Plan enrolment
All full members of Doctors Nova Scotia (DNS) are eligible to join the health and dental plan without providing satisfactory evidence of good health during the 60-day period after they have been a full member for three months.
Any member who wishes to join the plan after the 60-day period must provide satisfactory evidence of good health.
Eligibility criteria
Single, family, senior single and senior family plans are available to members who meet the following criteria:
| N.S. residents | Physicians whose principal residence as defined by the Canada Revenue Agency is in Nova Scotia. |
|---|---|
| Three months of membership |
Physicians who have been members of DNS for three months at any time (including when membership dues were paid through Maritime Resident Doctors and Dalhousie Medical School Society) are eligible with proof of medical insurability. Transfer from another plan Members who currently have a comparable plan may elect to transfer their benefits to the association’s Extended Health and Dental Plan. Canada Life will determine eligibility. No previous medical plan Members of DNS relocating from elsewhere who don’t have a pre-existing medical plan may be referred to Canada Life to apply for a private Individual Health Care Plan. |
| Members residing outside of N.S. |
Physicians who provide full-time patient care in Nova Scotia but report their residence address as outside Nova Scotia may appeal to the Board of Trustees, on a case-by-case basis, to be eligible to apply for the Extended Health and Dental Plan. The Board of Trustees’ decision regarding the appeal is final. |
Eligible dependents
- Legal spouse
- The person publicly acknowledged by you as your spouse who has cohabited with you continuously for a period of at least 12 months
- A stepchild, legally adopted child, or natural child of yourself or your spouse (excluding a foster child) who is under 21 years of age and not employed for more than 20 hours a week
- Unmarried children under 25 years of age while attending college, university or other accredited educational institution as full-time students, provided there is no mandatory student program in effect or available offering the same or similar coverage
- A child 21 years of age or older who by reason of mental or physical disability is incapable of self-sustaining employment and is totally dependent upon you for support and provided such child was covered under this policy prior to age 21
Evidence of health
Satisfactory evidence of good health isn’t required if application is made within 60 days of first becoming eligible. If coverage isn’t applied for within this 60-day period, evidence may be requested for the employee and his/her dependents, if any, before benefits commence.
The cost of obtaining satisfactory evidence of good health is to be provided at your own expense.
Coordination of benefits
If you receive coverage from more than one insurance company, benefits will be coordinated so that the amount payable under both policies does not exceed 100% of the actual expenses incurred.
If you are the person named on the member identification card, submit your claim to Canada Life. Once the claim has been processed, any balance can be claimed with the other insurance company under which you are covered.
If the claim is for your spouse, and he/she has coverage elsewhere, submit the claim to that insurance company first. If your plan also covers your spouse, you can claim the remaining balance from Canada Life. Claims for dependent children who are covered under both policies should be submitted first to the insurance company of the parent whose birth date is earlier in the calendar year.
Canada Life requires a copy of the payment statement or summary from the other insurance company and a copy of your receipt in order to pay any eligible balance.
Termination
Benefits cease with the termination of your membership to the association, or failure to meet eligibility requirements, with the exception of a surviving spouse who continues to pay full premiums.
Conversion privilege
If you terminate participation in the group health and dental plan, you may convert to an Individual Health and Dental plan issued by Canada Life provided that application is made within 31 days following your date of termination.
This conversion privilege (pg. 3) is also available to the surviving spouse and/or dependents.