Chamber Plan FAQs

Q. I missed the deadline for enrolling a new employee. What do I do now?

Have the employee complete an Employee Application and a Statement of Health and send it to the Plan Administrator. Coverage will take effect on the first of the month after the insurance company approves the application. If you have dental coverage, late applicants (employees and their insured family members) are each limited to $250 in dental benefits during the first 12 months of their coverage under the plan.

Q. What if I miss the deadline for adding a dependent?

Have the employee complete an Employee Change Request plus an Employee’s Statement of Dependent’s Health. Send both forms to the Plan Administrator. The dependent’s coverage will take effect on the first of the month after the insurance company approves the application. If you have dental coverage, late applicants are limited to $250 in benefits during the first 12 months of their coverage under the plan.

Q. Can I change the level of our coverage under a benefit we already have?

Most firms make benefit changes at the plan’s April 1 renewal date. The best way to initiate a change between renewals is to call your advisor. He or she can walk you through the options available to your firm.

Q. My spouse has coverage through his/her work – where should I send my dental claim form?

When couples both have health and dental coverage, they can send claims to both plans for maximum coverage. Send an adult claim to the patient’s plan first, then to the spouse’s plan for any outstanding expenses. For children’s claims, start with the plan of the parent born earlier in the calendar year.

Q. I found an old dental bill; can I still claim it under the group plan?

Health and Dental claims must be made within 12 months of the service date. If you leave your company, you have 120 days from your last day of work to submit any claims for eligible expenses incurred up to the end of the month you were with the firm.

Q. Do I need to report my disability benefits on my tax return?

If your employer paid any portion of your disability premium, any benefits received must be reported on your personal tax return. When a benefit plan includes disability coverage, it could be beneficial for the employee to pay the disability premium, even if the company pays 100% of the cost of other benefits. In these situations, employees don’t pay income tax on any benefits they receive.

Q. When do I add an employee to the plan?

I suggest having the new employee complete a Chamber Plan Employee Application as part of your hiring process and send that in to the Chamber. The Chamber will then wait three months from the date of full time employment before starting the benefits for the new employee on the next first of the month. If you decide not to retain the new employee then just fax a notice to the Chamber to cancel the benefits for the new employee. This process helps you avoid having the new employee declared a “Late Entrant” and having to complete medical forms and possibly being denied benefits, especially if benefits were a condition of employment.

 Q. When do Employee changes to our plan take effect?

Any employee change to your plan, adding employees, deleting employees, changing employee status takes effect on the first of the month following the submission of the change.

Q. What do I do if an employee is eligible to decline benefits?

If an employee is eligible to decline having any benefits under your group plan, I would suggest that you have the employee sign a waiver form indicating that they have been offered benefits and have chosen to decline the offer. If the employee changes their mind at a later date they will be declared a late entrant and have to complete medical forms and face the possibility of being declined benefits. The signing of a waiver form also offers some degree of protection for you the employer in the event the employee takes ill and challenges you on the offering of the benefit plan.

 Q. What If an employee has spousal benefits?

If an employee is covered under their spouse for health and dental benefits then they can opt out of the same coverage under your plan and just take the other benefits as offered such as Weekly Indemnity, Long Term Disability, Dependent Life, Employee Assistance Plan, or Critical Illness. If the spouse ever loses their benefits then the employee can change their status to include health and dental coverage for their spouse and family. If the employee has spousal coverage and still desires to join your plan to have duplicate benefits, then they can do so when they are first offered benefits under your plan. If they decline and choose to pick up the duplicate benefits at a later date then the employee and their family will be declared a late entrant and be required to complete medical forms.

 Q. Do I have to offer benefits to all employees?

If you offer benefits to one employee then you must offer benefits to all other eligible employees. If there are more than five employees in your firm then the rule is at least 75% of eligible employees must join the plan in an acceptable manner.

 Q. What is “Cost Plus”?

Cost Plus is a proven, tax-effective means of paying Health, Dental and Vision Care expenses not covered under your Group Insurance Plan, or where plan maximums are exceeded. Some of the most common uses include amounts over any limits in your current group plan, and specific treatments such as orthodontic dental work. The program covers all supplies and services considered eligible medical expenses under the Canadian Income Tax Act. For the business, Cost Plus charges are treated like group insurance premium, as an eligible business expense. Cost Plus benefits are not taxable in the hands of the individuals who receive them.

 Q. How do I waive the waiting period?

You can request that the employee’s waiting period be waived due to a condition of hire. This is usually only acceptable for senior staff or managers. The request should accompany the employee’s enrollment application.

Q. Does my group insurance cover me for travel, emergency medical insurance?

Yes. All group insurance plans provide emergency medical insurance for when you travel. Check your individual policies to see how long each trip can be in a year.

Q. How far back will my claims be paid?

Claims will be honoured for up to 12 months.

Q. Who is eligible to go on my plan?

With the Chambers Plan your business (or one of it’s principals) must maintain a membership in a participating Chamber of Commerce or Board of Trade. Sole proprietors, partners and employees are all eligible to apply if they are under age 75. They must be Canadian residents, work at least 2/3 of the company’s normal hours and not less than 20 hours per week.

All other insurance plans have similar rules but you do not need to be a member of a Chambers of Commerce or Board of Trade.

Q. Are there any other Insurance or Financial products which may benefit my Business?

I am a full service insurance broker with resources to offer various strategies for maximizing the use of retained earnings, business succession planning, business interruption insurance, RRSP’s, personal life protection products. Please call me for more information.

Q. Can I keep my Life Insurance when I leave my employer?

When employees leave their company, they usually have the right to keep the amount of life insurance provided by the group plan. If they elect to convert the coverage to an individual policy and pay the future premiums themselves they must complete the conversion within 30 days of leaving the firm.

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