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Making sure your family has coverage


Your family members, also known as dependants, include your spouse and/or child(ren) who may be eligible for benefits coverage under an employee group benefits plan.

You must have life, health and/or dental coverage for yourself, in order for your family members to be eligible for coverage. They are eligible to be added on the day you become eligible, or at a later date 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 days1 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 the employee group benefits plan.

To add Child Optional Life2, 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, even with proof of good health (evidence of insurability).

If you want to add your spouse or child to the other benefits available in the plan but you wait more than 31 days after the valid life event, they will be considered a late entrant.  

1Check your benefits booklet to confirm if this rule applies to you.
2Check your benefits booklet to confirm if this coverage is available to you.

Late entrant

If you have Single 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 new 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.)

If you have Family coverage, proof of good health is not required for your spouse or child even if they are a late entrant. They will have access to their benefits coverage as soon as you add them. Also, their dental coverage is not subject to the $200 maximum during the first 12 months and are only subject to the standard plan maximums.

If you are actively at work, you can add Spousal Optional Life2 at any time. Proof of good health will be required.

Learn how to add a family member or add Spousal Optional Life to your plan.

Eligible dependants

Let’s look more closely at each family member or dependant.

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* if a full-time student at an accredited school, college, university, or educational institution
    • not working 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, 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, will continue to be eligible for coverage. However, the child must have been covered under the employee group 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 member for support, maintenance and care, due to a mental or physical disability.

If you have questions about qualifying life events that make your dependants eligible for coverage, or how to make changes to your benefits coverage, please contact OTIP Benefits Services at 1-866-783-6847.



RELATED LINKS:

You called, we answered
My family status has changed. How do I add a dependant to my plan? How do I change my coverage?
Benefit reminders for end of school year
What do I do if I forgot to send in my overage dependant verification form for the current school year?
Life events – What they mean to you and your benefits coverage
Avoid being a late entrant
Taking stock of your benefits coverage

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