health
benefits

Health Benefit FAQs

How can I tell if I'm covered by the Plan?
To ensure that you are indeed covered at the time you incurred or will incur a claim, and to ensure that your employer has submitted the appropriate hours to the Plan on your behalf, you will need to contact the Plan Administrator. Individual Member records are not available on this web site. The Group Insurance Plan Booklet describes how you qualify and maintain coverage. (Please refer to the Eligibility sections, under General Information in the Group Insurance Plan Booklet.)

What if I become unemployed?
The Plan includes a six-month self-pay provision* for a Member in good standing who was covered under the Machinists, Fitters and Helpers Industrial Union

When does my coverage end?
Coverage is always provided on a whole-month basis only and will be terminated when:

1. Your Hour Bank falls below 150 hours and you fail to make a payment by the date specified on the self-payment notice (Members ONLY) to bring your Hour Bank up to the required hours; or,
2. You have already make 6 consecutive self-payments to the Fund.

Who is eligible as a dependent?
Eligible Dependents are:

Spouse:

• The person to whom the Employee is married or a person with whom they reside and who is represented as husband or wife. Only one person may qualify at any one time.

• Unmarried children under 21 years of age;
• Unmarried children age 21 or over are also eligible provided they depend wholly upon the Employee for support and maintenance and are full-time students in an educational institution, in which case the maximum age will be 25.
• Stepchildren, foster children and legally adopted children may be included the same as the Employee's own children, provided they depend upon the Employee for support and maintenance.
• A child who is physically or mentally incapable of self-support upon attaining age 21 may be continued under the Extended Health and Dental benefits while remaining incapacitated and unmarried, subject to the Employee's own coverage continuing in effect.

What is my Vision Care benefit?
A benefit of $600 per Employee/spouse is available for reimbursement of any one pair of eyeglasses in any 24-consecutive month period, frames, lenses, and dispensing fees. This limit also applies to contact lenses purchased in lieu of eyeglasses unless the contact lenses are the only means available to restore the visual acuity of the better eye to at least 20/70 or are purchased following cataract surgery. $65 eye exam every 24 months.

Please note that charges incurred in connection with sunglasses (whether or not prescription) or safety glasses are not a covered expense. However, prescription safety glasses are an eligible expense.

Please refer to the Vision Care section, under Extended Health Benefits in the Group Insurance Plan Booklet. Please be sure to read the entire section, including the Benefit Exclusions listed at the end of the section.

When did I last get glasses - am I eligible for another pair?
Individual Member records are not available on this web site. Please contact the Plan Administrator.

What is co-ordination of benefits?
If a Member or any eligible Dependents are entitled to receive similar benefits simultaneously under the Health Benefit Plan or any other group insurance plan (including Provincial Plans), to prevent over payment, benefits payable under this Plan would be co-ordinated with the other Plan.

For example: A Member's wife is covered under her employer's plan with family coverage. The Member, his spouse and their three children are all covered under both Plans. To determine which Plan would be primarily responsible for the dependent children: Between the Member and the spouse, whomever's birthday falls first in the calendar year, their plan is responsible for the initial reimbursement of benefits for the dependent children, then, any amounts that are not paid by that Plan are submitted to the other parent's plan.

In the event that the Member's birthday is in April and the spouse's birthday is in January. The spouse's plan would be primarily responsible for the spouse's claims and the claims of the children. Any amounts not paid by the spouse's plan can be submitted to the Member's Plan for reimbursement. Any amounts for the Member that are not paid by the Member's Plan, can be submitted to the spouse's plan for reimbursement.

Please see the Coordination of Benefits section of the Group Insurance Plan Booklet.