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.

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.