Protecting the health and wellness of your family is important.
Your family members, also known as dependants, include your spouse and/or child(ren) who may be eligible for benefits coverage under your group benefits plan.
They are eligible to be added on the day you become eligible, or later if there is a valid life event (e.g. marriage/common law, birth/adoption of a child, etc.).
If you need to add a new family member for life, health and/or dental coverage:
You have 31 days [1] from the date of the corresponding event (e.g., wedding day, day child is born or adopted, date spouse loses coverage) to add your spouse or child to your benefits plan.
You must have life, health and/or dental coverage for yourself for your family members to be eligible for coverage. To add Child Optional Life [2], you must do this within 31 days of your child(ren) being eligible (i.e. when you become eligible for coverage or the birth/adoption of your child). This benefit cannot be added after the 31 days.
If you want to add your spouse or child to the other benefits available in the plan but you waited more than 31 days after the valid life event, they will be considered a late entrant or applicant.
Late entrant
If you have benefits coverage, proof of good health will be required for your spouse or child if they are late entrants. Based on medical evidence, their extended health care coverage may be denied.
If extended health care coverage is approved, the added family member is covered as of the date coverage was approved (NOT the life event date). For dental coverage, late entrants are subject to a $200 maximum during their first 12 months of coverage. If you are not approved for extended health care coverage, you are still eligible for dental coverage.
IMPORTANT: Please advise your dental provider of these restrictions prior to service. To minimize delays in benefit claims, be sure to also update your service provider of your new plan number.
If you are actively at work, you can add Spousal Optional Life [2] at any time. Proof of good health will be required.
Eligible dependants
As per your benefits booklet, here is the definition of a dependant:
| Dependant |
Description |
| Spouse |
Your legal spouse, or a person continuously living with you in a role like that of a marriage partner for at least 12 months. |
| Child |
- a newborn child from the moment of birth
- your natural or adopted child, stepchild or foster child, who is:
- unmarried
- under age 21, OR under age 25/26* if a full-time student at an accredited school, college, university or educational institution
- not working on a full-time basis, and
- not eligible for coverage as a member under an employee group benefits plan
NOTE: A stepchild must be living with you at least part time to be eligible.
*Check your benefits booklet to confirm the maximum age for your child.
|
Each year, if your child is over the age of 21, OTIP will send you a notice to confirm your child’s eligibility to maintain their coverage under your plan.
If you have a disabled child:
A child, who is incapacitated or disabled on the date he or she reaches the maximum age (21 or 25*) when coverage would normally end, may continue to be eligible for coverage if the child was covered under the benefits plan before that date.
OTIP may request written proof of the child’s condition as often as reasonably necessary.
A child is considered incapacitated if he or she is incapable of engaging in any substantially gainful activity and is dependent on the plan member for support, maintenance and care, due to a mental or physical disability.
If you have questions about valid life events that make your family members eligible for coverage or how to make changes to your benefits coverage, contact OTIP Benefits Services.
[1] Check your benefits booklet to confirm if this rule applies to you.
[2] Check your benefits booklet to confirm if this coverage is available to you.