Contact Information

Extended Health Care and Dental Care Benefits

If you have any questions on plan coverage specifics or how your claim was adjudicated please contact Manulife Customer Service:  1-800-268-6195 or go to the Manulife Member Site.

You will need to quote the policy number 29835 and your member number which can be found on your Manulife card.

 

Emergency Travel Assistance

Please call the appropriate number below and quote World Access Plan # 9081

Canada/US

1-800-265-9977

Mexico

00-1-800-514-3702

Dominican Republic

1-888-751-4403

International Toll Free for participating countries

Country Code + 800-9221-9221

Other countries

use operator to call collect

519-741-8450

On-line Manulife Account

It is important to create your on-line Manulife account in order to use your HCSA and LSA and to track your claims.

Opening your online account is easy, just follow the steps in this brochure Connect to your benefits.

Manulife App

Fresh, intuitive design allows you to conveniently access your Manulife Benefits Plan.

Here’s a list of how you can use the mobile app:
  • submit your claims
  • review recent claims and payment information
  • find health care providers in your area with directions on how to get there
  • search My Drug Plan for a drug and find the lowest cost alternative
  • pharmacy saving search (find places to get your prescriptions for less)

Plan members using iOS and AndroidTM devices can now access the extended health and dental plan information using Manulife Mobile without having to enter sign-in credentials. By simply using your fingerprint to identify yourself as a plan member, you can start managing your account. Manulife has also launched facial recognition for iPhoneX.

Download the app from  Google Play or Apple app store. There are several Manulife Apps. Search Manulife and select the “Group Benefits Mobile”.

Manulife Vitality Program

Life Healthy. Earn Rewards.

Learn more about the Manulife Vitality Program

Plan Member Q&A

Question

How does housing allowance fit into the eligibility calculation?

Answer

GSI uses “Salary Basis” as a defined term to establish eligibility. Salary Basis includes base salary and housing allowance. We realize that clergy have the option to deduct the value of their residence from income to calculate income tax and Canada Pension Plan contributions.  This is unrelated to the ELCIC pension and benefits plans eligibility formula. GSI’s policies do not use taxable income for eligibility.  

GSI supports plan members in leading healthy lives and achieving financial security

This is accomplished by providing comprehensive extended health, dental and travel benefits, as well as a generous life and disability insurance program and an employee and family assistance plan (counselling and support services).

Benefits Coverage Descriptions

Group benefits are important not only for the financial assistance they offer, but also for the security and peace of mind they provide for you and your family should unforeseen needs arise. It is your responsibility to understand the benefits and to put them to the best possible use.

The purpose of the information in the tabs below is to describe your group benefit coverages provided under the Group Policy. In the event of a discrepancy between this information and the Policy the terms of the Group Policy will apply.

How to Make a Claim

Coordination of Benefits

Claim TypeDeadline
Health Module Benefits during employment12 months after the date the expense was incurred
Health Module Benefits after Termination90 days from the termination date
Life Insurance or AD&D90 days from the date of the loss
Long Term Disability180 days from the end of the Qualifying Period

Redesign with Modules

The updated design of the ELCIC Group Benefits Plan began January 1, 2021 and consists of 3 modules:

Blue, Green & Teal

Benefits Chart BGT with Comparison to current plan

The details of each module is included in the coverage descriptions on this page.

Policies of Note

Changing Modules

Changing Modules

 

After the initial module selection, plan members are able to change their module selection in certain circumstances.

Members may make a module change when there is a life event. Eligible life events are:

    • becoming a parent or when a dependent is no longer eligible as they attain age 21 or 25 if a full-time student;
    • a change in marital status
    • a change in co-ordination of benefits (i.e., your Spouse either gains or loses their employment health benefit plan).

Please note that the request for change must occur within 31 days from the event. Also, certain events will not qualify; some examples are: becoming disabled or starting a new Call at another participating employer (member needs to continue in their previous selection when benefits are reinstated).

Members may also make a module change at the annual re-enrollment on January 1st, where members can make a new selection to move to an adjacent module.

Members should also be aware that their claims history will be carried forward. This means that benefits with coverage maximums that are greater than one year such as vision care (24 months) will not reset with the redesign nor when a different module is selected at a later date.

Glossary of Definitions

Definitions 

The following definitions apply to the ELCIC Group Benefits Plan.

Accident is an unexpected or unforeseen happening or event involving an external force, causing loss or injury, independently of all other causes.

Actively at Work means at work, for the usual schedule, for an Employer at the Employee’s usual place of work. On weekends or holidays, or when on vacation, an Employee is deemed to be Actively at Work if he was Actively at Work on his last normal working day or on his last scheduled shift.

Adherence use Drug, service or supply in accordance with the terms for which it was prescribed.

Advisory Body Manulife Financial approved external experts that may provide Manulife Financial with recommendations, applying a Pharma-co-economic or cost effectiveness evaluation.

Annual Enrollment Date the date each year on which the Employee is permitted to make changes to his flexible benefits coverage.

Benefit Percentage (Co-insurance) the percentage of Covered Expenses which is payable by Manulife Financial.

Birth the complete live delivery of a child from its mother.

Child an Employee’s or Spouse’s natural or legally adopted child, or stepchild, who

(a) is dependent on the Employee or the Spouse for financial support;

(b) is a child of a Surviving Spouse who was insured under the Policy at the time of the Employee’s death;

(c) is unmarried;

(d) is not employed on a full-time basis;

(e) is not eligible for insurance as an employee under this or any other group policy; and

(f) is either under 21 years of age, or, if a full-time student at an accredited school, college or university, under 25 years of age.

A newborn child shall become insured from the moment of birth, including stillbirth.

A child insured under the Manulife Financial Policy who is incapacitated due to a mental or physical disability on the date the child reaches the age when the child would otherwise cease to be an eligible Dependent.

A child is considered incapacitated if the child is incapable of engaging in any substantially gainful activity and is dependent on the Employee for support, maintenance and care, due to a mental or physical disability.

Manulife Financial may require written proof of the Dependent’s condition as often as may reasonably be necessary.

A stepchild must be living with the Employee to be an eligible Dependent.

Dentist a doctor of dentistry, licensed to practice dentistry in the place where services are provided.

Dependent a plan member’s Spouse or Child who is insured under the Provincial Plan.

Disability or Disabled is the state of being Totally Disabled.

Disease Management Programs is an approach to healthcare that teaches patients how to manage a chronic disease. A system of coordinated healthcare interventions and communications for patients with conditions in which patient self-care efforts are significant in the management of their condition.

Drug is a medication that has been approved for use by Health Canada and has a Drug Identification Number.

Due Diligence is a process employed by Manulife Financial to assess new Drugs, existing Drugs with new indications, services or supplies to determine eligibility under the Policy. This process may use Pharma-co-economics, cost effectiveness analysis reference information from existing Federal or Provincial formularies, recognized clinical practice guidelines, or an Advisory Body.

Earnings fare the Employee’s regular salary or wage plus bonuses, overtime pay, vacation pay and housing allowance or equity paid. Note that the FMV of rent for a parsonage is not included in the life and disability insurance benefit coverage.

For the purposes of determining the amount of an Employee’s benefit at the time of claim, an Employee’s Earning will be the amount reported by the Policyholder to Manulife Financial and for which premiums have been paid.

Employee a person who:

a) is directly employed by the Employer and has met eligibility criteria.

b) is compensated for services by the Employer; and

c) is residing in Canada.

For the purposes of the Benefits which continue beyond retirement, the term Employee also means Retiree.

Employer shall mean the Policyholder and any of the following that have executed a subscription agreement with the Policyholder: ELCIC, member congregations of ELCIC, colleges, seminaries and other entities associated with ELCIC, and organizations which employ Rostered Employees and any not-for-profit faith based body corporate and affiliated corporation of such faith based body corporate.

Exclusive Distribution are Manulife Financial approved vendors.

Experimental or Investigational  is not approved as an effective, appropriate and essential treatment of an illness or injury.

Hospital is a legally licensed institution which is operated for the care and treatment of sick and injured persons as in-patients, and which:

a) is eligible to receive payments under a provincial hospital plan;

b) provides organized facilities for diagnosis, major surgery, or rehabilitation;

c) provides 24-hour nursing service by registered nurses, and has a Physician in regular attendance;

d) is not primarily operated as a nursing home or a place for rest, or for the care and treatment of the aged, the blind or deaf; and

e) is not primarily operated as a place for the care and treatment of alcoholics, drug addicts, or the mentally ill, unless the institution is eligible to receive payments under a provincial hospital plan.

For the purpose of this Policy, the chronic beds of a Hospital are not considered to be part of that Hospital.

Immediate Family Member is a person who is (a) the Employee; (b) the Employee’s Spouse or child; (c) the Employee’s or Spouse’s parent, or (d) the Employee’s or Spouse’s brother or sister.

Indefinite Lay-Off is a period during which the Employee is laid off work and which there is no fixed recall date.

Interchangeable Drug includes but is not limited to:

a) a generic equivalent to the brand name Drug deemed to be interchangeable by law where the Drug is dispensed;

b) a Drug that contains the same active ingredient that has not been deemed interchangeable in the province where the Drug is dispensed; but has been identified as interchangeable by Manulife Financial.

Leave of Absence is a period of absence from work for which the dates are fixed by legislation or by mutual agreement between the Employee and the Employee. Leave of absence include Maternity and Parental Leave of Absence.

Licensed, Certified or Registered is the status of a person who legally engages in practice by virtue of a license or certificate issued by the appropriate authority, in the place where the service is provided.

Life Events are considered to be one of the following:

a) change in marital status – marriage, separation (of 6 months), divorce

b) birth or adoption of a child

c) death of a Spouse or dependent child

d) gaining coverage under another plan (Spouse)

e) loss or significant change in Spouse’s benefit coverage due to loss of employment or due to discontinuation or significant alteration of Spouse’s benefit coverage

f) when a dependent is no longer eligible as they attain age 21 or 25 if a full-time student.

A Member has 31 days from a Life Event to make changes. Coverage is then retroactive to the date of the Life Event.

Life-Sustaining Drugs are non-prescription Drugs which are necessary to sustain life.

Lower Cost Alternative if two or more Drugs, supplies or services result in therapeutically similar results, or prescribing guidelines recommend alternate Drugs, supplies or services be tried first that are lower in cost, the Lower Cost Alternative will be considered.

Maternity Leave of Absence is the period of formal maternity leave to which an Employee is entitled by legislation governing the Employer, or a longer period, if the Employer’s normal practice permits.

For the purpose of this Policy, Maternity Leave of Absence will be deemed to commence on the earlier of:

a) the date fixed by mutual agreement between the Employee and the Employer;  and

b) the date the child is born.

Medically Necessary accepted and recognized by the Canadian medical profession and Manulife Financial as effective, appropriate and essential treatment of a phase of an illness or injury. Manulife Financial has the right after Due Diligence has been completed to determine whether the Drug, service or supply is eligible under the Policy.

Net Earnings is the employee’s Earnings, less deductions normally made for federal and provincial income tax.

Non-Evidence Limit refers to satisfactory medical evidence that must be submitted to Manulife Financial for Benefit Amounts greater than this amount.

Parental Leave of Absence is the period of formal child care leave to which an Employee is entitled by legislation governing the Employer, or a longer period, if the Employer’s normal practice permits.

Patient Assistance Program a program that provides assistance to insured persons prescribed select Drugs, supplies or services. Manufacturers and distributors may provide Patient Assistance Programs that include financial support, along with education and training.

Pharma co economics the scientific discipline that evaluates the value of pharmaceutical drugs, clinical services or supplies. This discipline includes but is not limited to clinical evaluations,  risks analysis, economic value and the cost consequences to plans. Pharmacoeconomic studies serve to guide optimal healthcare resource allocation, in a standardized and scientifically grounded manner as determined by Manulife Financial.

Physician a Doctor of Medicine licensed to practice medicine in the place where the services are provided.

Prior Authorization is a claims management feature applied to a specific list of Drugs, supplies or services to determine eligibility based on predefined clinical criteria and a Pharmacoeconomic or cost effectiveness evaluation.

Prior Plan is a previous Group Policy which insured all or some of the persons insured under this Policy, and which terminated within 31 days prior to the Effective Date of this Policy.

Provincial Plan is any plan which provides hospital, medical, or dental benefits established by the government in the province where the insured person lives.

Qualifying Period is a period of continuous Total Disability, starting with the first day of Total Disability, which must be completed by the Employee in order to qualify for benefits. The Qualifying Period is shown in the Benefit Schedule.

Reasonable and Customary – the lowest of:

  • the prevailing amount charged for the same or comparable service or supply in the area in which the charge is incurred, as determined by Manulife Financial; or
  • the amount shown in the applicable professional association fee guide; or
  • the maximum price established by law.

Retiree  is a person who was at least age 60 at termination of employment and who was an Employee of an Employer immediately prior to his termination.

Spouse means the legal spouse, or the person to whom at least one of the following situations applies:

a) they have been living with the employee, in a conjugal relationship for at least 12 continuous months. Note in this definition, 12 continuous months includes any period you were separated for less than 90 days because of a breakdown in the relationship.

b) they are the parent of your child by birth or adoption

c) they have custody and control of your child (or had custody and control immediately before the child turned 19 years of age) and your child is wholly dependent on that person for support.

Only one Spouse will be eligible for insurance under the Policy, and will be as indicated by the Employee on the applicable form for insurance under the Policy. Where this information is not contained on the Employee’s application, the person who qualifies last under this Policy’s definition of Spouse will be the eligible Spouse.

Total Disability or Totally Disabled

Restriction or lack of ability due to an illness or injury which prevents an Employee from performing the essential duties of:

a) his own occupation, during the Qualifying Period and the  2 years immediately following the Qualifying Period; and

b) any occupation for which the Employee is qualified, or may reasonably become qualified by training, education ore experience, after the 2 years specified in part a) of this provision.

The availability of work will not be considered by Manulife Financial in assessing the Employee’s Disability.

An Employee who must hold a government permit or license to perform his duties will not be considered Totally Disabled solely because such permit or license has been withdrawn or not renewed.

Vocational Plan (Vocational Rehabilitation) is a training or job placement program that is expected to facilitate a Disabled Employee’s return to his own job or other gainful employment.

Yearly Maximum Pensionable Earnings is the maximum amount of earnings of an individual that is used to determine the maximum contributionary earnings and the maximum benefits applicable under the Canada Pension Plan/Quebec Pension Plan. The Yearly Maximum Pensionable Earnings is revised annually.

Additional Policy Information

Additional Policy Information

To learn more about Manulife’s customer satisfaction and complaint resolution process, please download their brochure.

For additional questions, please contact GSI at admin@elcicgsi.ca – we are always happy to help.

Protecting Your Personal Information

We recognize and respect every individual’s right to privacy.  When you apply for coverage or benefits personal information about you, your spouse or dependents, must be gathered and kept in a confidential file.

This personal information is used for the purposes of providing group benefit plan administration services and insurance products to you.

Maintaining the security of your personal information is a top priority.  Only authorized personnel have access to your information, and the systems and procedures are designed to prevent the loss, misuse, unauthorized access, disclosure, alteration, or destruction of your information.

Personal information is not collected, used or disclosed without your consent, except where authorized by law.

Important Notes (the fine print)

Administration – Manulife Financial

Manulife Financial may from time to time adopt such administrative practices as are reasonably necessary in providing benefits under this Policy, as determined in its sole discretion.

Administration – Plan Sponsor

The group benefits are provided under a group insurance policy arranged by ELCIC Group Services Inc (GSI) with insurance companies as GSI does not provide benefits itself under this plan. Any benefit to which plan members may become entitled will be determined pursuant to the provisions of such group insurance policy. GSI will have no responsibility to plan members other than forwarding premiums received by it on account of plan member enrollment in the Plan to the applicable Insurance Company.

GSI contracts the plan with insurance companies on an annual calendar year basis and there is no guarantee that the contract will be renewed at the conclusion of its present term or that it will be renewed with the current insurance company or with the current benefits covered. Notice of such events or circumstances will be given within a reasonable timeframe.

GSI will establish premiums on an annual basis for the benefits which will include administration fees.

Claims will be adjudicated solely by the insurance company. Questions regarding claims must be directed to the insurance company.

The information that follows is a summary of the benefit coverages provided under the Group Policies. In the event of a discrepancy between this information and the Policies the terms of the Group Policies will apply. This information in either paper or electronic form does not create or confer any contractual rights or obligations. Possession of this information alone does not mean that you or your Dependents are insured. The Group Policies must be in effect and you must satisfy all the requirements of the Policies.

This information in either its paper or electronic form does not create or confer any contractual rights or obligations.

Possession of this information alone does not mean that you or your Dependents are insured. The Group Policy must be in effect and you must satisfy all the requirements of the Policy.

Administration – Manulife Financial

Manulife Financial may from time to time adopt such administrative practices as are reasonably necessary in providing benefits under this Policy, as determined in its sole discretion.

Administration – Plan Sponsor

The group benefits are provided under a group insurance policy arranged by ELCIC Group Services Inc (GSI) with insurance companies as GSI does not provide benefits itself under this plan. Any benefit to which plan members may become entitled will be determined pursuant to the provisions of such group insurance policy. GSI will have no responsibility to plan members other than forwarding premiums received by it on account of plan member enrollment in the Plan to the applicable Insurance Company.

GSI contracts the plan with insurance companies on an annual calendar year basis and there is no guarantee that the contract will be renewed at the conclusion of its present term or that it will be renewed with the current insurance company or with the current benefits covered. Notice of such events or circumstances will be given within a reasonable timeframe.

GSI will establish premiums on an annual basis for the benefits which will include administration fees.

Claims will be adjudicated solely by the insurance company. Questions regarding claims must be directed to the insurance company.

The information that follows is a summary of the benefit coverages provided under the Group Policies. In the event of a discrepancy between this information and the Policies the terms of the Group Policies will apply. This information in either paper or electronic form does not create or confer any contractual rights or obligations. Possession of this information alone does not mean that you or your Dependents are insured. The Group Policies must be in effect and you must satisfy all the requirements of the Policies.

This information in either its paper or electronic form does not create or confer any contractual rights or obligations.

Possession of this information alone does not mean that you or your Dependents are insured. The Group Policy must be in effect and you must satisfy all the requirements of the Policy.

Non-Disclosure (Cooperators Policy)

Subject to the incontestability provision of the Uniform Life Insurance Act, if medical evidence of insurability is required on behalf of either an Employee or a Dependent, and it is subsequently learned that the information regarding that Employee’s or Dependent’s medical history or condition was not disclosed, that Employee’s or Dependent’s insurance will be voidable at the option of Co-operators Life. Any premiums paid on behalf of the ineligible Employee or Depenent will be refunded. Any claim payments made will be recovered.

Age (Co-operators Policy)

Co-operators Life shall be entitled to proof of the age of an Employee before making payment or settlement of any claim under this Policy. Where the age of an Employee has been misstated and the correct age is such that no insurance would be in force under this Policy at the date of claim, there shall be no liability under this Policy with respect to that Employee.

Communication Archives

Eligibility for Enrollment Policy Changes

ELCIC Group Benefits Plan – Administrative Changes for 2021

 

The GSI Board has reviewed the Benefits Plan for equity both between Rostered (R) and Non-Rostered (NR) employees and between members either under or over age 65. These changes are effective January 1, 2021.

Reference New Provision Previous Plan Provision
Health + Dental All employees meeting eligibility will be required to enroll in a health + dental module. Employees meeting eligibility with spouses also having a work benefits plan were allowed to waive their health + dental coverage.
all benefits

NR vs R

All employees will be required to meet and maintain minimum earnings of 25% of YMPE* (no hours test) Non-Rostered employees also had to meet an hours test of 20 hours per week to qualify for benefits
Travel All active plan members will have the travel benefit (included in each module) Member aged 65+ did not have the travel benefit

*YMPE – Years’ Maximum Pensionable Earnings (as defined by Canada Revenue Agency)

Letter to Plan Members - June 25, 2020

Letter to plan Members June 25, 2020

 

The ELCIC Group Services Inc. Board of Directors (“the Board”) would like to thank everyone who took time to participate in the health redesign survey and attend the consultations. Your engagement in the process and your thoughtful comments speak to the importance placed on being a part of the ELCIC Group Benefits Plan (“Benefits Plan”) design review.

Redesign Survey and Consultation 

The strongest message that came from the health redesign survey and the consultations was the great appreciation for the Benefits Plan. Over 90% of participants indicated that the Benefits Plan was a very important part of the compensation package. This importance was underscored by the number of plan members who make claims on a regular basis and also the frequency and thoroughness with which plan members read the newsletters and benefits information available on the website.

A variety of suggestions were made regarding possible improvements to the health plan; all were studied by the Board when considering changes to the redesign. Recurring messages included: (1) addition of a health care spending account or other flexible options, and (2) need for travel insurance for working plan members age 65 and up. The aspect of the redesign that was most criticized was the need to meet an earnings threshold in order to require employers to pay premiums for enhanced benefits.

The survey comments and consultation conversations indicate that there may not be a consistent understanding of what is meant by the reference to ‘sustainable’ and the concern that sustainability might be at risk. The Board has determined that sustainability, in the ELCIC’s context, means managing costs to keep the Benefits Plan affordable for the congregations, which are currently paying 100% of the premium. Based on industry trends and developments and our own Plan’s usage, the Board recognizes that premium rates could rise to a level where many congregations would have to forgo having a paid pastor, due to the associated costs of offering a Benefits Plan. This concern is of vital importance going forward, especially in light of the opening comments around the value of the plan.

The Survey Results Report is available for those interested in more details.

 

New Modular Design

The Board considered the survey results and comments, together with the discussions held at the consultations, and determined that changes could be made to the redesign in consideration of this feedback. These changes (i.e., a new modular design) will maintain the goal of adding flexibility, while mitigating the risk to the plan’s sustainability. The Board hopes the redesign will address concerns expressed on the initial redesign proposal.

The new design will offer three modules for selection: Blue, Green and Teal. A summary of coverages in each module is outlined in this chart, which will be implemented on January 1, 2021.

Survey Results Report

Survey Results Report

 

ELCIC Group Services Inc. (“GSI”), in its role as Benefits Plan sponsor for the ELCIC Group Benefits Plan (“Benefits Plan”) regularly monitors each of its components. As part of this process, the Board of Directors (“the Board) regularly receives and reviews statistical reports detailing how members are using the Benefits Plan, as well as financial information in terms of how the Benefits Plan is running. Adjustments are regularly made to the Benefits Plan contract and design, based on this process.

Background
Approximately every five years, the Board undertakes a detailed look at the Benefits Plan, which might include comparison to the external market, a more in-depth review of utilization information, and consideration of how the Benefits Plan fits into ELCIC’s organizational and compensation philosophies.

The journey into examining the health and dental components of the Benefits Plan began in early 2015, with an educational presentation on the pharmacy landscape. This presentation provided the Board with insight into this rapidly changing and growing industry, which accounts for the majority of claims paid by the Benefits Plan. The Board then looked more closely at ELCIC’s claims trends and the related premium rate increases over the past decade.

Based on this research, and with the assistance of benefits consultants, the Board began to explore options to update the Benefits Plan’s health and dental components, in order to incorporate features that could provide greater flexibility, while also addressing fiscal responsibility. Ensuring that the Benefits Plan will be sustainable into the future was identified as an important guiding principle to this process.

To this end, the Board put forward its ideas for updating the Benefits Plan in October 2018. Some Benefits Plan members and congregations provided feedback to these suggestions, and because members indicated that they consider the Benefits plan to be a key component of their compensation, the Board felt that it was important provide a greater opportunity for feedback. To achieve this, GSI sent out a survey and held a series of consultations.

Survey
On December 16, 2019, Benefits Plan members (299 Rostered and 121 Non-Rostered) were sent a survey with benefits-related questions, as well as a brief section to collect basic demographic information. In the end, 34% of Rostered and 22% of Non-Rostered Benefits Plan members completed the survey.

At the same time, 347 employers subscribing to the Benefits Plan were sent a survey with benefits- related questions and a brief demographic section. 28% of employers completed the survey.

We sincerely thank all survey participants for their time and thoughtful comments. In the next section, we are pleased to provide an overview of what we heard from Benefits Plan Members and employers.

You may download the full Survey Results Report here.