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Glossary |
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Brain death
Irreversible unconsciousness with total loss of brain function
and complete absence of electrical activity of the brain, even though
the heart is still beating. |
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Child
Your natural, legally adopted, step or other eligible child1
who meets all of the following requirements:
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unmarried; |
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not cohabiting in a
conjugal relationship with another individual; |
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totally dependent on
you for support and maintenance; |
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one of the following
ages: |
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under age 21; |
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under age 26 if a full-time
student at an accredited post-secondary institution2; |
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of any age if physically
or mentally disabled, but otherwise qualifies under this definition,
provided he or she became disabled while covered by the plan
and you provide satisfactory proof that your child is incapable
of self-support as a result of the disability3; |
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living in Canada, unless a full-time student elsewhere; and |
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not in the armed forces (except for optional and dependent life
insurance coverage). |
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The plan can also include
the natural or legally adopted child of your common-law
spouse and another person, a child who resides with you
and is not eligible for publicly provided benefits substantially
equivalent to those provided under the plan and in respect
of whom you have legal custody or guardianship, and any
child who lives with you and is totally dependent on you
and/or your spouse for support. Totally dependent means
that no support or maintenance of a financial nature is
paid or payable on account of this child by an individual
other than yourself and/or your spouse and no other individual
receives (or would be eligible to receive if application
were made) publicly funded benefits or tax credits on
account of this child. |
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Confirmation of enrolment
as a full-time student must be provided. |
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Proof of your child's
continuing disability and incapability of self-support
may be required from time to time. Coverage may be terminated
if the child becomes capable of self-support. |
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Dentist
A doctor of dental surgery or a doctor of dental medicine licensed
to practice and prescribe in the area where services are rendered. |
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Dependents
Your eligible spouse and children. |
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Earnings
For permanent employees, earnings will be based on gross earnings, excluding bonuses, overtime and commissions.
For permanent part-time CUPE Health Sector employees, earnings will be based on regular earnings for the previous calendar year.
For any other permanent part-time Civil Service or Health Sector employees or temporary Civil Service employees, earnings will be based on guaranteed earnings. |
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Exceptions - Employee
death benefits
If you are a full-time Civil Service employee and
you did not elect a benefit of 3 x annual earnings on December 1,
1996, coverage is equal to 2 x your annual earnings, to a maximum
of $175,000.
If you are a full-time UPSE employee who did not elect
coverage of 3 x annual earnings during June 1996, or a part-time
UPSE employee who was covered before June 1, 1996, coverage is equal
to 2 x employment guarantee; minimum of $25,000 to a maximum of
$175,000 |
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Exceptions
- Spousal death benefits
Coverage is equal to $3,500 if you are a permanent,
full-time UPSE employee who transferred from the Civil Service to
the Health Sector on August 1, 1995, and remained an UPSE employee. |
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Exceptions -
When coverage begins
If you apply for any optional life insurance
within 31 days following your eligibility date, a portion of the
coverage (up to $30,000 for yourself, up to $30,000 for your spouse,
and $10,000 for each child) will come into effect on the first of
the month after Johnson receives your application. The difference,
if any, will take effect once the insurer approves your proof of
good health.
If you apply for any optional accident insurance,
coverage will come into effect on the first of the month after Johnson
receives your application.
No eligible individual may be covered more than once
under the optional accident insurance policy. If you are covered
as an employee or retiree, you cannot be covered as a spouse or
dependent child of another employee or retiree. In addition, only
one spouse can choose coverage for dependent children. Furthermore,
your spouse and eligible children can only be insured if you are
covered under the plan |
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Health Sector employees
You are part of the Health Sector if you belong to
any of the following groups:
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Prince Edward
Island Nurses Union (PEINU) |
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International Union of Operating
Engineers (IUOE) |
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Canadian Union of Public Employees
(CUPE) |
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Prince Edward
Island Union of Public Sector Employees (UPSE) |
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Excluded Employees |
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Non-Union, Non-Excluded Employees |
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You may join the PSGIP if you are:
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a permanent full-time employee working
at least 30 hours per week; |
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a permanent part-time employee; |
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a temporary UPSE, IUOE or excluded employee
hired for 12 months or more. |
Note: If you are a casual UPSE employee and
you had coverage before August 1, 1995, you may continue your
coverage in effect on August 1, 1995. However, you are not
eligible for any additional benefits. |
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Hospital
A facility that is licensed to provide active treatment for sick
or injured patients. It does not include rehabilitation hospital,
mental institution, convalescent hospital or home, an institution
used primarily for treatment of a specific illness or disease, a
nursing home, a chronic care facility, a home for the aged, a rest
home or any other facility that provides similar care. Beds set
aside for chronic care in a hospital are not covered.
Regarding accidental injury or death benefits
For in-hospital confinement monthly income, hospital means a legally
constituted establishment that meets all of the following conditions:
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operates primarily for the reception,
care and treatment of sick, ailing or injured persons as inpatients; |
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provides 24-hour service by registered
or graduate nurses; |
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has a staff of one or more licensed
physicians available at all times; |
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provides organized facilities for
diagnosis and surgical facilities; and |
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is not primarily a clinic, nursing
home or convalescent home or similar establishment nor, other
than incidentally, a place for alcoholics or drug addicts. |
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Immediate family
“Immediate family” refers to a spouse
(or common-law spouse), parents, grandparents, children over 18,
brothers or sisters. |
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Medically necessary
A service or supply provided or prescribed by a health care professional
to prevent, diagnose, or treat an injury, disease, or disability
that is:
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consistent with the
treatment of symptom(s) or diagnosed injury, disease, or disability; |
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not primarily prescribed
or provided for convenience; |
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the most appropriate,
safe, and cost-effective service or supply; and |
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generally recognized
as accepted medical practice. |
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to a health care professional, it means a person who is legally
licensed to practice his or her profession where services are
rendered, and includes physicians, pharmacists, dentists, and
other professionals as approved by the plan. |
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Mission statement
The Trustees of the Public Sector Group Insurance
Plan are mandated to act in the best interest of the plan and its
beneficiaries.
To achieve this objective, the Trustees are committed
to the following qualities:
| Proactiveness |
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Identify and analyse
group insurance trends and best practices |
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Make recommendations
to optimize the plan’s cost-effectiveness and long-term
sustainability |
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| Transparency |
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Inform parties
of all decisions |
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Educate beneficiaries
on the plan and their role |
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| Integrity |
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Adhere to the
Trust document at all times |
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Respect all legal
documents and requirements |
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Permanently
and totally disabled
Under accident insurance coverage, permanently and totally disabled
means your complete inability to engage in any occupation for which
you are qualified by education, training, or experience for the
rest of your life. |
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Physician
A doctor of medicine who is legally licensed to prescribe drugs,
administer medical treatment, and perform surgery within the scope
of this license. |
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Professional
counsellor
A therapist or counsellor who is licensed, registered or certified
to provide the applicable treatment or counselling. |
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Proof of good
health
Medical questionnaire that you must complete to show the status
of your health. Depending on your answers, Great-West Life can require
a medical examination and any other information. |
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Spouse
The person to whom you are legally married, or the person of the
same or opposite sex with whom you have been living in a common-law
relationship for at least 12 months.
Also note:
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Your spouse must live
in Canada, unless he or she is a full-time student elsewhere. |
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The plan does not cover
any spouse in the armed forces (except for optional and dependent
life insurance coverage). |
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The plan covers only
one spouse at a time. |
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Temporary employee
An employee in the unclassified division engaged to perform specific
duties for a specified time period because of:
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a leave of absence of
a classified employee through sickness, accident, vacation or
other approved leave of absence; |
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a vacancy in a classified
position while an employing authority is determining whether
or not a position is to be filled; or |
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the initiation of a
special project including an extra workload. |
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Totally disabled
Under long-term disability coverage, totally disabled means:
For all employees
During the qualifying period and the following 24 months of
disability, illness or injury must render you physically or mentally
incapable of performing the essential duties of your normal occupation.
If during this period another occupation becomes available for which
you are qualified, and you are mentally and physically able to perform
the essential duties of this job, you must accept it. Otherwise,
benefits will end.
After the qualifying period and the following 24 months of disability,
illness or injury must render you physically or mentally incapable
of being gainfully employed for:
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any occupation for which
you are or may become qualified by education, training or experience;
and |
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any occupation that
pays 75% or more of the current monthly earnings for your normal
occupation. |
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Usual cost
The usual cost of covered services and supplies that are medically
necessary to treat an illness, injury or pregnancy.
The plan will only cover:
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the amount that is usually
charged for the service or supplies in the area in which the
charge is made; |
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services and supplies
that are needed to diagnose or treat an illness, injury or pregnancy
and that are recognized by the Canadian Medical Association
as effective and appropriate and based on accepted standards
of Canadian health care; |
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services and supplies
that the plan is legally allowed by the government to cover.
The plan will not cover services or supplies that are covered
by the government plan in the insured person’s home province; |
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charges for services
and supplies that are incurred while the person is insured; |
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charges for services
and supplies for the least expensive treatment that is medically
adequate. |
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Waiting
period for temporary employees
If you are a temporary employee and you have a break in service,
you must fulfill a new waiting period. |
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