Eligibility Criteria for Spouse and Dependents

For GreenShield Coverage:

To be eligible for coverage, a spouse must be:

  • a Canadian resident covered under a provincial health insurance plan; and
  • legally married to your plan member or, if not legally married, has lived in a common-law relationship with the plan member for more than 12 continuous months. Only one spouse will be considered at any time as being covered under the Group Benefit Contract.

To be eligible for coverage, a dependent child must be:

  • a Canadian resident covered under a provincial health insurance plan;
  • an unmarried child who must be under the age 21; and
  • a child (plan member’s or plan member’s spouse’s natural, legally adopted, or stepchildren) who resides with your plan member in a parent-child relationship and/or is dependent upon your plan member, and not regularly employed.

To be eligible for coverage, an overage (adult) dependent must be:

  • a Canadian resident covered under a provincial health insurance plan; and
  • an unmarried child who is under age 25, if enrolled and in full-time attendance at an accredited college, university, or educational institute

Note: Children who are in full-time attendance at an accredited school do not have to reside with your plan member or attend school in their province. If the school is in another province, your must apply to your provincial health insurance plan for an extension of coverage to ensure the child continues to be covered under a provincial health insurance plan. Please note that the limitations of the Travel plan still apply*

*The travel insurance coverage requires the member to have active provincial health coverage, or GHIP (Government Health Insurance Plan) to be valid.  Each provincial plan has a set limit to the number of days they allow residents to be out of the province and continue to have active coverage.  If the time out of province is longer than the provincial plan allows (in Ontario, the day limit is 212 days), an extension to the provincial plan day limit is necessary in order to avoid losing active coverage and therefore the travel medical coverage.

Plan members need to determine how long they will be away against the number of days covered by their provincial plan and apply for an extension with their province if necessary.  The member can contact their provincial health plan for more details on extending active coverage while away.

Coverage begins when the individual leaves their province of residence and remains valid until the end of the school year plus 7 days, for the student to organize themselves and get home.  Anything beyond that will require them to purchase individual coverage regardless of how long their GHIP coverage is in place for.

If there is a medical emergency while away, the member will call the emergency number on their insurance card to begin filing a claim.  The member will need to advise the agent they speak to that they are in full time school and their plan does allow for the day limit to be extended when in full time study outside of Canada. The GHIP documentation including extension and proof of full time study will be required along with the insurance claim.  As a reminder, if the student has an emergency but requires additional treatment after the emergency is done and they are stable to travel, they must return to their home province.

To be eligible for coverage, a Special Needs dependent must be:

  • an unmarried child of any age, who is totally disabled by reason of mental or physical disability 
  • remains continuously so disabled, and is considered a dependent as defined under the Income Tax Act, provided the child was, or became, so disabled prior to the date they reached the applicable maximum age.

You may be required to complete and sign the Request for Change in Dependents form to confirm the dependent meets GSC’s eligibility requirements under the following conditions:

  • An existing dependent has just become a Special Needs dependent
  • A request is made to add a dependent who is a legal ward of the plan member
  • Validation of “in school” status

Please email our office at benefits.hr@lakeheadu.ca to request this form if applicable. 

Surviving Dependents

In the event of a plan member’s death while covered by this plan, coverage will continue for the eligible covered dependents until the earliest of the following dates:

  • 24 months after the date of death;
  • The date the covered person would no longer be considered a dependent under the plan if your plan member were still alive; or
  • The date the benefit plan under which the dependent is covered terminates.