Dependents are defined as the spouse and/or children of an employee, who reside in Canada and are covered under the Provincial Health Plan. Dependents are eligible for coverage on the date the employee is eligible, or the date they first meet the eligibility criteria of a dependent, whichever is later, provided dependent benefits are applied for within 31 days of the eligibility date.
- Parents, grandparents, and other extended family are not eligible dependents for group coverage.
- If a dependent (other than a newborn child) is hospitalized, coverage will begin when the dependent is discharged from hospital and actively pursuing normal activities. Newborns are covered from live birth.
- If the employee already has dependent(s) covered on the plan (i.e. Family coverage), any subsequent additional dependents acquired after the original application can be added without Evidence of Insurability. (see “Changes to Dependents”)
- Coverage for a dependent child automatically terminates at the lower age limit specified in your contract, unless the dependent child meets the criteria to continue coverage as an Over-Age Dependent. (See “Enrolling An Over-Age Dependent.”)
- Dependent coverage ends on the earliest of the date the employee’s coverage ends, the date the dependent is no longer an eligible dependent, or the date premium paid to the Insurer for the dependent’s coverage ceases.
Spouse
To be eligible, this individual must be a legally married spouse of the employee, or a common- law partner publicly represented as a spouse, residing with the employee for a minimum of 12 consecutive months (or as specified in your Booklet). The employee may only cover one spouse at a time and employees must insure the same person for all Spousal Benefits provided under this policy. Employees must indicate the date they began living common-law on the Enrollment Card. Employees currently on the plan who want to add a common-law spouse must provide you with a written declaration of the date they began living common-law. (see “Changes to Dependents”)
Children
The employee’s children and their spouse’s children, who are unmarried, unemployed and under age 22, are eligible dependents. Dependent children include natural, adopted, stepchildren, or children for whom the employee has Legal Guardianship. Children of a common-law spouse may be covered if the common-law spouse is living with the employee, is insured under this policy, and has custody of the child/children.
Over-Age Dependents – Students
An unmarried child who is attending college, trade school or university as a full-time student is eligible until the maximum student age outlined in the booklet, as long as the child is dependent upon the employee for financial support. The dependent must not work more than 30 hours per week. Confirmation of full-time attendance in an accredited post-secondary institution is required at the beginning of each school year.
WEBS will automatically generate a notification with your billing statement and provide an application for any members that have an over-age child. Members must complete the application of the date indicated on the form in order to keep the dependent on the plan. If GroupSource does not receive an updated application, the dependent will be automatically removed from the plan effective August 31.
Over-Age Dependents – Incapacitated
If a child becomes permanently incapacitated before age 22, or while a full-time student before age 25, the Insurer will continue coverage as long as the child is permanently incapable of supporting himself/herself financially, as confirmed in the Income Tax Act, due to a medically-diagnosed physical or psychiatric disorder. Medical documentation is required for the Insurer to consider continuation of coverage.
- Contact the GroupSource Medical Underwriting department to obtain the appropriate form, medicalunderwriting@groupsource.ca.
- Complete the form and return it to GroupSource Medical Underwriting department.
- The Insurer will review the Evidence of Insurability and provide confirmation in writing directly to the employee.
- As the Plan Administrator, you will be notified if the dependent continues to be eligible.
Dependent Survivor Benefits
Many group benefit plans include Survivor Benefits. In the event of an employee’s death, coverage for Extended Health Care and Dental Care benefits will continue to be offered to the employee’s eligible dependents, without any premium cost, for a period of 12 or 24 months from the date of the employee’s death. For more information, refer to your Booklet(s) or contact your Client Service Coordinator.