employee presentation for scm insurance services...dental care maximum benefit option 1 option 2...

November 23, 2020

Employee presentation for

SCM Insurance Services

V04 –

2020-0

2-2

0

About Desjardins

About Desjardins

#1Largest cooperative

financial group in Canada

Benefits plan overview

Important things to remember

New policy 644645 effective

January 1, 2021Be sure to tell your pharmacist and dentist that you have a

new insurance provider effective January 1, 2021.

If you have claims from now to December 31, 2020, these

claims will be submitted to Manulife. As of January 1, 2021

you can send your claims to Desjardins.

Benefits effective January 1, 2021

Basic life insurance

Dependent life insurance

Optional life insurance

Optional Critical illness

Short-term disability insurance *only offered for Regular Employees in Options 1 or 2*

Long-term disability insurance *not offered to Contract employees*

Extended healthcare

Dental care

Health Spending Account

Wellness Account

Basic & Optional Accidental Death and Dismemberment

*Insured through Chubb*

Basic Life Insurance

Reduction of amount 50% at age 65

Age limit When the plan member turns 70 or

retires, whichever comes first

Maximum $1,500,000 combined with Optional Life

Option 1* 1x annual earnings

Option 2 2x annual earnings

Option 3 3x annual earnings

Non Evidence Maximum $900,000

*Default Option

Dependent life insurance – Spouse and Child

Option 2* $10,000

Age limit When the plan member turns 70 or

retires, whichever comes first

Option 1 $5,000

Option 3 $20,000

*Default Option

Optional life insurance

Age limitWhen the plan member turns 70 or retires,

whichever comes first

Maximum amount of

Insurance – Member & Spouse

Any multiple of $10,000 with a minimum

of $10,000 and a maximum of $500,000

Subject to evidence of insurability approval

Member maximum combined with basic life $1,500,000

Maximum amount of

Insurance – Child

Any multiple of $5,000 with a minimum

of $5,000 and a maximum of $25,000

Optional Critical illness insurance

Age limit When the plan member turns 70 or retires,

whichever comes first

Maximum amount of

Insurance - Member

Any multiple of $10,000 with a maximum of

$150,000

Subject to approval of evidence of insurability by Desjardins for amounts over $50,000

Maximum amount of

Insurance - Spouse

Maximum amount of

Insurance - Child

Any multiple of $10,000 with a maximum of $150,000

Subject to approval of evidence of insurability by Desjardins for amounts over $20,000

Fixed amount of $10,000

Short-term disability insuranceOnly offered for Regular Employees in Options 1 or 2

Elimination period 1st day accident, 1st day hospitalization, 5th

day sickness

Age limit When the plan member turns 65 or retires,

whichever comes first

Maximum $2,250 per week/maximum 26 weeks of benefit

Percentage of benefit:

Option 1

Option 2*

55% of weekly earnings

65% of weekly earnings

*Default Option

Long-term disability insuranceNot offered to Contract Employees

Elimination period 26 weeks

Age limit When the plan member turns 65 or

retires, whichever comes first

Percentage of benefit:

Option 1

Option 2*

Option 3

50% of monthly earnings

Maximum Refer to Benefit Summary

Taxability of benefit Non-taxable

60% of monthly earnings

60% of monthly earnings with Cost of

Living Adjustment

*Default Option

Long-term disability insurance

Application

Employer statement

Employee statement

Attending physician statement

Dedicated claims and rehabilitation

specialists

Frequently asked questions

Extended healthcare

Deductible/

MaximumOption 1 Option 2 Option 3

Per Person/Family$1,000 per person

$2,500 per familyNone None

Global Maximum$10,000 per insured per

calendar yearNone None

Percentage of

reimbursement

Option 1 Option 2 Option 3

Drugs80%

Mandatory generic substitution

50%

Mandatory generic substitution

90%

Mandatory generic substitution

Hospitalization

expensesNot Covered

100% 100%

Travel insurance100% 100% 100%

Services & Supplies100% 50%

*except for Psychologists – 100%

100%

Vision care Not Covered 50% 100%

Extended healthcare

Limits for

eligible

expenses

Option 1 Option 2 Option 3

Hospitalization

expenses

Not Covered

Short-term: Cost of a semi-private

room

Long-term: $40 per day,

maximum of 180 days for

convalescent/rehabilitation centre

Short-term: Cost of a semi-private

room

Long-term: $40 per day, maximum

of 180 days for

convalescent/rehabilitation centre

Travel insurance

Lifetime max amount of

$5,000,000 per insured

Lifetime max amount of

$5,000,000 per insured

Lifetime max amount of

$5,000,000 per insured

Nursing careNot Covered

$10,000 per insured per calendar

year

$10,000 per insured per calendar

year

Extended healthcare

Limits for

eligible

expenses

Option 1 Option 2 Option 3

Paramedical

services

(refer to your

policy)

Psychologists only

$1,000 per insured per calendar

year

$350 for each discipline per

insured per calendar year,

except Psychologists

$1,000 per insured per calendar

year

$500 for each discipline per

insured per calendar year, except

Psychologists

$1,000 per insured per calendar

year

Eye examsNot Covered

$75 per 24 months for adults and

children

$75 per 24 months for adults and

children

Eyeglasses,

lenses and eye

surgery

Not Covered Not Covered$200 per 24 months for adults and

children

Benefit

termination

When the plan member turns 80

or retires, whichever comes first

When the plan member turns 80

or retires, whichever comes first

When the plan member turns 80 or

retires, whichever comes first

Dental care

Fee guide year Current year

Annual deductible No Deductible

Percentage of

reimbursementOption 1 Option 2 Option 3

Basic services(preventive, endodontics

and periodontics)

50% 75% 100%

Major restorative

services50% 75% 100%

Orthodontics 50% 75% 100%

Dental care

Maximum benefit Option 1 Option 2 Option 3

Basic & Major

restorative services

combined

$1,000 per insured each

calendar year

$1,250 per insured each

calendar year

$1,750 per insured each

calendar year

Orthodontics$1,000 lifetime $1,250 lifetime $1,750 lifetime

Benefit termination

When the plan member turns

80 or retires, whichever

comes first

When the plan member turns

80 or retires, whichever

comes first

When the plan member turns

80 or retires, whichever

comes first

Health Spending Account

Medical Expenses eligible based on CRA

guidelines and not covered under the core

benefit plan

Age limit When the plan member turns 80 or retires, whichever comes first

Benefit Amount Remaining flex credits may be added

Eligibility

Member & Dependent claims can be

submitted under the Health Spending

Account

Wellness Account (formerly Taxable Spending Account)

Refer to your benefit booklet for a list of

eligible expenses

Age limit When the plan member turns 80 or retires, whichever comes first

Benefit Amount Remaining flex credits may be added

EligibilityMember & Dependent claims can be

submitted under the Wellness Account

Basic & Optional AD&DInsured with Chubb

Reduction of amount 50% at age 65

Age limit for Basic and Voluntary

When the plan member turns 70 or

retires, whichever comes first

Maximum $750,000

Basic Option 1* 1x annual earnings

*Default Option

Optional Member Coverage

Any multiple of $10,000 with a minimum

of $10,000 and a maximum of $750,000

General information

Your payment card

How to submit a request

Drug-specific form is located under Submit a claim

section on the plan member site

Have your doctor complete the form

Submit it to us for approval

Review process takes 3 to 5 business days

We'll send a letter to notify you of our decision

What if my previous insurer had approved

my drug?

We will honour the authorization for 6 months

Once the initial 6 months has expired, we will

require a new prior authorization request

Prior authorization drugs

Available 24 hours a day, 7 days a week

On the spot medical assistance worldwide

More than 5 million Canadians have access to this service

Coordinators are specially trained

Multilingual

Work with doctors and nurses

60+ years in international medical assistance

Travel Assistance

Did you know…

Your dependent children are covered:

If they're under 21 or under 26 and attending

school full-time

You have declare their student status in Intelliflex

every August to ensure continued coverage

When you leave the company or retire:

You can convert your current insurance to an

individual policy without proof of good health

You'll find all the information you need in our

brochures.

General information

Online tools

Online tools

www.desjardinslifeinsurance.com

To Register Online

Secure website for plan members

Online tools

Register for direct deposit

Print payment card

Print personalized forms

Print your insurance certificate

Access your insurance booklet

E-claim submission

Manage dependent information including coordination of benefits

Access claims report for income tax purposes

Enroll in your group insurance plan

Validate personal information

Designate your beneficiaries

Access claims history

Change your coverage following a life event

Claims reports for income tax purposes

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If you do not complete your enrollment

➢ You will be assigned your current level of Health and Dental coverage

➢ Any excess Flex Credits will be allocated to your Health Spending Account (if

applicable)

➢ You will be assigned the default coverage levels for all other benefits

➢ Your beneficiary will default to your estate

➢ You will have no opportunity to make further changes until 2022 for the 2023

benefit year (notwithstanding Life Events)

1-888-412-64808 a.m. – 8 p.m. Monday to Friday (ET)

Desjardins Customer Service centre

Email

SCM’s Benefits team at benefits@scm.ca

Available during the enrolment window from November 23, 2020 –

December 4, 2020

Submit a claim

Claim submission methods

Paper form Point-of-service

Mobile appSecure websitePayment card

We have teamed up with TELUS Health so the following healthcare

professionals can submit claims on your behalf

Point-of-service claim submission

Physiotherapists

Chiropractors

Massage therapists

Podiatrists

Physical rehabilitation therapists

Naturopathic doctors

Acupuncturists

Psychologists

Vision care providers

1-800-263-1810 (all calls are recorded)

8 a.m. – 8 p.m. Monday to Friday (EST)

Email

Secure site for plan members using the ‘’Contact us’’ feature

Customer contact centre

1 800-263-1810

Mobile applications

Claim 360°

Mobile applications

Claim 360°

Mobile applications

Thank you!