Benefits FAQ
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A member (“employee”) is eligible for benefits coverage under the PEBT Benefits Program in accordance with your Collective Agreement and the eligibility requirements and waiting period outlined in the My Benefits section of this website.
To be eligible, you must:
- Work a minimum number of hours per week
- Have completed the waiting period, and
- Be “actively at work” on the eligibility date.
When you become eligible to receive benefits the following steps will be taken:
- The School District Benefits Administrator will provide you with the PEBT website address www.pebt.ca to access the PEBT Benefits Enrolment Form
- If you cannot access to the Internet, the School District Benefits Administrator will provide you with hard copies of the required enrolment forms.
- You must complete and sign the PEBT Benefits Enrolment Form and provide this form to the School District Benefits Administrator.
- The School District Benefits Administrator advises you of the benefits you are eligible for and the effective date for each benefit. You can review coverage details under the My Benefits section of this website.
If you were previously insured under the PEBT Benefits Program and terminated service and then return to work within the Reinstatement Period, your coverage may be reinstated from your date of recall.
If you are recalled by the district the following steps will be taken:
- The School District Benefits Administrator will determine if the normal waiting period applies based on the school district’s reinstatement period for benefits other than the Core LTD Plan.
- The normal waiting period will be waived for the following members for Core LTD as follows:
- A newly appointed member with prior LTD coverage in a different employee group in the same school district.
- A member whose hours of work as a regular employee have decreased within the preceding six (6) months has made the employee ineligible for coverage.
- A member appointed to the bargaining unit by the Labour Relations Board who had prior LTD coverage in a different employee group within the school district.
- A laid-off member who is recalled or rehired by the school district within six (6) calendar months of the layoff date.
Employees who do not complete and sign the PEBT Benefits Enrolment Form within four months of the initial Eligibility Date will be considered a late applicant.
For basic life and extended health: If you are considered a late applicant, you must provide satisfactory medical evidence of insurability to the benefit provider prior to becoming eligible for coverage. To become eligible for coverage, the following steps must be taken:
- You must complete the Evidence of Insurability Form and submit it to the benefit provider.
- The benefit provider will send the school district a letter stating whether you have been approved or denied coverage. Once the letter has been received, the administrator can enroll the member using the administration system with the effective date stated in the letter.
- Your coverage commences when formal written approval is received from the benefit provider(s). Retroactive premiums to the effective date of coverage may be required.
For dental: If you are considered a late applicant, the effective date of your coverage will be based on whether your district requires you to submit a dental declaration for approval or if there is a dollar amount restriction for your first year of coverage (i.e. $100/$125/$250 maximum for the first year). Your School District Benefits Administrator will advise which dental late applicant rules apply to your plan. Based on these options, the following steps must be taken to become eligible for coverage:
- For school districts that require a dental declaration to be submitted, the district administrator will send the declaration and a copy of your PEBT enrolment form to the benefit provider. The provider will send the school district a letter stating whether you have been approved or denied coverage.
- If approved, the effective date of coverage will be the 1st of the month following approval by the provider.
- For school districts with a dollar maximum late applicant restriction for the first year of coverage, the district administrator will enroll you onto the dental plan and PBC will apply the dollar maximum restriction for the first year. The effective coverage date will be indicated by the benefits administrator on the enrolment form.
- The effective date of coverage will be the date indicated by the benefits administrator on the enrolment form
You may enroll your eligible dependents in the PEBT Benefits Program.
If you are enrolling an eligible dependent, you must enter the dependent(s)’ names on:
- PEBT Benefits Enrolment Form (for new hires) or;
- PEBT Benefits Change Form (if adding or changing Dependents).
The following individuals are considered eligible dependents:
Spouse:
The person legally married to the employee or a person of the opposite or same sex who has been residing with the employee in a common-law relationship for the period of time specified in the definition of spouse in the My Benefits section of this website and who is publicly represented as the employee’s spouse.
Employees can only enroll one spouse in the PEBT benefits program at a time:
- A legal spouse
- An estranged spouse (separated)
- An ex-spouse (divorced)
- A common-law spouse (opposite or same sex)
Coverage may not be continued for an ex-spouse without a court order that states the member must continue coverage for the ex-spouse under the “employer-sponsored plan”.
You must sign the Common Law Spouse Declaration Form to enroll a common-law spouse.
Dependent Child(ren):
For extended health and dental coverage, see the definition of dependent children in this website’s Summary of Benefits of the My Benefits section.
For child optional life: Up to age 21, or 25 if in full-time attendance at school, to any age for disabled children. A child is effective from birth. If the child is institutionalized, the benefit will not be effective until the child ceases to be confined.
DEPENDENT CHILDREN MAY INCLUDE:
Child with a disability:
A mentally or physically dependent child with a disability may be covered to any age provided the child is incapable of self-sustaining employment and is wholly dependent upon you or your spouse for support and maintenance.
If you are enrolling a child with a disability as a dependent the following steps must be taken:
- You should indicate any applicable information regarding the child’s disability status on the PEBT Benefits Enrolment Form.
- Benefit provider(s) may require additional information later to verify the child’s status. If required, the benefit provider(s) will request the additional information directly from you.
- You should contact your School District Benefits Administrator if your dependent child becomes disabled later.
Step child / Adopted child:
If you are enrolling a step/adopted child as a dependent following your initial enrolment into the PEBT Benefits Program, the following steps must be taken:
- You must complete the PEBT Benefits Change Form to add a legally adopted child as a dependent and provide the form to the School District Benefits Administrator.
- The form must include the date of adoption.
- Stepchildren must be living with and/or legally adopted by you to be considered eligible dependents.
- Coverage will be effective on the effective date of the change.
Legal wards:
If you are enrolling a legal ward as a dependent child, the following steps must be taken:
- You must complete the PEBT Benefits Change Form to add a legal ward as a dependent child and provide that form to the School District Benefits Administrator.
- You must provide a copy of the court document. Please note that a notarized statement is not sufficient.
- Coverage will be effective on the effective date of the change.
Note: Grandchildren can be eligible dependents only if legally adopted by, or legal wards of, the employee.
DEPENDENTS THAT ARE ENROLLED AS LATE APPLICANTS:
If you apply for coverage for your dependents later than four months following their initial eligibility date, the dependent(s) will be considered a late applicant(s).
For extended health and dependent life (where applicable): If your dependent(s) is/are considered a late applicant, they must provide satisfactory medical evidence of insurability to the provider prior to becoming eligible for coverage. To become eligible for coverage, the following steps must be taken:
- Complete the Evidence of Insurability Form and submit it to the provider.
- The provider will send the school district a letter stating whether your dependent(s) has been approved or denied coverage. Once the letter has been received, the administrator can enroll the dependent using the administration system with the effective date stated in the letter.
- Coverage commences when formal written approval is received from the provider(s). Retroactive premiums to the effective date of coverage may be required.
For dental: If your dependent(s) is/are considered a late applicant, the effective date of coverage will be based on whether your district requires a dental declaration submitted for approval or if there is a dollar amount restriction for the first year of coverage (i.e. $100/$200/$250 maximum in the first year). Your District Benefits Administrator will advise you which dental late applicant rules apply to your plan. Based on these options, the following steps must be taken for the dependent(s) to become eligible for coverage.
- For school districts that require a dental declaration to be submitted, the district administrator will send the declaration as well as a copy of the PEBT Enrolment Form to the provider. The benefit provider will send the school district a letter stating whether your dependent(s) have been approved or denied coverage.
- If approved, the effective date of coverage will be the 1st of the month following approval by the provider.
- For school districts that have a dollar amount late applicant restriction for the first year of coverage, the district administrator will send a copy of the PEBT Enrolment Form to the provider.
- The effective date of coverage will be the date indicated by the benefits administrator on the enrolment form.
An over-age dependent child is eligible for benefits to the maximum age allowed in your district’s plan, provided they are a natural, adopted or step-child who is single (i.e. unmarried and not living in a common-law relationship) and financially dependent on you or your spouse. The overage dependent child must also be either in full-time attendance at a recognized school, college or university or be considered disabled. Full time attendance at school typically means more than ten hours of classroom instruction per week or to be registered in at least 3 classes per semester.
Pacific Blue Cross (PBC) will continue coverage as follows unless otherwise ineligible:
- When the dependent child reaches the minimum age of termination unless they are a student (i.e. Age 21 – may vary depending on your district’s plan) or functionally impaired – coverage ends at the end of the month of the dependent child’s birthday.
- When the dependent child reaches each birthday after previously qualifying for student status (i.e. age 22 to 24 – may vary depending on your district’s plan) – coverage ends at the end of the month of the dependent child’s birthday if not in school and/or no longer eligible.
- When the dependent child reaches the maximum age after previously qualifying for student status (i.e. age 25 – may vary depending on your district’s plan) – coverage ends at the end of the month of the dependent child’s birthday.
- If your over-age dependent child is disabled, PBC must approve continuation of coverage once your child has reached the minimum age, as specified in the My Benefits section of this website, for extended health and dental. To obtain approval, please complete the PEBT Change Form and provide a copy of the approved CRA or Persons with Disability (PwD) document to your School District Benefits Administrator. The School District Benefits administrator will submit the change form and the necessary documentation to the benefit provider. The provider will confirm in writing back to the School District Benefits Administrator whether coverage has been approved or declined. Your School District Benefits Administrator will contact you once confirmation has been received.
If your dependent child is considered an overage dependent, the following steps will be taken:
- The School District Benefits Administrator will provide you with the Over Age Dependent Form if the dependent child is nearing the maximum age (i.e. age 21), and for ages 22 to maximum age for annual re-certification.
- You must complete the Over Age Dependent Form if the dependent child is a student as defined above and return to the School District Benefits Administrator.
- You must return the completed form to the School District Benefits Administrator by the date shown on the form; otherwise, the dependent child will be removed from coverage at the end of the month the dependent child reaches the maximum age.
Check with your School District Benefits Administrator to determine which benefits can be waived and which are a mandatory employment condition.
You may be able to waive extended health and dental for yourself and all eligible dependents if you have coverage under another plan (i.e. spouse’s employer’s plan) by completing the waiver section of the PEBT Benefits Enrolment Form (for new hires) or the Change of Spousal or Other Coverage section of the PEBT Benefits Change Form. You may be required to provide evidence of the other benefits plan (if applicable in your district).
If you wish to apply for previously waived benefits coverage at a later date, you should refer to the sections on Life Events and Late Applicants.
You are required to nominate who will receive the proceeds of your life and/or accidental death benefits in the event of your death.
Important information about designating a beneficiary:
- The initial designation of a beneficiary is made on the PEBT Benefits Enrolment Form.
- You may nominate anyone you wish as a beneficiary.
- You may nominate more than one person as a beneficiary and allocate a percentage of the total benefit by beneficiary.
- You should appoint a Trustee on the PEBT Benefits Enrolment Form if the beneficiary(ies) are not of legal age.
- If you wish to change your beneficiary(ies), you must complete, sign and date the PEBT Benefits Change Form.
- The School District Benefits Administrator will file the PEBT Benefits Enrolment Form and PEBT Benefits Change Form (if applicable) in your personnel file for use in the event of your death.
Note:
- There are two types of beneficiaries – revocable and irrevocable.
- All beneficiaries are revocable unless the employee provides written notice to the Benefits Administrator that the beneficiary is irrevocable.
TO EFFECT A CHANGE FROM AN IRREVOCABLE BENEFICIARY TO ANY OTHER BENEFICIARY, ONE OF THE FOLLOWING DOCUMENTS IS REQUIRED:
- Renunciation by the irrevocable beneficiary, or
- Evidence of death of the irrevocable beneficiary, or
- Final Decree of Divorce, if the irrevocable beneficiary is the spouse of the employee
ESTATE AS A BENEFICIARY
If you do not wish to designate any specific person as beneficiary, you should indicate “Estate” on the PEBT Benefits Enrolment Form.
The proceeds of Life insurance and/or Accidental Death insurance in the event of your death will be paid in accordance with your Will, or if you do not have a Will, in accordance with the laws of intestacy of the province in which you reside.
As a general rule, payments to designated persons, such as the spouse or children of legal age, or children with an appointed trustee, are available more promptly as there is no need for Probated Wills or other title documentation.
Important Information about Incompetent Beneficiaries
If it is found that a beneficiary is not able, due to physical or mental incapacity, to complete the documents necessary to claim the proceeds of a policy to which they are entitled, there are several alternatives:
Physical Incapacity
A person who is blind, paralyzed or otherwise incapacitated due to illness or age may be physically unable to read or to sign claim documents. In such cases, special witnessing procedures are necessary to ensure that the person understands the significance of the papers being signed and the situation should be discussed with the provider.
If a Power of Attorney has been granted to another person, the provider will deal with that person, provided sufficient and proper authority is contained in the document.
Mental Incapacity – Guardian
It is customary for a mentally incapacitated person to have a guardian (curator, committee, conservator) appointed to look after the individual, the individual’s property or both. A court must appoint a guardian on application by family members, friends, etc. A guardian may be a spouse, relative or other responsible adult or a corporation such as a Trust Company.
Most jurisdictions have facilities for appointing a government official (Public Trustee, Public Curator) as a committee for an incompetent person, should no other person be qualified or able to assume the responsibility of guardian. In some provinces, the Public Trustee or similar official may automatically become a committee of an individual committed to a hospital.
Proof of Appointment
A certified copy of the court order appointing a guardian must be submitted, except if a Public Trustee or Public Curator is acting, in which case only a letter from him stating this will be obtained.
Powers of Guardian
In general, the powers of a guardian are limited to acts of administration and conservation of the property of the incompetent person. In response to a claim, the guardian will normally sign the Claimant’s Statement and be the payee for the proceeds. The guardian may elect an optional settlement in lieu of a lump sum payment of the proceeds.
A guardian must always show his capacity after or below the signature on any document (i.e. “as guardian for…”)
Exceptions
Exceptions to established procedures can be made where individual cases (generally very small amounts) are discussed with the Insurer with full details of the situation.
If optional spouse life insurance is offered at your school district the following steps can be taken:
- Applicants complete the PEBT Optional Life Application and submit it to Pacific Blue Cross (PBC).
- PBC may require further medical information to make a decision on your application.
- Within 5 business days of receiving your application, a letter will be sent to you if further medical information is required. Instructions about how to provide this medical information are outlined in the letter. PBC may also contact you by phone if necessary. If no further medical information is required, a decision will be made based on the information provided in the original application.
- If approved, a letter will be sent to the School District Benefits Administrator. The school district is responsible for notifying the applicant of the approval. Premium will be charged beginning on the 1st of the month following the approval date.
- If declined, you will receive a letter directly from PBC explaining their decision. The school district will be sent a letter advising that the application has been declined, however, reasons for the declination will not be disclosed.
- If you do not provide the requested medical information within 3 weeks from the date it was requested, PBC will send a follow-up letter. This letter will state that if the required medical information is not provided by the deadline date shown in the letter, PBC will be unable to review your application, assume you are no longer interested in applying for optional life coverage and will close your file.
- If you have submitted an application to PBC and would like to know the status of your application you may call PBC directly.
IMPORTANT INFORMATION ABOUT OPTIONAL LIFE INSURANCE
- You must be covered for basic life insurance to be eligible for this benefit.
- The School District Benefits Administrator will not make deductions for this coverage until written approval is received from the Insurer.
- The School District Benefits Administrator will advise the member of the approval of optional life coverage and the effective date for payroll deductions.
- All medical information indicated on the application will be maintained by PBC to maintain the member’s right to confidentiality of information.
- If you are currently being charged a smoker rate for optional employee life insurance, and you have abstained from the use of tobacco or nicotine products for at least the past 12 consecutive months, you may apply for the preferred non-smoking rate by completing the Smoker Declaration form.
- If an optional employee life insurance claim is filed and the smoking habits have been misrepresented, the claim will be denied. Premiums paid for the denied coverage will be refunded to the employee.
- The School District Benefits Administrator needs to file the original approval letter in the member’s personnel file.
If optional spouse life insurance is offered at your school district the following steps can be taken:
- Applicants complete the PEBT Optional Life Application and submit it to Pacific Blue Cross (PBC).
- PBC may require further medical information to make a decision on your application.
- Within five business days of receiving your application a letter will be sent to you if further medical information is required. Instructions about how to provide this medical information are outlined in the letter. PBC may also contact you by phone if necessary. If no further medical information is required, a decision will be made based on the information provided in the original application.
- If approved, a letter will be sent to the School District Benefits Administrator. The school district is responsible for notifying the applicant of the approval and updating the coverage level through the website. Premium will be charged beginning on the 1st of the month following the approval date.
- If declined, you will receive a letter directly from PBC explaining their decision. The school district will be sent a letter advising that the application has been declined, however, reasons for the declination will not be disclosed.
- If you do not provide the requested medical information within three weeks from the date it was requested, PBC will send a follow-up letter. This letter will state that if the required medical information is not provided by the deadline date shown in the letter, PBC will be unable to review your application, assume you are no longer interested in applying for optional life coverage and will close your file.
- If you have submitted an application to PBC and would like to know the status of your application you may call PBC directly.
Notes:
- You are responsible to ensure the Application is completed and signed.
- Your spouse is required to sign the Application.
IMPORTANT INFORMATION ABOUT OPTIONAL SPOUSE LIFE INSURANCE
- You may select an amount of optional spouse life insurance in multiples of $10,000 up to a maximum of $300,000.
- You must be covered for basic life insurance to be eligible for this benefit.
- The School District Benefits Administrator will not make deductions for this coverage until written approval is received from the Insurer.
- The School District Benefits Administrator will advise the member of the optional spouse life insurance approval and effective date for payroll deductions.
- All medical information indicated on the Application will be maintained by PBC to maintain your right to confidentiality of information.
- If you are currently being charged a smoker rate for optional spouse life insurance, and you have abstained from the use of tobacco or nicotine products for at least the past 12 consecutive months, you may apply for the preferred non-smoking rate by completing the Smoker Declaration form.
- If an optional spouse life insurance claim is filed and the smoking habits have been misrepresented, the claim will be denied. Premiums that have been paid for the denied coverage will be refunded to the employee.
- The School District Benefits Administrator needs to file the original approval letter in the employee’s personnel file.
If optional accidental death & dismemberment (AD&D) coverage is offered at your school district:
- You may select an amount of optional accidental death & dismemberment (AD&D) insurance in multiples of $10,000 up to a maximum of $500,000.
- You may select single or family coverage.
- You can apply for optional AD&D insurance anytime after you become eligible to join the PEBT Benefits Program.
- No medical evidence is required at any time.
- Premiums will be paid starting the 1st of the month coincident with or next following the effective date of coverage.
If you want to apply for optional accidental death & dismemberment insurance, the following steps must be taken:
- You must complete the Optional Accidental Death & Dismemberment (AD&D) Application and provide it to the School District Benefits Administrator.
- AIG automatically accepts the application for coverage.
- Premiums are payable on the 1st of the month coincident with or next following the effective date of coverage.
- The School District Benefits Administrator enters the requested amount of optional accidental death & dismemberment (AD&D) into the PEBT administration system.
- The School District Benefits Administrator files the original Application in the Member’s personnel file.
Notes:
You are responsible to ensure the Application(s) are completed and signed.
Beneficiary for Optional AD&D insurance for your family is automatically the employee in the case of death of an eligible dependent.
Basic life, basic accidental death & dismemberment (if applicable for your district/union local), and disability benefits are often governed by a member’s earnings.
Earnings are defined as:
- For LTD: member’s basic rate of pay, including premiums/allowances paid for regular duties performed during a regular work year and vacation pay, but excluding overtime.
- For life, AD&D (if applicable) and STD (if applicable): Based on your district’s policy and/or Collective Agreement. Please contact the School District Benefits Administrator for more information.
What happens when my salary increases my life insurance in excess of the non-evidence maximum (NEM)?
If your life insurance benefit includes a non-evidence maximum that is less than the overall maximum, as outlined in the My Benefits section of this website, you must provide evidence of good health and be approved for any eligible coverage over the non-evidence maximum.
To do so, you must complete the Evidence of Insurability Form and submit to PBC.
- PBC may require further medical information to make a decision on your application.
- Within five business days of receiving your application a letter will be sent to you if further medical information is required. Instructions about how to provide this medical information is outlined in the letter. PBC may also contact you by phone if necessary. If no further medical information is required, a decision will be made based on the information provided in the original application.
- If approved, a letter will be sent to the School District Benefits Administrator. The school district is responsible for notifying the applicant of the approval. Premium will be charged beginning on the 1st of the month following the approval date.
- If declined, you will receive a letter directly from PBC explaining their decision. The school district will be sent a letter advising that the application has been declined; however, reasons for the declination will not be disclosed.
- If you do not provide the requested medical information within three weeks from the requested date, PBC will send a follow-up letter. This letter will state that if the required medical information is not provided by the deadline date shown in the letter, PBC will be unable to review your application, assume you are no longer interested in applying for coverage over the non-evidence maximum and will close your file.
- If you have submitted an application to PBC and would like to know the status of your application, you may call PBC directly.
- All medical information indicated on the application will be maintained by PBC to maintain your right to confidentiality of information.
- The School District Benefits Administrator files the approval letter in the employee’s personnel file.
General information about your eligibility for benefits is contained in your Collective Agreement and the My Benefits section of this website.
Contact the School District Benefits Administrator to discuss if there are any changes to your eligibility for benefits.
PEBT Benefits may be continued during a leave of absence. Your School District Benefits Administrator will provide you with details about which benefits can be continued and for how long.
If you decide to take a leave of absence of more than 31 days, the following steps must be taken:
- You must complete the Notice of Leave Form for an upcoming leave of absence of more than 31 days, indicating the type of leave you are taking (i.e. Maternity Leave, Parental Leave or other paid or unpaid leave). Please note that if your leave from work is due to sickness or disability, this form is not required, but you should refer to the Disability FAQ section for information about benefits while you are disabled.
- The School District Benefits Administrator sends the completed Notice of Leave Form to Pacific Blue Cross (PBC) and files it in the member’s personnel file. Please ensure the form is fully completed, including ID and group number.
- If you are waiving benefit coverage while on a leave of absence you must also complete and sign a Waiver of Coverage Form and return to your School District Benefits Administrator.
- The School District Benefits Administrator will file the Notice of Leave Form and Waiver of Coverage Form (if applicable) in the employee’s personnel file.
The following information outlines the continuation of the PEBT Benefits Program coverage policies. For more details, refer to your Collective Agreement and/or contact your School District Benefits Administrator.
DISABILITY BENEFITS DURING A LEAVE OF ABSENCE
If disability benefits continue while you are on an approved leave of absence and you become disabled during the leave, the elimination period, as outlined in the My Benefits section of this website, will be deemed to commence on the date the member is scheduled to return to Active Employment, provided the member is still disabled and still eligible for LTD benefits.
MATERNITY, PARENTAL (INCLUDING ADOPTION) AND EI COMPASSIONATE CARE LEAVES IN CANADA
Coverage may be continued during a Maternity, Parental or EI Compassionate Care Leave, but not more than the period required under the relevant legislation. Continuation of coverage beyond the legislated time period requires Insurer approval. Please contact your School District Benefits Administrator for more information if you require an extension of coverage past the legislated time period allowed.
The Core LTD Plan will be extended while you are on Maternity Leave or Parental (including Adoption) Leave.
STRIKE OR LOCK-OUTS
Coverage may be continued during strike or lock-out, but not for periods longer than required under the relevant legislation or in school board policy and is subject to Insurer approval. Please contact your School District Benefits Administrator for more information.
LAY-OFF
Coverage may or may not be continued during lay off as described in the district’s Collective Agreement or school board policy and is subject to Insurer approval. Please contact your School District Benefits Administrator for more information.
SEVERANCE
Members offered severance may or may not be eligible for continuation of coverage depending on the Collective Agreement or school district policy and must receive prior approval from the Insurers before coverage extension is communicated to the member. The Insurers will consider each situation on a case-by-case basis.
RETIREMENT
Members who take a leave of absence immediately before retirement may or may not be eligible for continuation of coverage depending on the Collective Agreement or school district policy and must receive prior approval from Insurers before coverage extension is communicated to the member.
SECONDMENTS, ELECTIONS, APPOINTMENTS, LEAVES FOR PUBLIC OFFICE OR UNION LEAVES
Coverage may or may not be continued during secondments, elections, appointments, leaves for public office or union leaves as described in the district’s Collective Agreement or in school board policy. Please contact your School District Benefits Administrator for more information.
UNPAID LEAVE OF ABSENCE
Coverage for certain benefits may or may not be continued during unpaid leaves of absence as described in the district’s Collective Agreement or school board policy. However, LTD cannot be continued for any unpaid leave of absence that exceeds 31 days. Following an unpaid leave of absence of more than 31 days, your LTD coverage will be reinstated only after you return to work, and complete the waiting period of 3 consecutive months of active employment. Please contact your School District Benefits Administrator for more information.
If you terminate employment with the school district it is important that you obtain information regarding the conversion privileges for PEBT benefits.
- You may refer to the My Benefits section of this website for information regarding the conversion privileges for PEBT benefits.
- The School District Benefits Administrator will provide you with a Notice of Conversion Form that will tell you what benefits you are eligible to convert and contact information for each of the insurers if you are interested in conversion to an individual plan for a specific benefit.
- There are time limits for converting any eligible coverage to an individual plan. These are outlined on the Notice of Conversion Form that you will receive from the School District Benefits Administrator. If you do not receive this form, contact your School District Benefits Administrator as soon as possible to ensure the application deadlines are not missed.
- It is your responsibility to contact the benefit providers listed on the Notice of Conversion Form if you are interested in applying for an individual plan. Application is completely optional.
Spouse is defined as the person legally married to the member or a person of the opposite or same sex who has been residing with the member in a common-law relationship for an amount of time as specified in the My Benefits section of this website and who is publicly represented as the member’s spouse.
Employees can enroll only one spouse in the PEBT benefits program:
- A legal spouse
- A common-law spouse
- An estranged spouse (separated)
- An ex-spouse (divorced)*
*Please note that an ex-spouse can only be covered if the divorce papers specifically direct the member to continue coverage for the ex-spouse under the member’s plan with their employer. If the court order directs the member to provide benefits coverage for their spouse, the member will need to make separate arrangements for an individual plan for the ex-spouse.
If you are adding a spouse to the PEBT Benefits Plan, the following steps must be taken:
- You have four months to enroll a new spouse in your extended health and dental plans due to marriage or completing the co-habitation requirement for common law spouses.
- You must complete the PEBT Benefits Change Form and provide the form to the School District Benefits Administrator.
- To add a common-law spouse, the Common Law Spouse Declaration Form must also be completed and provided to the School District Benefits Administrator.
- You can only enroll one spouse in your benefits plans.
If you are separated but not yet divorced from your spouse, coverage can continue for your spouse. Only one spouse can be enrolled in the PEBT Benefits Program at one time.
Coverage may not be continued for an ex-spouse without a court order stating the member must continue coverage under the employer-sponsored plan. For all other circumstances, the ex-spouse is no longer eligible for coverage.
If you and your common-law spouse stop living together, the common-law relationship is deemed to have ended, and the spouse is no longer eligible for coverage under the PEBT Benefits Program.
If your spouse is no longer eligible for coverage, you must:
- Complete and sign a PEBT Benefits Change Form and provide that form to the School District Benefits Administrator.
You may change your eligible spouse to a common-law or a new legally married spouse on the date the new spouse is eligible for coverage. You are required to enroll your new spouse for coverage within 4 months of their eligibility date; otherwise, late applicant rules will apply.
If you have a new child through birth, legal guardianship or legal adoption the following steps must be taken:
- You must make the necessary update on the PEBT Benefits Change Form and provide this form to the School District Benefits Administrator.
- You must make the change within four months for extended health and dental, or the dependent child may be treated as a late applicant.
- The effective date of coverage will be the date of birth of the child or the date the adoption/legal guardianship takes effect. The coverage effective date will be delayed if the dependent child (except for a newborn child) is confined to a hospital or institution. In this circumstance, the coverage effective date will be the date the dependent child ceases to be confined to a hospital or institution.
If you gain a new child through legal or common-law marriage, the child must live with you or your spouse to be an eligible dependent child.
The following steps must be taken to enroll the child in your benefits plans:
- You must make the necessary changes on the PEBT Benefits Change Form and provide this form to the School District Benefits Administrator.
- You must submit the changes to the School District Benefits Administrator within four months for extended health and dental, or the dependent child may be treated as a late applicant.
You must complete the PEBT Benefits Change Form terminating coverage for a child that no longer qualifies as a dependent child and provide this form to the School District Benefits Administrator.
If your child is still financially dependent on you and is either a student and/or disabled, refer to the What happens when my child becomes over age based on the definition of dependent child section to determine if coverage can be continued for your child.
If you lose a spouse or dependent child, the following steps must be taken:
- You must complete the PEBT Benefits Change Form terminating coverage for your spouse or dependent child and provide this form to the School District Benefits Administrator.
- If you are making an optional life or optional accidental death claim, the School District Benefits Administrator will provide you with the appropriate claims forms.
- Termination of coverage will be on the effective date of the change.
If your spouse loses their own benefits plan and wants to be covered by the PEBT Benefits Plan, the following steps must be taken:
- You must complete the PEBT Benefits Change Form within 31 days of spouse’s benefits plan terminating and provide it to the School District Benefits Administrator.
- Coverage under the PEBT Benefits Program will be effective the day the spouse’s benefit plan is terminated.
- If the change is made more than 31 days after the effective date, you and any eligible dependents will be treated as a late applicant.
If your spouse gains their own benefits plan, the following steps must be taken:
- If you wish to change your PEBT Benefits Program coverage, you must complete the PEBT Benefits Change Form.
- If you wish to waive extended health and/or dental coverage under the PEBT Benefits Program and join your spouse’s plan, complete the Waiver of Coverage Form. Refer to the What happens when I want to waive coverage for myself and/or my dependents section for more details.
It is likely the School District Benefits Administrator will be advised in the event of your death by the Executor or Beneficiary of your estate.
In the event of your death, the following actions will be taken by the School District Benefits Administrator, provided they are aware of your death:
- The School District Benefits Administrator will send a letter to the Beneficiary requesting the following information, provided the location of the Beneficiary is known:
- Completed PBC Life Claim Form which will be provided by the School District Benefits Administrator.
- Proof of Death – Government-issued Certificate of Death OR completed Attending Physician’s Statement. Please note that the document submitted must be the original. Originals will be sent back upon request.
- Although not stated on the PBC Claim Form, PBC will require a copy of the premium statement page of the month the member died. This is used as confirmation of benefits eligibility by PBC. Please include this when submitting the claim to avoid delays with claim payment.
The School District Benefits Administrator will provide the provider with the original enrollment card and any subsequent beneficiary change forms.
If the location of the beneficiary is not known immediately, the School District Benefits Administrator will likely receive notice of your estate from the Executor.
The School District Benefits Administrator or the beneficiary is required to provide PBC with written notice of claim not later than 30 days from the date of death and, within 90 days from the date of death, provide PBC with the documents listed above if reasonably possible given the circumstances of the loss. If the above documents cannot be provided within 90 days, the School District Benefits Administrator should contact PBC to request an extension of this deadline.
The School District Benefits Administrator sets up survivor benefits (if applicable). See the Summary of Benefits section of the My Benefits section of this website for details.
When making an Accidental Death or Dismemberment Claim, the School District Benefits Administrator should communicate the nature of the claim to AIG Insurance Company of Canada. All reported claims can be communicated via either their toll-free number 1-877-317-8060, or their central email address at ahclaimscan@aig.com.
The following is an outline of the standard reporting requirements in order to open a claim:
- Policy Number, division if applicable
- Member Name
- Last beneficiary designation on file
- Date of Incident
- Amount of Principal Sum
- Details of incident
- Type of claim being advanced
- Claimant’s mailing address
Accidental Death Claim forms are available under the Forms section of this website. Due to the varying nature of dismemberment claims, all other claim form types will be provided by AIG upon request.
For disability benefits please refer to the “Disability” section of this FAQ.
If you are eligible for basic life insurance and are diagnosed with a terminal illness (death expected within 12 months) you may be eligible to receive up to 50% of your insured benefit amount to a maximum of $50,000. Application for the Living Benefit is voluntary and subject to insurer approval.
If approved, the benefit amount paid to your beneficiary and any amount which may be converted to an individual policy will be reduced by the amount payable to you under the Living Benefit. To apply for the Living Benefit Payment, please ask your School District Benefits Administrator to assist you with completing the PBC Living Benefit Checklist and PBC Living Benefit Claim Form and have your physician complete the PBC Living Benefit Attending Physician’s Statement.
Please send the completed forms to the following address:
Pacific Blue Cross
Disability and Life Claims
PO Box 7000
Vancouver, BC V6B 4E1
SICK LEAVE
Your district may provide a sick leave plan for members unable to work due to illness or injury for some or all of the period before eligibility for Long Term Disability benefits. Please refer to your Collective Agreement or contact your School District Benefits Administrator for more information.
SHORT TERM DISABILITY
While short term disability (STD) is not a benefit offered through the PEBT, some districts have chosen to transfer this benefit to Desjardins to keep administration consistent among benefits for unionized support staff. This also ensures better coordination between short and long term disability plans. Refer to the My Benefits section of this website to determine if you have STD coverage through the PEBT Benefits Program.
If this coverage is available to you, to apply for short term disability benefits, please complete the Short Term Disability Claim Form available from your School District Benefits Administrator. The School District Benefits Administrator will complete the Employer’s Statement, and you will then complete the Employee’s Statement and forward it to the provider. If you have not already completed the Attending Physician’s Statement for the Joint Early Intervention Service (JEIS), then you must also have this completed by your physician and include it with your application to the provider.
Please be aware that written proof of a claim must be submitted to the provider within 60 days of the disability commencement date. Furthermore, a claim should be submitted before this date even if you may be receiving disability payment under another plan, such as WorkSafeBC benefits. Subsequent written proof satisfactory to the provider of continued disability must be submitted to the provider at their request.
LONG TERM DISABILITY
For a description of the PEBT Long Term Disability Program click here.
Application for long term disability benefits is coordinated through the Joint Early Intervention Service (JEIS). Your Health Care Management Specialist (HCMS) from Desjardins will advise you and the School District Benefits Administrator of the information required. If you are away from work due to illness or injury and have not been contacted by an HCMS within six working days of your first day of absence, please contact your School District Benefits Administrator as soon as possible.
WAIVER OF PREMIUM
Members approved for Core LTD benefits automatically receive a waiver of premium for the following benefits (where applicable):
- Basic life insurance
- Dependent life Insurance
- Optional life insurance
- PEBT Other LTD plan
- Basic accidental death & dismemberment insurance
- Optional accidental death & dismemberment insurance
This means that while you have an open Core LTD claim with Desjardins, the coverage for the above-noted benefits remains in place without the payment of premium until you are no longer disabled, fail to provide proof of continued disability, you retire, or you attain age 65 or 35 years of pensionable service under the Municipal Pension Plan or any other registered pension plan arising out of employment with an employer and a minimum age of 55, whichever is earlier.
If you are disabled but not eligible for LTD benefits, waiver of premium for basic life, dependent life, optional life, optional spouse life, and optional child life is not automatic. The following steps must be taken:
- The School District Benefits Administrator completes the Employer Statement of the Waiver of Premium Claim Form and provides it to the employee to complete the Employee and Physician Statements and send it to Desjardins.
- Desjardins must receive notification for these forms within 90 days following the end of the 6-month elimination period.
- Applications will be adjudicated based on the same definition of disability as the Core LTD.
- A decision letter will be sent to the School District Benefits Administrator.
- The effective date of the waiver of premium will be the 1st of the month coincident with or next following the end of the six-month elimination period.
- Waivers of premium for employees disabled before the transfer to the PEBT Benefits Program are the responsibility of the previous life insurers.
Note: An employee who is disabled and receiving a WorkSafeBC benefit should still apply for the life insurance waiver of premium within the notification period (90 days following the end of the elimination period).
ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) INSURANCE, INCLUDING BASIC AD&D AND OPTIONAL AD&D
Accidental death & dismemberment waiver(s) of premium are tied to the approval of the life insurance waiver(s) of premium. As the basic and optional life benefits are automatically approved when Core LTD benefits are approved, the basic and optional AD&D premium is also automatically waived when Core LTD is approved. No separate application is required to apply for waiver of premium for these benefits.
REPORTING LONG TERM DISABILITY TO THE PENSION CORPORATION
Unionized support staff employees participating in the Municipal Pension Plan (MPP) that are approved for LTD continue to accrue pensionable and contributory service without employee or employer contributions while they are receiving benefits.
The School District Benefits Administrator will submit a Start (LTD) Form to the MPP to advise that the employee has been approved for LTD benefits. When the employee’s LTD claim has ended, an MPP LTD Stop Form is completed and submitted to MPP by the School District Benefits Administrator. Start and Stop Forms can be obtained by accessing the Employer’s Instruction Manual (Sections 6 and 7) on the MPP website. This website and instruction manual will also provide more detailed information on how to report earnings to MPP while an employee is receiving LTD benefits.
JOINT EARLY INTERVENTION SERVICES (JEIS) PROGRAM
All disabled members must participate in the Joint Early Intervention Services (JEIS) Program.
The mission of the JEIS program is to complement the LTD benefit plan by providing a proactive and timely service to members that facilitates the employee’s return to work in a caring, safe and timely manner.
The JEIS is fully supported by unions, school districts and the PEBT to assist members in their return to work.
For more information regarding the JEIS program, please click here.
CORE LTD ENHANCEMENT – EXTENDED HEALTH AND DENTAL COVERAGE CONTINUATION
Effective July 1, 2021, all active Core LTD claimants who have been receiving LTD benefits for less than two years will be eligible to have their portion of the premium contributions for their extended health and dental coverage paid for by the Core LTD program. This coverage continues until the member is no longer eligible for LTD benefits or has received LTD benefits for two years.
Members who decided to reduce or terminate extended health or dental coverage after they became disabled may be eligible to reinstate coverage as of the start date of LTD benefits, with the Core LTD program covering the cost of these benefits.
As you approach the two-year milestone of your LTD claim, you will receive a letter confirming the end date of this Core LTD enhancement and a reminder to contact your School District Benefits Administrator at your earliest convenience to discuss your options for continuing extended health and/or dental coverage beyond this date. The Collective Agreement determines the option to continue coverage. If you do not contact your School District Benefits Administrator, coverage may be terminated, and medical evidence of good health may be required should you wish to re-enroll for extended health and/or dental coverage in the future.
You can refer to My Benefits and the Collective Agreement for information on any benefits that may change once you reach age 65 (or at a later age depending on your district). If you have any questions regarding coverage after age 65, you should contact your School District Benefits Administrator.
If you are retiring at age 65, you may be interested in the conversion privileges available for the PEBT Benefits Program. To obtain information regarding the conversion privileges:
- You may refer to the My Benefits section of this website for conversion information applicable for each benefit.
- The School District Benefits Administrator will provide you with a Notice of Conversion Form that will tell you what benefits you are eligible to convert; it also provides contact information for each of the benefit providers if you are interested in conversion to an individual plan for a specific benefit.
- You are eligible for the conversion privilege if application is received by the benefit provider within 31 days for life and within 60 days for AD&D, extended health, and dental care following your termination date.
CONVERSION PRIVILEGES
BASIC LIFE, OPTIONAL LIFE, AND OPTIONAL SPOUSE LIFE CONVERSION PRIVILEGE
You can continue basic life insurance, optional life insurance, and/or optional spouse life insurance (if applicable) as an individual policy(ies) following termination or retirement from the district benefit plan on or before your 65th birthday. If you wish to do so, the following steps must be taken:
- Contact PBC using the contact information provided on the Notification of Conversion Form that you should receive from your School District Benefits Administrator.
- Conversion is optional.
- Conversion is only available to those employees following termination or retirement on or before their 65th birthday.
- The conversion can be done without medical evidence of good health provided the request is made within 31 days of the date of termination of the PEBT insurance.
- Some limits apply (An example of a limitation is the amount converted cannot exceed $200,000).
- Premiums will likely be higher than the premium under the PEBT Benefits Program.
BASIC AD&D, OPTIONAL AD&D CONVERSION PRIVILEGE
You can continue basic AD&D insurance and optional AD&D insurance (if applicable) as an individual policy(ies) following termination or retirement from the district benefit plan on or before your 69th birthday. If you wish to do so, the following steps must be taken:
- Contact AIG using the contact information provided on the Notification of Conversion Form that you should receive from your School District Benefits Administrator.
- The conversion can be done without medical evidence of good health provided the request is made within 60 days of the date of termination of the PEBT insurance.
- Some limits apply (An example of a limitation is the amount converted cannot exceed $200,000).
- Premiums will likely be higher than the premium under the PEBT Benefits Program.
EXTENDED HEALTH AND DENTAL CONVERSION PRIVILEGE
When your coverage under the PEBT extended health or dental terminates, you can convert to a Pacific Blue Cross (PBC) Personal Health and/or Dental plan. If your coverage terminates, the following steps must be taken.
- You must complete the Extended Health and/or Dental Conversion Form and send it directly to PBC.
- PBC must receive the first payment and application within 60 days of termination of PEBT benefits to waive the General Pre-existing Conditions clause in the Personal Health Plan.
- In some instances, waiting periods which apply to certain benefits (i.e., vision and dental) will also be waived if the member had coverage for these benefits under the PEBT Benefits Program.
- The individual policies do not have coverage equivalent to that of the PEBT Benefits Program.
Before your retirement, it’s important to advise the School District Benefits Administrator of your retirement date in writing. If you have any questions regarding coverage after retirement, contact the School District Benefits Administrator.
If you are retiring, you may be interested in the conversion privileges available for the PEBT Benefits Program. To obtain information regarding the conversion privileges:
- You may refer to the My Benefits section of this website for conversion information applicable to each benefit.
- The School District Benefits Administrator will provide you with a Notice of Conversion Form that will tell you what benefits you are eligible to convert; it also provides contact information for each of the benefit providers if you are interested in conversion to an individual plan for a specific benefit.
- You are eligible for the conversion privilege if the application is received by the benefit provider within 31 days for life insurance and within 60 days for AD&D, extended health, and dental care following your termination date.
Conversion Privileges
Basic Life, Optional Life, and Optional Spouse Life Conversion Privilege
You can continue basic life insurance, optional life insurance, and/or optional spouse life insurance (if applicable) as an individual policy(ies) following termination or retirement from the district benefit plan on or before your 65th birthday. If you wish to do so, the following steps must be taken:
- Contact PBC using the contact information provided on the Notification of Conversion Form that you should receive from your School District Benefits Administrator.
- Conversion is optional.
- Conversion is only available to those employees following termination or retirement on or before their 65th birthday.
- The conversion can be done without medical evidence of good health provided the request is made within 31 days of the date of termination of the PEBT insurance.
- Some limits apply (An example of a limitation is the amount converted cannot exceed $200,000).
- Premiums will likely be higher than the premium under the PEBT Benefits Program.
Basic AD&D, Optional AD&D Conversion Privilege
You can continue basic AD&D insurance and optional AD&D insurance (if applicable) as an individual policy(ies) following termination or retirement from the district benefit plan on or before your 69th birthday. If you wish to do so, the following steps must be taken:
- Contact AIG using the contact information provided on the Notification of Conversion Form that you should receive from your School District Benefits Administrator.
- The conversion can be done without medical evidence of good health provided the request is made within 60 days of the date of termination of the PEBT insurance.
- Some limits apply (An example of a limitation is the amount converted cannot exceed $200,000).
- Premiums will likely be higher than the premium under the PEBT Benefits Program.
Extended Health and Dental Conversion Privilege
When your coverage under the PEBT extended health or dental terminates, you are entitled to convert to a Pacific Blue Cross (PBC) Personal Health and/or Dental plan. If your coverage terminates, the following steps must be taken:
- You must complete the Extended Health and/or Dental Conversion Form and send it directly to PBC.
- PBC must receive the first payment and application within 60 days of termination of PEBT benefits to waive the General Pre-existing Conditions clause in the Personal Health Plan.
- In some instances, waiting periods which apply to certain benefits (i.e., vision and dental) will also be waived if the member had coverage for these benefits under the PEBT Benefits Program.
- The individual policies do not have coverage equivalent to that of the PEBT Benefits Program.
If you are a member covered for extended health under the PEBT Benefits Program, you are eligible for coverage while travelling outside your home province. Please refer to the extended health section under My Benefits for coverage details.
Print off the medi-assist brochure if you will be travelling outside your home province. Call the relevant number for immediate assistance and guidance if a medical issue arises.
Please note the following expenses are not covered when incurred out-of-province:
- Expenses incurred due to elective treatment and diagnostic procedures, or complications related to such treatment.
- Expenses incurred due to therapeutic abortion, childbirth, or complications of pregnancy occurring within 2 months of the expected delivery date.
- Expenses for continuous or routine medical care normally covered by the government plan in your province of residence.
While travelling outside your province of residence, you are eligible for reimbursement for the following expenses in an emergency:
- Local ambulance services when immediate transportation is required to the nearest hospital equipped to provide the treatment essential to the patient.
- The hospital room charges and charges for services and supplies when confined as a patient or treated in a hospital for a maximum of 90 days.
If reasonably possible, the provider should be notified within five days of the patient’s admission to hospital. When the patient’s condition has stabilized, the provider has the right, with the approval of the attending physician, to move the patient by licensed ambulance service to the hospital nearest the patient’s home, which is equipped and has space available to provide further medical treatment. Where transportation would endanger the patient’s health, the 90-day limit may be extended with the provider’s express written consent.
- Services of a physician and laboratory and x-ray services.
- Prescription drugs in sufficient quantity to alleviate an acute medical condition
- Other emergency services and/or supplies if the provider would have covered them inside your province/territory of residence.
Emergency travel assistance is also available through medi-assist, a plan which will coordinate the following services to:
- Locate the nearest appropriate medical care
- Obtain consultative and advisory services and supervision of medical care by qualified licensed physicians
- Investigate, arrange and coordinate medical evacuations and related transportation needs
- Arrange and coordinate the repatriation of remains
- Replace lost or stolen passports, locate qualified legal assistance and local interpreters, and other incidental aid you and/or your dependent may require when in distress. Your Pacific Blue Cross worldwide emergency medi-assist card provides instant information on how to contact medi-assist. Call the nearest medi-assist emergency access number listed on your card. Call collect or contact the local telephone operator for help placing your call to medi-assist if necessary. Have your Pacific Blue Cross Policy, ID and provincial health care numbers ready for personal identification.
While travelling outside your province of residence, you are eligible for reimbursement for non-emergency expenses subject to the following conditions:
- Non-emergency expenses are reimbursed as if these expenses were incurred in your province of residence, subject to the deductible, in-province reimbursement percentage, and maximums. See details under the extended health benefit in the My Benefits section of this website to determine what expenses are eligible in your province of residence.
- Expenses payable or provided under a government plan are not eligible for reimbursement.
The PBC Emergency Out-of-Province Claim Form should be used to claim reimbursement for out-of-province expenses. You should note that the claiming deadline for MSP services is 90 days from the service date.
An overview of your out-of-province plan can be found in the extended health benefit section under the My Benefits section of this website.
This section of the PEBT website is intended to help you understand what happens to your benefits in the case of different work and life circumstances. It’s important to note that some of these situations may require immediate action by you or by the School District Benefits Administrator. Once you select a category, you will be provided with several possible ‘What happens when’ situation links. These links will lead you to detailed information you need to know about your benefits and what action(s) should be taken.
If your situation is not listed and you require additional information, contact your School District Benefits Administrator.
