While on Leave

When going on leave, you have four choices when it comes to continuing your benefits:

1. Continue all of your current benefits for the duration of your leave
2. Continue income replacement benefits only (Life Insurance, Accidental Death & Dismemberment, Extended Disability Benefits)
3. Continue Life Insurance and Accidental Death & Dismemberment only
4. Discontinue all benefits for the duration of your leave

Once your leave begins, you aren’t able to change your mind about your benefit coverage, so it’s important to consider your options carefully to be sure you and your dependants have the coverage you need while you’re away from work. Depending on the arrangement you have with your employer, you may be responsible for paying benefit premiums while you’re on leave. Note that if you’re responsible for premium payments and you have Spending Account coverage, you can use it to cover your Extended Health Care (Drugs, Other Medical Services and Supplies and Travel Emergencies), Dental and Vision premium payments.

If you choose not to continue your benefits, you’ll have a break in coverage, which will leave you subject to the pre-existing condition clause if you get sick or are injured up to 26 weeks after your return to work.

Note that if you opted out of core benefits (Dental Care, Vision Care, Drugs, Travel Emergency and Other Medical Services and Supplies) while you were working because you were covered under your spouse and you then lose spousal coverage while you’re on leave, you can request to participate by submitting a change application form to your employer. Coverage will be effective the day after the loss if the change application is received by your employer less than 31 days after the loss. If the form is received by your employer more than 31 days after the loss of coverage, coverage will be effective the first of the month following the date the change application form is received.

If you choose to continue your benefits while on leave, your coverage will continue for a maximum of 30 months or until you go back to work. If your leave will be longer than 30 months, you can apply for an additional 18 months of coverage.

Note that if you’re responsible for the monthly premium payments and you miss a payment, your benefit coverage will be cancelled, and you’ll be responsible for paying additional administration fees. Our standard process is to set up automatic withdrawals to help prevent missed payments and a disruption in your coverage.

While on a leave, your Spending Accounts are still active and available for you to use for the remainder of the current plan year. Most employers will not deposit any new credits into your accounts during your leave; however, if you do receive credits while on leave, your accounts will operate the same as when you are actively at work.

If you are on EDB, there may be an exception that will allow you to continue accessing your Spending Accounts. If in doubt, check with your employer or employee group representative.

During your leave, you can make the following changes to your general health benefits (Drugs, Dental Care, Vision Care, Other Medical Services & Supplies).

1. Change your single coverage to family coverage because of a life event (e.g. marriage, birth of a child, etc.) or after losing spousal or other dependant coverage. If this happens, you need to apply within 31 days of the event or you’ll be considered a late applicant.
2. Change your family coverage to single coverage. To do this, complete the appropriate Change Application, and send it to your employer.
3. Add a dependant to your family coverage. To do this, complete the appropriate Change Application and send it to your employer.

A pre-existing condition is an accidental injury or illness for which you received medical attention, consultation, diagnosis or treatment during the 12 months before your benefits became active. No benefits will be payable if the disability is related to a pre-existing condition occurring within 26 weeks of the start of your coverage or any subsequent start of coverage following a lapse greater than 90 days.

You may have a pre-existing condition if:

• you have an accidental injury or illness for which you saw a doctor or specialist during the 12 months prior to starting your ASEBP coverage or;
• within the last 12 months of your leave you saw a doctor or specialist for an accidental injury or illness during the period you were without coverage, and;
• you become totally disabled (related to that condition) within 26 weeks of the date of enrolment or re-enrolment in EDB.

You may not have a pre-existing condition if:

• after your EDB coverage started, you were first diagnosed or treated for an accidental injury or illness that has resulted in you being unable to work;
• your injury or illness occurred while you were on leave, but you continued your EDB while you were on leave (there was no break in coverage), and;
• your injury or illness occurred within 90 days of a termination, but you returned to work with the same employer (e.g. there was a natural employment break in the school year).

If you have a pre-existing condition, you may not be eligible for EDB. Contact our Early Intervention Services team with the specifics of your situation to help assess if you qualify.

ASEBP’s Extended Disability Benefit (EDB) is a total disability plan. To qualify for EDB, you must fit the following criteria:

• You must be totally disabled and incapable of performing the material and substantial duties of your normal role as a result of a medically supported injury or illness for 90 consecutive days. This 90-days is known as the elimination period.
• Once you’re approved for EDB, for the next 24 months after your 91^st day, you must be incapable of performing the material and substantial duties of your normal role, resulting in a loss of 30% or more of your pre-disability income due to a medically supported injury or illness.
• Following the 24 months after your 91^st day, ASEBP will determine if you are medically capable of earning 60% or more of your pre-disability income in any occupation that you are or may become suited for through education, training or experience.

While you’re on extended disability leave, most of your benefits will continue as usual. The only benefits you may be responsible to pay premiums for are Dental Care and Vision Care benefits. You can choose to decline this coverage while you’re on leave. Check with your employer to see who is responsible for paying premiums.

Note that if you’re responsible for premium payments and you have Spending Account coverage, you can use it to cover your premium payments.

If you return to work after an approved extended disability leave and within six months must stop working again because of the same disabling condition or related causes (or within 30 days after you return to work for a new disabling condition, from unrelated causes), your period of disability will be considered a re-occurrence of the previous disability so long as all of the following conditions are met:

• You must have received benefits for your first period of disability
• You continued to be covered under ASEBP’s EDB coverage after the first period of disability and there was no break in coverage
• The successive period of disability began after you returned to active employment
• You apply within six months of going off work

If all of these conditions are met, your EDB coverage will start immediately after your disability claim is approved at the same level as your last claim for disability. Note that you must provide medical evidence of your disabling condition.

To help improve your prospects for getting back to work, ASEBP may arrange for you to see a health care provider not employed by ASEBP for an assessment and/or treatment. A medical assessment is a neutral, objective, professional opinion that may be used:

• To expedite an appointment, if you are not under the regular care of a specialist or due to long waitlists
• If there has been no progress or improvement in your condition(s)
• If inconsistent medical information is on your file
• To provide additional medical information to confirm diagnosis or for treatment recommendations, etc.

If ASEBP determines that a medical assessment is necessary, you need to participate in the medical assessment in order for you to continue receiving extended disability payments. The results of the assessment will provide input into your support, recovery and/or return-to-work plan and will be shared with your health care provider(s).

ASEBP will regularly request information from you regarding other sources of income. You’re required to update us of all other benefits or income you:

• Receive
• Are eligible to receive
• May become entitled to receive (even if the source isn’t listed below)

This information is requested to ensure accurate extended disability payments and avoid potential overpayments which you will be required to repay. Your extended disability payments may be reduced by the amount of income or benefits you receive from other sources. Examples of these sources include:

• Disability benefits from Canada Pension Plan (CPP), Workers’ Compensation or other disability plan
• Automobile or general liability benefits
• Employer sick leave benefits
• Severance, termination pay or other remuneration received from any employer
• Self-employment income
• Any income from pensions such as CPP, Alberta Teachers’ Retirement Fund or Local Authorities Pension Plan will be deducted if it exceeds 85 per cent of the combination of pre-disability salary and income from the pension plan

If you receive ASEBP benefits because you were injured in an accident where you were not at fault, ASEBP has subrogation rights. This means that you may be required to make a legal claim to recover the amount of these benefits from the other party. Depending on the outcome of your claim, you may be required to reimburse ASEBP for any benefits which have been paid or will be paid to you. ASEBP will pay a reasonable portion of your legal fees in such circumstances. Contact us for more information about this process.