Excluded benefits guide glossary

To satisfy this requirement, an employee must:

• Be fully capable of performing their regular duties; and
• Be either:
  • Working at the employer’s place of business or a place where the employer’s business requires them to work
  • Absent due to vacation, weekends, statutory holidays or shift variances

For the purposes of Employee Basic Life Insurance, annual earnings are defined as 12 times your current monthly base rate of pay for your current classification, calculated as bi-weekly salary times 26.0893. Annual earnings are the employee’s basic annual salary paid by the employer, including salary protection, classification adjustments and some temporary market adjustments. Overtime, allowances, bonuses, or any other additions to pay are not included.

The final price after flex credits have been deducted from costs.

An employee who is employed for work that is not of a continuous nature. Refer to your Terms and Conditions of Employment for excluded employees for information on eligibility requirements for benefits.

The bargaining unit consists of those public service employees who are members of one of the following bargaining units:

• British Columbia Government and Service Employees’ Union (BCGEU)
• British Columbia Nurses Union (BCNU)
• King's Printer (UNIFOR)
• Professional Employees Association (PEA)

The person(s)/registered charity named to receive the insurance benefit if the employee dies while insured. If the employee dies without designating a beneficiary, payment will be made to the employee’s estate.

The employee is the beneficiary for Spouse Optional and Child Optional Life Insurance. 

The service provider that adjudicates the claims on behalf of the employer:

• Canada Life is the carrier for extended health and dental
• Canada Life is the carrier for life insurance products

A request to the insurance provider for payment under the benefits plan.

A common-law spouse is a person of the same or opposite sex where the employee has signed a declaration or affidavit that they have been living in a common-law relationship or have been cohabiting for at least 12 months. The period of cohabitation may be less than 12 months where the employee has claimed the common-law spouse’s child/children for taxation purposes.

By enrolling your common-law spouse in your benefits program, you're declaring that person as your common law spouse. A separate form (declaration) is not required. 

Clinical examination and diagnosis of hard and soft tissues, including carious lesions, missing teeth, determination of sulcular depth and location of periodontal pockets, gingival contours, mobility of teeth, recession, interproximal tooth contact relationships, occlusion of teeth, TMJ, pulp vitality tests, where necessary and any other pertinent factors.

A policy that enables members to convert to individual benefits plans (extended health and dental, life insurance) when group coverage ends.

A provision in a group insurance policy describing which insurer pays a claim first when two policies cover the same claim. This provision applies only to extended health and dental plans. Under this provision, the total benefit amount that an individual can claim is 100% of the cost of the eligible expense incurred (meaning, the combined reimbursements across all plans cannot exceed the total cost of the expense).

The amount you must pay each year before the plan starts to reimburse eligible medical expenses.

A spouse or child who meets the eligibility requirements and is covered under your benefits program.

The fee charged by pharmacies to dispense a medication.

Employees who may participate in the Flexible Benefits Program. This includes regular excluded employees, whether full or part-time (unless expressly excluded) and auxiliary excluded employees upon meeting eligibility criteria (for example: completion of 1,827 hours of work in 33 pay periods). See the Terms and Conditions of Employment for additional information on eligibility criteria.

Charges for services and/or supplies that have been specifically included in the Extended Health and Dental contract as a benefit. An expense is incurred on the date the service is provided or the supply is received.

Any payment to a pharmacy or practitioner which represents an amount more than the recognized fee schedules is not included in the definition of an eligible expense. 

A specific event or change that allows you to make changes to your benefits options within 60 days of the event. Eligible life events include events such as a birth or death of a dependant, a change in marital status, or the loss of a spouse’s benefits coverage.

BC Public Service or an employer participating in the public service benefits program.

The whole of one’s possessions (assets and liabilities) left by an individual upon their death.

The documentation of good health to be approved for Employee Optional and Spouse Optional Life Insurance.

This is also called 'evidence of good health.'

The statement you receive from the extended health/dental insurance carrier that itemizes how you're being reimbursed for the expenses that you submitted.

The dental fee schedule published by the BC Dental Association for dentists (general practitioners), dental specialists, and denturists that contains eligible dental services, financial limits, treatment frequencies, and fees in effect on the date the dental service was performed.

Most, but not all, plans will cover costs based on the fee guide. It's not mandatory for dental offices to follow the fees suggested in the fee guide. 

A child is considered a full-time student when they meet the attendance requirements specified by the educational institution. If not specified, full-time attendance means that the child is enrolled for at least 15 hours of instruction per week, per term, and is physically present on campus OR virtually present on campus by way of regularly scheduled, interactive, course-related activities conducted online. Students must be able to demonstrate, if requested, that they meet full-time attendance requirements. 

Employer provided flex credits cover the full cost of benefits coverage for this option.

An individual employee account that provides reimbursement of eligible healthcare expenses not otherwise covered under your group benefits plan. Plan members may allocate some of their flex credits (before tax dollars) to an HSA, and claim them later, tax free, against eligible out-of-pocket expenses.

Benefits plans that an individual purchases for themselves.

Under PharmaCare, drugs deemed the lowest cost alternative are usually (but not always) generic drugs. Generic drugs contain the same active ingredients and are manufactured to the same standards set by Health Canada, and to the same strict regulations established by the Food and Drugs Act. Only minor ingredients like dyes, coatings or binding agents may vary. The real difference is in price; generic drugs cost 30 to 50% less, on average.

A person who's under 19 years of age.

The final price after flex credits have been deducted from costs.

Non-cash benefits, like extended health and dental, provided to employees by their employer. Employees are not required to pay the tax on the cash value of the benefit.

Annual enrolment period where you can update your benefit choices, with changes taking effect on January 1 of the next calendar year.

A defined group of services and professions that supplement and support medical work but do not require a fully qualified physician. These services include:

• Acupuncture
• Naturopathic physician
• Chiropractor
• Physiotherapy
• Massage therapy
• Podiatry

PharmaCare helps British Columbians with the cost of eligible prescription drugs and designated medical supplies. It’s one of the most comprehensive drug programs in Canada, providing reasonable access to drug therapy through 7 drug plans.

Assistance through PharmaCare is based on income. The lower your income, the more help you receive. There’s no cost to register and there are no premiums. More information is available on the PharmaCare page.

Confirmation with Canada Life regarding eligible medical/dental expenses and reimbursement percentage.

The amount paid by the employee or the employer to maintain insurance coverage.

An amount equal to the employee’s life insurance.

An employee is considered disabled if disease or injury prevents them from being gainfully employed. Gainful employment means work:

• That a person is medically able to perform
• For which they have at least the minimum qualifications
• That provides income of at least 60% of their indexed annual earnings*
• That exists either in the province or territory where they worked when they became disabled or where they currently live

The availability of work will not be considered in assessing disability.

Represents the standard fees health care practitioners would charge for a given service or the standard cost of a covered item. R&C limits are reviewed regularly and are subject to change at any time. If the cost charged for the item or service is more than the R&C limit for that item or service, you'll be responsible for paying the difference.

For R & C charges related to paramedical services, log into My Canada Life at Work and look under Benefits > Coverage and balances > Health, Drugs, Vision & Dental (50088) > Health > Health professionals to view.

If you have any questions about R&C limits for a given service, contact Canada Life at 1-855-644-0538. 

A process where drugs that are deemed therapeutically equivalent are grouped together, and then the cost of the lowest-priced drug in the group (typically a generic drug) is used as the reimbursement level for all drugs in the group.

An employee who's employed for work that is of a continuous full-time or continuous part-time nature.

A trial period of employment for assessment and/or rehabilitation purposes.

The amount you're paid back for an expense that you incur. Reimbursements can be partial or total.

The examination and evaluation of a specific condition in a localized area.

Benefits that are fixed, authorized, or established by statute. The employer is required by the law of the province (Employment Standards Act) to provide these benefits to employees.

Non-cash benefits, like Employee Basic Life Insurance (employer’s portion) provided to employees by their employer. Employees are required to pay the tax on the cash value of the benefit.

Life insurance protection provided during your term of employment. Term life insurance has no cash value.

A benefit payable to eligible auxiliary employees who are ill and who do not qualify for coverage under the Short-Term Illness and Injury Plan. See your Terms and Conditions of Employment on Careers & MyHR for further information.