Extended Health Care Plan #51391

Summary of Canada Post’s post-retirement benefits

Extended Health Care Plan #51391

This summary describes benefits for eligible retired employees of Canada Post and their eligible dependants and eligible survivors. You must be covered under a provincial health care plan to be covered under Canada Post’s Extended Health Care Plan.

Legal Notes: Canada Post has reserved the right, in its sole discretion, to modify, reduce and/or terminate the benefits provided under the post-retirement Extended Health Care Plan for you, your eligible dependants and your eligible survivors. Canada Post will inform you, in writing, of any proposed change(s) to your benefits if necessary. This is not a legal document and represents a summary of the Canada Post Extended Health Care Plan #51391. The wording in the Great-West Life plan document # 51391 shall prevail.

Who can join this plan?

To be eligible for the Canada Post’s post-retirement Extended Health Care Plan, you must meet the following eligibility criteria:

  1. You must have been formerly represented by APOC, CPAA, PSAC, Urban Postal Operations (UPO) CUPW and have retired on or after January 1, 1993, or you must have been formerly an Executive or a Management/Exempt (MGT/XMT) employee and have retired on or after January 1, 1993, but before January 2, 2011. If you were formerly a Rural and Suburban Mail Carrier (RSMC) employee represented by CUPW, you are not eligible for coverage under this plan.
  2. You must have been eligible for coverage under the Canada Post Extended Health Care Plan (numbers 51391 or 51390) on the day before you retired (your last day of employment).
  3. You must have completed the required number of years of continuous service* at Canada Post on your date of retirement OR be totally disabled and approved for a disability retirement. Your date of retirement is the day following your last day of employment. For medical retirements, your date of retirement is the day following your last day of employment that is entered in SAP.
  4. You must:
    • be in receipt of a monthly pension from the defined benefit component of the Canada Post Registered Pension Plan, OR
    • have been a member of the Canada Post Group Retirement Savings Plan (RSP) for two or more years, OR
    • have been a member of the defined contribution component of the Canada Post Registered Pension Plan for two or more years.
  5. If you are a member of the defined benefit component of the Canada Post Registered Pension Plan and
    • you are in receipt of an immediate pension (including a disability pension), upon your retirement your application must be received by the plan administrator, Great-West Life, within 60 days of your retirement date; OR
    • you have deferred your pension within five years from the date of your retirement, your application must be received by the plan administrator, Great-West Life, within 60 days following the date you are in receipt of a monthly pension.
  6. If you are a member of the Group RSP or defined contribution component of the Canada Post Registered Pension Plan, you must be within 10 years of the date on which unreduced benefits are payable to you under the Canada/Quebec Pension Plan. Your application must be received by the plan administrator, Great-West Life, within 60 days of your retirement date (including disability retirement).
  7. You must provide Great-West Life with a void cheque and pay the required premium before your benefits start.

* You must have completed at least 15 years or have previously been grandfathered** with 10 years of continuous service at Canada Post on the date of retirement OR be totally disabled and approved for a disability retirement.

**Grandfathering years of service

Urban Postal Operations (UPO) employees represented by CUPW and Executive and Management/Exempt employees who have completed 10 years of continuous service before January 1, 2008, will be eligible for post-retirement benefits even if they retired before having completed 15 years of continuous service.

Employees represented by PSAC who have completed 10 years of continuous service before January 1, 2009, will be eligible for post-retirement benefits even if they retired before having completed 15 years of continuous service.

Employees represented by APOC and CPAA who have completed 10 years of continuous service before January 1, 2010, will be eligible for post-retirement benefits even if they retired before having completed 15 years of continuous service.

Eligible dependants

Upon retirement, if you are eligible for the post-retirement Extended Health Care Plan, you can choose single or family coverage.

A spouse qualifies as an eligible dependant if that person is the retired employee's legal, common-law (one year co-habitation) or former spouse (if there is a court order to provide benefits). A retired employee can only cover one spouse at a time.

A child qualifies as an eligible dependant if the child is an unmarried natural, adopted, foster or step-child of the retired employee or the covered spouse, or is a child that the retired employee or covered spouse has been appointed guardian for all purposes by court order. The child must be financially dependant on the employee and be under the age of 21 or, if over the age of 21, must either be a full-time student (12 hours a week) and under the age of 25, or incapacitated for a continuous period beginning before age 21 or while a full-time student and before age 25. To ensure continued benefits coverage for your over-age dependant children who are students, you must complete and submit to Great-West Life a “Declaration of Hours of Attendance for Over-age Dependant Students” form. For over-age incapacitated dependants, please contact Great-West Life for further information.

If you choose family coverage upon retirement it is recommended you complete the “Dependant Information” form that was included in your retirement/termination letter from Canada Post. If you do not submit an updated “Dependant Information” form, the same dependants that were covered under your plan while you were an active employee will continue to be covered as long as they meet the definition of an eligible dependant under the plan.

You must notify Great-West Life directly of any dependant changes (such as death of a dependant, change of spouse,) when they occur.

Eligible survivors

If you have family coverage, your dependants may be eligible for survivor benefits if you die while covered under the Canada Post post-retirement Extended Health Care Plan and they were covered immediately before your death. They may be eligible to continue this coverage for as long as they meet the definition of spouse and/or dependant child, and apply for survivor coverage within 120 days of your death. If you were a member of the defined benefit component of the Canada Post Registered Pension Plan they must also be in receipt of a monthly survivor pension from the defined benefit component of the Canada Post Registered Pension Plan. (There is no similar requirement if you were a member of the Canada Post Group RSP or the defined contribution component of the Canada Post Registered Pension Plan.)

Extended Health Care Plan coverage details

Below is an overview of your Extended Health Care Plan coverage if you are part of the following employee groups:

Your Employee Group Your Retirement Date
If you were formerly represented by CUPW – UPO On or after April 1, 2000
If you were an Executive or a Management/Exempt employee On or after January 1, 2001 and before January 2, 2011

On or after January 2, 2011 please refer to the Summary sheet for details for EHCP plan #162954 and the Healthcare Spending Account funded by Canada Post.

If you were formerly represented by PSAC On or after October 31, 2001
If you were formerly represented by CPAA On or after May 1, 2003
If you were formerly represented by APOC On or after October 10, 2000
Or you are an eligible surviving dependent of an employee or a retired employee from one of the above groups and you meet the eligibility criteria outlined above in the “Eligible survivors” section.

If you retired on or after January 1, 1993 but before the dates indicated in the table above for your employee group, please contact Great-West Life for details on your coverage. If you retired prior to January 1, 1993 you are not covered under this plan. Please contact Public Service Superannuation (PSSA) for details on your coverage if you are enrolled in PSSA post-retirement benefits.

There may be a temporary delay in coverage between the date your active employee benefits terminate and when your post-retirement benefits start. We encourage you to purchase an adequate supply of maintenance medication before your retirement date.

Keep your receipts if you incur any claims during the delay in coverage. You can submit a claim for reimbursement once your post-retirement benefits start. You have up to 12 months from the date an expense was incurred to submit a claim for reimbursement.

Prescription drug coverage

All eligible drugs on the Canada Post Controlled Drug Formulary are reimbursed at 80 per cent. You can see your covered drug list by visiting canadapost.ca/drugplan. The list of covered drugs is reviewed several times a year by an independent panel of expert medical professionals to see if new prescription drugs need to be added to the list.

There is no maximum for drugs with the exception of lifestyle drugs, which are limited to $500 per calendar year each for smoking cessation products, drugs used to treat sexual dysfunction and for anti-obesity drugs. Benefits for fertility drugs are limited to a lifetime maximum of $5,000.

Some drugs require prior authorization from the plan administrator, Great-West Life, to be paid by the plan. (Drugs requiring prior authorization are shown in bold italic type on the list of covered drugs.) If you need to obtain prior authorization for a prescribed drug, ask your doctor to complete a Prior Authorization form (available at canadapost.ca/drugplan) and then forward the completed form to Great-West Life.

Remember to bring the current list of covered drugs with you to your medical appointments. Have your doctor refer to the list to see whether he or she can prescribe a drug that is covered for the medical condition that needs to be treated. If you are unable to take a covered drug due to a contraindication (for example, an allergy) or if you have tried at least one drug from the list for your medical condition and the drug has not been effective, you may apply to have your drug covered by having your doctor complete a Request for Drug Exception form.

Extended health care coverage

Notes:

  1. Before incurring an expense, such as nursing care, orthotics, glasses, wheelchairs or breathing equipment, we recommend that you contact Great-West Life (see contact information section below) to confirm coverage and plan maximums.
  2. The services covered under the Extended Health Care Plan are subject to the definitions of “reasonable and customary” in addition to applicable plan maximums.

Reasonable expenses: treatment is considered reasonable if it is accepted by the Canadian medical profession, proven to be effective, and of a form, intensity, frequency and duration that is essential to diagnosis or management of the disease or injury.

Customary expenses: are the lesser of actual expenses and customary charges for covered services and supplies. Customary charges are the lowest of representative prices in Canada where the treatment was provided, prices shown in any applicable professional association fee guide and maximum prices established by law.

Government coverage: unless prohibited by law,benefits can be paid under this plan only for the portion of the cost that is not payable under a government plan. If a service is eligible for coverage under a provincial plan, the Extended Health Care Plan cannot reimburse the portion of the expense covered by the provincial plan

The following coverage is for each covered person and is subject to certain eligible maximums. All reimbursements are based on what is considered to be reasonable and customary treatment (as defined above) of a disease or injury. The list is not all-inclusive. Contact Great-West Life for more information.

Covered Expenses Covered % Coverage Description
Ambulance 80% To the nearest centre where essential treatment is available.
Hospital Room 100% Covers the difference between the standard ward daily rate and the hospital’s rates for private or semi-private accommodation up to but not exceeding the chosen daily maximum of $60 for Basic Hospital, $130 for Option A, or $200 for Option B.
Home Nursing Care 80% Covered expenses for nursing care are limited to a maximum of $15,000 in a calendar year. To establish the amount of coverage available under this plan before home nursing begins, you should apply to the plan administrator, Great-West Life for a pre-care assessment.
Medical Supplies 80%

Must be prescribed by a physician. Includes coverage for breathing, orthopaedic, and prosthetic equipment, mobility aids including wheelchairs once every two years for dependant children under age 18 and once every three years for any other person, communication aids, diabetic supplies and other medical supplies. Custom-fitted orthopaedic shoes can also be prescribed by a podiatrist, chiropodist or orthopaedic surgeon.

Contact Great-West Life for specific coverage details for medical supplies.

Diagnostic Services & Physician Services 80% Diagnostic laboratory and x-ray procedures performed in your province of residence if not available under your provincial government plan. Services of a physician in your province of residence if not available under your provincial government plan but are eligible for coverage under the provincial government plan of another province.
Accidental Dental 100% This benefit reimburses dental treatment required from accidental injury to sound, natural teeth. Treatment must be completed within 12 months of the accident if 18 years of age or older.
Vision Care 80% Glasses, contact lenses and laser eye surgery are covered to a combined maximum of 80% of $400 ($320 payable) every four calendar years. To confirm when the calendar year period starts for your employee group, please contact Great-West Life at 1-866-716-1313. Coverage for eye examinations by a licensed ophthalmologist or optometrist, including refraction, once every two calendar years.
Hearing Care 80% The plan covers hearing aids when prescribed by an otolaryngologist or audiologist, including tubing and ear molds provided at the time the hearing aid is purchased. Repair charges are also covered. Batteries are not covered. Covered expenses are limited to a maximum of 80% of $500 ($400 payable) every five years.
Out-of- Province/Out-of-Country Emergency Care 100% For medical emergencies while outside of your province of residence or outside of Canada, 40-day trip limitation. CAD$100,000 per trip maximum. Additional information on out-of-country coverage is available through Great-West Life. Please refer to the Global Medical Assistance and Emergency Out-of-Country Coverage summary sheet.
Paramedical Services* Calendar Year Maximum Doctor’s Note Required
Acupuncturist (including acupuncture by a physician) 80% of $600 ($480) No
Chiropractor 80% of $600 ($480) No
Massage Therapist 80% of $400 ($320) No
Naturopath 80% of $600 ($480) No
Osteopath 80% of $500 ($400) No
Physiotherapist 80% with no annual maximum Yes
Podiatrist/Chiropodist 80% of $500 ($400) No
Psychologist/Social Worker 80% of $1,000 ($800) Yes
Speech Language Pathologists/Therapists 80% of $600 ($480) Yes
*Services must be performed by a qualified professional specialists in the paramedical service provided in the province in which they are registered/licensed to practice.

Annual deductible

Based on the date of retirement, an annual deductible ($50 for single coverage and $80 family coverage) applies to the retired employees listed below.

Employee Group Retirement Date
If you were formerly represented by UPO CUPW On or after April 1, 2000, but before September 30, 2003.
If you were an Executive or a Management/Exempt employee On or after January 1, 2001, but before April 1, 2004.
If you were formerly represented by PSAC On or after October 31, 2001, but before January 1, 2006.
If you were formerly represented by CPAA On or after May 1, 2003, but before January 1, 2007.
If you were formerly represented by APOC On or after October 10, 2000, but before February 1, 2006

If you retired on or after the dates indicated above, an annual deductible does not apply.

If you retired on or after January 1, 1993, but before the dates indicated above, an annual deductible ($25 for single coverage and $40 for family coverage) applies.

Drug and Identification Cards

Members of the Extended Health Care Plan receive two cards from Great-West Life. One is a drug card that can be used at the pharmacy to pay for 80% of the cost of prescription drugs that are on the Canada Post Controlled Drug Formulary. The other card is an identification card that can be presented to service providers such as hospitals who require identification and confirmation of coverage. On the back of the identification card you will find the Medex emergency telephone numbers should you need health care while travelling outside of Canada or outside your province of residence.

You will use the same cards that you had as an active employee. If you need a replacement card, please contact Great-West Life.

Submitting claims

All EHCP #51391 claim forms and receipts must be received by Great-West Life within 12 months of the date expenses are incurred. Claim forms received more than 12 months after the date the expense was incurred will not be eligible for reimbursement.

Electronic coordination of benefits at the pharmacy is not available between two Canada Post retired employees who are both covered under plan #51391. If you are eligible for coordination of benefits, you must use the hard-copy claim form.

Premiums

Information on premiums can be found on the Monthly Premium Rate Table.

When does coverage terminate?

  • The date this plan terminates.
  • If you miss a premium payment, your benefits will terminate retroactively to the date premiums lapsed.  
  • Benefits terminate upon your death. Survivor benefits may apply to your dependants. Surviving dependants should call Great-West Life at 1-866-249-5723 for more information. They must apply for survivor coverage within 120 days of your death.

What happens if I miss a monthly premium payment?

Great-West Life will deduct your monthly premiums directly from your bank account. If you miss a monthly premium payment, your post-retirement benefits coverage will stop. The following month, in addition to your regular monthly premium, you will also be charged for the missed premium. If there are insufficient funds in your bank account for both the regular monthly premium and the missed premium, your benefits will be terminated permanently and you will not be permitted to re-enrol.

Please ensure that Great-West Life has your current banking information and that you have sufficient funds in your account to cover your monthly premiums. In addition to notifying Great-West Life of any changes to your bank account information, you must also notify Great-West Life if you change your address.

Changes to coverage

When you retire, you can choose single or family coverage. If you subsequently need to change this coverage, please notify Great-West Life. You will need to complete a Group Coverage Change form, which is available through Great-West Life.

The coverage change will be applied on the effective date of the change provided you make the request within 60 days of the date of change. If the request for change is made after 60 days from the effective date of the change, the coverage change will happen on the first of the month following a three-month waiting period. The three-month waiting period begins from the date the Group Coverage Change form is received by Great-West Life.

Changes to the level of hospital coverage take effect on the first of the month following a three–month waiting period. The three-month waiting period begins from the date the Group Coverage Change form is received by Great-West Life.

Where to find more information

Great-West Life

Claims: 1-866-716-1313

Premiums/Enrolment: 1-866-249-5723

Your covered drug list online canadapost.ca/drugplan
Your online benefits resources

GroupNet for Plan Members: groupnet.greatwestlife.com

Canada Post retiree website: canadapostalumni.ca

Out-of-country or province medical emergencies Call collect from anywhere except Cuba: 1-410-453-6330.
Within Cuba call collect: 905-816-1901
Within Mexico: 001-800-101-0061
Within the UK: 0-800-252-074
Within Canada and the U.S.: 1-800-527-0218
Public Service Superannuation (PSSA) English: 1-800-561-7930
French: 1-800-561-7935