Home > Active Members >
Pay Direct And Assisted Coverage

When you no longer have sufficient credit in your bank for your benefits coverage, you may maintain your coverage if you are a dues- paying member in good standing by contributing at the required rate to obtain assisted coverage or by making direct payments at the full rate of $400 per month, plus tax. You are entitled to a period of assisted coverage if you are disabled (and in receipt of disability or WSIB benefits) or genuinely unemployed and you have advised the Union Dispatch Office and have not refused work. When your bank has fallen to where there are insufficient monies to maintain your coverage you will be sent a warning notice by the Benefits Office.

If you are entitled to assisted coverage, you will have to apply and receive approval on a month-by-month basis. Each payment on assisted coverage must be accompanied by a declaration confirming your employment status. You may be required to appear before the Trustees from time to time to establish continuing eligibility. Assisted coverage is limited to 12 months, after which you must provide evidence of your ongoing genuine unemployment and availability for work. You will be required to provide a recent Canada Revenue Agency tax assessment and such other evidence as the Trustees may require. If you take, or have previously taken, a transfer of your Pension Plan benefits prior to age 55 (age 50 in the Barrie Pension Plan), you may qualify for assisted active coverage in future years only if contributions are subsequently received on your behalf for at least 15,000 hours at the full rate and provided all other requirements are satisfied. Also, you will not qualify for assisted or free retiree coverage if you take or have taken a pension transfer.

If you are entitled to assisted coverage or pay direct and you are not retired, you can choose between the BASIC PLAN and the FULL PLAN. The BASIC PLAN includes the Life Insurance, Accidental Death & Dismemberment and Common Carrier benefits only. The FULL PLAN includes all of the health plan benefit coverages. The contribution required for the BASIC PLAN is lower than that for the FULL PLAN. The assisted coverage rate for the FULL PLAN is currently $170 per month, plus tax. The assisted coverage rate for the BASIC PLAN is currently $23 per month (plus tax).

Once you have selected the BASIC PLAN, you cannot then change that election until you return to contributory employment, accumulate sufficient credit to qualify for further benefits, use them up and again qualify for and receive assisted coverage. If you let your assisted coverage lapse, you must return to contributory employment and requalify for benefits, after which assisted coverage would be available when your credits are used up.

If you are not entitled to assisted coverage, you must pay direct if you want your coverage to continue. The monthly premium you have to pay is $400, plus tax, for the FULL PLAN or $34 (plus tax) for the BASIC PLAN. Pay direct is limited to a 12 month period after which you may only continue to pay direct if there are extenuating circumstances approved by the Local 46 Trustees. You may be required to appear before the Trustees from time to time to establish your continuing eligibility to pay direct. If you stop paying direct and are not working for a contributing employer, your coverage will cease. You will not be allowed to begin direct payments again until you return to contributory employment and requalify for benefits.

Pensioner coverage applies at or after age 65 if you retire and receive a pension (or receive a distribution from the Low Rise Pension Plan).

Make your cheque payable to The Local 46 Health Benefits Plan and mail it to the Benefits Office. Post-dated cheques for future months of coverage cannot be accepted; however, post-dated cheques are accepted from disabled members, retirees and spouses.

Make sure your name and address are on your cheque, and attach the cheque to your completed declaration if paying for assisted coverage.

Your cheque must be mailed to the Benefits Office and postmarked no later than the 20th of the month prior to the month for which you are paying direct. Alternatively, it may be handed in at the Benefits Office as a money order or cheque (NOT cash) no later than the 25th of the month prior to the month for which you are paying direct. You will be advised if no payment has been received.

If you are working under a special agreement or on travel card and your employer is paying less than the full contribution rate to the health benefits plan, you must check with the Benefits Office about how often you need to pay direct to maintain your full benefits coverage continuously and without interruption.

For example, if the full rate is $1.65 per hour, and assume your employer’s special agreement requires him to contribute only $1.20 per hour. If you work 150 hours per month, your bank is credited each month with 150 x $1.20 = $180. To maintain your full coverage continuously you will have to pay direct $25.00 (plus tax) every month, so that every month your bank is credited as follows:

Employer contributions
150 x $1.20 = $180.00
Direct payment of $25.00 (plus tax) $ 25.00
Total $ 205.00

Since your bank will be charged the full month’s draw of $205, this will ensure that the balance in your bank will remain constant. It is important to note that you will not be eligible for assisted coverage if your employer’s special agreement requires him to contribute at a rate lower than the full rate.

A portion of your pay direct payments (i.e. those made towards your extended health and dental premiums) may be tax deductible from your income. Receipts will be issued by the Benefits Office on request. Tax receipts issued with respect to pay directs will be pro- rated so that only that part of the pay direct premium relating to the health and dental coverage will be shown on the receipt. The receipts are only useful if the amount indicated on the receipt together with your allowable medical expenses exceeds 3% of your income for the year. In this case you may claim the excess (over the 3% level) as a deduction. The deduction will likely not apply to many members.

NOTE: The tax payable on Health Benefit Plan contributions is the Ontario Retail Sales Tax which is currently set at 8%.


HEALTH BENEFITS PLAN — IMPORTANT NOTICE

Our Plan is self-insured and, as such, the entire cost of all of the benefits provided to active members and pensioners must ultimately be covered by the contributions paid by, or on behalf, of Plan members and the investment income earned on the Health Benefits Trust Fund assets. The Trustees regularly monitor the ability of the Plan to continue to provide the current level of benefits, at the current level of contributions, for the various categories of members (those working or retired, those on assisted coverage or paying direct) and spouses. Any widespread or long term downturn in our industry could result in sharply lower contributions being received as fewer members would be working. At the same time there could be a significant increase in costs as there would be more members on assisted or pensioner coverage, and from higher utilization of the Plan.


Plan benefits are not guaranteed. While the Trustees hope to continue to provide the current level of Plan benefits to all members (including those not working or retired) and their dependents, the Trustees necessarily reserve the right to amend, suspend or cancel any, or all, of the Plan benefits or coverages, and/or to require higher contribution from members and others covered by the Plan should financial, regulatory, industry or any other conditions warrant such actions.

The Board of Trustees may modify the benefits coverages, and member and pensioner contributions, at any time. If the net assets of the Health Benefits Trust Fund fall below 66 2/3% of the total balance of all member dollar bank accounts, the Board of Trustees will take immediate steps to modify the benefits coverage and require increased contributions from members and/or pensioners and spouses.

Should the net assets of the Health Benefits Plan fall below $250,000, all members and dependents will cease to be eligible for benefits. Eligibility will start again on the first day of the month after the net assets of the Plan rise to over $500,000.

You should note in particular that bank balances are not refundable.