employee presentation for scm insurance services...dental care maximum benefit option 1 option 2...
TRANSCRIPT
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
SCM’s Benefits team at [email protected]
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)
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!