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Enrolment/Eligibility

You are responsible for managing the enrollment or re-enrollment process. Having new employees enrolled at the start of their employment should be an integral part of your on-boarding even though insurance coverage may not become effective until a future date. The following processes can help you administer your group benefits plan.

Enrolling

Prior to enrolling an employee confirm their eligibility as follows:

• Is employee a resident of Canada and are they covered by the provincial health care plan? If no, they are not eligible for coverage unless they have a valid work permit in effect and have Provincial Health Care coverage or an equivalent health insurance policy from an insurer that provides for emergency medical coverage in the event of an injury or sickness.
• Is employee in a covered eligible class as defined in group policy? If no, they may not be eligible for coverage.
• Is employee a permanent employee and working the minimum number of hours per week as defined in group policy? If no, they may not be eligible for coverage.
• Is the employee’s salary aligned with the definition of earnings as defined in the group policy? If not, be sure to verify prior to enrolling.
• Please note that plan member’s gender is a required field and is only used for the purposes of determining rates. RBC Insurance will not communicate with the plan member in any way that denotes gender. When entering this information, please use the gender that the plan member self-identifies with: male (M); female (F); or other (U).

To help you capture required information to register your employee first have your employee complete the Group Enrollment Form and then sign into Online Administration to enrol your employee. Keep the Group Enrollment Form original on file. Refer to the ‘How to’ section ‘Add a plan member’ for detailed instructions.

Waiting Periods

Refer to your group policy for your plans waiting period as it must be adhered to. Eligible employees who are hired after the effective date of your group policy are eligible for coverage following the waiting period. When enrolling using Online Administration the tool will automatically apply any required waiting periods.

Waiving Waiting Period

To waive the waiting period of a new hire one of the following conditions must apply:

• It is a condition of their employment
• The employee has moved from part-time or contract to full-time status and has satisfied the waiting period during their period of employment
• The employee earns more than $50,000 annually

Enroll the employee using “Add A Plan Member”, confirm you wish to waive the waiting period. Acknowledge that the criteria is met and select “‘Next” to proceed.

• If you select “YES” to waive a waiting period, you will receive a drop down with the confirmation of allowances for waiving a waiting period.
• If the plan member does not meet the criteria, you can change the response to NO and the waiting period will apply.
• If you confirm to the terms for Waiving the Waiting period, Input “NEXT” and the coverage will begin on the date of hire.

Plan Participation

Participation requirements are defined in your Group Insurance Contract. Participation is at the plan level and not at the benefit level. An employee must enroll for all benefits with the exception of extended health and dental. Extended health and dental coverage can only be waived for employees and/or their dependents when they have coverage through their spouse or partner’s benefit plan. If the spouse or partner’s coverage subsequently terminates, the employee and/or dependents may enroll under this plan without penalty, within 61 days of the termination of the spouse/partner’s plan. Refer to the ‘How to’ section ‘Reinstating Waived Coverage’ for detailed instructions.

If an employee refuses coverage, please have the employee complete a Refusal of Coverage Form and email to admin@groupinsurance.rbc.com and keep the original form on hand. If application for coverage that was previously refused by the employee is made, an Evidence of Insurability Form must be completed and submitted for review.

Evidence of Insurability (EOI)

The Evidence of Insurability Form must be completed in the following situations:

• When an employee or dependent is a Late Entrant
• When an employee applies for a coverage amount above any no-evidence maximum as defined in your group insurance policy
• When an employee or dependent is re-applying for coverage that was previously cancelled or declined
• When an employee or dependent previously refused coverage under this policy and is subsequently applying
• When an employee or dependent applies for Group Optional Term Life coverage

The employee must complete the Evidence of Insurability Form and email to MedicalUnderwritingSupport@rbc.com. If additional medical information is required, the applicant or the applicant’s physician will be notified directly. We will pay the cost of obtaining this information, except in the case of a Late Entrant (i.e. an employee or dependent who applies for coverage more than 61 days after becoming eligible). In this case, the cost is at the employee’s own expense. You will receive correspondence about our decision, with a duplicate copy enclosed for the applicant. The duplicate copy outlining our decision should be provided to the employee.

If approved, the effective date of coverage will be outlined in the approval letter. The coverage approved will be reflected within the next two billing cycles.

Rehires

Rehired within 6 months:

• If employee returns to work within 6 months, you can automatically waive any waiting period and re-enroll the employee. The employee must be reinstated within 61 days of being rehired. To do this simply email admin@groupinsurance.rbc.com or use the ‘contact us’ feature with your groups policy number, name of the returning employee, the date the employee returned to work and the effective date of coverage.

Rehired after 6+ months:

• If the employee returns to full-time work more than six months after employment termination, the employee is considered a new employee and the waiting period won’t be waived; the usual enrolment procedures are followed. Have the employee complete the Group Enrollment Form and then sign into Online Administration to enroll your employee. Keep the original Group Enrollment Form on file. Refer to the ‘How to’ section ‘Add a plan member’ for detailed instructions.

Rehired after maternity/parental leave or layoff:

• You can waive the waiting period if an employee returns to work on a full-time basis after the end of a statutory maternity/parental leave or a layoff if the employee elected to discontinue coverage during the maternity/parental leave of absence. The employee must be reinstated within 61 days of returning. To reenroll the returning employee, email admin@groupinsurance.rbc.com with your policy number, name of the returning employee’s name, the date the employee returned to work and the effective date of coverage.

Out of Country Business Travel

Employees on Work Assignment Outside of Canada

• Business travel for 12 months or less to a country not considered “High Risk” below is permitted.
• Business travel for 12 months or less to a country not considered “High Risk” below is permitted.
• Business travel for any length of time to a “High Risk” or “Country of Concern” requires approval.
• An Out of Country Business Travel form must be completed when approval is required as outlined above.

“High Risk” Countries or “Countries of Concern” are generally defined as ones where the Government of Canada has a “avoid all travel” advisory in effect. Our current countries of concern are:

Quebec Residents Only

As part of strengthening French language requirements, the Quebec government has introduced Bill 96, effective June 1, 2023. Bill 96 requires businesses to respect their Quebec residing clients’ right to be informed and served in French.

To comply with the Bill 96 regulations, RBC Insurance will be providing the ‘Plan member booklets/ certificates’ in both English and French to plan members residing in Quebec. Non-Quebec residing plan sponsors with Quebec based employees can reach out to RBC Insurance Sales and Service teams to request French booklets.

When speaking to clients residing in Quebec, remember to:

• Present applications and all other policy documents in French first, even if their preferred language is English.
• Delete any previous versions of the applicable paper forms and the online enrollment templates. We strongly encourage you to use the new updated versions dated June 2023 and onward, as using an incorrect version may result in the application being rejected.