Obligations and responsibilities of the Policyholder in group insurance

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What are the policyholder’s obligations and responsibilities to plan members?

It is the policyholder’s responsibility to ensure that all plan members and their dependents are eligible for coverage at the time they join. The policyholder must also ensure that this eligibility continues on an ongoing basis as long as members are covered by the group insurance contract. Eligibility standards and criteria are detailed in the contract in effect between the policyholder and Humania Assurance.

The policyholder is responsible for providing members with their certificate of insurance as well as with a copy of the policy and the booklet detailing the coverages available to them.

What are the policyholder’s obligations to the insurer with respect to eligibility for insurance?

The policyholder must forward the enrolment forms to the insurer or its representative within the time limits set out in the group insurance contract. The policyholder is responsible for the accuracy of the information provided in the enrolment forms. Failure to meet the deadlines may result in the loss of the member’s rights in the event of a claim.

The policyholder is also responsible for deducting premiums and remitting them to the insurer on a monthly basis.

In the event of a claim submitted by a member, the member must provide the insurer with such information as is required for the consideration of the claim submitted.

What are the obligations of the policyholder to the Insurer regarding changes to members’ files?

The policyholder must notify the Insurer of any change that may affect a member’s insurance coverage. This includes sending a notice of change to the insurer when there is a change in salary, dependents, etc. The notice of change must be sent to the insurer within the time limit set out in the group insurance contract. Failure to meet the deadlines may result in the loss of the member’s rights in the event of a claim.

Other policyholder responsibilities

The policyholder has a duty to inform the members with regard to the group insurance master policy. However, the policyholder cannot provide advice to the members. It must refer members to the insurer or its representative when a request exceeds its duty to inform.

How is eligibility determined and where can this information be found?

In order to become eligible for coverage after being hired, an employee must first complete the qualifying period set out in the contract. This period varies from contract to contract and is found at the beginning of the contract on the page entitled GENERALTERMS AND CONDITIONS.

The employee must also meet the contract eligibility criteria, which can be found in the GENERAL PROVISIONS section of the contract under the subheading Eligibility. These criteria may vary from one contract to another so it is very important for the policyholder to refer to their contract or to contact the insurer or their representative in case of doubt.

What are the time limits for submitting new memberships and changes to a member’s file?

The normal period for submitting a membership or a change affecting a member’s file is 30 days. However, this period may vary from one contract to another. The policyholder must refer to their contract in the GENERAL PROVISIONS section under Responsibilities of the policyowner to determine the period that applies. Failure to meet the deadline may result in the loss of the member’s rights in the event of a claim.

Is the policyholder required to notify the Insurer in the event of a temporary layoff or leave without pay?

Yes, the Insurer must be notified of layoffs and leave without pay within the time limits set out in the contract, as these situations may impact the member’s benefits and rights in the event of a claim. The deadline is the same as for any notice submitted to the insurer to change a member’s file and is found in the GENERAL PROVISIONS section under Responsibilities of the policyowner.

Want more information?

Contact our customer service team at 1 800 818-7236, Monday to Friday, 8am to 5pm or by email at adm.coll@humania.ca.