FAQs

Coordination of Benefits - when more than one benefit plan exists, to which plan should I submit claims? 

You should submit your claim to your own Insurer first (primary carrier).  Your spouse should submit to his/her carrier.  Claims for dependent children must be submitted to the plan of the parent with the earlier birth date in the calendar year.  If the parents have the same birth date, then submit the claim to the plan of the parent whose first name begins with the earlier letter in the alphabet.  This is referred to as Coordination of Benefits (COB). If you will be coordinating claims please complete the Coordination of Benefits form available on our Forms page.

If any portion of a claim is not covered/paid by the primary carrier, the claim for the balance of expenses should be sent to the secondary carrier for consideration (the amount reimbursed cannot exceed 100% of allowable expenses).

In situations where parents are separated / divorced, then the following order applies: 1) the plan of the parent with custody of the child; 2) the plan of the spouse of the parent with custody of the child; 3) the plan of the parent not having custody of the child; and 4) the plan of the spouse to the parent in item (3).  Take photocopies of your claim and receipts.  Submit your claim to your Insurer based on the above criteria.  Once you receive your cheque and Explanation of Benefits (EOB) statement, complete a new claim form for the other carrier.  Attach the EOB statement with photocopies of your original claim. Submit this information to the coordinating plan (your spouse's). 

Can I cover my spouse and dependent children?

Depending on the benefits offered through your group plan, you may be eligible to elect family coverage. Your Employee Benefits Booklet contains detailed information as to spousal and dependent child eligibility requirements. Most plans allow for an extension of coverage for a dependent child over age 21 who qualifies as a full-time student.

If you have a dependent child with a mental or physical disability, or any other special circumstances, please contact your Group Plan Administrator or RWAM Group Administration to determine if coverage is available or can be extended. 

What does Non-Evidence Maximum (NEM) refer to? 

Certain benefits (such as Life, Accidental Death & Dismemberment, and Disability coverage) may be wage-related. A Non-Evidence Maximum (NEM) refers to the maximum amount of insurance coverage which may be available to an eligible insured person without having to provide medical evidence of health (Evidence of Insurability). If a NEM applies to a particular benefit under your group plan, the NEM amount will be stated in your Employee Benefits Booklet on the applicable 'Schedule of Benefits' page. For some group plan benefits without a specified NEM, mandatory Evidence of Insurability may need to be provided. Check with your Group Plan Administrator.

You should review your coverage regularly, especially if your salary increases, to determine if you are eligible to apply for additional coverage beyond the NEM.  Coverage approved over and above the NEM will be subject to an overall maximum coverage amount, stated on the 'Schedule of Benefits' page of your Employee Benefits Booklet.  If you are uncertain or have any questions about your eligibility, contact your Group Plan Administrator or RWAM Group Administration.

How do I apply for additional coverage over the Non-Evidence Maximum (NEM), assuming I'm eligible to do so? 

You must complete and submit a Group Health Evidence form (also known as Evidence of Insurability) to RWAM for additional coverage over and above the Non-Evidence Maximum (NEM). Please ensure that the correct insurance carrier's form is submitted (providers are listed at the back of your Employee Benefits Booklet). Health evidence forms for the various insurance carriers are available on our Forms page.

There may be times when additional information is required from your doctor based on the medical information that you have provided on your health evidence form. 

Additional coverage will only become effective once the Insurer approves coverage after reviewing your health evidence. If your application for the additional coverage is declined, your existing coverage will remain unaffected.

 Do I need to report changes in my personal status?

Yes. You should contact either your Group Plan Administrator or RWAM Group Administration directly to report any changes in your personal status or life circumstances which might affect your coverage, including:

• Marital status (divorce, marriage, separation, common-law)
• Changes in your name or that of your dependent(s)
• Birth of a child, adoption, student coverage, disabled child

Whenever you have a major life change, it is advisable for you to review your beneficiary designation to see if it is up to date and reflects your current wishes. Refer to your Employee Benefits Booklet for more information under the heading 'Changes Affecting Your Coverage'. 

I'm leaving my employer and will no longer have any group Life, Health and/or Dental insurance. What options are available to me? 

If your group Life insurance coverage is being terminated because your employment has terminated or you are no longer eligible for group insurance coverage, you may be entitled to convert your existing group Life coverage to an individual Life insurance policy. To convert group Life coverage to an individual policy, you must apply to the Insurer (via RWAM) within 31 days after the date your group Life coverage terminates. You should contact RWAM's Group Life Insurance Department immediately for information and necessary forms.

With group Health and/or Dental insurance, you may be eligible to convert your coverage to an individual plan. This must be done within 60 days of the applicable termination date. Please contact RWAM's Group Accounting Department for further information.

For Out-of-Province/Out-of-Canada options, please call SecuriGlobe directly at 1-844-370-2065.  SecuriGlobe has access to 14 different carriers to obtain the best possible rate for an individual or family, depending on their specific needs.  Single and multi-trip annual emergency medical plans are offered, along with trip cancellation, trip interruption, snowbird, sport travel and special risk coverage.

What is the difference between issue date and effective date on my RWAM OneCard?

What is the difference between 'Refusal' vs. 'Waiving' of benefits? 

You may waive Extended Health Care and/or Dental benefits if you are currently covered under your spouse's or common-law spouse's plan.  You are still eligible for any other benefits your group plan may have (i.e. Life insurance and Disability insurance, if applicable).

A refusal of all coverage is discouraged, as a certain level of participation of eligible employees must be met.  In some cases, you may have the option to refuse all coverage but cannot choose some benefits and refuse others.  If you refuse all coverage, you can apply for coverage in the future but health evidence will be required.  You should not refuse coverage solely because you are covered for comparable Extended Health Care and/or Dental benefits under your spouse's plan.

 After what duration of absence do I need to notify RWAM?