Group Administrative Guide Group Administrative Guide · Empire Life Group Administration Guide 7 How can I help to avoid delays in processing my requests? • Please indicate your

GROUP ADMINISTRATION GUIDE

GRP-2151-EN-06/18

Insurance & Investments Simple. Fast. Easy.®

Empire Life Group Administration Guide

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Contents

INTRODUCTION ....................................................................................................................................................6

We’re here to help .......................................................................................................................................................6

Protection of personal information ........................................................................................................................6

Working with Empire Life Head Office ..................................................................................................................6

Group Customer Service ...........................................................................................................................................6

Contact Information ...................................................................................................................................................6

Group Administration .................................................................................................................................................6

Contact Information ...................................................................................................................................................6

How can I help to avoid delays in processing my requests?...........................................................................7

How do I order supplies? ...........................................................................................................................................7

Common Terms ...........................................................................................................................................................7

INTRODUCTION TO WWW.EMPIRE.CA ...........................................................................................................8

Public Website ..............................................................................................................................................................8

Group Plan Administrator Website .........................................................................................................................8

Group Plan Member Website ...................................................................................................................................8

ADMINISTRATION ..................................................................................................................................................9

Helpful Tips ....................................................................................................................................................................9

Adding a New Employee ...........................................................................................................................................9

Employee Enrolment for Mandatory Plans ..........................................................................................................10

Employee Enrolment for Non-Mandatory Plans ................................................................................................10

Refusing Extended Health and/or Dental benefits due to Spousal Coverage ...........................................11


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Late Enrolment .............................................................................................................................................................11

Waiting Periods (Eligibility Period)* .........................................................................................................................11

Waiving Waiting Periods .............................................................................................................................................12

Applying for Optional Life or Spousal Optional Life Coverage .......................................................................13

Temporary Refusal of Benefits for Maternity/Paternity Leave .........................................................................13

How to Change an Employee Name .....................................................................................................................13

Beneficiary Designation .............................................................................................................................................14

Change a Beneficiary Designation ..........................................................................................................................14

Termination of an Employee ....................................................................................................................................15

Conversion Option ......................................................................................................................................................15

Employee Reinstatement ..........................................................................................................................................15

Group Employee Information Health Form .........................................................................................................16

Additional Tips for Completing the Group Enrolment Form ..........................................................................16

Change in Occupation, Class or Division .............................................................................................................17

Change in Salary ..........................................................................................................................................................17

Add or Change the Status of a Dependant ..........................................................................................................18

Dependant Children Attending Post-Secondary School .................................................................................18

Common-Law Spouse Memorandums ................................................................................................................19

EXTENDED HEALTH, DRUG & DENTAL CLAIMS ............................................................................................ 20

Helpful Tips for Paper Claim Submission ..............................................................................................................20

eClaims Submission ....................................................................................................................................................20

Drug Claims ...................................................................................................................................................................20

Paramedical Claims .....................................................................................................................................................21


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Assignment of Claims .................................................................................................................................................21

Hospital Claims .............................................................................................................................................................21

Durable Medical Equipment .....................................................................................................................................21

Out of Country/Province Claims.............................................................................................................................22

Submitting a Dental Claim ........................................................................................................................................22

Electronic Submission of Dental Claims ...............................................................................................................23

Additional Tips About Your Dental Coverage ......................................................................................................23

Coordination of Benefits for Health and Dental Benefits ................................................................................23

Incidental Health Expense (IHE) or Health Care Spending Account (HCSA) Provisions .........................24

LIFE & DISABILITY CLAIMS ................................................................................................................................... 25

Helpful Tips ....................................................................................................................................................................25

How to Initiate a Claim for Weekly Indemnity/Short Term Disability Benefits ...........................................25

How to Initiate a Claim for Long Term Disability Benefits (LTD) ....................................................................26

How to Initiate a Claim for Waiver of Premium ..................................................................................................26

How to Initiate a Life Insurance Claim ...................................................................................................................27

BILLING ..................................................................................................................................................................... 28

Helpful Tips ....................................................................................................................................................................28

Pre-Authorized Debit (PAD) ......................................................................................................................................28

Internet/Online Banking ............................................................................................................................................28

E-Billing ...........................................................................................................................................................................28

How to Get Started .....................................................................................................................................................29

To View Your Monthly e-Bill .....................................................................................................................................29

Understanding Your Monthly Billing .......................................................................................................................30


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Payment by Cheque ...................................................................................................................................................30

FREQUENTLY ASKED QUESTIONS .................................................................................................................... 31

OUR COMMITMENT TO YOU – SERVICE TURNAROUND & OPERATING STANDARDS .................... 36

Process ...........................................................................................................................................................................36

Standard .........................................................................................................................................................................36

Type of confirmation ..................................................................................................................................................36

Administration ...............................................................................................................................................................36

Claims .............................................................................................................................................................................36

Customer Service ........................................................................................................................................................36


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INTRODUCTIONWe’re here to help

As a plan administrator, we recognize the key role you play within your office. We know that your time is valuable

and we want to make it easy for you to get the information and support you need.

This guide is designed to help you with the day-to-day administration of your plan. However, we recommend that

you refer to your group benefits contract for a detailed description of the types of benefits offered under your

plan and the provisions that apply.

Although this guide is designed to generally reflect your group benefits plan, you may find references to benefits

or provisions that do not apply to your plan – please ignore these references.

Protection of personal information

The protection of personal information is an integral part of doing business at Empire Life. Protecting personal

information is important to us and you can rest assured that we will protect all the information you provide to

us about yourself, your employees and their dependants. You can read our full Privacy Policy on the Empire Life

public website.

Working with Empire Life Head Office

If you have questions or need assistance, we have two teams ready to help you - Group Customer Service

and Group Administration.

Group Customer Service Contact Information

• Claims questions

• Billing questions

• Plan Member website questions

Tel: 1 800 267-0215

Fax: 1 888 841-9145

Email: [email protected]

Group Administration Contact Information

• Questions about how to Add, Terminate or Change an employee’s coverage

• Plan Administrator website questions

Tel: 1 800 267-0215

Fax: 1 888 841-9145

Email: [email protected]

Empire Life Mailing Address

Direct all inbound Canada Post or Couriers for Empire Life Head Office to:

Group Solutions

The Empire Life Insurance Company

259 King Street East

Kingston, ON K7L 3A8

https://www.empire.ca/privacy-policy


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How can I help to avoid delays in processing my requests?

• Please indicate your plan number on all documents.

• Submit all requests promptly and within the eligible submission period detailed below.

• Ensure all documents are complete and signed, if applicable.

• Have all employees provide a void cheque to receive claim payments via EFT (Electronic Funds Transfer).

How do I order supplies?

All of the forms you require are available on the Empire Life website by clicking on the Forms and Tools tab/Group

Plan Administrator Forms.

If you would like an additional supply of forms, you can order them online on the Plan Administrator website or

you can contact [email protected] or 1 800 267-0215 to request a shipment of forms.

Common TermsCSU – Customer Service Unit PA – Plan Administrator

EFT- Electronic Funds Transfer PAD – Preauthorized Debit

EOB – Explanation of Benefits PAW – Plan Administrator Website

LTD – Long Term Disability PMW – Plan Member Website

NEL – No Evidence Limit WI – Weekly Indemnity

COB – Coordination of Benefits

https://www.empire.ca/group-benefits/group-forms



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INTRODUCTION TO WWW.EMPIRE.CAPublic Website

You can access information about Empire Life, our products and company policies (e.g. the Empire Life Privacy

Policy) on the public website. The Group Benefits page offers a wealth of information about Empire Life and our

group benefits products. You can also access Group Benefits News and some of our standard group benefits

forms without a User ID or password.

Group Plan Administrator Website

Only Empire Life plan administrators can access this password-protected part of the site. Once logged on to the

site an administrator has easy access to:

• Billing Statements,

• Employee Benefits booklets, and

• The option to print claim forms or duplicate Benefit Summaries and Wallet Cards.

A plan administrator with Update access can process employee changes including:

• Add/Terminate an employee

• Add eligible dependants

• Waive Health and/or Dental coverage

To request access to the Plan Administrator website, please visit www.empire.ca and follow these easy steps:

• Select Group Plan Administrator

• Click on “Request a Registration Package” located just above the User ID field

• Read the Electronic Administration of Policy Agreements

• Forward the completed & signed registration package to [email protected]

or fax to 1 888 841-9145 and you will be provided a User ID via email.

Group Plan Member Website

We encourage all employees who have group coverage with Empire Life to register for the

Group Plan Member website. This is a password-protected part of the site that your employees can join.

Once logged on to the site an employee has easy access to:

• Detailed Claim History,

• The Employee Benefits booklet,

• eClaims services (if selected by the Employer/Company)

• FAQs and links to other helpful websites and resources, and

• The option to print claim forms and/or a replacement Wallet Card,

https://www.empire.ca

https://web4.empire.ca/Unifi/Console/uv3design/u_.uhtml?STATE_NAME=mainGroupAdmin&LOCALE=en_CA&uFn=DWL&uAn=GroupAdmin

https://pmw.empire.ca/pmwweb/login.jsp


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ADMINISTRATIONHelpful Tips• Clearly mark your plan number, division number and company name on all correspondence.

• Submit all requests within the eligible submission period to prevent any delays.

• Provide employees with the Personal Benefit Summary & Wallet Card as soon as you receive them from Empire Life.

• Ensure all forms are signed and dated.

• Make all applicable changes to employee status within 31 days.

Adding a New Employee

When a new employee begins employment with your company and is eligible for coverage under your plan,

you should discuss the group benefits plan with them and have them complete the Employee Information

section of the Group Enrolment Form. You, as the plan administrator, must complete and sign the Employer

Section of the form.

To Add a New Employee on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select Add. The New Member Checklist will appear and will provide prompts at every step to assist you in the process.

• Throughout the Add process you will receive a confirmation screen indicating the information has been submitted to Empire Life. If additional information is required to finalize the change you will be presented with additional instructions.

• The original Group Enrolment form should be kept for your records, preferably in the employee’s personnel (Human Resources) file.

If you do not have access to the Plan Administrator website, please submit a completed Group Enrolment Form

to Empire Life – Group Administration for processing. A digital copy can be sent by email to

[email protected] or faxed to 1 888 841-9145.

• A Personal Benefit Summary with a Wallet Card will be issued as a Certificate of Insurance. This will outline the employee’s coverage and will be mailed to you in approximately 5-10 business days via Canada Post.

• Please verify the information on the Personal Benefit Summary with the copy of the Group Enrolment Form before giving the Personal Benefit Summary to the employee.

Enrolling an eligible employee to your group benefits plan on time is one of the most important first steps in ensuring your employee has access to their coverage without any delays or restrictions. To prevent any delays or restrictions to your employees’ coverage please submit the completed and signed group enrolment form to our Head Office within 31 days of your employees’ eligibility date.

https://www.empire.ca/search-group-forms?combine=Group%20Enrolment%20Form




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If the Life and Long Term Disability coverage exceeds your group plan’s Non-Evidence Limit (NEL), your employee

must complete a Group Employee Health Information Form (medical information) and attach it to the Group

Enrolment Form.

For faster processing, we highly recommend that all employees have their Extended Health, Dental and/or Health

Care Spending Account claims reimbursements deposited directly into their bank account by Electronic Funds

Transfer (EFT). Please have the employee complete the banking information section on the Group Enrolment

Form and attach a void cheque. The cheque must have the employee’s full name and address embossed on it to

be considered a valid cheque. A void cheque only needs to be sent in with the first claim for set-up. The only time

the employee needs to submit a new void cheque is when their bank account details change.

Employee Enrolment for Mandatory Plans

If your plan is mandatory, the only coverage an employee can refuse is Extended Health and/or Dental coverage

and only if the employee’s spouse and eligible dependants are covered for these same benefits by another

insurance company. The employee then must be enrolled for all remaining benefits available under your

company’s group benefits plan.

In addition, if eClaims services have been selected, employees must register for the Plan Member website in order

to access eClaims services.

Employee Enrolment for Non-Mandatory Plans

If your plan is non-mandatory, an employee has the option of refusing all coverage. To refuse all coverage an

employee must complete the Refusal of All Benefits Section of the Group Enrolment Form. The Administrator

must also sign this form as the authorized official and witness. This form must be sent to Empire Life. If at a later

date, the employee wishes to enter the plan, the employee is required to submit medical evidence, and coverage

is only effective on the date of approval by Empire Life.

Employees should always be encouraged to participate in the full benefit package, unless they have coverage

elsewhere. Your contract has a minimum participation requirement and if an insufficient number of employees

enrol for coverage your plan may be subject to termination. Please explain to all employees that if coverage is

refused when initially offered, and they change their mind at a later date, the employee will be required to submit

medical evidence. Benefits will be underwritten and if approved they may be limited. See the Late Enrolment

section below for additional details.

In addition, if eClaims services have been selected, employees must register for the Plan Member website in order

to access eClaims services.




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Refusing Extended Health and/or Dental benefits due to Spousal Coverage

If an employee and their dependants are covered for Extended Health and/or Dental coverage by another

insurance company, they can choose from the following 3 options:

• select Family Coverage with Empire Life and maintain their other coverage as well - this is referred to as Coordination of Benefits (COB),

• select Single Coverage with Empire Life and their dependants would be covered under their other coverage plan, or

• refuse Extended Health and Dental coverage with Empire Life and maintain coverage with their other insurance company.

Each of these options is identified on the Group Enrolment Form. The employee must indicate their choice on

the enrolment form in the “Waiver/Notice for Coordination of Benefits” section and provide the name of the other

carrier to avoid delays in processing.

An Group Change Form (Insured Employee) should be completed for employees, already enrolled in the Empire

Life plan who would like to change their coverage. The Group Change Form (Insured Employee) should also be

completed within 31 days if an employee loses coverage under the spouse’s plan.

To update this information on the Plan Administrator website:

• to the Plan Administrator website. From the Employee Tab, select employee, click change, click coverage and select add/maintain health coverage with other insurer.

• You will be required to add the name of the other insurance company and the coverage type (single or family) of the other insurer.

• Select the desired Empire Life coverage from the change Empire Coverage field, enter the effective date and submit.

If you do not have access to the Plan Administrator website, please submit a completed Group Change Form

(Insured Employee) to Empire Life – Group Administration for processing. A digital copy can be sent by email to


Late Enrolment

It is very important that all employees are enrolled within 31 days of becoming eligible for benefits. If the

employee is not enrolled within the required time period, the employee will be considered a late enrolment

and will automatically be medically underwritten for all benefits. If approved, Dental coverage will be restricted

for the first 12 months. If Orthodontic benefits are included in your plan, a restriction of orthodontic coverage

will apply for the first 3 years of coverage. Please refer to your group benefits contract for additional details

regarding these restrictions.

Waiting Periods (Eligibility Period)**For purposes of this document Waiting Period will mean the same as Eligibility Period.

When an individual enters employment with your company and works the minimum required hours per week,

as outlined in your group benefits contract, they become eligible for benefits under your group benefits plan

following the completion of a Waiting Period. The Waiting Period (Eligibility Period) for your plan is on the

Schedule of Benefits pages in your group benefits contract. It may vary from 0 days


https://www.empire.ca/search-group-forms?combine=Group+Change+Form+%28Insured+Employee%29




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(coverage is effective upon employment) to 12 months (coverage is effective 12 months from the employee’s date

of full time hire) or more. The Waiting Period may also vary by benefit.

Complete the Group Enrolment Form on the employee’s first day of work and send it to Empire Life immediately.

Your responsibility is then discharged and Empire Life will automatically add the individual to the plan after

completion of the Waiting Period. If an employee’s Group Enrolment Form is submitted prior to completion of

the Waiting Period, and his/her employment is terminated before the effective date, please notify us in writing

immediately to stop enrolment proceedings.

If your plan has a requirement for all benefits to be underwritten prior to coverage being effective, a Group

Employee Health Information Form needs to be provided. Coverage will be effective upon underwriting approval.

It is important to note the Group Employee Health Information form is only valid for 90 days from the date the

employee signed it.

Waiving Waiting Periods

The Waiting Period was established when your group benefits contract was submitted and approved by

Empire Life. The Waiting Period is calculated from an employee’s first day of full-time employment.

If the Waiting Period is to be waived (in whole or in part) for an individual who is hired by your company, please

send a written request explaining why (e.g. hiring an executive employee). This correspondence should be

accompanied by a completed Group Enrolment Form and must be received within 31 days from date of hire.

If a request to waive a Waiting Period (in whole or in part) is made after 31 days from the date of hire, waiver of

the Waiting Period will only be applicable for Extended Health and Dental coverage, all remaining benefits must

satisfy the normal Waiting Period. Providing medical evidence is no longer an option.

To Waive the Waiting Period on the Plan Administrator website (the following needs to be done at time of

enrolling employee online):

• Sign in to the Plan Administrator website. From the Employee Tab, select Add. The New Member Checklist will appear and will provide prompts at every step to assist you in the process.

• Throughout the Add process you will see several screens that allow you to add a note. In one of the note sections, please enter “waive the Waiting Period” and as long as the employee has been enrolled within 31 days of hire date, the Waiting Period will be waived at time of activation.

If you do not have access to the Plan Administrator website, please submit a completed Group Enrolment Form

to Empire Life – Group Administration for processing and note on the form that you would like to waive the

Waiting Period. A digital copy can be sent by email to [email protected] or faxed to 1 888 841-9145.





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Applying for Optional Life or Spousal Optional Life Coverage

If your plan includes an Optional Life Benefit, an employee may apply for this coverage by completing the Group

Application for Employee/Spousal Optional Life Insurance and Accidental Death and Dismemberment Benefits.

As the Plan Administrator, you must complete the Employer Section on the lower part of the form.

The employee must indicate the amount of Optional Insurance that they are applying for, the beneficiary

designation and the relationship of the beneficiary to the employee. The employee must also provide a

completed Group Employee Health Information Form. Empire Life will contact the employee if additional

information is required.

If your plan includes a Spousal Optional Life Benefit, the employee should complete the Optional Spousal

Insurance section of the form and provide a completed Group Dependent(s) Health Information form. The

beneficiary on Optional Spousal Life Insurance is always the employee.

Please refer to your group benefits contract for additional details regarding the rates for these benefits.

Temporary Refusal of Benefits for Maternity/Paternity Leave

If an employee chooses to temporarily refuse benefits during Maternity/Paternity Leave, please have them

complete the Maternity /Paternity Leave Temporary Refusal of Benefits Form. This form is used when an employee

commencing Maternity or Paternity Leave chooses to refuse continuance of group insurance.

This right of refusal can be exercised as follows:

• For the entire term of a Maternity/Paternity Leave.

• The employee, if refusing, must refuse for all coverage that the employee currently pays any portion of the premium.

• The completed Maternity/Paternity Leave Temporary Refusal of Benefits Form must be received by Empire Life no later than 30 days after the commencement of the Maternity/Paternity Leave.

If an employee is refusing benefits, it is important that the employer advise Empire Life of the start date and the

expected return to work date of the employee. This information can be sent by email to group.administration@

empire.ca or faxed to 1 888 841-9145.

How to Change an Employee Name

When an employee changes their name due to marriage or other reasons, the employee must complete the

change of name portion of the Group Change Form (Insured Employee).

To Change the employee’s name on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select employee, click change, and then click on member information. You can then select Name and update the name.


(Insured Employee) to Empire Life – Group Administration for processing or you can email the information to

[email protected] or fax to 1 888 841-9145. Once changed, a new Personal Information and Benefit

Summary with Wallet Card will be issued to you reflecting the change in name.

Note, if a Court Decree is indicated as a reason for a name change, a copy of the Court Decree should be sent to

Empire Life with the Group Change Form (Insured Employee).











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Beneficiary Designation

There are two types of beneficiary designations - revocable and irrevocable.

Revocable – the employee may change their beneficiary designation at any time without the current beneficiary’s

knowledge or authorization.

Irrevocable – the employee must have the designated beneficiary’s signed authorization to change the

beneficiary to another person. In Quebec, the law governs that if a spouse (includes common-law and same sex

partner), is the named beneficiary the designations will default to irrevocable unless otherwise indicated on the

enrolment form.

Change a Beneficiary Designation

Unless an employee’s beneficiary is irrevocable, as requested by the employee on the Group Enrolment Form or

due to the laws of the province in which they reside, a change in beneficiary may be made at any time.

The employee must complete section #1 and #7 of the Group Change Form (Insured Employee). It is

extremely important that the employee sign this form. Without the employee’s signature, a change in beneficiary

cannot be completed.

To Change a Beneficiary Designation on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select employee, click change, click on member information and then select beneficiary designation. Enter the beneficiary details and the effective date and select submit.

• Keep the original Group Change Form (Insured Employee) for your records, preferably in the employee’s personnel (Human Resources) file.


(Employee Changes) to Empire Life - Group Administration for processing. A digital copy can be sent by email to


Please note that the date, which is provided next to the signature of the employee, is the date of the beneficiary

change on Empire Life’s records. The Insurance Company is not liable for incorrect payment if the change has not

been received and recorded prior to a settlement.

Please note that if the insured employee was a resident of Quebec at the time the group benefits contract was

issued, the Quebec laws governing the change of beneficiary will govern even if the insured employee moves to

another province. If a spouse is named beneficiary by an employee residing in the province of Quebec, the spouse

will automatically be made an irrevocable beneficiary unless otherwise indicated on the Group Enrolment Form

which would indicate revocable.





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Termination of an Employee

When an employee leaves your company, you must terminate their benefits with Empire Life. You should complete

the Group Change Form (Plan Administrator Changes). It is extremely important that the last day worked for the

employee is provided as this will be the last day of coverage (e.g. December 13, 2011). Benefits do not continue

until the last day of the month and no partial month credit will be given.

To Terminate Coverage for an Employee on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select Change, Member Status, and Terminate Plan Membership. You will be provided with prompts to assist you in the process.

• Keep the original Group Change Form (Plan Administrator Changes) for your records, preferably in the employee’s personnel (Human Resources) file.

If you do not have access to the Plan Administrator website, please submit a completed Group Change Form (Plan

Administrator Changes) to Empire Life - Group Administration for processing. A digital copy can be sent by email

to [email protected] or faxed to 1 888 841-9145.

When an employee terminates, please collect and destroy their Personal Information and Benefit Summary and

Wallet Card (Certificate of Insurance).

Please note that a notice of termination must be submitted promptly as a maximum of only two (2) months’

premium credit is allowed.

Conversion Option

If an employee is terminated and they are under the age of 65 they may apply for an individual policy without

evidence of insurability if the following conditions are met:

A completed Application for Conversion of Group Coverage and the first premium are received at the Group

Administration Department of Empire Life within thirty-one (31) days after:

• The date of termination of the insured’s employment, or

• The date of the termination of the insured’s membership in any of the classes of employees eligible for insurance, or

• The date of termination of the plan.

Please contact [email protected] for information on rates and eligible amounts of insurance.

Employee Reinstatement

Situations may arise where an employee whose employment was terminated is rehired at a later date. If the time

elapsed between the date of termination and the date of re-employment is six (6) months or less, the employee

may be reinstated. If more than six (6) months have passed, the individual is treated as a new employee.

Reinstatement of an employee rehired within 6 months:

• Complete a Group Change Form – Plan Administrator Changes.

• Notify Empire Life within thirty-one (31) days after the employee rejoins your company.

https://www.empire.ca/search-group-forms?combine=Group+Change+Form+





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• A Group Enrolment Form is not required.

• The waiting period, if applicable, can be applied to this employee or waived.

Reinstatement if more than six (6) months have passed:

• A Group Enrolment Form is required

• The waiting period, if applicable, can be applied to this employee or waived

• To Reinstate Coverage for an Employee rehired within 6 months on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select Change, Member Status, and Reinstate Plan Membership. You will need to enter the effective date of reinstatement before selecting submit.

• The original Group Change form should be kept for your records, preferably in the employee’s personnel (Human Resources) file.

If you do not have access to the Plan Administrator website, please submit a completed Group Change Form –

Plan Administrator Changes to Empire Life - Group Administration for processing. A digital copy can be sent by

email to [email protected] or faxed to 1 888 841-9145.

An employee who was laid off and has now been rehired should not be shown as a reinstatement. Reinstatement

is applicable only if all benefits were terminated during the lay-off period and the employee was cancelled.

Group Employee Information Health Form

A Group Employee Health Information Form is required under the following circumstances:

• If an employee is eligible for amounts of insurance in excess of your plan’s No Evidence Limit (NEL) as outlined in your group benefits contract. Amounts in excess of the NEL are subject to satisfactory evidence of insurability.

• For non-mandatory plans this form is required if an employee is a Late Enrolment.

• If your plan includes an Optional Life benefit this form would also be required.

The Group Employee Health Information Form is completed by the employee and not by a doctor or paramedical

service. It is important that all questions are answered completely and that this form is signed by the employee,

and dated, before being sent to Empire Life. If this form is incomplete (or answers given are incomplete) Empire

Life will contact the employee by mail for clarification.

If further information is required and the requirement is a paramedical or medical examination, the cost will be

paid by Empire Life. You will be notified via mail of Empire Life’s decision.

Additional Tips for Completing the Group Enrolment Form

• If your plan has more than one billing (monthly invoice), each addressed to a different company name, use the name of the division in which the employee is to be enrolled.

• The Group Enrolment Form must be signed and dated by the employee, as this is a legal Life and Accidental Death beneficiary designation.

• If you show earnings as an hourly rate, please indicate the number of hours worked per week.


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• If total remuneration is split by base salary, commissions, or a combination of these, this should be indicated on the Group Enrolment Form. T-4’s may be requested by Empire Life for verification of income.

• Ensure that the occupation of the employee shown on the Group Enrolment Form coincides with the correct occupation for the class in which the employee is to be enrolled.

• The Date Employed should be the date of Full-Time employment for an employee.

Change in Occupation, Class or Division

Any changes to move an employee from one class and/or division to another must be done within 31 days

of the change.

If an employee has a new occupation with your company please include the new occupation on

the Group Change Form.

• To change occupation, class or division for an Employee on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select Change, Member Information.

• For class or division changes – select class or division whichever is applicable

• For occupation changes – select salary and other employment information and update the occupation.

• The original Group Change form should be kept for your records, preferably in the employee’s personnel (Human Resources) file.


(Plan Administrator Changes) to Empire Life - Group Administration for processing. A digital copy can be sent by


Change in Salary

Our Administration Department must be kept advised of any salary increases and/or decreases to ensure the

employee records are up to date. This is very important in the event a Life or Disability claim is submitted as the

volumes will be determined by the amount we have in our records.

Submit salary changes within 60 days of the increase or decrease. Failure to do so will result in the salary change

being effective the date we receive the change at Empire Life.

To change a salary for an employee on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select Change, Member Information, and salary and other employment information. You will be provided with prompts to assist you in the process.

• The original Group Change Form – Plan Administrator Changes should be kept for your records, preferably in the employee’s personnel (Human Resources) file.


(Plan Administrator Changes) to Empire Life - Group Administration for processing. A digital copy can be sent by



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Add or Change the Status of a Dependant

Our Administration Department must be kept advised of dependant status changes to ensure the employee

records are up to date and being billed properly.

To change dependant status for an Employee on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select Change and Dependant Information. You will be provided with prompts to assist you in the process.

• The original Group Change Form – Plan Administrator Changes should be kept for your records, preferably in the employee’s personnel (Human Resources) file.

If you do not have access to the Plan Administrator website, please submit a completed Group Change Form –

Plan Administrator Changes to Empire Life - Group Administration for processing. A digital copy can be sent by


Dependant Children Attending Post-Secondary School

A dependant child is insured under the plan up to their 22nd birthday. However, if a dependant is attending an

accredited educational institution in Canada or the United States on a full time basis they will continue to be

insured until they reach their 26th birthday or their graduation (whichever comes first). The name of the college/

university and the start date/end date of the program must be provided to Empire Life. This information must be

updated and provided to Empire Life every year prior to the start of the school year for coverage to continue.

To update school information on the Plan Administrator website:

• Sign in to the Plan Administrator website. From the Employee Tab, select Change, dependant information.

• Select the name of the dependant.

• Under the Schooling Information heading, change the full-time student indicator to yes.

• Enter the school start date and school end date, enter the name of the school and select the location from the menu. Add an effective date and submit.

If you do not have access to the Plan Administrator website, please email this information to the Group

Administration Department at [email protected] or fax to 1 888 841-9145.

A special agreement to extend coverage is required for a dependant attending an approved educational institution outside of Canada or the United States. We strongly recommend that you contact Empire Life Group Administration as soon as possible to allow time for processing and approval.


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Common-Law Spouse Memorandums

Your plan requires a minimum of one (1) year co-habitation period prior to a common-law spouse being eligible

for coverage unless there is a child born of the union.

The change in dependant information section of the Group Change Form (Insured Employee) should be

completed if an employee who is already enrolled in your Plan wishes to provide coverage for their common-law

spouse. If the common-law spouse and the employee have been living together for a minimum of one (1) year or

a child is born of the union and this information is provided to Empire Life the coverage status of the employee will

change from single to family.

It is important that any change in status is communicated to Empire Life within 31 days to ensure there are no

delays or restriction in coverage.

Please note that coverage can only be provided to one of the following: a legal spouse, an ex-spouse or a

common-law spouse.


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EXTENDED HEALTH, DRUG & DENTAL CLAIMSHelpful Tips for Paper Claim Submission

• Complete an Extended Health Benefits Claim Form for Extended Health and Drug claims and an Empire Life Dental Claim Form for dental claims.

• Clearly mark your plan number and company name on all correspondence.

• Complete all claim forms in full and sign where required.

• Include your current address and postal code.

• Attach original receipts that include patient name, date of service, nature of service and amount charged.

• Provide a void cheque to receive claim payments via EFT (Electronic Funds Transfer).

• Submit all Extended Health, Drug & Dental claims within 365 days of the service date or 90 days should your group benefits contract terminate with us.

eClaims Submission

If eClaims services have been selected by the Employer/Company, employees can submit Extended Health claims

using our eClaims services on the Plan Member website. To submit Extended Health claims online employees must:

• be registered for the Plan Member website,

• enrol for EFT payment of claims and provide their email address to receive their electronic EOB,

• keep the original claim payment receipt(s) and any supporting document(s) (e.g. referral letter) for 12 months following the date of the online claim submission(s).

Empire Life may periodically request original receipts and any supporting documentation to validate the accuracy

of the information provided or to conduct a random review. If employees fail to provide receipts or the supporting

documentation in the time period requested by Empire Life, their access to eClaims submission will be suspended.

In the interim, employees can submit paper claims.

Note – for more information on eClaims services please refer to FAQ at the end of this guide.

Drug Claims

The Empire pay-direct drug plan is recognized by pharmacies across Canada. To fill a prescription, your employee

simply presents their Wallet Card to the pharmacist and pays the required deductible amount (if any) per

prescription. If an employee elects to pay cash for their prescription, they should complete an Extended Health

Benefits Claim Form and submit their original receipt to Empire Life – Group Health Claims. If your plan does not

include a pay-direct drug plan, your employees will be required to submit original drug receipts and an Extended

Health Benefits Claim Form to Empire Life.






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Paramedical Claims

Provincial and territorial legislation specifies for each province or territory which paramedical practitioners are, or

are not, regulated. In cases where the paramedical practitioner is not regulated, Empire Life has set the required

level of education, training and/or professional affiliations. A list of credentials acceptable to Empire Life is available

on the Empire Life Plan Member Website.

Assignment of Claims

Dental & Hospital claim payments can be assigned directly to the provider, if requested. Other Extended Health

benefit claims can not be assigned and must be purchased by the employee. Once purchased, the employee can

submit an Extended Health Benefits Claim Form and their original receipt to Empire Life – Group Health Claims.

Hospital Claims

It is possible for the hospital to bill Empire Life directly if an employee incurs expenses for a semi-private or private

hospital room. The employee will be required to sign a document assigning payment to the hospital. Once the claim

has been reviewed by Empire Life, an explanation of benefits (EOB) will be sent to the employee for their records.

Durable Medical Equipment

If an employee requires a medical supply (i.e. wheelchair, knee brace, orthotic, etc), a letter from the prescribing

doctor will be required in addition to the original receipt and the Extended Health Benefits Claim Form. All

documents should be submitted to Empire Life – Group Health Claims.

• The letter from the physician should include the patient’s name and diagnosis as well as provide details of the required equipment.

• If the cost of the equipment is expected to exceed $300, a pre-determination or estimate should be submitted to Empire Life. This will allow our claims team to confirm coverage for your employee prior to them purchasing the equipment.


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Out of Country/Province Claims

The Out of Province or Country benefit provides coverage for your employees should they experience a medical

emergency when travelling. If the cost of treatment is expected to exceed $200, your employee should contact

Allianz Global Assistance (formerly Mondial Assistance) using the contact information on their Wallet Card.

If the cost of treatment is expected to be less than $200, your employee will be required to pay for their treatment

and submit any receipts for medical treatments to their provincial plan for consideration. Once the claim has been

reviewed by the provincial plan, the following should be submitted to Empire Life – Group Health Claims:

• An Extended Health Benefits Claim Form

• Original receipt(s)

• Explanation of Benefits from the provincial plan

• Additional details required to process the claim including the

• Date of departure and return to the province of residence

• The province and/or country travelled to

• Nature of emergency

Allianz Global Assistance will be able to assist your employee with their medical care during an emergency that

occurs outside of their province of residence. They may be able to assist in finding an appropriate medical facility,

confirming and paying the applicable charges directly to the medical facility, etc. Please see your employee

benefits booklet for more information regarding the services provided by Allianz Global Assistance.

If prescriptions are required and purchased while out of province of residence, these receipts should be submitted

to Empire Life using the normal procedures.

Before obtaining elective treatment out of your province of residence, please contract the Group Customer

Service unit at [email protected] to confirm if the treatment is eligible under your plan.

Submitting a Dental Claim

When an insured employee and/or a dependant have an appointment with the dentist, they should bring an

Empire Life Dental Claim Form. The employee should complete part 2 of the Dental Claim form. The dentist will

complete part 1 of the form and include their office verification. The Dental office may provide a standard Dental

Claim Form to your employees, which will be accepted by Empire Life, provided it contains all required information

to process the claim including the signature of the employee and the dentist.

An employee’s dentist may agree to accept payment directly from Empire Life. To assign payment to the dentist,

the employee must sign the applicable section in part 1 of the claim form. The employee’s signature must be on

the claim form in order for Empire Life to pay the dental office directly. If an employee requests that the payment

be assigned, Empire Life will send a cheque to the dental office and the employee will receive an explanation of

benefits for their records.

All dental claims should be submitted to Empire Life – Group Health Claims within 365 days of the date of service

or 90 days should your group benefits contract terminate with us.


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Electronic Submission of Dental Claims

Electronic claims submission saves your employees the effort of mailing claim forms to Empire Life and reduces

postal delays. We will be able to receive the claim faster, which means that the employee will receive claim

payment faster.

The dental insurance claim form will be sent directly to Empire Life from the dentist’s office. There is no need for

a paper claim form. Before leaving the dentist’s office, the employee should receive a ‘claim acknowledgement’

report indicating that the claim has been submitted electronically and what procedures were performed by the

dentist or hygienist.

The dental office will require the employee’s insurance information to submit the claim electronically to Empire

Life. It is important that the employee update their address and insurance information if there have been any

changes since their last visit to the dentist.

Additional Tips About Your Dental Coverage

• All dental claims should be submitted to Empire Life within 365 days of the date of service or 90 days should your group benefits contract terminate with us.

• If a series of treatments is expected to exceed $300, a predetermination or estimate should be submitted. This will allow our claims team to confirm coverage for your employee prior to the treatment being completed.

• If your Dental plan includes Level 3 (Major Restorative coverage), it is an excellent idea to include pre-treatment x-rays with the claim and/or estimate. This will assist in avoiding delays when additional information may be requested from the dentist doing the work.

• If Empire Life contacts the dentist for additional information, a copy of the request will be sent to the employee for their records.

• If an employee is a late enrolment on your plan, coverage will be restricted for the first 12 months of coverage. If orthodontic benefits are included in your plan, late enrolment restrictions will apply for the first 3 years of coverage. Please refer to your group benefits contract for additional details regarding these restrictions.

Coordination of Benefits for Health and Dental Benefits

All policies contain a coordination of benefits provision. If an employee has Extended Health and/or Dental

benefits with Empire Life and their spouse also has these benefits, coordination of benefits can be used.

Coordination of Benefits will be applied if the spouse’s coverage is also with Empire Life or if they have coverage

with another insurance company.

• The employee must always submit claims for expenses they incurred through the Empire Life plan first. The spouse must do the same with his/her insurance company.

• If there are children, the spouse whose birthday falls closest to January 1st is always the first payer (e.g. employee’s birth date is March 4th, spouse’s birth date is Feb 10th, the spouse’s insurance company pays first for all children’s claims).


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When submitting a claim to Empire Life as the second payer, you must submit:

• Extended Health or Dental Claim Form

• Copies of original receipts, for Extended Health

• The Explanation of Benefits (EOB) that is received from the insurance company that was first payer.

Benefits payable from all plans will not exceed 100% of the actual incurred expenses.

Incidental Health Expense (IHE) or Health Care Spending Account (HCSA) Provisions

If your plan includes an IHE or HCSA benefit, employees can use their IHE or HCSA for health expenses that are

not eligible under the Extended Health and/or Dental benefit. Any medical expense that would qualify under the

Income Tax Act (Canada) would be eligible for reimbursement under the IHE or HCSA benefit.

Eligible Expenses include but are not limited to:

• Extended Health and Dental Deductibles (where applicable)

• Extended Health and Dental Coinsurance (where applicable)

• Vision Care Expenses

• Eligible expenses, as defined under the Extended Health Benefit Provision and the Dental Benefit Provision (if applicable) for which the maximum has already been paid during the policy year

• Extended Health and Dental expenses not otherwise eligible under the Plan but eligible under the Income Tax Act as determined by the Company



25

LIFE & DISABILITY CLAIMSHelpful Tips

• Ensure Empire Life has current salary information for all employees.

• Confirm that all required information on the claim form is complete, legible and the forms are signed in all the appropriate areas.

• Claims should be submitted to Empire Life as soon as possible following the last date the Employee worked.

How to Initiate a Claim for Weekly Indemnity/Short Term Disability Benefits

If an employee becomes sick or injured and is eligible to submit a claim under your Weekly Indemnity (WI) benefit,

please send a completed Weekly Indemnity (WI) Claim Form (Short Term Disability - STD).

There are three parts to the WI Claim Form. The Plan Administrator completes the Employer Statement. The

Employee completes the Employee Statement and signs the Patient Authorization. The Employee’s physician

completes the Attending Physician Statement.

Empire Life is not responsible for the cost of having this form completed.

If the claim is a result of a work related accident or illness, a claim should always be made with the Workplace

Safety & Insurance Board (WSIB)/Workers’ Compensation (WCB)/CSST along with the claim with Empire Life.

Details of the accident as well as any communication from WSIB/WCB/CSST should be submitted to Empire Life.

If the claim is a result of a motor vehicle accident, a copy of the police accident report will be required.

• When completing the Employer Statement please indicate the Employee’s WI benefit, not salary, when answering question #4. The benefit amount is shown on your monthly billing. If the plan provides coverage for commissioned salespeople, please submit copies of the two most recent T-4s with the claim.

• Regularly advising our Administration Department of any salary changes, or submitting these on the Plan Administrator website, will ensure that an Employee receives the correct WI benefit.

• Delays in the assessment of a WI claim can be avoided by ensuring all required information on the claim

• form is complete, legible and the form is signed in all the appropriate areas. WI claims should also be submitted as soon as possible following the last date the Employee worked.

• Most plans have two different elimination periods; one if the Employee is off work due to an accident and another if the Employee is off work due to sickness.

• Some plans may pay from the first day of hospitalization if the Employee is admitted to the hospital overnight. There is also a plan option to include payment from the day that outpatient surgery is performed. If your plan has either of these features, it will be noted on the ‘Schedule of Benefits’ pages in your group benefits contract.



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How to Initiate a Claim for Long Term Disability Benefits (LTD)

If an employee becomes sick or injured and is eligible to submit a claim under your Long Term Disability (LTD)

benefit, please submit all three of the LTD application forms. The same three forms are used to apply for Waiver

of Premium benefits for Group Life Insurance.

The Plan Administrator completes the Group Policyowner’s Statement Re Disabled Claimant. The Employee

completes the Claimant’s Statement for Disability Benefits and signs the top portion of the Attending Physician’s

Statement - Long Term Disability (LTD). The Employee’s physician completes the Attending Physician Statement.


If the claim is a result of a work related accident or illness, a claim should always be made with the Workplace

Safety & Insurance Board (WSIB)/Workers’ Compensation (WCB)/CSST along with the claim with Empire Life.

Details of the accident as well as any communication from WSIB/WCB/CSST should be submitted to Empire Life.

If the claim is a result of a motor vehicle accident, a copy of the police accident report will be required.

• When completing the Employer Statement please indicate the Employee’s LTD benefit as of their last day at work, not their salary. The benefit amount is shown on your monthly billing. If the plan provides coverage for commissioned salespeople, please submit copies of the two most recent T-4s with the claim.

• Regularly advising our Administration Department of any salary changes, or submitting these on the Plan Administrator website, will ensure that an Employee receives the correct LTD benefit.

• Delays in the assessment of a LTD claim can be avoided by ensuring all required information on the claim form is complete, legible and the forms are signed in all the appropriate areas. LTD claims should be submitted as soon as information supports the Employee is likely to be off work for the complete duration of the elimination period, which will be noted on the Schedule of Benefits pages in your group benefits contract.

How to Initiate a Claim for Waiver of Premium

If an employee becomes sick or injured and meets the definition of disability throughout the elimination period,

he/she may be eligible for Waiver of Premium for his/her Group Life Insurance benefit.

If the Employee has Weekly Indemnity or Long Term Disability benefits with Empire Life, a Life Waiver of Premium

claim will automatically be considered and we will advise if additional claim forms are required.

If the Employee does not have disability benefits with Empire Life, please submit all three of the application forms.

The same three forms are used to apply for Long Term Disability benefits.

The Plan Administrator completes the Group Policyowner’s Statement Re Disabled Claimant. The Employee

completes the Claimant’s Statement for Disability Benefits and signs the top portion of the Attending Physician’s

Statement, Long Term Disability (LTD). The Employee’s physician completes the Attending Physician Statement.











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If the Waiver of Premium claim is approved, it takes effect at the end of the elimination period. Waiver of

Premium claims should be submitted as soon as information supports the Employee is likely to be off work for

the complete duration of the elimination period, which will be noted on the Schedule of Benefits pages in your

group benefits contract.

If provided by your group benefits contract, Extended Health and Dental benefits may continue on a

premium paying basis.

How to Initiate a Life Insurance Claim

The Plan Administrator or beneficiary needs to contact our Group Life & Disability Claims Department to advise

us of all life or dependant life claims with a benefit amount of $75,000 and under.

For life claims valued at $75,000 and under, we may be able to assess the claim by gathering verbal information

from both the Plan Administrator and the beneficiary. If we are unable to assess the claim with the verbal

information collected, we will advise all parties of what additional information is required.

For life claims over $75,000 and all Accidental Death and Dismemberment (AD&D) claims (regardless of the

benefit amount), please submit a completed Group Life Insurance Claim Form and a copy of the Funeral

Director’s Statement or Death Certificate to Empire Life. Once the paperwork is received and reviewed, we will

advise all parties if additional information is needed to assess the claim.

For AD&D claims, we may also require a Coroner’s and Toxicology Report, WSIB/WCB/CSST Report, Police

Report, etc.

For an employee aged 60 or over, we may require proof of age (photocopy, signed and dated as “true copy” of

birth certificate, driver’s license, or passport).

Empire Life is not responsible for any fees associated with the completion of these forms.

When an employee has named their Estate as beneficiary, a notarized copy of the employee’s Last Will and

Testament will be required in addition to the completion of the Group Life Insurance Death Claim Form. If there

is no Will, we require a notarized copy of Letters of Administration. These usually take some time to obtain and

may delay a decision on the claim.



28

BILLINGHelpful Tips

• Sign up for PAD (Pre-Authorized Debit) and E-Billing.

• Clearly mark your plan number and company name on any cheques submitted to Empire Life.

• Ensure payments are made in a timely manner.

Pre-Authorized Debit (PAD)

PAD is an easy way for you to pay your Group Plan monthly premium. Complete the PAD authorization –

Pre-Authorized Debit (PAD) Form and provide a void cheque. Your monthly premium will be withdrawn from

the account provided on the 10th of each month. If the 10th of the month falls on a weekend or holiday, the

payment will be deducted the next business day.

Internet/Online Banking

You have an option of paying your monthly premiums by internet banking from your personal computer.

Empire Life is listed with most of the major banking institutions; please contact your local branch to receive

information on registering Empire Life for Online premium payment.

E-Billing

E-Billing is an easy, paperless way for us to let you know when your monthly bill is ready. When you register

for e-billing, you will receive a monthly email notification that your bill is available for viewing. You can then

choose to save the bill on your computer or print it for your records.




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How to Get StartedYou must be a registered user of the Empire Life Plan Administrator website.

If you are not registered Visit www.empire.ca and follow these easy steps:

Select Group Plan Administrator

Click on ‘Request a Registration Package’ located just

above the user id field

Forward the completed & signed registration package

to [email protected] or

fax 1 888 841-9145 and you will be provided

a user ID via email.

If you are registered 1. From the Empire Life Plan Administrator Home page, select the link “Register for e-Billing”

2. Select the division you wish to register for e-Billing

3. Enter the email address to which you would like the Monthly Notification sent

4. Press Submit

To View Your Monthly e-Bill

1. Log on to the Empire Life Plan Administrator website

2. Select the Contract Tab

3. Select ‘Billing’ for the specific division you would like to view

4. Select ‘Current Billing’ *Your current and previous bills are available as a PDF document

5. update your E-Billing information Select the Update e-Billing link from the billing screen.

Billings are mailed approximately one (1) week prior to the premium due date. Monthly premiums are due in

advance on the first of the month for that month’s coverage (i.e. the January Billing represents the premium due

for January’s coverage and should be paid by January 1st; it will be received by you the last week in December).

Adjustments for additions, terminations, increases of coverage, and other changes will be included on your Billing,

provided that notification of changes are received at Empire Life’s Head Office on, or prior to, the l5th of the

preceding month. For example, changes received by January 15th will appear on the February billing.


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Understanding Your Monthly Billing

Some points to remember:

• Empire Life does not charge or credit part of a month’s premium.

• The amount listed for Weekly Indemnity and Long Term Disability is the amount of benefit for which an individual is insured, not the employee’s salary.

• For Extended Health and/or Dental coverage, if your plan’s single rate is shown it means only the employee is insured. If the family rate is shown, it means coverage is provided for an employee and their eligible dependants.

Your Billing is divided into four sections:

Division billing coverage page

This page identifies your Group, shows the payment due date, accounting transactions since your last billing,

and the total amount due. Please return this page with your payment.

Certificate detail

This section details your employee’s coverage. It shows the insured volumes of coverage for each employee

as well as the premium payable for each coverage.

Payroll summary

This provides a breakdown of the premium and sales tax (if applicable) due in respect of each employee, and

further subdivides these amounts into the portions payable by the employer and the employee.

Rate summary

This provides a summary of the rates used to calculate the current month’s Billing.

Payment by Cheque

Please submit the face page of your billing and attach a cheque for the total amount billed. Also ensure your

Group and Division number applicable to the payment is noted on the cheque. Payment can be sent by postal

mail to the following address:

Group Administration, Group Solutions





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FREQUENTLY ASKED QUESTIONSCan an employee choose to refuse benefits during Maternity/Paternity Leave?

Yes, please have them complete a Maternity/Paternity Leave Temporary Refusal of Benefits Form. This form is

used when an employee commencing Maternity or Paternity Leave chooses to refuse continuance of Group

Insurance. The Right of Refusal can be exercised as follows:

• For the entire term of a Maternity/Paternity Leave.

• The employee, if refusing, must refuse for all coverage that the employee currently pays any portion of the premium.

• The completed Maternity Leave/Paternity Leave Temporary Refusal of Benefits form must be received by Empire Life no later than 30 days after the commencement of the Maternity/Paternity Leave.

What is Late Enrolment?

The most common oversight is when the Group Enrolment Form is submitted late (31 days after the eligibility

date of employee) thus making your employee a late enrolment causing coverage restrictions and underwriting

requirements. This causes frustration for both you and for your employee. To prevent this from occurring

please submit the completed and signed group enrolment form to our Head Office within 31 days of your

employee’s eligibility date. These forms can be faxed to 1 888 841-9145 or a digital copy can be sent by email to

[email protected] or by postal mail to the following address:

Group Administration, Group Solutions




What happens when an employee is laid off?

If your group plan includes a lay off provision, your employee can continue their group coverage (with the

exception of any disability benefits) for a specific amount of time. Please refer to your group benefits contract

for additional details

Can coverage be extended for an employee on severance?

The Employment Standards Act provides an extension of coverage up to a maximum of 8 weeks. This is generally

known as the ‘in-lieu of period’ and applies to all provinces.

Severance coverage beyond the ‘in-lieu of period’ can be offered to the employee by the employer, however,

Empire Life is not obligated to extend any coverage as the employee no longer meets the definition of employee.

Empire Life will review each request to extend coverage for an employee on severance and will confirm which

coverage can be extended.

Empire Life will not extend any disability coverage (WI or LTD) to any employee beyond the in-lieu of period.




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What does coinsurance mean?

The coinsurance applicable to your Extended Health and Dental plan is indicated on the schedule of benefits

pages in your group benefits contract.

If 100% coinsurance is shown, Empire Life will reimburse 100% of an eligible expense up to your plan maximum

and limitations.

If your Extended Health or Dental plan has an 80%, 50% or other coinsurance percentage indicated, Empire Life

will reimburse that percentage of the eligible expense, subject to the plan maximum and limitations.

What is the difference between prescribed and prescription drugs?

Prescription drugs can only be dispensed with a written doctor’s prescription. Drugs prescribed by a doctor but

available without a written doctor’s prescription are considered prescribed drugs.

What is the difference between prescription and generic drugs?

All drugs sold in Canada must be approved by the Federal Health Protection Branch. Each product must also meet

the strict regulations established by The Food and Drug Act and both generic and brand name drugs are subject to

the same rigorous standards.

Approximately 40% of all prescriptions in Canada are filled with generic drugs, but a generic equivalent is not

available for every brand name drug. Under the Canadian Patent Act, companies have a lengthy period of patent

protection to sell their products without generic competition.

The active ingredient in a generic drug and brand name drug must meet the same scientific norms and standards

and, in fact, they are often from the same supplier.

Generic drugs cost 40 to 50 percent less than Brand name drugs, on average.

What is a Benefit year?

A benefit year refers to the twelve (12) month period which applied to certain maximums within your Extended

Health and/or Dental benefits. Your benefit year may be:

Calendar year – Starting January and running through to the end of December

Policy year – Starting at your policy anniversary date and running twelve (12) months from that date

Benefit year – Starting from the effective date of that benefit for twelve (12) months.

A benefit year period would occur when a new benefit is added to your plan on a date other than your policy

anniversary date. Please refer to your group benefits contract for additional details regarding your benefit year.

What is a Deductible?

If your plan has a deductible for Extended Health or Dental benefits this will be indicated on the Schedule of

benefits pages in your group benefits contract. A plan deductible is a dollar amount which must be paid by the

employee before Empire Life makes payment under the plan.

Empire Life will never apply more than the single deductible to any one family member. Therefore, if only one

individual in a family incurred a claim in a benefit year, only the single deductible needs to be paid.


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Are Weekly Indemnity & Long Term Disability benefits considered taxable income?

If the employer pays all or part of the premium, disability benefits are subject to income tax. If the employee

pays 100% of the premium, disability benefits are income tax free.

How do I calculate an employee’s Life volume and monthly premium rate?

In order to calculate an employee’s Life volume and premium rate you will need their Salary Amount,

the Benefit Amount, and the life rate.

Amount of Life Coverage – Benefit Amount is either a flat amount or a percentage of salary. If percentage,

multiply that percentage by the salary amount (i.e. 150% x $34,000 = $51,000).

Monthly Life Premium Rate – Multiply the Life rate (i.e. $0.41 per $1,000 of entitlement) by the salary amount

and then divide by $1,000 (i.e. $51,000 x 0.41 = $20,910 / $1,000 = $20.91 monthly).

How do I calculate an employee’s LTD volume and monthly premium rate?

In order to calculate an employee’s LTD volume and premium rate you will need their Salary Amount,

the Benefit Amount, and the LTD rate.

Amount of LTD Coverage – Benefit Amount is either a flat amount or a percentage of salary.

If percentage, multiply that percentage by the salary amount and divide by 12 for a monthly

rate (i.e. 67% x $34,000 = $22,780/12 = $1,899 monthly).

Monthly LTD Premium Rate – Multiply the LTD rate (i.e. $2.15 per $100 of entitlement) by the salary amount

and then divide by $100 (i.e. $1,899 x 2.15 = $4,082.85 / 100 = $40.83 monthly).

How does an employee apply for excess coverage?

If a group insurance plan has salary related benefits and an employee is eligible for excess coverage, as their

salary makes them eligible for coverage over the NEL (No Evidence Limit), the following occurs:

• Two letters are sent to the company address. Plan Administrator letter – to notify the PA of the employee name and reason for underwriting. This letter requests that you forward an attached letter to the employee. Employee letter – to notify of excess volume and medical requirements needed for assessment. If only a Group Employee Health Information (EHI) Form is required, the form is included. If a paramedical exam is required, the letter to the employee notifies that we must receive confirmed interest before we will place the order for the examination. The bottom portion of the letter to the employee includes a form that the employee can complete and return by fax, email or mail.

• Empire Life’s Medical Underwriting Department will review the information; if additional information required, they will advise the employee.

• If the employee is approved, the Plan Administrator website will display the new volume in the Certificate coverage underwriting screen, with the underwriting status as approved; Approval letters (one for PA and one for the employee) are sent to the company address with a new Wallet Card, if applicable.

• If the employee is declined, a letter will be sent to the employee to notify of the decline, the reason for the decline, and any necessary criteria to be met for reconsideration if available.

• The letter will be sent to home or work (sealed) depending on which option was chosen by the employee on the EHI or paramedical form. The volume will remain at the NEL, grandfathered volume or current volume.

• If the employee chooses not to complete the Group Employee Health Information (EHI) form, the volume will remain at the NEL, grandfathered volume or current volume.



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When are premiums due?

Your group premiums are due on the first (1st) of each month. In other words, your February premium is due on

February 1st. Our billings are prepared and mailed approximately ten (10) days in advance of the due date. Upon

receipt, please return the Division Billing Coverage page with your payment. If payment is not received by the end

of the month for which it is due, claims will not be paid until the premium is received.

How do I notify you of a change in address for our Company?

Please notify the Administration team by email at [email protected] of your new address and the

date of your move.

What is a Vital Assist Health Benefit (VAHB)?

The Vital Assist Health Benefit is an affordable solution for Critical Illness coverage that simplifies the eligibility and

claim process. Vital Assist is payable once in an employee’s lifetime and provides a Lump Sum payment along with

a Medical Expense Benefit to ease the financial burden of medical expenses when suffering from a critical illness.

Please refer to your group benefits contract for additional details if your plan includes the VAHB benefit.

What is a Health Care Spending Account (HCSA)?

A HCSA offers choice and flexibility for employees and provides cost containment for employers.

At the beginning of the year, employers decide on a dollar amount (HCSA credits) to allocate to employees.

Employees can spend their HCSA credits according to their needs. For example, the employee may choose to

use their HCSA credits for benefits not covered by their traditional benefit plan.

Please refer to your group benefits contract for additional details if your plan includes a Health Care Spending Account.


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What is AssistNow?

AssistNow is an Employee Assistance Program (EAP) that can help resolve issues early, so they don’t grow

into bigger problems that can be more difficult to deal with. It offers:

• Confidential counselling so employees can get the help they need, when they need it.

• A wide range of wellness services to help employees manage their home life, health and wellbeing—so they can focus on their work while at work.

• A management consultation service to help leaders deal effectively with challenging employer-employee issues.

• A crisis response service to provide peace of mind to leaders, knowing that, in the unlikely event of a critical incident, expert support and crisis management is only a phone call away.

Please refer to your group benefits contract for additional details if your plan includes the AssistNow benefit.

How does eClaims work?

If eClaims services have been selected by the Employer/Company, employees can submit Extended Health

claims using our eClaims services on the Plan Member website. To submit Extended Health claims online

employees must:

• register for the Plan Member website,

• enrol for EFT payment of claims and electronic EOBs, and

• keep the original claim payment receipt(s) and any supporting document(s) (e.g. a referral letter) for 12 months following the date of the online claim submission(s).

Empire Life may periodically request original receipts and any supporting documentation to validate the

accuracy of the information provided or to conduct a random review. If employees fail to provide the receipts

or documentation requested within the specified time period, Empire Life will suspend the employee’s eClaims

access until the information is received and a satisfactory review has been completed. In the interim, the employee

can submit paper claims.

What if an employee calls about access to eClaims?

If an employee calls to ask why they do not have access to eClaims, it could be due to one of the

following reasons:

• eClaims services have not been selected by the Employer/Company,

• the employee’s access may be suspended for failing to provide original claim receipts or supporting documentation in the time frame requested by Empire Life (note – in the interim, employees can submit paper claims ),

• the Policy is on hold,

• the employee has been terminated, or

• the Policy has been terminated.

If none of the above apply, call our Customer Service team at 1 800 267-0215 for assistance.

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OUR COMMITMENT TO YOU – SERVICE TURNAROUND & OPERATING STANDARDSNote: Our ability to achieve the standards shown below is dependent on receipt of all required information.

Process Standard Type of confirmation

Administration

New Enrolment/Changes 24 hours - via PAW

3 business days - via

Email/Fax

Employee Benefit Summary and Wallet Card will

be mailed from Empire Life

Email Questions 24 hours Email response

Claims

Extended Health Claim 7 business days Employee receives an Explanation of Benefits with

a record of the Electronic Funds Transfer (EFT) or

cheque, if applicable.

eClaims Receipt Review 1-2 business days Employee receives an Explanation of Benefits with

a record of the Electronic Funds Transfer (EFT) or

cheque, if applicable.

Dental Claim 7 business days Employee receives an Explanation of Benefits with

a record of the Electronic Funds Transfer (EFT), a

cheque or confirmation of payment made to the

dental office, if applicable.

Customer Service

Email Questions 24 hours Email response

Note: This guide does not override the terms and provisions of your group benefits contract. you are responsible

for administering your plan in accordance with the terms outlined in your contract.

Insurance & Investments – Simple. Fast. Easy.®

www.empire.ca [email protected]

GRP-2151-EN-06/18

Documents

Group Administrative Guide Group Administrative Guide · Empire Life Group Administration Guide 7 How can I help to avoid delays in processing my requests? • Please indicate your