here for you / disability guide Understanding roles and responsibilities of members, employers and HOOPP
Contents 2 / Here for you 3 / How your plan works, when you can t 5 / Free accrual 6 / The qualifying period 11 / Rehabilitation programs 12 / Disability pension 15 / Understanding the differences between free accrual and a disability pension 17 / Reapplication and appeal 17 / Shortened life expectancy 18 / Frequently asked questions 20 / Summary of terms
Your pension plan helps pave the way for financial security when you retire, but if the unthinkable happens and a disability leaves you unable to work for extended periods of time or not at all you can rest assured that your Plan will help to minimize some of your financial worries.
2 // here for you Here for you This booklet will give you an overview of the main features of HOOPP disability benefits as of August 2010. Detailed information about your Plan s provisions and your entitlements can be found in the Healthcare of Ontario Pension Plan Text (the Plan Text), the official Plan document. In cases where the information provided in this booklet, by your employer or by any other source differs from that contained in the Plan Text, the Plan Text will govern. Decisions based on the information provided in this booklet are your responsibility. What the terms mean Some terms that we use throughout this booklet have specific meanings in the context of the Plan. We have put these terms in bold italics the first time they appear in this booklet and provided a Summary of Terms at the back of the booklet. You ll also find a comprehensive glossary at hoopp.com.
// disability guide 3 HOW YOUR PLAN WORKS, WHEN YOU CAN T If you are going to be off work due to a disability, this booklet is for you. It provides details on benefits that can apply if you re in this situation. If your health leave ends within 15 weeks, HOOPP s disability benefits won t apply. HOOPP provides two disability benefits free accrual and a disability pension to Plan members who have approved medical evidence of partial disability, total disability, or total and permanent disability. Important Definitions Partially disabled: You have a medically certifiable physical or mental impairment that HOOPP has determined currently prevents you from doing your own job. Totally disabled: You have a medically certifiable physical or mental impairment that HOOPP has determined currently prevents you from doing any job. Totally and permanently disabled: You have a medically certifiable physical or mental impairment that HOOPP has determined will prevent you from doing any job for the rest of your life. To see how benefits relate to the level of disability, please refer to the chart on the next page. This chart provides an overview of disability benefits and Plan member responsibilities. You should Know... A health leave authorized by your employer doesn t automatically trigger a disability benefit. To be considered for disability benefits, you need to provide medical evidence to HOOPP and be approved. The extent of your disability as demonstrated by the medical evidence that you and your physician(s) supply to HOOPP determines what benefits you qualify for.
4 // here for you How Benefits Relate to Level of Disability This chart provides an overview of disability benefits and Plan member responsibilities. Once you have supplied medical evidence to HOOPP... If HOOPP determines... You receive your next step(s) You are partially disabled Free accrual supply medical evidence at next required date You are totally disabled Free accrual supply medical evidence at next required date You are totally and permanently disabled Choice Free accrual or disability pension continue to receive free accrual and supply medical evidence at next required date (as required by Plan s physician) apply for a disability pension You are not disabled, or have not provided medical evidence No free accrual, no further contributory service unless contributions permitted by employer remain on employer-approved health leave, for up to four years, but not make contributions (no benefit accrual) remain on employer-approved health leave, for up to four years and, if employer approves, make contributions and build contributory service re-apply with new medical evidence if still on health leave return to work, terminate, or (if old enough) retire
// disability guide 5 FREE ACCRUAL Free accrual is contributory service that s credited to you you and your employer don t have to make contributions. In other words, with free accrual you continue to build your HOOPP pension without having to make contributions. What s free accrual? Free accrual begins after the qualifying period and may continue until you recover, return to work, reach age 65 or build 35 years of contributory service, whichever happens first. For partial disability, free accrual can continue for up to four years from the date your health leave starts less the qualifying period. For total disability, you may qualify for free accrual past the fouryear limit for partial disability. Eligibility for free accrual To be eligible for free accrual, you must have contributed to the Plan before going on a health leave. Please note that members over the age of 65 or who have 35 years of contributory service are not eligible to apply for or receive free accrual. As well, if you die while receiving free accrual, pre-retirement death benefits apply. See the chart on page 16 for details.
6 // here for you THE QUALIFYING PERIOD The disability qualifying period for free accrual happens during the first 15 weeks of a health leave. Partial earnings if you are paid a portion (e.g., 60 per cent) of your pre-leave earnings during the qualifying period, you must make contributions on the pay you receive, and accrue benefits at that level, or top up your contributions to your pre-leave level in other words, make contributions during the qualifying period as if you were being paid 100 per cent of your earnings or top up within six months of the end of the qualifying period. Your contributory service will be based on contributions received. No earnings If you receive no earnings during your qualifying period, you can contribute either the full amount of what you would have contributed had you been working or a lesser amount. Contributions must be made within six months of the end of the qualifying period. Your contributory service will be based on contributions received. If you contribute below that level, your service will be prorated. For example, if you contribute 50 per cent, you will receive half the contributory service. Workplace Safety & Insurance Board (WSIB) You can make contributions on any WSIB benefits you receive during the qualifying period or within six months of the end of the qualifying period. Your contributory service will be based on contributions received.
// disability guide 7 Roles and Responsibilities (Before free accrual can begin): you your employer hoopp are responsible for ensuring you understand your contribution options during the qualifying period decide whether to top up contributions during the qualifying period, if you are not receiving 100 per cent of your pre-health leave earnings; and, if you will contribute on any earnings you receive from WSIB decides whether to place you on a health leave and notifies HOOPP provides you with a copy of this booklet which includes medical forms collects any required or optional top-up contributions relating to the qualifying period, and remits them to HOOPP advises HOOPP of any change in your leave or employment status credits you with any contributory service you accrue from contributions during the qualifying period
8 // here for you Medical evidence of disability To apply for free accrual, you will need to provide HOOPP with medical evidence of your disability using two medical forms: Member s Statement of Disability to be completed by you Physician s Statement of Disability to be completed by your physician Both forms must be submitted to HOOPP, along with any medical reports and documentation you have relating to your medical condition before the end of the qualifying period. You must indicate that you are applying for free accrual on the Member s Statement of Disability. It s important to ensure that HOOPP receives your medical forms before the end of the qualifying period because: 1. Free accrual cannot begin until HOOPP has reviewed and approved you for free accrual. If you qualify for free accrual, it can start as soon as possible after the 15-week period. 2. If HOOPP receives the forms after the 15 th week of your health leave, there may be a gap in your contributory service between the end of the 15 weeks and, if you qualify, the start of free accrual. Applying for free accrual Here s what will happen after HOOPP reviews your medical evidence: If you are approved, you will be credited with free accrual as of the date your medical evidence was received, but not before the end of the qualifying period.
// disability guide 9 HOOPP will let you know if you ve qualified for free accrual and inform you of when to provide medical evidence if you wish to apply to continue receiving free accrual without a gap. You re responsible for getting your medical evidence to HOOPP by the specified date. If HOOPP determines you are partially disabled, you can continue to build benefits through free accrual for up to four years, minus the qualifying period. If, based on medical evidence, HOOPP determines you are totally disabled or totally and permanently disabled, you may qualify for free accrual past the four-year limit for partial disability. You will be required to provide new medical evidence as requested, and be reassessed by HOOPP to determine whether you continue to qualify as totally disabled. You must provide the evidence by each deadline HOOPP provides. If you do not, HOOPP may terminate your membership in the Plan and provide you with your options. If you qualify, you can remain on a total disability leave until you recover and/or return to work, reach 35 years of contributory service, reach age 65, retire, or terminate membership in HOOPP whichever occurs first. At that point you will be provided with your options. Members on a total disability leave (and receiving free accrual) can elect early retirement from HOOPP once they are age 55 or older. If you are totally and permanently disabled, you have more options, which you can find in the chart on page 14. If you are not approved because you don t meet the definition of at least partially disabled, you will not receive free accrual. Your employer may allow you to remain on a health leave and both you and your employer may continue making contributions to HOOPP to build contributory service. If your employer doesn t allow you to make contributions, you will remain a member of the Plan as long as you remain on leave, to a maximum of four years, as long as you are employed but you will not build any additional benefits. While on health leave, you may apply again at any time (with new medical evidence) for HOOPP disability benefits. For details, see Reapplication and Appeal on page 17.
10 // here for you If your employment is terminated While you are receiving free accrual you may elect to have your membership in the Plan continue until the next date HOOPP requires medical evidence, at which time HOOPP will determine if you still qualify to receive free accrual. If you provide the required medical evidence and are approved as partially disabled, you can continue to receive free accrual for a maximum of four years from the start of your health leave, if you are still partially disabled. While you are not receiving free accrual HOOPP will terminate your membership in the Plan and send you termination options. Roles and Responsibilities (free accrual): you your employer hoopp are responsible for ensuring you understand HOOPP s free accrual rules ensure your medical forms are submitted to HOOPP within the time allowed if you wish to apply for free accrual pay any costs for obtaining and submitting medical information if you are determined to be totally and permanently disabled, choose either free accrual or a disability pension makes the decision to place you on a health leave notifies HOOPP that you are on a leave provides you with a disability kit advises HOOPP of any change in your leave or employment status credits you with any contributory service you accrue from contributions during the qualifying period credits you with free accrual if you qualify advises you of the next date by which medical evidence is required for continuance of free accrual
// disability guide 11 Rehabilitation programs If you go on a rehabilitation program, the Notice of Rehabilitation form must be completed and sent to HOOPP for approval. It s recommended that the form be submitted at least four weeks before the beginning of the rehabilitation program. HOOPP defines a rehabilitation program as one that: has the objective of enabling you to return to work has specific, measurable goals, which are time dependent is usually months in duration, not years HOOPP assumes your rehabilitation program will be successful, and therefore, unless otherwise informed, free accrual will end as of the end date of the program indicated on the Notice of Rehabilitation form. In addition, HOOPP will treat your health leave and free accrual as ended if you return to the position you held prior to the start of your health leave or if you return to work permanently. Roles and ResponsIBIlities (free accrual and rehabilitation programs): you your employer hoopp ensure that medical evidence continues to be submitted to HOOPP as required, in order for you to continue to be eligible for free accrual decides whether to place you on a rehabilitation program, and notifies hoopp if you are placed on a program that is intended to last more than three weeks provides details on the program to HOOPP, so that HOOPP can determine if you can continue to receive free accrual while on the program monitors your progress, and advises HOOPP of any changes to the program is responsible for advising HOOPP of the outcome of the program advises HOOPP when you return to work credits you with any contributory service you accrue from contributions during the qualifying period credits you with free accrual if the program qualifies advises you of the next date by which medical evidence is required
12 // here for you Disability pension If you are found by HOOPP to be totally and permanently disabled, you can choose to receive a HOOPP disability pension or continue to receive free accrual (see page 5). Be sure to weigh the pros and cons of both options before making a decision. You may wish to consult with a financial advisor or your employer. Before starting a disability pension, you must resign from all of your HOOPP employers. By doing so, you may lose other benefits as a result be sure to discuss this decision with your employer. A disability pension is an immediate pension based on the contributory service (including free accrual) accrued before your disability retirement date. HOOPP disability pensions do not include early retirement benefits. If HOOPP has determined you are totally and permanently disabled based on the medical evidence you have provided, you can apply for a HOOPP disability pension. You can apply for a disability pension immediately when you become disabled, while you are on a health leave, or while you are on a total disability leave. To qualify for a HOOPP disability pension, you must: have contributed to the Plan before your date of disability be under age 65 have less than 35 years of contributory service be vested indicate on the Member s Statement of Disability that you are applying for a disability pension provide a completed Physician s Statement of Disability to HOOPP please note that a previous physician s statement will not be sufficient What to do if you qualify for a disability pension If you are approved for disability pension, you must terminate your employment with all of your HOOPP employers and submit a Retirement Notice to HOOPP indicating your intention to apply for a disability pension within 60 days of receiving the approval letter. Your pension payments will begin on the first of the month following either the date of termination or date of approval whichever comes later. If you are unemployed, your disability pension will start on the first of the month following your approval. HOOPP will provide you with the form to complete to start your pension.
// disability guide 13 Roles and ResponsIBIlities (disability pensions): you your employer hoopp are responsible for ensuring that you understand HOOPP s disability pension provision are responsible for ensuring that you meet all application rules and deadlines pay the costs of submitting any medical evidence must resign from all your HOOPP employers to receive a disability pension if approved and wish to proceed with the option must ensure that your notification of retirement is submitted to HOOPP indicating your intention to apply for a disability pension within 60 days of receiving the approval letter is responsible for providing you with the disability kit if it hasn t already been provided to you is responsible for providing confirmation that you have resigned, so that you can receive your disability pension is responsible for processing your retirement assesses your medical condition and notifies you of the results of that assessment starts your pension if you qualify lets you know the next date medical evidence is required
14 // here for you The following chart shows how free accrual and a disability pension applies to the three descriptions of disability: Partially disabled Totally disabled Totally and permanently disabled Definition unable to perform your own job unable to perform any job unable to perform any job permanently Maximum benefit four years of free accrual less 15 weeks to normal retirement age 65 or a maximum of 35 years of contributory service, or recovery, whichever comes first free accrual to normal retirement age 65 or a maximum of 35 years of contributory service, or recovery, whichever comes first choice of: free accrual to normal retirement age 65 or a maximum of 35 years of contributory service, whichever comes first a disability pension, see p. 12 Other eligibility criteria you must have made contributions to your employer prior to your health leave and been on your health leave for 15 weeks you must have made contributions to your employer prior to your health leave and been on your health leave for 15 weeks for free accrual, you must have made contributions to HOOPP before your health leave and have been on your health leave for 15 weeks for disability pension, you must: be a vested member have made contributions to the Plan be under age 65 have less than 35 years of contributory service
// disability guide 15 Understanding the differences between free accrual and a disability pension If you are approved for free accrual, you can build pension service as though you were still contributing to HOOPP and can then choose normal/early retirement once you reach retirement age. If you are approved for a disability pension, you collect an immediate unreduced pension regardless of your age. The chart on the following page explains the differences.
16 // here for you Benefit survivor Options Normal/ Early Retirement lifetime benefit (subject to reduction factor if age is less than 60 or with less than 30 years of eligibility service at retirement) bridge benefit applies only to early retirement member can choose the level of pension benefits received by a qualifying spouse so that it is either 60 per cent, 80 per cent or 100 per cent of the member s lifetime pension if there is no qualifying spouse, the primary non-spouse beneficiary receives the member s monthly pension excluding any early retirement benefits for the balance of the 180-payment period. Disability retirement lifetime benefit based on accrued service; no reduction surviving spouse receives 60 per cent of member s lifetime pension if there is no qualifying spouse, the primary non-spouse beneficiary receives the member s monthly pension excluding any early retirement benefits for the balance of the 180-payment period. Free accrual member can continue to receive free accrual, if approved, to either age 65 or 35 years of service or to date of death whichever comes first a four-year limit applies to partial disability the eligible spouse can elect an immediate or deferred pension or transfer to an amount equal to the commuted value to an RRSP or cash out If there is no spouse, nonspouse beneficiary gets the commuted value in cash less applicable taxes
// disability guide 17 REAPPLICATION AND APPEAL Appeals are carried out by an independent medical examiner, whose costs are covered by HOOPP. If, however, you miss this medical appointment, you will be fully responsible for the cost. Reapplication: If you are on a health leave and still employed but turned down for free accrual, you don t need to appeal. You may simply apply again at any time during your 4-year health leave with new medical information. Appeal: You can appeal the Plan s decision within 60 days. Simply contact HOOPP if you wish to do so. Submit all medical evidence related to the application for disability pension. SHORTENED LIFE EXPECTANCY If a doctor licensed in Canada gives you a medical opinion that you have a life expectancy of less than two years, you can apply to HOOPP to withdraw a lump sum payment based on the Plan s shortened life rules. The lump sum payment is subject to tax. HOOPP will advise you how much money is available for withdrawal. If you have a qualifying spouse, you must also get his or her permission to withdraw the funds. Under provincial law, your spouse is entitled to benefits upon your death, and must therefore agree to the withdrawal. If your spouse agrees, he or she forfeits the right to spousal benefits upon your death. Both you and your spouse should seek independent legal and financial advice before making a decision to forfeit your spouse s entitlements. An Application to Withdraw Funds from HOOPP form can be obtained by calling HOOPP at the phone numbers listed on the back cover of this booklet.
18 // here for you Frequently asked questions about Free accrual What if I don t get the medical evidence forms to HOOPP by the end of the qualifying period? Does that mean I won t get free accrual? No. The end of the qualifying period is not a deadline it s the earliest date that free accrual can begin. If you get the forms to us after the qualifying period, you ll still receive free accrual if the medical evidence shows you qualify for it but it will begin as of the date we receive your medical evidence forms, and there could be a gap in your contributory service. Can I accrue benefits if there s a gap between the end of the qualifying period and the start of free accrual? If your employer allows you to make contributions during such gap periods, then, yes, you ll build service. You ll need to remit these contributions to your employer no later than six months from the end of your health leave. If contributions aren t allowed or you choose not to make them, you will not build any pension benefits during the gap. If I don t qualify for free accrual, but my employer allows me to make contributions, when do I have to make them? You can make contributions while you are on the health leave or within six months of the end of your leave if you have returned to work and resumed making regular contributions with your employer. Once that deadline has passed, this period is not available for purchase under HOOPP s buyback provisions. If I need more medical forms, where can I get them? The Member s Statement of Disability and Physician s Statement of Disability forms are available: from your employer from hoopp.com by calling or writing HOOPP (please see information on the back cover of this booklet)
// disability guide 19 about disability pension Is my disability pension income taxable? HOOPP will withhold tax as required by the Income Tax Act. Can I work while receiving a disability pension? No. To qualify you must be permanently and totally disabled, unable to perform any job. Will the income I receive from my HOOPP disability pension affect any of my other compensation, such as my employer provided long-term disability or WSIB benefits? It may. Ask your employer for more information. Do I have to apply for a disability pension if I am totally and permanently disabled? No. You have a choice between the disability pension and free accrual. HOOPP recommends you seek the advice of a financial advisor when making this decision. about rehabilitation work programs Do I have to make contributions to the Plan while I m on a HOOPP approved rehabilitation program? No. If you re on a HOOPP-approved rehabilitation program, your health leave continues to a maximum of four years, as does free accrual. You will still have to provide HOOPP with the medical evidence of your disability as required.
20 // here for you Summary of Terms Here are simplified explanations of some of the key terms used in this brochure. Exact definitions of most of the terms are provided in the Healthcare of Ontario Pension Plan Text, the official Plan document. Basic lifetime pension: This is the monthly lifetime payment you will receive from HOOPP at retirement based on HOOPP s pension formulas. Contributory service: This is the length of time, measured in years and part years that you have contributed to HOOPP. It includes any past service you buy, service transferred into HOOPP, or service received while disabled. Free accrual: This is a service for which neither you nor your employer made contributions. It can be credited to you during a health leave or total disability leave if you submit medical evidence that shows you meet HOOPP s definition of partially disabled, totally disabled, or totally and permanently disabled. Partially disabled: You have a medically certifiable physical or mental impairment that HOOPP has determined currently prevents you from doing your own job. Qualifying spouse: Your qualifying spouse is someone who, at the time a determination is needed: is legally married to you, but not separated from you, or has been living with you continuously in a conjugal relationship for at least a year, or is the mother or father (natural or adoptive) of your child, and lives with you in a relationship of some permanence Totally disabled: You have a medically certifiable physical or mental impairment that HOOPP has determined currently prevents you from doing any job. Totally and permanently disabled: You have a medically certifiable physical or mental impairment that HOOPP has determined will prevent you from doing any job for the rest of your life.
Pour obtenir la version française du présent livret, veuillez communiquer avec le HOOPP.
1 Toronto Street, Suite 1400 Toronto, Ontario M5C 3B2 T 416-646-6445 T 1-877-43HOOPP(46677) F 416-369-0225 August 2010 CP-06-35 E clientservices@hoopp.com W hoopp.com