Manulife Group Benefits

YOUR PLAN CHOICE IS LOCKED IN FOR 2 YEARS:

Please note you are only able to change your plan type by one level once every 2 years, so please choose carefully. Information on how to do this will be sent to you every May in odd numbered years.

Levels of increasing coverage are:  L A B C.

The only other opportunity to change your plan is if you experience a Life Event change: marriage, divorce, birth/adoption, loss of spousal coverage, death of dependent, and in these cases you must notify us within 31 days of the event.

 

MANDATORY PARTICIPATION:

Please remember that participation in the plan is mandatory. Plans A, B, & C offer increasing levels of benefits, and the company pays 50% of the premium for each of these plans. Plan L is 100% paid by the Park Paving, so it will be at no cost to you, but note that it only covers you for life insurance.  Please select plan L if you do not wish to pay any premiums and do not want any benefits other than life insurance.

 

Our benefit year runs from June 1 – May 31 each year. Premiums are deducted from your pay at a rate of $2/hour worked and will stop once you have covered your portions of premiums for the year. If you have not paid enough into the plan you will be asked to pay the balance owing prior to your last day worked this season. If you should cease to work at Park Paving Ltd. before the end of the season, your coverage will be terminated on the last day you worked.  At that point, any insurance monies deducted for future months will be reimbursed to you, and any short payment in premiums for months worked will be taken from your final pay.

Some plans allow refusal of certain benefits if the plan member has coverage under their spouse’s plan. If you wish to add coverage at a later date, you may reapply for these benefits at which time satisfactory medical evidence may be required.

I am applying for Extended Health Care for

I am applying for Dental Care for

Dependant Life may be mandatory. Refer to the policy details.

If yes, please provide the following details:

Please indicate type of coverage under other plan:

In cases where the information is not complete, a default value of Secondary will be applied.

By providing your banking information, your claim payments will be deposited directly to your account. Locate your banking information on your personal cheque or bank statement, or contact your branch.

By providing your email address, you will receive an invitation to register for your Plan Member secure site where you can view your electronic claim statements.

I hereby apply for coverage (“Coverage”) under the Group Benefits plan issued to my plan sponsor by Manulife. I understand that certain aspects of such Coverage may extend to my spouse and eligible dependants (collectively, “Dependants”I certify that the information in this form is true and complete to the best of my knowledge. I understand that as the applicant, it is my responsibility to ensure that any further verbal or written statement provided by me, and/or my Dependants, in the future is true and complete to the best of our knowledge. I acknowledge and agree that this Coverage or any portion of this Coverage, and future claims thereunder may be denied or terminated as a result of the provision of false, incomplete, or misleading information. I authorize Manulife to collect, use, maintain and disclose personal information relevant to this application (“Information”) for the purposes of Group Benefits plan administration, audit, assessment, investigation, claim management, underwriting and for determining plan eligibility (“Purposes”I authorize any person or organization with Information, including any medical and health professionals, facilities or providers, professional regulatory bodies, any employer, group plan administrator, insurer, investigative agency, and any administrators of other benefits programs to collect, use, maintain and exchange this information with each other and with Manulife, its reinsurers and/or its service providers, for the Purposes. I am authorized by my Dependants to consent to this Authorization, on their behalf as if they were signing it themselves, and to disclose and receive their Information, for the Purposes. I authorize my plan sponsor to make deductions from my pay for my Group Benefits plan, if applicable. I authorize the use of my Social Insurance Number (“SIN”) for the purposes of identification and administration, if my SIN is used as my plan member certificate number. I agree a photocopy or electronic version of this authorization is valid.

If applicable, I authorize Manulife to deposit all payments (“Payments”) due to me from the above referenced Group Benefits policy (“Policy”), into the bank account (“Account”) that I have identified on this form. I confirm that this direct bank deposit authorization applies to the financial institution herein named by me and any other financial institution I choose to name in the future; and shall remain valid until revoked in writing by me, or my duly authorized representative.

I understand and agree that upon the deposit of any Payment(s) into the Account, Manulife is fully discharged from any further liability with respect to such Payment(sI also understand and agree that Manulife may, at any time and without prior notice, discontinue the direct deposit of Payment(s), as requested herein, and require my personal written endorsement relating to future Payment(sI also hereby acknowledge and agree that any Payment(s) made by Manulife into the Account, to which I am not entitled, either by contract or by law, shall not form part of my property, and shall be immediately refunded to Manulife, either by me or by representatives of my estate.

If applicable, I authorize Manulife to correspond with me through the email address identified on this form regarding my Coverage, for the Purposes. I understand such correspondence may contain Information; and that the Information is being sent in a manner that is not guaranteed as a secured means of communication. I agree that Manulife is not liable for damages which I may incur as a result of interception by a third party of an email transmission sent by Manulife or by me pursuant to this authorization. I agree should the email address identified on this form change that I am responsible for updating the email address maintained by Manulife. I understand that if I do not wish to receive emails from Manulife, I can remove my email address online or by contacting the Customer Service Centre.

I understand that any Information provided to or collected by Manulife in accordance with this authorization, will be kept in a Group Benefits life, health or disability file. Access to my Information will be limited to:

• Manulife employees, representatives, reinsurers, and service providers in the performance of their jobs;
• persons to whom I have granted access; and
• persons authorized by law. I have the right to request access to the personal information in my file, and, where appropriate, to have any inaccurate information corrected.

I acknowledge that more specific details regarding how and why Manulife collects, uses, maintains, and discloses my personal information can be found in Manulife’s Privacy Policy and Privacy Information Package, available at www.manulife.ca/planmember, or from my Plan Sponsor.

All sections of this page should be completed as it will replace any prior designations.

Percentages must total 100% to be valid.

Irrevocability

Note: If beneficiary is shown as irrevocable, his/her consent is required to change it. Include a signed and dated consent with this form. You are responsible for ensuring the validity of your designation.

You may wish to designate a contingent beneficiary(ies) to receive any proceeds under this group policy if all of the primary beneficiary(ies), named above for either coverage, should die before you. In that event, a contingent beneficiary will automatically be entitled to the benefit that would have been payable to the primary beneficiary(ies If you name more than one contingent beneficiary, then the proceeds will be split, evenly, amongst the contingent beneficiaries you choose to name. Should there not be any surviving beneficiaries at the time of your death, the proceeds will be paid to your estate.

as Trustee to receive any amount due to any beneficiary under the age of majority (not applicable in Quebec).

Due to the legal significance of a beneficiary appointment this designation must be signed and dated to be valid.

A copy, fax, scan or image of the beneficiary designation in this form is as valid as the original.

I hereby revoke any previous beneficiary designations in relation to my foregoing coverage(s) and designate the person(s) named above.

At Manulife, we know that confidentiality of personal information is important. Any information you provide to us will be kept in a Group Life and Health Benefits file. Access to your information will be limited to:

• our employees and service representatives in the performance of their jobs
• persons to whom you have granted access; and
• persons authorized by law

You have the right to request access to the personal information in your file and, if necessary, correct any inaccurate information.

I acknowledge that more detailed information concerning how and why Manulife collects, uses and discloses my personal information is available at www.manulife.ca/planmember, or by requesting a copy from my plan sponsor.

Manulife assumes no responsibility for the validity or sufficiency of the content provided by you. The items ‘you’ and ‘yours’ refer to the plan member, the term “Plan Sponsor” refers to the entity that offers the group benefits plan, such as an employer.

What is the purpose of a beneficiary?

If you intend for some or all of your death benefit to go to specific individuals, it is important to make sure that you plan ahead and select those beneficiaries. Having an up-to-date beneficiary designation will make this possible by listing your primary and contingent beneficiaries and intended allocations.

Beneficiary: the person, people or entity who will receive any death benefit from the basic or optional coverage you have selected through your group benefits plan that becomes payable upon your death. Basic and optional beneficiaries may differ.

Types of beneficiary – Primary vs. Contingent

Primary: the person, people or entity you choose to receive the death benefits. If you choose more than one beneficiary, you will need to indicate what percentage of the benefit you would like each person to receive. When multiple primary beneficiaries are named, the total of the percentages allocated to each primary beneficiary must add up to 100%.

Contingent: the person, people or entity you designate to receive the death benefits if all of the primary beneficiaries die before you. If you select more than one contingent beneficiary, the benefit will be split evenly between the contingent beneficiaries.

What happens to the death benefit when. . .

The primary beneficiary dies before you and no contingent beneficiary is named.

The death benefit will be paid to your estate.

The primary beneficiary dies before you, but there is a contingent beneficiary(ies) designated.

The benefit will be paid to the contingent beneficiary(ies

You assign two primary beneficiaries, and one beneficiary dies before you, and you have not updated your beneficiary form information.

The entire death benefit that would have been paid to the deceased beneficiary will be paid to the surviving primary beneficiary.

Irrevocable vs. Revocable

Irrevocable: the beneficiary you choose cannot be changed without the written permission of that individual.

For example, if you choose your spouse or partner to be the designated beneficiary and you end up separating, you will not be able to change the beneficiary designation without a completed release form from them.

In Quebec, naming your spouse (must be a civil union) as a beneficiary automatically means that he/she is an irrevocable beneficiary, unless you specify otherwise or divorce.

Revocable: a revocable beneficiary means that the beneficiary you choose can be changed at any time without the permission of that individual.

For example, if you choose your spouse or partner to be the designated beneficiary and you end up separating, you can then change that beneficiary designation without asking for that person’s permission.

Naming a minor as a beneficiary

If a benefit becomes payable to a minor who is named as a primary or contingent beneficiary, the benefit can only be paid on behalf of the minor to a trustee or guardian for property, otherwise it will be paid into court to be held until the beneficiary has reached the age of majority for your specific province. It is important therefore, if you are choosing a beneficiary who is a minor at the time of the designation to also name a trustee.

If you are a Quebec resident, the parents are considered tutors of their child.

If a minor has been designated as an irrevocable beneficiary, the policy is automatically frozen until the beneficiary has reached the age of majority for your specific province. A parent, guardian or trustee cannot consent to a beneficiary change on behalf of a minor.

Minor: a person named as a beneficiary who is under the age of majority for your specific province.

Trustee: a person appointed by you to hold the minor’s proceeds in trust until the minor reaches the age of majority for your specific province.

Tutor: a tutor acts like a trustee.