As an employee of Acadia University, upon joining the University you are required to participate in the Group Health Insurance, Long Term Disability, Basic Group Life and Accidental Death and Dismemberment Insurance Plans, provided you meet the following criteria:

1)  You are employed in one of the following employment categories:

Full Time - you are working in a continuing full-load capacity as defined for your class of employment;

Sessional - you are working in a full-load capacity as defined for your class of employment for at least 8 consecutive months per year.

Half-time - you are working in at least a half-load but less than full-load capacity as defined for your class of employment on an ongoing basis 12 months of the year.

Job Sharing - you share one full-time 12 month position in maximum two week cycles equally with another employee so that each of you is working in a half-load capacity.

Retired employees enrolled as active employees prior to retirement are eligible employees.

2)  You are a resident of Canada and for Group Health Insurance are eligible for benefits under the provincial government health care program in the province of residence.

3)  You are under the age of 65.

During your New Employee Orientation you will be provided with information regarding the benefits you are eligible for, together with appropriate application forms. These should be returned to your Pension & Benefits Professional in the HR Department [HYPERLINK TO KERRY AND CHECK THIS IS CORRECT]

Applications for all plans should be submitted within one month of the date you are hired or you may be asked to provide evidence of good health.  Evidence of good health is required on all applications for Optional Life Insurance.  Please refer to the Group Life Insurance Plan for details.

Coverage is effective on the date of eligibility, except when: (a) the employee is not actively at work on the day that coverage would otherwise become effective, or (b) the application is made after the 31 day period.

If you are not actively at work when you normally have become eligible, your coverage will commence when you return to work on a full-time basis.

Evidence Of Health

Proof of good health is not required if application is made within 31 days of first becoming eligible.  If coverage is not applied for within this 31-day period, evidence may be requested for the employee and his/her dependents, if any, before benefits commence.

Coverage for your eligible spouse and dependent children is available under both the Group Health and Optional Life Insurance Plans.

Spouse and dependents defined below shall exclude any person for whom evidence of health, if required, was not approved by Medavie Blue Cross.

1)  Spouse means a spouse legally married to the employee in an ecclesiastical or civil ceremony or a partner who cohabits on a continuous basis with the employee in a spousal relationship that is not a legal marriage, including a partner of the same gender, provided that the cohabitation existed for a period of 12 months prior to the partner being admitted to the plan.  The subscriber requesting coverage for such a partner must give written notice to Medavie Blue Cross.  Unless such written request is made, the period legally married to the subscriber shall be considered to be the covered spouse.  Discontinuance of cohabitation with the subscriber shall terminate coverage of the partner.

2)  Children shall mean the subscriber's natural, adopted or stepchildren who are dependent upon the subscriber for financial care and support.  Such children must be unmarried, and less than 21 years of age; or, to age 25 if attending an accredited educational institution, college or university on a full-time basis.  The children of the subscriber's common-law spouse shall be covered provided the children are living with the subscriber.

Unmarried children 21 years of age or older shall qualify, if they are dependent upon the subscriber by reason of a mental or physical disability and became totally disabled prior to attaining age 21, and who have been continuously disabled since that time.  Unmarried, unemployed children who became totally disabled while attending an accredited educational institution, college or university on a full-time basis prior to their attaining age 25 and have been continuously so disabled since that time shall also qualify as a dependent.

Dependent coverage begins for your eligible dependents on the same date as your coverage, or as soon as they become eligible dependents if added later, provided that dependent benefits were applied for within 31 days of their becoming eligible.  If coverage is not applied for within this 31 day period, evidence of health on the dependents may have to be submitted and approved before coverage begins.

Coverage for health benefits is effective from the first day you are actively employed.  If, at any time, you or a dependent for whom you have applied for membership is hospitalized, coverage for that individual will begin upon his or her discharge from the hospital.

The cost of your employee benefits program is shared by you and the University as follows:

• Long Term Disability Insurance is paid for in full by the University;

• Basic Group Life and Accidental Death & Dismemberment is paid by you through payroll deduction;

• Group Health Insurance premiums are split 50/50 between you and the University;

• Optional Life Insurance is paid by you;

• Dental premiums are split, with 25% paid by you and 75% by the University (available to Faculty only).

There is a Group Insurance adjustment that is applied in such a way that the combined premium of Long Term Disability, Basic Group Life and Accidental Death and Dismemberment are shared evenly by you and the University.

If you already have equivalent health coverage through your spouse's employer, you will be permitted to waive your membership in the University's Group Health Insurance Plan.  However, if you choose not to waive your membership, it may be possible for you to claim reimbursement under both plans.

When claiming under two plans, expenses should be filed first with the plan under which the person being treated is insured as an employee.  Any balance remaining after payment of claims under the primary plan may then be submitted to the secondary plan, the total refund from both plans may not exceed your actual out-of-pocket expense or your payment will be adjusted accordingly.

Claims for dependent children should be submitted first by the parent whose birthday falls earlier in the calendar year.

Dental Claims

Many dentists will bill Medavie Blue Cross directly and send you a bill for any remaining balance. However, in those instances where you do need to submit a claim, your dentist should complete the Medavie Blue Cross Standard Dental Claim Form.

Send your claim form to Medavie Blue Cross along with your receipts within 12 months. Write your name, policy number and group identification number on the receipts. Be sure that your Benefits Administrator has your current address.

Send all claim forms and original receipts to:

Medavie Blue Cross
PO Box 2200
Halifax, Nova Scotia
B3J 3C6 

For your convenience, you can also call Medavie Blue Cross’ customer enquiry centre with questions about your dental claims. Just call 1-800-667-4511 and give them your plan and identification number which is shown on your Medavie Blue Cross Card.

Health and prescription drug claims

You typically do not have to submit claims for drugs. You will be given a card to pay your "co-pay" amount at the pharmacy. The pharmacy submits for the remainder of the claim.

For some health supplies and services, you will need to submit a claim form along with your original paid-in-full receipts to Medavie Blue Cross. Write your name, policy number and your group identification number on the receipts. Be sure your Benefits Administrator has your current address.

You must submit all claims to Medavie Blue Cross within 24 months of the date the supply and/or service was provided.

Claim forms are necessary to be reimbursed for these services:

• Vision care
• Private duty nursing or VON services
• Treatment for an accidental dental injury

In most cases, your healthcare provider will be able to provide you with the applicable Medavie Blue Cross claim form.

Send your claim form and original receipts to:

Medavie Blue Cross
PO Box 2200
Halifax, Nova Scotia
B3J 3C6 

For your convenience, you can also call Medavie Blue Cross' customer enquiry centre with questions about your health or prescription drug claims. Just call 1-800-667-4511 and give them your plan and identification number which is shown on your Medavie Blue Cross Card.

Co-ordination of Benefits

Canadian insurance companies follow a process called Coordination of Benefits (CoB) when both partners have family coverage. CoB ensures you receive the maximum benefit available from your health and dental policies. In fact, two policies can be combined to give you up to 100% reimbursement of eligible claims.

Here's how Coordination of Benefits works:

Submit your medical, dental, and prescription drug expenses first to your Health Association benefits program (either by using your Medavie Blue Cross card or by submitting your paper claim form). You can then submit any unpaid portion of your claim to your spouse’s plan.

Submit your spouse’s medical, dental, and prescription drug expenses first to your spouse’s benefits program. You can then submit any unpaid portion of your spouse’s claim to your Health Association benefits program.

If your dependent children are covered under your and your spouse’s benefit programs, you must submit their medical, dental and prescription drug expenses first to the benefit program of the parent whose birth date falls earliest in the calendar year (the month, then day). Any remaining balance can then be reimbursed from the other plan. When parents are separated or divorced, the custodial parent claims under his or her plan first.

When you submit a claim for an unpaid balance from another insurance company, Medavie Blue Cross will need a copy of the receipt and a copy of the statement showing the portion of the claim paid by the other company. Although you have 12 months to claim any remaining balances, your receipts should be submitted as soon as possible.

If you need help determining the order in which your claims should be submitted, call Medavie Blue Cross toll-free at: 1-800-667-4511.

Health Spending Account

How to make a claim:

A) If you are covered by the Acadia Group Health plan..

1. Complete a Health Spending Account Claim Form (pdf format)
2. Attach original receipts
3. Attach original claim form completed by your provider (i.e. dentist, optometrist, etc.)

B) If you have Health Coverage insurance elsewhere and have only the Health Spending Account with Acadia...

1. Take copies of your claim form and receipts
2. Submit claim form and receipts to your insurance carrier.
3. Your insurance carrier will provide you with an "Explanation of Benefits" statement which you must attach to the HSA claim form
4. Attach copies of your provider's claim form and receipts which you originally sent to your insurance carrier.

NOTE:  All claims must be submitted directly to Medavie Blue Cross

The amount of the receipt paid will be deducted from the balance in your HSA.  The HSA can be used for items and services not covered, or not covered in full, under your current health plan, including dental charges.

If you become disabled, your membership in the benefits program continues much as before.  During any period in which you are receiving Short Term Sick Leave, there will be no change in your coverage or payroll deductions.  If you are covered for sick benefits under Employment Insurance, the University will carry your benefits until you return to work, at which time premiums paid by the University must be refunded.

If the disability is prolonged and you become eligible for Long Term Disability (LTD) benefits, your premium may be waived for your LTD, Basic and Optional Life and Accidental Death & Dismemberment coverage.  Your Group Health Insurance may be maintained at your own expense.

If you take a sabbatical, or other paid leave, your coverage will remain in effect throughout the duration of your leave.*  You will continue to pay your share of premiums as usual and your benefits will be based on the salary you would have earned had you not taken such a leave.

Your coverage may also be maintained during periods of approved unpaid leave*, such as maternity leave.

Sessional employees who accept a further term of employment prior to the completion of the current term, are considered to be on an approved unpaid leave of absence during the intervening period.

Note:  Group Health Coverage is dependent upon the subscriber being eligible under a Provincial Government Health Program.

*See Accidental Death and Dismemberment for information of entitlement due to death or injury caused by accident.

All coverages end on your last day of work.  However, you may convert your Group Health, Basic Group Life and Optional Life Insurance Plans to individual programs anytime within 31 days of the termination date.

When you retire (at any age), you will be permitted to maintain your Group Health Insurance at your own expense.  For rates, please contact your Group Pension & Benefits Professional.

Your Long Term Disability coverages will end and you will be given the opportunity to convert your Basic and Optional Life Insurance and Accidental Death & Dismemberment Insurance to individual policies at your own expense.

For information on a conversion policy please contact Manulife Financial at 1-800-453-7300, extension: 4350.

Should you die before retirement, death benefits under the Basic and Optional Life Insurance Plans will be paid to the beneficiary(ies) names on your most recent enrolment materials or to your estate if you have not names a beneficiary.  Additional death benefits may be payable under certain government-sponsored plans.

Reference is made at various points throughout our website to government departments with which you may be required to make contact.  Addresses and telephone numbers of the local offices of these departments are listed below for your convenience.

• Nova Scotia Medical Services Insurance (MSI)
• Workers Compensation
• Employment Insurance (EI)
• Canada Pension Plan / Old Age Security