While on Leave
If you’re introducing a baby to the family or taking a personal leave of absence for any other reason, you can choose to continue your Alberta School Employee Benefit Plan (ASEBP) benefits while you’re on leave. If you become sick or injured, you may also be eligible for income replacement. This section includes information about different types of leaves, each with their own set of guidelines.
Note that the following is a comprehensive summary of the official, legally binding ASEBP insurance policies and plan documents, which are available through your employer or by contacting us.
Maternity and Parental Leaves
According to Canadian law, maternity leaves are broken into two parts: health-related leave and parental leave.
Continuing your Benefits
While you’re on leave, you have the option to continue receiving benefit coverage, as you did when you were working. If you choose not to continue your benefits while on leave, they will be reinstated on your first day back at work. Note that a gap in coverage beyond what is allowed according to the Alberta Labour Standards may cause future claims to be denied if you get sick or are injured during the first 26 weeks after you return to work.
For Maternity Leave
Your benefits may continue for either your entire health-related leave or just a portion of it, depending on the arrangement with your employer. If you want to receive benefits throughout your health-related leave as well as the parental portion of your leave, you can apply to continue all or some of your benefits, and they will begin the first day after your employer stops paying your premiums. Check with your employer to see who will be responsible for paying your benefit premiums during your leave.
For Parental Leave
If you’re only taking the parental portion of the leave (e.g. in cases of adoption, or both partners sharing leave, etc.), you can still apply to continue some or all of your benefits during your parental leave (which is officially considered a personal leave of absence by ASEBP). Check with your employer to see who will be responsible for paying your benefit premiums during this time.
See Managing your Benefits During a Personal or Maternity Leave for details.
Partial income replacement while you’re on maternity leave is covered through Employment Insurance (EI) provided you were paying into EI through your employer while you were working. As EI is a government program, you should contact Service Canada to ensure you’re set up to receive income replacement once your leave starts. You’re eligible to receive EI for both the health-related and parental portions of your leave.
If you have a complicated pregnancy that requires you to be off work for more than 45 days before your expected due date, your school jurisdiction will let ASEBP know you are away. ASEBP will follow up to guide you through the Extended Disability Benefits (EDB) application process. If you’re approved for EDB, your EDB coverage will remain in place until either your recovery following the delivery of the baby or until your underlying medical condition has been resolved. After your EDB coverage stops you will transition to Employment Insurance.
Support for You
Through your Employee and Family Assistance Program (EFAP), a number of resources are available for new parents, including help with postpartum depression, support for new dads, and assistance transitioning back to work. The EFAP is a proactive health program that offers completely confidential physical and mental well-being support services to you and your family. These supports are available in person, online and over the phone, 24/7/365.
Personal Leaves of Absence
Continuing your Benefits
If you’re planning to take a personal leave of absence, you can choose to continue receiving all or some of your benefit coverage for the duration of your leave. Depending on your arrangement with your employer, you may be responsible for premium payments while you’re on leave. Your employer will be able to tell you who will be paying your benefit premiums during this time.
If you decide not to continue your benefits, they will be inactive during your leave, and will be reinstated when you go back to work. Any gap in your coverage, however, may cause future EDB claims to be denied if you are unable to work due to illness or injury during the first 26 weeks after you return to work.
See Managing your Benefits During a Personal or Maternity Leave for details.
Retiring From a Personal Leave
If you are on a personal leave of absence and decide to retire or take Early Retirement benefits directly from your leave, your benefit coverage will remain the same as when you were on leave. When you retire, you take your current benefits with you, which may be different from the benefit coverage you had while you were working.
If you Become Ill or Injured
If you become seriously ill or injured, you may be eligible for the Early Intervention Program (EIP) or Extended Disability Benefits (EDB). EIP is designed to help you keep working when you have had to reduce your hours due to illness or injury. EDB is designed to support you if you have been deemed medically disabled and unable to work for 90 days due to illness or injury, or if you have participated in EIP and your recovery has not progressed as expected.
The start of the 90 days of sick leave (sometimes called the elimination period) is the date of your disability (accident, injury or medical incident) and is usually the day after your last day worked. If you are on a regularly-scheduled school break (e.g. summer break, winter holidays, spring break) then the start of the elimination period will be the date you become totally disabled (not the day you were scheduled to return to work).
It’s important to note that even if you’ll be away from work due to illness or injury during a regularly-scheduled school break, you’ll still need to provide ASEBP with regular updates on changes in your abilities or health status that impact your return to work. These updates help us keep your benefits in place to support you during this time.
Early Intervention Program (EIP)
During these 90 days you’re able to access EIP, which is a voluntary program offered to employees who are not totally disabled and are still able to work modified hours and duties. The program is a proactive way to help injured or ill employees stay at work. You must be in treatment for your illness or injury to qualify for EIP and EDB.
Why participate in EIP?
By participating in EIP, not only will you benefit from the advantages of early intervention, but you will also be protected if you need to apply for EDB. For example, if you're participating in EIP and your condition deteriorates or a complication arises, you would not need to meet the EDB criteria of being totally and continuously disabled for 90 days. If you are able to work reduced hours and you chose not to participate in EIP, you would not meet the criteria for EDB.
Depending on the hours you work while on EIP, your 90-day elimination period can be extended. Working more hours means a longer elimination period, which will allow you time to recover from your illness or injury while still working partial hours.
Who can access EIP?
EIP is designed for employees who have Extended Disability Benefits coverage and need to reduce their hours of work by 30 per cent or more because of an injury or illness. To qualify, your condition must be temporary with a high likelihood that you’ll be able to perform your regular job duties at your usual hours within a few months. EIP is not intended to be a permanent, partial-disability program. Note your participation in EIP will need to be supported by medical documentation.
Shortly after your illness or accident, if you’re unable to return to work at your usual hours, you’ll be assessed for EIP. Your early intervention facilitator will provide you with more details about this process.
You’re eligible to participate in EIP until you:
- Have recovered from your illness or injury
- Are working 70 per cent or more of your pre-disability hours
- Decline to participate in a reasonable return-to-work plan, or your employer cannot accommodate a return-to-work plan because of undue hardship
- Are no longer able to work because of a declining medical condition and must apply for EDB
- Have reached the end of your elimination period for EDB
If you Become Ill or Injured During a Personal Leave of Absence
If you continued your coverage during your personal leave and you get sick or injured during your leave, you can apply for Extended Disability Benefits (EDB) and serve the 90-day elimination period. However, if your EDB application is approved, no benefits will be paid and no benefit waivers will be put into place until the end of your approved personal leave. For more information, contact ASEBP and ask to speak with Early Intervention Services.
If you Become Disabled
If you have a serious or prolonged illness that makes you unable to work more than 90 days, you may be eligible for Extended Disability Benefits (EDB). EDB is a total disability program, which means you must be completely unable to work due to your illness or injury. During the 90-day elimination period, an ASEBP intake facilitator will contact you to gather information and guide you through the application process. Note your participation in EDB will need to be supported by medical documentation.
To be eligible for EDB, you must:
- Complete an application. We recommend doing this as soon as possible to avoid disruption of income, but we will accept applications up to 15 months from the date of disability, but pertains to the elimination period
- Have EDB coverage and meet the definition of total disability
- Have been working more than a 0.2 FTE at the time of your injury, or the minimum required by your employer, which could be greater than a 0.2 FTE
- Have continued your benefits during a leave of absence if you become ill or injured during that leave of absence
- Not have a pre-existing medical condition
- Be under the age of 65
- If you’re receiving EDB payments as you approach age 65, your coverage will end on the last day of the month following the month in which you reach age 65. (E.g. if you turn 65 on December 1, 2017, your disability coverage would end on January 31, 2018.)
- If you’re not receiving EDB payments as you approach age 65, your EDB coverage will end three months before you turn 65, due to the 90-day EDB elimination period.
If you’re an employee who will be living outside Canada because of an approved teacher exchange program or secondment position, you’re eligible for ASEBP EDB coverage for a maximum of 24 months. If you choose to return home within the 90-day elimination period, the regular provisions of the EDB plan will apply.
If you’re disabled due to an accident, you may be entitled to additional benefits through your Accidental Death & Dismemberment coverage.
Monthly earnings include salary, administrative allowances, pay while on vacation, isolation pay, retroactive salary and compensation for an acting assignment longer than three months. It doesn't include signing bonuses, overtime, car allowances, expense allowances or reimbursements, salary earned while teaching night or summer school classes, early retirement incentives or pay in lieu of vacation.
Benefits are paid monthly through direct deposit to the bank account you've identified on My ASEBP.
|Plan D||Plan E|
|70% of your basic monthly earnings, to a maximum benefit of $23,333 per month. This amount is taxable because your employer pays 100% or a portion of the benefit premiums.||662/3% of the first $2,500 of your basic monthly earnings plus 45% of any additional basic monthly earnings, to a maximum benefit of $15,542 per month. This amount is tax-free because you pay 100% of the benefit premiums.|
Your benefit premiums for Extended Disability Benefits, Life Insurance, Accidental Death & Dismemberment and Extended Health Care, (Drugs, Other Medical Services and Supplies and Travel Emergencies)* are waived by ASEBP when you are approved for EDB. They are based on the coverage you have at the end of the 90-day elimination period. If you have Dental Care and Vision Care benefits, you may be responsible for covering premiums. Check with your employer to see who is responsible for paying premiums.
If you’re responsible for your Dental Care and Vision Care premium payments and have a Health Spending Account (HSA), you can submit the premiums you pay as an HSA expense.
- In rare cases, coverage for Extended Health Care, Dental Care and Vision Care are not guaranteed to last through your entire EDB leave.
- You must disclose any additional disability coverage that you have.
Rehabilitation Employment is a temporary program designed for short-term transition back to work while on EDB. The program allows for modified hours, or alternate work or training during your rehabilitation and supports a progressive return to your previous level of employment.
While on EDB, if you become well enough to work a modified schedule, talk to your claims facilitator about Rehabilitation Employment. Rehabilitation Employment needs to be pre-approved by ASEBP to ensure the work or training meets the program’s objectives. ASEBP will check in and review your progress periodically.
While performing Rehabilitation Employment your monthly EDB payment is reduced by 50 per cent of any salary or earnings you receive. (E.g. if you’re receiving $3,000/month while on EDB, when you’re participating under the Rehabilitation Employment program and earn $1,000/month from your employer, your EDB payment will be reduced by half of your earnings, or $500. This leaves you with a total EDB payment of $2,500/month.) Income from alternate work that is not part of an approved rehabilitation program will be offset at 100 per cent.
For more information about Rehabilitation Employment, contact your claims facilitator.
If your Illness is Progressively Disabling
If you’re not able to perform all the regular duties of your job because of a progressively debilitating illness that’s expected to result in total disability, our Progressive Disability Program can provide income protection. You may still be able to continue working part time in a limited capacity. Your work hours reduce as your ability to work decreases.
Benefits into Retirement
If you’re on EDB and decide to retire or take Early Retirement benefits directly from your leave, your benefit coverage will remain the same as when you were on leave. When you retire, you take your current benefits with you, which may be different from the benefit coverage you had while you were working.
What's not covered?
The following are a number of treatment situations and services not covered under the plan. Note that this list is not exhaustive.
- Treatment for an injury or illness for which there is a pre-existing condition
- Treatment that is experimental, educational or for the purpose of research
- Treatment provided free of charge
- Expenses covered through a government program, whether or not you or your dependants choose to participate in the program
- Medical services and supplies provided by a dental or medical department in which there is a conflict of interest (e.g. maintained by the employer, a mutual benefit association, labour union, trustee or similar type of group)
- Expenses incurred while on active duty in any military or peacekeeping force
- All coverage where your conduct would constitute an indictable offence within Canada
Managing your Benefits During a Personal or Maternity Leave
When going on leave, you have four choices when it comes to continuing your benefits:
- Continue all of your current benefits for the duration of your leave
- Continue income replacement benefits only (Life Insurance, Accidental Death & Dismemberment, Extended Disability Benefits)
- Continue Life Insurance and Accidental Death & Dismemberment only
- 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 still apply for coverage within 31 days of the loss. You’ll need to provide proof of involuntary loss to your employer when you apply. If you don’t apply for coverage within those 31 days, you’ll need to wait until you return to work and provide medical evidence that you’re eligible to be covered under the plan.
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.
Spending Accounts While on Leave
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.
Allowable Coverage Changes During a Leave
- 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.
- Change your family coverage to single coverage. To do this, complete the appropriate Change Application, and send it to your employer.
- Add a dependant to your family coverage. To do this, complete the appropriate Change Application and send it to your employer.
Working for Another Employer While on Personal or Maternity Leave
If you accept a job with benefits while you’re on leave, whether that job is with an ASEBP participating employer or not, the benefits you have during your leave will end on the date the benefits at your new job take effect. Please notify ASEBP after you accept a new job and ASEBP will ensure that when you return to work for your original employer, the benefits you had before your leave will be reinstated without any penalties.
If you accept a job without benefits while you’re on leave, whether that job is with an ASEBP participating employer or not, you will have the option to keep the ASEBP benefits you have during your leave. If this is the case, there’s no need to inform ASEBP of your new job.
A pre-existing condition is an accidental injury or illness for which you received medical attention, consultation, diagnosis or treatment during the 12 months before your benefits became active. No benefits will be payable if the disability is related to a pre-existing condition occurring within 26 weeks of the start of your coverage or any subsequent start of coverage following a lapse greater than 90 days.
You may have a pre-existing condition if:
- you have an accidental injury or illness for which you saw a doctor or specialist during the 12 months prior to starting your ASEBP coverage or;
- within the last 12 months of your leave you saw a doctor or specialist for an accidental injury or illness during the period you were without coverage, and;
- you become totally disabled (related to that condition) within 26 weeks of the date of enrolment or re-enrolment in EDB.
You may not have a pre-existing condition if:
- after your EDB coverage started, you were first diagnosed or treated for an accidental injury or illness that has resulted in you being unable to work;
- your injury or illness occurred while you were on leave, but you continued your EDB while you were on leave (there was no break in coverage), and;
- your injury or illness occurred within 90 days of a termination, but you returned to work with the same employer (e.g. there was a natural employment break in the school year).
If you have a pre-existing condition, you may not be eligible for EDB. Contact our Early Intervention Services team with the specifics of your situation to help assess if you qualify.
What is Total Disability?
ASEBP's Extended Disability Benefit (EDB) is a total disability plan. To qualify for EDB, you must fit the following criteria:
- You must be totally disabled and incapable of performing the material and substantial duties of your normal role as a result of a medically supported injury or illness for 90 consecutive days. This 90-days is known as the elimination period.
- Once you're approved for EDB, for the next 24 months after your 91st day, you must be incapable of performing the material and substantial duties of your normal role, resulting in a loss of 30% or more of your pre-disability income due to a medically supported injury or illness.
- Following the 24 months after your 91st day, ASEBP will determine if you are medically capable of earning 60% or more of your pre-disability income in any occupation that you are or may become suited for through education, training or experience.
Coverage During your Extended Disability Leave
While you’re on extended disability leave, most of your benefits will continue as usual. The only benefits you may be responsible to pay premiums for are Dental Care and Vision Care benefits. You can choose to decline this coverage while you’re on leave. Check with your employer to see who is responsible for paying premiums.
Note that if you’re responsible for premium payments and you have Spending Account coverage, you can use it to cover your premium payments.
Re-occurrence of Disability
If you return to work after an approved extended disability leave and within six months must stop working again because of the same disabling condition or related causes (or within 30 days after you return to work for a new disabling condition, from unrelated causes), your period of disability will be considered a re-occurrence of the previous disability so long as all of the following conditions are met:
- You must have received benefits for your first period of disability
- You continued to be covered under ASEBP's EDB coverage after the first period of disability and there was no break in coverage
- The successive period of disability began after you returned to active employment
- You apply within six months of going off work
If all of these conditions are met, your EDB coverage will start immediately after your disability claim is approved at the same level as your last claim for disability. Note that you must provide medical evidence of your disabling condition.
Medical Assessments for Extended Disability Leave
To help improve your prospects for getting back to work, ASEBP may arrange for you to see a health care provider not employed by ASEBP for an assessment and/or treatment. A medical assessment is a neutral, objective, professional opinion that may be used:
- To expedite an appointment, if you are not under the regular care of a specialist or due to long waitlists
- If there has been no progress or improvement in your condition(s)
- If inconsistent medical information is on your file
- To provide additional medical information to confirm diagnosis or for treatment recommendations, etc.
If ASEBP determines that a medical assessment is necessary, you need to participate in the medical assessment in order for you to continue receiving extended disability payments. The results of the assessment will provide input into your support, recovery and/or return-to-work plan and will be shared with your health care provider(s).
Alternative Income While on Extended Disability Leave
ASEBP will regularly request information from you regarding other sources of income. You’re required to update us of all other benefits or income you:
- Are eligible to receive
- May become entitled to receive (even if the source isn’t listed below)
This information is requested to ensure accurate extended disability payments and avoid potential overpayments which you will be required to repay. Your extended disability payments may be reduced by the amount of income or benefits you receive from other sources. Examples of these sources include:
- Disability benefits from Canada Pension Plan (CPP), Workers' Compensation or other disability plan
- Automobile or general liability benefits
- Employer sick leave benefits
- Severance, termination pay or other remuneration received from any employer
- Self-employment income
- Any income from pensions such as CPP, Alberta Teachers' Retirement Fund or Local Authorities Pension Plan will be deducted if it exceeds 85 per cent of the combination of pre-disability salary and income from the pension plan
Injured in an Accident (Not your Fault)
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.