Group insurance FAQ

Is group insurance mandatory?

Most group insurance plans are mandatory, but you might be exempt under certain conditions.

For more information, see your insurance booklet or contact your plan administrator.

Can I be covered by 2 group insurance plans?

Yes, you can be covered by more than one group insurance plan. 

To find out the order in which claims have to be submitted, see our coordination of benefits document (PDF, 455 KB).

Who is a dependant?

A dependant is a family member who is covered under your plan.

Depending on your coverage type, you might be able to add your spouse or children as dependants.

For more information on the terms and conditions, see your insurance booklet or contact your plan administrator.

How many beneficiaries can I have on my group insurance?

There's usually no limit to how many beneficiaries you can have on your group insurance.

For more information, see our beneficiary designation document (PDF, 217 KB).

Which drugs are covered by my group insurance?

Your group insurance covers:

• Drugs on your plan’s list

Your group insurance doesn’t cover:

• Excluded drugs

Note that other limitations and exclusions may apply.

What makes up the cost of a drug at the pharmacy?

The total cost of a drug is made up of the following elements:

• Drug cost (price paid by the pharmacy)
• Mark-up (to cover operating expenses)
• Dispensing fee (to cover professional services)

How is reimbursement for a drug calculated?

Your reimbursement is usually a percentage of the eligible amount for the drug. Other factors apply, including:

• Reasonable and customary charges
• Annual deductible or deductible per dispensed prescription
• Plan type

For more information, see your insurance booklet.

Are dispensing fees covered by insurance?

Your insurance plan may only cover part of the dispensing fee. 

To find out, use our drug search tool. You can access it on our secure site or in the Omni app.

How do I know if a drug is covered?

To find out if a drug is covered by your insurance, use our drug search tool. You can access it on our secure site (under Coverage information) or in the Omni app.

Am I eligible for disability benefits?

You could be eligible for disability benefits if you meet these 4 criteria:

1. You had disability coverage when the disability started.
2. You're ill or you've had an accident.
3. You're under continuing medical care of a doctor in Canada.
4. You're unable to work because you have a total disability, as defined in your insurance booklet.

What is a return-to-work plan?

A return-to-work plan is designed to help you go back to work after a disability.

If you can't go back yet due to medical reasons, we discuss other options with you, your employer and your doctor.

What is a waiting period?

A waiting period is the time you have to wait to receive benefits after the start of your disability. It varies depending on your contract.

For more information, see your insurance booklet or contact your plan administrator.

When do I need to submit a disability insurance claim?

To find out when you need to submit a disability insurance claim, see your insurance booklet.

Long-term disability: If you've already submitted a short-term disability claim, you don't need to submit a new claim.

When will I find out if my disability insurance claim is approved?

Once we've received all the completed forms, we need a few days to go over your claim before we make a decision.

• Short-term disability: about 5 business days
• Long-term disability: about 10 business days

When will my disability benefits start?

Your disability benefits start when your claim is approved and the waiting period has ended. We deposit your benefit payments in an account of your choice.

I'm on disability. Will any of my medical information be shared with my employer?

We don't share your medical information with your employer without your consent. Here is some information we do share with them:

• Whether you're eligible for benefits
• Your return-to-work plan
• What they need to know to make your return to work easier

If I have other sources of income, do they affect my disability benefits?

If you have other sources of income (a workers' compensation board or pension plan, for example), we deduct them from your benefits.

What if I’m receiving benefits from a public plan or workers’ compensation board?

If you’re receiving benefits from a public plan or a workers’ compensation board (such as the SAAQ, WSIB or CNESST), you still have to submit a claim. We can check what coverage you're eligible for.

Can I work while on disability?

To find out if you can work while on disability, contact your claims specialist.

Can I travel while on disability?

To find out if you can travel while on disability, contact your claims specialist.