By Michael Thomas, The Investment Guild

Dental coverage
If you elect Dental Coverage and later ‘opt out’, you will not be allowed back in for three years. There is a co-insurance option of 80, 90 or 100 per cent. Increasing your dental co-insurance percentage can only be made every two years (at renewal). Lowering the dental co-insurance can be done once per year (at renewal). This request must be submitted in writing.

Prescription drug co-insurance
There is a co-insurance option of 80, 90 or 100 per cent. Increasing your prescription drug co-insurance percentage can only be made every two years (at renewal). Lowering the prescription drug co-insurance can be done once per year (at renewal). This request must be submitted in writing.

Drug card
Each employee eligible for Extended Health Care will receive a drug card for prescription drugs. Should you use a participating pharmacy, you will not be required to complete and submit claim forms to your insurance company. Instead, you will pay only the co-insurance portion of the cost (if any) and the pharmacist will submit the balance electronically to your insurance company for payment. If you decide to use a non-participating pharmacy you will pay for the drug and submit your claim form and receipt for reimbursement.

Eligible prescription drugs
“Managed Health Care” — This prescription drug plan was put into effect in the mid 90s to control the ever increasing cost for this benefit. Eligible expenses have been designed to match the same listing as currently being used by the Provincial Drug Benefit program. The plan will always substitute the generic equivalent of a brand-name drug, when one is available and will list only the most cost effective brand name drugs in each therapeutic class. Upon enrolment in the group insurance plan, it is imperative that all employees are advised of the type of plan they are on so this information can be given to their doctor at the time of receiving a prescription. Doctors may be able to prescribe an alternate, eligible drug for one that is not covered. Some prescription drugs may not be covered.

     The “Prescription Drug Plan” covers all medically necessary drugs requiring a prescription (except fertility and anti-smoking). The plan includes mandatory generic substitution. Should the physician insist that only a brand name medication be dispensed he/she must indicate “do not substitute” on the prescription and the plan will pay for that brand name. However, should the patient insist on a brand name medication, the patient is responsible for the difference between the brand name and the generic equivalent. This plan is more costly than the Managed Health Care (MHC) plan because of the more expensive brand names.

Long-term disability income protection plan
This is a new plan especially for owners and operators and only available for members of the CNLA. If you are insured under your Association’s Group Insurance plan, long-term disability insurance is included. This plan is very inexpensive and insures the actual income you report on your income tax returns.

     Many owner/operators use income splitting and other tax planning methods (i.e. salaries to spouse and children). In reality if the active owner/operator were disabled all income could stop; therefore insuring these tax planning techniques under this new plan may be more realistic. The CNLA endorses this new individual disability product from Unum/Provident Insurance Company. If you choose to be covered under this new plan then you can opt out of the Group LTD you currently have. Unum/Provident must approve your application. However, once approved, as a member of CNLA, you receive a lifetime 30 per cent discount on the premium. As well, if you currently have a Unum, Paul Revere or Provident Insurance Company disability plan, you are eligible for a 15 per cent discount on the existing plan.

Consider these valuable features of Unum’s professional series plan:

• Protection in your occupation – You are considered totally disabled if you can’t perform the important duties of your occupation.
• Built-in residual disability (based on loss of income) and partial disability based on loss of time or duties) benefits.
• You may elect to switch to residual disability benefits at any one time during your partial disability. In addition, we ensure that you’re reimbursed for any additional benefit you would have received during the 12 months prior to making this switch.
• Flexible waiting periods (30, 60, 90, 120, 180, 365 and 730 days) and benefit periods of two or five years; and to age 65.
• Choice of additional options including: Cost of living adjustment to disability benefits; and Guaranteed future insurability – monthly benefits may be increased annually up to age 55.
• Guaranteed rates and guaranteed benefits equal guaranteed peace of mind.