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 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 an interpretation of the official, legally binding ASEBP insurance policies and plan documents available through your employer or by contacting us.

What's covered?

Maternity and Parental Leaves

According to Canadian laws, maternity leaves are broken into two parts: health-related leave, and parental leave. During the 15 weeks of health-related leave, your benefits will remain intact. 

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 any gap in your coverage may cause future claims to be denied if you get sick or are injured during the first 26 weeks after you return to work.

 If you have Spending Account coverage, your available credits may change while you’re on leave. See Spending Accounts While on Leave for details.

For Maternity Leave

Your benefits will continue during the health-related portion of your leave. If you want to receive benefits throughout the parental portion of your leave as well, 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. 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. 

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.

Income Replacement

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. 

Complicated Pregnancies

If you have a complicated pregnancy that requires you to be off work for more than 30 days before your expected due date, your school jurisdiction will let ASEBP know you are away. ASEBP will follow up to determine whether or not you’re eligible to participate in the Early Intervention Program (EIP) or Extended Disability Benefits (EDB). 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 Homewood Health, our Employee and Family Assistance Program (EFAP) provider, there are a multitude of resources available for new parents, including help with postpartum depression, support for new dads and transitioning back to work. The EFAP is a proactive health program, providing 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, and are free of charge for covered members and their dependants if you have an EFAP with ASEBP (check with your employer).

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 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 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 (sometimes called the elimination period) is the date of your 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. July/August, Christmas, or spring break, etc.) 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).

Early Intervention Program (EIP)

During these 90 days—sometimes called the elimination period—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, assuming 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 Completely 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.

Eligibility

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
  • 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

If you’re eligible for Extended Disability Benefits, you qualify for income replacement at the level stated in your plan. You can find which plan you’re on under Coverage on My ASEBP or on your ASEBP ID card on the My ASEBP Mobile App under Extended Disability Benefits.

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 does not 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 $17,500 per month. 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 $11,792 per month.

 

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. You may be responsible for covering premiums for Dental Care and Vision Care benefits. Check with your employer to see who is responsible for paying premiums.

Note that if you’re responsible for premium payments and have a Spending Account, you can use it to cover your dental and vision premium payments.

Plan D Plan E
Your employer pays all or a portion of the premiums, meaning that benefits payable under this plan are subject to income tax. You pay 100% of the premiums, meaning that benefits payable under this plan are not subject to income tax.

*Special Notes:

  • 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

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 is expected to result in total disability, an ASEBP program called Accommodation Employment 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.

Accommodation Employment needs to be supported by medical documentation and you’ll need to apply for Accommodation Employment within 30 days of the reduction of your usual working hours.

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

Additional Information

Managing your Benefits During a Personal or Maternity Leave

When going on leave, you have four choices when it comes to continuing your benefits:

  1. Continue all of your current benefits for the duration of your leave
  2. Continue income replacement benefits only (Life Insurance, Accidental Death & Dismemberment, Extended Disability Benefits)
  3. Continue Life Insurance and Accidental Death & Dismemberment only
  4. 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 your personal leave continues past the end of the plan year (August 31), your Spending Accounts will close. When your account closes, you will still have 60 days to submit eligible expenses that were incurred during that plan year. Following that 60-day period, your accounts will remain closed until you return to work and any expenses you submit will not be reimbursed. After outstanding expenses are paid to you, any unused credits will be forfeited to your employer. 

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

During your leave, you can make the following changes to your general health benefits (Drugs, Dental Care, Vision Care, Other Medical Services & Supplies).

  1. 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 may be subject to restrictions, including being categorized as a late applicant.
  2. Change your family coverage to single coverage. To do this, complete the Change Application form (find the right one for you on the Forms page), and send it to your employer or school jurisdiction.
  3. Add a dependant to your family coverage. To do this, complete the Change Application form and send it to your employer or school jurisdiction.

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.

Pre-Existing Conditions

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 and begins within 26 weeks of the start of your coverage, or any subsequent start of coverage following a lapse in your coverage.

You 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 do 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).

If you have a pre-existing condition, you may not be eligible for EDB. Contact ASEBP's Early Intervention Services with the specifics of your situation to help assess if you qualify. 
 

Example:

You take a leave of absence from March to December and choose to discontinue your EDB benefits. In September, during your leave, you injure your leg, recover and return to work in January, at which time your EDB coverage is reinstated.

In April—16 weeks after your return to work—you develop an infection related to your leg injury and become totally disabled. Because the infection is related to the leg injury which occurred during the leave of absence when you didn’t have disability coverage and you haven’t worked a full 26 weeks after EDB was reinstated, the pre-existing condition clause applies and you wouldn’t be eligible for disability benefits.

Had you continued EDB during your leave of absence, the pre-existing condition clause would not apply.

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 your regular employment duties 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 your regular duties which results 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 within 30 days after you return to work for a new disabling condition), 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

When receiving extended disability payments, you need to notify ASEBP of all other benefits or income you:

  • Receive
  • Are eligible to receive
  • May become entitled to receive (even if the source is not listed below)

Your ASEBP 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.

NOTE: This information is only current as of Sep 15, 2017. Please visit asebp.ca for the most up-to-date information.

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