The Municipality of Trent Lakes Group Policy Number: G Class: Employee Name:

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1 The Municipality of Trent Lakes Group Policy Number: G Class: Employee Name: Certificate Number: E - All Union Employees of The Municipality of Trent Lakes Welcome to Your Group Benefit Program Group Policy Effective Date: January 01, 1997 This Benefit Booklet has been specifically designed with your needs in mind, providing easy access to the information you need about the benefits to which you are entitled. Group Benefits are important, not only for the financial assistance they provide, but for the security they provide for you and your family, especially in case of unforeseen needs. Your Plan Administrator can answer any questions you may have about your benefits, or how to submit a claim. This booklet produced: April 03,

2 Ta ble of Con tents Ben e fit Sum mary....3 How to Use Your Ben e fit Book let....8 Explanation of Common Insurance Terms Why Group Ben e fits? Your Plan Ad min is tra tor Ap ply ing for Group Ben e fits Mak ing Changes The Claims Pro cess...14 Nam ing a Ben e fi ciary How to Sub mit a Claim...14 Co-or di na tion of Ex tended Health Care and Den tal Care Ben e fits Who Qualifies for Coverage? El i gi bil ity Ev i dence of Insurability Late Ap pli ca tion...17 Late Den tal Ap pli ca tion Ef fec tive Date of Cov er age Ter mi na tion of In sur ance Re sil ience Ser vices Em ployee Life In sur ance...20 De pend ent Life In sur ance Ba sic Ac ci den tal Death and Dis mem ber ment In sur ance Ex tended Health Care Den tal Care Sur vi vor Ex tended Ben e fit...52 Long Term Dis abil ity...52 Notes The Municipality of Trent Lakes

3 Ben e fit Sum mary This Benefit Summary provides information about the specific benefits supplied by Manulife Financial that are part of your Group Plan. This version of the Benefit Summary produced: April 03, 2013 Resilience Services Short Term Counselling - approximately (4) to (6) hours of counselling for an unlimited number of Issues Resilience Services Legal Counselling Service Financial Counselling Service Online Courses - unlimited access to online courses Online Childcare and Eldercare Resource Database - unlimited access to a national online childcare and eldercare resource database Employee Life Insurance Benefit Amount - $50,000 Employee Life Insurance Termination Age - your benefit amount reduces by 50% at age 65 and terminates at age 70 or retirement, whichever is earlier Dependent Life Insurance Benefit Amount - $7,500 spouse; $2,500 each dependent child Dependent Life Insurance Termination Age - employee s age 70 or retirement, whichever is earlier Accidental Death and Dismemberment The Accidental Death and Dismemberment Benefit is insured by Chartis Insurance Company of Canada. Accidental Death and Dismemberment A description of this benefit appears in this Booklet under the section Your Group Benefits. Please refer to the Table of Contents for the page number. The Municipality of Trent Lakes 3

4 Ben e fit Sum mary Extended Health Care Extended Health Care - The Benefit Extended Health Care The Benefit Overall Benefit Maximum - Unlimited Deductible - Nil Benefit Percentage (Co-insurance) - 100% for - Hospital Care - Medical Services & Supplies - Professional Services - Vision - Drugs Note: The Benefit Percentage for Out-of-Canada Emergency Medical Treatment is 100%. The Benefit Percentage for Referral outside Canada for Medical Treatment Available in Canada is 50%. The Benefit Percentage for Emergency Travel Assistance is 100%. Termination Age - employee s age 65 or retirement, whichever is earlier Extended Health Care - Direct Drugs - Plan 5 Di rect Drugs - Plan 5 Charges incurred for the following expenses are payable when prescribed in writing by a physician or dentist and dispensed by a licensed pharmacist. drugs prescribed by a physician or dentist for the treatment of a sickness or injury oral contraceptives hematinic vitamins (vitamins to treat blood disorders) properly identified in the Compendium of Pharmaceuticals and Specialties preventive vaccines and medicines (oral or injected), excluding charges for vitamin B6 and B12 injections for treatment of weight loss diabetic supplies (excluding cotton swabs, rubbing alcohol, automatic jet injectors, insulin infusion pumps and similar equipment) Charges for the following are not covered: anti-smoking drugs the administration of injectable medications dietary supplements, health foods, nutritional products, and vitamins (except injectable and hematinic vitamins) drugs, biologicals and related preparations which are intended to be administered in hospital on an in-patient or out-patient basis and are not intended for a patient s use at home drugs used in the treatment of a sexual dysfunction 4 The Municipality of Trent Lakes

5 Ben e fit Sum mary - Drug Maximums Fertility drugs - $15,000 per lifetime - Drug Maximums All other covered drug expenses - Unlimited Payment of Drug Claims Your Pay Direct Drug Card provides your pharmacist with immediate confirmation of covered drug expenses. This means that when you present your Pay Direct Drug Card to your pharmacist at the time of purchase, you and your eligible dependents will not incur out-of-pocket expenses for the full cost of the prescription. The Pay Direct Drug Card is honoured by participating pharmacists displaying the appropriate Pay Direct Drug decal. To fill a prescription for covered drug expenses: a) present your Pay Direct Drug Card to the pharmacist at the time of purchase, and b) pay any amounts that are not covered under this benefit. You will be required to pay the full cost of the prescription at time of purchase if: you cannot locate a participating Pay Direct Drug pharmacy you do not have your Pay Direct Drug Card with you at that time the prescription is not payable through the Pay Direct Drug Card system For details on how to receive reimbursement after paying the full cost of the prescription, please refer to the provision How to Submit a Claim. Vision Care eye exams, to a maximum of $ every 24 months purchase and fitting of prescription glasses or elective contact lenses, as well as repairs, or elective laser vision correction procedures, to a maximum of $350 per 24 months if contact lenses are required to treat a severe condition, or if vision in the better eye can be improved to a 20/40 level with contact lenses but not with glasses, the maximum payable will be $200 per 24 months visual training, to a maximum of $200 per lifetime Extended Health Care - Vision Care The Municipality of Trent Lakes 5

6 Ben e fit Sum mary Extended Health Care - Professional Services Pro fes sional Ser vices Services provided by the following licensed practitioners: Chiropractor - $400 per calendar year(s) # Osteopath - $10 per visit to a maximum of 20 visit(s) per calendar year(s) # Podiatrist/Chiropodist - $10 per visit to a maximum of 20 visit(s) per calendar year(s) Massage Therapist (recommendation by a Physician is required) - $400 per calendar year(s) Naturopath - $10 per visit to a maximum of 20 visit(s) per calendar year(s) Speech Therapist - $60 for the 1st visit, $40 for additional visits up to a maximum of $260 per calendar year(s) Physiotherapist (recommendation by a Physician is required) - $400 per calendar year(s) Psychologist - $60 for the 1st visit, $40 for additional visits to a maximum of $420 per calendar year(s) # Note: Expenses under this Benefit Program are payable only after the Provincial Plan s maximum for the benefit year has been paid. Charges for x-rays are covered up to a maximum of $25 per calendar year for Chiropractor. Health Service Navigator Health Service Navigator Available as part of your Extended Health Care benefit, Health Service Navigator provides health resources and information to assist you and your eligible dependents in learning more about your health concerns and health services available within Canada and your local community. HSN services terminate when the extended health care coverage terminates for the User or the User reaches age 70, whichever is earlier. It features access to: A national physician search database Provincial health plan information tips and tools to best navigate and leverage the Canadian health resources available Credible health, medical condition, treatment plan and medication information A second opinion service, where applicable delivered through a second opinion provider and a consortium of provider hospitals. The member care centre support is available from 8 AM to 8 PM Monday to Friday your local time at The Municipality of Trent Lakes

7 Ben e fit Sum mary Dental Care The Benefit Deductible - Nil Dental Care Dental Care - The Benefit Dental Fee Guide - Current Ontario Fee Guide for General Practitioners Benefit Percentage (Co-insurance) - 100% for Plan A - Basic Services 50% for Plan B - Major Restorative Services 50% for Plan C - Orthodontic Services Benefit Maximums Unlimited for Plan A - Basic Services $1,500 per calendar year for Plan B - Major Restorative Services $2,500 per lifetime for Plan C - Orthodontic Services Termination Age - employee s age 65 or retirement, whichever is earlier Long Term Disability Benefit Amount - 75% of your monthly earnings, to a maximum of $5,000 Long Term Disability Qualifying Period days Maximum Benefit Period - to age 65 Termination Age - age 65 less the Qualifying Period, or retirement, whichever is earlier The Municipality of Trent Lakes 7

8 How to Use Your Ben e fit Book let De signed with Your Needs in Mind The Benefit Booklet provides the information you need about your Group Benefits and has been specifically designed with YOUR needs in mind. It includes: Your Benefit Booklet includes... a detailed Table of Contents, allowing quick access to the information you are searching for, Explanation of Common Insurance Terms, which provides a brief explanation of the insurance terms used throughout this Benefit Booklet, a clear, concise explanation of your Group Benefits, information you need, and simple instructions on how to submit a claim. Important Note Important Note The purpose of this booklet is to outline the benefits for which you are eligible as an employee of The Municipality of Trent Lakes. The information in this booklet is a summary of the provisions of the Group Policy. In the event of a discrepancy between this booklet and the Policy (available from your Plan Administrator), the terms of the Group Policy will apply. The booklet in either its paper or electronic form is provided for information purposes only and does not create or confer any contractual rights or obligations. Possession of this booklet alone does not mean that you or your dependents are insured. The Group Policy must be in effect and you must satisfy all the requirements of the Policy. Where required by law, you or any claimant under the Policy have the right to request a copy of any or all of the following items: the Policy, your application for group benefits, and any Evidence of Insurability you submitted as part of your application for benefits. In the case of a claimant, access to these documents is limited to that which is relevant to the filing of a claim, or the denial of a claim under the policy. Manulife Financial reserves the right to charge you for such documentation after your first request. We suggest you read this Benefit Booklet carefully, then file it in a safe place with your other important documents. 8 The Municipality of Trent Lakes

9 How to Use Your Ben e fit Book let Your Group Ben e fit Card Your Group Benefit Card is the most important document issued to you as part of your Group Benefit Program. It is the only document that identifies you as a Plan Member. The Group Policy Number and your personal Certificate Number may be required before you are admitted to a hospital, or before you receive dental or medical treatment. Your Group Benefit Card The Group Policy Number and your Certificate Number are also necessary for ALL correspondence with Manulife Financial. Please note that you can print your Certificate Number on the front of this booklet for easy reference. Your Group Benefit Card is an important document. Please be sure to carry it with you at all times. The Municipality of Trent Lakes 9

10 Explanation of Common Insurance Terms The following is an explanation of the Insurance terms used in this Benefit Booklet. Ben e fit Per cent age (Co-in sur ance) Benefit Percentage (Co-insurance) the percentage of Covered Expenses which is payable by Manulife Financial. Covered Expenses Cov ered Ex penses expenses that will be considered in the calculation of payment due under your Extended Health Care or Dental Care benefit. Deductible Deductible the amount of Covered Expenses that must be incurred and paid by you or your dependents before benefits are payable by Manulife Financial. Dependent Dependent your Spouse or Child who is insured under the Provincial Plan. - Spouse your legal spouse, or a person continuously living with you in a role like that of a marriage partner - Child for Dependent Life your natural, adopted, foster, or stepchild, who is: - unmarried; - under age 21, or under age 26 if a full-time student; for Extended Health Care your natural or adopted child, or stepchild, who is: - unmarried; - under age 21, or under age 25 if a full-time student; for Dental Care your natural or adopted child, or stepchild, who is: - unmarried; - under age 21, or under age 25 if a full-time student; - not employed on a full-time basis; and - not eligible for insurance as an employee under this or any other Group Benefit Program. 10 The Municipality of Trent Lakes

11 Explanation of Common Insurance Terms a child who is incapacitated on the date he or she reaches the age when insurance would normally terminate will continue to be an eligible dependent. However, the child must have been insured under this Benefit Program immediately prior to that date. A child is considered incapacitated if he or she is incapable of engaging in any substantially gainful activity and is dependent on the employee for support, maintenance and care, due to a mental or physical disability. Manulife Financial may require written proof of the child s condition as often as may reasonably be necessary. a stepchild must be living with you to be eligible. for Dependent Life Insurance a child must be at least 24 hours old to be eligible. Drug medications that have been approved for use by the Federal Government of Canada and have a Drug Identification Number. Drug Earnings your regular rate of pay from your employer (prior to deductions), excluding bonuses and overtime pay. Earnings may include other income as agreed to in writing by your employer and Manulife Financial. Earnings For the purposes of determining the amount of your benefit at the time of claim, your earnings will be the lesser of: the amount reported on your claim form, or the amount reported by your employer to Manulife Financial and for which premiums have been paid. Ex per i men tal or In ves ti ga tional not approved or broadly accepted and recognized by the Canadian medical profession, as an effective, appropriate and essential treatment of a sickness or injury, in accordance with Canadian medical standards. Experimental or Investigational Immediate Family Member you, your spouse or child, your parent or your spouse s parent, your brother or sister, or your spouse s brother or sister. Immediate Family Member Li censed, Cer ti fied, Reg is tered the status of a person who legally engages in practice by virtue of a license or certificate issued by the appropriate authority, in the place where the service is provided. Licensed, Certified, Registered Life-Sustaining Drugs drugs which are necessary for the survival of the patient. Life-Sustaining Drugs The Municipality of Trent Lakes 11

12 Explanation of Common Insurance Terms Medically Necessary Med i cally Nec es sary broadly accepted and recognized by the Canadian medical profession as effective, appropriate and essential in the treatment of a sickness or injury, in accordance with Canadian medical standards. Non-Evidence Limit Non-Evidence Limit you must submit satisfactory medical evidence to Manulife Financial for Benefit Amounts greater than this amount. Provincial Plan Provincial Plan any plan which provides hospital, medical, or dental benefits established by the government in the province where the insured person lives. Qualifying Period Qualifying Period a period of continuous and total disability, starting with the first day of total disability, which you must complete in order to qualify for disability benefits. Rea son able and Cus tom ary Reasonable and Customary the lowest of: the prevailing amount charged for the same or comparable service or supply in the area in which the charge is incurred, as determined by Manulife Financial; or the amount shown in the applicable professional association fee guide; or the maximum price established by law. Take Home Pay (Net Earn ings) Take Home Pay (Net Earnings) your earnings, less deductions normally made for federal and provincial income tax. Waiting Period Waiting Period the period of continuous employment with your employer which you must complete before you are eligible for Group Benefits. Ward Ward a hospital room with 3 or more beds which provides standard accommodation for patients. 12 The Municipality of Trent Lakes

13 Why Group Ben e fits? Government health plans can provide coverage for such basic medical expenses as hospital charges and doctors fees. In case of disability, government plans (such as Employment Insurance, Canada/Quebec Pension Plan, Workers Compensation Act, etc.) may provide some financial assistance. Why Group Benefits? But government plans provide only basic coverage. Medical expenses or a disability can create financial hardship for you and your family. Private health care and disability programs supplement government plans and can provide benefits not available through any government plan, providing security for you and your family when you need it most. Your Group Benefit Program is provided by The Corporation of the County of Peterborough and Participating Municipalities, in partnership with The Manufacturers Life Insurance Company. Your Plan Administrator Your Plan Administrator is responsible for ensuring that all employees are covered for the Benefits to which they are entitled by submitting all required premiums, reporting all new enrolments, terminations, changes, etc., and keeping all records up to date. Your Plan Administrator As a member of this Group Benefit Program, it is up to you to provide your Plan Administrator with the necessary information to perform such duties. Your Plan Ad min is tra tor is Phone Num ber: ( ) - Please record the name of your Plan Administrator and contact number in the space provided. Applying for Group Benefits To apply for Group Benefits, you must submit a completed Enrolment or Re-enrolment Application form, available from your Plan Administrator. Your Plan Administrator then forwards the application to Manulife Financial. Applying for Group Benefits Making Changes To ensure that coverage is kept up-to-date for yourself and your dependents, it is vital that you report any changes to your Plan Administrator. Such changes could include: Making Changes change in dependent coverage change of beneficiary change in name applying for coverage previously waived To make such changes, you must complete the Application for Change form, available from your Plan Administrator. The Municipality of Trent Lakes 13

14 The Claims Pro cess Naming a Beneficiary Naming a Beneficiary Manulife Financial does not accept beneficiary appointments for any benefits other than Employee Life Insurance under this Plan. This Policy contains a provision removing or restricting the right of the group life insured to designate persons to whom or for whose benefit insurance money is to be payable. How to Submit a Claim How to Sub mit a Claim All claim forms, available from your Plan Administrator, must be correctly completed, dated and signed. Remember, always provide your Group Policy Number and your Certificate Number (found on your Group Benefit Card) to avoid any unnecessary delays in the processing of your claim. Your Plan Administrator can assist you in properly completing the forms, and answer any questions you may have about the claims process and your Group Benefit Program. Claim Payment Pay ment of Ex tended Health Care and Den tal Claims Once the claim has been processed, Manulife Financial will send a Claim Statement to you. The top portion of this form outlines the claim or claims made, the amount subtracted to satisfy deductibles, and the benefit percentage used to determine the final payment to be made to you. If you have any questions on the amount, your Plan Administrator will help explain. The bottom portion of this form is your claims payment, if applicable. Simply tear along the perforated line, endorse the back of the cheque and you can cash it at any chartered bank or trust company. You should receive settlement of your claim within three weeks from the date of submission to Manulife Financial. If you have not received payment, please contact your Plan Administrator. You may not commence legal action against Manulife Financial less than 60 days after proof has been filed as outlined under Submitting a Claim. Every action or proceeding against Manulife Financial for the recovery of insurance money payable under the plan is absolutely barred unless commenced within the time set out in the Insurance Act or applicable legislation. Co-or di na tion of Ex tended Health Care and Den tal Care Ben e fits Co-ordination of Extended Health Care and Dental Care Benefits If you or your dependents are insured for similar benefits under another Plan, Manulife Financial will take this into account when determining the amount of expenses payable under this Program. This process is known as Co-ordination of Benefits. It allows for reimbursement of insured medical and dental expenses from all Plans, up to a total of 100% of the actual expense incurred. 14 The Municipality of Trent Lakes

15 The Claims Pro cess Plan means: other Group Benefit Programs; any other arrangement of coverage for individuals in a group; and individual travel insurance plans. Plan does not include school insurance or Provincial Plans. Order of Benefit Payment A variety of circumstances will affect which Plan is considered as the Primary Carrier (i.e., responsible for making the initial payment toward the eligible expense), and which Plan is considered as the Secondary Carrier (i.e., responsible for making the payment to cover the remaining eligible expense). If the other Plan does not provide for Co-ordination of Benefits, it will be considered as the Primary Carrier, and will be responsible for making the initial payment toward the eligible expense. Order of Benefit Payment If the other Plan does provide for Co-ordination of Benefits, the following rules are applied to determine which Plan is the Primary Carrier. For Claims incurred by you or your dependent spouse: The Plan insuring you or your dependent spouse as an employee/member pays benefits before the Plan insuring you or your spouse as a dependent. In situations where you or your dependent spouse have coverage as an employee/member under more than one Plan, the order of benefit payment will be determined as follows: The Plan where the person is covered as an active full-time employee, then The Plan where the person is covered as an active part-time employee, then The Plan where the person is covered as a retiree. For Claims incurred by your dependent child: The Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birthdate, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. However, if you and your spouse are separated or divorced, the following order applies: The Plan of the parent with custody of the child, then The Municipality of Trent Lakes 15

16 The Claims Pro cess The Plan of the spouse of the parent with custody of the child (i.e., if the parent with custody of the child remarries or has a common-law spouse, the new spouse s Plan will pay benefits for the dependent child), then The Plan of the parent not having custody of the child, then The Plan of the spouse of the parent not having custody of the child (i.e., if the parent without custody of the child remarries or has a common-law spouse, the new spouse s Plan will pay benefits for the dependent child). Where you and your spouse share joint custody of the child, the Plan covering the parent whose birthday (month/day) is earlier in the calendar year pays benefits first. If both parents have the same birthdate, the Plan covering the parent whose first name begins with the earlier letter in the alphabet pays first. A claim for accidental injury to natural teeth will be determined under Extended Health Care Plans with accidental dental coverage before it is considered under Dental Plans. If the order of benefit payment cannot be determined from the above, the benefits payable under each Plan will be in proportion to the amount that would have been payable if Co-ordination of Benefits did not exist. If the insured person is also covered under an individual travel insurance plan, benefits will be co-ordinated in accordance with the guidelines provided by the Canadian Life and Health Insurance Association. Submitting a Claim for Co-ordination of Benefits Submitting a Claim for Co-ordination of Benefits To submit a claim when Co-ordination of Benefits applies, refer to the following guidelines: As per the Order of Benefit Payment section, determine which Plan is the Primary Carrier and which is the Secondary Carrier. Submit all necessary claim forms and original receipts to the Primary Carrier. Keep a photocopy of each receipt or ask the Primary Carrier to return the original receipts to you once your claim has been settled. Once your claim has been settled by the Primary Carrier, you will receive a statement outlining how your claim has been handled. Submit this statement along with all necessary claim forms and receipts to the Secondary Carrier for further consideration of payment, if applicable. 16 The Municipality of Trent Lakes

17 Who Qual i fies for Cov er age? El i gi bil ity You are eligible for Group Benefits if you: are a full-time employee of The Municipality of Trent Lakes and work at least the Required Number of Hours, Eligibility are a member of an eligible class, are younger than the Termination Age, are residing in Canada, and have completed the Waiting Period. The Termination Age and Waiting Period may vary from benefit to benefit. For this information, please refer to each benefit in the section entitled Your Group Benefits. Your dependents are eligible for insurance on the date you become eligible or the date you first acquire a dependent, whichever is later. You must apply for insurance for yourself in order for your dependents to be eligible. Re quired Num ber of Hours Full-time employee - 25 hour(s) per week for 52 weeks per year, including paid vacation. Required Number of Hours Evidence of Insurability Medical evidence is required when you apply for insurance in excess of the Non-Evidence Limit. Evidence of Insurability Medical evidence is also required for all benefits, except Dental insurance, when you make a Late Application for insurance on any person. Late Application An application is considered late when you: apply for insurance on any person after having been eligible for more than 31 days ; or Late Application re-apply for insurance on any person whose insurance had earlier been cancelled. If you apply for benefits that were previously waived because you were covered for similar benefits under your spouse s plan, your application is considered late when you: apply for insurance more than 31 days after the date benefits terminated under your spouse s plan; or apply for insurance and benefits under your spouse s plan have not terminated. Medical evidence can be submitted by completing the Evidence of Insurability form, available from your Plan Administrator. Further medical evidence may be requested by Manulife Financial. The Municipality of Trent Lakes 17

18 Who Qual i fies for Cov er age? Late Dental Application Late Dental Application If you apply for coverage for Dental insurance for yourself or your dependents late, insurance will be limited to $125 for each insured person for the first 12 months of coverage. Effective Date of Coverage Effective Date of Coverage If Evidence of Insurability is not required, your Group Benefits will be effective on the date you are eligible. If Evidence of Insurability is required, your Group Benefits will be effective on the date you become eligible or the date the evidence is approved by Manulife Financial, whichever is later. You must be actively at work for insurance to become effective. If you are not actively at work on the date your insurance would normally become effective, your insurance will take effect on the next day on which you are again actively at work. Your dependent s insurance becomes effective on the date the dependent becomes eligible, or the date any required evidence of insurability on the dependent is approved by Manulife Financial, whichever is later. Your dependent s insurance will not be effective prior to the date your insurance becomes effective. Termination of Insurance Termination of Insurance Your Group Insurance will terminate on the earliest of: the date you cease to be an eligible employee, the date you cease to be actively at work, unless the Group Policy allows for your coverage to be extended beyond this date, the date your employer terminates coverage, the date you enter the armed forces of any country on a full-time basis, the date the Group Policy terminates or insurance on the class to which you belong terminates, the date you reach the Termination Age, or the date of your death. Your dependents insurance terminates on the date your insurance terminates or the date the dependent ceases to be an eligible dependent, whichever is earlier. 18 The Municipality of Trent Lakes

19 Resilience Services Your benefit program includes Resilience, a full service employee and family assistance program, supplied through a leading national employee and family assistance program service provider. Resilience Services Please note that this booklet is a summary of benefit only. In the event of a discrepancy between this benefit booklet and the Resilience Agreement, the terms of the Agreement will apply. Your Plan Administrator or Manulife Financial can answer any questions you may have about this benefit. Ser vices Pro vided for You and your De pend ents The following Resilience services are available to you and your dependents, as required: Short-term Counselling This Short-term counselling service ( Short-term Counselling ) provides assistance in the event of an incidence of personal stress, problems or trauma, including job stress, marital/family problems, alcohol/drug problems, anger management, pre-retirement planning, bereavement, physical/sexual abuse, and general health issues ( Issue ). Short-term Counselling includes: Toll-free telephone access, available twenty-four (24) hours a day, seven (7) days a week, (in English or French) to provide emergency assistance if required and to schedule appointments; a needs assessment and a referral to an appropriate counsellor; and approximately four (4) to six (6) hours of counselling, as required by you in the counsellor s discretion. The counsellor shall provide support; assess the problem(s); teach coping skills and self-management techniques; and develop a response plan. If, in the counsellor s discretion, Short-term Counselling is not appropriate for the Issue, the counsellor will provide you with a referral to the appropriate service agencies and/or institutions. This is a referral service only and does not include provision of or payment for such further services. You may request Short-term Counselling for an unlimited number of Issues. Legal Counselling If during your Short-term Counselling, the counsellor agrees that you require legal counselling, Manulife Financial will provide a referral for general legal counselling which will be provided directly by either a) the lawyer referral service of the Canadian Bar Association or b) Lawline, a national telephone legal advice service ( Legal Counselling ). Manulife Financial will be responsible for contacting the legal service selected by you in order to arrange a first appointment and for direct payment for Legal Counselling. Note, however, that Manulife Financial shall have no other responsibility with respect to such Legal Counselling including content, timing and appropriateness thereof. Should you require legal services other than this Legal Counselling, you shall be exclusively responsible for arranging it and paying all fees and expenses. The Municipality of Trent Lakes 19

20 Financial Counselling If during your Short-term Counselling, the counsellor agrees that you require financial counselling, Manulife Financial will provide you with general financial counselling regarding debt management and budgeting. Online Courses As part of the group of services offered under Resilience, you have unlimited access to online courses. These courses address a variety of topics including how to deal with a job loss, how to manage stress, how to embrace or lead change, and how to be an effective leader. Online Childcare and Eldercare Resource Database You also have unlimited access to a national online childcare and eldercare resource database. This database includes information about childcare and eldercare programs available in Canada. There is also a quality service checklist you can use to help you evaluate and select one of these provincially registered programs. This is an information service only and does not include payment for any childcare/eldercare services. Exclusions Resilience Services do not include the following: Any expense incurred by you or your dependent for which Manulife Financial is not specifically responsible, including the cost of materials, travel costs, fees, medical expenses, appointment cancellation charges and other expenses. Any goods or services furnished to you or your dependent outside the strict terms of this Benefit Booklet. Employee Life Insurance Employee Life Insurance If you die while insured, this benefit provides financial assistance to your beneficiary. If your beneficiary dies before you or if there is no designated beneficiary, this benefit is payable to your estate. Naming a Beneficiary You have the right to designate and/or change a beneficiary, subject to governing law. The necessary forms are available from your Plan Administrator. You should review your beneficiary designation to be sure that it reflects your current intent. 20 The Municipality of Trent Lakes

21 The Ben e fit Benefit Amount - $50,000 Employee Life Insurance - The Benefit Non-Evidence Limit - $50,000 Qualifying Period for Waiver of Premium days Termination Age - your benefit amount reduces by 50% at age 65 and terminates at age 70 or retirement, whichever is earlier Waiting Period 3 months Submitting a Claim To submit an Employee Life Insurance claim, your beneficiary must complete the Life Claim form which is available from your Plan Administrator. Employee Life Insurance - Submitting a Claim Documents necessary to submit with the form are listed on the form. A completed claim form must be submitted within 90 days from the date of the loss. To submit a claim for the Waiver of Premium benefit you must complete a Waiver of Premium claim form which is available from your Plan Administrator. Your attending physician must also complete a portion of this form. A completed claim form must be submitted within 180 days from the end of the qualifying period. Waiver of Pre mium If you become Totally Disabled while insured and prior to age 65 and meet the Entitlement Criteria outlined below, your Life Insurance will continue without payment of premium. Definition of Totally Disabled Totally Disabled means a restriction or lack of ability due to an illness or injury which prevents you from performing the essential duties of: your own occupation, during the Qualifying Period and the 2 years immediately following the Qualifying Period Employee Life Insurance - Waiver of Premium Employee Life Insurance - Totally Disabled any occupation for which you are qualified, or may reasonably become qualified by training, education or experience, after the 2 years specified above The availability of work will not be considered by Manulife Financial in assessing your disability. The Municipality of Trent Lakes 21

22 If you must hold a government permit or licence to perform the duties of your job, you will not be considered Totally Disabled solely because your permit or licence has been withdrawn or not renewed. Employee Life Insurance - Entitlement Criteria Entitlement Criteria To be entitled to Waiver of Premium, you must meet the following criteria: you must be continuously Totally Disabled throughout the Qualifying Period. If you cease to be Totally Disabled during this period and then become disabled again within 3 weeks due to the same or related illness or injury, your Qualifying Period will be extended by the number of days during which you ceased to be Totally Disabled. Manulife Financial must receive medical evidence documenting how your illness or injury causes restrictions or lack of ability, such that you are prevented from performing the essential duties of: - your own occupation, during the Qualifying Period and the following 2 years, and - any occupation for which you are qualified, or may reasonably become qualified by training, education or experience, after the 2 years specified above. you must be receiving from a physician, regular, ongoing care and treatment appropriate for your disabling condition, as determined by Manulife Financial. At any time, Manulife Financial may require you to submit to a medical, psychiatric, psychological, functional, educational and/or vocational examination or evaluation by an examiner selected by Manulife Financial. Employee Life Insurance - Termination of Waiver of Premium Ter mi na tion of Waiver of Pre mium Your Waiver of Premium will cease on the earliest of: the date you cease to be Totally Disabled, as defined under this benefit. the date you do not supply Manulife Financial with appropriate medical evidence documenting how your illness or injury causes restrictions or lack of ability, such that you are prevented from performing the essential duties of: - your own occupation, during the Qualifying Period and the following 2 years, and - any occupation for which you are qualified, or may reasonably become qualified by training, education or experience, after the 2 years specified above. the date you are no longer receiving from a physician, regular, ongoing care and treatment appropriate for the disabling condition, as determined by Manulife Financial. 22 The Municipality of Trent Lakes

23 the date you do not attend an examination by an examiner selected by Manulife Financial. the date of your 65th birthday. the date of your death. Re cur rent Dis abil ity If you become Totally Disabled again from the same or related causes as those for which premiums were previously waived, and such disability recurs within 6 months of cessation of the Waiver of Premium benefit, Manulife Financial will waive the Qualifying Period. Employee Life Insurance - Recurrent Disability Your amount of insurance on which premiums were previously waived will be reinstated. If the same disability recurs more than 6 months after cessation of your Waiver of Premium benefit, such disability will be considered a separate disability. Two disabilities which are due to unrelated causes are considered separate disabilities if they are separated by a return to work of at least one day. Conversion Privilege If your Group Benefits terminate or reduce, you may be eligible to convert your Employee Life Insurance to an individual policy, without medical evidence. Your application for the individual policy along with the first monthly premium must be received by Manulife Financial within 31 days of the termination or reduction of your Employee Life Insurance. If you die during this 31-day period, the amount of Employee Life Insurance available for conversion will be paid to your beneficiary or estate, even if you didn t apply for conversion. Employee Life Insurance - Conversion Privilege For more information on the conversion privilege, please see your Plan Administrator. Provincial differences may exist. Dependent Life Insurance If one of your dependents dies while insured, the amount of this benefit is paid to you. Dependent Life Insurance The Benefit Benefit Amount - $7,500 spouse; $2,500 each dependent child Dependent Life Insurance - The Benefit Termination Age - employee s age 70 or retirement, whichever is earlier The Municipality of Trent Lakes 23

24 Waiting Period 3 months Dependent Life Insurance - Submitting a Claim Submitting a Claim To submit a Dependent Life Insurance claim, you must complete the Life Claim form which is available from your Plan Administrator. Documents necessary to submit with the form are listed on the form. A completed claim form must be submitted within 90 days from the date of loss. Dependent Life Insurance - Waiver of Premium Dependent Life Insurance - Conversion Privilege Waiver of Pre mium If your Employee Life Insurance premium is waived because you are totally disabled, the premium for this benefit will also be waived. (See Employee Life Insurance...Waiver of Premium). Conversion Privilege If your spouse s life insurance terminates, you may be eligible to convert the terminated insurance to an individual policy, without medical evidence. Your spouse s application for the individual policy, along with the first monthly premium, must be received by Manulife Financial within 31 days of the termination date. If your spouse dies during this 31-day period, the amount of spousal Life Insurance available for conversion will be paid to you, even if you didn t apply for conversion. If you reside in the province of Quebec and if your dependent child s insurance terminates, you may be eligible to convert the terminated insurance as outlined above by the Conversion Privilege for spousal coverage. For more information on the conversion privilege, please see your Plan Administrator. Provincial differences may exist. 24 The Municipality of Trent Lakes

25 Basic Accidental Death and Dismemberment Insurance This benefit is insured by Chartis Insurance Company of Canada. The wording for the benefit has been provided by Chartis Insurance Company of Canada who assumes sole responsibility in the case of any discrepancy between this wording and Policy BSC issued by them. AD& D - Basic Accidental Death and Dismemberment Insurance FOR EMPLOYEES OF THE CORPORATION OF THE COUNTY OF PETERBOROUGH AND COUNTY-WIDE PARTICIPANTS The Basic Accidental Death and Dismemberment plan covers you 24 hours a day, anywhere in the world, for specified accidental losses occurring on or off the job. If you suffer any of the losses listed below in the schedule of losses as the result of an accidental injury which results directly and independently of all other causes and the loss occurs within 365 days of the date of the accident, the benefits indicated below will be paid. Who is Covered? Class I: All active employees of the Policyholder: Divisions: 1 - Corporation of the County of Peterborough 2 - Township of Asphodel-Norwood 3 - Township of North Kawartha 4 - Township of Havelock-Belmont-Methuen 5 - Township of Cavan-Millbrook-North Monaghan 6 - Township of Otonabee-South Monaghan 7 - Township of Douro-Dummer 8 - Municipality of Trent Lakes Division 1,2, 3, 8: Coverage terminates on the earlier of attainment of age 70 or retirement. Division 4, 6, 7: Coverage terminates on the earlier of attainment of age 65 or retirement. Division 5: Coverage reduced by 50% at attainment of age 65, and further reduces an additional 50% at age 70, and shall terminate on the earlier of attainment of age 75 or retirement. Amount of Coverage Class I: An amount equal to that payable under the Policyholder s Group Life Insurance subject to a maximum of $200,000. The Municipality of Trent Lakes 25

26 Schedule of Losses Loss of Life - The Principal Sum Loss of Both Hands - The Principal Sum Loss of Both Feet - The Principal Sum Loss of Entire Sight of Both Eyes - The Principal Sum Loss of One Hand and One Foot - The Principal Sum Loss of One Hand and the Entire Sight of One Eye - The Principal Sum Loss of One Foot and the Entire Sight of One Eye - The Principal Sum Loss of One Arm - Three-Quarters of The Principal Sum Loss of One Leg - Three-Quarters of The Principal Sum Loss of One Hand - Two-Thirds of The Principal Sum Loss of One Foot - Two-Thirds of The Principal Sum Loss of The Entire Sight of One Eye - Two-Thirds of The Principal Sum Loss of Thumb and Index Finger of the Same Hand - One-Third of The Principal Sum Loss of Speech and Hearing - The Principal Sum Loss of Speech or Hearing - Two-Thirds of The Principal Sum Loss of Hearing in One Ear - One-Sixth of The Principal Sum Quadriplegia (total paralysis of both upper and lower limbs) - Two-Times The Principal Sum Paraplegia (total paralysis of both lower limbs) - Two-Times The Principal Sum Hemiplegia (total paralysis of upper and lower limbs of one side of the body) - Two Times The Principal Sum Loss of Use of Both Arms or Both Hands - The Principal Sum Loss of Use of One Hand or One Foot - Two-Thirds of The Principal Sum Loss of Use of One Arm or One Leg - Three-Quarters of The Principal Sum Loss of Four Fingers of One Hand - One-Third of The Principal Sum Loss of All Toes of One Foot - One-Eighth of The Principal Sum 26 The Municipality of Trent Lakes

27 Loss as above used with reference to quadriplegia, paraplegia, and hemiplegia means the complete and irreversible paralysis of such limbs; as above used with reference to hand or foot means complete severance through or above the wrist or ankle joint, but below the elbow or knee joint; as used with reference to arm or leg means complete severance through or above the elbow or knee joint; as used with reference to thumb and index finger means complete severance through or above the first phalange; and as used with reference to eye means the irrecoverable loss of the entire sight thereof. Loss as above used with reference to speech means complete and irrecoverable loss of the ability to utter intelligible sounds; as used with reference to hearing means complete and irrecoverable loss of hearing in both ears. Loss as used with reference to Loss of Use means the total and irrecoverable loss of use provided the loss is continuous for 12 consecutive months and such loss is determined to be permanent. All claims submitted under this policy for Loss of Use must be verified by agreement between a licenced practicing physician appointed by the Policyholder and a licenced practicing physician appointed by the Company, or in the event that the two physicians so appointed cannot arrive at an agreement, a third licenced practicing physician shall be selected by the first two physicians and the majority decision of the three physicians shall be binding on the Policyholder and the Company. This procedure may be waived by the Company at its sole discretion. Indemnity provided under this Section for all losses sustained by any one (1) Insured Person as the result of any one (1) accident, will not exceed the Principal Sum, with the exception of quadriplegia, paraplegia and hemiplegia, where indemnity will not exceed Two Times the Principal Sum. Disappearance If the body of an Insured Person has not been found within one year of disappearance, forced landing, stranding, sinking or wrecking of a conveyance in which such person was an occupant, then it shall be deemed subject to all other terms and provisions of the policy, that such Insured Person shall have suffered loss of life within the meaning of the policy. Beneficiary Designation In the event of Accidental Loss of Life, benefits shall be payable as designated in writing by the Insured Person under the Policyholder s current basic group life insurance policy. In the absence of such designation, benefits shall be payable to the Estate of the Insured Person. All other benefits shall be payable to the Insured Person. The Municipality of Trent Lakes 27

28 ADDITIONAL BENEFITS Repatriation If accidental death, covered by the plan, occurs more than 200 kilometres away from your permanent place of residence, the plan will reimburse the actual expenses up to $10,000 which are incurred for the preparation and shipment of the deceased s body to the place of residence. Rehabilitation If you suffer an injury listed in the loss schedule, this plan will pay up to $10,000 for special training, provided such training is required because of the covered injury and in order to qualify you for an occupation in which you would not be engaged except for the accident. All such expenses must be incurred within two years from the date of the accident and are limited to the cost of the training and materials needed for such training. Family Transportation When injuries covered by the policy result in an Insured Person being confined to a hospital, outside 200 Km from his/her permanent city of residence, within 365 days of the accident and the attending physician recommends the personal attendance of a member of the immediate family, the Company shall pay the actual expenses incurred by the immediate family member for transportation by the most direct route by a licensed common carrier to the confined Insured Person s hotel accommodation in the vicinity of the hospital, and transportation to and from the hospital but not to exceed the amount of $10, The term member of the immediate family means the spouse (or common-law spouse) parents, grandparents, children age 18 and over, brother or sister of the Insured Person. Conversion Privilege On the date of termination of employment or during the 90 day period following termination of employment, you may change your insurance to the Chartis Insurance Company of Canada s individual insurance policy. The individual policy will be effective either as of the date that the application is received by the Insurance Company or on the date that coverage under the policy ceases, whichever occurs later. The premium will be the same as you would ordinarily pay if you applied for an individual policy at that time. Application for an individual policy may be made at any office of the Chartis Insurance Company of Canada. The amount of insurance benefit converted to shall not exceed that amount issued during employment. Home Alteration and Vehicle Modification If an Insured Person receives a payment under the Table of Losses herein and was subsequently required (due to the cause for which payment under the Table of Losses was made) to use a wheelchair to be ambulatory, then this benefit will pay, upon presentation of proof of payment: A. The one-time cost of alterations to the injured person s residence to make it wheel-chair accessible and habitable; and 28 The Municipality of Trent Lakes