Administrative FAQs

As a Plan Member you have questions. We have answers

We know group insurance benefits can be confusing. We are here to help and have detailed some of the more frequently asked questions and subsequent answers. If you require additional assistance, please do not hesitate to contact RWAM directly.

Please note these frequently asked questions contain general information only, are subject to change, and may not apply to your specific situation. Your Employee Benefits Booklet outlines the specific coverages associated with your group plan as well as any requirements and exclusions specific to your plan.

I forgot my User ID and password for the Plan Member Services website. How do I obtain this information?

RWAM does not record or have access to individual IDs. Go to the RWAM Plan Member Services website and click  'Forgot your User ID'.  After you have entered your verification information, our system will retrieve your 12-digit User ID. This number should be recorded.

If you don't remember your password, click on 'Forgot your password'.

  • If your email address is on our system, the option will appear to have your password emailed to you. There is a two-email process for security purposes. Click on the hyperlink inside the first email, which will open a new web browser page, where you will be asked to confirm that you wish to receive a temporary password by email. Once you complete that page, you will receive a second email containing a temporary password. Use the temporary password and your user ID to sign in on the Plan Member website/mobile app, and you will be prompted to change your password. The password must consist of 8-12 characters, including upper and lower case letters and at least one number (no symbols).
  • If there is no email address attached to your profile, please request assistance using our Information Request Form.

What is a RWAM OneCard?

Your RWAM OneCard contains your group number and individual certificate number and can be used at the pharmacy, hospital and/or dentist. Emergency Travel Assist telephone numbers are listed, if applicable to your group plan, for assistance while travelling outside your province of residence or Canada.

Can I view/print a copy of my RWAM OneCard online?

A replacement card can be printed from the Plan Member Services website. You can also contact your Group Plan Administrator, or contact RWAM directly to have a new card sent to your employer. 

If you have the RWAM Mobile App, you can access your RWAM OneCard at any time through the app. 

How long do I have to apply for benefits after I have been hired?

Check your Employee Benefits Booklet for your group's waiting period. You have 31 days from your date of eligibility to submit your completed enrolment form.   If your enrolment form is submitted to RWAM more than 31 days after you first become eligible for insurance, you are considered to be a 'late applicant' and Evidence of Insurability will be required for you and any eligible dependents.  Coverage will not take effect until all required information is submitted to RWAM, reviewed, and written approval is received with the effective date of coverage.  Please note that the effective date is not retroactive and reflects the date approved by the insurer. 

How long will it be before I receive my RWAM OneCard?

RWAM OneCards are printed at RWAM the day after your enrolment has been added to our system. They are mailed to your employer. 

Will my eligible dependents' names appear on my RWAM OneCard?

Dependent names will appear if your drug plan is with Green Shield Canada.  If your drug plan is with Express Scripts Canada dependent names will not appear on the card. Your RWAM OneCard will always have your name on it as you are the insured plan member. 

What is the difference between issue date and effective date on my RWAM OneCard?

You may waive Extended Health Care and/or Dental benefits if you are currently covered under your spouse's or common-law spouse's plan.  You are still eligible for any other benefits your group plan may have (i.e. Life insurance and Disability insurance, if applicable).

A refusal of all coverage is discouraged, as a certain level of participation of eligible employees must be met.  In some cases, you may have the option to refuse all coverage but cannot choose some benefits and refuse others.  If you refuse all coverage, you can apply for coverage in the future but health evidence will be required.  You should not refuse coverage solely because you are covered for comparable Extended Health Care and/or Dental benefits under your spouse's plan.

What is the difference between 'Refusal' vs. 'Waiving' of benefits?

You may waive Extended Health Care and/or Dental benefits if you are currently covered under your spouse's or common-law spouse's plan.  You are still eligible for any other benefits your group plan may have (i.e. Life insurance and Disability insurance, if applicable).

A refusal of all coverage is discouraged, as a certain level of participation of eligible employees must be met.  In some cases, you may have the option to refuse all coverage but cannot choose some benefits and refuse others.  If you refuse all coverage, you can apply for coverage in the future but health evidence will be required.  You should not refuse coverage solely because you are covered for comparable Extended Health Care and/or Dental benefits under your spouse's plan.

What does Non-Evidence Maximum (NEM) refer to?

Certain benefits (such as Life, Accidental Death & Dismemberment, and Disability coverage) may be wage-related. A Non-Evidence Maximum (NEM) refers to the maximum amount of insurance coverage which may be available to an eligible insured person without having to provide medical evidence of health (Evidence of Insurability). If a NEM applies to a particular benefit under your group plan, the NEM amount will be stated in your Employee Benefits Booklet on the applicable 'Schedule of Benefits' page. For some group plan benefits without a specified NEM, mandatory Evidence of Insurability may need to be provided. Check with your Group Plan Administrator.

You should review your coverage regularly, especially if your salary increases, to determine if you are eligible to apply for additional coverage beyond the NEM.  Coverage approved over and above the NEM will be subject to an overall maximum coverage amount, stated on the 'Schedule of Benefits' page of your Employee Benefits Booklet.  If you are uncertain or have any questions about your eligibility, contact your Group Plan Administrator or RWAM Group Administration.

How do I apply for additional coverage over the Non-Evidence Maximum (NEM), assuming I'm eligible to do so?

You must complete and submit a Group Health Evidence form (also known as Evidence of Insurability) to RWAM for additional coverage over and above the Non-Evidence Maximum (NEM). Please ensure that the correct insurance carrier's form is submitted (providers are listed at the back of your Employee Benefits Booklet). Health evidence forms for the various insurance carriers are available on our Forms page.

Can I cover my spouse and dependent children?

Depending on the benefits offered through your group plan, you may be eligible to elect family coverage. Your Employee Benefits Booklet contains detailed information as to spousal and dependent child eligibility requirements. Most plans allow for an extension of coverage for a dependent child over age 21 who qualifies as a full-time student.

If you have a dependent child with a mental or physical disability, or any other special circumstances, please contact your Group Plan Administrator or RWAM Group Administration to determine if coverage is available or can be extended. 

Am I obligated to elect family coverage, if my spouse has family coverage through their employer?

No, if comparable coverage is in place through your spouse, you are not obligated to elect family coverage.  However, you may choose to take family coverage as a way to coordinate benefits to a maximum of 100% of your eligible expenses. 

Coordination of Benefits - when more than one benefit plan exists, to which plan should I submit claims?

You should submit your claim to your own Insurer first (primary carrier).  Your spouse should submit to his/her carrier.  Claims for dependent children must be submitted to the plan of the parent with the earlier birth date in the calendar year.  If the parents have the same birth date, then submit the claim to the plan of the parent whose first name begins with the earlier letter in the alphabet.  This is referred to as Coordination of Benefits (COB). If you will be coordinating claims please complete the Coordination of Benefits form available on our Forms page.

If any portion of a claim is not covered/paid by the primary carrier, the claim for the balance of expenses should be sent to the secondary carrier for consideration (the amount reimbursed cannot exceed 100% of allowable expenses).

In situations where parents are separated / divorced, then the following order applies: 1) the plan of the parent with custody of the child; 2) the plan of the spouse of the parent with custody of the child; 3) the plan of the parent not having custody of the child; and 4) the plan of the spouse to the parent in item (3).  Take photocopies of your claim and receipts.  Submit your claim to your Insurer based on the above criteria.  Once you receive your cheque and Explanation of Benefits (EOB) statement, complete a new claim form for the other carrier.  Attach the EOB statement with photocopies of your original claim. Submit this information to the coordinating plan (your spouse's). 

When is a trustee required for my beneficiary designation?

A trustee is required if the beneficiary is under the age of 18 or incapacitated.  Once the beneficiary attains the age of 18, RWAM does not automatically remove the trustee.  A new designation must be received to make this change.  This allows the employee the choice of when to remove the trustee.  It is important to review your beneficiary designation if your personal circumstances or those of your beneficiary change.  Laws vary between provinces.  If you have concerns we recommend you speak to a lawyer. 

What is a Dependent Child?

A child is considered an eligible dependent under your group insurance plan when the child is:

  • under age 21 (or according to your employer's plan),
  • not working full-time,
  • legally and financially dependent on you for support, and
  • unmarried.

What do I need to do if my dependent child is 21 or older and attending school?

I have a dependent under 21 years of age but working full-time. Are they still eligible under my plan?

No, as they are no longer considered to be fully dependent on you, they would not qualify as an eligible dependent. 

What if my dependent child is studying outside their home province?

RWAM must be notified using the form 'Out-of-Province/Out-of-Canada Coverage Extension Request for Student Study/Work Term' if a dependent child is studying outside of their home province and will be away for a consecutive time period exceeding your group insurance Out-of-Province/Out-of-Canada plan limitations.  Refer to the 'EHC Schedule of Benefits' page of your Employee Benefits Booklet for your Out-of-Province/Out-of-Canada trip limitation. 

If I am under age 21, but working full-time, am I obligated to elect coverage?

Yes, you are no longer considered to be fully dependent, and therefore are not eligible to remain on your parents' group insurance plan. 

Do I need to report changes in my personal status?

Yes. You should contact either your Group Plan Administrator or RWAM Group Administration directly to report any changes in your personal status or life circumstances which might affect your coverage, including:

  • Marital status (divorce, marriage, separation, common-law)
  • Changes in your name or that of your dependent(s)
  • Birth of a child, adoption, student coverage, disabled child

Whenever you have a major life change, it is advisable for you to review your beneficiary designation to see if it is up to date and reflects your current wishes. Refer to your Employee Benefits Booklet for more information under the heading 'Changes Affecting Your Coverage'. 

Can I continue to cover my ex-spouse?

Yes, provided there is a court order (divorced) and that you are not remarried or living common-law.  Group insurance does not allow more than one individual at a time to be covered as a dependent spouse or common-law spouse. 

Can I continue to cover my ex-spouse?

Yes, please update your address on the Plan Member Services portal, or advise your Plan Administrator or RWAM.

I'm leaving my employer and will no longer have any group Life, Health and/or Dental insuranc. What options are available to me?

If your group Life insurance coverage is being terminated because your employment has terminated or you are no longer eligible for group insurance coverage, you may be entitled to convert your existing group Life coverage to an individual Life insurance policy. To convert group Life coverage to an individual policy, you must apply to the Insurer (via RWAM) within 31 days after the date your group Life coverage terminates. You should contact RWAM's Group Life Insurance Department immediately for information and necessary forms.

With group Health and/or Dental insurance, you may be eligible to convert your coverage to an individual plan. This must be done within 60 days of the applicable termination date. Please contact RWAM's Group Accounting Department for further information.

For Out-of-Province/Out-of-Canada options, please call SecuriGlobe directly at 1-844-370-2065.  SecuriGlobe has access to 14 different carriers to obtain the best possible rate for an individual or family, depending on their specific needs.  Single and multi-trip annual emergency medical plans are offered, along with trip cancellation, trip interruption, snowbird, sport travel and special risk coverage.

 

What is a Benefits Confirmation?

RWAM produces a Benefits Confirmation for each insured employee once a year.  The Benefits Confirmation includes all pertinent employee information, as well as Health and Dental claims paid for the current and previous year.  Employees should carefully review the Confirmation to ensure all information is current.  Any changes to earnings, dependents or beneficiary must be reported to RWAM.