| Company Name: |
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| Mailing Address: |
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| City: |
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| Province: |
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| Postal Code: |
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| Phone: |
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| Fax: |
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| Contact Name: |
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| Email Address: |
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| Preferred Method of Contact: |
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| Name the Regional Landscape Association you are a member of: |
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GROUP LIFE INSURANCE
Proprietors, Officers
& Supervisory Staff (Class A):
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2 x annual earnings up to a maximum of $850,000 (Evidence of insurability required for amounts in excess of $600,000)
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| All Other Employees (Class B): |
1 x annual earnings up to a maximum of $25,000 |
ACCIDENTAL DEATH AND DISMEMBERMENT
All Employees
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2 x the Group Life Insurance amount
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DEPENDENT GROUP LIFE
Spouse
Child(ren)
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$5,000
Birth to 13 days - $500
14 days to age 21 - $2,500
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LONG TERM DISABILITY
Waiting Period:
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90 days 120 days |
| Benefit Period: |
Payable to age 65 |
| OWN OCCUPATION DEFINITION |
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| Proprietors, Officers & Supervisory Staff (Class A): |
3 years |
| All other employees (Class B): |
2 years |
| Monthly Benefits: |
70% of monthly earnings to a maximum of $8000 |
EXTENDED HEALTH CARE
Yearly Deductible:
Hospital:
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$25 single/$50 family
Semi-private room rate
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Plan pays 100% of Covered Medical Expenses over the deductible amount in any one calendar year. |
DRUG CARD
Annual Deductable:
Managed Health Care Drugs:
Prescription Drugs:
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Nil
80%, 90%, or 100% Co-insurance
80%, 90%, or 100% Co-insurance
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| OPTIONAL BENEFITS: |
Dental Care
Vision Care
Short Term Disability
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| *EMPLOYEE DATA REQUIRED FOR COSTING (All Fields Mandatory) |
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RATES ARE SUBJECT TO REVIEW ANNUALLY (AUGUST 1) |
