July 2012 Re: Travel Health Plan Information Kit As you are aware, starting September 1, 2012, your current asrtrust retiree benefits plan with Green Shield will include a 30-day Essential Travel Health Plan, provided and paid for by the asrtrust. This new plan provides guaranteed coverage for an unlimited number of trips each lasting up to 30 days at no cost to you. Please see the enclosed Travel Guide for reference. In addition, you now have a one-time opportunity to purchase additional travel coverage through Green Shield to extend the number of days per trip limit to suit your personal travel needs. Going away for longer than 30 days at a time? Extended Travel Health Plan is available! This is your only opportunity to purchase a 30, 60, 90 or 150-day per trip extension to the Essential 30- day Travel Health Plan at preferred group premiums and without having to qualify with a medical questionnaire! Once you have purchased this extended option, you will then have a one-time only opportunity to change this coverage (increasing or decreasing the number of days per trip). This Extended Plan gives you the same unlimited coverage and benefits as the Essential Plan; but it also allows you to extend the amount of time you can spend outside the province/country during any given trip regardless of how many times you travel outside of your province (or country) each year. As an added feature, Green Shield is including Trip Cancellation coverage at no extra cost. Coverage for this Extended Plan is fully paid by you and you can purchase this special group coverage without worrying about pre-existing conditions or answering any medical questions to qualify. And, renewal is automatic year after year so as long as you stay in the plan, you will never need to answer any medical questions to stay enrolled. Your trip extension options The Extended Plan allows you to select the number of days you would like to add to your existing Essential 30- day Plan coverage for an unlimited number of trips per year. Your choices are: 1. Add 30 days (for a total of 60 days of coverage per trip) 2. Add 60 days (for a total of 90 days of coverage per trip) 3. Add 90 days (for a total of 120 days of coverage per trip) 4. Add 150 days (for a total of 180 days of coverage per trip) Remember this is a special one-time offer! You must enrol and select your preferred trip duration option before September 1, 2012. (See page 3 for how to sign up for this exciting opportunity) Page 1
Competitive group premiums yes, this is a good deal! This Extended Plan is available to you at a very competitive group premium. And although the coverage is annual (for 12 full months regardless of the month(s) you travel), we ve made it easier on you by breaking down the annual premiums into 12 equal monthly payments. The following chart outlines the monthly contributions required to cover the cost of this additional coverage, which is effective September 1, 2012: Additional Top Up Coverage Days Extended Travel Health Plan Premiums (Prices in effect September 1, 2012 August 31, 2013) Member under age 65 MONTHLY CONTRIBUTION Member age 65 and over Single Family Single Family 30 days (Total 60) $ 15.75 $ 31.50 $ 29.93 $ 59.85 60 days (Total 90) $ 18.38 $ 36.75 $ 34.65 $ 69.30 90 days (Total 120) $ 21.00 $ 42.00 $ 53.55 $ 107.10 150 days (Total 180) $ 25.20 $ 50.40 $ 64.05 $ 128.10 Important this Extended Plan coverage is automatically renewed year after year. This is convenient for you because you don t have to re-enrol or answer medical questions to qualify for coverage. Your automatic monthly premium payments (the details) Here are a few important points about your monthly premium payments: Premiums for Extended Plan coverage are subject to retail sales taxes in Manitoba, Ontario and Quebec. These premiums are guaranteed for the first year only and may change in the future based on actual claiming patterns. Premiums will be collected using the same monthly withdrawal process currently used for your monthly Health Care Contributions to your asrtrust retiree benefits program. If you are currently under age 65, your monthly premiums will be automatically adjusted the month after you turn 65. Your coverage status (single or family) for the Extended Travel Health Plan will be the same as your current coverage status under your asrtrust retiree benefits program. Your first premium payment Although your coverage is effective September 1, 2012, your first payment for your Extended Plan travel coverage will be taken on October 1. This first payment will be a double payment covering both September and October. Page 2
Why should I purchase the Extended Plan? The Extended Plan option presents a unique and limited opportunity for you to access additional trip extension coverage for life and will not require medical evidence. An opportunity like this is not available in the travel insurance market. Additional highlights of selecting any of these top up options: Coverage will be unlimited for emergency services Multi-trip travel coverage includes an unlimited number of trips in a year, with each trip duration up to the maximum number of total days selected. This eliminates the need for purchasing singletrip top up coverage for each trip. Note you must return to your province of residence for at least 24 hours before your trip duration coverage resets. Trip Cancellation covers eligible expenses for the non-refundable portion of prepaid travel expenses incurred by the covered person up to a maximum of $2,000 per trip. Note for expenses to be eligible, the trip must be cancelled prior to the departure date and as a result of a death, injury or sickness; travel advisory to postpone your trip; natural disaster; legal obligation such as jury duty; or quarantine. Future changes you will have a one-time opportunity (that s once per lifetime) at the start of a policy year (September 1) to change your top up option. And if you experience a life event (e.g. where you are adding or removing a spouse/dependent), you can change your top up coverage option anytime during a policy year, as long as it is within 60 days of the life event. Here are the change options: Reduce your trip duration move to an option with a fewer number of days per trip. Only a written request is required to do so. Increase your trip duration move to an option with a higher number of days per trip. A medical questionnaire is required and is subject to Green Shield approval. How do I enrol for this coverage? It s easy! If you would like to purchase the Extended Travel Health Plan with coverage effective September 1, 2012, please complete the attached Enrolment Form on page 5 and return it to us either via toll-free fax at 1-866-831-2107 or using the enclosed prepaid business-reply envelope. Remember this is a special one-time offer, so don t delay! The deadline to enrol for this very competitively priced Extended Plan coverage is September 1, 2012. What happens after I enrol for this coverage? After you ve sent us your enrolment form (via mail or fax) to join the Extended Plan, you will receive a confirmation of coverage letter in the mail. The best part is that this will all be seamless for you you can continue to use your current Green Shield ID number and card. Page 3
What if I don t normally travel for more than 30 days at a time? The Individual Travel Health Plan might be for you! For members who prefer to purchase additional coverage on a trip-by-trip basis, Green Shield also offers Individual Travel Health Plan coverage at competitive prices, which are also fully paid by you. Because this coverage is issued on an individual basis for each trip you plan to take, you are required to answer medical health questions and coverage is subject to approval by Green Shield. This option may be of interest to you if you don t routinely travel for long periods, or don t want to commit to regular premium payments for the Extended Plan described earlier, or if you didn t opt for the Extended Plan and find that you now have an opportunity to travel. Please note: you must apply at least 2 weeks prior to your trip departure date. Your Individual Plan options If you only need to top up your coverage for a single, specific trip, you have the option to apply for and purchase an additional number of days over and above your Essential 30-day Plan. Trip duration periods include trips for up to an additional 15, 30, 60, 90, or 150 days. Here are the premiums for these options (please note your applicable age-band and remember that applicable taxes will also apply to the rates below): Age Individual Travel Health Plan Premiums (Prcies in effect September 1, 2012 August 31, 2013) 15 days (Total 45) Premiums per person for a single trip top up 30 days (Total 60) 60 days (Total 90) 90 days (Total 120) 150 days (Total 180) 49 $ 35 $ 65 $ 135 $ 220 $ 450 50-64 $ 45 $ 80 $ 165 $ 250 $ 575 65-69 $ 60 $ 110 $ 225 $ 350 $ 800 70-74 $ 90 $ 165 $ 340 $ 525 $ 1,200 75-79 $ 120 $ 220 $ 475 $ 775 $ 1,800 80+ $ 190 $ 380 $ 830 $ 1,290 $ 3,000 Contact Green Shield at 1-855-722-0472 to obtain an individual travel coverage information package or visit the asrtrust website at www.asrtrust-gm.com to download plan details, pricing details and an application form. How Green Shield makes it easier for you If you choose to purchase the Extended Travel Health Plan, the change will be seamless for you. You can continue to use your current Green Shield ID number and card. Your travel plan information, including the emergency travel assistance numbers to contact in case of emergency, will not change and can be found on your current ID card the same card you use to access your health and dental benefits, including pay-direct drug and travel assistance. And remember prior to departure, you can contact Green Shield Travel Assistance for Canada Direct Calling Codes, information about vaccinations, government issued travel advisories, and VISA/document requirements for entry into the country of destination. Questions? A telephone hotline has been created to respond to your inquiries about purchasing this additional travel coverage and to review available options. Please call 1-855-722-0472 between the hours of 8:30am and 4:30pm Eastern Time. You can also send an email anytime to indto@greenshield.ca with your questions. Page 4
PLAN SPONSOR (full name) Auto Sector Retiree Health Care Trust EXTENDED TRAVEL HEALTH PLAN ENROLMENT FORM Please print information clearly. Inquiries regarding this form and the extended travel coverage elections can be directed to 1-855-722-0472 GREEN SHIELD ID # Quick reference: This is a ONE TIME election form and appropriate premiums will apply. COMMENTS: Return this form no later than September 1, 2012 Please mail completed form to: ATTN: IAT TRAVEL GREEN SHIELD CANADA PO BOX 1606 STN A WINDSOR, ON N9A 9Z9 PLAN MEMBER INFORMATION Surname: Legal First Name: Preferred First Name: Age: Birthdate: Employee ID#: Gender: Mailing Address: (YYYY/MM/DD) Phone Number: ( ) Email Address: EXTENDED TRAVEL COVERAGE ELECTION Please check only ONE of the following extended travel options. You will not be able to opt out of this coverage until Sept 1, 2013. **All rates are a per month rate and applicable taxes are additional to the rates provided below.** Extended Travel Options [Additional Top Up ] 30 DAYS 60 DAYS 90 DAYS 150 DAYS Internal Use Only Member under age 65 Member over age 65 Current Option Code Coverage Status Single Family Single Family OPT 1 $15.75 $31.50 $29.93 $59.85 OPT 2 $18.38 $36.75 $34.65 $69.30 OPT 3 $21.00 $42.00 $53.55 $107.10 OPT 4 $25.20 $50.40 $64.05 $128.10 By signing this enrollment form or by providing my personal information to Green Shield Canada, I agree the information is complete and accurate to the best of my knowledge. I also authorize the deduction of the above payments to be deducted from my pension or directly from my bank account, whichever method is currently being used today for my Health Care Contributions. Signature of Plan Member: Date: For further information on GSC s privacy policies and procedures, please refer to your benefit plan booklet and our website at www.greenshield.ca. Rev 201207 V4 Page 5