HEBP Disability and Rehabilitation - Are You Covered?
May 19, 2017
Almost four million adult Canadians (roughly 14% of the adult population) report being limited in their daily activities due to a disability*. With disability claims on the rise in our country, that means having good long-term disability coverage at work is more important than ever.
For MGEU members in healthcare, the Healthcare Employees Benefits Plan (HEBP) offers a long-term disability program (the Disability and Rehabilitation program, or “D&R” as it’s known) to provide income replacement to employees who, due to illness and/or injury, can’t work in their job or any other. The D&R program is a valuable source of income protection for employees who are sick or injured and unable to return to work after four months of being on leave.
It will only pay benefits once a 119-day wait period or four-month period of leave has been completed and the employee is deemed to be disabled from their own occupation. During the 119-day wait period, employees may use sick leave with pay, sick leave without pay, vacation pay and Employment Insurance Sickness benefits. If benefits are approved, the program replaces 66.6% of an employee’s average earnings prior to the date of disability.
Typically, the employer will cover the cost of the premiums for D&R coverage while the employee is at work or on a leave with pay, while the latter may be required to prepay premiums while on a leave of absence. Before opting not to prepay premiums, it is important that MGEU members fully understand the implications of this decision.
Below are some valuable tips and information that MGEU members with D&R coverage through HEB should be aware of when they start working and if they are diagnosed with a long-term disability.
Who is eligible for HEB D&R coverage?
- Full-time employees (permanent
or temporary/term); and
- Part-time employees (permanent
or temporary/term) who work on average at least 15 hours per week.
Who is not eligible for HEB D&R coverage?
- Casual employees;
- Employees age 64 and 8 months
- Part-time employees who work on
average less than 15 hours per week.
Your Collective Agreement will indicate if you have Disability and
Rehabilitation coverage through HEB with your employer.
When would I start receiving D&R payments if I am disabled?
Benefits are payable once you have satisfied the 119-day wait period. During the wait period, you may receive sick pay and/or vacation pay from your employer or Employment Insurance Sickness Benefits.
When does coverage start?
Coverage starts on the day you commence Active Service in your job. You and your employer must sign and submit an original D&R Plan Enrolment Form to HEB within 60 days from the date you are eligible for D&R coverage.
What happens if my Enrolment Form is submitted late?
You may have to provide Evidence of Insurability (evidence of good health), which is assessed by an external insurance company (Great-West Life). If the assessment determines that you have a pre-existing condition, you are therefore not eligible for D&R coverage within the plan.
It is important to ensure that the forms are submitted within the time limits to protect your coverage. Please verify with the employer and HEB that these forms are completed and submitted within the 60 day time limit. If you have concerns that your form has not been submitted on time, please contact HEB at 1-888-842-4233 ext. 300.
What is a pre-existing condition under the HEB D&R program?
If you have become totally disabled and
have been covered under the D&R Plan for less than 12 consecutive months, HEB will consider that you have a
- If you have incurred medical expenses or received care or treatment by a physician for a disability resulting from the same or a related cause that is being claimed for, during the 90 days after the date your coverage became effective, HEB will review the period of 90 days prior to the date your coverage became effective.
- If you incurred medical
expenses or received care or treatment by a Physician for a disability
resulting from the same or a related cause that is being claimed for during the
period of 90 days prior to the date your coverage became effective, you will not be entitled to D&R
What happens to my D&R coverage when I am on leave without pay?
- Sick leave without pay: D&R premiums must be prepaid up until the
date that you are approved for D&R benefits (119 day wait period).
- Personal, educational or maternity/parental
leave or layoff: D&R premium
prepayment is optional. However, if you opt to prepay the premiums for
continued coverage, the forms must be submitted to HEB prior to the leave of absence or layoff.
What happens if I decide not to prepay my D&R premiums?
- D&R coverage terminates and
you will not be eligible for benefits if you become ill or disabled;
- You must re-enrol in the
D&R plan upon your return to work. This will impact your D&R coverage
start date and may disqualify you from benefits if you cease work due to
illness or injury within one year of this new effective date.
Can I pay my premiums retroactively when I return to work?
HEB will allow you to reinstate your D&R Coverage in certain situations. Please refer to page 8 of the brochure for details.
I want to maintain my coverage, but I can’t afford the premiums.
Speak with HEB and discuss if funding arrangements are available to have your premiums covered.
It is important that members speak with HEB and their employer prior to proceeding on a leave of absence without pay to discuss health coverage options available and to ensure the proper paperwork is submitted on time.