screen without making or saving changes, select the Cancel button. b) Updating the Certificate Number To change a Certificate Number, select the Update Cert # link found in the Task Center. Page 8 of 79

9 This will open a screen with the Change Effective Date, Cert #, and Override Reason fields enabled. Enter the Effective Date. Enter the new Cert# - this value must be 10 digits. If the new Certificate Number is less than 10 digits, the system will automatically add zeros in front of the number entered. (For example, if the employee number is 425, the system will assign ) Select the applicable Override Reason from the drop down box. Select the Save button. This will refresh the screen and save the changes. Since the Certificate Number appears on the Benefits Card, you will need to request a new card. Please see the section on Requesting Benefits Cards for this process. To exit the screen without making or saving changes, select the Cancel button. c) Updating the Country/Province To update the Country or Province of a Certificate, select the Update Country/Prov. link found in the Task Center. This will open a screen with the Effective Date, Country and Province of Billing fields enabled. Page 9 of 79

10 Enter the Effective Date. This can be current or future dated only. Please contact our Group Benefits Administration Department if you need to enter a retroactive date. Select the new Country (if applicable) from the drop down box. Select the new Province of Billing or State (if the United States was selected as the Country) from the drop down box. Select the Save button. This will refresh the screen and save the changes. To exit the screen without making or saving changes, select the Cancel button. Note: This change may have implications on the billing in reference to any applicable provincial sales and/or premium tax. d) Updating the Section ID To update the Section ID of a Certificate, select the Update Section ID link found in the Task Center. This will open a screen with the Effective Date and Section ID fields enabled. Enter the Effective Date of the change. This can be current or future dated only. Please contact our Group Benefits Administration Department if you need to enter a date in the past. Enter the new Section ID for the Certificate. Section ID s can be up to 20 alphanumeric characters long. Page 10 of 79

11 Select the Save button. This will refresh the screen and save the changes. To exit the screen without making or saving changes, select the Cancel button. e) Updating the Class/Plan Transfer To update the Class or Plan of the Certificate, select the Class/Plan Transfer link found in the Task Center. This will open a screen with the Effective Date, Class and Plan Code fields enabled. Enter the Effective Date of the change. Select the new Class from the drop down box. Select the Plan Code (if there is more than one Plan for the specific Class) from the drop down box. Select the Save button. This will refresh the screen and save the changes. To exit the screen without making or saving changes, select the Cancel button. f) Updating the Division/Subdivision. Transfer To update the Division or Subdivision of a Certificate, select the Div./Subdiv. Transfer link found in the Task Center. Page 11 of 79

12 This will open a screen with the Effective Date, Division and Subdivision fields enabled. Enter the Effective Date of the change. Select the new Division for the Certificate from the drop down box. Select the new Subdivision for the Certificate from the drop down box. Select the Save button. This will refresh the screen and save the changes. To exit the screen without making or saving changes, select the Cancel button. g) Viewing the Enrolment Summary The Enrolment Summary item will appear in the Task Center if the Certificate was enrolled using Plan Administrator web, and provided the plan member was not a late applicant. To view the Enrolment Summary, select the Enrolment Summary link found in the Task Center. This will open a new screen with the Enrolment Summary displayed. See the next pages for a sample. Page 12 of 79

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15 The Enrolment Summary can be viewed or printed. To exit the screen, select the from the top right hand corner of the screen or select Print This Page. Plan Member This Certificate Menu item allows you to make updates to personal information for Plan Members. To access the Task Center option, select the Plan Member item in the Certificate Menu. a) Updating the Plan Member s Personal Information Select the Update Plan Member link found in the Task Center. This will open the Plan Member Info screen where you can update Plan Member details. Page 15 of 79

16 To update the First Name, Middle Name or Last Name, enter the new information in the appropriate fields. To update the Birth Date of the Plan Member, enter the date of birth in the appropriate field. Note: If the change in date of birth affects the eligibility of the Plan Member (coverage start date or coverage termination date), you will not see these changes immediately after saving. This change will be reflected one business day after you made the change. To update the Title, Corr. Lang. (language of correspondence) or Gender, simply select the new value from the appropriate drop down boxes. To update the Home Address, enter the new information in the Address 1, Address 2, Address 3, City, Country, Province and Postal Code fields then enter the Effective Date. To update the Contact Info., enter the new information in the Home Phone field (area code, then phone number), the Office Phone field (area code, then phone number, then extension) and/or Address field. If adding or changing the Address, you need to confirm the by re-entering it in the Confirm Address field. Select the Save button. This will refresh the screen and save the changes. To exit the screen without making or saving changes, select the Cancel button. Since the first and last name of the Plan Member appears on the Benefits Card, if you are making an update to these fields you will need to request a new card. Please see the section on Requesting Benefits Cards for this process. Employment This Certificate Menu item allows you to make updates to a Certificate s Employment Type and Job Title. To access the Task Center options, select the Employment item in the Certificate Menu. a) Updating the Employment Type Select the Update Emp Type link found in the Task Center. The Update Employee Type screen will open with the Employment Type, Num(ber) of H(ou)rs./Week and the Effective Date fields enabled. To update the Employment Type, select the new value from the drop down box. Page 16 of 79

17 Note: Your Policy has been set up to allow, for eligibility purposes, only certain Employment Types. If you select an Employment Type that is not considered eligible, you will receive a message when you try to save this change. For example: If you select Part Time Hourly and your Policy does not allow this type, the message will be: The system will not allow you to save this change. If the Employment Type you entered is correct, the Plan Member is no longer eligible and must have all their benefits and their status terminated. Please see the section Terminating the Certificate for instructions on how to do this. To update the Num(ber) of H(ou)rs./Week, enter the new numeric value in the appropriate field. (For example, enter 40, 37.5 or 30 as applicable.) Note: Decimal places are allowed. Note: Your Policy has been set up with a minimum number of hours which the employee must work in order to be eligible for coverage. If the value entered into this field does not meet the minimum requirements, you will receive a message indicating this information. For example: if 30 hours is the minimum number of hours worked per week and you enter 15, the following message will display: The system will not allow you to save this change. If the Num(ber) of H(ou)rs./Week you entered is correct, the Plan Member is no longer eligible and must have all their benefits and their status terminated. Please see the section Terminating the Certificate for instructions on how to do this. For either of the above changes, you must enter the Effective Date that is applicable to the change, prior to saving the change. Select the Save button. This will process the change, once the screen is refreshed, the changes will be reflected. To exit the screen without making or saving changes, select the Cancel button. b) Updating the Job Title Select the Update Job Title link found in the Task Center. This Update Employee Job Title screen will open with the Job Title and Effective Date fields enabled. Page 17 of 79

18 Enter the new Job Title in the appropriate field. Enter the Effective Date. Select the Save button. This will refresh the screen and save the changes. To exit the screen without making or saving changes, select the Cancel button. Income This Certificate Menu item allows you to make updates to a Plan Member s Income and add New Income types. To access the Task Center options, select the Income item in the Certificate Menu. a) Updating Income Select the Update Income link found in the Task Center. The Update Income screen will open with the Effective Date, Frequency and Amount fields enabled. The Income Type field will be disabled as this was set at the time of enrolment. Enter the Effective Date which is the date the income update and/or frequency is effective. You will not be able to change Income three months retroactively from the current date. If the Effective Date is not entered before the Save button is selected, the following message will appear: To change the Income Frequency, select the new value from the drop down box. To change the Amount, enter the new value in the Amount field. Note: The decimal place is not required. The system auto-formats the value after the record is saved, if it is not entered. Select the Save button to save the change. The screen is refreshed and the change is saved. Page 18 of 79

19 To exit the screen without saving or making changes, select the Cancel button. b) Adding a New Income Adding New Income should only be used for loading a New Income Type such as a bonus or commission. To maintain salary adjustments the Update Income link should be used. Select the New Income link found in the Task Center. The New Income screen opens with the Effective Date, Income Type, Frequency, and Amount fields enabled. Enter the Effective Date which is the date the income and/or frequency is effective. You will not be able to add an Income three months retroactively from the current date. If the Effective Date is not entered before the Save button is selected, the following message will appear: Select the Income Type from the drop down box. Some of the values are: Bonus, Commission, Overtime and Profit Sharing. Refer to your Policy Contract to determine if the new Income Type is used to calculate the Benefits Volume. Select the Frequency of the new Income Type from the drop down box. Enter the Amount of the new Income Type in the Amount field. Note: The decimal place is not required. The system will auto-format after the change is saved, if the value is not entered. Select the Save button to save the change. The screen is refreshed and the change is saved. The updates will display and will be reflected on the Volumes page (if applicable). To exit the screen without saving or making changes, select the Cancel button. Page 19 of 79

20 Direct Deposit This Certificate Menu item allows you to add and edit a Plan Member s information for Direct Deposit. Plan Members must be registered for Direct Deposit in order to use our EZClaim Online services and our mobile app. To access the options, select the Direct Deposit item in the Certificate Menu. If there is currently no active Direct Deposit information on file, you will be prompted to enter the required banking account details. If there is an active account registered for the plan member and you need to change the account details, enter the new information and select Save You can also Cancel Direct Deposit, but doing so means that the Plan Member will no longer be able to use EZClaim Online or Mobile, and will receive cheques delivered by Canada Post. Override Flags This Certificate Menu item, which is view only, is the Override Flag screen. This screen displays the Override Flags that were set at time the certificate was enrolled. From the Certificate Menu, select the Override Flags. The Override Flag section consists of 3 sections (if applicable) containing the following fields: Page 20 of 79

21 a) Override Flags This section shows if an exception was made to: Waive all tax on the certificate (for example, for Status Indians) The late entrant status was waived Certain employment requirements were waived The minimum employment age was waived b) Waive Wait Period for Insured Benefits This section shows if an exception was made to: Waive the Plan Member s waiting period for all insured benefits Start the benefits on a specific date c) Waive Wait Period for Health Care Spending Account (HCSA)Benefits This section shows if an exception was made to: Waive the Plan Member s waiting period for HCSA Start the Health Care Spending Account on a specific date Page 21 of 79

22 Dependents This Certificate Menu item allows you to add and maintain Plan Member dependents. To access the Task Center options, select the Dependents item in the Certificate Menu. a) Adding New Dependents Select the New Dependent link found in the Task Center. The Dependent Detail screen will open. Fields in the Dependent Detail and Dependent Info. sections will be enabled. From the Category drop down box, select Spouse or Child. Once the Category field is populated, the Subcategory values will be enabled in the Subcategory drop down box. Select the applicable Subcategory value. The chart below will explain the eligibility details for the Dependents. Note: Applications for Disabled Dependents must be submitted to the Group Benefits Administration Department. Page 22 of 79

23 Note: Students must first be loaded as a Minor; this will ensure that the effective dates are calculated accordingly based on your Policy s Student Termination Age. To change a Minor to a Student, please refer to Updating Qualification Information. Category SubCategory Definition Spouse Married The legally married husband or wife. Spouse Common-Law Married The partner of the same or opposite sex who resides with the Plan Member in a conjugal relationship who the Plan Member publicly represents as a partner. Check your Policy Contract to determine the cohabitation clause that applies to the common-law partner. (i.e. one year). The Plan Member must apply within 31 days of the date of eligibility (i.e. cohabitation date + waiting period = eligibility date.) Child Minor The Plan Member s natural child, adopted child, stepchild, a child the Plan Member has been granted final guardianship or custody of by an order of the Court, or child of the Plan Member s Spouse. To be eligible, the Child must not have a Spouse or Partner, be supported by the Plan Member, and not be working on a full-time basis. Check your Policy Contract to see the Maximum Age for Dependent Children. Child Student Eligible Students must not be working on a full-time basis. Their coverage terminates on the earlier of their withdrawal from full-time studies or the end of the school term (unless they will be returning to school for the next term). Coverage for continuing students will not terminate during school breaks or between terms. The Student will be covered up to the maximum Student Age stated in your Policy Contract if a full-time student. The Plan Member must apply for the coverage within 31 days of the date of eligibility. To maintain coverage for a continuing Student, the Plan Member should submit an APPLICATION FOR COVERAGE OF DEPENDENT CHILD OVER AGE 21 - FORM 441 before September each year. If the Plan Member is applying for this coverage (for the Student) after Plan Member enrolment, the forms will need to be provided along with the other forms being submitted to Equitable Life. See the section on Transactions Requiring Contact with Equitable Life for more information. Child Disabled The Plan Member s developmentally or physically Disabled natural child, adopted child, stepchild, child the Plan Member has been granted final guardianship or custody of by an order of the Court, or child of the Plan Member s Spouse. To apply to continue coverage for a Disabled Dependent Child, in the 31 day period before the child s 21 st birthday, the employee should submit: An APPLICATION FOR COVERAGE OF DEPENDENT CHILD OVER AGE 21 - FORM 441, and A physician s letter stating the nature of the child s condition and that he/she is incapable of self-sustaining employment and is chiefly dependent upon the Plan Member for support. Note: As this application needs to be reviewed for approval, continue to submit applications for disabled dependents to Group Benefits Administration Department to be processed. Page 23 of 79

24 You must enter the Qualification Date for a Spouse. In the case of a Married Spouse, the Qualification Date is equal to the Date of Marriage. In the case of a Common-Law Spouse, the Qualification Date is equal to the Date of Cohabitation (the date they began living together). Enter the Application Date. This is the date that the Plan Member is applying for coverage for the Dependent. This date is used to determine if the Plan Member is applying for coverage within 31 days of the Eligibility Date. Enter the Dependent Info. The mandatory fields are: First Name, Last Name, Birth Date, Corr. Lang. (language of correspondence) and Gender. Select the Save button to save the Dependent information. This will process the Dependent and verify coverage according to the dates entered and determine if the Dependent requires medical evidence, if the coverage is in force and the coverage Effective Date. If adding a Spouse or Overage Dependent, Benefits Cards will need to be requested for the new Dependents. Please see the section on Requesting Benefits Cards for the process. The screen will close and the new Dependent will appear in the list of Dependents. You need to check the Process Response to make sure there are no medical forms required for approval of coverage. See the section on Process Response for details. If the addition of the new Dependent affects the Family Category, you also need to update the Family Category information. See the section on Family Category for details. To exit the screen without saving or making changes, select the Cancel button. b) Updating Dependents Select the Dependent to make the change by highlighting that row. Select the Update Dependent link found in the Task Center. Page 24 of 79

25 The Update Dependent screen will open with the fields enabled. To make updates to the First Name, Middle Name and/or Last Name, enter the new information in the appropriate fields. To make changes to the Birth Date, enter the new date of birth or use the calendar to select the date. Note: In the case of a child, if the change in date of birth affects the eligibility of the Dependent (coverage start date or coverage termination date) you will not see these changes reflected immediately after saving the Birth Date change. This change will be reflected the day after you make the change. To update the Title, Corr. Language (language of correspondence) or Gender, select the new value from the appropriate drop down boxes. To exit the screen without saving or making changes, select the Cancel button. Note: If the Spouse or Overage Dependent name is being updated, new Benefits Cards need to be requested. Please see the section on Requesting Benefits Cards for the process. c) Terminating Dependents Select the Dependent to terminate by highlighting the row. Page 25 of 79

26 Select the Terminate Dependent link found in the Task Center. The Terminate Dependent screen will open with the Termination Date and Status Reason fields enabled. Enter the Termination Date in the appropriate field. The Termination Date entered should be the date that the Dependent is no longer eligible for coverage. For example, date of separation, date of divorce or the date a child reaches the Child Maximum Age. Select the Status Reason from the drop down box. Select the Save button to save the change. The screen is refreshed and the change is saved. To exit the screen without saving or making changes, select the Cancel button. d) Updating Qualification Information: This is used to change a Common-Law Spouse to a Married Spouse and/or a Minor Child to a Student Child. To change a Common-Law Spouse to a Married Spouse, highlight the Spouse from the list of Dependents, then select the Update Qual(ification) Info link found in the Task Center. Page 26 of 79

27 The Update Qualification Info. screen will open. Select the Edit button. This will enable the Expiry Date field.. Enter the last day the Spouse was considered Common-Law (ie the day before the date of marriage). Select the Save button. This will save the change. Select the New button that now appears. Page 27 of 79

28 Select the Married from the Subcategory drop down box. Select the Save button. This will save the information entered. Select the Cancel button at the bottom of the screen to exit the Qualification Changes screen. The new Qualification Information will display in the list of Dependents. To change a minor child to a student, highlight the child from the list of Dependents, then select the Update Qual(ification) Info link found in the Task Center. Page 28 of 79

29 The Update Qualification Info. screen will open. Select the New button. If the New button is not visible it is because the minor child has not yet reached the maximum age for a dependent, and is still a minor, as defined in your policy. Select the value of Student from the Subcategory drop down box. Enter the Effective Date and Expiry Date. Note: The Effective Date must be set to one day greater than the Expiry Date (the date after full time studies are expected to end). Select the Save button. This will save and display the information entered. Page 29 of 79

30 If a Dependent Child is being changed from Minor to Student, new Benefits Cards need to be requested. Please see the section on Requesting Benefits Cards for the process. Family Category This Certificate Menu item allows you to make changes to the coverage details for Plan Members and their Dependents. a) Updating Family Category Select the Family Category from the left menu. The Family Category screen opens. The Family Category might need to be changed when a Plan Member adds a new dependent, or needs to terminate coverage for a dependent, or when re-applying for a previously forfeited benefit. Page 30 of 79

31 Select the benefit to be changed from the Family Category tree (in this example, we ve selected Dental). Select Update Family Cat from the Task Center Then select the Edit button. Page 31 of 79

32 Select the new Family Category value from the drop down box. The allowable values will be None, Single, Couple and Family as applicable to your Policy. Select the applicable Override Reason value from the drop down box. Enter the Effective Date of the change. Note: This is the date the change should take effect. You will not be able to downgrade the Family Category retroactively with a date more than three months in the past or upgrade the Family Category more than 31 days in the past. The change in premium will show on the next bill and will reflect the retroactive change in premium (if applicable). The Re-Application Status of Valid should be selected if a change in coverage is being requested. Select the Apply button and verify the changes requested are displayed. Select the Save button to save the changes. The system will verify the information and the coverage change will be displayed once the screen is refreshed. Page 32 of 79

33 You will be returned to the Update Family Category window. Select the next benefit to be edited (if applicable). Select Edit, repeat steps as above, select Apply and Save. Select the Apply button when you have finished your edits. Then select Save. Page 33 of 79

34 Select the Close button on the Update Family Category screen. To exit the screen without saving or making changes, select the Cancel button. This can be selected either before or after selecting the Apply button. Note: If your plan offers any of the Equitable HealthConnector services, these are mandatory and cannot be forfeited; therefore the Family Category should be set in accordance with the family status. Benefits This Certificate Menu item, which is view only, is the Benefits screen. This screen displays the Benefits (current and historical) for each of the Covered Lives under the Certificate as well as the Evidence of Insurability information. From the Certificate Menu, select the Benefits item. The Benefits section consists of the following fields: a) Benefits Section Covered Life: You can select the Covered Life to view from this drop down box, once selected the benefits for the particular Covered Life are displayed. Page 34 of 79

35 Decline Check Box: If this check box is checked, this means the Benefit has been declined or the Covered Life is not eligible. LOB: This is the Line of Business. Benefit: This is the Benefit name. Status: This is the Status of the specific Benefit for the selected Covered Life. Status Reason: This is the Status Reason for the Status of the Benefit if it is terminated. Eff Dt: This is the Effective Date for the current Status. Benefit Exp. Dt.: This is the system calculated Benefit Expiry Date. The Plan Member s date of birth and the termination age of the Benefit will determine this. Extended. Exp. Dt.: This is the Extended Expiry Date. In the case of a Benefit extension due to a severance package, the Extended Expiry Date will display in this column. b) Evidence of Insurability Evidence of Insurability will only display if underwriting is required, in progress or if it has been completed previously. The Status field will display Open if underwriting is required or in progress. Otherwise it will display Closed if underwriting has been completed. The Underwriting Date field will display the date the Evidence of Insurabiltiy was requested if the status is Open and date the coverage descision was made if the status is Closed. The Coverage Decision field will display the reason for the request for Evidence of Insurability if the status is open or the coverage decsion if the status if Closed. The Evidence Required For section displays the reason for the request for Evidence of Insurability. c) Benefit Termination List Decline Check box: If this check box is checked this means the benefit has been declined or the Covered Life is not eligible for this benefit. Page 35 of 79

36 LOB: This is the Line of Business. Benefit: This is the Benefit name. Status: This is the Status of the specific Benefit for the selected Covered Life. Status Reason: This is the Status Reason for the Status of the Benefit. Eff Dt: This is the Effective Date for the current Status. Benefit Exp. Dt.: This either shows the system calculated Expiry Date for the Benefit based on the Certificate s date of birth and the termination age of the benefit or the termination date of the benefit if the benefit has been Forfeited/Declined. Ext. Exp. Dt.: This is the Extended Expiry Date. In the case of a Benefit extension due to a severance package, the Extended Expiry Date will display in this column. Volume Amounts This Certificate Menu item, which is view only, is the Volume Amounts screen. This screen displays the current and historical records for the volume-based benefits. The Volume Amounts screen is divided into two sections. First, the Volume Amounts section which displays the current volume amounts and second, the Volume Amount History section which displays the historical volume amounts. The following fields are available for viewing in the Volume Amounts and/or the Volume Amount History section: Covered Life: From this drop down box, you can select a specific Covered Life to view the Volume Amounts detail. As Of Date: The current date will be displayed in this field. You can select the As Of Date to view a past dated or future dated change in the current Volume Amounts section. Name: This column displays the Name of the Covered Life for the volume information displayed. LOB: This is the Line of Business. Benefit: This is the Benefit name. Amount: This is the Amount of coverage (volume) based on the benefit amount calculation defined for the plan, which could be based on salary. For example, if the benefit calculation is 1x earnings and the Page 36 of 79

37 Plan Member earns $60,000 the volume will display as $60,000. If the benefit includes a reduction clause (for example, reduces by 50 percent at age 65) there will be a record displayed in the historical section (as a future dated record). Income: This is the Income amount as of the current date that the benefit calculation is based on. If Volume Amounts are based on multiple income types (salary, commission) this value will display the combined amount. # Units: If the Volume Amounts are based on Number of Units (typically for Optional benefits), it will display in this field. Eff. Dt.: This is the Effective Date of the volume amount. Exp. Dt.: This is the date the current volume expires. For example, if a new volume is effective as of a future date, the date the current volume expires will display. Otherwise, the Expiry Date will display as the calculated Expiry Date based on the date of birth of the Plan Member and the termination age of the benefit. (For example, for Life the benefit may terminate at age 70.) Beneficiaries This Certificate Menu item is the Beneficiaries screen which allows you to make updates to the current beneficiary and also add new or additional beneficiaries. If adding an additional beneficiary you must first change the share percentage (% Share) of the current beneficiary before adding the new one, as the total amount must not equal more than 100 percent. Also, if changing from one beneficiary to another, you need to first change the status of the current beneficiary to inactive. Note: Beneficiary designations should always be applied at the All LOB s (All Lines of Business) level. a) Adding a New Beneficiary Select the New Beneficiary link found in the Task Center. Add all the required information in each section. Beneficiary Details Section Page 37 of 79

38 Unknown Beneficiary: If you do not have the beneficiary details, you can use this check box to auto assign the Plan Member s Estate as the beneficiary and if you receive the information at a later date, it can be updated accordingly. Beneficiary Type: The values in the drop down box are Primary and Secondary. If the Primary Beneficiary is deceased at the time of the Plan Member s death, then the benefits would be assigned to the Secondary Beneficiary. You cannot add the Secondary Beneficiary if there is no Primary Beneficiary designated. Effective Date: Enter the date the beneficiary record is Effective which is the date the Plan Member signed the form. Relationship: Enter the Relationship of the beneficiary. This is a free-form text field so that you can enter Spouse, Child, Parent, Sibling, etc. % Share: This is the percentage of the Benefit Amount that would apply to the beneficiary being added. If there will be multiple beneficiaries designated, the total sum of the percentage share must equal 100 percent. Status: This is the Status of the beneficiary record. The system will default to Active. Status Reason: When adding new beneficiary records, the Status Reason is not required. You can skip this field. Country and Province: These are optional Fields and can be left blank. Person/Corp: Select from the drop down box Person or Corporate. Corporate would be used if the Plan Member is assigning a corporation (non-person) as the beneficiary. One example of this would be the naming of a charitable organization as a beneficiary. Trustee Required (minor): Select this box if the beneficiary being added is under the age of majority as outlined in the Plan Members province of residence. Trustee Requested: This is an optional box that can be selected if the beneficiary being added is under the age of majority in the Plan Member s province of residence. Please note that you must request this information from the Plan member and enter it on the system.. Estate: If the Plan Member has requested on the form to designate their estate as the beneficiary, you can use this check box to auto assign the Plan Member s Estate. Beneficiary Info. Section Page 38 of 79

39 The First Name, Last Name, Corr. Lang. (language of correspondence) and Gender are mandatory fields. The Middle Name,Birth Date, Title and Marital Status fields are not mandatory. Corporate Beneficiary Section The Legal Name and Corr. Lang. (language of correspondence) fields are mandatory if a Corporate beneficiary is selected. The Short Name field is not mandatory. Once the information is loaded, select the Apply button. The system will validate the information loaded to be sure it is complete. Then, the new entry will appear in the Beneficiary screen. When the Update Pending message below is displayed, you can select the Save button to save the new beneficiary. The beneficiary information is saved and the screen closes. b) Updating a beneficiary Select the Beneficiary to be updated by highlighting them from the list. Select the Update Beneficiary link found in the Task Center. Page 39 of 79

40 Update all the required information in each section. Beneficiary Type: This can be changed from Primary to Secondary or vice versa. Effective Date: This field is a mandatory field when changing the status of the beneficiary as well. Enter the Effective Date of the change which is the date the Plan Member signed the form. Relationship: This is a free-form text field. You may update this field as required (Spouse, Child, Parent, Sibling, etc.). % Share: If adding an additional beneficiary (where the % Share will be 50 percent for each beneficiary) you can update the share percentage. The update to the existing Beneficiaries share percentage must be made before adding the new beneficiary. Status: If the current beneficiary is no longer applicable, the Status can be changed to Inactive (from Active). Status Reason: The Status Reason is a mandatory field if the Status is changing to Inactive. Country and Province: These are optional Fields and can be left blank. Trustee Required (minor): Select this box if the beneficiary being added is under the age of majority in the Plan Member s province of residence. Trustee Requested: This is an optional box that can be selected if the beneficiary being added is under the age of majority in the Plan Members province of residence Please note that you must request this information from the Plan member and enter it on the system. Estate: If the Plan Member has requested on the form to designate their estate as the beneficiary, you can use this check box to auto assign the Plan Member s Estate. Page 40 of 79

41 Changes can also be made to the Beneficiary Info. Complete the Mandatory Fields and then select Apply and Save. First Name and Last Name: This field can be updated to accommodate a name change. The Birth Date, Title, Corr.Lang. (language of correspondence) and Gender: fields can all be updated to correct an error. Once the updates have been made to the appropriate fields, you must select the Apply button. This will apply all the changes made and validate that all the required fields have been completed. Once the Apply button has been selected, the new information entered will display in the Beneficiary screen and the Update Pending message will display, and the New, Save and Cancel All buttons are enabled. If you have changed the % Share to something other than 100 percent (for example, if there is a new beneficiary being added in addition to the current beneficiary in order to share the total benefit amount), you can select the New button and follow the instructions on adding a New Beneficiary. If you attempt to Save the change now, the message below will appear indicating that the % Share does not equal 100 percent. You must select the New button in this case. Page 41 of 79

42 In the case where the old beneficiary is no longer Active (status changed to Inactive), selecting the New button will allow you to add a new beneficiary to this Certificate. Again, in this case, if you try to Save the change (changing the status from Active to Inactive), the system will display the message below, indicating that the total share must equal 100 percent. The status change must be accompanied by adding a New Beneficiary. After you have completed the information, select Apply and then Save. If you changed a field only in the Beneficiary Info. (First Name, Last Name, Birth Date, etc.) section, you will be able to save the change, by selecting the Save button. Once the change is saved, you are returned to the Beneficiary section, with the updated information displaying in the Beneficiary screen. Adding a New Beneficiary (in the Update Screen) As mentioned above, after changing the Status of the beneficiary or the % Share, you can add a new or additional beneficiary from the update screen. After changing the Status and selecting the Apply button, select the New button. Page 42 of 79

43 Add all the required information in each section. Instructions on how to do this through the Update Screen are available in Adding a New Beneficiary. COB (Coordination of Benefits) This Certificate Menu item is the COB (Coordination of Benefits) screen. Coordination of Benefits is where coverage is also provided through another insurance plan. a) Adding COB to the Certificate To display the COB screen, select the COB item in the Certificate Menu. You will need to determine which Covered Life and which Benefit to apply the COB to. Using the (+) and (-) symbols, you can expand and collapse the Covered Lives and the benefits in the COB search screen. If the COB applies to all family members, the COB can be added under the Spouse only which will then apply to any dependents below this Covered Life within the Benefit Tree. Select the appropriate folder from the screen above. If the COB applies to all the health benefits, including dental, you can add this at the Extended Health Care level instead of adding it separately to individual benefits. Once the folder is selected, the New COB option is enabled in the Task Center. Select the New COB link found in the Task Center. The New COB screen will open. Page 43 of 79

44 Select the COB Coverage from the drop down box. The values available under Spouse will be Family or Single. If COB is for the whole family, Family should be selected. The Prime Determ. field will be auto-filled with the Canadian Life and Health Insurance Association Inc. Date of Birth (CLHIA DOB) rule. If the COB is only for the selected Covered Life, Single should be selected. The Prime Determ, field will be defaulted to blank and disabled. The values available under Child will be Single or Exception. If the COB is for the selected Covered Life and the normal CLHIA DOB rules apply, Single should be selected. The Prime Determ. field will be disabled and CLHIA DOB rules will apply. If normal CLHIA DOB rules do not apply, Exception should be selected. The Prime Determ. field options will be Insured Primary or Spouse Primary. Insured Primary means that this plan will be the first payor for claims for the selected Child and Spouse Primary means the Spouse s plan will be the first payor for claims for the selected Child. Enter the Effective Date. Select the Status from the drop down box. The values are Active (for new COB records) and Inactive (for terminating a COB record). Select the Status Reason (only required if the Status is Inactive). Enter the Carrier name. This is the Insurance Carrier that the other coverage is provided through. Enter the Policy ID of the other coverage. This field is not mandatory. Enter the Certificate ID of the other coverage. This field is not mandatory. Enter the Employer name of the other coverage. This field is not mandatory. You can also enter a note in the COB Notes field. This is a free-form text field that you can store information regarding the COB situation for the Certificate. Select the Save button. You can select the Cancel button to exit without saving or making the change. Once saved, the appropriate folder will display a green check mark indicating that COB has been applied to this LOB/Benefit. Business) or Benefit that has a green check mark displayed. Page 44 of 79

45 b) Updating Existing COB Records Select a LOB (Line of Once the benefit has been highlighted, you can select the Update COB link found in the Task Center. The Update COB screen will open. You can make updates to the following fields: COB Coverage: This can be changed from Family to Single or Single to Family. Note: the differences between these two options is that Single means the alternate coverage only covers one Covered Life and Family means the alternate Carrier covers all Covered Lives. Carrier: The Insurance Carrier name may change. Policy ID: The Policy ID of the alternate coverage may change. Certificate ID: The Certificate ID of the alternate coverage may change. Employer: The Employer name where the alternate coverage is provided may change. Note: For the above changes in the Carrier Detail section, you can make these changes without updating the Effective Date of the COB. Select the Save button to save the changes. You can select the Cancel button to exit the screen without saving or making the change. Page 45 of 79

46 c) Terminating COB Records Select a LOB (Line of Business) or Benefit that has a green check mark displayed. Enter the Effective Date that the COB is no longer effective. Change the Status from Active to Inactive. You may select the Status Reason from drop down box. You are able to enter COB Notes to this free-form text field. You can provide other details in this space and it will be displayed when viewing the COB. Select the Save button. To exit the screen without saving or making the change, select the Cancel button. Benefits Cards This Certificate Menu item is the Benefits Cards screen which is where you are able to view, print or Benefits Cards; request Benefits Cards from our head office and delete pending requests for Benefits Cards for Plan Members and their dependents. If you have chosen our paperless option, you will only have the ability to view, print and Benefits Cards. a) Print Cards Select the Print Cards link found in the Task Center. Page 46 of 79

47 The Benefits Cards screen will open. You will notice a Language drop down box where you can select if you would like the card produced in English or French. To view or print a card, select View/Print beside the Plan Member s name (Insured) or the name of a dependent (Spouse or Child). An electronic version of the Benefits Card in PDF format will open, which you can then view, save or print. To a Benefits Card, select beside the Plan Member s name (Insured) or the name of a dependent (Spouse or Child). This will display the Address you previously provided. If you want to send the selected Benefits Card to a different address, or directly to the Plan Member, you can change the displayed address before you select Send. Select the Send button to send the . A PDF version of the card will be attached to the . Once the Send button is selected, a message will display to confirm the Benefits Card has been sent. Page 47 of 79

48 b) Order Cards Select the Order Cards link found in the Task Center. The Request Wallet (Benefits) Cards screen will open. Select the Issue Reason from the drop down box. You are able to request cards at two Covered Life levels. The default is set to All Adults. This option will order cards for all the adults belonging to that Certificate who are eligible for cards. This includes a Spouse, Overage Dependent Children (Student) and Disabled Dependent Children. The other option is the Specific Covered Life selection. If you select this option, the Covered Life Name drop down box is enabled and you can request a card for the Covered Life selected. Please ensure cards are only requested for those eligible to receive a card (Insured, Spouse, Overage Dependent and Disabled Dependent Children). Select the Save button. Page 48 of 79

49 You can select the Cancel button to exit the screen without saving or making the change. The card request will be displayed: c) Deleting an Existing Card Request If there is an existing card request displayed that is marked with a Status of Pending the Delete Card Request option will appear in the Task Center. Select the Delete Card Request link found in the Task Center. A message will display confirming that the request should be deleted. Select the Delete button to proceed. Select the Cancel button to exit without deleting the request. Once the request is deleted, the following message displayed. Page 49 of 79

50 Premium Calculator The Premium Calculator displays a summary of coverage and the associated premium cost for the selected Plan Member, based on the current month. The Current Month fields default to display the current month and provide a calculation based on a full month s worth of premium. Adjust the date in the Current Month box to calculate a pro-rated premium estimate for a specific time period. In this example, we chose 15 days, from August 1-15th. You will see the calculator updating the Total row in the Premium Calculator Summary, as well as the row for each benefit, based on the inputs you provide. Page 50 of 79

51 Click on the question mark symbol in the Premium Calculator Summary for a quick how-to. You can adjust the volume of coverage to forecast the premium cost of a future change. This example shows the new premium calculation for increasing Short Term Disability from a volume of $1275 to $1500. Before: After: You can choose a different Family Category (eg for Health and Dental benefits) and the Calculator will update based on the current rates for the selected coverage. Page 51 of 79

52 Below is a chart of the field names, the definitions and acceptable values. Class Benefits Effective Date Volume Rate (view only) Premium Total Displays the benefits that the Plan Member s current class offers You can enter a different date and change other details, to anticipate a change in premium for a future-dated change. The calculator defaults to showing a whole month s premium charge, but you can alter the effective date to calculate a pro-rated charge for less than a full month of coverage. Displays the amount of coverage Inforce for the Plan Member. You can change the volume to calculate the new premium for a future-dated change. Displays the rate for each benefit. It is either a flat rate for a service based benefit such as Health, or a fluctuating rate for volume-based benefits such as Long Term Disability. Displays the estimated premium, which is calculated by multiplying the volume of coverage for the Plan Member by the rate. Displays the grand total of premium for all benefits and coverage as selected Process Response This Certificate Menu item is the Process Response screen. This is where you will determine if the Plan Member or Covered Life is a late applicant, if they are eligible for an amount over the Non- Evidence Limit, or if medical underwriting is required. Select the Process Response link from the Certificate Menu. The Process Responses list will open. Plan Members and their dependents must apply for coverage within 31 days of their eligibility, and must serve applicable waiting periods. If you enroll a Plan Member who is a late applicant, you will receive the following message. Page 52 of 79

53 In this case, medical underwriting is required. Have the Plan Member complete and submit a Form 452 Statement of Health. Select a row from the list and the Response Message will display. The following information is provided in the Process Response screen: Benefit Covered Life Response Dt. Response Message Indicates the Benefit for the Response Message. Indicates the Covered Life that has the Response Message. Indicates the Effective Date of the Response Message. Displays the Response Message. Use the chart below as a guideline to determine whether or not medical underwriting forms are required. Response Over the NEL Coverage is declined EOI trapped for late Action Required or Information Required The plan member is eligible for an amount over the Non-Evidence Limit. The plan member must complete the required Statement of Health form (No. 452) and submit to Equitable Life for review and approval. The benefit for this covered life has been declined. The covered life has been trapped as a late applicant. The Covered Life must complete the required Statement of Health form (No. 452) and submit to Equitable Life for review and approval. Page 53 of 79

54 Rate Summary This Certificate Menu item, which is view only, is the Rate Summary screen. This screen displays the current rates for each benefit under this Plan Member s class. This screen also shows the rates for optional benefits such as Optional Life. Health Care Spending Account (HCSA) If applicable, the HCSA screen can be used to change a Plan Member s HCSA information. To view a Plan Member s HCSA information, select the Health Care Spending Account item in the Certificate Menu. a) View HCSA Details Benefit Period Section This allows you to select from a list of available Benefit Periods to see the HCSA details. Health Care Spending Account Summary Section This displays the HCSA allocation information for the Benefit Period selected from above. Page 54 of 79

55 The displayed fields are as follows: Carried Forward: The amount Carried Forward from the prior Benefit Period. Allocated Amount: The amount of money Allocated to the Plan Member for the current Benefit Period selected. Total Amount: The Total Amount of money available based on the prior period s Carried Forward amount and the Allocated Amount for the current Benefit Period selected. Less: Claims Paid Amount: The amount of money that has been used for the Benefit Period selected. Balance: The Balance of money available based on the Total Amount minus the Less: Claims Paid Amount. Claims must be incurred by: The date that Claims must be incurred by for the Benefit Period selected. Claims must be Submitted by: The date that Claims must be Submitted by for the Benefit Period selected before money will be forfeited. Reason: The termination Reason if the HCSA has been terminated. Period End Summary displays the amount of money that will be forfeited at the end of the Benefit Period selected if not used, the amount that will be Carried Forward to Next Period (if applicable) and the type of the HCSA the Plan Member is enrolled in (Risk Method). Allocation Details This displays the Allocation Amount for the Benefit Period selected, the Allocation Override Reason if the system generated amount was changed and if the allocated amount is to apply to the next Benefit Period (Also Apply to Future Prd). Page 55 of 79

56 Allocation History This displays a history of the changes in the amount allocated for the Benefit Period selected. Participation Details This displays the changes in the Plan Member s participation in the HCSA. This will show all history on changes in participation for the Benefit Period selected which includes the Effective Date for the change, the participation indicator of Yes or No, the reason for the change and the Family Category. b) Updating Allocation To add or change the allocation amount for the current Benefit Period for a Plan Member, select the Update Allocation link found in the Task Center. This will open a new screen. Page 56 of 79

57 Enter the new allocation amount in the Revised Allocation Amount field. Select the check box Also Apply to Future Periods if you would like this Plan Member to have this newly entered Allocation Amount automatically entered each year. Select an Override Reason for adding or changing the amount from the drop down box and then select Save. You can select the Cancel button to exit the screen without saving or making the change. c) Updating Participation If the Plan Member is not eligible, or does not want to participate in the HCSA or now needs to participate because they previously opted out, select the Update Participation link found in the Task Center. This will open a new screen. Select either the Yes or No button beside the HCSA Participation. Enter the Effective Date of the change and select an Override Reason for the change. Select the Save button when complete. If the plan is set up to have different Allocation Amounts (Single/Couple/Family) and you would like to change a Plan Member s HCSA based on this, you can do this here. Select the applicable Family Category; enter the Effective Date for the change and then select Save. You can select the Cancel button to exit the screen without saving or making changes. Mass Income and Occupation Changes The Mass Changes option allows Income and Occupation changes to be done on a group or on a Plan Member basis. Select the Mass Changes button located in the tool bar. The Mass Changes screen is displayed. This screen has a Search Certificate function to assist in narrowing down the Plan Members that are displayed. For example, if you wish to display Plan Members that belong to Division 001, Class B, select the Division and Class fields. Either enter Division 001 and Class B in the appropriate fields or select them from the corresponding drop down boxes. Then select the Page 57 of 79

58 Search button. The results that are displayed will only be for Plan Members that meet the searched criteria of Division 001, Class B. From the Certificate List select the Plan Member(s) to be changed. Each Plan Member that is to be changed to the same value (for example, all changing to $30,000 annually) needs to be selected. Your selections are indicated/confirmed by a check mark in the left hand column of the screen as highlighted below. Once all the necessary Plan Members have been selected that require the same update, you will note that there are four buttons located below the list. The following section explains what each button does. Note: In order to make changes, your selections must have the same Income Type and Freq.(uency), (for example, Annual Salary). To see this level of detail for each selection, hover over a specific row and a tool tip will display specific data including: Income Type, Income Frequency, Number of Hours per Week, Amount, Last Modified Date and Occupation. Page 58 of 79

59 a) Adding Income Add Income allows you to add an Income Type that isn t already defined. For example, if you have a number of Plan Members that need to have the Income Type of Commissions added, you can do that here. Complete the necessary fields marked by a red asterisk. Fields include: Change Eff. Dt.: Enter or select the Change Effective Date from the calendar option. Income Type: Select the appropriate option from the drop down box; you will note that the already defined Income Types do not appear in the drop down box. Frequency: Select an appropriate Frequency from the drop down box, (annually, monthly, etc.). # Hrs/Week: Enter the Number of Hours Worked in a Week. Amt. /Prc.: Enter the Amount for the desired income. You can select the Save button to continue or the Cancel button to exit the screen without saving or making changes. b) Editing Income The Edit Income feature allows you to add a New Income Amount, Dollar Change or Percentage Change to the selected Plan Member. In the event that Plan Members are selected where the Income Type and Frequency do not match for each record, the following message will display when selecting the Edit Income option. Page 59 of 79

60 New Income New Income allows you to change the income amount to a new, flat amount. For example, a particular group of Plan Members income should change to $27,500 annually effective January 1, Complete the necessary fields marked by a red asterisk. Fields include: Change Eff. Dt.: Enter or select the Change Effective Date from the calendar option. Income Type: Select the appropriate option from the drop down box; you will note that the already defined Income Types do not appear in the drop down box. Frequency: Select an appropriate Frequency from the drop down box, (annually, monthly, etc.). # Hrs/Week: Enter the Number of Hours Worked in a Week. Amt. /Prc.: Enter the Amount for the desired income. You can select the Save button to continue or the Cancel button to exit the screen without saving or making changes. Once the changes have been saved, the Certificate List will display and any Plan Members that have changed will display with the revised data and a process status of unprocessed until the changes take effect overnight. Page 60 of 79

61 Dollar Change Dollar Change allows you to increase or decrease to the highlighted Plan Members by dollar specific dollar amount. For example, a particular group of Plan Members should get a $100/week increase. Complete the necessary fields marked by a red asterisk. Fields include: Change Eff. Dt.: Enter or select the Change Effective Date from the calendar option. # Hrs/Week: Enter the Number of Hours Worked in a Week. Amt. /Prc.: Enter the Amount for the desired income. Increase/Decrease: Select the appropriate option based on the income change. You can select the Save button to continue or the Cancel button to exit the screen without saving or making changes. Percentage Change Percentage Change can be used when it is necessary to increase/decrease all selected Plan Members by an indicated percentage. For example, a particular group of Plan Members had a two percent increase effective January 1, Page 61 of 79

62 Complete the necessary fields marked by a red asterisk. Fields include: Change Eff. Dt. Enter or select the date from the calendar option. # Hrs/Week Enter the number of hours worked in a week. Amt. /Prc. Enter the percentage the income will change by. Increase/Decrease: Select the applicable option based on the income change. You can select the Save button to continue or the Cancel button to exit the screen without saving. c) Editing Occupation Within the Mass Change functionality, a Plan Member s occupation can be changed. Complete the necessary fields marked by a red asterisk. Fields include: Change Eff. Dt.: Enter or select the Change Effective Date from the calendar option. Occupation: Enter the new Occupation. d) Deleting Change Delete Change functionality is available for Mass Income/Occupations changes that have not been processed. To enable the Delete Change button, highlight the Plan Members that have a Process Status of unprocessed and then select the Delete Change button. Page 62 of 79

63 The system will display a warning message to confirm if you want to continue and delete the selected changes. Select the OK button to delete the pending change or select Cancel if you want to cancel the request. Transactions Requiring Contact with Equitable Life There are some processes that will remain the responsibility of our Head Office Group Benefits Administration Department. For these changes, please continue to send in the required forms and the changes will be processed. Benefit Extensions (for e.g. after a Plan Member s employment has ended) Reinstatement of a Plan Member Reinstatement of a Dependent Adding a Disabled Dependent Adding a Common-Law Spouse with a Child (if the child belongs to the Common-Law Spouse only); and Late applicants If you have any questions about the above processes, feel free to contact the Group Benefits Administration Department at Equitable Life by at groupbenefitsadmin@equitable.ca or call us (Option 5) Adding a new Plan Member To add a new Plan Member, select the Certificate menu item. Once in this screen you can click the New button at the bottom of the screen. Page 63 of 79

64 This will open a new page. Note: At any point you can exit this screen by clicking the Cancel button at the bottom of the screen. A pop-up window will open with the following three options: Save and Enroll Later: This will save the Plan Member s certificate with a status of unprocessed for you to enroll at a later date. Discard Certificate: This will delete the information entered and return you to the Certificate screen. Return to Certificate: This will take you back to Enrolment to finish entering the Plan Member data. a) Plan Sponsor Information The first section on the screen is the Plan Sponsor Information. In this section you will enter the Plan Member s Group Plan information by selecting values for each of the fields from the drop boxes or by entering data in the field. Page 64 of 79

65 Below is a chart of the field names, the definition and acceptable values: *indicates a mandatory field Division* Class* Cert #* Section ID Family Status The Division to which the Plan Member belongs. From the drop down list, select the applicable Division. The Class to which the Plan Member belongs. From the drop down list, select the applicable Class. The Certificate Number. This field is only visible if you as the Plan Administrator choose your own certificate number for each Plan Member. Otherwise, the system will issue the next available certificate number for the new member. Note: The system requirements are 10 numeric (not alpha) characters in the Cert # field. If the Certificate Number assigned is less than 10 digits, once the certificate is enrolled the system will add zeros to front of the number to make up the 10 required digits (i.e. if the Cert Number is 1234 the system will create ). The Section Identification of the Plan Member to a maximum of 20 alphanumeric characters. This is only required if the billing is to be sorted by a section code. The Family Status (Category) - the allowable values are Single, Family and Couple if your policy allows. To determine what value to select, look at the Plan Member s enrolment form. If the Plan Member has no dependent children, select Single. If the Plan Member has included one dependent, and the policy allows Couple coverage, select Couple. If the Plan Member has included one dependent, and the policy does not allow Couple coverage, select Family. If the Plan Member has included more than one dependent (spouse and/or multiple children), select Family. Page 65 of 79

66 b) Health Care Spending Account (HCSA) Next is the HCSA section which will only be enabled if the Class/plan has an HCSA. Here you will be prompted to enter information only if the HCSA is set as a manual allocation plan or if the Plan Member does not want to participate in the HCSA. You will select values for each of the fields from the drop boxes or enter data in the field. Below is a chart of the field names, the definition and acceptable values: *represents mandatory field Family Cat. Allocation Amount Apply to future benefit periods No Participation Reason The Family Category assigned to the HCSA. This field is defaulted to the Family Category value entered in the Plan Sponsor Information section. This field will only be enabled if the plan is set up to allocate HCSA amounts by the family status, otherwise this field will be disabled. Amount of the HCSA for this Plan Member. This field is used on manual allocation plans for you to enter the Allocation Amount for the current period. This field will only be enabled if the plan is set up as manual allocation otherwise this field will be disabled. Select if you are defining an amount in the Allocation Amount field and want the same amount applied to subsequent years. This field will only be enabled if the plan is set up as manual allocation otherwise this will be disabled. Selected if the Plan Member is not participating in the HCSA. Reason for which the Plan Member is not participating. Select the applicable value from the drop box. This field will only be enabled if you have selected the No Participation box otherwise this will be disabled. c) Employment Next is the Employment section where you will enter the Plan Member s employment information by selecting values for each of the fields from the drop boxes or entering data in the field. Below is a chart of the field names, the definition and acceptable values: *represents mandatory field Num of Hrs/Week* Occupation* Date Employed* Employment Type* The number of hours the Plan Member works per week. The Plan Member s current job title. The date the Plan Member was hired The employment type (i.e. Full Time, Part Time etc.). From the drop down list, select an Employment Type. Page 66 of 79

67 d) Income Next section is the Income section where you will enter the Plan Member s current income information by selecting values for each of the fields from the drop boxes or entering data in the field. Below is a chart of the field names, the definition and acceptable values: *represents mandatory field Income Type* Amount* Frequency* The type of income the Plan Member earns (i.e. salary, commission etc.). The amount of income per selected frequency. The frequency of the selected income type (i.e. Hourly, Weekly etc.). After the income information is entered you must save it by clicking the save button. This will save the current entry and allow you to continue. e) Plan Member Information Next section is the Plan Member Information section where you will enter the Plan Member s personal data by selecting values for each of the fields from the drop boxes or entering data in the field. Page 67 of 79

68 Below is a chart of the field names, the definition and acceptable values: *represents mandatory field First Name* Middle Name Last Name* Birth Date* Gender* Language* Address 1* Address 2 Address 3 City* Country* Province* Postal Code* Address Confirm Address Registration# /Health #* The first name of the Plan Member. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The middle name, if any, of the Plan Member. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The last name of the Plan Member. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The date of birth of the Plan Member. The format for this field is mm/dd/yyyy or you can select the date of birth using the drop-down calendar. The gender of the Plan Member. The preferred language of correspondence for the Plan Member. This field is defaulted to English but French can be selected from the drop box. The address of the Plan Member. Three lines are provided. Please be sure to include apartment numbers, suite numbers, etc. as applicable. These fields will allow for P.O. Box type addresses. The city in which the Plan Member resides. The country of residence of the Plan Member. This field is defaulted to Canada but the USA can be selected form the drop box. The Province of residence of the Plan Member. This is a drop down field with a list of all provinces if Canada was selected as the Country or all the States if the USA was selected as the Country. The postal code of the Plan Member. The address of the Plan Member. By entering the address the Member will automatically be signed up to receive notifications when a claim has been processed resulting in an Explanation of Benefits. To confirm the address of the Plan Member. If a Province that has a Provincial Drug Program is selected, the applicable Provincial Drug program wording will appear. This will require a selection of Yes or No. If a Yes is selected under the Provincial Drug program, this field will be enabled and require the Provincial Drug Program registration number/health number. f) Direct Deposit Next is the Direct Deposit section to allow for the Plan Member to receive Direct Deposit for claim payments. Here you will add the banking details as provided on the Plan Member s application by selecting values for each of the fields from the drop boxes or entering data in the fields. Page 68 of 79

69 Below is a chart of the field names, the definitions and acceptable values. We ve also included a sample cheque which illustrates the location of the required information. *indicates mandatory field Bank # Transit # Account # Currency Confirm Bank # Confirm Transit # Confirm Account # Institution Code as stated on application. Bank Transit Number as stated on application. Account number as stated on application. Account Currency. Re-type Institution Code as stated on application. Re-type Bank Transit Number as stated on application. Re-type Account number as stated on application. g) Selections for Health and Dental Next is the Selections for Health and Dental section where you can choose the Health and/or Dental coverage if applicable, based on the Plan Member s requests on the application. You will do so by selecting values for each of the fields from the drop boxes or entering data in the field. Below is a chart of the field names, the definition and acceptable values: *indicates mandatory field Benefit Coverage Desired Override Reason The list of benefits. The options for coverage. Select the applicable value. This field will be enable if a different value from the default Family Status above is selected. Select the applicable reason from drop box. Page 69 of 79

70 Below are some business scenarios that might occur at enrolment time and the values that should be selected for each of the fields. Business Scenario Decline Override Reason Single Plan Member No Changes to be made requesting single coverage at time of enrolment Family Plan Member Click Single option Select value requesting single Health coverage at time of enrolment Family Plan Member requesting NO Health or Dental coverage at time of enrolment Click None option Select value h) Dependents Next is the Dependents section where you will enter any dependents to be loaded under this Plan Member by selecting values for each of the fields from the drop boxes or entering data in the field. Below is a chart of the field names, the definition and acceptable values: *represents mandatory field First Name* Middle Name Last Name* Language* Birth Date* Gender* Relationship* Relationship Type* Coverage Expiry Date The first name of the dependent. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The middle name, if any, of the dependent. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The last name of the dependent. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The preferred language of correspondence for the dependent. This field is defaulted to English but French can be selected from the drop box. The date of birth of the dependent. The format for this field is mm/dd/yyyy or you can select the date of birth using the drop-calendar. The gender of the dependent. This is a drop down field with either Female or Male as the selections. The type of Dependent. This is a drop down field with either Child or Spouse as the selections. The Dependent Subcategory. If the Relationship of Spouse was selected the options will be Married or Common Law. If Child was selected the option will be Minor or Student. If the Relationship was selected as Child and Student selected as the Relationship Type, the box will be enabled. The date the student will have finished their schooling should be entered in this field. The format for this field is mm/dd/yyyy or you can select the date of birth using the drop-calendar. After the information is entered for a dependent you must save it by clicking the save icon. Page 70 of 79

71 This will save the current dependent and allow you to add additional dependents. i) Coordination of Benefits Next is the Coordination of Benefits (COB) section. You can add COB details for Plan Members and their covered dependents for Health and/or Dental benefits. You will select values for each of the fields from the drop boxes or enter data in the field. Below are charts of the field names, the definition and acceptable values: *represents mandatory field mandatory field Covered Life Benefit COB Coverage Carrier Employer The list of dependents added under this Plan Member. Select the applicable dependent from the drop box. If the COB is for all family members add the COB to only the spouse s record. The list of benefits COB can be applied to. Select the applicable value from the drop box. If the COB applies to all benefits, select the All Benefits value. The type of COB coverage in relation to who it covers. Exception is for a special set up, Family is for all dependents and Single is for only the dependent chosen in the Covered Life field. Name of the other insurance carrier. Name of place of employment in which the other benefits are provided. Once all the values have been entered in the required fields, you must click the save icon. The information is saved and you can either add Coordination of Benefits details to another covered life or continue to the next section. j) Beneficiary Next is the Beneficiary section where you will designate the beneficiary information as stated on the application by the Plan Member. This section has many parts and depending on the selections made, it will expand the section for required information. You will select values for each of the fields from the drop boxes or enter data in the field. Page 71 of 79

72 Below are charts of the field names, the definition and acceptable values: *represents mandatory field Estate If this checkbox is selected, the system will automatically assign the Plan Member as the beneficiary (estate). Beneficiary Detail Person/Corp. Beneficiary Type Relationship The beneficiary being designated is a person or a corporation. This field is defaulted to Person but if the value is changed to Corporate, the Beneficiary info section will change based on the information that is required. The values are Primary or Contingent. You cannot assign a contingent beneficiary without first defining a Primary beneficiary. A contingent beneficiary is assigned so that in the event that the primary beneficiary is deceased at the time of the Plan Member s death, the benefit will be paid to the contingent beneficiary assigned. The relationship of the beneficiary to the Plan Member (i.e. Spouse, Child, Parent, Friend etc.). % of Share If the Plan Member wishes to designate multiple beneficiaries, the sum of the share must equal 100%. If there is only one beneficiary designated, the percentage Share should be entered as 100. Trustee Required for Minor Person/Corp. Beneficiary Info. (Person) If the beneficiary being designated is less than the age of majority, this checkbox must be selected. Once the checkbox is selected, the screen lengthens and a section for Trustee Detail is displayed. The Trustee being designated is a person or a corporation. This field is defaulted to Person but if the value is changed to Corporate, the Beneficiary info section will change based on required information. Below are charts of the field names, the definition and acceptable values: *indicates mandatory field First Name Middle Name Last Name Language The first name of the beneficiary. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The middle name, if any, of the beneficiary. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The last name of the beneficiary. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The preferred language of correspondence for the beneficiary. This field is defaulted to English but French can be selected from the drop box. Page 72 of 79

73 Beneficiary Info. (Corporate) Below are charts of the field names, the definition and acceptable values: *indicates mandatory field Legal Name Language The full legal name of the corporation. The preferred language of correspondence for the beneficiary. This field is defaulted to English but French can be selected from the drop box. Trustee Info. (Person) Below is a chart showing field names,,definitions and acceptable values: *indicates mandatory field First Name Middle Name Last Name Language Relationship The first name of the trustee. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The middle name, if any, of the trustee. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The last name of the trustee. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The preferred language of correspondence for the beneficiary. This field is defaulted to English but French can be selected from the drop box. The relationship of the trustee to the member (i.e. Spouse, Child, Parent, Friend, etc.). Trustee Info. (Corporate) Page 73 of 79

74 Below are charts of the field names, the definition and acceptable values: *represents mandatory field Legal Name Language The legal name of the beneficiary. This field allows for letters and special characters, such as (-) hyphens and ( ) apostrophes. The preferred language of correspondence for the beneficiary. This field is defaulted to English but French can be selected from the drop box. Once all the information is completed, you must click the save icon. This will save the beneficiary detail you just added and allow you to add additional beneficiaries. The Beneficiary data for this entry is then saved and a summary will appear. k) Override Flags Next is the Override Flags section. It is used for waiving a plan member s waiting period as an exception or for specific plans that have a manually tracked waiting period which defines the Benefit Start Date for the Plan Member. This section is also used to apply a tax exempt status for Status Indians. Select the applicable override by clicking the box beside the override needed. Enter effective date if applicable and select a Reason from the drop down list. Below is a chart of the field names, the definition and acceptable values: *represents mandatory field Waive Waiting Period for Insured and HCSA Tax Exempt for all Benefits Benefit Start Date for Insured Benefits or HCSA When this option is checked, it will override any defined waiting periods and start the Plan Members coverage as of the hire date. When this option box is checked, the billing sales tax will not to be calculated for this Plan Member. Checking this option box allows you to specify a Benefit Start Date specific to Insured Benefits or the HCSA, which will override any defined waiting periods used to determine the Plan Members Benefit Start Date. Note: The HCSA option will only be accessible to you if the Class selected has an HCSA. Page 74 of 79

75 l) Enroling The final step is the Enrolment section. At this point, you must ensure that you have a completed and signed Plan Member application form. Once you have this, you can click the Enrol button. During the enrolment process the system will verify that all required data has been entered and will determine eligibility based on the defined plan setup. Once the enrolment is processed a new window will open with the Response List. You may or may not receive messages in the response list. Refer to the following chart to determine if further action is required if you do receive one of these messages: Response Over the NEL EOI trapped for Late EOI trapped for everyone Action Required or Information Required The Plan Member is eligible for an amount over the non-evidence limit. The Plan Member will need to complete the Statement of Health form (452) and submit it to Equitable Life for review and approval if they wish to be covered for the higher volume amount. The Plan Member and dependents (if applicable) are late applicants and must complete the required Statement of Health form (452) and submit it to Equitable Life for review and approval in order to be covered for the benefit. The Plan Member and dependents are late applicants and must complete the required Statement of Health form (452) and submit it to Equitable Life for review and approval in order to be covered for the benefit. m) Certificate Enrolment Summary You can view an enrolment summary by selecting the View Certificate Enrolment Summary button. This will open a summary of the detail entered during the enrolment. You have the option to print the summary. This summary is stored under the Plan Member s account on the Certificate Summary screen and is accessible to you and the Plan Member after enrolment for up to one year from the date of creation. Page 75 of 79

76 If the Plan Member is a late applicant you will receive the following message as the summary will not be available to view: Page 76 of 79

77 Note: The HCSA section will only appear if you have enrolled a Plan Member into a Class that has an HCSA. Once you have printed the Certificate Enrolment Summary you can now click the exit icon at the top of the window to be returned to the Response List screen. Plan Member benefits cards will be automatically ordered and any other notifications that Equitable Life requires as a result of the enrolment will be automatically sent. Page 77 of 79

78 n) Finishing the Enrolment The Response List screen displays two options: one to View Certificate Enrolment Summary which is covered in the section above and to Add New Certificate which provides the option to enroll another Plan Member. If you would like to perform another task, you can navigate away from the page by clicking another link from the menu bar or if you are finished you can logout. Page 78 of 79