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TRANSCRIPT
APPENDIX “KKK”
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1-.00
1.
INTRODUCTION & SUMMARY
This manual provides a description of, and processes for themaintenance of t~e sel f-insureå employee benefits program,covering Canadian employees of NTL, NTC, BNR and NTSL.. Theunderlying corporate cons iåeration is the proyision o'E benefitscoverage to all' employees at the lowest cost .to the corporation.
2"
l.Ol EMPLOYEE BENEFIT P~rS
Benefi t coverage through the Heal th and WeI fare Trust------ - - -- ------ --- -- -- -NTL/ C-- ------- ---- - -- --------
MAAGEM.ENT UNION PENSIONERS BNR NTSL
HEALT!i
Semi-Pri vate x x: x x
Dental x
x( A)
x: (A)
x x xExtended Health x
LONG TERM DISABILITY x x x x
SURVIVOR
Group LifePart IPart IIDependent
xx
xx
xx
xx
xxx
Survivor Transition x (B) x x
Survivor Income x x x
(A) For thos e employees covered under Quebec Blue Cross only"
(3) - Non management, non union.
The distinction between employee groups can generally be regardedas union versus all other groups which are referred to asmanagement.
3
1" 02 TAXATION - BENEFITS
Heal th LlD SIB STB GroupC"',.'" Li::e
Relating to Employees:
( a) Benefit recei veò taxable to employee No Yes No. No. No
( b) Employee contribution tax deductible No ~jo
( c) Employer contribution is a taxable No No No No Yes*'¡benefit to employee
Relating to Northern Te lecom:
Employer contribution deductible Yes Yes Yes Yes Yes
Relating' to Trust Funã'. Benefits paid deductible No Yes Yes Yes Yes
( Reporting Required (Ref .. Section 8 ) No Yes Yes Yes Yes**
*1£ under specified limits"
* * If over specified limits
4
1.03 RES?ONS IBILITIES
l" 04 Bene fi ts Manaaement Commi t tee"
This Committee is organized into four components: invest~ents,control i funding and design., The pi:'incipal responsibilities areoutlined below..
Review and eval ua te new employee benefit plans and compare',.ith the terms of existing benefit plans"Determine, eval ua te anå report annual lyon the Companybenefits costs versus these costs in other large corporations.
Ini tiate ideas, approaches which will contribute betterbenefit plan design, administration funding and cost"
Examine and endorse employee benefit information to bepresented to the Management Resources anè Compensation andPension Policy Committees of the NTL subsidiary bo~rds andcommi ttees .
Establish anã maintain a basis for the creation of ongoingfive-year plans for employee benefi ts recognizing a changingemployee profile; company.growth, etc.
(
Examine and enåorse employee benefits infonnation prior torelease to the public and organization groups exter~al to thecompany..
1.05 NTC Benefi:.s
NTC Benefits (l462) is responsible for analyses of claims from aneligibili tYi claims aniount i anã preparation, point of view.
1.06 NTC Trust Accounting
NTC Trust Ac coun ting (i 1 3 2) has the respons ibili ty of maintainingthe Trus t's accounting records. Responsibilities include:
Recording employer and employee contribution on the"unitization" record..
Recording' benefits paid on the basis of the Honthly Claimsreports as issued by Mutual Life and Quebec Blue Bross..
Monitoring and control~ing balances in the banking accounts.
Establishing the chart of accounts.
1.0'7 NTC Trust Accounting is responsible for the general administrationand control of the Trust Fund" This includes:
Verifying all related' expenses to the Trust and initiatingpayment thereof.
Verifying all claims/benefit payments through the MonthlyClaims reports and monitoring the carriers' account balances"
Preparing year-end experience statements by employer! employeegroup and benefit plan"
Preparing of monthly and quarterly r~ports as described"
In can junction with the NTL Tax Department, the proces 5 ing ofall statutory filing requirements, and sending the returnsto NTL Tax Depart.inen t "
Proj ecting claims payouts and aåvising NTL Pens ion Departmentof liquidity requirements.
1,,08 NTC Payroll DeparL-nent
NTC Payroll Department (ll2l) is responsible for:
(a) Issuing all T4's-T4A's/TP4A's Supplementariesto the beneficiaries..
(b) Preparing T4-T4A!TP4-TP4A Summaries and send themto NTL Tax Department (88) along with the governmentcopies of the Supplementaries (per (a) above) andreconciling schedules..
(c) EnsuI'ing STB beneficiaries are advised of the exempt
portion of this benefi t. upon advice from Mutual Li fe, byeither an atta.ched letter or directly on. the T4.
i ;09 NTL Pension Department=
The NTL Pension Depar~-nent (48) has the responsibility for theinvestment of the assets in the Health and Welfare Trust, subject tothe guidelines stipulated under section 25.
1.10 NTL Tax Department
NTL Tax Department (88) is responsible for:
(a) Reviewing and filing the Tru$t information returns- T3!TP3 and the T4-T4A!TP4-TP4A Summaries.,
(b) Ensuring that the HWT is operated within theguidelin~s established in the Advance Ruling, and
(c) Monitoring all changes, both statutory and administrative,that may have any tax implications"
1 . ii The NTL Tax Department (88) must be advised of any proposedmodifica tion to the He al th and WeI fare Trust funds and of anypolicies and procedures relating thereto. As any modifications tothe Trust may invalidate the advance rule and/or create adverse taximplications, NTL Tax Department will x'eview any proposed changes andmake recommendations..
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l..12 NTL Treasury
(
Corpora te Finance Analys is and ":Control (65) of the NTL TreasuryDepartment shall annually review the actual cost of each of theemployee benefit' plans in comparison with prior and anticipatedfuture costs" NTL Treasury shall also review and evaluateregularly plans for the funding of employee benefit plans" NTLTreasury establishes general financial policy but also isresponsible for the approval of all financial and relatedchanges to the Health and Welfare Trust fund.
l" 13 NTL/C Legal De?artIent
The counsel is responsible for ensuring that all Benefit andFinancial (including tax) concerns are sec~reå in all documentsinvolving the Trust Fund and Northern.. Counsel is alsoresponsibie for ensuring time is available to beginre-negotia tions prior to the expiration of the Agreements" Thepresent expiration for the following documents:
Mutual Life ASO 12.31.82 by Administratoror 60 days by Trustee afterl2.3L.80 .1.1.81 or upon 60 days"notice90 days notice
Quebec Blue Cross ASOMontreal Trust Agreement
The above documents are attached as Appendices..
i .14 Montreal Trust
ii'\.':1
Montreal Trust as Trustees of the Health and Welfare Trust Fundas âocumented in the agreement between Northern Telecom Limitedand Montreal Trust attached as Appendix D.. The principalservices are:
l. Daily cash reports (to NTC Trust Accounting)2. Monthly statement of assets and inves~~ents3. Safe-keeping of securities4" Acquisition and sale of securities as directed by
Pension Investment Depar~~ent (48).
l.15 Mutual Life
As administrator of the Administrative Services Agreement,Mutual Life shall provide the following services in addition
toclaims payments.
i. Periodic Claims Analysis;
2. Claim Control Information;
3" Claims Accounting;
4. Claim Forms;
5. Costs ~nalysis including projections :or future periodsand estimates of outstanding liabilities;
6.. Advice on Plan Design Trends;
7. Provide on a monthly basis information for third party
payments in the agreed format;
8.. Provide year end information for the processing of T4!T4A
TP4!TP 4A to NTC Payroll by mia January, in the agreed format .,
7
i "l6 Mu~ual Life shall advise the Trustees and Northern' Telecom of thelevel of funding required to pay for expected claims.. This adviceis to be provided no later than year end for each year. MutualLife's Group Policyholder Se::-vice otficer is Mr.. Gerry Ward; theiractuary is Mr" Kurt Von Schilling.. The phone number is456-0471/2/3/5 "
i.17 .'\uditorsAn external audit is to be performed annually on the completeHeal th and Welfare Trus t operation.
'",
~"oo E:1LOYEE BENEFIT PL.~S
8
2,,01 COMPREHENSIVE HEATH CARE PLAN(applicable to all active employees designated as a management orsupport staff arade.. . ..The following outlines the general provisions of this plan"complete àetails of the plan are containeå in appen~ix A toA.SO agreement, administrative proceèures, employee bookletsenti tIed "Your bene f i. t.s program ", etc.
2" 02 General Details of Plan
Morethe
1. The comprehensive health care' plan (encompassing thesupplementary hospitalization benefit, extended health carebenefit, basic, major and orthodontic dental benefit and otherhealth care expense benefits is available to all eligibleemployees in the above groups on an inãividua 1 or familybasis"
2 "The benefits consist of reimbursement by thè Administrator toan eligible participant in the plan in the percentages shownbelow i and may be subj ect to a deductible, maximum limits i andexclusions of certain expenses as detailed in the plan:
(. ~2" 03 Supplementary Hosoi talization Benefit
Reimbursement PercentageDeductible
- lOO%- None
2,,04 Extended Health Care Benefit and Basic Dental Benefit
~eimbursement PercentageDeductible
2,,05 Major Dèntal Benefit
~eimbursement PercentageDeductible
2.,06 Orthodontic Dental Benefit
Reimbursement RercentageDeductible
- 80%_ applicable to the combined eligibleexpenses of both the Extended HealthCare Benefit and Basic Dental Benefit
- S25. per person per calendar. year_ $50. ~aximum per family (employee and
dependent s) per calendar year_ where two or more members of a family
unit are injured in one accident, thedeductible will be S 25 with respect tothe total eligible expenses arisingfrom the accident
50%-' None
50%- None
_.__;_,_W' ____.._._~.~_._.___.__.._._.._.._._..___. _......____.__.._~ _ ._'_._ __...._. .__. _...._.._ ._..___,_____ ___ _.____.._.__._______
9
~.. 07 The MJI.xlMUM AMOUNT PAYABLE for eligible expenses incurred in acalencaL year unèer the Major Den tal Benefit will be $ 2 1000.. inre-s-pect of an employee and $2,000" in respect of each dependent ofthe employee.. The maximum lifetime amount payable for eligibleexpenses incurreå under the Orthodontic Dental Benefit will beSl/500. in rèspect of an employee and $1,500. in respect of eachdependent of the employee.
2. 08 Other Health Care Expen~e Benefit
ReL~bursement PercentageDeductible
- 50%- None
Wher-e an employee i s deductible plus any co-insurance payments madeby the employee for eligible expenses (up to any applicablelirni ts) under the Extended neal th Care Benefi t, Basic DentalBenefit, Major Dental Benefit and Other Health Care ExpenseBene=it, but excluding the Orthodontic Dental Benefit, exceedsS i, 000 in any calenãar year for the famiiy unit, reimburseinentwill increase' to 100% for all eligible expenses under thesebenefits"
2" 09 CLAIMS PROCESSING - GENERA
(
i .. Th e Admini strator i in respect of any claim under theComprehen~ive Health Care Plan, may require i as the case maybe i the original s of itemized hospital or dental bill s,reports i records, drug and equipment bil Is, an itemizedstatement completeã by the physicia.n or other- practitioner whoa ttended the employee or åepenåent, pre-trea trent x-rays,stuåy models or any other information deemed reasonable underthe circumstances.
2" Proof of a Comprehensive Health Care claim satisfactory to theAdministrator must be mace within 18 months after the date onwhich the expense is incurred"
2.10 CLAIMS PROCESSING ROUTINE - HEALTH CARE EXPENSES
1, When an employee anà/ or the employee i s dependents haveaccumulated receipts or bills for health care in anyonecalendar year for allowable expenses in eXcess of theappl icable deductibles shown under paragraph 2" 0 2 above, theemployee obtains a claim form (Exhibit A) from the personneldepartment concerneä and completes all pertinent poi:.tions ofthe form.
2.. Health care bills for each member of the family are grouped..h.il receipts for expenses incurred by the employee are enteredtogether on the claim form, followed by receipts for thespouse and each child.
3., The employee completes, dates and signs the claim form, andforwards the form together with all original bills, receipts,i=tc" directly to the Administrator for reimbursement..
10
4" Upon receipt by the Administrator of due proof that theemployee and/or the employee i s dependents have incurred theeligible expenses, for medically necessary services ,theAãministrator will provide reimbursement directly to theemployee with respect to such expenses subj ect to the te~s ofthe plan"
5" p..ny difference bet',.een the total amount of the claim submittedand the actual amount of reimbursement by t~e Administrator isexplaineò to the employee when a settlement is maäe. Thesedifferences r'esult from the application of co-payments,deë.uctibles, or from ineligible expenses"
6.. A copy of the processed claim form is returned by theAdministrator to the employee together with a reimburs~ngcheque and, if applicable, an "explanation of benefits" form"
2" 11 CLAIMS PROCESSING ROUTINE - ALL. DENTAL. EX:PENSES
1. W:ien an employee and/or the é111ployee's 'òepènèents claim dental
expenses in anyone calendar year in excess of the applicableåeductibles shown under paragraph 2.. 0 2 above, the employeeobtains a claim form (Exhibit B) from the personnel depart.:nentconcerned.. Part i on the form is completed by the dentist andgives details about the patient and services performed" Part2 is fully completed by the employee and the form maileddirectly by the employee to the Administrator forrei:mburse.inent.
( 2.. Upon receipt and approval by the Aåministrator of due proofthat the employee and/or the employee's depenàents haveincu:i-red the eligible expenses t for necessary dental services,the Administrator will provide reimbursement with respect tosuch expen~es subj ect to the terms of the plan.
3.. Any difference bet',oeen the total amount of the claim submittedanà the actual amount of reimbursement by the Administrator, isexplained to the employee when a settlement is made.. Thesedifferences result from the application of co-payments,deductibles, or from ineligible expenses. .
4., The actual calculation of the benefit payable is shown by theAåministrator in the upper right area of the claim form. Acopy of the processed claim form is returned by theAdministrator to the. employee together with reimbursing chequeanã, if applicable, anå 11 explanation of benefits II form.
2.12 CLAIMS ANALYSIS
l" On a monthly basis, the Administrator forwards a Claims Reportlisting individual payments made during the month.. Thesereports are verified for correctness by the NTC Benefits on aad hoc basis.
p.\' - .c~.
t "~.....,ie iviuluai Llle Assurance Company 01 Canada/Walerloo. Ontario
~ SUMMARY OF EXTENDED HEALTH AND OTHER HEALTH CARE EXPENSES
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--rn-m DENTAL PLAN CLAIM FORM 90002
PATI£NT.~ L,AST NAME GIVEN "'...ESIA~E
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:'N::E=S7 ':l'~: Th.i.T I A.M Fil'ANC::...¡.., 'RES~O:.iS;2~.e:0 MYCE"-'I'Ei ;:C'M i~ E ENTIRE C':S": _0: íHE n:i=':T.v;::~..r i t.IJ~Ti-:.t;,ZE :=E.~5.'" SE C~ THE INrC::~.';' TICN CCN1.AINt:: iNlkiS~....ili.i =e.~.,c "'c i~E fJ:.Tl,l,i. :.1~E. ;'SEt.'Fi~~ICE C.:JMP':.!\"ICF :,:"".:.~.£ OF! TS AGE'\lT5.
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S=::N;.TL$E OF PAT:EN'! iOR- ~l.i;E"i~ G:.AM:':ANl
PUi .; :C =~ =:Cmp!Ete~ b¡ ë::erO::'t d~r::!st~..la:l fOrm -li;r¡ pans- ~ ane 2 com:il-ei&O 10 :\f~UhJr:fL:!E o! Can~,,:i ai ::ie iiccre::~ s!"owr: on ¡hewe !lei cer.!f:cø~e .
E:m:iloyee'i number as shownon me we /let cenific2.te
Are õt')' c:! !lie exoe.ises. ~!øimerj on :ris ~o:-m ~ar2!lie :.i:icer sn:' otherbene'fit p;~n'? Yes C No CII yes. piease- ;ive grOt.D niJmtJer :hæ r: ame of ~he pin" acministratorand the cef1rfic;¡~e :i.lirlcer uricer :.Employ"' Name
!.ailing Address:
2 ls. a.n;: of tr:e- Uei!tr¡ieri~ cerior;i';~~ tt e r'esu¡~ cf an ac=ic:!"-:? 'fes = No::jf yes. piëõse .::I'.,e the ce~.ails of ::-e accideru '.ince' .:. ~ridditionaiinformation, eño inaicæ:t€' 11 e. Ciai~ was mace ICif ;/J'?fi.rreri sCompens¡;¡'on benefits
Sireet Api3_ Does ~he :re;tmeni incluce ~r e rE':iiacerr£:nt of a der;ture crowri or br:cge':
Yes;: No CIf yes. pjea~e give ine daie of pliO' ol¡¡cement ano t~e raaSOn forreplace men: "nde' 4 I" dcHHonal Informelion)
AclC:,licnal Inlor:nel;On To be corr,oieted il questiens' 2 or :i ;,õ\e oeenanswo9rea with YES
City Frav
Post.! C,de
Patient FirsiN~me
last Name
t;elaiions~¡~ !O En':~icy~e 5 I au~h,jriie ::-c- rele:ise of ani' inf:ir;naucr. cr records ri;ouesìed H"I:esoect of 1/''S c:aim to the p~an ac:ninisuaior or itS açens and ceni1,:nai ~r.e. info,,. .HIOr"1 ';J'I=r. .is :rue- :::rr~ci 2nd CCm.PIE-H? :0 :nF j:e~t 01tr i lC:icw¡ecç'¡
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"3" 00 LONG TERM DISABILITY (LTD) PUB(applicable to all employees in accordance with the definitionsshown below)
The following outlines the general provisions of this plan" Morecomplete details of the plan are contained in the appendices to theASO agreement, aåministra ti ve proceãures i employee booklets entitled
. ."Your benefits program", etc.
3.01 GENERA DETAILS OF PLf~
I. ~~y active employee who becomes totally disabled, and hascompleteå the qualifying period of 52 weeks on the Company'ssickness and accident (S&A) disability plan, is eligible forLTD benefits in accordance with the following employee groupsand definitions:
Defini tion of Total Disability
Employee Group
(a) All unionized,including certifiedprof-essionals,All non-union hourly
(
(b) All management,'A.ll non-union salaried
Total disabil i ty means that theemployee, as a result of injuryor disease, is unable to performthe duties of any occupation,ei ther wi thin or outside theCompany, for which the employeeis reasonably sui te¿ by eå uca t ion,retraining and experience"
Total disability means that theemployee, as aresul t of injury ordisease, is unable to ferform,during any 52 week qualifyingperioà anàthe 12 month periodimmediately following, the regularäuties of the employe e 'soccupation, and following theexpiry of the 12 month period, tooerform the duties of any~ccupation, either withiñ oroutsiàe the Company, for which theemployee is sui ted by education,training anä. experience.
In both (a) and (b) above, the determination of "totaläisabil ity" is without consideration to the availability ofemployment of such occupations.
2" The amount of monthly LTD benefit will be an amount, asdetermined by the Company, for which t.he employee was eligibleat the comiencement of the disabilit.y
..-.._._-.....~---------_..._.------_.._--_._.__.__...._-_._._..__..._-------_. . -
12 "
3" This LTD benefi -: is integra ted with any primarygovernment-provideå disability benefits so that the employee'sincome from all sources àoes not exceed 90% of an employe e i simmediate pre-disability monthly earnings"
4, If, while disabled and receiving LTD benefits, the employeeresumes part or full-time employment as part of an approvedrehabilitation program, and such employment pays less than 75%of 'pre-disability monthly earnings, the LrD benefit payment isadjusteã tò bring total monthly income to t~e 75% levei"
3,,02 CLAIMS PROCESSING ROUTINE
1" wnen a disabled employee, at the 10 month stage of disability,appears likely to exhaust the 52 weeks of regular S&A benefits,the meãical and personnel departments concerned arrange for thecompletion of confidential LTD claim forms (~xhibi ts A & 3)"
2 , These completed forms, together wi th any other supportingdocumentation 'ana recorienãations' by the Company's medicaldepart.üen t, are fOI'l1arded to the Aåministra tor for LTD claimsaãjuàication.. There is a S55 surchargê for any furtherAdministrator LTD adj u~ication.
(
3" Following careful consiãeration 0-£ all documentation received,the Administrator' eit:'ìer does or does not admit the case as aLTD claim, accorãing to the applicable definition in paragraph3.0l under "General details of plan" above" Appropriateconfirmation of such a decision is provided to .the Company'smedical director anå NTc Benefits"
4" Upon receipt of confirmation that the Aàministrator will admitthe claim, NTC Benefits department, in concert'with t.iieemployee's personneldepart."ient, proviòes the Administrator withfull ãetails of the monthly LTD benefit payable, date of benefitcommencement, and such other applicable data which relates to thecase, including the employee iS benefits coverage and ded uctionsto be maintained during the period of LTD. The disabled employeeis similarly advised of all details by the personnel departmentw'hen the claim has been. appro\Teò by the Administrator"Applicable LTD cheques are mailed monthly òirectly to
theemployee by the li.dministrator.
5" LTD benefits are paid to the disabled'employee until one of thefollowing occurs, whichever is the earliest:
the employee ceases to be totally disableå, or
the employee fails. to submit proof of continuance of totaldisabil i ty as required by the Aãministrator, or
"
,
the employee fails to submit, upon request by theAdministrator, to a medical examination by a medical examinerappointed by the Administrator ,or
- the' e~ployee refuses to participate in a rehabilitationprogram which has been approved by the attendingphysician, the Company anâ the Administrator, or
the em~loyee engaggs in any occupation £or remuneration orprofi t or any educational program other than in arehabil! ~ation program approved by the attending physician,the Company and the Administrator, or
the benefit perioà expires, (at age 63) or
- the employee dies"
6. If ~he employee i s case is not admitteã as a LTD claim, theAdmini stra tor so confirms such a decision to the. Company' smedical director and NTC Benefits. In such a case, theemployee is appropriately advised and a prescribeà 2 year
. leave of absence routine is instituted by the personnelãepart.'1ent following ex.pir:: of the 52 week of S&A benefits"
7. Proof 0= a LrD claim satisfactory to the Administrator mustbe made to the Admistrator within three (3) mont~s after theexpiration of the qualifying period of 52 weeks of S&Abenefi ts ,;
." ~J .03 CLAIMS ANALYSIS
(
3.04
3.,05
l. On a monthly basis i the Administrator forwaràs a Claims Reportlisting individual long term ãlsability benefit payments madeãuring the month, together with deductions for income taxes,.c/op p, UIC, premi urs for supplementary hospitalization, creditunion, union dues, etc" These reports are verified forcorrectnes s by the NTC Bene fits and for~ardeå to the payrol 1department for third-party payments and record-keepingpurposes"
REHABILITATION EXPENSES
Any and all out-of-pocket expenses incurred by the Administratoras a result of assisting the disabled' employee to undertake someform of employment or training as part of an approvedrehabilitation program, will be paid directly by Northern Telecomoutside the Heâlth and Welfare Trust. These expenses should alsoinclude any costs of approved outside or independent medicalservices"
REASSESSMtNT FEES
Any fees incurred as a result of the Administrator arranging forperiodic medical reassessment of the disabled employee will bepaid directly by Northern Telecom outside the Health and ~velfareTrust.. These reassessments are for the purpose of deterrining
13
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14whether the disabled employee remains qualified to continue toreceive LTD bene~its, or shouid be involved in a rehabilitationprogram, or is declared fi t to resume employment.
3" 06 WAIVER OF PREMIUMS - GROUP LIFE INSUR.iiCE & SIB
Any disabled employee, whose case has. been approved for LTDbe::efits, is automatically granted a "waiver of premium" forcompany sponsored life insurance and SI2 purposes (whereapplicable) .
If the employee is participating in these programs as of the firstday of disability, all premi ums paid by the employee, via payrolldeductions, are refunded to the employee upon commencement of LlDbenefi ts as advised by the Personnel Department. Coverage ineffect at the commencement of disability would continue for theperiod of LTD at no cost to the employee-
(,
Itt NORTHERN TELECOM
CLAIM FOR LONG TERM DISABILITY BENEFITSGroup No
90002
EMPLOYER'S STATEMENT:
Before !he end of Ihe qualifying period submit this form with the Employee s Statement (on reverse srde of this formi direclly 10 the Medrcal Department aiNor1hern Telecom in (he enclosed pre-aOdressed envelope .
E N s E N ompoyee s ame ex mpoyee a ccupa ion
Dept No Division Location loe Code SOCial Insurance Number Coni Service Dale
y, Mo Oay
i ,
E:npioyee 5 GraDe Union Gro!.:: lif applicaolei Bargaining Unit CODe NumberhI aoplicablel Daie iast Wor~ed Amount 01 LTD Benelil
Vr MO Oays MO
A. EARNINGS;
¡. .~ DISABILITY BENEFITS;
8as;c salary or Nage /.lUS COLA if ãpolicablei immedlãiely pI or to commencement of disability S per month
Last cay for whictì short..term ($ to A) benefits paid:. Yr
2 Workmen 5 Compensation cavabie? Yes 0 No 0 If yes S
Mo Day
weekly 0 monthly 0 from Yr _ MD Day
Mo Cay w C B Cla1ri Number (if known).
3 Canada olOuebec Pension Plan. To your knowledge has Ihe emoloyee claimed benefits? Yes 0 No 0
4 If you are aware of any other sources from which the employee is ciaiming Dr receiving disability benefis please name them.e
5 \A.. "cr: definition of total disaoility applies 10 this employee (i e Union Non-union Houriy or Salaried. or Management)?
(C.. BRIEF BACKGROUND OF EMPLOYEE'S EDUCATION, 'TnAINING AND EXPERIENCE:
Eoucation:
2 Training:
3. Experience: Staning with curreri! job tille list lilies of all previous jObS Denormed bolh within and outside Northern Telecom Attach copy of current jobwrrte-up or pUblished job descriDlion.' -Dates From I Date's To Job Tille
Yr MO Yr Mo
I
:
iI
II
;-.-
. . ;,
.,
Di:!e .Authcr:zt:d Siqna~ ,_!"~_.. -- ~.._--- ._--_.~-~..---
--;'---~".:-f'crtrn-'fi:'J'-Ti:I::I:'Ç(Tiw-" ..__.._-_._. .._.-.
n~ ATTENDING PHYSICIAN'S STATEMENT OF DISABILITYGroGp No
90002
Paiienl s Name Age
i hereby authorize the relene to the Medical Dept. of Northern Telecom and to The Mutual Life Assurance Company at Canada of any Informatronrequesfed In respect of thili claim.. .iate Signature of Patient;he paUent Is responsible for the securing of this form and any charge whIch may be made for lis camplellon.
To Physicians - Please noteThis lorm has been specifically designed wilh Ihe Physician in mind. By being comprehensive. il will hopefully reduce the physician s administrative work.load. Please compleie the sections reiaiing 10 your patieni and stroke out non.applicable areas In order to help Ihe claimant suffcient deiailsof History In.vestigation Findings and Trealment are essential
This form to be mailed direciry 10 Ihe Medical Dept. of Nonhem Telecom in the enclosed pre-addressed envelope.
1. HJSTORY
a) When did symptoms firs I appear or accident happen? Month Day Yr
b) Date lotal disability commenced? Monih Day Yr
c) Has palient ever had same or similar condition? DYes DNa o Unknown1/ . Yes'. state when and describe
d) Is condition due to injury or sickness arising out of patient semploymeni? DYes o No o Unknown
e) Names of other treating physicians
2.. DIAGNOSISal Diagnosis (including any complications)
Primary
Secondary (if applicable)
(.~
b) Subjeclive symptoms
c) Objective findings (including results of current X-rays EK G s or any other special lests)
3. TREATMENT
a) Date of first visit MOnth Day
Day
o Other (specify)
Yr
b) Date of latest visit Month Yr.
c) Frequency o Weekly o Monthly
dl 1$ patient following recommended treatment program? DYes o No
4. TYPE OF TREATMENTa) Describe therapy and projected duration of treatment program
b) Date and description 0/ surgery (If applicable) Month Day Yr
5. PHYSICAL IMPAIRMENT
a) Is palient: o ambulatory o house confined o bed confined o hospital confined?
b) If ambulatory and/or house confined please complete the section below:o No Limitation of functional capacity; capable of suenuous activityo Minimal Limitation of functional capacity; capable of moderate activityo Medium Limitation of functional capacity; capable of light activityo Severe Limitation of functional capacity: incapable of minimal activity
c) Remarks
ia50-NT.281 See over
AI~ NORTHERN TELECOMI L4 ATTENDING PHYSICIAN'S STATEMENT OF DISABILITY Group No
90002
Patieni s NameAge
( l hereby authorIze the releue 10 the MedlC31 Dept. 01 Norihem Telecom and 10 The Mulual Ule Assurance Company of Canada of any Informationnquested In relp&Ct of thli claIm.
Date Signature of PalientThe palløn! Is riuponilble for the lacuring 01 thli lorm and any charge WhIch may be made for III completion.
To PhysIcians - Please noie .This form has been specifically designed wrth the PhysJcian in mind. By being comprehensive it wil hopefully reduce the physician s administrative worK.loao Please complete lhe sec1ins reiaiing to your patieni and stroke oul non-applrcable areas In order 10 help the claiman! sufficient details of History In.vesligation Finoings and Treaimenl are esseniiaJ.
This form to De l7alleo direciiy to rhe Medical Depi of Nonhern Telecom in the enclosea pre.addressed envelope.'.
1" HISTORY
a) When did symptoms first aopear or accident haopen? Month Day Yr
bi Dale toial disaOlltly commenced' Monlh Day Yr
cl Has patieni ever had same or similar condilion?II . Yes' siåt-e when ana describe
o Yes o No o Unknown
d) Is condition due 10 injury or SICkness arising oul of patieni s employment? DYes o No o Unknown
el Names of Olher irealing phys;cõans
2, DIAGNOSIS
a¡ Diagnosis (including any complications)Primary
Secondary Iii applicable). .~
( bJ Subiecllve symptoms
cJ Objective findings (including results of current X-rays E K G s or any other special tests)
3. TREATMENT
a) Date of firsl visit Month Day
Day
Yr.
bl Date of latest visit Month Yr
c) Frequency o Weekly o Monthly o Other (specify)
d) Is palieri following recommended lreatmeni program? o Yes o No
4" TYPE OF TREATMENTal Describe therapy and proiected duration of treatment program
.':. ::
b) Date and description of surgery (If applicable) Month Day Yr
5" PHYSICAL IMPAIRMENT
a) Is patient: o ambulatory o house confined o bed confined o hospital confined?
b) If ambulatory andror house confined please complete the section below:
o No Limitation of functional capacity: capable of strenuous activityo Minimal Limiiation of functional capacity; capable 01 moderate activityo Medium Limitation of lunclional capacity; capable of. light activityo Severe Limitation 01 functional capacity: incapable of minimal activity
c) Remarks
ieSD.i,r Õ 81 ,..
--'-----_.._._----~._-------_._---_.--_.~~--.._-_..._.-...._.._-----------------------_.._..
.00 SURVIVOR INCOME 3E~EFIT( applicable to all active employees designateå as a managementor manacement SUPDort staff orade._ JThe following outl ines the general provisions of this benari t"More complete details of the benefit are contained inAppenëix A to the ASO agreement, administrative procedures,employee booklets enti'cled "Your benefits program", etc..
4.. 01 GENERA DETAILS OF BENEPIT
1. Or. the death of a participating eligible employeo= from anycause, t~e Administrator will pay a Survivor Income Bene fi t(S"I.B,,) consisting of a
Spouse Benefit
( a) 50% of the lesser of the employee i s basic annual sala.ryor the Yearly Maximum Pension Earnings in effect underthe Canaëa/Quebec Pension Plan in the year of death,plus
(b) 25% of t~e employee i s basic annual salary in excess ofthe Yearly Maximum Pension Earnings in effect under theCans.da/Quebec Pension Plan in the year of death.
(In the case where death is the result of an occupationalaccident, a lump sum payment will be payable in aãdition toany other benefits paya.ble under this benefit.. The lump sumbenef! t is an amount equal to the employee '5 basi.c annualsalary" Plus, w'here applicable, a
Chílå Benefit
An amount equal to LO% of the employee! s basic annualsalary, payable on behalf of each dependent child, to ~maximum of t'..o children.'
If the employee dies leaving rio spouse, the amount ofthe Child i S Benefit will be 20% of the employee i s basicannu~l salary payable on behalf of each dependent child to amaximum of t~o children.
2" The S..LB. will be reduced by the Survivor's Pension towhich the spouse ~s entitled under the Canada/Quebec PensionPlan including benefits for the two youngest dependentchildren under l8 years of age.
3" The minimui total S.. I" B. will not be less than an amountequal to 25% of the employee i s basic annual salary"
-_..-----_. ----_.._--------
15
..-_.:--'_._'~.'-'- ~-'-.',~._'..'._.~-"----'_.._'-"-'_._----_.'---'.'._-...._-_.._. _..... ..- _._.. .-......._._.~._.._._.....--.... ....._.__.._~-~._--_...__._.----_.~-----.._-------_.__........
16
l.02 CLAIMS PROCESSING ROUTINE
I" Upon notification of the death of an active employee.withel ig ible dependen t (s) , divisional personnel deparL~entsprepare a memorandum to NTC Benefits for approval of paymentof the benefit.. In the case of inactive employees receivinglong term disability benefits at the time of death, NTCBenefits provides similar da~a" Full details in support ofthe claim are required as follows;
Full name of deceaseå employee i employee number idepartment number, location and job graãeclassificationFull name and aaaress of eligible surv ivod s) to whomthe S.LB., is to be paid, including social insurancenumber( s)
Amount of monthly benefit, commencement date,termina tion da~es where appl icable, anë accountingclassificationAmount of lump-sum payment (if applicable) andaccounting classification
TDl!TPDl income tax forms covering the eligiblesurvivor( s)
( Death or burial certificate, marriage certificate ofspouse, birth certificates of depenãent children, orany other offical ãocument as applicable
2.. In cases where the eligibility of the survivor(s) isquestionable or cannot be verified or properlysubstantiated, the personnel department provides fulldetails to NTC Benefits who then arrange for submission ofthe case to the Employees' Benefits Committee for adecision.
3. All approved S"LB.. cases are confirmed to divisionalpersonr.el deparL~ents by NTC Benefits preparatory to theco¡rencement of payments by the Administrator"
4" Details of approved S"I.B. cases and the authority tocommence payments to eligible survivor( s) are confirmed tothe Administrator by NTCBenefits. These àetails include:
Full name, address and relationship of eligiblesurvivor(s) to whom the S.LB. is to be paid, includinga claim number
----- ----~-~_..._--_..__._.__.._._._--..------~.-_..._------._.._._-------_.------_..... .17
Full name of deceased employee, date of death, plusothe~ supporting personal and employment details
~ount of monthly benefi t, commencement date, andter.ination dates where applicable in the case ofdepenõent children
Anount of lump-sum payment (if applicable)
Completed TDijTPDl tax for.s
5. As arranged with the. Administrator, the first monthlybenefit. cheque payable to the eligible survivor( s) isforwar::ed to NTC Benefits i.n order that it may be associatedwith a suggested letter of explanation regarâing the benefitto the recipient. The cheque and suggested letter ofexplanation (which the personnal depart.-nent ",'iil' fOlïalize)are next routed to the personnel depart~ent concerned fordelivery to the recipient.
6.. Future mont~ly benefit cheques are for~arded directly to theeligi'ble survivor(s) by the Administrator"
7. Proof of as" LB. claim sa tis factory to the Aàministra tormus't be made wi thin three (3) months of the åate of death 0 rthe er.ployee..
(
-1,,03 CLAIMS ANALYSIS'j
1. On a monthly basis, the Administrator forwarès a Cl aimsReport listing individual S.I..B. payments made during themonth, together with åeõuctions for income tax. Theserepor~s are veri fied for correctness by NTC Benefitsdepar~~ent and forwarded to the payroll department forthird-party payments and record-keeping pu.:poses"
-.- _._--~- ------.- ---~_..~-----_.--- --~-~ ----_.- '--'-~- -.'. ._.-
_ ___~A_ -;________ _ ._..__ _ ___.___ .._. __ _.._.._ ._. __._ _.__ ... . - . _____ - -. ._ .__ 0 __ ~_ - _..__.._ .. _-0.. _ ._.__ _ ___ _ _ ______ ---- ------- -~--------.18
5.,00 SURVIVOR TRASITION BENEFIT(appl icable to all unionized employees, including certifiedprofessionals, and non-union hourly and salaried employees)Al so applicable to those pensioners who retired af".er Julyl, 1979 or ãate of ratification, whichever is later.
The ::ollowing outlines t:'1e general provisions of the benefit"More complete details of
the benefit are contained in theappendices to the ASO agreement, aãministrative procedures,employee booklets entitled "Your bene fi ts program ", etc"
5 ,,0 i GE~E~~L DETAILS OF BENEFIT
1. On the death of an eligible employee or pensioner from anycause, the Administrator wil 1 pay a sur'li vor transitionbenefit (S"T.B,,) as determined by the Company, per month for'a maximum of 60 consecutive months. Payment will cease when60 consecutive monthly payments'. have beÊ!n ;.ade or when the~eare no eligible depenèen t( s), whichever occurs first.
2" Where an eligible employee dies as a direct re sul t of anoccupa tional accident, the Aàministra tor will pay inaddition to the monthly benefit, a lump sum amount .determineå by the Company, as defined in the benefit group"
.3 .. In addition, the Company will continue to pay premiums,where applicable, for provincial health insurance coverage=or the õeceased employee' s eligible dependent( s) for up to60 consecutive months, under the NT plan..
(
5.02 CLAIMS PROCESSING ROUTINE
1. Upon notification of àeath of an employee or pensioner witheligible dependent( s), divisional personnel ãeparL~ents (orthe pensioner relations depart-inent) prepare a memorandum toNTC Benefits department, for approval of payment qf theS. T. B. In the case of inactive employees receiving longterm ãisability benefits at the time of death, NTC Benefitsprovides similar data to the Administrator.. Full details insupport of the claim are required as follows:
Full name of ãeceaseõ employee or pensioner, employeenumber, department number, location and job gradeclassisifcationFull name, address and relationship of eligibledependent(s) to whom the S.T.B. is to be paid,incl uding social insurance number ( s)
Amount of monthly benefit, co~~encement datei durationòf payment and accounting classification
---.._---..-.-:-----
---------...-_..--------_..._-~_....__...._...----~_._---.-~...-..__.--.._._-_._._----
Amount of lump-sum payment (if applicable) andaccounting classification
TDl/TPDl income tax forms covering the eligibledependent( s)
Provincial heal th insurance enrollment card s coveringthe eligible dependent( s), where applicable
Death or burial certificate i marriage certificate ofspouse, birth certificate of dependent children, or anyother official document as applicable
2. !n cases where the eligibility of the åepenèent(s) isquestionable or cannot be verified or properlysubstantiated, the personnel depar~~ent provides fullõetail s to NTC Benefits who then ar~ange for submission ofthe case to the Employees' Benefit Com~ittee for aèecision..
3" All approved S" T" B. cases are confirmed to divisionalpersonnel departments by NTC Benefits preparatory to thecommencement of payments by the Aaministrator..
4, Details of approved S.,T.B.. cases and the authority tocommence pa.yments to eligible dependent(s) are confirmed tothe Administrator by NTC Benefits. These åetails include:
(..'1
Full name, address and relationship of eligibleõepenåent(s) to whom the S.T"B" is to be paid,including a claim number
Full name of deceased employee, ãate of death, plusother supporting personal and employment details
Amount of monthly benefit, commencement and terminationàatesAmount of lump-sum payment (if applicable)
Schedule of income tax exemptions covering the 60 monthper'io¿, and completed TDl/TPDl tax forms
5. As arranged with the Administrator', the first monthlybenefit cheque payable to the eligible depenãent(s)isforwarded to NTC Benefits in order that it may be associatedwith a suggested letter of explanation regarding the benefitto the recipient ,; The cheque and suggested letter ofexplanation (which the oersonnel department will formalize)are next routed to the personnel department concerned fordelivery to the recipient.
6. Future transition cheques are forwardeã ãirectly to the
) -eligible dependent( s) by the Administrator"
19
,i;
¡
i
i
i
!
i
,i¡¡i
Ij¡
--_...--_..-.._._------._- ------------~-
-:~------:-:-_..-------------_._-- -------- ---~-_.~_.__.. _.- -_._-_.~ ~---- .. -- ._-- ---._. ----_. - ~-- ---- _. -_.. ._- ._.. ..- _.._-- --_._...._. -_.. _.- ._--. - -----------------_.
(
20
7. Proof of a S .T.B" claim satisfactory to the Aàministratormust be made within three (3) months of the date Df death ofthe employee or pensioner.
5" 03 CLAIMS ANALYSIS
l. On a monthly basis, the Administrator forwaràs a ClaimsReport. list:.:ig individual S.T"9,, payments made during themonth, tocether with deductions for income taxes andpremiums ;overing supplementary'hospitalization. Theser'eports are verified for correctness by NTC Benefitsand fon/arded to the payroll department for thü"d-partypayments and record keeping purposes"
'. ~
.:-::::-:.---'~.--:-:~---:.-::::=-:.=:.-:.::.:::-:.---'._..---:-----....__._._-_._._...~._--_.._~_.__....._-_._.._-~.._-..-----------_._._._.~.__._----_._---
21
6.00 GROUP LIFE INSURACE - P.,,RTS I AND II( applicable to alI a~ployees and pensioners (to age 65) on avolunt.arv basis)The following outlines the general provisions of this plan.More complete details of the plan are contained in the officialcontracts, administrative procedures, employee booklets entitled"Your bene fits prograJ ", etc"
6 . 0 1 GE~ERA DETAILS OF PLA
1. On the death, from any cause, or an active employee orpensioner who was participating in the program, theAårninistrator will pay the applicable amount of lifeinsurance to the designated beneficiary( ies) "
2. Where an active employee was participating in Part I of theprogram and death occurs accidentally, the Administrat.orwill pay twice the applicable amcuntof life insurance tothe designated beneficiary( ies) .
3" 1:1 the event a participating active employee in Part I of.the program suffers any acciden:tal àismemberr.ent i theAåliinistrator will pay the applicable amount of insurance tothe employee in accoràance with the provisions of the plan.
6. 02 ÇL~IMS PROCESSING ROUTINE
\ l., Upon notifi::ãtion of death of an active employee orpensioner who was participating in the program, àivisionalpersonnel depart..nents (or NTC Benefits in the case of anemployee receiving long term disability benefits orpensioner relations deparLment in the case of a pensioner)arrange for prompt completion and return of the pertinentclaim form (Exhibit A) by the claimant and attendingphysician" If there is no attending physiciani a certifiedcopy of the coroner is repott must be provided.
2. If the deceased i s estate is designateã as the beneficiary,aàdi tional information is required as follows:
(a) Quepec - a notarial copy of the deceased i s last
will, or in the absence of a will, a notarial copyof the marriage coritract, where one exists.
(b) All other Provinces - a notarial copy of thedeceased's last will, or in the absence of a .williletters of administration. In addition, if thetotal proceeds of all policies exceeds S5, 000. i' anotarial copy of the letters probate is required"
( c) Letters probate or letters of administration maybe waived by Northern Telecom in cases of hardshipwhere no beneficiary is named and there is no Willbut a widow( er) does exist. An application may bemaàe to NTC-Benefits for special consideration ofa small advance"
22
3" In the case of accidental death or accidental dismembermentof an active employee, the completion of separate claimforms (Exhibits Band C) by the claiman t and attend ingphysician is required., Divisional personnel depart.ï1ents orNTC Be nefi ts arrange for the prompt completion and return ofappropria te claim forms in either case.
4" Completed claim forms covering death, acciàental èea t~, oraccidenta.i ãismember¡ent are forwarded by divisionalpersonnel departments (or NTC B'ene fi ts depart.iient orpensioner relations department, as applicable) to theAdministrator, together with the original enrollment cards"
The Administrator will verify and pay the amount ofinsurance s!?ecified in the claim, subject to a SuccessionDuty release or a. Certificate of Discharge being required inthe case of death, depending on the province in which thedeceased was domici2.ed"
5.. A proof of åeath or dismemberment claim sat.isfacto.ry to thei1.dministrator must be made within three (3) months of theda te of death (or accidental åismerber:nent) of an employeeor pensioner.
6..03 CLAIMS Ji.NALYSIS
(1. On a monthly basis, the Administrac:or for'wards a Claims
Report listing individual claims paid during the month.These reports are verifieå for correctness by NTC Benefitsand pensioner relations department"
.--.-1 i\ ~~ ~~u;r ~~A~s~r~:~C:~~ñY~~ë:ñ~:ii:a;~o~:~~I;
Empioyee 0 OR Dependent 0 Spouseo ChildName of deceased
'.,ast address of deceased
Policy No G Certificate NoSocial Ins. No01 employee j- i CJ-i II)
Dale 01 death Date of birth
STATEMENT OF GROUP POLICYHOLDER (i e employer or union or administrator etc.)Please insert above mformation complete this statement and forward this 10rm to the claimant or his or her representative The claimant is re-sponsible for obtaining and supplying your office with the physician's and claimant s statements and any additional requirements.
Amount of Amount of Accidental Death Amount of insuranceBasic Insurance S Benefi (it being claimed) S if dependent claim S
Salary of empioyee Sat last day ai work
Effective dateot this salaryDate empioyee
was last at work
,.
Name of group poi'i;yholder
Date 19 Signature Title
STATEMENT OF AHENDING PHYSICIAN(This statement ,nust be completed if an accidental death benefit is being claimed: otherwise an official death certificate may be:submitted inplace of this statemenl.)
Date of death Place of death Age at death
Cause of death: A Disease or Gonditíon directly leading to death
B Contributing or secondary conditiön
: ii death was due 10 accident, suicide or homicide';pecify which and describe briefly
Date of first attendancein last illness
Was there orwill there be:
an inquest?an autopsy?
Yes 0 No ClYes a No 0
Date of last attendancein last illness
DECLARATION: These statements are true and complete to the best of my knowledge and belief.
Date 19 Signature MD
Address Postal Code
STATEMENT OF CLAIMANTIn what capacity or by what tltleda you make If claiming as beneficiary or legalthis claim? (beneficiary ~xecutor etc.) heir give your ~ate of birth
(If claimed by e:iecutar or administrator. a notarial copy .of letters probate or jetters of administration. as ¡he case may be wil be required)
Are you claiming an i:accidental death benefit? Yes No i: If . Yes please complete the form Proof of Accidental Death #2336.
If the certificate does not stipulate paymentin ins'talments is settlement to be made by
o IncomeCl Deposit o Cash
If an income is elected, a special form (to be provided) andproof of agel may be required.
Was the deceased insured unt:er any other group orindividual policy or policies issued by the Mutual Life'? Yes Cl No i:
If "Yes", indicatethe policy no.(s)
CERTIFICATION: i hereby certifylhat the above answers are full, complete and true, to the best of my knöwledge.AUTHORIZATION: I hereby authorize and request any physician. hospital, clinic. indIvidual, law enforcement or government organization, orother entity that has any records or findings pertaining to the death of the lie insured to furnish copies andlor give details of all available infor-mation including prior medical history autopsy. toxicological or pathological findings 10 The Mutual Life Assurance Company of Canada.A. photostat of this authorization shall be as valid as the original
Signed at Date
1ignaiure of Claimant
Address of Claimant Postal Code
ANY CHARGE FOR COMPLETING THIS FORM IS THE RESPONsialLITY OF THE CLAIMANT.490.:8-77
:::::,:=__=.:::-;-:-_,,,_~~:,:--;,,;__,:-____'___.______"______M_____._____--__.________...______--.___________._________._
r¡ The Mutual Life Assurance Company of Canada/Waierloo Ontario
~ PROOF OF ACCIDENTAL DEATH
It is the claimant s responsibility to provide proof that death was caused by an accident.
leiise forward newspaper clippings of the accident
I n the case of a motor vehicle accident please provide a copy of lhepolice report.
Fur1tier information and documentation may be requested.
Confirming my application for the accidental death benefit under Policy(ies) No.
and/or Group Policy No Certificate No.
i provide the following details which are true to the best of my knowledge and belief
~
Date of accident: ... Time:
Location of accident:
Type of accident:
Brief description of accident:
c
Names and addresses of witnesses to the accident:
¡./
Date Signature of Claimant
2J3¡;5~;;'
._..._._~..~-_.._....~.....-~.~..
I" The Mulual Lire Assurance Company of Canada i Waterloo Oniario
~ CLAIM FOR ACCIDENTAL DISMEMBERMENT BENEFIT
Date 01BirthName or Insured Person
)Iicy No. G Certificale NoSocialInsurance No
STATEMENT OF GROUP POLICYHOLDER
Total benefit amoun~ shown in contract S Amount being claimed S Eltective daie of Insurance
II insurance has been cancelleo. give date and reason
Date last at work 19
Dale of return 10 wÓr~ 19
Is claim due to an occupational accident? Yes C No C
Is claim being made to thll Workmens Compensation Board? Yes 0 No 0
Give any additional information whiCh might assist Ihe Company in considering this claim.'l ;'
Name of Group Policyholder
(: .':\
j
ate 19 Signature Title
STATEMENT OF CLAIMANT
Date of accident 19 Date of hospital confinement if any From To
Physician s Name and Address (Please print)
Details of Accident (where and how it happened)
AUTHORIZA nON: I hereby authorize any physician or practitioner who has observed or may hereafter observe me for diagnosis or treatment andany hospital or clinic where I have been or may hereafter become a patient, and any insurance company or any organization, that has any recordsor knowledge of me or my health, to give full particulars thereof including any prior medical history to The Mutual Life Assurance Company ofCanada A photostat 01 this authorization shall be as valid as. the original.
Signed at Date.,
jnature of Claimant
Address of Claimant Postal Code
490AO-5-77 NOTE TO CLAIMANT.. PLEASE HAVE REVERSE SIDE COMPLETED BY THE ATTENDING PHYSICIAIi..,~--_._--'--.._~_.- -..._-------.-..._-~---._..
-:~..:.~::~-:.~.~.7.~::.::-:::-:::=::::=~'=':-===::7:-:'.7=:::.:---------'---..:..-..---.---.--.-.----..-.-.---..---------.-.----.-.-'---------23
7.00 PENSIONER HEALTH CARE PLA( applicable to al 1 pens ioners and survivor annuitants ofNorthern Telecom)
The following outlines the general provisions of this plan"More complete details of the plan are contained in Appendix D tothe ASO agreement, administ::ative procedures, etc..
'7 .0 I GENEP,pi DETAILS OF PLAN
l, The pensioner health care plan (encompassing thesupplementary hospi talization benefit, extended health carebenefi t, and other heal th care expense benefit) is availableto aii pensioners and survivor annui tants on an individualor family basis.,
2" The benefits consist of reimbursement by the Administi:'atorto an eligible participant in the plan in the percentagesshown below, and may be subj ect to a deductible, maximumlimi ts, and exclusions of certain expenses as detaileà inthe plan.,
i.02 Supplementary Hospitalization Benefit
Reimbursement Percentage - LOO%Deduc~ible - Uone
Extended Health Care Benefit
Reimbursement Percentage - 80%Deductible - S25. per person pr calendar year- S 50. maximum per family
(pensioner and dependents) percalendar year
_ where two or more m~~bers of afamily unit are injured in oneaccident, the deductible will be$25 with respect to the totaleligible expenses arising fromthe accident
7,,03 Other Health Care Expense Benefit
Reimbursement Pei:'centageDeductible
- 50%- None
Where a person's deductible plus any co-insurance payments madeby the per'son for eligible expenses (up to any applicabielimits) under the Extended Health Cafe Benefit and Other HealthCare Expense Benefit exceeds S1,000 in any cale'ndar year for thefamily unit, reimbursement will increase to 100% for alleligible expenses under these benefits.
7.04 CLAIMS PROCESSING ROUTINE
1. When a pensioner and/or the pensioner's dependents haveaccumulated receipts or bills for health care in anyonecalendar 'year for allowable expenses in exce7s of the .applicable deductibles shown
above, the pensioner obtains
------~-
~-;:.-::---.. --:---- ------------- ---- ._..._.-..-. _._- - --- --- -_.-. ~- _.- ------- - ..-- ._-~-~.-. ---_._-- .- ._--. - . - _.__.. -- - -_.~._.--_._--_.._--- ~ - _._- _._---------------
24
a claim form (Exhibit A) from the pensioner relationsàepartment and proceeds to complete all pertinent portionsof the form.,
2" Heal th care bills for each member of the family are grouped.All receipts for expenses incurred by the pensioner areentered together on the claim form, followed by receipts forthe spouse and each child.
~" The pensione.! completes, dates anã signs the claim form, andforwards the form together with. all original bills,receipts, etc. directly to the Mmin istrator forreimbursement.
4" Upon receipt by the Administrator of due proof that thepensioner and/or the pensioner' 5 dependents have incurredthe el igibl e expense s i for medically necessary services, theAdministrator will provide reimbursement with respect tosuch expenses subject to the terms of the plan"
5 .;my difference bet'Heen the total amount of the claimsubmitted and the actual amount of reimbursement by theAdministrator is ex~,iained to the pensioner when asettlement is made" These differences result from theapplication of co-payments i deãuctibles, or from ineligibleexpenses.
(6. The actual calculation of the benefit payable is shown by
the Administrator in the upper right area of the ciaL~ form"A copy of the processed claim form is returned by theAdministrator to the pensioner together with a reimbursingc~eque and, if applicable, and "explanation of benefits"form.
7" The Administrator, in respect of any claim under thePensioner Health Care Plan, may require, as the case may be,the originals of itemized hospital bills, reports, records,drug and equipment bills, an itemized statement completed bythe physician or otherpracti tioner who attended thepensioner or dependent, study models or any otherinformation deemed reasonable unde:i' the circumstances"
8. Proof of a Pensioner Health Care clai.'1 satisfactory to the.ridministrator must be made within l8 months after the
dateon which the expense is incurred.7,,05
CLAIMS ANALYSIS
l. On a monthly basis, the Administrator forwards a ClaimsReport listing individual payments made during the month..These reports are verified for correctness byNTe Benefitson an ad hoc basic"
,~~':-.___...__...___...__._.lI'-~."""''''''_~_'''_.'-___~.''--__~._.__._.__..--.--------,..'-W--------
'-'---, lV~-"s:-~~=~.~.~~~~- ':~~E:~-:~-'~~~~~ T~-AN-~-OTHE~-~~A L-~~~-~;~- E~';~~S ~~------r--;;;~_m
INSTRUCTIONS FOR THE USE OF THIS FORM
i Group the bills for each member of your family
C. Complete Part A - LIst 01 Expenses..
.J. Do not submit a claim until you h~ve expenses in excess01 the deductible,
4 If any of the expenses included are eligible for reimbursementunder any other plan. place i: check-mark (,I) in theleft hand margin opposite the patient s first name.
S. Complete Part B ., Employee's Statement.
6 Detach the pink copy for your records. Submit the original and canarycopy to Mutual Life of Cana~a.
7 Submit this form and originai bils receipts etc lor the expenses toMutual' Life 01 Canada at the address shown on your wallet certificate.
8. Please Quote your group and employee number on all correspondence
Patient s
First Name
Indicate:Employee.
Spouse or Child
I Dale 61 II Daie
.! O.Y Sinh ServicesRendered
Mo.: Vr, I Ol!)' : Mo. : Yi
Type 01 Service(show Rx No
lor drugs)
For drugi only:Name of Drug orDIN (Number)
Name 01 D,ugSlore. Hospitalor Practitioner
AmountCharged
i!
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ri
i
I
I-I
i
I I ! i!
iI j I
,
I
1
I II
TOTAL ..
PART B - EMPLOYEE'S STATEMENT
Group Number 90002
Employee's Number as shownon the Wallet Certificate
Employeti's Name
Mailng Address
"ìtreetJ
Apt.
...'
City
Province Postal Code
490ME.DP..NT.11..80
If this claim incli.des expenses for children over age 21. please give
First Name of Child
Name of School
Estimated Completion Date
None of the above expenses is eligible for reimbursement under any otherplan except for the items identified by a check-mark
The above information is true and correct. All expenses listed were forservices or supplies received by myself or my eligible dependentsNone of the expenses included has been submitted previously toThe Mutual Life Assurance Company 01 Canada.
I authorize the release of any information relating to the expenses claimed onthis form to The Mutual Lile Assurance Company of Canada or its
agents
Date Signature
..'=-:-=::::~:::-:::.:~==..,'~7-""---:-"7."":---;-:-_.'--------'._'-_..~._-_..---~-_.__._-_.-_._.-._--_.-.---_._-_....------..__._-_.
25
8.,00 TAXATION - BENEFITS
8.01 A Health and Welfare Trust was established with Montreal Trust asthe trustees. With tne Health and Welfare Trust i special taxconsidera tions apply as follows:
8..02 A) Health Care
(i) Employer
All contributions made to the lrust wiii bedeductible in the year in which they are incurred"See Section 9 for determination of contributionlevels.
( i i) Employees
(l) Benefits received under the plan \oil 1 not betaxable"
(2) Northern 's co~tributions will not result in ataxable benefit..
(3) Any uncovered costs if in excess of 3 % of netincome are deductible.
( iii) Reoortina of Benefits, -
(.:\.~
No reporting is required"
8 .03 B) Long-Term Disability
( i) Emolovern *(l) Al 1 contributions made to the Trust will be
deductible in the year in which they areincurred" See Section 9 for determination ofcontribution levels.
(¿) Emplòyee CPP and Uie contributions mus t be madeon any benefits paid. However, where .theemployee is also receiving a disability pensionunder the CPP Act i then employee CPPcontribut.ions are not exigible"
(3) Employer QPP contributions are not required tobe made on any benefits paid.
(4) Employer contribution 5 to Quebec Medicare arenot required in respect of payments made underthis plan at this time.
¡.,
._~_._.._--~_.__._----------_.._-~--_..__.__...__....-._.__._-_.__.~._.._---_..__.._.-.~_.__._.~-~.._._._-_.------_._...-._---_.._.__.__._-_._--_._---.-----------._~.._.
8.04
(
B) (contd)
25
(2) Northern's contributions will not result in ataxabl e benefit.
(3) CPP anà UIC cont:dbutions must be deducteä fromany benefits paid. However ( where the eniployeeis also receivi:ice. àisabilitv cension under the~ - ~Cpp Act, then CPP contributions are notexig ible.
(iii) Reporting of Benefits
(l ) Benefits paid unèer this plan must be reported
on Forms T4/TP4 Supplementary with theapplicable deduc~ions at source (CPP JQPP, UIC,inccrne taxes, union dues, etc.).
(2) The name of the "Payor" to appear on theT4's/TP4's is "Northern Telecom Limit.ed Healthand WeI fare Trust Funã".
c) Survivor Income Benefit
( i) Employer
(i) All contributions maàe to the Trust will bedeductible in the year in which they areincurred" See Section 9 for determination ofcontribution levels~
(2) CPp/QPP & vic contributions are not exigible.
(ii) Employees
(1) Benefits re¿eived by beneficiaries qualify as a"death benefit" i the amount of which is reducedproportionately to reflect the amounts contri-buted by employees.
A "death benefit", broadly defined, is theexcess of the amount( s) received in the yearover one year's salary of the deceased employeeor SlO, 000 whichever is the lesser.
(2) Northernl s contributions will not result in ataxable benefit..
(3) cpp loPP & UIC are not ex ig ibl e.
(4) Employee s i contributions will not be Aeductiblein computing their income subj ect to tax.
.__.~.__..._-_._._---_....__.__._.__.._~~-_.._-_.._._...~_. _._..._....-----_._._......-_..._._._.-----_....._.__..-_._--_._......-_._.__._._._-_....._._._--,-...._------, . .....
8.05
(
.i..1
C) (contd)( iii)
2ì
Reoortina of Benefitsh r'(l) Benefi ts paid' und er this plan must be reported
on For.s T4A!TP 4A Supplementary with applicabledeductions at source" Note that it is the fullamount of the benefi t ( s) paid in the year thatis to be reported on T4A!TP4A forms.
(2) The name of the "Payor" to appear on theT4A i s!TP4A i s is "Northern Telecom Limited Heal thand WeI fare Trust Fund""
(3) The notation "Death Benefi t" should appear ont:ie T 4A i s/TP 41\. 's"
D) Survivor Transition Benefits( i) Emoloyer
(1) All contr¡ibutions made to the T:::.st '",ill bedeductible in the year in which they areincurred. See Section 9 for determination ofcontributio~ levels"
(2) CPP/QPP & UIC contributions are not exigible.
(i i) Employees
(1) Benefits received by beneficiaries qualify as a"death benefit", as defineå.
( iii)
Upon adv ice from Mutual Li fe, NTC Payroll shallensure the beneficiaries are advised of theexempt portion"
(2) Northeni' s contributions will not result in ataxable benefit.
(3) CPP lopp & UIC are not exigible.
Reportina of Benefits. J(i) Benefits paid under tñis plan must be reported
on Forms T4A/TP4A supplementary with applicabledeductions at source. Note that it is the fullamount of the benefit(s) paid in the year that. is to be reported on T4A/TP4A forms. "
(2) The name of the "Payor" to appear on theT4A i s/TP4A l s is "Northern Telecom Limited Heai thand Wel fare Trust Fund"~
(3) The notation "Death Benefit" should appear' onthe T4A i s/TP4A 's.
28
8.06 E) Group Life Insurance - Par~ I and Part II
( i) Employer
AIl contributions made to the Trust will be deòuct-ible in the year in which they are incurreò. SeeSection 9 for deter~iriation of contribution level s.
(ii) Employees
(l) 'I'he Group Life Insurance proceed 5 received underthe plan (Part I & II) by beneficiaries as aconsequence of the death of an employee will beexempt from tax, upon advice from t~e PensionRelations Dept. to NTC Payroll .
(2) The premi urs paid by the Trust (par~ i only)will result in a taxable bene£i t (subj ect to theS25 i 000 exemption) to the employees. Thepremiums in effect amount to the Group Li feInsurance proceeãs paid by Mutual Life through-out the yea.r.,
(iii) Reporting of Benefits
(l) No reporting of the benefits is requireã.
(2) The taxable benefit, if any, must be reported onForm T4/TP4 Supplementary, for active employees,and on Forms T4A/TP4A Supplementary, ferpensioners ~
.._'.-._";.::"'::=:::_7.,:=::::..,:_:':::.=:~~--'---:7'-::7:-.-'":-:-.-..._-_._-_.._.._..._.._~-"--.._._-_._-_....__.--_.._._._-_._._--~._._._-------_.._------_.-_..__._..._----.-.-------.
29
9.. 00 TAXTION - TRUST FUND CONTRIBUTIONS
9,Ol Given the taxable position of the benefits, the followingprocedures are how Northern and employees i contributions tothe Trust Funà are to be carried out.. For the Health CarePlan, Northern's contributions and those of employees, if any,will be deposited to the Health and Welfare Trust. Fund with .Montreal Trust in Montreal"
. 9.,02 For LTD, Northern i s contributions will be deposited to theTrust Fund.. For SIB and STB Northern's and employees'contributions will be deposited to the Trust. Fund. MutualLife will pay all eligible clai~s less applicable deductionsat t~e sour~e" .
9.,03 For the Group Life Insurance, Part I and Par-: II, Northern 'sand employees' contributions will be deposited to the TrustFund"
9" 04 Stop loss premiums are to be paid directly by Nori:hern toMutual Life forcoverage - LTD,Group Life II"Northern.in the
all benefit programs under thè stop lossSIB, STB, Group Life I (incluãing AD&D) andSu.t:h stop loss premiums are tax: ãeåuctible toyear in which they are incurred.
9.. 0 5 NTC - Trust Accounting maintains the records of monthlycontributions by benefit group anõ employee group (whereapplicable) .,
_. .. .,. -~ ~- ... ._.-..-.- _ -- ---. ~._. .-.'_. _.. . ~ --
----------~...... ...._....-_. ------.----_.__.-------_.~ ----_..~-.-_.._. --- ---_..- --_..-
30
i 0.,00 TAXATION - jI.NUAL FILING
10" OL Trust Fund Income
In computing the income of the Trust for tax purposes, Northern 'scontributions, employees i contributions incluäing Life Insurancepremiums and the transfer of the Pensioners i Insura.nce sub- funds(principal and interest) to the Trust shall not be considered asincome" All benefits paià in L'1e year except these paid underthe Health Care Plan will be ded~ctible" Group
Life Insurance
premiums paid by the Trust to Mutual Life will also bededucti~l e. The only income earneà is that of invest~ent incomefrom the T~ust itse i f"
10,,02 T3/TP3 - Trust Information anà Income Tax Return
(a) Annually NTL Ta x Depart:nent will provide initialinior.ation and forward the T3/TP3 to NTC TrustAccounting ..
(b) NTC Trust Accounting shall complete the formes) and
(c) NTL Tax Department shall review the return ( s) and filethem with the appropriate governmental taxationauthori ties.
(d) The deadline for the filing of the returns is March 31 ofeach year..
10" 03 T4-T4A/TP4-TP4A Summaries and Supplementaries
(a) NTC Pa,yroll Department will i.ssue all T4-T4Jl'/TP4'-TP4ASumnaries and Supplernentaries"
(b) NTC Payroll Department will senã the T4-T4A/TP4-TP4ASumaries and government copies of the Sl1pplementariesalong with the appropriate reconciling schedules to NTLTax Departinent.
(c) NTL Tax Department will review and file T4-T4A/TP4-TP4ASumaries with the appropriate governmental taxationauthorities.
LO" 04 Tax Remittance Number (Federal & Provincial)
Al though benefit payments under
( i)( ii)(iii)
Long Term DisabilitySurvivor Income Benefits i andSurv ivor Transition Benefit
i"
.~_..- - _._'..-..~----_._.. _.----_. ---- .~. _.... - --'- ~-- -- - ~ .
_.--:--:'--~.-;--'.:-:-:-:-~..-:~=:-::.:=.::.::-=:~.::=:::::-::"---:-;.~~:--_._-----_._.__._..__..._._-_._..__._._-_..._---_._--_...._-_._------.-_..__._-----_....
31
will be made by either Northern or Mutual, they will do so int.heir capacity as agents of the Trust. consequently any taxreporting Le" T4-T4A/TP4A, tax remitt.ances etc.. will have tobe done by Northern on behal £ of the Trust"
The tax remittance nll~bers are (NEL300070) Federal &(~-3 901 527 -0001) Quebec" There fore two separate accounts mustbeset UP in the Trust i s name: one to handle Federalremittan~es and the other to handle Provincial (Quebec)r emi t tances.,
10.05 Unemolovrent Insurance Premium Rate.. .rhe employer premi ur rate to be used, where applicable, isNorthern 's reduceà rate of 1. 19 in 198L .. """"" ",-?, \.1.'~ i .
10.. a 6 Quebec Medicare
We are in the orocess of writina to Quebec Revenue to
ãeteI1in~ w'hether or not. the: Tri:st must pay the 1.5%"employer-" contribution to Quebec meåìcare in respect ofbenefi t payments under the Long Term Disability Plan"
In the in terim we sugg est that no such payment be mad e.
LO" 07 Taxation - succession Duties
('\
Quebec remains as the only province to impose Succession Duty.consequently the "value" of the SIB/STB payments are to bein.cluded in computing the value of the äeceased' 5 estate..Section 56 of the Succession Duty Act states that no propertymay be transferred/remitted until a disposal permit has beenobtained from the Minister" Exceptions are provided insactions 57 & 58. In the case of SIB/STB payments to a"consort" of the deceased employee, we may remit the paymentswithotit obtaining a disposal permit.. However, within 10 ãaysof the month following the first monthly payment we mustcomplete a ãeclaration, in duplicate i and file it with theMinister" Where the SIB/sTB payments are made to a child,father, mother and certain other specified beneficiaries ofthe deceased the first Sl, 500 per such beneficiary notexceeding $ 10 i 000 in all (in cases wher'e paid to a number ofbeneficiarie s) may be trans ferreã without a disposal permit.Here too the Minister would have to be notified as in the caseof payments to a consort above.
Note that Section 18 of the Succession Duty Act sets out therules for determining the "value" of SIB/STB payments forpurposes of inclus ion in the deceased is estate..
"
.....---;,-~-.
32
11.00 FUNDING POLICIES
Funding of the Health and WeI fare Trust for benefits as listedbelow is determined by NTL Treasury., DNR approval has beenobtained by NTL Tax Department
ll"Ol Health Care Plans
Contributions to this benefit are not funced as the claimspayments are on an incurred basis only. This is a monthlypay-as-you-go basis based on claims payments by the administrator.
11" 02 Long-Term Disability
Funàing of actuarial liability at 20 percent per year uniformlyover a five year period beginning in the year in which theclaims are incurred is acceptable and consistent with theAdvance Income Tax Ruling from the Department of NationalRevenue. Payments a.re made at fiscal year-end"
ll.03 Survivor Income Benefit
These benefits should be employer funded on a pay-as-you go (PAYG)basis after the employees i funãs have been exhausted. Payment ismade by Northern "by fiscal year-end" This eliminates any need toallocate part of the income of the Trust Fund to the SIB Beneficiai:"y.
) 1 1" 04 Survivor Transition Benefit
This benefit is funded identically to that of the SurvivorIncome Benefit.
LL,,05 Group Life Part I
Northern i S contributions amount to total claims and expensespaid less employees i contributions.
11.06 Group Life Part II (Rate Stabilization Fund)
This is totally funded by the employees' contributions"Al I contributions to this benefit are "unitized" (see section l8)in the Rate Stabilization Fund.
11.07 Pensioners' Insurance Funà
Northern i 5 contributions wil 1 be based on recommendations by thecarrier, r.1utual Life. The acceptable level of funded liability,existing reserves and the current year's employees i contributionswill all be considered by Mutual in determining Northern i s currentyear i s contributions which is to be nO later than December 31st.However, at no time will the Pensioners' Insurance Fund beoverfunded. See Section 20 for further elaboration on the P" I.F.
.__...._~_.__.~---~-:- --._--_.. -..-..------ ----
33
12.,00 PAYMENT OF EXPENSES
The following expenses will be charged to the Health and Wel fareTrust., Expenses, in adài tion to claÌJs paid are as follows:
i 2.01 Trustee admin~stration charges:
The charge is on a sliding scheàule based on t~e value of theassets in the Trust" The 1980 schedule .is attached as AppendixA.
Montreè~ Trust will pay in terest to the Trust fund on any surpluscash balances at t~e standard savings account rate"
12.02 Bank charges:
The bank charges for t~e Waterloo accounts are negotiated byNTL Treasury" Currently these are 13 cents per cheque anà 20cents per' deposit., Interest is paid at prime less 3 1/2 % on theaverage monthly combined balance after float requirements,presently at S30,OOO, are met"
i 2.03 wnile :nost expenses are paià through the' Trust Fund, those for theHeal~h Care plan (which includes all dental) for both Mutual Lifeand Quebec Blue Cross must not be paid through the Trust Fund.Norther:- must pay these fees directly to the respective cartiers.See Appendices E and F for the current rates.
12.04 The Trust fund shall pay the following expenses:
(.\ Trustee aàministration charges
Bank chargesMutual Li fe expenses only for:
Survivor Income BenefitSurvivor Transition BenefitLong Teril DisabilityGenet'al administration and profit changes onthese three benefit plans.
12.05 Northern Telecom as opposed to the Trust, shall pay the followingexpenses:
~1utuai Li fe expenses only for:
Health Care PlanDental Care PlanGeneral admin'istration and profit charges .onthese two benefit plansStop loss coverage
Quebec Blue Cross feesLloyds of London - Stop loss coverage"
-...,-_..--_.-_..........._.
.7."'::::'~-----'--------.-_._---_.'--~.."-' .-,..-.__..-~.._--_._._._..__..~., .'._'_.W_"~_'_"~_'__"__' __._____._..._'.___._______________ __. _. .. .
34
3.00 CONTROL AND AUTHORIZATION - MUTUAL LIFE
13..01 The importance of control cannot be over-emphasized given the factthat significant amounts of money flow through the mechanism on areg;,larbasis" The following is to be the control policy inregard to Mutual Life.
l3 "Q2 As Mutual Life informs NTe Trust Accounting of the disbursementsfrom account 0000-379, NTC Trust Accounting willmoni tor suchflows. NTC Trtist Accounting will be in a position to verify therequest by monitoring the daily bank statements anà comparingt~; previous months i Monthly Benefi t Reports as provideè by MutualLi=e..
13,,03 There is no presumption of exacti.tude in NTL Trust Accounting i smoni toring, as there are many tL~e lags effects in the mechanismThis depar~~ent is however, responsible for ensuring replenish-mep.ts are reasonable and for investigating any out of the ordinaryoccurrences" A detailed reconciliation shall be done at leastevery quarter by NTC Trust Accounting - matching statements withMonthly Benefit Reports"
.13..04 NTC Trust Accounting shall regularly inform NTC PensionDepar~~ent of time frames that a replenishment of theDi sbursernent Account may occur., An estimate of the amount to be
., óepositeà shall ~ccompany such advice.
13.05 Upon review of daily bank statements NTC Trust Accounting shalladvise NTL Pension Deoartrent of the amount to be transferred.This authorization sh~ll be confirmed in writing within 3 workingdays. Upon receiving such advice i NTL Pens ion Depa.rt.uent shallinstruct the Trustee to transfer said funds to the appropriateaccounts - account 0000-395 in the case of Mutual Life.. Thisauthorization shall be confirmed in writing within 3 workingdays ..
13.06 With respEct to special transfers ¡ these shall b~ co-ordinated byNTL - Treasury. who shall aãvise as appropriate, and co-cordinatesaid transactions.. Typically, these transfers include release ofreserves from insurance carriers or year-end funàingcontributions..
._-----._~--_._._----------_._---.--:-._-_.- _._-- - -~.-_.~ -. - .._.- . -_..- - - _.-. - .._-~. ---_.__. .._----- ._- - .- . - - - -- _..
35
i 4.,00 CONTROL AND A.UTHORIZATION - QUEBEC BLUE CROSS
L4"OL An initial working fund was establisheõ with Quebec BlueCross in the amount of $'75,000., Onlike Mutual Life, thisamount and all subsequent amounts are to be depositeõdirectly to 81 ue Cross"
14.02 As claims are received by the carrier, they are verified aseligible in accordance with a master list and itsamendments as providec by NTC Compensation,,' To pay aclaim, Blue Cross shall draw on the working fund.
14.,03 Bi ue Cross shall prepare t..o separate and distinct invoiceson a monthly basis, or as the working fund approaches a nilbalance" One invoice shall serve only to replenish theworking fund, it shall be for the amount of claims paidsince the previous billing. This invoice is paid by theT:-ust .,
l4.04 The second invoice is the administration and profit chargeearned by Blue Cross" This invoice is paià by Northern.
jt"
\,.
14" 05 The control aspect enters when the carrier prov ides NTCTrust Accounting with a monthly claims report.. This reportcontains the total claims paid, the number of claims paid,applicable administråtion fees payable, and ye~r-to-datefigures for claims and e~penses.
14" 06 Upon receipt of the claims report and invoices, NTC TrustAccounting shall verify the reasonableness of thestatements by the monitoring process" Hhen the carriersstatements are considereõ IIreasonable", me TrustAccounting shall aàvise NTL Pension Depar~~ent of theamount to be transferreà. NTL Pension De?ar~~en~ shallinstruct the Trus tee to trans fer saià funds àirectly toQuebec Bl ue Cross.. The transfers should indicate QuebecBlue Cross as the payee with Montreal Trust being theTrustee for Northern Telecorr's Health and Welfare Trust.All authorizations shall be confirmed in writing within 3working days.
14.07 Northern retains the riqht to audit the accounts' of QuebecBlue Cross. This should be done on a calendar basis.
._._.__._0.____.__.__..__.____.____._.._..._____...___--------.---.-...----~~-.-.-:cc=~.=.,,,:::.':~-----..-.---..--.--.------.--.-.--...--.---...--.--.-.--.--..-.-.----.-...-.----..-....---.----.---
36
,.00 CONTROL-?æPORTING!MONITORING
1 ~.. 01 The following reports are provided:
Nature of ReDort Frequency Originator
A, Clai::s ?-eport. Monthly 1'1u'tual LifeQuebec Bl ue C~oss
B. Claims Analysi s Quarterly NTC TrustActuai vs '. Es timate A.ccounting
Coo Anniversary Reports Jl.nnually NTC TrustAccounting
Reference above:
Distribution
NTC Ccmpensa tionNTC Tr ust Accounting
BMC Meraber-s
BMC Members
A., These reports incl uåe information on aggregate claims pa ià, numberof' claims paid in current period, administration fees payable, typeof benefit claimed.
.:)
B" The purposes are to monitor current progress identifyingdeviations and to proviõe insight on liquidity requirements.In formation relates contribution a.nd expenses through the Trust..
C" This comprehensive report includes:i)
i i)iii)i v)v)
vi)vii)
viii)ix)
)
Claims paid by employee groupStatement of reserves for SIB, STB, LTD, PIF, TotalsAnalys is of all administration feesTrial BalanceStatement of AssetsAnalysis of Pensioner's Insurance FundAnalysis of Rate Stabilizat~on FundAnalysis of Group Life Insurance IStatement of changes in the Fund
37
15,,02 The following reports will be produced on a monthly basis byMutual Life and sent to NTC Trust Accounting and NTC Benefits.Separate reports are produced for each company and eniployeegroup"
'. l5" 03 Exhibit i - Group Li fe Insurance - surnmarize¿ by Pol icynumber, wi t'h dei:ail attached by employee"
15" 04 Exhibit 2 - LTD payments - showing bargaining unit code byemployee and giving a list o~ deGuctions madefrom each employee and including a breakdown ofexpenses charged by Mutual.
is .05 Exhibit 3 - STB payments - showing bargaini~g unit code anddeductions m~¿e"
15.. 06 Exhibit 4- - SIB payments - shows bargaining unit code andàeductions - incl udes breakdown Of expenseschargeà for bot'h SIB and STB.
15.07 Exhibit 5 - Dental and Extendec Health Claims paia - showsthe number of checks issued, the total claimspaid and the total expenses"
15.08 The above reports are sent to the Benefits Department of eachcompany involved, with copies of all report~ going to NTCTrust Accounting"
15,,09 Quebec Blue Cross submit the following invoices on a monthlybasis to NTC Trust Accounting i and NTC Benefits.
Exhibi t 6 - Extended Heal th Claims.
Exhibi t 7 - Administration expenses for (6) above"
------._--_._------------_._-------------~--.__.---_.--~-:-"":"".::~-=-:-------------_.._---.----_.._.__.__.__....._-_..._---_._---_._---_._---_._--------
EXHIBIT 1 Page 1 of 2
Policy 1040-2, 1040-3, 13900,13901,13901 AD&D, 14901
January 1981 Claims
1040-21040-)13 9001390113901 .:D&D1490 i
S 13,068.'17i3,786.6.:;28,112.12
103,092..4823,813,,5250,213 .. 52
TOTHS 5292,086.55
Expenses
$ 45i.~j'2,860..121,031,,833,498..10
692,541,460.29
$ 9,994.35
Totals
S 13,519,7476,646,,7629,143.95
106,590.5824,506..0651,613..31
$ 302,080.90
'Ih¿re 1;er-epolicies:
no claims paid in January 1981 under the following
'\.~
1040-113900,\14688i 4 90014900B15250
10 I'A LEX P E ~ S E S :
$ 9,994.3588.. 3 7
S'l 0 , 0 8 2 .. 7 2
,.---
~,,' ....y
r~X
l1Ilì
lT i
('¡¡Ge L of 2
----
~---
-------- _.- :
Nor
ther
n T
e1nc
oii i
. im
!.ecl
._._
_.--
---~
--_.
_-_.
_---
- -
Dea
th C
laim
s -
Jani
ia.r
y ~
9ß1
Pol
. II
Fol
io /I
Cer
tific
ate
/IN
ame
Date of neath
Cla
ims
Exp
ense
s--
----
----
---
----
----
_...
i
1040
-31
17 '3 3 7
6.11. 80
$ 5,682.17
$23
6.68
i
1190
12
1707
6114.1. 80
21,8
13.5
273
6.96
I
13901 AD&O
317
0763
14. i
.80
21,8
1J.5
269
2.5/
1¡ ! i
Che
ql1e
fl89
Dat
ed 8
.1.8
1I~
,3-Õ
Y~~
~:1 ;j
----
---
:1 'i
1390
14
1755
4731
.12.
8016
,072
.94
538.
86:1
1490
15
1755
1i7
31.1
2.80
20.0
91.1
858
4.28
I i
Cheque 1190
Dat
eu 2
0.1.
81I~
~i6\
:.!:~
I .1--
_._-
---
1390
06
1754
972t. 12 .80
1ll ,
507.
7 B
1,93
.22
I
1390
07
1755
9629
.10.
130
1.1.
,108
.3(1
39ll.
li8
CheCj\ie iin
Dat
ed 2
2.1.
81Ii
&fi
~!:f
----
--13
901
817
5/14
818
.1..8
010
,885
.65
JBB .00
1390
19
1747
487.
12.8
017
;L75
.89
570.
93
1390 L
1017
5398
24.1
2.80
7.2
l16.
68
282.
113
Che
que
1/92
----
¡
Dated 22.l.81
~_~i
J°8_
:l~i
_._-
----
--i
1040
-311
173'
192
26.1
0.80
4,59
2.50
204.
99
1040
-)12
1745
40L
L.1
2.80
7,06
7.34
276.
96
10l1
0-3
1317
4193
21. i
1. 8
0ll,
410.
0240
3.25
to(I
O-J
1417
41.9
12 1.i 1. flO
l1.,'
tlO.0
233
1.82
1040
-315
1720
809.
10.8
02,
0(19
.43
131.
03
1040
-316
17 5
299
31.1
2.80
6,78
4.02
268.
02
Che
fjue
fl93
i;'fi
J.f3
.33
_._-
----
-
1040
-31.
717
5893
6. L. ß 1
6,78
2.39
268.
67
1040
-318
1752
'10
11).
12.8
02,
Olf
i.lll
110.
07
lO!i
O-3
1.9
1737
'10
28.1
.0.8
09,
950.
/12
360.
80
CIi(!(!'IC II!)
'i nnteit 27.1.81.
!-l!
.~ft
~9_:
-1_~
__...__ _____0-
. . .
/2
¡i"ßC 2
PoL
. if
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?olicy 90,002 - No=~~ern Telecom A.S.O. \
Maüi Sec::ion
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M ., ;; of des. p2.iè c1 ai::s EX?eDSeS Total. .cnL."l
.; an.. · 81 i 54 52,679.73 2,762.56 55,442..29:=eb.. 526 42,135~SO 1,972..97 ~4 , i 08.. 47Ma.ze:. 392 26,229.37 1,426..39 27,655..76A-"""'' , 4 00 26,208..71 1,450,,78 27,659..49:-....-May 273 19,158.28 1,000.96 2~,159.24
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Total 2,345 166, 41L. 59 ~,~i3..66 175,025.25. .
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Policy 90002 - Northern Telecom \ .
Main
Dental Benefit.'"
~,. ,
Month !!. of. cks. Paid Claims Ex?enses Total': -
Jan~ '81 846 74,824.35 2,395,,69 77,220..04Feb.. 72ï 66,i46..6ï 2,079.51 68,826..18March .. i .. 61,655,.61 2,007,,11 63,662.72I-~li.pr il 675 59,829.60 1, 9'12.55 61,i42,,15May 787 68,688.58 2,220..8l iD,909.39
- '.
~; ..
. -
.. Total 342 i 36 0.483 r 748 331,744..81 10,615..67
...-.__. ----- .........:-..... _..----------~
EXHIBIT 6
QUEBEC BLUE CROSS INVOICE
Bill to: NORTHERN TELECOM HEALTHAND WELFARE TRUS l FUNDc/o H.C. Dennis, Dept. ll32
CLAIMS PAID TO NORTHE~~ TELECOM EMPLOYEES IN THE MONTHOF
Amount ofClaims Paid
No.. ofClaims Paid
Extended Heal t:i
Group l73
( Dental
Group 1 771 Î 81 ÎSA180181182183184
5574569l'
Total Dental
Grand Tota.i
EXHIBIT 7
QUEBEC BLUE CROSS INVOICE
Bill to: ~ORTHERN TELECOM CANADA.304 The East MallIslington, OntarioM98 6E4
c/o H..C.. Dennis, Dept., 1132
A.DMINISTRATIVE EXPENSES COVERING CLAIMS P,i\ID INTHE MONTH OF
CLAIMSP l\ID
ADMINISTRATIVEEXPENSES
(Claims x 7~%)
EXTENDED EEJ..LTH
DENTAL
TOTAL
-- ..-_.-..~.. .,. .... _._.- . --_.. - -
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ife
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IIW'l QUl\RT~_Rr.y l\Nl\.YSIS
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alan
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38
6" 00 BANKING
..:" 01 Two bank accounts were opened by NTL Treasury in the name of theT::uste e.~
Denosi t Account Disbursement Account
0000-395 0000-379
Bank of Montrea'l3 King & Erbs Street SouthWai:erloo
Contact: Sam Hendry(519) 885-9312'
l6.. 02 Fu::.tner special arrangements ',.ere made enabling Mutual Life tobe the sol e signatory agent for the Disbursement Account"Mutual Life's signing officers for thi~ account are:
Mr.. Pet~r Denomme, Executive Officer - Admini stration i a.nåMr. Donald Post, V" P.. Group In suranc e"
16.03 lfuile two accounts are not essential, they were consiãeredber.eficial for control purposes" The Deoosi.t Account receivesmonthly transfers (deposits) from the Tr~stee and, at mon~h-endtransfers funds sufficient to replenish the DisbursementAccount. All bank statements for the Deposit Account are sent toMontreal Trust with a copy sent to NTC Trust Accounting.. 1'ecombined balances of the two Waterloo accounts should bepositive at all times"
16" 04 Rega.rding the Disbursement Account, this account is in the nameof ì-1ontreal Trust but with Mutual Life signing officers" MutualLife is responsible for all disbursements. Statements andcheques are sent to Mutual Life for reconciliation with astatement copy sent to NTC Trust Accounting. Every quarter adetailed reconciliation providing outstanding cheques listingãate, payee, benefit type, amount paid, etc., will be sent toN'lC Trust t..ccountirig.; NTC Trust Accounting is responsible forverifying the "reasonableness" of disbursements through theDisbursement Account by comparison with the Monthly BenefitReport as issued by Mutual Li fe. It will al so endeavour toensure that the month-end trans fer of funds from the Deposi tAccount equals the Disbursement Account debit balance, asverified by the bank statements.
~-~--~--__ __.____ .__~... 'or__ ____..... _.__ _ .r_'_--__."__"___ . ..-.__.,- ....--.-...---~- ..--- _..---~
-:::=::-:::=:.-:::==:-::::..~----_.._---
39
..6,,05 Quebec Blue Cross part.icipates in the Trust in an indirectmanner" Instead of a separate bank account as in the case ofMutual Life, a working fund has been establisheä and amountsare trans ferred direc~ly to Blue Cross. Quebec Blue Cross isrecorded as the payee, and Montreal Trust as the Tr~stee forNort.hern lel ecorn i s Heal th anà Welfare Trust" lhese trans fersshould be maGe to the following aãcress:
cia Mr. J.J.E" TrudeauExecutive Vice-President
Quebec Hospital Services As socia tion550 Sherbrooke St" West
Montreal, QuebecH3A lB9
(514) 844-3781
16.06 'le Trust account to which :11 contributions, bot~~ employe::and employee, are sent to is:
:.,\
Heal th and Welfare Trust Funà900920
t-ontr eal Trust1 Place Ville MarieMontreal, Quebec
Contact: HI'" Oswald D'Mello(514) 86l-168l
l6,,07 This account is the invesL~ent account managed by the NTLPension Department. NTC Trust Accounting will monitor theãay-to-day balance in this account as
advised by MontrealTrust and the Pension Department.. NTC Trust accounting shalladvise the Pension Department of liquidity require.ments of theTrust in sufficient time to allow for optimum timing ofinvest."nents" NT'L Treasury in conjunction with NTC TrustA.ccounting shall prepare cash £10\'1 forecasts to assist in thetiming 0 f such investi"lents"
The principal services the Truste~ provides are daily cashreports, monthly statements assets and invest."lents, thesafekeeping of securities and acquisition and sale ofsecui'ities as directed by the Pension Invest.lnentDepartment-48 "
The Trustee signing officers for the account (900920) are:Mr. Oswald D'Mello:Mr. Foss Raleigh,Mr.. Henry Baou1 s .
~~ ~ ~ ~I ~~ ~ EMPLOYEE ~ ~ EMPLOYER ~~ ~ ~ .~ "...".,,""".... ~ ..............,,,.. ~~ ll_ ~~ 'I" '. .. I'" .. " ".. . '. II .. , It " ..., , .. " ., .."".... 'I II II .. .. .f~ ".. \I 'I 11" " II " .. .. .. .. .. .. .. , n II .. .. " .: ~ ~~ ~ ~~ ~ ~C TRUST ACCOUNTING ~~ ~ ;1 ~-; ...1I~".I.oi.,~.Ii."......~ .....II~ ÚII.U~
ArMIN FEE PA~ENTS ~ ..........."....... . .. .. .;i ~ ~BY NTC (Sec ~ion 14. 00) ~ ~ ~ ~~ ~ :J ~I;1 ~ ~ ~~ ~ ~ ~~ ~ ~ ~~ ~ ~ ;~I..........",~..............."..~ ~.~ ~ ~ ~~ ~ il ~ ~~ ~ ~ MONTREAL TRUST ~ ~I~I ; ~ ~ ~I~ ~ ~ 9 00920 ~ ~~; ;1 ~ ~~ ~ ~ L--i l,i'1.-........,"1.....,..............~i i~......,...;¡...................,~..........."..;; ~~ ~ ~ ~~!;; r~ ~ ~~ ~ ~ DEPOSIT ~ ~ ~~ ~ ~ 0000-395 ~ ~ ~I~ ~ ~ ~ ~:¡ ~ ; ~ ~; ~ ~ ~ ,I ~~ ........ ~ .... . . . ~ DISBURSEMENT ~I ~ ~.'4" 00) ~ . ~ r-' 0000-379 ~ ,1 ~~ ~ ~ ~ ~;i~ ~ ~ ~ ~ ~I~ ~l ~ ~ ~ :¡~ ~ MUTUAL LIFË1 ~ ; QUEBEC BLU~i~ ~ ~ CROSS ;1~ ~ ~~ ...............................: ,It ~~ ..."......" '. to" .. , , .. .. , .. .. " , . .. .. , . .. .. .. ~ ~~ ~ ~ ..~ ~i--~ ~ EMPLOYEE ~
Description ofEvents
C::NTRIBUTIONS
DEPOSIT TO':'RUSl Hi'ND
(
F li1'DS TRANSE'ER~O CARRIER ~CCOUNTSFOR CLAIMS ?AYM~TS
ADMIN FEE PAr.E:BY TPUST Fti'"D
( Section
PAYMENOF' CLAIMS
40
CASH FLOW DIAGRA
; ~~ SPECIAL ~
~
~
4 i
1.,00 pi:.TNDS TRASFERS
i i ..01 Gene:!al
T~e nc=~ai day to day operating procedures ~re to be performed byNTC Tr~s t Accounting" Upon noti fication fro~ Mutua 1 Li fe andcor:f.:=::ed by Montreal Trust, NTC Trust Accounting shall aåv ise theN7L ?ension Department of its liquidity requira~ents" At thatpoint the Pension Department shall instruct Montreal Trust totransfer the said amounts to the deposit account at the Bank ofMcn~=eal in Waterloo"
17.02 Sfec.:al
S~ec.:al trans=ers are those that occur on an infrequent basissuch as the Pensioners i Insurance Sub-Fund transfers.. These areto 'be co-ord inated throuch NTL Tr easur'l who wil i ad.v ise HutualI.i.::-e, t..~ont=eal Trust, NTC Trust Account-inc an¿ N'IL PensionVei:ar":.::ient the s-cecifics and nature of such transfers.. In mostca~es,~ this tran~fer will take the fo~ of an electronic funåstrans fer 'to either NT and then to the Trust lund, or direct tothe Trust Fund. Payment to the Trust Fund takes the followingfor::ct "Montreal Trust, Trustee for Northern Telecom i 5 Heal t.h andHelfare Trust". The format for the detei:T.ination of the fundingrequirement is attached as Exhibit A.
':\'l
-:~.-:~::-~--~-_.--_.~----"--'-'---'_._'"-'--'-'_.'-'-'---_.--~_..-.--_.~.-.._~.-_... .._....._-_._. ._........_-..-'_.__..-._...._....._..._.- .-_.._-_.._- .._-.._......__._--_._......._----_._----_._.__._-----_._-----.,.
i.'-:.
1980HEALTH AND WELFARE TRUST YEAR E~D FUNDING
ESTIMATED1
RESERV:; FUNDING CLAIMS YEAR ENDB ENE FIT RESERVES LIABILITY MEeHAN I SM PAID CONTRIBUTION
SIB 0 420,708 PAYG 24,747 nilSTB 0 348,349 PAYG 52,975 ni i
LTOZ..::
87 1 10 + 21555 725,373 20 ~ pa 123,539 24,973..80
.!I.CCRUALS
90,000
390, 000
1. Proi:"ated to December 1980
2 . NT Lan d B N R Re s e r v e s
3 . TOTAL NTC BNR NEDCO--Liability 725,373 569,945 22,103 133,325
CL aims paid (123,539) (87,139) (4,423) (31,977)
:....~ Enà 3aL. 601,834 482,806 17,6 a 0 101,348i\ Avg. Ba 1 . 663,603 526,375 19,892 117,336.5"
Interest on Avg. Ba 1.
ê 1 0 '5 66,360 52,637.55 1,98 '3 1. 1 , '7 3 3 . 6 5
Y!E. Li abi 1i ty 668,194 535,443.55 19,669 113,081.65
20 % Funding 133,638.8 107 ,088.7 3,933.8 22,616.33
Reserves 108,665 87,', 1 10 21,555 Nil
Contribution 24,973.8 19,978.7 (1T,621.2) 22,616.30
\
..__....,._-------_._...-.-----_._- - ---
-::=.-:::====:---_._-_._-------------_.-.-._-_.~- _.._--~-_.__..__...__.__._~._,._--_..__....._-_.._.- - .._--_..-_......_.~.._.__._-_.__.._..__._.._..__.._._.--_..-----'-_._. .
43
l8" 00 UNITIZATION
18.. 01 Uni ti zation is the mechanism for esta):lishing which employeegr.oL1ps contributed what funds. This is done on apercent-of-the-whole-fund basis, i.e., beginning month figuresfor each contributing group are converted to a percent of thetotal fund. The maintenance of this allocation proceåure isdone by NTC Trust Accounting" The net of total contributionsanã ex.?enses are then addeã to the beginning mont~'l' s balance"Investz:ient income attributable to each month is then allocatedto the beg inning month balance"
1 8.02 The technique descr ibed is standard industry practice for theprocess of unitization" While there exists a short-term timevalue 0 f money problem for early contributions anã lateexpenses i it is generally considered that there will be anaveraging effect over the longer term. .Thi s situation couldbe reduced if daily caiculations and allocations were made"Presently, howeve~, unless the inter-month funds risesigni£ic antly, practical considerations sUggest a monthlyallocation of income" Valuation is done on a book rather thanmarket basis.
'\
.~.-..,_..-.....--_._,...__----_.---..._-- _i:'__-
44
3. 00 STOP LOSS INSURACE
19.. 01 Stop loss coverage is generally only considered for benefitswhich have' a low chance of occurrence and yet the associatedliability is very large" Presently Northern Telecom has twoforms 0 f stop los s or catastrophic ins urance.. The first is astop loss level of 125% of expected claims. This covers thefollowing benefits:
- Long Ter~ Di sabil i tySurvivor Income Benefi tSurvivor Transi tien Benefi t
- Group Life Insurance Part I- Group Life Insurance Part II- Accidental Death anä Dismemberment
19.02 The Extended Health and Dental Benefit Plans are not included inthe Stop Loss"
19,,03 The Stop Loss coverage mentioned is held by Mutual Life, thecurren t charge is one quarter of a percent of the expec~edclaims during the policy yeàr.. Tlis is paid by Northern.
19,,04 The second form of stop Loss insurance went into effect onDecember 3, 1980. It is a three year policy with Lloyãs ofLonãon covering Northern Telecom Ltd. and its subsidiaries forlosses resulting from anyone occurrence in excess of S l, 000.000either Canadian or U..5. or both. "Occurrence~ is defined as anacc:iãent . in vol ving two persons or an outbreak or epidemicinvolving at. least four persons which manifest wi thin a periodof at least sixty ãays" The specifics of this excess insurancecoverage is attacheã as Appendix B., The combined annual cost of t:iiscoverage, S26,600"OO for Canada and the U,,5. is paiò by Northern.
('-
45
":0,,00 PENSIONERS' INSURACE FUND (PU,)
J.Ol Th is fund cover s the li fe insurance on the pensioner s of theCanadian companies of NTL including BNR.. The PIF is divided intothree separate units., These represent funds for NTL/c, BNR andNTSL" The coverage for which a pensioner is insured is that amountof insurance for which the employee was insurec as an activeemployee on the òa te 0 f retirement, It is red uced on the firstanniversary of the date 0: retire~ent by S% of such amount anèfurther reduced by like amount on each of the next fouranniversaries after date of retire~ent to remain at the level of 75%of pre-retirement insurance"
20.02 F1mding policy of the PIF is to prov.lce flexibility to thecompany. The funding policy is deter.ined by NTL Treasury" Thefunding change shoulò be made during the three months followingreceipt of an actuarial valuation" The actuarial valuation of thePensioners i Insurance Funà should be calculated as of January lst ofeach yearby Pouliot Guerard. The valuation is based on theproj ected retirement rates of company employees and L~e group lifemortality rates., The reti=ement rates are identical to those of thecompany pension plans i retirements are ass~~ed to occur in ~~emidàle of the year,
(l¡
Employee contx'ibutions are split between Group r and the PIF asdetermined by NTL Treasury" The employees currently contribute theamount of 50 cents per month per $1,000 0 £ Part I coverage overS10,000 of which 28,,2 cents is designated for the Pensioners'In surance Fund. To be consistent with the fund ing policy theemployer contributes the difference between the funàing requirementsand the employees i contributions"
20.,03
20,,04 included in the PIP are the following sub-funds which areadministered by Mutual Life until maturity at which time they willbe transferred by Mutual Life to the Heal t~ anà Wel fare TrustFund" The specifics of these special transfers a.re addressed in alater sectioñ. Interest on the;e sub-£unàs are to be paid on.1anuary lst and Mai;'ch 31st for these sub-funds muturing on thoserespective dates..
SUB-FUND MATURITY INTEREST RATE PRINCIPAL
SA i'arch l, 1982 9,,38% $ 1 , 73 1, 982 . 32
i 977 January 1, 1982 9.. 3l % 2l8, 795.09
1978 January i, 1983 8..99% 2,674,839.79
19 i 9 January 1, 1984 9.74% 2,673,422.26
20.05 -lhe companies which contribute to the Pensioners i Insurance Fund
and whose employees are covered by it will be charged for theirrespective share of the expenses incurred by the Pension
) department in administering the PIP"
46
~ . 00 INVEST~~T OBJECTIVES AND GUIDELINES
,,01 The primary objective is the maintenance of funds sufficient to meetprese~t anå future benefit payments i this is to be achieved throughrates of return on fund inves~~ents sufficient to minimize fundingcosts and to finance the improvement of benefit payments"
21,,02 Fund :.~vest.'7e!1ts è.re to be maintained in diversified portfolios tomini~ize invest~e!1t risk"
2 l. 03 Fund investments are to be made mainly in fixed income invest-ments i namely bonds, mortgages and short-term. Further, untilsuch time as benefit payments experience is established, invest-ments are to be made for terms no longer than 5 years.
21.04 Fund investments are to be made within the framework of theinves~-:ent guidelines for bonds, mortgages and short-tenn port-.folios as stated under Exh~bits A, B & C"
21..05 Inves~.ents will comply with prevailing health and welfarelegislations anõ tax provisions..
._-_._..._--_.._.--------.--------~_..__...----,-;.--~--~..~._. ------ _._--~-_._.__.__.. _. . ...' - ..,---~ .-
47
2l . 06 EXH~BIT A".. :~
Cl'..'L'\IAN BOND PORTFOLIO
a) INVESTMENT OBJECTIVE S
l" Total r~~urn approach to bond portföl io management,i" e. generate satis factory yields anà protect capita 1against adverse interest rate movements.
2. Achieve above average returns by taking advantage ofinterest rate swings to secure capital gains"
3- Improve overall portfolio quality in order to reàuceinvestment risks"
4" To outperform the results of a sample of similarCanaàian funàs"
~) INVESTMENT GUIDELINES
l. All bonàs investments must comply with the provisionsof prevailing Health and Welfare fund legislations.
2. Inves~~ents mav be made in bonãs or debentures issuedby or guarante~ã by the Govern.inent of canada, theProvinces, and major Corporations.
3. Specifi~ limitations by sector, ;.ill 1:e applied tothe following bond categories.
- Government of Canada No limi t
Provincial or ProvincialGuaranteed
No limit overallspecific Limit for
Ontario - 30%Specific Limit for B. c. ,
Saskatchewan, Alberta,Mani toba, or Quebec20%
Anyone MaritimeProvince - 10%
- . Corpor.ate No limit overall
4. Preference will be given to Government of Canadabonds and prime Provincial bonds for liqui.dityconsiderations.. However, investments in otherprovincial dnd Corporate issues may be sought,accepting less liquidity on the basis that yieldpreIDi urs wi! 1 resul t in overal i higher return.
,--- _.._- - --..-_.._..--- ----~~ ~-_.- -~-----~-..- ._-- ....... ...._._..__. - .~ _._~_._.__..-- .~... '
-~~-. _..__.. - .-- --.--- -_. --~ ~-- . .~-_._... - -_.--- ~ - -- -...- _._----- ._-.-~---~ ------- ._------------_._~--- . ....
48
CANADlpB BOND PORTFOLIO (cont' d. )
5.. There are no restrictions on inves'L"7ents in anyspecific Government of Canada or p~ovincial Govern-ment issue, although consiòeration should be given Lothe size of public issue outstanding" Provincialbonds should have outstanãing issues of at leas~S lOOM"
6" Only Corporate bonds and debentures may be purchaseà,which are rated B++ or higher by the Canaàian BondRating Service or Dominion Bond Ra"ting Servicei orcorporate bonàs and debentures of local subsiàiariesof foreign corporations which are fully guaranteed bythe fore ion cor"Ooration wi ~h an ecual or betterrating i.rJ the. U~.ited States by either Moody's orStandard: anà 'poor' s" A minL'1Wi of 90% or: the port-folio will be invested in issues rated sinale "A" andhigher.' . -
Î" The maxinin investment in the àebt issue of anyonecorporation shoulà not exceed 5% of the corporation i soutstanding debt.Preference will be given to corporate issues withs inking fund requirements"
a" The main purpose of trading the bonã portfolio is torestructure term, i.. e. shortening maturities if high-er rates are expected to reduce market riSKS, anãlengthening maturities to take advantage of interestrate swings to secure capital gains.
9. When not in conflict with the te=m structuringstrategy, bond s may be traded to improve yielò orquality 6f the p6rtfolio.
LO. The choice of bond coupon rate will be dependent oninterest rate outlook. vfuen near term outlook isnegative or mixed, the higher coupon bonds proviäedownsiãe support; when the outlook is positive, thediscount bond provides better relative performance"
1 1" Extendible and retractable bonds provide some of thedefensive characteristics of short maturities ,~ithsome of the capital gains of longer maturities" Atreasonable price premi~ over straight bonds, theyare to be pre ferredinstruments.
l2. No investment shall be made in the securities ofNorthern Telecom Li.mi ted, Bell Canaòa or _ any of t0eirsubsidiary or associáie compänies.
---_.----~--_. _... ~_. -----------.....-._--_.._-.. .._- - _._- .._--~-_. . --------- _._--_._~_.- --_._-_._-
4Q
21.07 EXHIBIT B
..'
(. . ~
.,,
CANADI~E SHORT-TERM PORTFOLIO
a) INVEST~ENT OBJECTIVES
1. TO maintain temporary funds sufficient to meet therequirements of longer term invest."1ents in bonds andmortgages"
2" To generate satisfactory yields and protect capitalfrom adverse interest rate movements.
. 3. To improve overall quality in order to reduce invest-ment risk.
b) INVESTMENT GUIDELINES
1. All short-term investments must comply with the pro-visions of prevailing Health and Welfare legis-la tions. .
2. Invest:nents may be made in short-ter;n instruments toincl ude government securitie s (treasury bill s);chartered bank securities (bearer deposit notes,deposi t receiots i term notes, certi ficates ofdeposi ts i bank swap deposits, or bankers accept-ances); and corporate securities (finance companiespaper, commercial papers, and call loans to invest-ment dealers)..
3. Subject to periodic review, specific limitations bysector will be applied to the following short-termcategories:Gover~~ent of Canada No limit overall
_ provincial or ProvincialGuai:'anteed
No limit overall
.- Chartered BanksAssets over S lOBAs sets over S 2B
S5M in anyone bankS 3M in anyone bank
- CorporateRated R-l or A-'l Sl" OM in anyone
corpora tionS l. OM to anyone dealerCall loans to dealers
4. Preference wiii be given to government i primecorporate and major chartered bank securities forliquidity considerations. However i investments inminor chartered banks and corporate issues may besought i accepting less liquidity on the basis thatyield prerni urs wil 1 result in overall
higher return"
_.__--_ .-- .~___ _.__________~________ ___...._. ~._...~__ __~___:- ____ _..~ M_____~_._ ____ -_.. ~..----
5 "
SEORT-TERM p~ L COnt' d . )Onl.y corporate securities maY be puròased, ..hich arerated. R-l. (n.M.L.) by the Dominion ""nd Ratingservice or A-l bY the canadian BOnd Raün9 seOice,or l.ocal subsidiaries òf foreign corporations ..hichare full.y guaranteed. by the foreign corporationhaving an equal or better rating from a comparabierating ser.ice in t1,e united States,
in.es~ents in calL. l.oans 'D invest.~t dee1ers m'ybe made, p-rovided that theY are fUUY collaterai.zed..i th acceptabl.e securities, and that they are e" tend-ed to majo~ investment deaiers"
Short-term inves",,,ent' are to h.ve m.turities óf oneyear or l.e's" The term .trJcture ..il.l depend oni.quidity requirements, yield, a!,d interest rateoutiook.
The short-term portfoliO may be traded, to improveyield or quai.tY' tinen not in confiict ..itr, ."el.iquidity requirementS' ter~ may be e"tenôed orshortened to t~e advant.ae of inteies~ rate ~ingsto secure capital gains" ..
No investment shaU be made in tbe securities of~orthern Teiecom Limited, SelL. canada, or anY oftheir su'bsidiary or associated companies..
C A.'l AD iAN
6 "
7 .
8"
9.- ::0
.\
,~----,-_.~----,... -,_.-., ....
5lEXHIBIT CCANADIAN MORTGAGE PORTFOLIO
a) INVESTMENT OBJECTIVES
To obtain maximum return, with a lowdiversified portfolio of mortgages.eval ua ted against the median returnssimilar Canadian funds.
level of ri sk from aResLll ts will beof a sample of
b) INVESTMENT GUIDELINES
1. All mor~gage investments must comply with. provisionsof prevailing health and welfare fund legisiation.
2., Mortgage commit.rnents will be restricted to NHAinsured and MICC insured mortgages where loan tototal value ratio exceeãs 75% and to conventionalmortgages where the ratio does not exceed 75 %..
3. Diversification among the vartous mortgage investmentareas incluãing single family residential housing,condominium/ apartments, townhouses! apartmentbuildings, shopping centres, offices and industrialbuildings, should bè sought within the quality andrisk standard mentioned below and net return avai l-able"
4" A mortoaoe ter~ of up to 5 years is acceptable,depending on the type of project, the credit of theproject, the duration of any leases and/or governmentsubsidy programs.(
S. Amortization should relate to the credit worthinessof the borrower and the remaining economic life ofthe project with maximum amortization of 30 years,except for NHA loans up to 35 years.
6. Investment in any single proj ect wil 1 be restrictedto a Sl million maximß~ and a $100,000 minimum.
'7.. Investment in mortgages. shall not exceed 50%0£ thetotal assets at market.
8. All mortgages should receive a suitable opinion as toeligibili ty for Health and Welfare fund invest.rnentfrom the servicing agent..
9. All approved commitments must be serviced by aservicing agent whose servicing agreement meets legalapproval 0 f both Northern Telecom, and MontrealTrust.
10. No investment shaii be made in the properties ofNorthern Telecom Limited, Bell Canada or any of theirsubsidiary or associated companies.
-----_...._---~-~--:-,--_._. ____ - __ _.. __~.. __ ___ _-0_- ___ ______._---..,.,. ,.--,---.,-
52
2" 00 GENERA TRUST INFORM.ZiTION
'" 01 Actuarial ConsultantsTo ensure that NTL' s insurance liabilities were balanced withadequate contribution and funding levels, actuarial consultantswere used" Pouliot Guerard and Associates of Montreal wereretained for the purposes 0 f cash flow projections" Our accountactuary is Mr" Marc Fernet (514) 285-11 22" The Trust wil irequire actuarial estimates for Long-Term Disability, SurvivorIncome and Surviror Transition Bene£i ts and L'ïe Pensioners iInsurance Fund on a yearly basis" These will be provided byMutual Li fe with input by Pouliot. Guerard"
22,,02 Policy Year
The policy year will be a calendar year for all coverages andemployees regardless of when the coverages were transferred tothe Trust Funã" Experience for partial year, will be reportedfor coverages transferred in during the year"
2 2" 03 Conversion Charces=
""\ì,
The conversion charges (i. e., an ex-employee switching fromMqtual 's coverag e) on Group Life Par~ I, excluding acciåentaldeath and ãismemberment plan, and Pårt II woulà be handled byMutual Life in th~ manner similar to retention expenses, i.e.monthly claims plus expenses" Reports would break out theconversion charges separately from other expenses"The conversion charges will be recorded separately fromretention in the Trust and recovered from the Health and WelfareTrust in a manner similar to the general expense recovery"Under the current policy, 60 percent of conversion charges arerefunded if the ~onverted policy is terminated by the employeewithin 12 montns or, if there is no claim, within a 12 monthperiod. The Trust will record r'efund of conversion charges bynetting against convers ion charges recorded during the year.
22.04 Self-Insurance Manual Revisions
The reponsibility for updating approved contents of this Manuallie with the originating depart.inents" Changes should be in aformat that allows for easy insertion.. For co-ordinationpurposes all approved changes should be directed to the BenefitsManagement Committee secretary; who shall maintain a currentlist of BMC member departments and individuals. The secretaryshall then distribute the changes"
.....___._____-:_____.___._.___.___.__ ___M_..__.M._...........~_._.._.___._._.M..___...__._.......__._ .......__...._._.._.__....__...__.__,__._____..._.__..___.___._._____..___._.___.
23.00CHART OF ACCOUNTS
x = valid general led~er account
53
TOTAL NTC/L MGMTFUND UNIONS MSS PEN BNR NTSL
BALANCE SHEET
1. BANK ACCOUNTS
~ ~ ~ ~ ~
1 . 1
1 .2
1 ,,3
1. 4
HON~RE~L TRUSr COMP~NYBANK OF MONTREAL - DE?OSIl
- 'llATERLOOBANK OF MONTREAL - MUTUAL LIfE
- WATERLOOQUEBEC BLUE CROSS - WORKING FUND
2. INVESTMENTS
2 . 1
2.22 . 3
2" 4
MORTGAGESSHORT-TERM INVESTXENTSBONDSSINKING fUND DEBEN:URES
3. RECEIVABLES
3 . ,3 .2'
3.33.43.. 5
3.6
NTCBNRNTSLMUTUAL LIFE - CURRENTMUTUAL LI F E - DEFERREDACCRUED INTERES I'
4. PAYABLES
4 . 1
4.24.3
MUTUAL LIFENTCMONTREAL TRUST
6. RESERVES
6. 1 FUTURE USE6" 2 LONG-TERM DI SAB ILITY RESERVE6.3 SURVIVOR INCOME BENEFITS RESERVE6.4 SURVIVOR TRANSITION BENEFITS RESERVE6 . 5 PEN S ION E R S i INS U RA N C E FUN D
6.6 RATE STABILIZATION :FUND6.7 GROUP LIFE PART I - RESERVE6.8 DEPENDENT LIFE INSURANCE - RESERVE
P &L ACCOUNT S
7. CLAIMS PAID
7. 1 DENTAL7.2 EXTENDED HEALTH7 . 3 F UT U RE USE7.4 LONG-TERM DISABILITY7.5 SURVIVOR INCOME BENEF ITS7.6 SURVIVOR TRANSITION SENEF ITS
~
xX
X
X
.._--_... _._---_.__.~ --_..- ... .~._-.. "--_.p- --~-:_-_..---.;---. _.__......._-
x:
X
X
X
X
X
X
X
X
X
X
X
X
~
X X X X
X X X
X X
X X X
X X X X
X X X X
X
X X X X
X X X X X
X X X X
X X X X
X X
X X X
7.-::--:~::-::::~:-:-:=::-=::.====.'::-:::_-:-.--;7-:::;----_.-._----.--'.-----.--.--.----------.---------.--~-----..~ .
54
CHlI.RT OF ACCOUNTS
x :: val id general ledger accountrOTAL NTL/CFUND UNIONS ~1GMT PEN BNR NTSL
I I i
7.. 7 GROUP LIFE PART I X X X X
7" 8 GROUP LIFE - PART I - A. D" & D" X X X X
7.. 9 GROUP LIFE PE~S IOt~ERSX X X
i.10 GROUP LIFE - PART II X X X X X
7" 11 FUTURE USE7.12 FUTURE USE
8. EMPLOYEE & EMPLOYER CONTRIBUTIONS
8" 1 DENTAL X X X X
8.. 2 EXTENDED HEALTH X X X X X
8.3 FUTURE USE8..4 LONG-TERM DISABILITY X X X X
8.5 SURVIVOR INCOME BENEFITS . X X
8.6 SURVIVOR TRANS IT ION BENEFITS X X
8.. 7 GROUP LIFE PART I X X X X
8.8 GROUP LIFE PART I '- A. D" & D. X X X X
8.9 GROUP LIFE PE~SIONERSX X X
8.10 GROUP LIFE - PART II X X X X X
8. II DEPENDENT LIE'EX
g.12 FUTURE USE
"~\"IO . EXPENSE ACCOUNTS
(10. 1 TRUSTEE A.DMIN ., FEES X
10.2 MUTUAL LIFE ADMIN.. FEES X X X X X
10.. 3 FUTURE USE10,,4 BAliK CHARGES X
IO.S BA-N'K INTEREST X
10.6 MORTGAGE SERVICE FEE X
10..7 MORTGAGE FINDER i S FEE X
il. INCm-m ACCOUNTS
11.1ii.211" 3
11.4l1. 5
11. 6
MORTGAGE INTERESTSHORT-TERM INVEST" INTERESTBOND INTERESTBANK INTEREST RECEIVEDGAIN ON SALE OF BONDS .INTEREST O~ S. F. DEBENTURES
XXXXXX
JOUR.i¡AL ENTRIES
NO. 1 - CASH RECEIPTS & DISBURSEMENTS - MONTREAL TRUSTNO. 2 - DENTAL & EXTENDED HEALTH CLAIMS PAID BY MUTUAL LIFENO" 3 - GROUP LIFE INSURANCE CLAIMS PAID BY MUTUAL LIFENO" 4 - BILLINGS TO BNR & NTC FOR CLAIMS PAIDNO. 5 - LTD CLAIMS PAID)0. 6 - CASH TRASFERS = BK" OF MTL".,io. 7 - SIB, STB CLAH1S PAIDNO. 8 - SPECIAL ADJUSTMENTNO" 9 - CLOSING OUT INCOME, CLAIMS & CONTRIBUTIONS TO RESERVES
------------. .-._._.- -- ._- ..._---- ..._._~_. - ~_.__. -- - - . .. .._-- --'" ----. _.- -- ----- ._~.-. .- - --_...- ~.__..------ _. .~...-------_.- -------------- ---
24" 00
-_..~,
Main Activities and Journal Entries
Bank Accounts
l.. All contributions and rese~ves are deposited inthe Montreal Trust account in Montreal (Ale900920) "
2" As funds are required to pay claims anòexpenses, the funds are trans ferred from theMontreal Trust account to the Bank of Montreal_ Deposit account in Waterloo"
3" Mutual pays claims and expenses by writingcheques on the Bank of Montreal - Disbursementsaccount in Waterloo.
4.. At month end, the Bank of Hontreal - Disburse-ments account is cleared by a transfer from theBank of Montreal - Deposit Account"
55
-'
M1I
N A
CT
TV
I''IE
S A
ND
,1O
UH
Nl\L
EN
'('R
IE:S
Dlm
TA
L l\
ND
EX
TE
ND
ED
llF.
JL'll
l
NT
L/C
- MANA.GEMENT -
Trust Books
Em
ploy
er iS
8 o
aks
1. Employees or pensioners* file claims
directly to Mutual Life. '
2. Mutual processes claims, writes
cheques on the ßank. 0 E Montrea 1
-\vaterloo, and remits cheques
directly to employees or Uieir
doct
or o
r de
ntis
t.3. Mutual files monUily claims
report and invoices NTC for
expe
nses
.
OR. Claims Paid
CR. Cash
OR. Benefit Costs
CR. Cash
(For Admin. Expense)
4. i Trust bills employers for
reimbursement of claims.
OR. Acc. Rec.
CR
. Con
tr i
butio
ns
5. E
mpl
oyer
cei
mi)l
irseS
trus
t fun
dfor claims paid.
DR. Cash
CH. Acc. ReG.
OR. Bene f it Cos ts
CR. Cash
.~ F
or C
laim
s Pa
id)
NO
TE
S:1. A.t this time, Dental 6. Extenòed Health in the Trust fund as outlines above, apply
on ly to NTL/ C-Managemen t: BNR, NTSL.
2. For Dental & Extended Health - Employer pays fl1.11 cost, except Eor NTSL.
3. Actual accounting entries wili 'Jive detailerl l)Ce;ikòown per chart of accounts.
~ A
lso
cove
rs P
ensi
oner
s an
d su
rviv
or I\
nnul
tant
stn Q
'
.,/-~
" .~..~
~:
MA
IN l\
C'lI
.VI'l
IES
AN
D J
OU
HN
l\f, E
N'lR
JES
DE
NT
AL
AN
D E
XT
EN
DE
D r
1EA
L'1H
- UNION -
(wlth
Que
bec
All1
e C
ross
)
Trust BOOks
Employer's Books
I i I i i I i I 1 i i
i. Wel fare Trust sends WorKin~ fund
to QueDec Blue Cross.
DR
. Cas
h-W
orki
ng P
und
(Q.O
.C.)
CR. Cash-titl. Trust
DR
. Cla
tins
Pa
i.ll
CR. Cash-Hkg. Fund
DR. ßenefit Costs
CH. Cash
(For
Aiii
n tn
. Exp
ense
)
2. Employees file claims directly
to Quepec Blue Cross
3. Quebec Blue Cross processes claims i
wri tes cheques on the v~orking
Fund toreimb~rse employees.
4. O
uel)e
c n.
C. f
iles
Ilonl
:h i.
y cI
a Î.i
nsreport and invoice NTC for
expe
nses
5. Trust Re.imbucses Quebec B.C. for
cla lms pa id
6. Trust ßi.lls employer for
reim
burs
emen
t of
clat
nis
7. Employer reimburses Trust. Fund
for
cla
imsp
a ili
NO
TE
:Employer pays full cost
DR. Cash-Wkg. Fund
CR
. Cas
h-M
tl. T
rus
t
DR. ACC. Rec
CR
. Co
n t r
ì.1
u t t
on
5
DR
. Còs
llC
H. l
\cc.
Rec
.DR. Rene fi.t Costs
CR
Cas
t1r
For
Cla
ims
Paid
)
Ul -.
I i i I i l I i i I i I i I \ i
."_,
,.f
MAIN ACTIVITIES AND JOURNAL ENTRIES
LO
NG
-'lE
RM
DJ
SAIJ
I L
ITY
'l'rust BOOKS
LEmployer submits to Mutual Life
for adjudícation.
E~
~?-
y'e
r · s
ßoo
k s
DR. Rec. - Mutual Life*
CR
. Pay
able
s(P
ed. T
ax, e
tc.)
DR. Cash
CR. Rec. - Mutual
1..1
fe*
DR
. Pay
able
s (F
ect.
Tax
,et
c. )
*CR. Cash
DR. ßenefit Costs
CR. Caslì
NO
TE
S:L LTD applies to NTL/C - Mgt. N'lC - Union, Non-Un:Îon,
2. Employer pays full cost of benefit
3. A
ctua
l Acc
ount
ing
entr
ies
wi.i
l giv
e tle
tai 1
brea
kdow
n pe
r C
hart
of A
cco\
ints
BNR, NTSL
* For deduc t Lons wi thhe Id from
Em
ploy
ees.
ui en
2 ;
Mutual Life notifies employee of
of approved claim
3.Mutual pays claims monthly by
wr
i tin
g ch
eque
s on
the
Ban
k of
Montrea i for the gross pay les s
dedu
ctio
ns.
4.Mutual files monthly claims and
expe
nse
repo
rts
i inc
ludi
.ng
deta
ilof
ded
uctio
ns m
ade
(Fed
. Inc
. 'P
ax,
CP Pi urc l Union dues i etc.).
Mut
ual r
eim
burs
es it
sel f
for
expe
nses
and
ded
uctio
ns.
DR
. Cla
ims
Paid
Adm
in. E
xp.
CR. Cash
5.M
utua
l rem
its c
lieau
e fo
rdeductions withheld from
empi
oyee
s.
DR
. Pay
able
to T
::nip
I oy
er*
en. Cash
6.Employer remits clieques to third
parties for è1eductions withheld
from employees.
7. At year end employer makes
additional cOntributions to the
Trust Fund as required in the
Fund
ing
Polic
y.
1. DR. Cash
CR. LTD Contributions
MlI
N A
CT
IVllI
ES
A.N
D ,1
0lJU
-m.I
.. L
Wl'U
ES
. SU
RV
IVO
R I
NC
OM
E ß
EN
EF
11'5
'Pru
st ß
ooks
Employer's Books
l.E
rnp
loye
e s
con
tr.i
111\
t Lo
n s
rem
i. l:
I:e,
ìto
'1'r
us t
L)y
Em
p la
yer.
DH
. Cas
liC
R. C
o ri
t t 'i
111l
: jon
8O
H. I
~iii
ploy
ee d
eclu
ctlo
l1s
Cl(. CñU!i
2. E
mpl
oyer
not
ifies
!'l.t
ual o
f.ap
prov
ed c
laim
s.
3. Mutual pays monthly claims by
writing dieques on the Oank 0 E
1'1o
ntre
al fo
r th
e gr
oss
amou
nt le
ssde
t'uct
ions
.
4. Hutiial files monthly clatms ant'
expe
nse
repo
rts,
inci
udin
g cl
eta.
ilsof cleductlons made (income tax)
ancl reimburses itself for expenses
and
dedu
ctio
ns.
DR
. CL
.a.1
ms
Paid
A'1min. Exp.
~m. Cash
OR
. Rec
. r1l
llUA
.L L
IFE
eil. Payables (Income
'l'a
x )
5. ;
Mut
ua 1
rem
its c
hequ
e to
em
ploy
er, f
or d
educ
tions
with
held
from
. em
ploy
ee s
.i
6. i Employer remit.s Cheques to third
p~rties for deductions withheld
from emL'loyeea.
DR. Cas11
Crl.. Rec. MU'lIJA.L ¡.lIFE
DR. Payables (Income
'lax)
"C
fL C
asJi
7. Claims pal~ and ~dmin. Expenses
are
char
ged
to S
IB R
ese
r.ve
at
year end.
NO
TE
S:1. SIB apI?lies only to N'lT..fc Management anrl N1'SL
2. Cost is shared by employer. õnd einpl.oye~r
3. Accounting entries will give detaiL. breakòowii
per Chart of Accounts
* P
or (
~ed
l.ctìo
ns w
ithhe
ld fr
G'"
Em
ploy
ees.
tn '0
,'mIN ACTh ..-tÍES AND JOURN/\J.. ENTHIES
S¡m
VIV
OH
TH
lIN
SIT
ION
ßE
NF.
FIT
S
'1Ini:;!: lJlJol\a
----
-.-
1. Employer notifies Mutual Life of a¡iprov~d claims.
2. M
utua
l pay
s cl
aim
s m
onth
ly b
y w
ritin
g ci
iequ
es o
n tJ
ieB
ank.
of
Mon
trea
l for
the
gros
s pa
y le
ss d
eljii
ctio
ns.
.i. .
Mut
ual f
.iles
mon
thly
cla
ims
and
expe
nse
repo
rts,
incl
udin
gdetail of deductions made (ied. Inc. Tax, and semi-private
in Ontarioi and also reimburses itself for expenses and
dedu
ctio
ns.
OR
. C1.
ai.in
s Pa
ttilIdm in. Exp.
en. Cash
4. Mutual remits cheque to employer for deductions withlield
from employees.
5. Employer remits cheques to third parties for
l1eductions withheld from employees.
6.
Trust b.llls employer for claj.ris and Admin. Expenses.
7. Employer reimhurses Mutual for claims and expenses.
8. At year-end, employer makes additional contributions
to the fund as requlred in the Funding Pollcy.
NO
TE
S. 1
. ST
B a
pplie
s to
Uni
on E
mpl
oyee
s, n
on-u
nion
and
cer
tain
Pen
sion
ers
2. Employer pays full cost.
~~!l
piO
YL
!r'B
Hon
ks
ni~
. He
c. M
u t i
l a i
L i f
e ·
eH. P
ayab
les
(Fed
. Tax
iet
c. )
.. 1'or de,111ctions wi t.hlie id from
Em
ploy
ees.
~ o
,"--
-:::.
d :1 i i 1
."~~
.;
MA
IN A
C'l'
IVI'l
lES
AN
D J
OU
HN
l\L E
N'lH
IE:S
GROUP LIFE INSURlOCE - PT, i
1.E
:mpl
oyee
s ca
n tt:
ibn
tions
r.e
nd. t
ted
to Trust by employer
2. Portion of employee contribution
(20.2~/Sl,OOO) is credite~ to
Pensionet:s Insurance Fund (P.I.F.)
3. Employer notifies l'utual of
appr
oved
cla
ims
4. M
utua
1 p
ays
cIa
i.IlS
and
re
i.inb
iirse
sitsel E from the Dank of Montreal
Acc
ount
5. Mutual files monthly elalms and
expe
nse
repo
rts
6. Trust bills employer for claims
and Admin. expenses
7. Employer reimburses Mutual for
claims and Admin. expense for
Active Employees
8.För Pensioners' cIa 1ms, Employer
mak
es c
ontr
i.but
ion
acco
n'lin
g t.o
tlù:!
rese
rve
requ
irem
ents
out
lined
in the FtinlHng pol icy.
Trust Books
§.~~
ploy
et"'
s B
ooks
DH. Cash
CR
. Con
td.h
ntlo
nsD
1L E
lIp lo
yee
cier
ìiic
t i.O
llSen. Cash
Dn.
Con
trth
iitio
ns -
Gp.
I,iE
e-I
cn. P.I.F. Conti-ibulipns
DR
. Cla
ims
Pa
iilA
tlini
.n. E
xp.
CR. Cash
DR
. Acc
. Ree
....
ere
Can
tri.
but i
ons
DR. Cash
CR. Ace. Rec.
on. Benefit Costs
CR. Cash
1. DR. Cash
CR
. P.L
F. C
ontr
-tbi
ltion
sOR. ßeneElt Costs
CR. Cdsh
NOTES: 1. Group Life applies to N'lLlc - Mgt, NTe - lIni.on, N'1'C - Non Union, ßNR, NTSL.
2. Cost is fully paid by Nor-the!70 for N'rr.I/C - management and N1'SL¡ cost shat:ed with
employees in other groups
3. Accounting entries wili give detai 1 breakdown pee cliart of accounts.
Q) ~
_...~
~ ...
..-~.
..__.
_.-.
-.-
.. -'-
'._~"
~--'-
----
'-_.._
"--_
.'-'--
"""-
'...-
., -_
._--
_...-
..~-~
._--
-_._
-_._
...._
~--~
----
~._-
-~._
-_..-
.~.._
.._...
.__.
_.__
.._-_
.~...
.-.._
----
-_...
.__.
.~.-
...._
.-...
_~..-
-_._
----
._--
- ...
~-_.
._-_
..~_.
._..
_..._
. --.
-_.._
._--
-.-_
...,,-
_.._
-_..
." ..
- ...
.....
M~IN ACTIVITIES AND JOURN~L ENTRIES
. .._---
GR
OU
P I.
.TI
E I
NSI
J.H
l\NC
E -
Pi\W
l' 2
'rnist ß ooks
Employer's OoOles
1. E
mpl
oyer
rem
its d
educ
tion
s fr
Ql'
empl
oyee
s to
Tru
stDR. Cash
CR
. Ra
te S
tabi
i iz
at io
nfu
nd
DR. Employee deductions
CR. Cash
2. Employer notifies Mutual of
appr
oved
cla
ims
3. Mutual pays claims and reimburses
itsel f from the Bank of Mon treal
Acc
ount
4.Mutual files monthly claims and
expe
nse
repo
rts
DR
. Cla
.ims
Pai.d
Admin. Expense
CR. Cash
S. Claims paid by Mutual are charged
against Rate Stabilization Fund
at year end.
NO
TE
S:1. Group Life applies to NTL/C - Mgt. mc - Union, Non-Oni.on, N'SL, ßNR
2. Cost is fully paid by employee
3. Accounting entries will give deta.il breaki10wn per char-t of accounts.
m N
APPENDIX A
MONTREAL TRUST FEE SCALE
(
~~ . l""_d.~_..¡r ¡r".w.,..-l .~~.ii:¿iu.i.c.j .H-i.~..
J!Y, Pension Administration
c/o Northern Telecom LtdP.O. Box 458, Station A.Hississauga, Ontario
I
NC~~tRR I¥ Q 101010 I 0rLtP lopt¡ilLSA.3A2.. i
I-1anager., ¡
.A.tt.: Pension Fund
'. - )
Rnal Fee AdjustmentBASIC SCALE
-(CALCULATED BASED ON AVERAGE ACCOUNT VALUE AT BOOK n MARKETn )
.ACCOUNT NUMBER VALUATION DATE ACCOUNT VALUE
900920 $
TOTAL VALUE $AVERAGE VALUE $ 4 . Ö 0 a . 00 0 . C 0
. 3 6'~ ON THE FIRST S 1, 000 .. 000 OF ASSETS $ 3.600.0C
. 04% ON THE NEXT S 3,000.000 OF ASSETS 1.200.0C
. % ON THE NEXT S OF ASSETS
. % ON THE NEXT S OF ASSETS
. % ON THE S BALANCE
FEE _. BASIC SCALE ~~,800.00 ,
¡ ((ONAL SERVICES
PENSION Cr.Eo.UES ISSUED _. tI $ $TERMINATION & REFUND CHEQUES tI S
GOVERNMENT REPORTS tI $ .
ii ~J1sI
FEE - ADDITIONAL SERVICES . iiI FUND EVALUATIONi
REPORTS I I~ $ ~:s
TOTAL FEE FORI; ILESS PREVIOUSLY BILLED
.1$BALANCE DUE
(PRORATION ATTACHED IF APPLICABLE)
Interim Fee .(ESTIMATE BASED ON ACTUAL)
BASIC SCALE (1/12 OF -A" ABOVE) PER MONTH - S 400.00ADDITIONAL SERylCES (1/12 OF "B" ABOVE) PER MONTH - S
FUND EVALUATION (1/12 OF "C' ABOVE).
PER MONTH - $
TOTAL INTERIM FEE 1ST MONTH 1$ 40Õ.OÖ------~ .
. .Aal Invoice . S..
Northern Telecom Health & Welfare Fund
~INVOICE NUMBER 15 0 5 2 811
INVOICE DATE
6006-11B.. ~.... ," _.'_ 0._.. . ._. ..... ..... ._' . "
\'i:"
.~ ~Jl~~
"..:"'.t;..' ..!. ..~
.: .:
.":. ~\¡
. '. '.. .L .'
. ".':
. (....:.."
6.. '.
:-~.~..';.J.~ .... .. ~......, _ _.._..._... ...~. _......_.. .__......._ __ .. ." _"'" ._
FEE AGREEHENT
NORTHRN TELECOH LTD.
PENSION FU
THE FOLLOWING ANNUAL FEE' SCALE is APPLICABLETO THE YEAR 1980.
BASTC SCALE
The. ba.M.c. ~c.e. wU be. a.ppUe.d to .the.a.veJge. book. vo.he.* on ct.6e.
hel 1.riclcürig up to $1,000,000 of¡ Ma;iga.ge. aM Re. Eó:te. -uvtU.t-me. .
On the first $ 1 million of assets .36 of 1%
On the next $ 1 million of assets .1S of 1%
On the next $ ,3 million of assets .12 of 1%
On the next $20 million of assets .06 of 1%
On the balance .04 of 1%
* ÁVeJge. book. va1e. me.aii .the.. agglle.ga.e. 06 the ope.lÚg and clo.61.ng book_. vo.ie. 06 the. óund noll .the c.hoge peJd cüv,¿ded cy ;/iX) (2).
FOI the. pUJpo~e 0 n c.cua.g f¡eei i the bCt'¿c. .ó e.e æU app.tfJ.6 e.pa.ely
fpll .the fl.t $ 1 rrn 06 eac.h tU.6c1ed a.cc.ount undeJ OWL a.dmüi1..:t-.tan.. ÁMe: ovVl $ 1 min -ú e.a.c.h ac.c.wi ma.y .ten be c.mUne.d a.ndthe ba.a.c.e. ofi the bc.lc. óee ~c.a.e appUed .t the aggtiega.e.
Fall 1980 i a6.6 ocúed a.c.c.otuit. htclude. Bil NoJrheJ Re. ear..h Pert.la YtFurid a.rid NoJihvu Telecom Lt. Hea.h a.nd We1óaJe TJtt Fwid.
SECURITY TR/iSACTIONS
FOJ. 1980 a.rid ~u.b.6equent lje., :thvi wL be a $7 ceeiy brrta.c.ori
6e.e.. Th. wU apply :t a. c.pJ. .6e.ClIj tJ..ri..a.c.ort .In the Boridaoo Equ.y poJióoUoi. 06 NoJrheJ Teiec.om Ud. and .Jele.d a.c.c.ui-.
MASTER TRUST
FOii f.zato ri 0 Ó pac1aii fi u.nd6 and Ó Oll pltepev.. n 0 Ó rno ntli yJtpoli, a.n a.dcUori óe.e on $600 peJ a.nn nOii each paúpa.ii.-
APPENDIX B
LLOYD · S OF LONDON - EXCESS INSURANCE POLICY
(
\l
~::~~f~~.!J.J:.
(\(
\.
-..-"".~ .'.l:"-""¡:'~~;;..i..,
.....
.1...._..'.. J. H. MINET (CANADA) INC.)i 11 Richmond Street)
Suite.310Toronto i Ontario
M5H 2G4
.". t
I. NAMD ASSURD
Northern Telecom Limited and. all subsidiary, associated and affiliated,companies as now or hereafter constituted.
. .i., . ......II" LIMIT OF LIABILITY
$10,000,000 eaèh and every loss anyone occurrence, and in the aggregateexcess of Assureds r Retention. In the event of loss or .Josses,Underwriters agree to autqmatic reinstatement of the full Umit ofLiability at pro rata additional premium for the unexpired term of thisinsurance but in no event shall Underwiters be liable for more than$ 20, OO~, 000 during the full term of this insurance.
III. ASSUP..DS f RETENTION
$1, 000, 000 aggregate each and every loss anyone. occurrence in the eventof loss or losses which occur' or which commence during the policy periodhereon under the Assureds' Employee Benefit Programme(s) as administeredor serviced by or otherwise involving Prudential Assurance or NutualLife of Canada. In the event of a loss involving Canadian and UnitedStates of America personnel the retention to be applied . in the sameproportion as incurred loss.
iV. . POLICYPERIOD
12:01 a.m. December 3, 1980 to 12:0l .a.m. December 3, 1983 (LocalStandard Time).
v. INSURING AGREEMENT
Und en,ri ter s agree to inde:nni fy the Nameà Assured ,for the amoun t ofultimate net loss in excess of the Assureds' Retention which the Named.Assured may become obligated to pay all persons covered under theAssured's Employee Benefit Progratme(s) as adminii:tered or serviced byor otherwise involving Prudential Assutance or Mutual Life of Canada.(other than short term disability benefits which administered byAssured) in respect of losses arising anywhere in the world, includingwhilst flying as a pilot, cre'Viember or passenger in any aircraft,involving:
( a) Death (whether arising out of accidentbenefits) including survivor incone benefitscommutation Clause) t~hich Occurs during this
benefits and/or life(subject to a two yearpolicy period.
.,'
. ... J.._.~~.~..:gg;;:~.~.'"
- 2 -
tt.
(b) Dismemberment and/or Permanent Lo~al Disablement by accident whichoccurs or commenced during this Policy Period.
(c) Temporary Total Disablement (snort term disability benefitslimited to 52 weeks) commencing du"Cng this Policy Period"
Cd) Medical, Hospitalisation and Dental Services (subje~t to a two yearcommutation clause) commencing ¿u~ing thiß Policy Period.
(e) Long Term Disablement and Per::ê.ent Total Disablement (mortgagerèpayment) (subject to a two rear coi:utation clause) commencing.during this Policy Period. .
Provided all losses are solely due to:
(1) The same accident involving at least tivO persons with. losses paidunder (a) and/or (b) and/or (c) and/or (d) and/or (e) above.
(2) An outbreak or epidemic of the same sickness or disease involvingat least four persons with losses paid under (a) and/or (~) and/or
(d) and/òr (e) above.
f:~
It is understood and agreed t.hat this Policy excludes losses in respectof Workmen r s Compensation Act and Employer s Liabiiit! coverages.
It is also understood 'and agreed that all significant cha.nges in theNamed Assured i s Employee Benefit' Progral!e(s) will be' advised toUnderi"riters at each anniversary but fa.ilure to do so will not affect"the coverage as specified herein.
(
I t is further agreed that slIbjec t other,.:se to the terms) limitationsand cond itions he~eof;
(a) thi's Policy covers claims arisi~¿; Out or bodily injury c~used byexposure to the ele~entS as tha rêsult of an accident covered bythis Policy J and
(b) if an Insured Person disappea~5 a...c the b~cly is not~ found lo'ithin areasonable' period of. tii7e, or: :; ::a:diium period of one year, andUndenrriters, having exar.ineci 2.2.1. available evidence shall have noreason other than to presume ¿~:;~~ in circ~~stances rendering themliable shãll forthwith pay suc~ ~~~efit, 'but if the Insured Personis subsequently found to be li.:i~¿; any sum returned to the l\amedAssured shall immedia tely be rê:u:i¿ed to Undc.rt,;riters.
Vl. DEFINITIONS
The. cerm "Loss Occurrènce" as uSèd i.~ ::,is Policy shall r.e~n eithee
(l )
OR
01 )
An accident involving at least ~~8 pe~sons.
An outbreal;: or epidemic of th", ù::e sicknèssnt least four persons coy:r:.: under theProgramme, who shall.have ~ith~::
or disease involvingAssured's Benefit
t'~~~::...:
( .J\~.~J'
t~. .
3
(a) Received Hospital Treatment (which shall include hospitalout-patient i s treatment).
OR
(b) Received Treatment by. a qualified physician when hospitalfacilities are not available.
OR
(c) Died before receiving treatment by a qualified physician ortreatment in a hospital) in respec t of stich sickness or disease..
.;
Only lÇ)sses in respect of covered persons contracting .the same sicknessor disease and wluch manifests itself within a periodpf 60 days shallbe iiicludep. in one "Loss Occurrence".
Ultimate Net Loss
. The term' .'ui timate net loss" shall mean the to tal sum whic.h the NamedAssured shall become obligated to pay 'under the Assured i s EmployeeBenefit Programe(s) as adminis~ered or serviced by or otherwiseinvolving Prudential Assurance or l1utual Life of Canada as a COnsequenceof any occurrence including expenses for litigation) settlement.. adjustment and investigation of claims and suits which are paid as aconsequence thereof. .Insured Person
The term "Insured Person" shall mean any person. covered by the Assured'sEmployee Benefit Prograrmne( s) as administered or serviced by or other-wise involving Prudential Assurance or Nutual Life of Canada.
VII. NOTICE OF LOSS
The Named Assured shall advise Unden:riters of each occurrence which) inthe judgment of the Named Assured) may result in a claim under'
thispolicy and shall also report any subsequent development relativethereto.
VIII. PAYlllNTS OF LOSSES
Underwriters' share (if any) of each :loss settlem¿mt shall be payableupon receipt of evidence of the amount of said share provided the loss
. has actua~:ix b;.n, pai~ by or o~hJllf of the Named Assured..~ / ~_ tL~/.: ';.c'-t.c.C..:'~,~,,::,.,/'.,-i &-;../'c."7/t¿ i.4..~_,..._ t! ¿-c.;c';/-c . '. / ".Commutatiori Clause applicable to long term disability, surv:ivors incomebenefit, and medical) hospitalization and ¿ental ber.efits' only asfollows:
.. -. 4
':.=';:,-,
It is understood. and .agreed that not later than t\ýenty four months fromthe date of. the loss occurrence the insured shall advise insurers of allclaims not finally set tIed which åre likely to result in claims. orfurther claims under. this policy. Underwriters tYill then capitalisesuch claim or claims on the formula as set out below) and the payment byUnderwriters. of their proportion of the. æ¡ount so ascer,tained to be thecapitalised value of such claim or c1ai'ës shall constitute a completeand final release of Underwriter s.
Long Term Disablement
At the. -end of a two year period froLl the final date of the "LossOccurren'ce" a lump sum equivalent' to 8 years benefits subject to amaximum sum of $500)000, each person shall be added to the sum paid orpayable during the first two years of åisablement.
Survivors Income Benefit
At the end of a two year period from the final date of .the "LossOccurrence" a lump sum equivalent to 8 years benefits subject to a-maximum sum of $500~ 000) each person shall be added to the sum paid;:' orpayable during -the first two years.
Medical, Hospitalisation and Dental Benefit
.(At the end. of a two' year period froii the final date of the "LossOccurrence" a lump sum equivalen t to 8 times the amount paid or payablefor the s'econd. year of these benefits shall be added to the sum paid orpayabl&during the first two years.
ix. SUBROGATION
In case of any payment 'hereunder, Undenrriters tdll act in concert i,Tiththe Named Insured and/or Prudential Assurance and/or Hutual Life ofCanada in 'the exercise of the Named Assureds i right of recovery agains tany person or other entity. The apportioning .of any amounts which maybe so recovered shall follotol the principle that the Named Insured-and/or Prudential Assurance and/or Hutu'e.l Life of Can?da that shall havepaid an amount in add ition to any paYDent. he.reunder shall first bereimbùrsed up to the amount paid by them; the Unden,-riters are then tobe reimbursed out of any balance then re::aining up to the amount paidhereunder; lastly) the Named Insured andlor Prudential Assurance and/orHutual Life of Canada are entitled to. claim the residue) if. any.Expenses necessary to the recovery of arty such amounts shall beapportioned between the ~amed Insured ~nd/or Prudential Assurance and/ori'lutual Life of .Canada concerned, in the. ratio of their respectiverecoveries as finally settled.
X. INSPECTION OF RECOP~S
The Underwriters shall' have the right to inspect, through thcirauthorized representatives, Dt all ruesona.ble times during the currencyof this Agreement and thereafter, th~ boo~s i recorås and papers of theì\D.med Assured pertaining to this instll:anc:e e:1d all claims hereunder.
Cèi~;'i": .
(.-
'.c" .
- 5 -
BA1~RUPTCY AND INSOLVENCY
In th~ event of .the bankruptcy or insolvency. of the Named' Assured,Underwriters shall not be relieved thereby of the payment of any claimshereunder because of such. bankruptcy or insolvency_
xi:(.. SERVICE OF SUIT
.~-"It is agreed that in the event of the failure of Underwriters hereon topay any àmount claimed to be due hereunder, Underwriters, at the requestof the Named Assured, will submi t to the jurisdiction of any Court ofcompetent jurisdicition within the United States and/or Canada and Vrill. comply with aii requirements necessary to give such Court jurisdictionand all matters arising hereunder shall be determined in accordance withthe law and prac tice of such Cour t.
It is further agreed that service of process in such suit' may be madeupon Mendes & Haunt, Three. Park Avenue, l~ew York, N.Y. 10016 and/or.J.A. Madill, C..A., Suite 1..400,635 Dorcheste'r Blvd. Ouest, :Hçintreal,
Quebec H3B 183 Canada and that in any suit instituted against anyoneof them upoi' this policy, Underwrite!' s will abide by the final decisionof such Court or of any Appellate Court in the event of an appeal. .
XIII. APPEALS
In'.:the eVent the Named-' Assured elects not to appeal judgment in excessof the Assureds' Retention. Under~~iters may elect to make such appealat their Otff cost and expense) and s:iall be liable for the taxable costsand disbursements and interest .on judgments incidental thereto, but in.no event shall the liability of tnden:riters for ultimate net lossexceed the amount set forth herein' for anyone occurrence and inaddition the cost and expense of such appeal.
XiV. CANCELLATION
This policy may be cancelled by theXamed Assured or by Underwriters bysending by registered mail notice t.o the other party stating not lessthan ninety (90) days prior to ann:..iersary that cancellation shall beeffi:ctive as of said anniversary date only.. The mailing of notice asaforesaid shall be sufficient proof of notice, and the insurance underthis policy shall end on the anniver sary ¿ate and. hour of cancell ationstated in the notice.
If this' policy shaii be cancelled, !lnden'riters shall retain the prorata proportion of the pri=miur for .:he pe.riod this policy has been inforce.
X,V. CURRENCY
The premi~ms under this policy are ?aY2ble in the currency of the UnitedStates of America and Canada in equal pro'pol:tions. Losses under thispolicy are payable in Uniteå States '==- Can.:èian dollars as applicable.
.. '. ~
J. ,-
6 -
XVI. CONFLICTING STATUTES
..:.....
. ~ . .
'... ".
In the event that any provision of this 'policy is nne..forceable underthe laws of any State, or other j~risdiction wherein it i~ claimed thatthe Named Assured. is liable for any injury covered hereby tben thispolicy shaii be enforceable by the Named Assured with the same effect asif it was e.nforceabie under such la\.,s.
XVII. WAR AND CIVIL VAR EXCLUSION CLAUSE'
Notwithstanding anything to. the contrary contained herein this Poliçydoes not cover Loss or Damage directly or 'indirectly occa.sioned by).happening through or in consequence of war, invasion) ac ts of foreignenemies, hostilities (",'hether \o7ar be declared or not) J civil war)rebellion) revolution) insurrection) military or usurped power ~rconfiscation or nationalisa.tion, or requisition or destruction of ordamage to prôpe;cty b)' or under the order of any government or publ.ic orlocal 'authority.
=¡_..
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(
APPENDIX C
NORTHERN TELECOM - MUTUAL LIFE ASO
l1titthCtMtafccum
MEMORANDUM
August 13, 1981
/.(e,,,,,''~~:.:'
To: D.J. Cooper BNR CorkstownG. Coul sen 88 Mi ssi ssaugaB.B. Craig 48 MississaugaH. C. Denni s 1132 IslingtonA.F, GjyeO 65 MississaugaJ. Henderson 1462 IslingtonP. R .' Kn u b 1 ey 104 MississaugaC. Mi chaud NTSL Nunls IslandV.G. Raymond 1405 IslingtonD. L Su 11 i va n 81 Mi ssi ssaugaPaul. Simon 1315 Isl ingtonKei th Robi nson 1120 Isl i ngtonSteve Wisniewski 1121 Isl i ngton
P.D. Day, 65 Mi ssi ssaugaFrom:
Subject: 'Self-Insurance Manual
Attached is the signed ASO Agreement which is to be inserted asAppendix C. (
-2\~~Paul Dc Da~
,c.
ADMINISTRATIVE SERVICES AGREEMENT
iIS AGREEMENT made as of the 1st day of January, 1980~.
BETWEEN
MONTREAL TRUST COMPANY, a company dulyincorpora ted under tne laws of thePro v ince of Quebec, having its head.off ice in the City of Montreal, Quebec
(hereinafter referred to as the"Trustee" )
AND
NORTHERN TELECOM LIMITED, a companyorganized and existing under the lawsof Canada, having its registered officeat 1600 Dorchester Boulevard, Montreal,Quebec
(hereinafter referred to as "NorthernTelecom" )
AND
THE MUTUAL LIFE ASSURANCE COMPANY OFCANADA, a corporation incorporated byAct of the Parliament of Canada, havingits Head Office in the City ofWaterloo, Ontario
(hereinafter referred to as the"Administrator") .
WHEREAS the Trustee herein did enter into a Trust Agreement dated as ofthe'1st day of January, 1980 with Northern Telecorn Limited in respectinter alia of Survivor Plans, Health Care Plans, and Long Term DisabilityPlans (hereinafter referred to as the "Trust Agreement") and providing forthe establishment of a trust to be administered by the Trustee.
AND WHEREAS the Trust Agreement provides for the appointment by theTrustee of an Administrator for the carrying out of the normaladministration of the terms of the Trust Agreement and the parties heretowish to enter into this Agreement pursuant to such provision.
NOW THEREFORE WITNESSETH THAT in consideration of the mutual covenantsand agreements herein contained and subject to the terms and conditions~reinafter set out the parties agree as follows:
1
==..~-... ..-
-i-
.::,
1. Definitions
In this Agreement:
. "Trust Agreement" mea ns the Trus t Agreement dated as of January 1st,1980 between Northern Telecom Limited and Montreal Trust Company andincludes The Health and Welfare Plan and its Appendices as may beamended from time to time.
2. ..Term
This Agreement shall .continue until terminated by either party heretoin accordance with the provisions of Article 12 hereof.
3. Administrative Services
(1) The Administrator shall provide the following basic administrativeservices:'
(a) receive and e~amine all claims¡
(b) determine the eii'gibility of claimants and the propriety ofeach claim under the Trust Agreement ¡
(c) notify claimants of the allowance or disallowance of theirclaims i
(d) remit payment of allowed claims as provided in the appendices; (
(e) maintain appropriate records of all claims received and allpaymen ts made;
(f) notity the Trustee of any disputed claim;
(g) upon requ~st by the lrustee provide
(i) periodic claims analys is( i i) claim control information
(ii i) claim accounting(iv). claim forms(v) benefit pricing
(vi) cost analysis, including projections for future periodsand estimates of outstanding liabilities
(v ii) advice on plan design trenqs.(2) In addition, the Administrator shall provide such other services
related to the administration of the Trust Agreement, as may beagreed upon from time to time by the Trustee, Northern Telecom andthe Administrator.
(3) On reasonable notice the Administrator shall make available to theTrus tee during regular bus iness hours, for the purposes ofinspection and copy ing, all claims records, files, accounts andother documents relating to the administration of the TrustAgreement.
2
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4. Administration Fees
(1) The Trustee shall pay to the Admi~istrator for the services setforth in Article 3 (1) the following fees:
(i) General Administrat ion
(i i) Prof it
(ii i) Claims Administration(a) Survivor Income Benefit
(b) Survivor TransitionBenef i t
.
(/\~..
(c) Long Term DisabilityBenef it
. 45% ~f. ~ll cash claims paid inrespect òf the Survivor Plansand Long Term Disabili ty Plans.40% of all cash claims paid inrespect of the Survivor Plansand Long Term Disabili ty Plans
$70.00 per death claim, to becharged only once, where noclaim has been made under GroupInsurance Contract G 13900 orG l5 250, P I us$3.50 per cheque issued, plus$.20 for each deduction on eachcheque issued.
$70.00 per death claim, to becharged only once, where noclaim has been made under GroupInsurance Contracts G 13900 orG 13901, plus$3.50 per cheque issued, plus$.20 for each deduction on eachcheque
$125.00 per in-force claimduring the first yeai
: $137.00 per in-force claimduring the second year
L $151.00 per in-force claimduring the third yearplus $3.50 per cheque issued,plus$.20 for each deduction on eachcheque issued
(2) Northern Telecom shall pay to the Adminis tra tor for the serv icesset forth in Article 3 (1) the following fees:
( i) General Administration .45% of all cash claims paid inrespect of the Health CarePlans
(i i) Profit .40 % of all cash claims paid inrespect of the Health CarePlans
( iii) Claims Administration(a) Health Care Benefit $2.90 per cheque issued, plus
pos tage for each cheque
3
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$1.83 per cheque issued in the.first year of the Agreement,plus postage for each cheque$ 1.91 per cheque iss ued in th esecond year of the Agreement,plus 'postage for each cheque$1. 99 pe'r.. cheque issued in thethird year qf the Agreement,plus postage" for each cheque
In the event this Agreement continues beyond December 31, 1982, theparties shall agree upon .new administration fees. If the Trustee,the Administrator and Northern Telecom do not reach agreement onthe new, administrative fees prior to January 1, 1983, theadministration fees set out above shall continue in effect untilagreement is reached on new administration fees, such fees to beeffective retroactive to January 1, 1983.
(b) Dental Benef it
(3) The Trustee and Northern Telecom shall pay to the Administrator forthe services set forth in Article 3 (2) such fees as may be agreedupon from time to time between the applicable partïes.
5. Funding
(1) The Administrator shall advise the Trustee from time to time and atleast annually prior to the end of the caléndar year of the levelof funding required to pay the claims hereunder. The Administratorshall use its best efforts to so advise the Trustee by thebeg inning of December. (
(2) The Trustee will deposit in a bank account upon which theAdministrator is authorized to draw cheques, such funds as may bedetermined from time to time to be necessary i the Administratorwi 11 pay from such funds all cl aims approved in accordance with theterms of thi s Agreement and the Trust Agreement.
i
I
6. Invoic ing and Payment
(1) The Administrator shall submit invoices on a monthly basis to theTrustee and Northern Telecom for the administration fees incurredin the prev ious mon th as prov ided in Article 4 (1) and (2).
(2) The Trustee and Northern Telecom shall pay such invoices wi thinthirty (30) days of receipt thereof.
7. Indemn i ty
The Administrator shall reimburse i indemnify and save harmless theTrustee for any loss to or diminution of the funds administered by ithereunder arising from or due to the default, wilful misconduct, lackof good faith or negligence of the Administrator, its employees, agentsor servants.
4
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8. Amendments to Trust Agreement
The Trustee shall give the Administrator reasonable' notice of relevantamendments to the Trust Agreement affecting the performance of this
. Agreement.
9. Interpretation
Any reasonable interpretation of this Agreement and the TrustAgreement made by the Administrator in good faith and not contrary tospecific instructions of the Trustee shall be binding upon theTrustee.
1 O. Special Instruct ions
Notwithstanding any other provision of this Agieement and prior to thepayment of any claim hereunder, the Trustee or Northern Telecom mayinstruct the Administrator in writing of the amount of the claim to bepaid. Such amount shall not exceed the maximum amount payable underthe Trust Agreement for such ciaim.
11. Tru s tee · s Record s
The Trustee shall fûrnish to the Administrator such records and anyother information as the Administrator may reqsonably require toperform its serv ices hereunder subject always to the Trustee i s rightto refuse disclosure for reasons of confidentiality.
12. Termination
( l) Th is Agreement may be terminated:
(i) as.of December 3lr 1980 or any time thereafter, upon sixty(60) days pr ior notice by the Trus tee to l:he Administrator;
(ii) as or December 31, 1982 Or any time thereafter, upon sixty(60) days prior notice by the Administrator to the Trustee.
( 2) Upon termination of th is Agreement, the follo~ing shall occur:
(i) the' Trustee and Northern Telecom shall reimburse theAdministrator for any fees for services rendered hereunderfor which they are responsible as herein provided, up to thetermination date and remaining unpaid at such date; and
(ii) the Administrator shall surrender and deliver to the Trusteeall claims records, files, accounts and other documentsmaintained by the Administrator pursuant to this Agreement.
5
. .-"P-n~~~.____...._
"~~~'~~~tffl~j::1;~ff;~~;,;;t .,13. Notices
Any and all notices or other information to be given by one of theparties to the other shall be deemed sufficiently given when forwardedby prepaid registered or certified first clas~ air mail or by cable,telegram, telex, TWX or hand delivery to the other party.
Such notices shall be deemed to have. been received .five business daysafte r mail ing if forwarded by mai 1, and the following bus iness day if
-. forwarded by cable, telegram, telex.,. TWX or hand.
In the event of a generally-prevail ing labour dispute or othersi tuation which will delay or impede the giving of notice by any suchmeans, the- notice shall be given by such specified mode as will bemost reI iable and exped i t ious and leas t affec ted by such dispute orsituation. .
14. Non Waiver
The failure by any party at any time to enforce any of the provisior,sof this Agreement shall not be construed to be a waiver of suchprovision or of the right of ei ther party thereafter to enforce suchprovision.
15. Governing Law
This Agreement arid all questions pertaining to its validity,construction and administration shall be determined in accordance wi ththe laws of the Prov ince of Ontario.
IN WITNESS WHEREOF the parties hereto have executed this agreement andaffixed their corporate seals under the hands of their officers dulyauthorized in that behalf.
MONTREAL TRUST COMPANY THE MUTUAL LI FE ASSURANCECOMPANY OF CANAD~ì¿
50 r?d.~aT'Vice-President(Group Insurance)
,.,0
Executive f .(Group Market"Ohi 'rwllRTHERN TELECOM LIMITED
'~::~'~, ~w. ... "Vic ... . iSecretarY, "': ,;
~
~"
G,~
-~~"'._."''"''''~,..___~~.____,._ .._____J
APPENDIX D
NORTHERN TELECOM - MONTREAL TRUSTTRUST AGREEMENT
(
". I'"
THIS AGREEMENT made as of the 1st day of January, 1980.
BET WEE N:
NORTHERN TELECOM LIMITED,a corporation incorporated underthe laws of Canada, and hav ingits Registered Office in theCity of Montreal, Prov i nce ofQuebec, .(here inafter referred to as the"Corpora t ion" )
A l~ D:
MONTREAL TRUST COMPANY,a company incorporated pursuantto the laws of Quebec and hav ingits Head Office at the City ofMontreal, therein,
(here inafter referred to as the"Trustee" )
(WHEREAS:
1. The Corporation has established for the benefit ofcertain of its employees and the employees of such af f ilia ted or
subsidiary Corporations as the Corporation may designate, certain
Heal th and Helfare plans, and such other similar plan or plans as
the Corporation may from time to time place in effect, asfollows:
a) a. Heal th Care Plan;
b) a Management Long Term Disability Plan;
c) a Union Long Term Disabil i ty Plan;
d)' a Management Survivor Income Benefit Plan;
e) a Management Short Term Disabil ity Plan;
2
. f) a Group Life Insurance Plan i
all of which are hereinafter collectively referred to as the
"Health and Welfare Plan".
,2. To give effect to the Health and Welfare Plan it isnecessary to establish a trus t fund to be known as the "Heal th
and Welfare Trustu.
Now therefore in consideration of the premises and the
mutual covenants herein contained the Corpotation and theTrus tee, hereby covenant and agree as' follows:
ARTICLE I - DEFINITIONS
1. The term "Trustee II shall mean the Trustee here innamed its successors and assigns and shallinclude the person, legal entity or corporation
to whom the Trustee may deleg a te such powers asare necessary for the sound and efficientadministration of the Trust Fund.
("
2. The term "Benefitsll as used herein shall mean
payment benefits as determined under the Health
and WeI fare Plan.
3. TlTe te rm II 81 i!li:bili:!.y._B:~g~i:.E~~~Q!~ II as use d
herein shall mean the rules, regulations and
procedures established fro~ time to time by the
Corporation for determining the eligibility of
Employees for Benef i ts .
4. The term "Employees" shall mean those ac t i ve and
ret ire d em p loy e e s 0 f the Cor p 0 rat ion and.
3
designated affiliated or subsidiê~y corporations
which have aòopted the Heal th and Wel fare PI an,including dependents as defined in Schedule A, on
whose behal f contributions are or have bean made
to the Trust Fund and who are eligible for
benefi ts under the Heal th and Welfare Plan.
5. The term "Employer i s Contribut ion" as used here in
shall mean payments required to be made by the
Corporation and by designated affiliated or
subsidiary corporations to the Trust Fund toenable the Trustee to discharge. the obl1gations
aris ing under the Health and Welfare Plan.
6. The term "Trust Fund" as us ed here in shal 1 mean
-all of the assets of the "Health and Welfare
Trus t" incl ud i ng al 1 fund s rece i ved by way ofcontributions from the Corpora tion and those of
its designated affiliated or subsidiary (corpora t ions in accordance wi th the prov is ions ofthe Health and Welfare Plan and of this Trust
Agreement, and all employees i contributions
together with all profits, increments, andearnings thereon.
ARTICLE II - TRUST FUND
1. The Trust Fund is created for the purpose of
providing the Health and Welfare Plan benefitsfor the benefi t of the Employees.
2. All payments made to the Trustee from time to
time by the Corporation and designated affiliated
or subsidiary corporations and by the employees,
together with all profits, increments and
4
earnings thereon, shall be irrevocable and
consti tute upon receipt by the Trustee, the TrustFund to be administered by the Trustee ina c cor dan c e wit h' the t e r m s 0 f t his T r u s tAgreement, the He~lth and Welfare B~nefit Plan
and the Eligibility Requirements.
3. The Trustee shall from time to time on thewritten directions of an officer of theCorporation so designated by its Board ofDirectors, or failing such desjgnation, by the
Secretary, of the Employees i Benef i t Committee of
the Cor p 0 rat ion, . 0 raP 1 a n Adm i n i s, t rat 0 rappointed by the Corporation, make payments out
of the Fund to such persons, in such manner and
in such amounts as may be specified in suchdirections to the Trustee. In each instance, the
written directions shall be deemed to include a
certification to the Trustee that such directions
and the payments to be made pursuant thereto are
in accordance wi th the terms of the Heal th and
Welfare Plan, which certification shall con-
stitute full and complete protection to theTrustee in comply ing with such directions.
'ARTICLE III - TRUSTEE
1. The Trustee, who shall also be known as the"Trustee of the Health and Welfare Trust", hereby
accepts the trust created by the Trust Agreement.
and agrees to hold, invest, ~istribute andadminister the Trust Fund in accordance wi th the
5
terms and conditions of the Health and Welfare
Plan and this Trust Agreement.
2. The Trustee is authorized and empowered:
a) To sell or otherwise dispose of any prope rty
held by it i .
b) To exercise all voting and other rights in
respect of any stocks r bonds, properties or
other investments held in the Trust Fund i
c) To execute all documents of transfer and
conveyance that may be necessary orappropriate to carry out the powers herein
granted i
d) To make payments out of the Trust Fund and to
reimburse itself for disbursements incurred
pursuant to the exercise of the authorities
and powers herein set forth r unless paid by
the Corporation i
(".
e) All monies, securities for money and other
assets from time to time held' by the Trus tee
may be in negotiable form or recorded or
reg istered in the name of the Trus te e or inthe name of i ts nomin~e i
f) When instructed to do so' by the Corpora tion,
to commence, rna i nta in r de fend, adj us t andsettle suits and legal proceedings and to
represent the Trust Fund at any such suits or
proceedings at law or otherwise for theenforcement or realization of any investment i .
6
provided that the Truste~ shall not beobliged or required to do so unless it has
been first indemnified to its 'satisfactionagainst all expenses and liabilitiessustained or anticipated by it, and theCorporation hereby agrees so to indemnify the
Trustee.
g) In general, in the carrying out of its duties
and responsibilities under the TrustAgreement to exercise the general powers
accorded by law to trustees.
(',-,.
h) The Trustee shall hoI d, inves t and re i nve s tthe principal and income. The Trustee may
keep the investments of the Trus t fund whollyor partly, in its principal office or in' any
one or more of its branches in any Prov ince
of Canada. Unless otherwise direc ted by theCorpora tion, the Trus tee shal 1 make only such
investments as comply with the limitations
and restrictions imposed by applicableFederal and Provincial laws and regulations
respecting the investments of trust funds.
Notwithstanding the foregoing, theCorporation may, at any time, or from time to
time, direct the Tru~tee as to specific or
general investment of the Trust Fund, an~ the
Trustee shall comply wiih such directions.
Whenever the Trustee is required orauthorized to take any action pursuant to the
provisions of this paragraph upon therequest, direction or authorization of the.
7
Corporation, such request, direction or
authorization shall be a sufficientprotection to. the Trustee if contained in awri ting s i g ned by any person aU thor i zed byresolution of the Corporation i s Board of
Directors to. sign such a writing. TheCorporation will indemnify and hold harmless
the Trustee of and from any liability o~
expense incurred by it arising out of any
payment out of or disposition of the Trust
Fund made by the Trustee pursuant to any such
request, ~irection or auth9rization of the
Corporation.
i) The Trustee may hold such part of the Trust
Fund uninvested as the Trustee may deem
advisable in the best interests of the Trust
Fund for the proper administration thereof.
(j) The Trustee may keep such portion of the
Trust F~nd, as may from time to time bedeemed by it to be in the best interests of
the Trust Fund, on deposit in a chartered
bank or Government Savings Bank in Canada at
such rate of interest, if any, as may be
allowed thereon, or on demand deposit at an
agreed interest rate wi th any Tras t Company'
(including the Truste~) then iicensed under
the laws of Canada or of . any Province thereofto carryon business as ~uch.
k) Notwithstanding any other provision of this
Agreement and subject to clause 2 (h) hereof,
the Trustee will invest and reinvest all or
s u c h po r t ion 0 f the T r us t Fun d as the.
#
8
Corporation may from time to time direct in
writing in the Northern Teleco~ Group Trust. .Fund established by the Company and theTrustee pursuant to an Agreement. made andentered into as of the 1st day of January,
1980.
1) (i) the Trustee shall, in accordance with'
the written direction of the Corpora tion
from time to time invest all or any part
of the Trust Fund jointly with assets
belonging to any oth~r tru~t fundsmaintained under a pension planmaintained with the Trustee by theCorporation or by any Corporationassociated, subsidiary to or affili~ted
with the Corporation, and may jointly
invest and reinvest on behalf of the
Trust Fund and s~ch other trust ortrusts, allocating undivided shares or
interests in such investments orreinvestments to the two or more trus tsin accordance with their respective
interests. TO facilitate theadministration of such joint investments
or reinvestments, the Trustee shallidentify the .undivided shares orinterests by way'of "units" which shall
represent the undivided ownershipinterest of each participating trust
fund in the jointly owned investments i
(ii) the Trustee shall invest and reinvest
all or any portion of the Trust Fund in
accordance wi th the written direction of
9
the Company in any "Poo:'ed Fund" which
phrase shall mean in this Agreement any
pooled trust fund maintained by the the
Trustee or one of its associated or
affiliated Corporations licensed to do
business in Canada as a Trus.tee. Such
written direction shall specify thatsuch portion of the Trust Fund to be
invested in such Pooled Fund shall be
invested as part of one particularsection of the Pooled Fund or as parts
of two or more sections of the PooledFund in such proportions as is set out
in such direction, failing whichspecification the same shall be invested
as part of one particular section of the
Pooled Fund in such proportion as' the'Trustee deems adv isable .
m) The Trustee may, with the consent of theCorporation, borrow money in such amounts and
u po n s u c h t e r m s an d con d i t ion s as its hal 1
deem advisable and pledge any ßecurities or
other property for the repayment of any such
loan.
n) The expenses incurred by the Trustee in the
performance of its duties, and suchcompensation to the Trustee as may be agreed
upon in wri ting from time to time between the
Corporation and the Trustee, shall be paid by
the Corporation. All taxes of any and all
kinds whatsoever tha t may be lev ied upon or
in respect of the Trust Fund shall be paid
10
from or be the responsibili' y of the Trust
Fund.
0) The Trustee shall not be liable for themaking, retention, or sale, in good faith, of
any investment or reinvestment made by it as
herein provided, nor for any loss to ordiminution of the Trust Fund, except due to
the negligence, wilful misconduct or lack of
good faith df the Trus tee r its servants,
agents or employees.
(
p) The Trustee shall keep accurate and detailed
accounts of all investments and transactions
made by it pursuant to. th i s Agree men t an dshall keep separate records for each of theseparate Plans. The accounts and records
relating thereto shall be open to inspection
at all reasonable times by any persondes igna teä by the Corporation. wi thin ninety(9.0) days following the close of each fiscal
year of the Trust Fund, or wi thin ninety (90)days after the removal or resignation of the
Trustee. as provided for in paragraph (q)hereof, the Trustee shall file with theCorporation a statement setting forth all
investments and cash transactions effected by
it during such fisca~ year or during theperiod from the close of the last fiscal year
to the date of such removal or re'signation.Upon the expiration of ninety (90) days after
the date of filing such annual or otherstatement, but subject to the provisions of
paragraph (0) he reo f, the Trus tee shal 1 . bereleased and discharged from all liability
11
and accountability to anyone with respect to
its acts and transactions during the period
covered by the statement. The TrUstee shall
from time to time make such reports andfurnish such information concerning the trustto the Corporation as the Corpora t ion may in
wri ting request.
q) The Trustee may be removed by the Corpora tion
at any time upon ninety (90) days notice in
writing to the Trustee. The Trustee mayresign at any time upon ntnety (90) days
notice in writing to the Corporation. Upon
such removal or res ig na t ion of the Trus tee,
the Corporation shall, within said ninety
(90) day period, appoint a successor trusteeor trustees who shall have the same po~ers
and duties as those conferred upon theTrustee hereunder and, upon acceptance of (such appointment by the successor trustee or
trustees, the Trustee shall assign, transfer
and pay over to such successor trustee or
trustees the funds and properties andaccounts then constituting the Trust Fund.
The Trustee is authorized however, to reserve
such sum of money, as may at such time be
reasonably owing to it for payment of its
fees and expenses a~d any balance of such
reserve remaining after the payment of such
fees and expenses shall be paid over to the
successor trustee or trustees within thirty.
(30) days after the date of such removal or
resignation.
r) The Trustee shall not be bound to act in.
('
12
accordance with anY'directic..i or request 'ofthe Corporation or of its Board of Directors
until a duly authenticated copy of theinstrument or resolution conta~ning such
d ire c t ion or r e que s t s hal I h a v e be e n
delivered to the Trustee, and the Trustee
shall be empowered to act upon and sh all be
fully protected by the Corporation in actin~in accordance with any direction or request
of the Corporation upon rece ipt of any su ch
copy purporting to be authenticated andbelieved by the Trustee to pe genuine. Any
direction, request, certificate or otherinstrument to be made or given by theCorporation under any of the provisionshereof shall, unless otherwise providedherein, be deemed suff iciently au then t i ca tedif certified by the Secretary or an Assistant
Secretary of the Corporation.
s) The Trustee may appoint a qualified person,
firm or corporation to act as administratorof the. Trust Fund to determine on a sound
actuarial basis the amounts of Employer's
contributions required in order to fundadequately the Health and Welfare Plan and to
advise and carry out administrative pro-
cedures in accordanc.e with the Health and
W elf are PI a nan d the Eli 9 i b iIi t YRequirements.
ARTICLE IV - EHPLOYER' s CONTRIBUTIONS
1. The Corporation and its designated affiliated or
subsidiary corporations agree to make Employer iS,
13
contributions to the Tiust Fund 'in amounts suf-
f~cient to pay any claims which may be asserted
against the Trust Fund as a result of theadministration of the Health and Welfare Plan,
and as may otherwise be required from time to
time by the Trust for the purposes of the Heal th
and Welfare Plan,. as determined by the Trustee on
a sound actuarial basis.
2. The Trustee shall determine or cause to bedetermined, on a sound actuarial bas is from timeto time, and in any event, onc~ every calendar
year, the level of contributions to the Trust
Fund necessary to fund adequately the Heal th and
WeI fare Plan.
3. Subject to paragraphs (l) and (2) hereof,' theCorporation and its designated affiliated or
subs id iary corporations shall be respons ible forthe adequacy of the Trust Fund to meet anddischarge any and all payments and liabilities
under the Heal th and Welfare Plan.
(
ARTICLE V - NOTICES
l. Any notice provided for herein to be given by one
party to another shall be in writing and shall be
effectively given if del iyered personally or bytelegram or prepaid registered mail addressed tothe Trustee at:
Montreal Trust CompanyPension Trust AdministrationPlace Ville MarieMontreal, Quebec H3B 3L6
14
and if to the Corporatiun at:
Northern Telecom LimitedBox 458, Station AMiss issauga i Ontario LSA 3A2
Attention: Director i Corpora te Compensations
Any notice so given shall be deemed to have been"
given if delivered personally or given by prepaid
registered mail on the third business dayimmediately following the date of mailing of such
notice.
(
ARTICLJ; VI - AMENDMENT AND TERMINATION
1. This Trust Agreement may be amended in. anyrespect from time to time by mutual agreement of---------------the Corporation and the Trustee except that no
amendment shall divert the Trust Fund or any part
thereof as consti tuted immediately prior to such
amendment to a purpose other than the provision
of Benefits as herein defined.
2. Upon sixty (60) days prior written notice to the
Trustee f the Corporation may terminate its
obligation to make Employer i s contributions in
re~pect of benefits after the date of. writtennotice to the Trustee (hereinafter called the
"Notice of Termina tion" ). . Upon rece ipt of the
Notice of Termination the Trustee shall within
one hundred twenty (120) days determine and
satisfy all expenses, claims and obligations
arising under the terms of the Trust Agreement
and Health and Welfare Plan up to the date of the
Notice of Termination. The Trustee shall also
". .
15
determine upon a sound actuarial basis, the
amount of money necessary to pay and satisfy all
future benefits and claims to be made under the
Plan in respect to benefits and claims. up to the
date of the Notice of Termination. TheCorporation and the designated affiliated or
subsidiary corporations shall be responsible to
pay to the Trustee sufficient funds to satisf~
all such expense.s, claims and obligations, and
such future benefits and claims. The finalaccounts of the Trustee shall be examined and the
correctness thereof ascertained ~ndcertified bythe auditors appointed by the Trustee. Any funds
remaining in the Trust Fund af ter the sa tis fac-tion of all expenses, claims and obI i gat ions and
future benefits and clai~s, arising under the
terms of the Trust Agreement and the Heal th' andWelfare Plan shall revert to the Corporation.
(',-...
ARTICLE VII - GOVERNING LAW AND SEVERABILITY
1. This Trust Agreement. and all amendments thereto
shall be administered, construed and enforced in
accordance with the laws of the Province ofOntario.
2. If any provisi:on of this Trust Ag.reement, the
H e~ i t han d W elf are P 1 ~ n, the Eli g i b i lit Y
Requirements or the rules and regulations made
pursuant thereto, or any action taken in the
administration of the funds of the Trust Fund or
the Health and Welfare Plan are held to bei i leg a i or in val id for any. rea son, s u c h
illegality or invalidity shall not affect the
remaining portions of this Trust Agreement, the'
16
Health and Welfare Plan, the EligibilityRequirements, or the rules and regulations made
pursuant thereto unless such illegality orinvalidity prevents accomplishment of thepurposes of the trust hereby created. In the
event ot any such holding, the parties willimmediately commence negotiations to remedy any
such defect.
ARTICLE VIII - CLAIMS BY BENEFICIARIES
l. No person entitled to benefits under the Plan
shall have any claim'.against the Trustee or theTrust fund except by or through the Corpora t ion,and the Corporation shall indemnify and save the
Trustee harmless from any such claim including
the costs of defense.
ARTICLE IX - MISCELLANEOUS
1. Wherever in this Agreement the ~ord "Corporation"
is used, it shall be deemed to mean and shall
include the Corporation i s successòr and any otherCorporation with which the Corporation may have
amalgamated, whether under its present name or
any other name.
To the ex.tent required by any Federal orProvincial law or regulation that are or might be
promulgated from time to time, the Corporation
shall be the administrator of the Plan and the
duties of the Corporation as such administratothereby are delegated to the Trustee to the extent
prov ided in this Agreement.
l7A copy of the Heal th and Welfare Plan ini t i al 1 edby the Parties may be annexed to this Agreement
and may be amended from time to time and when so
annexed shall form part hereof, but no terms or
provisions of this Agreement shall be construed
or interpreted as imposing upon the Trustee any
obl iga tion to see' to the administra tion of or thecarrying out of any of the terms or provisions of
the Plan.
Any corporation resulting from any merger or
consolidation to which the Trustee may be a party
o r 5 u c c e e din 9 tot h e t r u s t 'b u sin e s s 0 f the
Trustee, or to which substantially all the trust
assets of the Trus tee may be trans f erred wh i le_ the Trustee continues to act as Trustee hereunder
shall be the successor to the Trustee here~nder
without any further act or formality with like
effect as if such successor trustee had orig in-
ally been named trus tee herein.(
IN ViITNESS WHEREOF, the parties have caused thisAgreement to be executed by their respective officers thereto
duly authorized and their corporate seals to be hereunto affixed
and attested as of this 1st day of January, 1980.
~..~t !_~C.'\!. C.::::'í. j~ORTHERN TELECOM LIMITED1 1i~',' ~er, G", JIlI¡~í ;..,... ,..-1 Vice President¡ ~.. '-"'-'':.) i ~.L~~~J1~~L~~per: (£L ~ '--.
Secretary
MONT9~UST COMPAllY ,/' . /~) /,,/d .~: ./ 'A ~.o .'~-t:-;rTELOCK. .SEWOR CONSULTANT, ~EAD OfFICE PENSION SEflVIC( ./
Per: .~~. cY' /' '.-.
APPENDIX E
NORTHERN TELECOM - QUEBEC BLUE CROSS ASO
ADMINI STRATIVE SERVICES AGREEMENT
AGREEMENT to be effective 1st day of January, 1981.
BETWEEN
COMPAGNIE MONTREAL TRUST, a company duly in-corpora ted und e r the 1 aw s of the Prov i nce ofQuebec, having its head office in the City ofMontreal, Quebec, ,
hereinafter referred to as the "Trusteell
AND
NORTHERN TELECOM CANADA LIMIT~E, a corpo ra t ionduly organized and existing under the laws ofthe Province of Ontario, having its head officeat 304 The East Mall, Islington, Ontario,
hereinafter referred to as "Northern Telecom"
AND
ASSOCIATION D'HOSPITALISATION DU QU~BEC, acom'pany du'ly incorporated under the laws of theProvince of Quebec, having its head office inthe City of Montreal 1 Quebec,
i\
here inafter refe rred to as the "Adminis trator"
WHEREAS the Trustee herein did enter into an Agreementrna d e a s 0 f the 1 s t 'd a y 0 f Jan u a ry, 1 9 8 0 wit h Nor the r nTelecom Limited in respect of, inter alia, an ExtendedHealth Care Plan and Dental Plan for certain employees ofNorthern Telecom Canada Limitée (the Ileinployees") (herein-after referred to as the "Trust Agreement") and providingfor the establishment of a trust to be administered by theTrustee.
AND WHEREAS the Trust Agree~ent provides for the ap-pointment by the Trustee acting on behalf of the employeesof an Administrator for the carrying out of the normaladministration of the terms of the' Trust Agreement and theparties hereto wish to enter into this Agreement pursuant tosUch provision. .
- 2 -
NOW THEREFORE THE PARTIES HERETO 'MUTUALLY COVENANT ANDAGREE AS FO LLOWS :
1. Def ini tions
In th is Agreeme nt:
(1) "Claims" means all benefits payable in respect ofthe Extended Heal th Care Plan and Dental Plan pur-suant to .the Trust 'Agreement.
(2) "Claims paid" means all amounts paid by the Ad-mi nistra tor in respe ct of the Extended He al th CarePlan and Dental Plan during the term of thisAgreement as benefits pursuant to the Trust Agree-ment.
2. Term
Th is Agreeme nt shall be for a term of one ye ar comme nc-ing as of January 1, 1981, and shall continue from yearto year thereafter unless and un til terminated as here-in provid_~d.
3. Termina tion
('
This Agreement may be terminated as of January 1, 1982or any.time thereafter by either the Trustee or the Ad-ministrator upon sixty (60) days prior written noticeto the other party.
Upon terrina t ion of th is Agreeme nt:
(1) Northern Telecom shall reimburse the Administratorfor all amounts payable for services rendered asherein provided under Article 4 up to the termina-.tion date,' and shall be entitled to credits, ifany.
(2) All funds transferred to the Administrator pur-suant to this Agreement and rema ining to theTrustee1s account including any accrued interestfrom date of termination, shall be repaid forth-wi th by the Administrator to the Tru stee.
(.3) The Administrator shall surrender and deliver tothe T r u s tee all c i aim s his tory car d s, r e cor d s ,files, accounts and other documents maintained bythe Administrator pursua'nt to the Agreement, allof wh ich docume nts ma in ta ined by the Admi nis tratorin carrying out its administrative services hereins hall be the prope rty of the Tru stee.
- 3 -
4. Administratiye Services
(1) The Administrator shall provide the followingbas ic admi nis tra t ive services:
(a) receive and examine all Claims;(b) verify the eligibility of Claims in accor-
dance with the master list provided to theAdministrator and as updated monthly byNorthern Telecom;
(c) determine that the amount of each Claim isin accordance wi th the provi s ions of the Ex-tended Health Care Plan and/or Dental Plan;
(d) remit payment of allowed Claims to or on be-half of the claimant;.
(e) maintain appropriate records of all Claimsreceived and all payments made and keepproper books of account;
(f) provide to Northern Telecom a Monthly ClaimsReport in respect of each month during the
- term of this Agreement, which Report shallinclude the aggregate of Claims paid, thenumber of Claims paid and administrationfees payable in respect of each such month,as well as the aggrega te of Cla ims pa id andexpenses for the current calendar year;
(g) upon request by the Trustee provide(i) periodic claims analysis(ii) claim control information(iii) claim accounting(iv) claim forms(v) benefit pricing(vi') cost analysis, including projections
for future periods and estimates ofoutstanding liabili ties
(vii) advice on plan design trends;
(2) The Administrator shall not be obliged to provideto the Trustee bank statements and reconciliationsin respect of any Claims paid or otherwise. TheTrustee shall have the right, at its expense, tohave an audit carried out in respect of the bank-ing arrangements and bank statements and support-ing documentation as they relate to Claims paid bythe Aèmi nis tra tor and other f inanci al transact ionsrelated to the carrying out by the Administratorof its services required to be performed herein.
- 4 -
(3) In addition, the Administrator shall provide suchother services related to the administration ofthe Trust Agreement as may be agreed upon fromtime to time by the Trustee and the Administrator.
( 4 ) On reasonable notice the Administratoravailable to the Trustee or its agentgular business hours, for the purposestion and copying, all Claims records,counts and other documents relatingministration of the Trust Agreement.
shall makeduring re-of inspec-files, ac-to the ad-
5. Administration Fees
(l) Northern Telecom shal i pay on behalf of employe es,to the Administrator for all services set forth inArt i c 1 e 4 ( i ) 7.5 % 0 f the net cos t ~ the Tr u stAgreement (i.e. total claims paid and adminis-tration fees) during the term of this Agreement¡to be paid on a monthly basis as provided inArtiçle 7.
(
(2) Northern Telecom shall pay on behalf of employees,to the Administrator for the services set forth inArticle 4 (3) such fees as may be agreed upon fromtime' to time by Northern Telecom and theAdmin istrator. .
6. Funding
(1) Upon execution of this Agreement, the Trusteeshall effect a transfer of funds from the account.of the trust fund to the Administrator of anamount equal to the estimate of Claims to be paidby the Administrator during the month of January1981 and such further sum as may be agreed to bet-ween the Trtistee and the Administrator. There-after, the Trustee shall effect a transfer offunds to the Administrator on a monthly basis inan amount equal to the aggregate of Claims paid bythe Administrator during the previous month asshown on the Monthly Claims Report to be providedby the Administrator to the Trustee. The Adminis-trator wiI i pay from such fund s trans fe rred allCIa ims approved by it in accordance wi th the termsof this Agreement and the Trust Agreement.
(2) No interest shall be paid to the Trustee orNorthern Telecom or charged by the Administratorunder this Agreement except as provided for underArtic Ie 3.
U,..ert\
/1.-. (J. .;fvV'~;~ rC
¡Jl¡1UCrI
- 5 -
7. Payment of Administration Fees
(1) Upon exe cu t ion of th is Agreeme nt, Northern Telecomshall effect a payment to the Administrator onbehalf of employeep of an amount equal to theadministration fees on the estimate of Claims tobe paid by the Administrator during the month ofJanuary .1981 and on such further sum as may beagreed to between the Trustee and the Adminis-trator, as referred to in Article 6.
(2) The Administrator shall submit to Northern Telecomwithin thirty (30) days after the end of eachcalendar month during the term of this Agreementan invoice for the admi nistra t ion fees paya b Ie inrespect of the previous month together with theMonthly Claims Report for such month as required'under Article 4(1) (f). Northern Telecom shall paysuch invoice on behalf of employees within thirty(30) days of receipt thereof.
8. Indemnity-
The Administrator shall reimburse, indemnify and saveharmless the Trustee on behalf of employees for anyloss to or diminution of the funds administered by ithereunder arising.from or due to the default, willfulmisconduct, lack of good faith or negligence of theAdminis tra tor, its employees, age nts or serva nts.
(
9. Amendments to Trust Agreement
The Trustee shall give the Administrator reasonablenotice of relevant amendments to the Trust Agreementaffecting the performance of this Agreement.
lO. In terpreta tionAny reasonable interpretation of th is Ag reeme nt and theTrust Agreement made by the Administrator in good faithahd not contrary to specific instructions of theTrustee shall be binding upon the Trustee acting onbehalf of employees.
11. Special Instructions
Notwithstanding any other provision of this Agreementand prior to the payment of any Claim hereunder, theTrustee may instruct the Administrator in writing ofthe amount of the Claim to be paiò. Such amount shallnot exceed the maximum amount payable under the TrustAgreeme nt for such Cla im.
- 6 -
1 2. Trustee i s Records
The .Trustee shall furnish to the Administrator suchrecords and any other inforiation as the Administratormay reasonably require to perform its services here-under, subject always to the Trustee1s right to refusedisclosure for reasons of confidentiality.
l3. Notices
Any and all not ices or other informa t ion to be give n byone -of the parties to the other shall be deemed suffi-ciently given when forwarded by prepaid registered orc e r t if i ed fir s t c 1 ass air rna i lor by cab i e, tel e g ram,telex, TWX or hand delivery to the other party at thefo llowing ad dress:
If to the Trustee Compagnie Montreal TrustPension TrustAdministrationPlace Ville MarieMontreal, QuebecH3B 3L6
If to the Administrator Association Dr HospitalisationDu Québec550 Sherbrooke Street Wes tMontreal, Que bec H3A IB9
If to Northern Telecom Northern Telecom CanadaLimi tée304 The East MallI sl ington, Ontario M9B 6E4
Attention: Director,Indirect Compensation
and such notices 'shall be deemed to have been receivedfifteen (l 5 )bu s iness days after mailing, if forwardedby mail, and the following business day if forwarded byç~ble, telegram, telex, ~lX or hand.
The aforementioned addresses of the parties may bechanged at any time by giving fifteen (15) days priorn~tice to the other parties in accordance wi th theforegoing.
In the event of a generally-preva il ing labour di sputeor other situation which will delay or impede the giv-ing of notice by any such means, the notice shall begiven by such specified mode as will be most reliableand expeditious and least affected by such dispute orsituation.
- 7 -
. 14. Non Wa i ve r
The .failure by any party at any time to enforce any ofthe provi s ions of this Agreement shall not be construedto be a waiver of such' provision or of the right of anyparty thereafter to enforce such provision.
15. Entirety
This Agreement embodies the entire agreement betweenthe 'parties with respect to the subject matter thereof,and there are no promises, 'terms, conditions or obliga-tions, oral or written, expressed or implied, otherthan those contained herein. All prior agreements andunderstandings related to the subject matter of thisAgreement are hereby cancelled except as otherwiseprovided herein. This Agreement may not be varied,amended or supplemented except by written instrumentsigned by all parties.
16. Governing-Law
This Agreeme~t and all questions pertaihing to itsvalidity, construction and administration shall bedetermined in accordance wi th the laws of the Prov i nceof Quebec.
17. Language Clause
The Parties hereto confirm that it is their wish thatthis Agreement, as well as all other documents relatingthereto, including notices, have been and shall be inEnglish only.. Les parties auxprêsentes, confirmentleurvolonté que cette convention de même que tous lesdocuments, y compris tous avis, sly rattachant, soientrédigés en anglais seulement.
.;.::
::
(
~/'.r
/........
,I!
- 8 -
IN WITNESS WHEREOF the parties have caused this Agree-ment to be executed by their duly authorized officers.
COMPAGNIE MONTREAL TRUST NORTHEID~ TELECOM CANADA/2,/~,/..../ -' ~pe¿/gyJi¿¿ Per ~~IT"~," "'''e, eO",":A",' "'" eme, "'"'''' ~ ~Per ~vy/ Per ~~g. ".LIMITt.E l ,
~ LEAL DEPi. r
" ~! F,
= i- -16 I
t~ APP~OV~D ¡iI:'23-1 2. ''ftJ
: DATE
ASSOCIATION D i HOSPITAL ISATION DU QUaBEC
Per ~~.Per
tt nUtthCHl1tafactim Northern Telecom
LimitedP.O. Box 458.. Station AMississauga. OntarioL5Á 3A2
TeL. 1416) 275.0960TWX 610-492.4388
i'Decemb~r 22, 1980
Quebec Hospital Service Association550 Sherbrooke Street West,Montreal, Quebec.
Dear Sirs;
In consideration of Quebec Hospital Service Association ("QBCII) having enteredinto an agreement with Montreal Trust Company (the "Trustee") and NorthernTelecom Canada Limited ("NTC") made as of the first day of January, 1981
(the "Agreement"), NTC hereby agrees to indemnify and hold harmless and payin QBC's stead and to its complete exoneration the amount of any premium taxtogether with interest and penalties if any, which QBC could be obliged topay in respect of any amounts payable or paid to QBC or transferred to itsaccount by NTC or the Trustee pursuant to the Agreement, should such amountsbe construed as a premium as defined in Section 1166 B of the Taxation Act .(Quebec).
The words "premium tax" as used herein shall refer to thè capital tax of 2¡;on premiums payable to insurance corporations under Section 1167 of theTaxation Act (Quebec) or any such tax payable under any amending or successor ('d..legislation. "In the event QBC is assessed any premium tax in respect of any amountspayable or paid to it under the Agreement, NTC shall have the right, at itsexpense, to cont est such assessment for and in the name of QBC, providedthat QBC shall be fully indemnified by NTC for all costs and expenses incurredby it arising out of such contestation.
Yours Very Truly,
NORTHERN TELECOM CANADA LIMITED
f~~~. \I i/L I~l /ip íF~RõVö1~, DATE _L-
per:£/~per:~,~
33 City Centre Drive. Mississauga. Ontario L562N5
,\.~:,: ,
~¡f,.,J I )C r
.~..
APPENDIX A
to the
TRUST AGREEt1ENT
Between:
NORTHERN TELECOM LIMITED
and.
MONTREAL TRUST COMPANY
l. Scope of Append ix
This Appendix sets forth the rules and regulations governing the followingHealth and Welfare Benefits (hereinafter collectively called "the Plan"):
(a) Survivor Income Benefit (SIB)(b) Comprehens i ve Heal th Care Benef i t (CHC)(c) Long Term Disability Benefit (LTD).
The Plan applies to those employees of Northern Telecom Limi ted and itssubsidiaries whose benefits are not negotiated under a Collective LabourAgreemen t.
2. Defini tions: In this Plan,
(a) "Administrator" means The Mutual Life of Canada or such other personor corporation as may be duly appointed as Administrator under theterms of the Trust Agreement i
(b) "Corporation" and "Company" mean Northern Telecom Limited and those ofits subsidiaries and affiliates to which the Plan applies;
(cl "Plan" means Survivor Income Benefit (SIB), Comprehensive Health CareBenefit (CHC) and Long Term Disability Benefit (LTD) and such otherHealth and Welfare Benefits as the Corporation may introduce pursuantto the Trus t Agreemen t ;
(d) "effective date" means January i, 1980 and as specifically notedtherea.fter.
(e) "employee" means a permanent full-time employee of the Corporation asdesignated in (1) above.
(f) "bas ic monthly salary" means the mon thly rate of the regularremuneration paid to. the employee by the Corpor~tion at the time ofdeath or commencement of total disability, excluding cost of living(COLA) and other allowances whe.re applicable, bonuses and overtime;
.1; "'.
(g) "bas ic annual salary" means the annual rate of the regularremuneration paid to the employee by the Corporation at the time ofdeath or commencement of total disabil i ty, excluding cos t of Ii ving(COLA) and other allowances where applicable 1 bonuses and overtime;
-1-
(h) "eligible dependents" shall have the meaning defined in eachindividual benefit.
( i) any ref erence to the male gender shall ~lso ref er to the femalegender, as appropriate.
3. Participation in the Plan
(a) An employee and any eligible dependents will automatically participatein the CHC benefit on the first of the month following the month thatthe employee commences employment wi th the Company, unless the benef i t~s deliberately waived by the employee due to spousal coverage.
(b) An employee will automatically participate in the LTD benef it on thedate that the employee completes three months of continuous employmentwi th the Company.
(c) An employee may apply to participate in the SIB on the later of:
(i) the date that the employee commences employment wi th the Companyif the employee has el ig ible dependents on that date, or
(ii) the date that the employee acquires eligible dependents.
r""
Application. to participate shall be made on forms prescribed by theCorpora tion wi th in 31 days of the above dates.
IE appl ication is made later than 3 i days, the employee must submit,wi thout expense to the Administrator or the Corporation evidence ofgood heal th satisfactory to the Administrator. The SIB will beeffective on the date of the approval of the application.
4. Continuation of Participation
(a) Except as provided below r an' employee (and el igibl€ dependents whereapplicable) will continue to participate in this Plan until theemployee's employment with the Corporation is terminated.
(b) An employee (and el ig ible dependents where applicable) will continueto participate in this Plan while the employee is in receipt ofSickness & Accident or LTD benefits under any plan provided by the-Corporation. Improvements introduced after commencement of LTDbenef its will not apply.
(c) An employee (and el ig ible dependents where appl icable) may be allowedto continue to participate in this Plan for all benefits except LTDwhile the employee is on a temporary leave of absence, if such leaveis approved by the Corporation and provided applicable premiums arepaid.
(d) An employee (and el ig ible dependents where applicable) will continueto participate in the CHC benefit until the end of the month in whichthe employee's employment is terminated.
(e) Dependents of a deceased employee will continue to participate in theCHC benefit until the end of the month in which the employee hasdied, and thereafter for as long as their dependency under the Planexists, provided they pay the applicable premiums.
-2-
5.. Currency
Payment fo~ benefits under this plan will be made in lawful money ofCanada.
6. Payment of Claims
(a) Where payments for benef its are payable to a person who, in theopinion of the Administrator, is incapable of managing his or her ownaffairs due to physical or mental disability, payment of benefits whenpermitted by law, not in excess of such amount as may be prescribed bylaw, may be' made to any person appearing on evidence satisfactory tothe Administrator, to be equitably entitled. thereto by reason ofhaving incurred expenses for the -maintenance, care or trea tmen t of theemployee or dependent.
(b) Any action or proceedings for the recovery of any benefit pursuant tothe Plan shall be commenced not earlier than 60 days after, and notlater than one year after, the date on which proof of claim is'received by the Administrator.
(c) The Administrator reserves the' right to disallow any claim or claimswhere in the opinion of the Administrator such claims are notaccompanied by the necessary receipts, invoices, statements or otherforms, documents or proof satisfactory to the Administrator.
I SURVIVOR INCOME BENEFIT (S IB)
1. Definitions
;t~'.
In this benefit,
(a) "spouse" means, (1."_
( i) the person who is legally married to the e~ployee, o~(ii) the person of the opposi te sex of the employee who, at the time
the right to claim a benef it arises, is cohabi ting with theemployee, and has beeh so cohabiting either,
(a) for 36 consecutive months immediately prior thereto in theevent marriage is prohibited by law, or
(b) for 12 consecutive months immediately prior thereto in theevent marriage is not so prohibited, and
(c) in both situations the po-habitant is publicly representedas the husband or wite of the' employee.
(b) ."el ig ible depende~ts" means the spouse of the employee, and
(i) any unmarried, natural or legally adopted children of theemployee who are financially dependent on the emp16yee orspouse i and are
cr ~\
P -3-Date of issue: 1982 11 19
(a) under .the age of I a years, or(b) under the age of 25 years and in full-time attendance
a t an accred i ted school, college or uni versi ty, or
(c) phys ically or mentaiìy incapable of self-support anbecame so before reach ing the age of 21 years.
(ii) for the purposes of the SIB children include,
(a) any children of the employee born posthumously wi thin301 days after the death of the employee, and
(h) any children in .the process of being adopted at thetime of the employee i s death, if such adoption iscompleted wi thin one year after the date of theemployee iS death.
(c) "occupational acicident" means ã' fortuitous' event causing inJuryor illness to the employee and occurring while the employee iscarrying out his duties.
2. Calculation of Amount of Benefit(a) Spouse Benef it: On the death of an employee an el igible
*correction dependent who is a spouse shall be entitled to a monthlypayment of an amount calculated in accordance with thefol lowing formula:
(i) 50% of either the employee's basic annual salary, or, thfYearly Maximum Pensionable Earnings in effect as definerand calculated under the Canada/Quebec. Pension Plan atthe date of death, whichever is the lesser, divided by12, and
(ii.) 25% of .the employee i s bas ic annual salary in excess ofthe Yearly Maximum Pensionable Earn ing s in effect asdefined and calculated under the Canada/Quebec PensionPlan a.t the date of death, divided by 12.
In addition to any other benefit, where the death of theemployee results from an occupational acc ident, the spouseshall be entitled to a lump sum payment equal to the employee'sbasic annual salary.
(b) Cnild Benefit: . On the death of an employee, an -eligibledependent who is a child shall be entitled to:
(i) a monthly payment of an amount equal to 10% of theemployee ~ s bas ic monthly sal ary, payable for eachdependent child, to a maximum of two children. If theemployee dies leaving dependent chi~dren but not leavinga spouse, the amount of the Child Benefit will.be 20% ofthe employee i s basic monthly salary payable for eachdependent child, to a maximum of two children.
Revised 1983 04 15-4-
(t) Reduction: The SlS will be reduced by th~ amount of the Survivor'sPens ion, incl uding benef i ts for the two younges t dependent chi Idrenunder is years of age, to which the spouse is entitled as def ined andcalculated' under the Canada/Quebec Pension Plan.
*New
Increases in the Survivor's Pension subsequent to the death of theemployee including benefits for the two youngest children under 18years of age, payable under the Canada/Quebec Pens ion Plan shall notfurther red uce the amoun t of the mon thly benef it. .
Effective January i, 1983, eligible employees in the province ofQuebec only, who continue working beyond the age of. 65 andsubsequently die while in active employment, shall have their SIBreduced by the equivalent amount of the Spousal Pension under theManagerial and Non-Negotiated Pension Plan.
In no event shall the SIB payable be less than an amount equal to 25%of the employee's basic monthly salary.
3. Payment of SIB
(a) On the death of ah employee the Administrator shall pay:
(i) to the spouse, the amount of the Spouse Benef it as calculated,commencing on the first of .the month following the date of deathof the employee and continuing monthly thereafter until thedeath of the spouse;
( i i) to the dependent chi ldren, or if the ch ildren are under the ageof majority r then as permitted or required by law, either to theparent or guardian of such children, or to the Executor of theLast Will of the employee, or to a Court of competent ,.jurisdiction, the amount of the Child Benef it as calculated, ~commencing on the first of the month following the date of deathof the. employee r and continuing monthly thereafter until thechild is no longer an el ig ible. dependent. _
4. Health Care Benefits during SIB
There shall be provided to the eligible dependent (s) for a period of60 consecutive months following the death of an employee, Company-paidprovincial health insurance coverage, in provinces where premiumsapply. Provision shall also be made for the eligible dependent(s) toparticipate in the Comprehensive Health Care plan, at their option andat their own expense, for as -long as the SIB is being paid.
5. Guaranteed Period of Payfue~t .
(a) Where the spouse, while in receipt of payments un'der' the SIB dieswithin 60 months after the 'date of death of the employee, then aspermi tted or required by law the Spouse Benef it as calcuiated shall be'paid either to the dependent children, if any i or if the dependentch ildren are not of the age of majority, to the guard ian of suchchildren, or to the Execbtor of the Last Will of the employee, or to aCourt of competent jurisdiction r for a period not to exceed 60 monthsafter the date. of death of the employee.",
¡j
.( b) If there are no dependent children then the Spouse Benef it ascalculated shall be paid monthly to. the estate of the decease~for a period not to exceed 60 months from the date of death 0employee.
i~~use(;/
-5-Revised 1983 04 15
6. Proof of Claim
(a) A claim for SIB shall be made in writing to the Administrator withinthree months after the date of death of the employee or spouse as thecase may be, and shall be accompanied by such proof of death,eligibility and entitlement as the Administrator may deem necessary.
.
(b) The Administrator shall require the person claiming this SIB to subn,.Lcproof that:
(i) an application for Survivo'rls Pension and child benefits ifapplicable has been made pursuant to the Canada/Quebec PensionPlan, and
(ii) a determination has been made under that Plan, and
(iii) the amount of the Survivor's Pension and other benefits whichare payable' under that Plan, or that application has beenrej ected, and the reasons therefor.
If such proof is not submitted, the Administrator may reduce themonthly SIB payable to any eligible dependents by the amount which theAdmini~trator deems would have been payable to the spouse as aSurvi vor' s Pension and, if applicable, to the two youngest dependentchildren who are under IS years of age.
II LONG TERM DISABILITY BENEFIT (LTD)
. 1. Definitions
(In this benef it,
(a) "qual ifying period" is a period of time during which 52 weeks ofSickness and ÅCc iden t Benef its were paid to the employee;
'. ."
(b) "total aisability". means that, as a result of illness or inj ury to anemployee he is unable during the qualifying period and during the 12month period immediately following to perform the regular duties ofthe occupation he' was performing at the beginning of the disablings ickne ss Or inj ur¥ ;
Following expiry of the 12 mdnth period above, he is thereafter unableto perform for profit or remuneration the duties of any occupation,ei ther wi thin or outs ide the Corporation, for which he has theappropriate education r training and experience.
In determining totai disability the availability of any occupationwill not be .considered.
Effective July 1, 1982, notwithstanding the above def inition~ if it isconfirmed that he is eligible for disability benefits under theCanada/Quebec Pens ion Plan, he will then also be el ig ible for the LTDbenefit..
-6-
Date of issue: 1982 11 19
(c) "totally disabled" shall have a correspond ing meaning to "totaldisability" .
2. Calculation of Amount of Benefit
(a) Basic Benefit
Subject to (b) hereof, an employee who is totally disabled shall bepaid a monthly amount equal to 60 % of his bas ic monthly salary.
(b) Integration of Benef i ts
The amount of the LTD benef it shal 1 be red uced by the amount that thesum of the employee's LTD benefit and any government disabilitybenef i ts payable to the employee in respect of the same disabi Ii ty,exceed 90% of the employee's bas ic mon th ly salary (plus COLA whereappl icable) .
For these purposes, "government disabili ty benef i ts" incl ude thosereceived under the Canada/Quebec Pension Plan Disability Benefit,Workers' Compensation, Government Automobile Insurance Income, and anyother government plans.
"Government disab il ity benef its" do not incl ude disab il ity benef itspayable under the Canada/Quebec Pension Plan for or on behalf ofdependent children as def ined thereunder, nor benef its payable underany individual disability income insurance policy, or a disabilityendorsement under an individual life insurance policy.
((c) Subsequent Indexed Increases
Subsequent to the commencement of ~e total disability, increases inthe government disability benefits, caused by the-~ension indexprovisions thereof, will not further reduce the amount of the LTDbenefit.
(d) Approved Rehabilitation Program
The amount of this LTD benefit shall be reduced by the amount that_ thesum of the employee's LTD benef it, and any remuneration from a Companyapproved rehabil ita tion program exceeds 75% of the employee's bas icmonth,ly salary (plus COLA where applicable).
3. Payment of LTD Benefit
On the total disability of an employee the Administrator shall pay thatemployee the LTD benefit as calculated pursuant to paragraph 2 hereof,commencing immediately following the qual ifying period and continu ingmonthly until the termination of the LTD Benefits pursuant hereto.
i¡ '"
-7-
4. Termination of Benef its
LTD Benef it payments to the employee shall èease on the earliest of thedate that:
(a) the employee ceases to be totally disabled, or
(b) the employee fails to submit proof of the continuance of totaldisability as required by the Administrator, or
(~) the employee fails to submi t, upon requèst by the Administrator, to amedical examination by a medical eXãminer appointed by theAdministrator, or
(d) the employee refuses to participate in a rehabilitation programapproved by the attending physician, the Company's physician and theAdministrator, or
(e) the employee engages in any occupation for remunera tion or prof i t orany educational program other than in a rehabil itation programapproved by the attending physician, the Company's physician and theAdministrator, ,or
(f) the employee attains the age of 65 years, or
(g) the employee dies.
5. Recurrence of Disability
( If, following rece ipt of LTD Benef its hereunder, an employee ceases to betotally disabled, but wi thin 60 calendar days is again totally disabled byreason of the same or related causes, such disability will' be consideredto be a continuation of the original disabili ty.6. Proof of Claim .
(a) A claim for LTD Benef i ts shall be made in a form sa tisf actory to theAdministrator within three months after the expiration of thequalifying period, and shall be accompanied by such medical and otherevidence of total disability that the Administrator may require.
From time to time the Administrator may require from the employee:
(i) proof in form satisfactory to the Administrator of thecontinuance of the total disabili ty i
(ii) a medical examination of the employee by a physician or otherqualif ied medical examiner appointed by the Administrator i
( iii) proof of age of the employee.
-8-
(b) The Administrator shall require the employee to submit proof that theemployee has submi t ted under the Canada/Quebec Pens ion Plan,
( i) an appl ica tion for disabil i ty benef i ts, and
( ii) that a determination of benef its has been made under that Plan,and
(iii) the amount of the benefits which are payabie thereunder, or thatthe application has been rejected, and the reasons therefor.
If the employee does not submit such proof, the Administrator mayreduce the LTD Benef i t payable to the employee by the amount tha t theAdministrator deems would have been payable to the employee pursuantto the Canada/Quebec Pens ion Plan.
7. Limitations
The LTD Benef it is not payable in respect of a disab il i ty resulting fromone or more of the following:
(a) intentionally self-inflicted injuries or illness, whether sane orinsane;
(b) any condi tion for which the employee is not under active treatment byand co-operating wi th a phys ic ian or surgeon duly licensed to prac tisemedicine;
(c) committing or attempting to commit an assault or crime;
(d) insurrection, striker riot, civil disorder or war, if the employee is (actually participating therein, and whether or not war be declared;
(e) alcohol ism or drug add iction, unless
(i) resulting in permanent physical or mental impairments thatcannot be treated, or
(ii) the employee is undergoing a course of treatment which isacceptable to the Company i s Med ical Director;
(f) pregnancy, unless due to severe complications;
(g) military service in any country. .
-9-
:1''.:li
III COMPREHENS IVE HEALTH CARE BENEFIT (CHC)
l. Def ini tions
In th is. ben e fit,
(a) "spouse" means the pe rson who is legal ly married to the employee, or aperson of the opposite sex who- is cohabiting with the employee and whois publicly represented as the spouse of the employee;
(b) "eligible dependents" means the spouse of the employee and anyunmarried na tu ral or legally adopted ch ildren of the employee orspouse who are financially dependent on the employee or spouse, and
(i) are under the age of 21 years, or
(ii) are under the age of 25 years and in full time attendance at anaccredited school, college or university, or
(iii) are physically or mentally incapable of self-support and becameso before reaching the age of 21. years;
(c) "reasonable and cus tomary charges" means charges which are usuallymade for the item of expense lis ted under El ig ible Expenses, in theabsence of coverage, but does not include any charges which are inexcess of,
(
(i) the prevailing fee guide, for services provided by generalpractitioners, of the provincial Dental Association in theprovince in which the expense is incurred, in the case ofservices rendered by a dentis t;
(ii) the prevailing fee guide of the provincial organization ofparadental practitioners in the province in which the expense isincurred in the case öf services rendered by- a paradentalpracti tioner, or
(iii) the general level of charges in the area where the expense isincurred in the case of all other services;
(d) "hospital" means any public institution, building or other premises,where:
(i l treatment requiring continuous conf inement is rendered, and anattempt is made to cure persons suffering from or ~fflicted withsickness, disease or inj ury, and,
(ii) when approved by the Administrator, specialized treatment ofconvalescing or chronically ill persons is rendered, but
(iii) the term "hospital" does not include nursing homes, rest nomes,old age homes, or other premises or places rendering similarcare;
-10-
(e) "chiropractorll means a member of the Canadian Chiropratic Associationor of any provincial association aff iliated therewith;
(f) IIdentist" means a person licensed to practise dentistry by theprbvincial licens ing au thori ty in which the den tal serv ices arerendered;
(g) "masseur" means a member of any provincial association of masseurs;
(h) "naturopath II means a person who holds a degree from a recogni zedschool of naturopathy;
(i) lIoptometrist" means a member of the Canadian Association ofOptometrists Or of any provincial association associated therewith,licensed to practice in the province in which the services arerendered;
(j) "osteopath" means a Doctor of Osteopathy who is a graduate of arecognized school of osteopathy, licensed to practice in the provincein which the services are rendered;
(k) IIphysician" means a person who is legally licensed to practicemedicine in the prov ince in which the services are rendered;
(l) "physiotherapistll means a member of the 'Canadian PhysiotherapyAssocia tion or of any provincial association affil iated therewi th,licensed to practice in the province in which the services arerendered;
¡f
(m) "podiatrist or chiropodist" means a member of the Canadian PodiatricAssociation or of any provincial association affiliated therewith,licensed to practice in the province in which the services arerendered;
(
(n) IIpsychologist" means a permanently certified psychologist who islisted on the provincial registry of the province in which theserv ices are rendered;
(0) "registered nurse" and "registered nursing assistant", mean a nursewho is listed on the provincial reg istryor: the province in which theservices are rendered;
(p) "registered pharmacist" means a person who is licensed to practicepharmàcy and whose name is listed on the pharmacists i reg.istry of thelicensing. body for the province in which such person is practicing;
(q) "speech therapist" means a person who holds a diploma or degree inspeech therapy from a recognized university;
rf ..\
-11-
(r) "paradental practitioner" means a person licensed by the provincialauthori ty where the services are rendered to work as a directpract it ioner, supplying and fitting dentures to the publ ic ;
(s) ,II el ig ible expenses" means those expenses 1 isted in Section 4 hereof;'. .
(t) "person" as used in Section 4 hereof, means employee or el igibledependent.
2-. Calculation of Amount of Benef its
(a) Supplementary Hospital Benef i t (SHB)
Employees whose claim for SHB have been allowed by the Administrato~shall be enti tIed to 100% of the claim as allowed.
(b) Extended Health Care Benefit (EHB), Basic Dental Benefit (BOB) andMinor Dental Benefit (MDB)
An employee whose claims for EHB or BOB are allowed by the Admini-strator shall be entitled to 100% of the Eligible Expenses for EHB andBOB incurred by the employee and his eligible dependents.
An employee whose claims for MDB are allowed by the Adminstrator shallbe entitled to 80% of the Eligible Expenses for MDB incurred by theemployee and his eligible dependents.
(The combined Eligible Expenses for EHB, BDB and MDB are subject tothe following ded uctible amounts:
(i) $25 for each employee and eligible dependent in respect to whoma cIa im was allowed, for each calendar year tå a maximum of $ 50per calendar year
(ii) where an employee and one or more of his or her eligibledependents are entitled to EHB, BDB or MDB or all as a resultof one acc iden t the max imum deductible shall be $ 25.
(c) Major Dental Benefit (MJDB)
An employee whose claim for MJDB is allowed by the Administratorshall be entitled to 50% of the Eligible Expenses for MJDB incurredby th~ employee and his eligible ~ependents, to a maximu~ EligibleExpense of $4,000 per calendar year each for an employee and each ofhis eligible dependents.
(d) Orthodontic Dental Benefit (ODB)
An employee whose claim for ODB is allowed by the Administrator shall
be enti tIed to 50% of the Eligible Expenses for ODB incurred by theemployee and his eligible dependents to a lifetime maximum EligibleExpense of $3,000 each for an employee and each of his eligibledependents.
-12-
(e) Other Health Care Benefits (OHCB)
An employee whose claim" for OHCB is allowed by the Administratorshall be entitled to 50% of the Eligible Expenses for OHCBincurred by the employee and his eligible dependents.
(f) Catastrophic Expense Benef i t (CEB)
When an employee whose claim for anyone or more Benef i t underthis Comprehens ive Heal th Benef it, except the Orthodontic Benef it,has been allowed by the Administrator, and that employee i s share ofthe Elig ible Expenses exceeds $ l, 000 in a calendar year, the employeeshall be entitled to 100% of the amount of the Eligible Expense inexcess of $1,000, except for the Orthodontic Benefi t.
3. Payment of Benefits
When the Adminis tra tor has allowed a claim for benef i t under th is CHCBenef i t the Adminis tra tor shall pay the employee or the person i ifany, to whom the employee has assigned the claim, the amount of theBenef i t as calculated.
4. Eligible Expenses
(A) Supplementary Hospi tal Benef i t (SHB)
,:!
For the purposes of this Benefit i Eligible Expenses means thereasonable and customary charges for medically necessary hospitaltreatment recommended by a phys ic ian i as follows:
(,(a) charges for the hospital room and board in an amount not toexceed the difference between c~arges for semi-privateaccommoda tion and publ ic ward accommodation for each day inhospi tal;
(b) charges for hosp i tal room and board for that portion i ifany i of the cost of public ward accommodation which thehospital must bill directly to the patient pursuant togovernment regulations, and where the law permits a patientto be re imbursed for such expenses;
(c) charges for each admiss ion as in-patient for public wardaccommodation, where the law permits a patient to bereimbursed for such expense ~
-13-'"
;!
~
(B) Extended Health Benef it (EHB)
100% of Extended Health Expenses after satisfying a deductiblecombined with BDS and MDS, Eligible Expenses mean the reasonable andcustomary charges for medically necessary treatment recommended by aphysician, as follows:
(a) charges for drugs, sera and injectibles (including oralcDntraceptives) if prescribed by a physician or dentist anddispensed by a registered pharmacist, physician or dentist;but charges for the following are not eligible expenses:
( i) food and food supplements, incl uding die tarysupplemen ts ;
( ii) vitamins and minerals except those which can only bepurchased wi th a wri t ten prescription of a phys icianor dentist;
( iii) cosmetic or hyg ienic products;
(iv) products, which in the opinion of the Administrator,are household remedies;
(v) experimental drugs;
(vi) any products prescribed for the treatment ofobesity.
(b) hospi tal charges incurred Quts ide Canada for emergencytrea tmen t, inc Iud ing hospital room and board, not to exceedthe difference between the actual cost of wardaccommodation plus charges for auxiliary hospi tal services,less the benefi t payable by the relevant provincialhospi tal plan for a maximum of 31 days for each period ofillness or inj ury;
(c) charges incurred outs ide Canada or the prov ince ofres idence of the employee for. the prof ess ional serv ices ofa physician, where
~ (i) the services are required for emergency treatment ofan injury or disease which occurred while the employeeor eligible dependent was travelling outside theprov ince, or
(ii) the services are not available in the province ofresidence of the employee or eligible dependent;
-14-
(d) charges incurred in Canada for the profess ional serv ices of aphysician where the employee or any eligible dependent of theemployee is not el ig ible for coverage by a provincial healthinsurance program;
(e) charges for professional services rendered in the home of theemployee or eligible dependent by a registered nurse (R.N.) orwhere an R.N. is not available when required, services of aregistered nursing assistant (R.N.A.), subject to a maximumtotal Eligible Expense in anyone period of illness ordisability of $10, 000. Such charges are not an Eligible Expenseif the R.N. or R.N.A. is related to the employee or eligibledependent by blood or marriage or is ordinarily a resident inthe home of the employee or eligible dependent;
(f) charges for diagnostic procedures, radiology, blood transfusionsand oxygen r includ ing the use of the necessary equipment for theadministration of these procedures;
(g) rental or, at the Administrator's option, purchase of awheelchair, hospi tal bed, iron lung or other durable equipmentrequired for temporary therapeutic use and approved by theCompany and the Administrator.
(h) charges for the purchase of trusses, braces, crutches rartificial limbs or eyes and surgical dressings.
(Orthopaedic shoes which are specially constructed for thepatient, including modif ications to such shoes, less the average i,..cost of regular footwear as determined by the Adminis tra tor. \.
Average cost will be determined as follows:
o to 5 years - $lS.6 to 11 years - 22.
12 to 17 years - 24.LS and over 35.
( i)' charges for licensed ground ambulance service to and from alocal hospi tal;
(j) , charges for emergency transportation of an employee or eligibledependen t by a licensed ambulance, air-ambulance,. or by anyother vehicle normally used for public transportation, to thenearest hospital equipped to provide the required treatment, toa maximum of one return tri~ per calendar' year. Licensed groundambulance service to and from the points of departure andarrival is also considered an Eligible Expense;
it~. ..
-15-
(k) charges for den tal serv ices requi red as a direct resul t ofaccidental injuries to natural teeth when such treatment isrendered wi th in ~ months of the. acciden t;
(1) charges for services of a psycholog ist, speech therapist ormasseur, to a maximum E~igible Expense of $200 per person in acalendar year;
(m) charges for services of a physiotherapist if not covered by theprov incial heal th insu rance plan;
(n) charges for serv ices of a ch iropractor or osteopath, to amaximum El ig ible Expense of' $ 200 per person in a calendar year,plus one x-ray examina tion by a chiropractor or osteopath percalendar year, after the maximum provincial heal th insurancepaymen t, if appl icable, has been made;
(0) charges for services of a naturopath, to a maximum EligibleExpense of $ 200 per person per calendar year i
(p) charges for services of a podiatrist or chiropodist to amaximum Eligible Expense of $200 per person per calendar yearfor non-surgical treatment, plus a maxmium Eligible Expense of$100 per person per calendar year for the surg ical ,removal oftoe nails or the excis ion of plantar warts, after the maximumprovinc ial health insurance payment, if applicable, has beenmade i
(q) charges for the following services and supplies as approved bythe Company and the Administrator:
l) Medically necessary supplies of a non-prescriptive naturerequired
- f or the treatme~t of cystic fibros is, -diabetes,parkinsonism and severe cases of permanent psoriasis
- for paraplegics and quadraplegics
- as a result of colostomy
2) Made-to-measUre elastic support stockings up to a maximumEl igible Expense of $25 per calendar year.
3) Portions of the cost for food replacements in. cases whereother food cannot be consumed because of surgery of thedigestive tract. That portion which can be consideredreasonable and customary charges for a normal diet will notbe cons idered el ig ible.
4) Eyepatches required for the treatment of lack oflacrimation.
5) Trachea tubes.
-16-
(C) Basic Dental Benèfit ('BDB)
100% of Basic Dental Expenses after satisfying a deductible combinedwith the EHB and MOB of $ 25 per person (up to a maximum of $ 50 perfamily) in each calendar year.,Eligible expenses mean reasonable and customary charges for thefollowing necessary treatment recommended by a dentist:
5.
6.
:f 7.
8.
9.
10.
11.
12.
13.
.11 -'-
1. Oral examina tions, once every 6 months.
2. Prophylaxis (cleaning and scaling of teeth) once every6 months. This treatment is eligible if performed bya Dentist, or a Dental Hygienist under the direct super-vision of a Dentist.
3. Bite-wing X-rays, once every 6 months.
4. Topical application of an anti-cariogenic agent~ onceevery 6 months. This treatment is eligible if performed bya Dentist, or Den tal Hyg ien ist under the direct supervis ionof a Dentist.
Full mouth series of X-rays, once every 24 months.
Extractions and simple alveolecomy at time of toothextraction.Surgical extraction of impacted teeth.
cAmalgam, silicate, acrylic, and composite fillings.
Prov ision of space main tainers for miss ing primary teeth andprovis ion of hab it-breaking appliances.Diagnostic X-ray and laboratory procedures required inrela tion to dental surgery.
General anaesthetic required in relation to dentalsurgery.
Consultation required by the attending Dentist.
Relining, rebasing, or repairing of an existing fixedbridge, removable partial or comple te denture.
-17-
Treatment
(a) Loutine oral examination anddiagnosis:- oral examination,- recall oral examination (once
eveLY 6 months),- special oral examination,
- treatment plannings,emergency and unusual. services,
- consul tat ion ,- house caii, insti tutional call
and office visit
(
(b) tests and laboratory examinations:- microb iolog ic culture,
biopsy of oral tissue,pa tholog ic report,cytologic smear from oral cavi ty,pulp vitality tests
(c) radiographs:- periapical (no more than once
in any 24 month period),occlusal,bitewing (once every 6 months),extra oral isialography,f istulography ,cys tography ,radiopaque dyes to demonstrateles ions,temporomand ibular joint,panoramic (once every 5 years),interpreta tion of rad iographsrecei ved from another source,tomography
( d) preventative services;- dental prophylaxis (once every
6 months),- topical application of fluoridephosphate (once every 6 months),
- oral hygiene instruction (onceevery 6 months),
- caries control,- interproximal discing of teeth
-18-
Canadian Dental AssociationProcedure
01100, 01110, 01120, 01121, 0113001200, 01210
013 00, 014 00, 01 500, 01 5; 0, 01 60 001610, 01800, 0181005100, 0520091100, 9111093100, 9920094100, 94200, 94400
04100, 0411004300, 043100432004330, 0434004400
02100, 02101, 02111-02123
02131-0213402141-0214602201-02205, 02301-0230502400024100242002430
02501-025050260002800
02920
11100,11200,11300,1130112000, 12100, 12200, 12400
13200, 13210
13600, 1360113700
(e) space maintainers and appliancesto control harmful habits i
(f) plastic fillings:- amalgam,
- silicate,acrylic or composite resin,
- trans i tional restoration offractured anterior,steel crown - primary teeth,
- cement
(g) surgical services:- surgical incision,- miscellaneous surg ical services
(h) anaesthesia in connection with oralsurgery
.',
(i) repairs and adjustments:- repair or recementing of crowns,
inlays, onlays, existing fixedbridgework or dentures,
- denture rebasing and relining
Exclusions
15100, 15110, 15111, 15120, 1520015210, 15300, 15310, 15400, 1540115500, 15600, 82100-82102, 8~200,82201, 82202
21101-21105,21211-21215,21300-2130522101, 2210223101-23103,23201-23205,27131
21201-21205,21221-21225,
23111-23114 ,23221-23224, 23211
21401, 21403, 21421, 27400-27404,27420-2742229800
75100, 75101, 7511079601-79604
92200-92202, 92250-92252, 92300,92310, 92311, 92330, 92340, 92350
29100,29300,55101-55105,55201-55204, 66100, 66200,66400, 66500, 66600, 66610,56200, 56201, 56210, 56211,56221, 56230, 56231" 56240,56250, 56251, 56260-56263,56265, 56270-~6273, 56300
6630066620 l..56220 \5624156264
Charges in respect of serv ices for the trea tmen t of ma10ccl us ion orservices for orthodontic treatment are not an Eligible Expense under thisBasic Dental Benefit.
(D) Minor Dental Benef it (MDB)
SÒ% of the following Dental expenses after satisfying adeductible combined with the EHB and BOB of $25 per persón (up to amaximum of $50 per family) in each calendar year.
l. Surg ical removal of tumors, cysts, neop lasms i plus theincision and drainage of an abscess.
2. Endodontic Treatment , including root canal therapy.
3. Periodon.tic Treatment, excluding periodontic àppliances.
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-19-
Eligible expenses mean reasonable and customary charge for thefollowing necessary treatment recommended by a dentist:
Treatment Canad ian Den tal Assoc ia t ionProced ure Codes
(a) endodon tics:- pulcapping,- pulpotomy,- root canal therapy,
periap ical serv ices,
31100, 3111032100, 32200-32202, 32210-3221233100, 33110, 33120, 33200, 3321033220, 33300, 33320, 33400, 3342033430, 33431, 33500-33504,33511-3351434100-34101, 34111-34115,34200-34203, 34212, 34213, 3440134402391203930039500-39503, 39600
- band ing of tooth- canal and/or pulp enlargement,- intentional removal, apical
filing and reimp1antation,- emergency procedure 39900-39905,
39940-39942,39985
39910, 39930,39960, 39970, 39980
( b ) periodontics, excl ud ingperiodontic appliances:- gíng ivaI plastry or curettage, 39100- alveolectomy, . 39110- non-surgical services, 41100, 41200, 41210, 41300, 42600- surgical services, 42001-42006, 42100-42104, 42200
42300, 42310, 42400- post-surgical trea tment, 42500- adj uncti ve procedures (occlusal 43200-43203, ..43210, 43211, 43250equilibration not exceed ing 8 43251, 43255, 43259, 43260times units each year), 43270-43272, 43300, 43310,
43400-43403, 4341'0, 43600, 4361043620
- post-treatment eval uation, 49100- case pattern section, 49400, 49410, 49500, 49510, 49600
49610, 49700, 49710, 49800, 49110- a1veoplasty 73100, 73101, 73110-73112
73119-73123, 73130-73135, 7314073141, 73150, 73151, 73160, 7316173200, 73201, 73300 ; 73301, 7331073311, 73320, 73321, 73330, 7333173340, 73341, 73350, 73351, 7336073361
-20-
(c) surg ical services:- uncomplicated removals,- surgical removals,
transplantation andreposi tioning,surgical excision
7ìlOl-71108,72100, 72210,72300, 72310,72411, 72440,74100-74119,
7111172220, 72230, 7224072320, 72400, 724107245074400-74410
Exclusions
Charges in respect of services for the treatment of malocclusion orservices for orthodontic treatment are not an Eligible
Expense under thisMinor Dental Benefit (MDB)
(E) Major Dental Benefit (MJDB)
50% of Major Dental Expenses listed below up to the maximum of $ 2,000payable per calendar year per individual. No deductible applies.
1. Inlays and onlays.
2. Crowns, including gold and porcelain veneer restorations,where other rna ter ial is not sui table.
3. The creation of a fixed bridge, removable partial or completedenture.
.1 4. The replacement of an existing fi xed bridge, removable partialor complete denture only under the circumstances set out inparagraph (h) on' page 23.
5. Injection of antibiotic drugs when prescribed by a dentist.
6. Services of a licensed Denturist when practicing wi thin thescope of his license.
7. Other necessary oral surg ical procedures not specif icallylisted under the Bas ic Dental Benef it.
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Eligible Expenses mean reasônable and customary charges for the followingtreatment recommended by a dentist:
Treatment
(a) crowns, inlays, ùnlays, (includinggold and porcelain veneerrestorations where other materialis not sui table)- gold foil restoration- metal inlay restorations,
- porcelain inlay restoration,- crowns
- hemisection
((b) fixed bridgework:
- bridge ponties,
- retainers,- abutments,
other prosth~tic services
(c) partial and complete dentures:- complete den tures ,
- partial dentures,
- partial denture additions,
-22-
Canad ian Dental Assoc ia tionProcedure Codes
24101, 24103,25100, 25200,25600-2560526100, 2670021411, 21413,27130, 27140,27300, 27301,27410-27414,27600, 27610,27700, 27701,29500, 29501,29510, 29511,29610, 29700,39200, 39210,
24200, 24201, 24300'25300, 25400, 25500
27100, 27110, 2712027200, 27210, 2722027310-2731227423-27425, 2750027620, 27630, 2764027702, 27710-2771229502, 29503,29512, 29513,
39220, 39230
60700, 62100, 62110, 62200,62300, 62400 62500, 62510, 62600,62700, 62800 6290065200, 65300, 6540067100, 67101, 67110, 67200, 6721067 3 0 0, 6 7 3 1 0, "67 4 0 0, 67 4 1 0, 67 4 206750069300, 69600, 69610, 69620, 6963069700-69705, 69800
51100, 51110, 51120, 51300, 5131051320, 51600, 51610, 5162052100, 52110, 52120, 52121, 52'20052210, 52220-52222, 52230-52232,52300-52310, 52320-52322, 5240052410, 52500, 52510,. 52520, 5253052531, 5280055520, 55530
(d) repairs and adjustments:- adj ustment to denture,- addi tion to tooth
54200, 54250, 54300-5430655500-55502, 55510-55512, 5552055521, 55524, 55525, 55529-55531,55534, 55535, 55539, 55600-55602,55610-55612
(e) surgical services:- fractures,- frenectomy,
- miscellaneous surgicalservices,
76940, 76941,77800, 77810,77850, 78110,79300-79306,79401
76950-7697977 8 20, 778 3 0 ~ 77 8 4 07812079308, 79309, 79400
(f) antibiotic drug injections(when prescribed by a dentist)
96100, 96101
(g) examinations:- oral examination,- diagnost ic casts,
- prosthodontic evaluation,
01700, 0171004500, 04510, 04520, 04540, 0455004560, 04710, 04720, 04740, 0475004760, 0477060100
(h) charges for replacement of an exis ting denture, bridgework, crown,inlay, onlay or periodontal splinting of not greater quality and valuethan the prosthesi~ being replaced, will be considered an EligibleExpense where:¡'
( i) thewasthe
(replacement is required to ~eplace an existing denture which'installed not less than 3 years prior to the replacement andexisting prosthesis cannot be made serviceable, or
(ii) the replacement is required to replace an existing bridgework,crown, inlay, onlay or periodontal splinting which was installednot less than 5 years prior to the replacement and the existingprosthesis cannot be made serviceable, or
(iii) the replacement is required to replace a temporary bridge ordenture with a permanent bridge or denture and replacement fakesplace wi thin i2 months of when the temporary appliance wasinstalled, or
(iv) the replacement is necessi ta ted by the extraction of additionalnatural teeth while the person was coveredhereunder.
The maximum amount payable under this benef it in anyone calendar yearis as specified in the Calculation of Amount of Benefits.
~.f ~~ -23-
(F) .Orthodontic Dental Senefit (ODS)
50% of Eligible Expenses mean reasonable and customary charges for thLnecessary treatment of maloccl usion or for orthodon tic trea tmen t asfollows, to a lifetime maximu~ payment of $1500 per per individual:Treatment Canadian Dental Association
Procedure Codes
( a) observation, adjustment:- oral examination, 01900,01910- cephalometric radiograph, 02701-02705, 02750-02754- hand and wrist radiograph, 02930- diagnostic cast, 04530- oral surgical procedure for 72409orthodon tic purposes,- s urg ical exposures of' unerupted 72412tooth, with orthodontic attachment- observation, adjustment, 80600, 80610, 80611, 80620- removable or fixed appli ance , 80621, 80622- repairs, al terations, 806'30, 80640, 80650, 80700- acti ve appliances for tooth 81100, 8l105, 81106, 81110, 8llllguidance or uncompl ica ted tooth 8LL1S, 81116, 81120, 81125, 81126movement, 81130, 81131, 81140, 81200-81214,
81250-81252, 81261, 81291- retention appliances 83100, 83 ILL, 83112, 83200
(b) comprehensi ve treatment: 84100, 84220, 84300, 84400, 8510085200, 85300, 86100, 86200, 8630r¡
( 87100, 87200, 87300, 88100, 8820L\ 88300, 89100, 89200, 89300, 8950089520, 89530, 89550, 89560, 8957089580
(G) Other Health Care Benefi ts (OHCB)
El ig ible expenses mean reasonable and customary charges of thefollowing medically necessary treatment recommended by a physician:. -(a) charges for róom,board and normal nursing care provided in a
licensed nurs ing home or cl inic, for convalescent or chron iccare, but not including custodial care, up to a maximum Eligible'Expense of $20 per day for a lifetime total of 365 -days;
(b) charges for private hospi tal room and board, such charges not toexceed the difference between the charges for semi-pri vate andprivate accommodation, not including a suite, for each day ofhospi ta1ization;
(c) charges for the purchase and repair of hearing aids (excludingbatteries) to a maximum Eligible Expense of $400 in any twoconsecutive calendar years;
-24-
(d) when recommended by a physic ian or optometrist, charges for: .
.( i) frames, lenses, and the fi tting of prescription glassesincluding prescription sun glasses and contact lenses, toa maximum Eligible Expense of $100 per individual in any,two consecutive c~lendaryears. Effective January 1, (1983, this maximum Eligible E~pense will be increased to~$150 per individual in any two consecutive calendar years.
(ii) contact lenses prescribed for severe corneal astigmatism,severe corneal scarring, këratoconus or aphakia, provided
. visual' acuity can be improved to at least the 20/40 levelby contact lenses' and cannot be improved to that level byregular gl~sses , to a maximum Eligible Expense of $400 inany two consecu ti ve calendar years:
(iii) services for visual' training or remedial exercises;
(iv) ocular examinations ,'. including refraction, to a maximum ofone such examination' in a calendar year for el ig ibledependent children, and to a maximum of one suchexamination in any two consecutive cålendar years foremployees and spouses.
5. Canadian Dental Association Procedure Codes
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Tha Canadian Dental' Association Procedur'e Codes are provided forident if ica tion of the ind i vidual treatment proced ures incl uded in eachEligible Expense of the various dental benef its. Where any province doesnot employ the Canad ian. Dental Association Procedure Codes, theappropriate Procedure Codes' in the fee guide of such province, for theequiva~ent. procedure, will apply.'
6. Proof of Claim .
(a) A claim for CHC benef it shall be made by an emp10yee in writing to theAdministr'ator . in satisfactory form w'Í thin 18 months after the date onwhich the expense claimed for is incurred.
(b) The Administrator requires the employee claiming for this benefit tosubmi t orig inal itemized hospital, dental, medical, drug, equipment,or other bills, phys ~cians' reports 1 hospital records, statements,invoices and documents as the Administrator may consider necessary toadjudge and allow or disallo.~ the claim.
(c) When the Adminis tra tor cannot determine from the forms, bil is anddocuments submi ttec: whether ,the charges incurred are EligibleExpenses, or when there has been a change in the Canadian DentalAssociation Procedure Codes, "the Administrator may allow a portion ofthe claim based on the cosi or charges for such alternative s~rvicesincluded in this' benef it as EI igible Expenses.
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-25-:
Revised 1983 04 15
7. Limi tations
(a) No benef its will be paid to or on behalf of an employee or hisel ig i ble dependents for any charges or El ig ible Expenses incurred inrespect of or arising from:
(i) any services for which benefits are payable under anyWorkers i Compensation Act or any similar law;
(ii) chargesfor a physician or dentist for any time spent intravelling, transportation costs or broken appointments;
(iii) services which .are cosmetic in nature, unless foracçidental inj uries and such treatment commences wi thin 90days of the accident~.
(iv) replacement of an existing appliance or prosthesis underany government plan or, subject to (d) below, any otherplan;
(v) crowns placed on a tooth not functionally impaired as aresul t of fractures or decay by inc isal or cuspal damage;
(vi) prosthetic devices which were ordered before the employeeor dependent became eligible under this benefit or whichar~ ordered wh ile employee or el ig ible dependent iscovered under this benef it but are installed more than 30days after termination of eligibility.
(b) Where Eligible Expenses are incurred outs ide Canada the amount payableunder this Benefit will be limited to the amount which is consideredreasonable and customary in the area in which the treatment isrendered.
(c) Where it cannot be satisfactorily determined by the Administrator thatDental expenses incurred are Eligible Expenses, 9r in the event of achange in' the Canadian Dental Association Procedure Codes, reimburse-ment may be provided with respect to such incurred expenses based onthe cost of alternative services which are defined in this plan asEligible Expenses.'
(d) \iVhere an employee participates. in another group plan, benef its willnot be payable wiJ"h respect to that portion of any Eligible Expensefor which benefits are paidby the other plan.
-26-Dat~ of issue: 1982 11 19
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'/'Applicat'ibn for Reissued Group Policy No. G 13900
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NORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES- .'
(herein called the Policyholder)
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hereby applie$" to The Mutual Life Assurance Company of Canada fora reissued Group Life Insurance Policy for the insured persons ofthe Policyholder, the form of such reissued policy having beenapproved by the Policyholder and this reissued policy to takeeffect as of ~uly i, 1980.
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Dated at '~ssigsaugår Ontario, as of the effective date of thisreissued po1ic'y .'.
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NORTHERN TELECOM LIMITED ANDPARTICIPATING' AFFILIATESBr.'-~~. ice-President, Human Resources
(Tit~l3 Y : (J ~ -' L .DAnd
Secretary(Title)
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Amendment to Group Policy No. G 13900
Issued by~..- ~''=~'
THE MUTUAL LIFE ASSURANCE COMPANY OF CANADA
to
NORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
The Schedule 1 on Policy Particulars (lA) is amended to add aparticipating affiliate, and a replacing Policy Particulars (lA) isattached.
********
Eligibility to be an Insured Person on Appendix A is amended to add aparticipating affiliate and a replaci?g Appendix A is attached.
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This amendment is effective on the 1st day of September, 1981.
Da ted at Waterloo, Ontario, as of the effective date of this amendment.
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President
Amendment approved and original attached to the policy.
NORTHERN TELECOM LIMITED ANDPARTICIPATING AFFILIATES
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I..EC.:,I_ :-.;:"'-'.By: L'
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vi -Pr~~ident, Human Resources(TiÔ.)-".~ '. .\t,_.~ I ;'x:; t- i__.__\
5eeret.a;'y
(Title)
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Agent:
Northern Telecom Limited will act as agent for the participatingaffiliates in all matters respecting this policy, including the amendmentof this policy and the acceptance of a new policy in place of this policy,and any thing so done by Northern Telecom Limited in such matters will beconsidered to be done on behalf of itself and the participating
. affiliates.Schedule 1
Participating Affiliates - Northern Telecom Canada LimitedNorthern Telecom Systems Limited
- Cook Electric Company of Canada Ltd.
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POLICY PARTICULAS (lA)
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APPENDIX A
Eligibility to be an Insured Person
A person is eligible to be an insured person
(a) on July i, 1980 if on the day prior to such date the person is insuredunder G 13900, or
(b) on July i, 1980 if the person is actively employed by the partici-pating affiliate, Northern Telecom Systems Limited on that date, or
(c) on September 1, 1981 if the person is actively employed by theparticipating affiliate, Cook ElectiÌ:c Company of Canada Ltd. on thatdate, or'
(d) on the date that the person commences active employment with thePolicyholder if the person's employment with the Policyholdercommences on or after the dates shown above,
provided the person is a salaried or hourly employee of Northern TelecomLimi ted, or its participating affiliates, or a commission salesman ofNorthern Telecom Systems Limited and is designated by the Policyholder tobe part of the Managerial and Non Negotiated groups.
Schedule of Benefits
Classification of Insured Persons
Annual'Rate of Earned IncomeLife
Insurance
Accidental Death& Di smemberment(Principal Sum)
At Least But Les s Than
S 2,000.3, 000.4, 000.5, 000.6,000.7, 000.8, 000.9, 000.
10',000.etc. by $1,000
S 2, 000.3,000.4,000.5,000.6,000.7,000.8, 000.9,000.
10,000.11,000.
steps
$ 2,000.3,000.4,000.5,000.6, 000.
.7,000.8, 000.9, 000.
10, 000.11, 000.
etc. by $1, 000
$ 2,000.3, 000.4,000.5,000.6, 000.7, 000.8,000~'-9, 000.
10,000.11,000.
stepsWhere an employee of Northern Telecom Limited or its participatingaffiliates is transferred outside of Canada, such employee will continueto be insured, on a temporary basis. The insurance coverage will be inaccordance with the terms of the policy under which the employee wasinsured while resident in Canada and the coverage will continue until theemployee can be accommodated in the ~group insurance plan of the.Policyholder in the country where the employee is then resident.
Termina tion of Benefits
An insured person i s Accidental Death and Dismemberment Insuranceterminates upon retirement.
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Amendment to Group Policy No. G 13900
Issued by
THE MUTUAL LIFE ASSURANCE COMPAN OF CANADA
to
NORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
The name of the participating affiliate Northern Telecom Systems Limitedis changed to Electronic Office Systems Group, and any reference toNorthern Telecom Syste~s Limited is amended to mean Electronic OfficeSystems Group. A replacing Policy Particulars (IA) page is attached.
********
This amendment is effective on the 1st day of January, 1982.
Dated at Waterloo, Ontario, as of the effective date of this amendment.(
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Secretary
Amendment approved and original attacaed to the policy.
NORTHERN' TELECOM LIMITED ANDPARTICIPATING AFFILIATES
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BY:
Resources
--And By:
Secretary(Ti tle)
Agent:
Northern Telecom Limited will act as agent for the participatingaffiliates in all matters respecting this policy, including the amendmentof this policy and the acceptance of a new policy in place of this policy,etnd any thing so done by Northern Telecom Limited in such mat.ters will beconsidered to be done on behalf of itself and the participatingaffiliates.
Schedule 1,.,'" '~.." .
Participating. Affiliates - Northern Telecom Canada Limited
- Electronic Office Systems Group- Cook Electric Company of Canada Ltd.
(
POLICY PARTICULAS (IA)
Amendment to ~roup Policy No. ~ 13900
Issued by
THE MUTUAL LIFE ASSURANCE' COMPANY OF CANADA
to
NORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
Appendix A-2 is te~minated.
********
This amendment is effective on the 1st day of ~uiy, 1982.
Dated at Waterloo, Ontario, as of the effective date of this amendment.
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Amendment approved and original attached to the policy.....-
NORTHERN TELECOM LIMITED ANDPARTICIPATING AFFILIATES
BY, .;¥~Vice-President i Human Resources(Title)........- " \. J~ 1-.-- l ~
And By:
Secretary(Title)
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agrees with
'NORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
(herein called the Policyholder)
to insure certain persons, in accordance with the provisions of this polley.
The provisions on the following pages form a part of this policy.I:It.,. l.' /-~;.
.... .,
This policy takes effect on the effective date and may be terminated as herein provided.
Premiums in amounts as herein determined are payable by the Policyholderat the Head Office of the Company or at such other place as the
Company may from time to time designate in writing to the Policyholder.
Signed at its Head Office, Waterloo, Ontario, as of the effective date.
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Reissue of Group Policy No. G 13900
This is a reissue of Group Policy No. G 13900, originallyissued July l, 1976. This reissue shows the provisions,terms, conditions and benefits in effect as of the effectivedate, July i, 1980'.
Any person, who is not actively at work on the effectivedate of this reissue, is not eligible for any increase inprovision benefits or amount of insurance as a result of thereissue of this policy. Any such increase will becomeeffecti ve on the date the person returns to active work.The Company may require satisfactory medical evidence,without expense to the Company, 'to establish the date thatthe person is physically and mentally fit to return toactive work.
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Defini tions
In this policy i
(a) "actively at work" and "active full-time work" mean the performance ofall of the regular duties of the person i s own occupation for one fullworking day or shift, as determined by the Policyholder, or considereda person on leave of absence prior to pension by the Policyholder i
(.b) "age 65" means the last day of the month in which the insured personattains age 65:
(c) "basic salary" means the rate of regular remuneration received by theinsured person excluding overtime i bonuses, allowances, premi urs andcost-of-living adjustments i .
(d) "effective date" means "July l, 1980 i
(e) lIinsured person" means a person insured under this policy:(f) "loss" means, with regard to hands and feeti dismemberment by
severence through or above the wrist or ankle joints: with regard toeyes i the entire and irrecoverable loss of sight beyond remedy bysurgical or otber means i
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(g) "participating affiliates" mean the companies specified in Schedule 1on Policy Particulars (lA):
(h) "pensionar" means a person retired on pension under the pension planof the Policyholder:
(i) "policy anniversary" means 'January 1, L9S1 and any anniversary 6f thatdate:
(j) ¡'policy year" means the period between the effective date and thefirst policy anniversary or any period of one year commencing on apolicy anniversary:
(k) "rate of earned income" means the rate of basic salary, calculated onan annual basisi received by the insured person at the time of deathor dismemberment in respect of the insured person i s regularemployment, except that in the case of a commissioned salesmanacti vely employed by the Policyholder, "rate of earned income" means.twice the rate of base salary calculated on an annual basis:
(1) "vehicle" means a vehicle that is drawn, propelled or driven by anymeans other than muscular power, and includes any aircraft,automobile, truck, motorcycle, moped, snowmobile and boat.
continued. . .
POLICY PARTICULAS (1)
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Agent:;(
Northern Telecom Limited will act as agent for the participatingaffiliates in all matters respecting this policy, including the amendmentof this policy and the acceptance of a new policy in place of this policy,and any thing so done by Northern Telecom Limited in such matters will beconsidered to be done on behalf of itself and the participatingaffiliates.
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Schedule iParticipating Affiliates ~ Northern Telecom Canada Limited
- Northern Telecom Systems Limited
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POLICY PARTICULAS (IA)
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'j, Premiums
(1) Premi urs are payable monthly in arrears. The first premium is payableon August 1, 1980. Subsequent premiums are payable on the 1st dayof each month commencing September l, 1980.
(2) The amount of the premium payable on any premium due date will becalculated in accordance with the following formula:
The monthly premium is equal to:
(i) The claims paid during the inuediat.ely preceding month, plus(ii) 2.85% of the claims paid for the immediately preceding month,
plus(iii) $70.00 times the number of claims paid for the immediately
preceding month.
(3) The above formula is subject to change on "January l, 1983 and annuallythereafter. Any change in this formula will be determined by theCompany at least 60. days prior to the da'te of change.
Eligibili tyThe eligibility fõr an insured person will be determined in the Appendicesattacned to this policy.
Amount of Insurance
r" (l) The amount of insurance for an insured person will be determi~ed fromthe Schedule of Benefits shown in the Appendices attached to thispolicy. Any increase or decrease in the amount of insurance for aninsured person due to a policy amendment or a change in classificationwill be effective on the date of the policy amendment or change in. classification unless otherwise provided below.
(2) Where an insured person is hot actively at work when an increase ininsurance would otherwise become effective, the increase w~ll not beeffecti ve until the person returns to active work.
POLICY PARTICULAS (2)
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Effecti ve Date of Insurance of an Insured Person
(1) Except as otherwise provided in this policy, a person who makeswri tten appl.ication on a form provided by the Company
(a) on or before the date of becoming. eligible will be insured on the dateof becoming eligible;
(b) within 31 days after the date of becoming. eligible, will be insured onthe date of completion of the application;
(c) later than 31 days after the date of becoming eligible, will beinsured only upon submission, without expense to the Company, ofevidence ,of insurability satisfactory to the Company, and theinsurance wiii become effective' on the date of receipt of the evidence''''by the Policyholder.
(2) (a) The insurance in respect of an eligible person who is not activelyat work, due to bodily injury or disease, on the date on which theinsurance would otherwise become effective, or
(b) any increase in insurance in respect of an insured person who isnot actively at work, due to bodily injury or disease, on .the date.on which the increase in insurance would otherwise becomeeffective,
will become effective on the date on which the person returns toacti ve work.
(The Company will have the right to require satisfactory medical evidence,wi thout expense to the Company, in order to establish the date on whichthe person is physically and mentally fit to return to active work. .
Termnation' of Insurance of an Insured Person
(1) Except as otherwise provided in this policy, the insurance (in wholeor in part) of an insured person will automatically terminate on the dateon which the insured person ceases to be eligible for that insurånce.
(2) where an insured person would otherwise cease to be eligible forinsurance because of illness or injury, the insured person will continueto be eligible for. insurance until the date of termination.
(3). Where an insured person ceases to be eligible for insurance because ofa te'mporary work stoppage, the insurance may be continued subject to theapproval of the Policyholder and the Company. Otherwise, the insurance ofthe insured person will cease on the date of commencement of '~he workstoppage.
(4) Where an insured person fails to disclose to the Company every factmaterial to the insurance under this policy, or misrepresents such facts,the insurance in respect of that person will be 'voidable at the option ofthe Company.
BENERA PROVISIONS (1)
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"'~~¡ít~~1The Contract
(1) This policy and the application therefor, a copy of which is attachedto and forms a part of the policy, constitute the entire contract ofinsurance between the Policyholder and the Company. The Policyholder.during the continuance of the policy will be a Policyholder of the Companyand the on.ly Policyholder in respect of the insurance under the policy,arid as such will be entitled to one' vöte at all annual and special generalmeetings of the Company. .("2) This policy may be amended with the approval of the Policyholder andthe Company, or terminated as herein provided, at any time without theconsent of the persons insured under it, but any amendment or terminationwill be without prejudice to any claim arising prior to the date of.amendment or termination of the policy.
(3) This policy may not be amended nor may any provision in the policy bewaived except by endorsement or rider signed by the officials of theCompany authorized to sign policies.
IncontestabilityThe statements made by the Policyholder in the application, other thanfraudulent statements, will be deemed to be true and incontestable afterthis policy has been in force for 2 years. The statements made by anyperson in the person i s application (or insurability report, if any) inrespect of insurance under the policy, other than fraudulent statements orstatements erroneous as to age, will be deemed to be true andincontestable after such person has been insured hereunder for 2 years.(Currency of Policy
Tne currency in respect of this policy is Canadian.
Period of Grace
A period of grace of 31 days is allowed for the payment of each premiumduring which period the policy will continue in force unless the'Policyholder has previously notified the Compa.nythat the policy willterminate at the end of the period for which the last premium was paid.If. a premium is not paid before the expiration of the period of grace, thepolicy will terminate at the end of the period of grace, but thePolicyholder will be required to pay to the Company any premium unpaid atthe date of termination. .Dividends
This policy will participate in the surplus distribution of the Company,to the extent and in the amo~nt determined by the Company. Suchparticipation will be in the form of a dividend which will be allotted asat the end of the policy year and will be paid to the Policyholder, if allpremiums due prior to the end of the policy year have been paid.
GENERA PROVISIONS (2)
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Where this policy terminates, the date of termination will be consideredto be the end of a policy year, for the purpose of this section.
.1
Inspection of Payroll
The Company will have the right to inspect at any time the payroll of thePolicyholder and any other records of the Policyholder relevant to this .policy in order to verify the amount of insurance to which an insuredperson is entitled, the premium charged and any other matter relating toinsurance under the policy.Assignment
The rights and interests of an insured person under this policy areassignable and should be filed with the Company.
Termination of Policy
(i) This policy will lapse when a premium has not been paid before the endof the grace period. At that time, the Company will notify thePolicyholder in writing' of the lapse and offer reinstatement terms. Ifthese terms are accepted and overdue premiums are paid, the liability ofthe Company will continue uninterrupted. If reinstatement terms are notaccepted the liability of the Company will cease effective at the end of"the period of grace.
(2) The Policyholder may terminate this policy by giving written notice tothe Company. The date of termination of the policy will be the date ofreceipt of such notice or the termination date stated in the notice if (later. If the date of termination does not fallon a premium due date,the Policyholder will be required to pay to the Company the pro-ratapremium for the period from the i-ast premium due date to the date oftermina tion.
(3) . The Company' may terminate this policy on the first policy anniversaryor on any monthly premium due date following the first policy anniversaryby giving written notice of termination to the Policyholder at least 60days in advance of the date of termination.
(4) Except as otherwise provided in this policy, the insurance of.-allinsured persons wiii immediately cease upon termination of this pOlicy.
GENERA PROVISIONS (3)
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Payment of Insurance
(l) On the death of a~ insured person from any cause, includingself-destruction while sane or insane, the Company will pay the amount, asdetermined" from the Schedule of Benefits in the Appendices attached tothis policy, for which the person was insured on the date of death.
(2) Any claim under this provision must be made in writing to the Companyat its Head Office giving proof satisfactory. to the Company of the claimand of the title of the claimant.
Optional, Methods of Settlement
(
(l) Subject to subsection (2), an insured person, or in the absence of an.election by the insured person, the beneficiary may elect one of thefollowing optional methods of settlement in lieu of payment in one sum:
(a) Deposit at interest - The Company will retain the insurance proceedson deposit. Interest at the rate of no less than 3 l/2 % per annum,and such additional interest as may be determined by the Company fromtime to time, will åccrue on the balance of the deposit and will bepaid in cash at each anniversary of the date of deposit except that nointerest will accrue after the death of the beneficiary or on anyamount withdrawn prior to the first anniversary of the date of thedeposi t. The Company will have the right to. determine from. time totime the minimum amount of any withdrawal, and may defer for a periodnot exceeding 30 days the payment of any withdrawal requested.
(b) Income - The Company will pay the insurance proceeds to thebeneficiary in the form of an income payable either for a guaranteedperiod of years or' for the lifetime of the beneficiary with or withouta guaranteed period, the amount of the income to be determined inaccordance with the income options available under individual lifeinsurance policies being issued by the Company at t~e time the
. election is made.
(2) The Optional Methods of Settlement are subject to the foiio~ingcondi tions :
(a) The minimum amount of insurance proceeds which may be applied .underany option for anyone beneficiary is Sl, 000. The income option isavailable only where the income is 'at least S10. per month for anyonebeneficiary.
(b)' The election of an option must be made in writing to the Company atits Head Office.
(c) The beneficiary must be a natural person entitled to receive paymentin that person's own right. .
(d) Election of the option must be made not later than one year followingthe death of the insured person.
GROUP LIFE INSURACE PROVISION (1)
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(e) The beneficiary will not have the right to change or vary an optionelected by the insured person unless the Company at its Head Officehas been otherwise directed in writing by the insured person.
.l, Beneficiary .
The beneficiary of an. insured person is as stated in the person Isapplication unless subsequently changed. If an insured person has notappointed a beneficiary or if no beneficiary is alive at the date of deathof the insured person, the insurance of the insured person will be paid tothe estate of the insured person.
.,.1.;
Extended Benefit on Termination of Insurance
Where insurance of an insured person terminates while this provisioncontinues in force, the amount of insurance terminated with respect to aninsured person will be paid by the Company if death occurs within 31 daysof the date of termination of the insurance.
Conversion Privilege
(1) Where insurance of an insured person terminates, the insured personwill, subject to subsection (2) and without supplying evidence ofinsurability, be entitled to an individual policy on the life or theinsured person on a One Year Term, a Term to Age 65, or on any Whole Lifeplan which provides for uniform premiums and a uniform death benefit andwhich is regularly issued bY the Company for the amount of the individualpolicy.
(2) The issue of the individual policy will be subject to the followingconditions:
(
(a) If this provision continues in force,
(i) The amount of the individual policy will not excèed the lesser of(1) the amount of the insurance terminated, or (2) the maximumamount of insurance for which the person has been insured underthis policy.' less the total amount of individual insurance still inforce on the person i s life which was previously obtained under theconversion privilege of this policy, and
(ii) The individual policy will take effect 31 days after the insuranceis terminated.
(b) 'If this provision terminates,(i) an individual policy is available only to a person who has been
continuously insured under this policy during the five year periodirnedia tely preceding the termination of the provision, and
GROUP LIFE INSURACE PROVIS ION (2)
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(ii) the amount of the individual policy will not exceed S5,000 or 25%of the amount of insurance terminated, whichever is greater,but not exceeding the amount of. insurance terminated, reduced byany amount of insurance for which the person may be or may becomeeligible under any group policy issued within 3l days after thedate of the termination, and
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j(iii) the individual poliqy ~ill take effect on completion of the
application and payment of the required premium.
'( c). Written application for thè individual policy must be submitted to theCompany within 31 days after the insurance is terminated and therequired premium must be paid with the application.
(d) The individual policy will not. contain a Total Disabilitý orAccidental Death Provision.
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(e) The premium for the individual policy will be in accordance with thescale of premiums in use by the Company at the effective date of theindividual policy for the class of risk to which the applicant belongsand taken at the applicant i s insurance age at the effective date.
(f) The individual policy will be in exchange for all benefits terminatedunder this prevision and will contain the same provisions as areregularly included by the Company in new policies issued at the dateof application.
((g) The One Year Term plan and the Term to Age 65 plan will not be
available to an insured person who has attained 65 years of age.
(3) Where a part of the group of insured persons is withdrawn from thegroup and the persons in the part' wi thdrawn cease to be insured persons,tpis provision will be considered to have terminated in respect of suchpersons for the purpose of this Conversion Privilege.
GROUP LIFE INSURACE PROVISION (3)
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Payment of Benefit
(1) Upon receipt and approval by the Company of due proof that an insuredperson has euffered any of the losses shown in the table below as a directresul t of bodily injury caused solely through accidental, violent andexternal causes and such loss occurred within 365 days of the date ofsustaining" such injury, the Company will, subject to the terms of thisprovision, pay the benefit shown in the following table.
(2 ) Table of Losses and Benefits
Loss of Life )
Loss of Both Hands ). Loss of Both "Feet )Loss of the Sight of Both Eyes ) The Principal SumLoss of One Hand and One Foot )Loss of One Hand and the Sight of One Eye )Loss of One Foot and the Sight of One Eye )
Loss of One Hand )Loss of One Foot ) One-Half the Principal SumLoss of the Sight of One Eye )
(3) The injury mus~ be sustained while the insured person is insured underthis provision.
(4) The principal sum with respect to an insured person will be determinedfrom the Appendices attached to this policy. (-The total amount payable under this provision will, in respect of anyoneaccident, not exceed the principa¡ sum for which the person. is insured. .
(5) Payment. of any benefit under this provision will be made to theinsured person if living. Otherwise, payment will be made to thebeneficiary named by the insured person. If no beneficiary has been namedor the beneficiary does not survive the insured person, then payment willbe made to the estate of the insured person.
Extended Benefit on Termination of Insurance
Thi s provision contains no extended benefit on termination of insurance.Conversion PrivilegeThis provision contains no conversion privilege.
Limi tations
Benefits under this provision are not payable for any loss resultingdirectly or indirectly, wholly or partially from any of the followingcauses -
(a) Suicide or self-inflicted injuries, while sane or insane;
(b) Committing or attempting to commit a criminal offence;
ACCIDE~TAL PEATH AND DISMEMBERMENT INSURACE PROVISION (1)
(c) Civil disorder or war, whether or not the insured person is actuallyparticipa ting therein and whether or not war be declared i
(d) Injuries sustained by the insured person as the result of driving avehicle' if, when the injuries were sustained, the blood of the insuredperson contained in excess of 80 milligrams of alcohol per lOamillilitres of blood.
Claims
(l) Any claim under this provision must be made in writing to the' Company. at its Head Office giving proof satisfactory to the Company of the claimand of the title of thecl aiman t .
. (2) Proof of loss will be required 'by the Company, on forms supplied bythe Company, wi thin 3 months after the date of the loss.
(3) The Company will have the right and opportunity, when and so often asit may reasonably require, to examine the person of any insured person whois making claim for benefits hereunder.
ACCIDENTAL DEATH AND DISMEMBERMENT INSURACE PROVISION (2)
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APPENDIX A
Eligibili ty to be an Insured Person
A person is. eligible to be an insured person
(a) on 'July I, 1980 if on the day prior to such date the person is insuredunder G l3900, or
(b) on July 1,.1980 if the person is actively employed by the partici-pating affiliate, Northern Telecom Systems Limited on that date, or
(c) on the date that the person commences active employment with thePolicyholder if the person i s employment with the Policyholdercommences on or after 'July l, i 980,
provided the person is a salaried or hourly employee of Northern TelecomLimited, or its participating affiliates, or a ç:ommission salesman of':Northern Telecom systems Limited and is designated by thePòlicyholder tobe part of the Manågerial and Non Negotiated groups.
Schedule of BenefitsClassification of Insured Persons
Annual Rate of Earned IncomeLife
Insurance
Accidental Death& Di smembermen t(Principal Súmr.
But Less Than (At Least
$ 2,000.3,000.4,000..5,000.6,000.7,000.8,000.9,000.
10,000.etc. by $1,000'
$ 2,000.3,000.4,000.5,000.6, 000.7, 000.8, 000.9, 000.
10,000.LL,OOO.
steps
$ 2,000.3,000.4, 000.5, 000.6, 000.7, 000.8, 000.9,000.
10,000.11,000.
etc. by $1, 000
$ 2,000.3,000.4,000.5,000.6,000.7, 000.8, 000.9,000.
10, 000.11,000....steps .
Where an employee 'of Northern Telecom Limited or its participatingaffiliates is transferred outside of Canada, such employee will continueto. be insured, on a temporary basis. The insurance coverage will be inaccordance with the terms of the policy under which the employee wasinsured while resident in Canada and the coverage will continue until theemployee can be accommodated in the group insurance plan of thePolicyholder in the country where the employee is then resident.
Termination of BenefitsAn insured person's Accidental Death and Dismemberment Insuranceterminates upon retirement.
.,( . ( :....1.... I ~ I
APPENDIX A-l
Eligibili ty to be an Insured Person
A person is eligible to be an insured person
(a) on 0uly l, 1980 if on the day prior to such date the. person is insuredunder G 13 900, or
(b) on the date that the person commences active employment with thePolicyholder if the person i s employment with the Policyholdercommences on or after July 1, 1980,
provided the person is an employee of Northern Telecom Limitèd or itsparticipating affiliates, and is designated by the Policyholder to be partof the Certified Professional group.
Schedule of Benefits
Classification of Insured Persons
LifeInsurance
Accidental Death& Dismemberment(Principal Sum)Annual Rate of Earned Income
At Least But Less Than
S 2,000.3,000.4,000.5,000.6,000.7, OQO.8,000..9,000.
10,000.etc. by Sl,OOO
S 2, 000.3,000.4, 000.5, 000.6,000.7,000.8, 000.9,000.
10,000.11,000.
steps
S 2,000.3, 000.4, 000.5, 000.6, 000.'7,000.8, 000.9, 000.
10,000.11,000.etc. by Sl,OOO
S 2,000.3, 000.4, 000.5, 000. .6, 000.7, 000.8, 000.9, 000.
lO, 000.11,000.
stepsWhere an employee of Northern Telecom Limited or its participatingaffiliates is transferred outside of Canada, such employee will continueto be insured, on a temporary basis. The insurance coverage will be inaccordance with the terms of the policy under which the employee wasinsured while resident in Canada and the coverage will continue until theemployee can be accommodated in the group insurance plan of the. Policyholder in the country where the employee is then resident.
Termination of Benefits
An insured person's Accidental Death and Dismemberment Insurancetermina te s upon retirement. .
.\ (
APPENDIX A-2
Eligibili ty to be an Insured Person
A person is' eligible to be an insured person
(a) on 'July 1, 1 9 80 i'f on the day pr ior to such date the per son is ins uredunder G 13900, or
(b) on the date that the person commences active employment with thePolicyholder if the person's employment with the Policyholdercommences on or after July l, 1980,
provided the-person is an employee of Northern Telecom Limited or its..participating affiliates, and is designated by the Policyholder to aSupervisor of the Western Region Installation group.
Schedule of Benefits
Classification of Insured Persons
LifeInsurance
Accidental Death'& Dismemberment(Principal Sum).Annual Rate of Earned Income
At Least But Less Than
S 2, 000.3, 000.4, 000.5, 000.6, 000.7,000.8,000.9, 000.
10,000.etc. by $1, 000
S 2, 000.3, 000.4,000.5, 000.6, 000.7,000.8,000.9,000.
10,000.11, 000.
steps
$ 2, 000. $ 2, 000.3, 000. 3, 000. (4, 000. 4, 000. \
~ .
5, 000. 5, 000.6, 000. 6, 000.7,000. 7, 000.8,000. 8, 000.9, 000. 9,000.
10,000. 10,000.11, 000. 11, 000.
etc. by Sl,OOO stepsWhere an employee of Northern Telecom Limited or its participatingaffiliates is transferred outside of Canada, such employee will continueto be insured, on a temporary basis. The insurance coverage will be inaccordance with the terms of the policy under which. the employee wasinsured while resident in Canada and the coverage will continue until theemployee can be accommodated in the group insurance plan of thePolicyholòer in the country where the employee is then resident.
Termination of Benefits
An insured person's Accidental Death and Dismemberment Insuranceterminates upon retirement.
. (,~ ('" ,
APPENDIX B
Eligibility to be an Insured Person
A person is eligible to be an insured person
(a) on 0uly I, 1980 if on the day prior to 'such date the person is insuredunder G 13900 asa pensioner of the Policyholder, if the personretired on or after 0uly 1, 1976, or
(b) on the date that the person retires on pension with the Policyholder,if the person retires on or after 'July i, 1980
provided the person was insured as an active employee under this policyuntil retirement on pension.'
Schedule of Benefits
Classification of Insured Persons Life Insurance
1. All Pensioners *
* The amount for which a pensioner is insured hereunder shall be theamount of insurance for which the pensioner was insured as an activeemployee on the d~te of retirement, reduced on the first anniversary ofthe date of retirement by 5% of such amount and further reduced by a likeamount of each of the next four anniversaries of the date of retirement.In no case, however, shall the amount of insurance be reduced to less thanS1,500.
. ~. '. (
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APPENDIX C
Eligibility to be an Insured Person
A person acting in a consulting capacity as designated by Northern TelecomLimi ted, is eligible to be an insured person
(a) on July 1, 1980 if on the day prior to such date the person is insuredunder G 13900, or
'tb) on the date that the person commences such duties, if on or after Julyl, 1 980.
Schedule of Benefits
Classification of Insured Persons Life Insurance
l. All Persons' acting in aconsul ting capacity
An amount equal to two times theannual rate of :fees of the insuredperson, such amount to be roundedto the next higher S l, 000, if notalready a mul tip1e thereof.
Where an employee of Northern Telecom Limited or its participatingaffiliate is tranšferred outside of Canada, such employee will continue tobe insured, on a temporary basis. The insurance' coverage will be'in .accordance with the terms of the policy under which the employee wasinsured while resident in Canada and the coverage wiii continue untilemployee can be accommodated in the group insurance plan of thePolicyholder in the country where the employee is then resident.
the"(",.,
\.. . . ..;-..
Application for Reissued Group Policy No. G 14900
'j~\-
NGRTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
(herein called the Policyholder)
(
hereby applies'- to The Mutual Life Assurance Company of Canada fora reissued Group Life Insurance Policy for the insured persons ofthe Policyholder, the form of such reissued policy having beenapproved by the Policyholder and this. reissued policy to takeeffect as of ~uly 1, 1980.
Dated at Mississauga, Ontario, as of the effective date of thisreissued policy.
~., _.. ,....s. l, L¡¡:C;AI_ J:"¡;P,. ~._-----~. l! p( ~ ç l
JR'~ID'~'- ,.Yo" ,... I. "_=-.il
NORTHERN TELECOM LIMITED ANDPARTICIPATING AFFILIATES.
By,. G","" ~.JÇ p;~:ent Human(~L,al. ¡~L ,. LBy:
Resources
And
S-ecretary(Ti tIe)
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Amendment to Group Policy No. G 14900
Issued by
THE MUTUAL LIFE ASSURANCE COMPANY OF CAADA
to
NORTHERN TELECOM LIMITED AND PARTICIPATING AFFlLIATES
The Schedule I on Policy Particulars (lA)' is amended to add aparticipating affiliate, and a replacing Policy Particulars (lA) isattached.
********
Eligibility to be an Insured Person on Appendix A is amended to add aparticipating affiliate and a replacing Appendix A is attached.
******** (,
This amendment is effective on the' 1st day of September, 1981.
Dated at Waterloo, Ontario, as of the effective date of this amendment.
Secretary
.p.. /""'7' A ~) AI--":! l ~J.'/ ¡'~..7'/¡l, II . ,r¿'.: l- '. _"j/ " C. .
President
¡J' ¿t' )/'~ ".:'" . ~l! _" "'.' ../....""t~;__1 .. ç.. ' ~ ...~"t:, ~.
Amendment approved and original attached to the policy.
NORTHERN TELECOM LIMITED ANDPARTICIPATING AFFILIATES
r=='~""~"'-nlr LL.C~::::_-c:. ~
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By:H.uman Resources
And By: '-/Secretary
(Title)
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/ (i) "dependant" means with respect to the S.chedule of Benefits, any\ unmarried' child of an insured person or the spouse, provided s~ch
child is under the age of 21 years, or is unmarried, under the age of25 years and attends an accredited school, college,' or universityfull-time, excluding any child who is not wholly dependent on theinsured person for maintenance and support.
Agent:
No'rthern Telecom Limited will act as agent for the participatingaffiliates in all matters respecting this policy, including the amendmentof this policy and the acceptance of a new policy in place of this policy,and any thing. so done by Northern Telecom Limited in such matters will beconsidered to be done on behalf of itself and the participatingaffiliates.
Schedule 1
Participating' Affiliates - Northern Telecom Canada Limited- Northern Telecom Systems Limited- Cook Electric Company of Canada Ltd.
POLICY PARTICULAS (lA)
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~. ..APPENDIX A
Eligibi lity to be an Insured Person
A person is eligible to be an insured person
(a) on July 1, 1980 if on the day prior to such date the person is insuredunder G 13900, or
(b) on July 1, 1980 if the person is actively employed by the partici-pating affiliate, Northern Telecom Systems Limited on that date, or
(c) on September 1, 1981 if the person. is actively employed by theparticipating affiliate, Cook Electric Company of Canada Ltd. on thatdate, or
(d) on the date that the person commences active employment with thePolicyholder if the person's . employment with the Policyholdercommences on or after the dates shown above,
provided that the person is insured under Group Policy G 13900. issued tothe Policyholder by the Company and provided the person is a salaried orhourly employee of Northern Telecom Limited, or its participatingaffiliates or a commissio~ salesman of Northern Telecom Systems Limitedand is designated by the Policyholder to be part of the Managerial and NonNegotia ted groups.
Schedule of Benefi tß
Classification of Insured Persons
I. All Employees An amount equal to
Optional LifeInsurance (\,
50% * or75% *.'or
100% * or125% * or150% * or175% * or200% *
ClassificationOf ¡nsured Persons.
* of the insured person i s rate of basic salary, calculated on an annualbasis, rounded to the next higher $1,000 of insurance and subjectt~ aminimum amount of insurance of $10,000.
A person may elect to be insured for one of the above optional amounts ofinsurance within 31 days of becoming eligible under this policy and at noother time without. submission of evidence of insurability satisfactory tothe Company.
. An insured per son may ~lect to increase the amount of optional insurancesubject to a maximum of 200% .of annual rate of earned income, uponacquiring a spouse or a. dependant or an additional dependant withoutsubmi tting evidence of insurabi~i ty.
An insured person may elect to decrease or terminate the amount ofoptional insurance a t any time.
continued. . .
Amendment. to Group Policy No. G 14900
Issued' by
THE MUTUAL LIFE ASSURANCE "'GOMPAN OF CANADA
.to
NORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
The name of the participating affiliate Northern Telecom Systems Limitedis changed to Electronic Office Systems Group, and any reference toNorthern Telecom Systems Limited is amended to mean Electronic OfficeSystems Group. A replacing Policy Particulars (IA) page is attached.
********
This amendment is effective on the 1st day of January, 1982.
( Dated at Waterloo, Ontario, as of the 'effective date of this amendment.
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Amendment approved and original attached to the policy.
NORTHERN TELECOM LIMITED ANDPARTICIPATING AFFILIATES
t ':.~'~p.'i- ::;FTlt i, Pt..S J ~:~~l'r¡t I..'/; y,.-=i
(\/1 "J~ L''h v__ c" -i c,,~.-- ~" )¡.,Vice-President i Human Resources. ..-.:\ .
And By:' (Tit:~L" ~r- ~.1)
By:
Secretary(Title)
(l) "dependant" means with respect to the Schedule of Benefits, anyunmarried child of an insured person o'r the spouse, provided such (child is under the age of 21 years, or is' unmarried, under the age of "25 years, and attends an accredited school, college, or universityfull-time, excluding any child who is not wholly dependent on theinsured person for maintenance and support.
Agent:
Northern Telecom Limited will act as agent for the participatingaffiliates in all matters respecting this policy, including the amendmentof this policy and the acceptance of a new policy in place of this policy,and any. thing so done by Northern Telecom Limited in such matters will beconsidered to be done on behalf of ~tself and the participatingaffiliates.
Schedule 1
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Participating Affiliates - Northern Telecom Canada LimitedElectronic Office Systems GroupCook Electric Company of Canada Ltd.
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APPENDIX A
Eligibility to be an Insured Person
A person is eligible to be an insured person
(a) on September I, 1981 if the person is actively employed by theparticipating affiliate, Cook Electric Company of Canada Ltd. on thatdate, or
(b) on the date that the person commences active employment with thePolicyholder if the person i s empl0Yment with the Policyholderconuencesafter September i, 1981, "'. ~.,.
lprovided that the person is insured under .Group Policy U 13900 issued tothe Policyholder by the Company and provided the person is a salaried orhourly employee of Northern Telecom Lirni ted, or a commission salesman ofEl ectronic Office Systems Uroup and is designated by the Policyholder tobe part of the M:imageri.al and NonNegotiated groups.
Schedule of Benefits
Classification of Insured Persons
ClassificàtionOf Insured Persons
Optional LifeInsurance
1. All Employees An amount equal to 50% * or75% * or
100% * or125% *.. or150% * or175% * or200% *
* bf the insured person i s rate of basic salary, calculated on an annualbasis, rounded to the next higher $1 i 000 of insurance and subject to aminimum amount of insurance of $10,000.
A person may elect to be insured for one of the above optional amounts ofinsurance wi thin 31 days of becoming eligible under this policy and at noother time without submission of evidence of insurability satisfactory tothe Co'mpany.
An insured person may elect to increase the amount of optional insurancesubject to a maximum of 200% of annual rate of -earned income, ùponacquiring a spouse or a dependant or an additional dependant withoutsubmi tting evidence of insurability.
An insured person may elect to decrease or terminate' the amount ofoptional. insurance at any time.
continued. . .
Amendment to :Group Policy No. ~ 14900'
Issued by
THE MUTUAL LIFE ASSURACE COMPAN OF CANADA
toNORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
Appendix A-2 is terminated.
********
This amendment is -effective on the 1st day of 'July, 1982.
Dated at Waterloo, Ontario, as of the effective date of this amendment.
l. ;1:1\. ~c. -C.tfß.,.~ /ipc. (
Secretary President
Amendment approved and original attached to the policy.
By:
NORTHERN TELECOM LIMITED ANDPARTICIPATING AFFILIATES
~:jf::-:UIan Re~ources(~T;de,U L-''-L.EGAL. C",PT.
And By:
Secretary( Ti tle)
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agrees with
NORTHERN TELECOM LIMITED AND PARTICIPATING AFFILIATES
(herein called the Policyholder)
to insure certain persons, in accordance with the provisions of this policy.
This policy takes effect on the effective date and may be terminated as herein provided.
Premiums in amounts as herein determined are payable by the Policyholderat the Head Offce of the Company or at such other place as the
Company may from time to time designate in writing to the Policyholder.
The provisions on the following pages form a part of this policy.
Signed at Its Head Office, Waterloo, Ontario, as of the .effective date.
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Reissue of Group Policy No. G 14900
. '.
This is a reissue of Group Policy No. .G 14900" originally'.;"issued October 1, . 1 976. This reissue shows the .provisions,'terms, conditions and benefits in' effect as of the effècti vedate, July I, 1980.
Any person, who is not actively at '~õrk on the effectiv~date of this reissue, is not e~igible for any increase inprovision benefits or amount of insurance as a result of thereissue of this policy. Any such increase will becomeeffective on the date the person returns to active work.The Company may require satisfactory medical evidence,without expense to the Company, to establish the date thatthe person is physically and mentally fit to return toacti ve work.
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Defini tions
In thi s policy,
( a) "actively at work" and "active full-time work" mean the performance ofall of the regular duties of the person i s own occupation for one fullworking day or shift, as determined by the Policyholder, or considereda person on leave of absence prior to pension by the Policyholder i
(b) "age 65" means the last day of the month in which the insured personattains age 65;
(c) "basic salaryll means the rate of regular remuneration received by the-.';,'insured person excluding overtime, bonuses, allowances, premiums andcost-of-living adjustments;
( d)
(e)
( f)
"effective date" means July 1, 1980;
"insured person" means a person insured under this policy;
"participating affiliates" means the companies specified in Schedul-e. 1.'"on Policy Particulars (lA);
(g) "pensioner" means a person retired on pension under the 'pension planof the Policyholder;
(,.'
(h) "policy anniversary" means January I, 1981 and any anniversary of thatdate;
(i) "policy yearll means the period between the effective date and thefirst policy anniversary or any period of one year commencing on a'policy anniversary;
(j) "spousell means with respect to the Schedule of Benefits, the person ofthe opposite sex of the employee who, at the time the right to claim abenefit arises, is cohabiting with the employee , . and has been socohabi ting either,
(i) for 36 consecu-tì ve months immediately prior thereto in the eventmarriage is prohibited by law, or
(ii) for 12 consecutive months immediately prior thereto in the eventmarriage . not so prohibited, andis
(iii) in both situations the co-habitant is publicly represented asthe husband or wife of the employee;
(k) "rate of earned income" means the rate of basic salary, calculated onan annual basis, received by the insured person at the time of deathin respect of the insured person i s regular employment, except that inthe case of a commissioned salesman actively employed by thePolicyholder, "rate of earned income" means twice the rate of basesalary calculated on an annual basis i
continued. . .
POLICY PARTICULAS (l)
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(1) "dependant" means with respect to the Schedule of Benefits, anyunmarried child of an insured person or the spouse, provided suchchild is' under the age of 21 years, or is unmarried, under the age25 years and attends an accredited school, college, or universityfull-time, excluding any child who is not wholly dependent on theinsured person for maintenance and support.
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l\gent:Northern Telecom Limited will act as agent for the participatingaffiliates in all matters respecting this policy, including the amendmentof this policy and the acceptance of a new policy in place of this policy,and any thing so done by Northern Telecom Limited in such matters will beconsidered to be done on behalf of itself and the participatingaffiliates.
Schedule 1
Participating Affiliates - Northern 'Telecom Canada Limited- Northern Telecom Systems Limited
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POLICY PARTICULAS (IA)
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Premiums
(l) Premi urs are payable monthly in arrears. The first premium is' payableon August 1, 1980. Subsequent premiwns are payable on the 1st day ofeach month commencing September l, 1 980.
(2) The amount of the premium payable on any premiwn due date will becalculated in accordance with the following formula:
The monthly premi.um is equal to:
(i) The cla.ims paid during the imm~diately preceding month, plus(ii) 2.85% of the claims paid for the immediately preceding month.
(3) The above formula is subject to' change on January l, 1983 and annuallythereafter. Any change in this formula will be determined by theCompany at least 60 days prior to the date of change.
Eligibili ty
The eligibility for an insured person will be determined in the Appendicesat tached to thi s policy.Amount of Insurance
(l) The amount of insurance for an insured person will be determined fromthe Schedule of Benefits shown in the Appendices attached to thispolicy. Any increase or decrease in the amount of insurance for aninsured person due to a policy amendment or a change in classificationwill be effective on the date of the policy amendment or change inclassification unless otherwise provided below.
,(2) Where an insured person is not actively at work when an increase in
insurance would otherwise become effective, the increase will not beeffective until'the person is actively at work.
POLICY PARTICULAS (2)
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Effecti ve Date of Insurance of an Insured Person
(l) Except as otherwise provided in this policy, a person who makeswritten application on a form provided by the Company
(a) on or before the date of becoming eligible will be insured on the dateof becoming eligible;
(b) within 31 days after the date of becoming eligible, will be insured onthe date of completion of the application;
(c) later than 3 1 days after the date q.f.,.pecoming eligible, will beinsured only upon submission, without expense to the Company, ofevidence' of insurabili ty satis~actory to the Company, and the'insurance will become effective on the date of receipt of the evidenceby the Policyholder.
(2) (a) The insurance in respect of an eligible person who is not activelyat work, due to bodily injury or disease, on the date on which theinsurance would otherwise become effective,. or
(b) any increase in insurance in respect of an insured person who isnot actively at work, due to bodily injury or disease, on the dàte.on which the increase in insurance would otherwise becomeeffective,
will become effective on the date on which the person returns toactive work. (The Company will have the right to require satisfactory medical evidence,without expense to the Company, in order to establish the date on whichthe person is physically and mentally fit to return to active work.
Termination of Insurance of an Insured Person
(1) Except as otherwise provided in this policy, the insurance (in wholeor in part) of an insured person will automatically terminate' on the dateon which the insured person ceases to be eligible for that insurance.
(2) Where an insured person would otherwise cease to be eligible forinsurance because of illnes s or injury, the insured person will continueto be eligible for insurance until the date of termination.
(3) Where an insured person ceases to be eligible for insurance because ofa temporary work stoppage, the insurance may be continued subject to theapproval of the Policyholder and the Company. Otherwise, the' insurance 'ofthe insured person wiii cease on the date of commencement of the workstoppage.
(4) Where an insured person fails to disclose to the Company every factmaterial to the insurance under this policy, or misrepresents such facts,the insurance in respect of that person will be voidable at the option ofthe Company.
GENERA PROVISIONS (1)
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The Contract
(I) This poiicy and the application therefor, a copy of which is attachedto and forms a part of the policy, constitute the entire contract ofinsurance between the Policyholder and the Company. The Policyholderduring the continuance of the policy will be a Policyholder of the Companyand the only Policyholder in respect of the insurance under the policy,and as such will be entitled to one vote at all annual and special generalmeetings of the Company.
(2) This policy may be amended with the approval of the Policyholder andthe Company, or terminated as herein provided, at any time without theconsent of the persons insured under it-,"i¡"but any amendment or terminationwill be without prejudice to any claim arising prior to the date ofamendment or termination of the pOI'icy. .
(3) This policy may not be amended nor may any provision in the policy bewai ved except by endorsement or rider signed by the officials of theCompany authorized to sign policies.
IncontestabilityThe statements made by the Policyholder in the application, other thanfraudulent statements, will be deemed to be true and inconte'stable afterthis policy has been in force for 2 years. The statements made by anyperson in the person i s application (or insurability report, if any) inrespect of insurance under the policy, other than fraudulent statements orstatements erroneous as to age, will be deemed to be true andincontestable after such person has been insured hereunder for 2, years.Currency of Policy
The currency in respect of this policy is Canadian.
Period of Grace
A period of grace of 31 days is allowed for the payment of each premiumduring which period the policy will continue in force unless thePolicyholder has previously notified the Company that the policy willtermina te at the end of the period for which the last premium was paid.If a premium is not paid before the expiration of the period of grace, thepolicy will terminate at the end of the period of grace, but thePolicyholder will be required to pay to the Company any premium unpaid atthe date of termination.
Dividends
This policy will participate in the surplus distribution of the Company,to the extent and in the amount determined by the Company. Suchparticipation will be in the form of a dividend which will be allotted asat the end of the policy year and will be paid to the Policyholder, if all.premiums due prior to the end of the policy year have been paid.
'GENERA PROVISIONS (2)
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,Jtd¡~E~f'= ~~;:tlllr'"'~:~s'è,r"Where this policy terminates, the date of ,termination will be consideredto be the end of a policy year, for the purpose of this section.
Inspection of Payroll
The Company will have the right to inspect at any time the payroll of theP.olicyholder and any other records of the Policyholder reievant to thispolicy in order to verify the amount of insurance to which an insuredperson is entitled, the premium charged and any other matter relating toinsurance under the policy.Assignment .:' ~....
The rights and interests of an .insured person under this policy areassignable and should be filed with the Company.
Termination of Policy
(1) This policy will lapse when a premium has not been paid before the endof the grace period. At that time, the Company will notify the .~olicyholder in writing of the lapse and offer reinstatement terms. Ifthese terms are accepted and overdue premiums are paid, the liability ofthe Company will continue uninterrupted. If reinstatement terms are 'not'.accepted the liability of the Company will cease effective at the end ofthe period of grace.
(2) The Policyholder may terminate this policy by giving written notice tothe Company. The date of termination. of the policy will be the date of (receipt of such notice or the termination date stated in the notice if "later. If the date of termination does not fallon a premium due date,the Policyholder will be required .to pay to the Company the. pro-ratapremium for the period from the last premium due aate to the
date of,te rmi na tion .
(~) The Company may terminate this policy on the first policy anniversary.or on any monthly premium due date following the first policy anniversaryby giving written notice of termination to
the Policyholder at least 60
"days in advance of the date of termination.
(4) Except as otherwise provided in this policy, the insurance of allinsured persons will immediately cease upon termination of this policy.
BENERA PROVISIONS (3)
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Payment of Insurance
(1) On the death of an insured person from any cause, includingself-destruction while sane or insane, the Company will pay the amount f as '.¡determined from the Schedule of Benefits in the attached Appendices f forwhich .the person was insured on the date of death.
'(2) Any claim under this provision must be made in writing to the Companyat its Head Office giving proof satisfactory to the Company of the claimand of the title of the claimant.
Optional Methods of Settlement~. ...~..".
(2) The Optional Methods of Settlement are subject to the followingcondi tions:
(a) The minimum amount of insurance proceeds which may be applied "tinderany option for anyone beneficiary is $1,000. The income option isavailable only where the income is at least $10. per month for anyonebeneficiary.
(b) The election of an option must be made in writing to the Company atits Head Office.
(c) The beneficiary must be a natural person entitled to receive paymentin that person i s own right.
(d) Election of the option must be made not later than one year followingthe death of the insured person.
GROUP LIFE INSURACE PROVISION (1)
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(e) The beneficiary will not have the right to change or vary an optionelected by the insured person unless the Company at its Head Officehas been. otherwise directed in writing by the insured person.
Beneficiary
The beneficiary of an insured person is as stated in the person'sapplication unless subsequently changed. If an insured person has notåppointed a beneficiary or if no beneficiary is alive at the date of deathot the insured person, the insurance of the insured person will be paid tothe estate of the insured person.
Extended Benefit on Termination of Insurance
Where insurance of an insured person terminates while this provisioncontinues in force, the amount of insurance terminated with respect to aninsured person will be paid by the Company if death occurs within 31 daysof the date of termination of the insurance.
Conversion Privilege
(i) Where insurance of an insured person terminates, the insured personwilli subject to subsection (2) and without supplying evidence ofinsurabili ty, be entitled to an individual policy on the life of theinsured person on a One Year Term, a Term to Age 65, or on any Whole Lifeplan which provides for uniform premiums and a uniform death benefit andwhich is regularly issued by the Company for the amount of. the individualpolicy.
(2) The issue of the individual policy will be subject to the followingcondi tions :
(
(a) If this provision continues in force,
(i) The amount of the individual policy will not exceed the lesser of(1) the amount of the insurance terminated, or (2) the maximumamount of insurance for which the person has been insured underthis policy less the total amount of individual insurànce still inforce on the person i s life which was previously obtained under thecoriversion privilege of this policy, and
(ii) The individual policy will take effect 31 days after the insuranceis terminated.
(b) If this provision terminates,
(i) an individual policy' is available only to.a person whò has beencontinuously insured under this policy during the five year periodimmediately preceding the termination of the provision, and
GROUP LIFE INSURACE PROVISION (2)
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(ii) the amount of the individual policy will not exceed S5,OOO or 25%of the amount of insurance terminated, whichever is greater,reduced by any amount of insurance for which the person may be ormay become eligible under any group policy issued within 31 daysafter the date of the termination, and
(iii) the individual policy will take effect on completion of theapplication and payment of the required premium.
(c) Written application for the individual' policy must be submitted to theCompany within 31 days after the insurance is terminated and therequired premium must be paid with" the application.
(d) The individual policy will not. contain a Total Disability orAccidental Death Provision.
(e) The premium for the individual policy will be in accordance with thescale of premiums in use by the Company at the effective 'date of theindividual policy for the class of risk to which the applicant belongsand taken at the applicant's insurance age at the effective date.
.( f) The individual policy will be in exchange for all benefits terminatedunder this provision and will contain the same provisions as areregularly included by the Company in new policies issued at the dateof application.
(g) The One Year Term plan 'and the Term to Age 65 plan will not be
( available to an insured person w40 has attained 65 years of age.(3) tv.ere a part of the group of insured persons is withdrawn from thegroup and the persons in the part withdrawn cease to be insured persons,this provision will be considered to have terminated in respect of suchpersons for the purpose of this Conversion Privilege.
GROUP LIFE INSURACE PROVISION (3)
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APPENDIX A
Eligibili ty' to be an Insured PersonA person is eligible to be an insured person
(a) on 0uly I, 1980 if on the day prior to such date the person is insuredunder G 14900, or
__(b) on -July I, 1980 if the person is actively employed by the partici-pating affiliate, Northern Telecom Systems Limited on that date, or
(c) on the date that the person commenêë-s active employment with thePolicyholder if the person i s employment with the Policyholdercommences on or after July 1, 1980,
provided that the person is insured under Group Policy G 13900 issued tothe Policyholder by the Company and provided the person is a salaried orhourly employee of Northern Telecom Limited, or its participatingaffiliates or a commission salesman of Northern Telecom Systems Limitedand is designated by the Policyholder to be part of the Managerial and NonNegotiated groups.
Schedule of Benefits
Classification of Insured Persons
ClassificationOf Insured Persons
Optional Li feInsurance (
l. All Employees An amount equal to 50% . * or75%. * or
100% * or125% * or150% * or175% * or200% *
* of the insured person i s rate of basic salary, calculated on an annualbasis, rounded to the next higher $1,000 of insurance and subject-to aminimum amount of insurance of $10,000.
A person may elect to be insured for one of the above optional amounts ofinsurance within 31 days of becoming eligible under this policy and at noother time without submission of evidence of insurability satisfactory tothe Company.
An insured person may elect to increase the amount 'of optional insurancesubject to a maximum of 200% of annual rate of earned income," uponacquiring a spouse or a dependant or an additional dependant without£ubmitting evidence of insurability.
'An insured person may elect to decrease or terminate the amount ofoptional insurance at any time.
continued.. .