Infosheet No. 7
NLTA Group Insurance – Members’ Benefits/Responsibilities
The NLTA Group Insurance Plan is owned by the Association and operated through a Board of Managers (all members) appointed by the Executive. By a legal Deed of Declaration, these individuals are given the mandate and responsibility for overseeing the successful operation of all aspects of the plan and ensuring that the coverage provided meets the needs of members.
The NLTA offers all members a comprehensive basic insurance plan consisting of A1 – Term Life, A3 – Accidental Death and Dismemberment, and B – Health. Members are also automatically enrolled in: B2 – Dental, C – Long Term Disability and CI – Basic Critical Illness. Government contributes to the premium for three basic options; namely, A1, A3 and B.
A2 – Voluntary Member Term Life
A5 – Voluntary Spousal Term Life
A4 – Voluntary Accidental Death and Dismemberment
CV – Voluntary Critical Illness Member
CS – Voluntary Critical Illness Spouse
CC – Voluntary Critical Illness Child
T – Travel/Emergency Medical Out of Country
How Does a Member Enroll in this Plan?
All members on regular or term/replacement contracts are automatically enrolled in the basic plan as well as C – Long Term Disability and CI – Basic Critical Illness when they commence teaching. No application is necessary.
Note: For Long Term Disability, members are automatically enrolled if they are under the age of 60.
How are Premiums Paid?
Premiums are automatically deducted during 24 of the 26 pay periods for members on regular payroll. Information on the pay stubs clearly shows the amount of premium for each option.
Is Coverage Under the NLTA Insurance Plan Compulsory?
NO. Any member may choose to remove himself/herself from any benefit by completing the appropriate “opting out” form. However, before doing so, members are urged to contact the NLTA office or Johnson Inc. for consultation, since the coverage for the premiums offered can rarely be found in non-group plans. The NLTA negotiates coverage and premiums for a group of over 14,000 members, not on a one-to-one basis, as exists in the open market. Also, remember that for the basic plan, government contributes to a portion of the premium.
If I Opt Out, Can I Re-enter the Plan?
YES, but with the following conditions: evidence of medical insurability must be provided, or for dental, a penalty imposed.
Can I Continue Coverage When I am on Approved Unpaid Leave?
YES, but it is the member’s responsibility to action the following: (a) pay the required NLTA membership fee for the period of leave, and (b) arrange to pay the required premiums by contacting the Plan Administrator, Johnson Inc. Remember that while you are on unpaid leave, there is no pay from which the premiums can be deducted and payment of premium by bank deduction must be arranged with Johnson Inc. Failure to follow the steps in (a) and (b) will result in termination of coverage and a member would have to apply to re-enter the plan. Evidence of medical insurability must be provided and approved by the underwriter.
Does the Government Contribute to the Basic Plan Premiums While I am on Unpaid Leave?
For maternity/parental/adoption leave for up to 52 calendar weeks – YES. For all other unpaid leaves – NO. Members must pay premiums for all benefits, including the government’s contributions for A1, A3 and B.
If I Change Status, are my Dependents Covered?
YES. A change from single to dependent status will normally take place automatically if the plan administrator, Johnson Inc., is informed within 31 days of such change. Check your pay stubs and premium rates to confirm status. This is your responsibility. The computer system cannot identify members as married to each other. Premiums will not be refunded retroactively beyond the current insurance year in which Johnson Inc. was informed of the change in status.
What is my Coverage Under the Basic Plan?
- A1 – Term Life, provides for a benefit to your designated beneficiary of two times your annual salary/pension at the time of death. After age 65, coverage is reduced to $15,000.
- A3 – Accidental Death and Dismemberment, to age 65 provides for a benefit of two times your annual salary/ pension at the time of death. Dismemberment benefits, hospital indemnity and other benefits are based on the policy. Coverage ceases at age 65.
- B – Health insurance, covers 80 percent of eligible costs and 100 percent of the ingredients of prescription drugs at generic pricing levels. Members pay the dispensing fee only and any markup. See Option B of the Group Insurance Overview for details or contact the Claims Department at Johnson Inc. A health insurance card will be issued.
How do I Name a Beneficiary for Life Insurance Policies?
Beneficiary forms are provided at the time of being insured. If you have not filled one out, or have forgotten whom you named, or wish to change your beneficiary, please contact the Plan Administrator, Johnson Inc. It is the member’s responsibility to name a beneficiary. Failure to do so will result in the death benefit being paid to your estate. In this instance, the person(s) whom you might have wished to assign your life insurance may have a lengthy waiting period to retrieve benefits, especially if there is no will.
What is the Purpose of the Health Insurance Card?
This card is provided as a service to all insured members for the purpose of purchasing eligible prescription drugs. Upon presentation to the pharmacist, a member is required to pay only the dispensing fee and any markup. The plan will pay 100 percent of the cost of the ingredients at the generic pricing level. Most drugs which are considered prescription by law will be covered (with limits on sexual dysfunction and fertility drugs). The card is valid in all provinces in Canada.
What about Dental Insurance?
It is the member’s responsibility to familiarize him/herself with those dental benefits which are not covered. For the Dental plan, members are advised to submit a treatment plan to the Plan Administrator, Johnson Inc., before procedure is performed if expenses are expected to exceed $300.
No application is necessary. Permanent and replacement teachers are automatically enrolled in the Dental plan, but the premiums are paid in full by the member. Not all dental procedures are covered. For major expensive procedures, you are advised to get an estimate and check with Johnson Inc.
Dental Claims Procedures
Please note the additional option available for the payment of dental claims as follows:
- Present your NLTA Group Insurance card to your dentist.
- If your dentist accepts direct payment from Johnson Inc., then any eligible expenses will be submitted directly to Johnson Inc.
- However, if your dentist does not accept direct payment, you may pay in full and submit a completed Standard Dental Form (available at your dentist’s office) to the Claims Department at Johnson Inc.
Is there Insurance for Substitute Teachers?
YES, by application to the Plan Administrator, Johnson Inc. Health and Dental insurance coverage is identical to the plan for regular teachers. The Life and Accidental Death benefits are currently capped at $15,000 each. No medical evidence is necessary if the application is made within 31 days of the first day of substitute teaching. In order to maintain eligibility from one year to the next, a substitute must have taught at least ten days the previous year, and at least once before November 30th of the current year. All substitute teachers may also purchase additional Life and Accident insurance under Options A2 and A4 and Voluntary Critical Illness, under CV, CS and CC.
Premiums cannot be deducted from a substitute teacher’s cheque. Arrangements must be made with the Plan Administrator, Johnson Inc., for premium payments. Contact the Plan Administrator for applications and a program booklet.
Retired Substitute Members
Retired substitute members (not eligible for pension) are eligible in the month following their 55th birthday to continue the substitute coverage they had at the time of retirement provided the substitute member has: (i) been paying premiums for the last five years; (ii) at least five years substituting; (iii) at least 100 days substituting in the last five years; and (iv) at least ten years attachment to the teaching profession.
After 20 consecutive days substituting, the substitute becomes a replacement teacher and receives premium contribution by government for the basic plan retroactive to the first day teaching.
What Role does Johnson Inc. Play?
This company has been hired on a contractual basis by the NLTA Group Insurance Managers to perform various insurance functions, i.e. consulting, administering underwriting agreements, and paying claims, much the same way as the Association engages the services of other professionals, e.g. lawyers and auditors, to render services beyond the expertise of those employed by the NLTA. Often, members believe that they have insurance with Johnson Inc. This is, of course, not the case. Johnson Inc. only carries out the wishes and policies of the Association, as directed by the NLTA Group Insurance Managers.
What about Home and Auto Insurance? Is this NLTA Group Insurance?
Home and Auto insurance is not part of the NLTA Group Insurance Program. Provincial legislation prohibits Home and Auto insurance as group insurance. These are options provided over and above the NLTA group insurance program for members who wish to have premiums deducted through payroll. The administrators of the NLTA Group Insurance Plan, Johnson Inc., through a subsidiary, Unifund, have been authorized to use the payroll deduction method for Home and Auto for those insured members who sign individual home and/or auto insurance contracts with Unifund. Members are in no way obligated to insure their home and/or auto in this manner. This is not, and cannot be, group insurance. Therefore, Managers have neither control, nor authority, over the individual contracts signed, nor cover any claims resulting from them. Members have always been encouraged to shop around before insuring their home and/or auto.
Can I Purchase Insurance Over and Above the Basic Plan?
YES. The NLTA plan provides for voluntary insurance options: A2 – Member Term Life, A5 – Spousal Term Life, A4 – Accidental Death and Dismemberment, B2 – Dental, C – Long Term Disability, CV/CS/CC – Critical Illness, and T – Medical Out of Country. A2, A4, CV/CS/CC and T are available by application only. The Dental plan has an automatic enrollment, and the disability insurance has automatic enrollment for all members under age 60.
I have Life, Accident, Health and Dental Insurance. Can I Insure my Salary?
YES. Members under age 60 are automatically enrolled in Option C – Long Term Disability Insurance. Consider this possibility: you are medically disabled and cannot continue teaching. Your paid sick leave runs out. Your salary STOPS – what will you and your family live on? This situation is addressed in Infosheet No. 2 entitled “Sick and Can’t Work – What Then?”
NLTA Group Insurance Website
The NLTA Group Insurance website contains particulars on all of the above-mentioned insurance coverages, both basic and voluntary: groupinsurance.nlta.ca.
A Final Reminder
1) The NLTA is the master policy holder for Group Life, Accident, Long Term Disability, Health, Dental, Critical Illness and Travel Insurance for its members. Johnson Inc. has been hired to perform consulting, brokerage and administration insurance services on behalf of the NLTA.
2) Home and Auto Insurance on payroll deduction is personal, not NLTA Group Insurance. The NLTA has no control, rights or jurisdiction over these coverages.
For further information or answers to additional questions on NLTA Group Insurance, check out our website groupinsurance.nlta.ca or contact:
NLTA Programs and Services
Telephone: 726-3223 or 1-800-563-3599
10 Factory Lane, St. John’s, NL A1C 6H5;
Tel: 709-737-1528 or 1-800-563-1528
Note: In the event of a discrepancy between this Infosheet and the Group Master Policy, the terms of the Group Master Policy will apply.
This Infosheet is one of a series which are updated periodically and which provide information of a general nature only. Documents such as Collective Agreements, legislation and policies referenced in Infosheets will govern the specific rights and benefits of members. For further information, please contact: Programs and Services, NLTA Office, 3 Kenmount Road, St. John’s, NL A1B 1W1. Telephone: 726-3223 or 1-800-563-3599 (toll free) • email@example.com • www.nlta.nl.ca