Trio Comprehensive Group Health Insurance Plan

The TRIO Comprehensive Group Health Insurance Plan has been designed so that coverage may be tailored to meet the requirements of both large and small municipalities.

Flexibility is the key word that describes the TRIO Comprehensive Group Health Insurance Plan. All told, there are 648 possible combinations of coverage available through the plan.

A "Core" plan has been established which sets a minimum standard of coverage for all municipalities. The "Core" benefits are mandatory to all municipalities participating in this Comprehensive Plan. "Plan Enhancements" are available to the municipality on an optional basis and consist of one or two additional levels of coverage for each benefit

The Core coverages are: (shown in bold on the following chart)

  • Group Life and Basic AD&D Insurance
  • Dependant Life Insurance
  • Long Term Disability
  • Supplementary Health Insurance
  • Employee Assistance Program

These optional coverages are also available:

  • Weekly Indemnity
  • Dental care
  • Optional additional life insurance
  • Voluntary AD&D Insurance

The following is an outline of the TRIO Comprehensive group insurance program which is available to all municipalities within the province.

Eligibility

  • All full-time, permanent employees; seasonal employees, if hired for a period of more than three months; and part-time employees, if working in excess of 15 hours per week on a permanent basis, are required to participate in the group insurance program on the first day following three months of continuous employment;

  • Mayors and Councillors are eligible to be covered for their term in office if the municipality elects coverage for this class; and

  • Retirees (who are in receipt of a pension benefit from the municipality, who are least 55 years of age and who have a minimum of 20 years service with the town) may continue $20,000 Life and AD&D insurance and all supplementary health and dental benefits to age 65.

Note: Seasonal employees, part-time employees, and Mayors and Councillors are not eligible to be covered for weekly indemnity or long term disability insurance benefits.

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Group Life Insurance

Schedule of Insurance

Core Benefit One times annual earnings rounded to the next higher $1,000 if not  already a multiple thereof. (Minimum $10,000)
Option I Two times annual earnings rounded to the next higher $1,000 if not already a multiple thereof. (Minimum $20,000)
Option II Three times annual earnings rounded to the next higher $1,000 if not already a multiple thereof. (Minimum $30,000)
Maximum $1,000,000; non-evidence maximum $600,000
Mayors and Councillors Flat $50,000
Early Retirees Flat $20,000 (to age 65)

Note: Coverage for Mayors and Councillors continues without reduction for the period they are elected to office regardless of age.

Basic Accidental Death And Dismemberment Insurance

24 hour occupational and non-occupational coverage is provided based on the same schedule as the group life insurance plan. Benefits are provided for covered losses due to accidental injuries occurring within 365 days from the date of the accident causing such loss.

Dependent Life Insurance

Schedule of Insurance

If Core Life is Selected:
Spouse $5,000
Each Dependent Child $2,500
If Group Life Option I or II is Selected:
Spouse $10,000
Each Dependent Child $5,000

Weekly Indemnity Insurance (Optional)

Schedule of Insurance
66 2/3% of weekly earnings to a maximum benefit of $1,250 per week (taxable).

Waiting Period
Benefits commence on the first day of absence due to an accident or hospitalization, and on the eighth day due to illness.

Benefit Period
Benefits are payable for a maximum of seventeen weeks.

Long Term Disability Insurance

Schedule of Insurance

Core 55% of regular monthly earnings to a maximum of $10,000 (non-taxable*). Amounts over $6,000 are subject to medical evidence of insurability.
Option I 60% of regular earnings to a maximum of $10,000 (taxable). Amounts over $6,000 are subject to medical evidence of insurability.

* In order to be considered a non-taxable benefit, the LTD premium must be entirely employee paid.

Payment Period
Benefits commence on the later of expiration of weekly indemnity/sick leave benefits or 120 days of continuous disability and are payable to age 65 or prior recovery.

Definition of Total Disability
"Disability" and "disabled" mean that because of injury or sickness:

  1. the claimant cannot perform each of the material duties of his or her regular occupation for the first 12 months of benefit payment; and

  2. thereafter, the claimant cannot perform each of the material duties of any gainful occupation for which he or she is reasonably fitted by training, education, or experience.

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Supplementary Health Insurance

Schedule of Insurance

Option I 100% Prescription Drugs (Direct Pay Card)
100% All Other Eligible Expenses*
(Note: Option 1 is closed to new entrant employees
Option II 80% Prescription Drugs
(Direct Pay - Card - 20% Co-Pay)
100% All Other Eligible Expenses*
Option III Prescription Drugs (Direct Pay Card – Dispensing Fee Co-Pay)
100% All Other Eligible Expenses*
*Eligible Expenses *Eligible Expenses include semi-private hospital room, ambulance, non-emergency transportation benefit, private duty nursing, paramedical practitioners, hearing aids, vision care benefit, etc. See details below.

Hospital Expense

  • Charges up to the semi-private room level.

Prescription Drugs

  • Drugs and medicines requiring a physician's prescription and dispensed by a licensed pharmacist, including oral contraceptives, but excluding nicotine replacement products and treatments for erectile dysfunction (impotence), and;

  • insulin for diabetics.

Other Expenses include but are not limited to:

  • doctors' services for treatment provided outside the province of residence;

  • ambulance transportation to the nearest centre where adequate treatment is available (including licensed air ambulance);

  • out-of-hospital services of a Registered Nurse, licensed practical nurse, or Registered Nursing Assistant up to a maximum of $5,000 in any calendar year;

  • services of legally licensed paramedical practitioner, chiropractor, osteopath, chiropodist, naturopath, acupuncturist and massage therapist up to a maximum of $250 for each practitioner in any calendar year;

  • physiotherapy to a maximum of $1,000 per year;

  • out-of-hospital services of a psychologist up to a maximum of $200 in any  calendar year;

  • out-of-hospital services of a speech therapist for correction of speech impairments up to a maximum of $200 in any calendar year;

  • one pair of orthopaedic shoes per calendar year;

  • hearing aids prescribed by a specialist up to a maximum of $300 in any five year period; and

  • insulin syringe, clinitest or similar home chemical testing supplies; and, for an insulin dependent diabetic only, blood glucose electronic monitoring machine and blood letting devices up to a lifetime maximum of $350. Supplies for a blood glucose monitoring machine and blood letting devices will also be covered up to a maximum of $700 in any calendar year.

Transportation Expense
If an employee or a dependent requires necessary medical services, including x-rays and examinations, which are not readily available in their area, and they must travel more than 200 kilometres round trip to receive such services, the plan will pay for transportation expenses to the nearest hospital or specialist.  (Certain conditions apply.)

Survivor Benefits
In the event of the employee's death while insured under this benefit, coverage will be extended to the surviving spouse and children for all supplementary health benefits except vision care for one year from the date of death.

Vision Care Expenses

  • Eyeglass frames and lenses up to but not exceeding $100 in any two year period, (or contact lenses selected in place of lenses and frames); the benefit is  payable once per twelve month period for dependent children under age 19, provided a change in prescription is required;

  • Contact lenses (up to $250 during the entire time the person is insured) if they are prescribed because the regular surface of the lens of the eye (the cornea) is impaired in some way, and if the visual acuity can be improved to at least the 20/40 level with contact lenses but not with ordinary eyeglasses; and

  • One eye examination performed by an optometrist for a child under age 19, once in a 12 month period, and for any other person, once in a 24 month period.

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Dental Care Insurance (Optional)

Schedule of Insurance

Classification/Amount of Insurance

Option I
Co-Insurance: 80% Basic and Preventive Treatment
Deductible: Nil
Annual Maximum: $1,000 per year
Fee Schedule: Current Fee Guide of the Newfoundland Dental Association
Option II
Co-Insurance: 80% Basic and Preventive Treatment
70% Major Restorative Treatment
Deductible: Nil
Annual Maximum: Unlimited for Basic Treatment
$1,500 for Major Restorative Treatment
Fee Schedule: Current Fee Guide for the Newfoundland Dental Association

Covered Expenses include but are not limited to:

Basic and Preventive Treatment

  • oral examinations, prophylaxis, topical application of fluoride solutions and bite-wing x-rays;
  • extractions and alveolectomy;
  • general anaesthesia and diagnostic x-ray and laboratory procedures required in relation to dental surgery;
  • amalgam, silicate, acrylic and composite fillings;
  • space maintainers;
  • relining and rebasing of existing dentures;
  • endodontic treatment; and
  • periodontic treatment.

Major Restorative Treatment (Option II Only)

  • Provision of crowns;
  • Provision of an initial prosthodontic appliance (e.g., fixed bridge restorations, removable partial or complete dentures);
  • Replacement of an existing prosthodontic appliance; and
  • Repairs to existing dentures

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Employee Assistance Program

The Employee Assistance Program (EAP) is available to all employees and their dependents.  An EAP is a voluntary, confidential, short-term counselling advisory and information service that can help employees and eligible family members deal with a variety of personal and work-related issues.  Services are provided by FGI, Canada’s largest EAP firm.

Employees can call a toll free number 24 hours a day, 365 days a year and talk confidentially to a professionally trained counsellor or, if needed, a counsellor can refer the employee to a local resource for additional assistance.  Up to five face to face visits are provided and unlimited telephone access.

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Optional Group Life Insurance

Employees may select from $10,000 to $200,000 of coverage in units of $10,000 for themselves and/or their spouse.  Evidence of good health is required for all amounts.  Premium rates are based on the age of the insured. Contact us for a quotation.

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Voluntary Accidental Death and Dismemberment Insurance

Schedule of Insurance      

Classification
Amount of Insurance
Employee Only Option An amount of coverage from a minimum of $10,000 to a Maximum of $250,000 in units of $10,000.
Family Plan Option The employee's spouse is insured for 50% of the benefit selected by the employee and each dependent child is covered for 15%.  In the absence of a spouse, the dependent children would be insured for 20% of the employee's benefit.  If there are no children, the spouse’s benefit increases to 60%.
Employee Only Option $0.026
Family Plan Option $0.039

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If you need more information, please contact us.