General Policy Terms

Important Information

The information on this website outlines the eligible benefits covered under the Writers' Coalition Program. This Plan was developed specifically for the arts and membership is limited to the artistic community associated with a Participating Organization. When requested by a Participating Organization, its employees may also apply. The Plan is underwritten by Actra Fraternal Benefit Society (AFBS).

AFBS is a not-for-profit, Member owned, federally incorporated insurance company and financial institution operating for over 30 years. Members of AFBS are primarily members of ACTRA and The Writers Guild of Canada. AFBS is proud to expand its membership across Canada to include associate members that come from other professional organizations in the arts (Participating Organizations).

All terms and conditions with respect to the Writers' Coalition Program are governed by the master policy, issued by Actra Fraternal Benefit Society. In the event of a discrepancy, benefits will be paid according to the terms of the master policy and applicable legislation. The master policy is issued in Ontario and governed by the laws of that province.

AFBS insures extended health care, dental, prescription drug, life, and accidental death & dismemberment under the Writers' Coalition Program.

Travel emergency medical is provided by Industrial Alliance Insurance and Financial Services Inc and the member and family assistance program is provided by Morneau Shepell. The terms and conditions contained in the policies of these two programs issued by the providers to AFBS apply.

AFBS retains the right to change, modify or terminate in whole or in part, any insurance benefit contained in our policy and add or remove benefits from other providers. We do not have control over Industrial Alliance and Financial Services Inc or Morneau Shepell and they can change, add, remove or terminate in whole or part, any insurance benefit contained in their policies.

Definitions

Insured Person: Means a member or, where applicable, their dependant(s) who are insured under the provisions of this policy.

Member: Means a member of a Participating Organization or such other individual as the Policyholder may deem eligible to participate under this policy and who has applied for and been issued a Certificate of Insurance by AFBS.

Participating Organization: Means an organization that meets the Writers' Coalition Program eligibility, as established by the Policyholder, and where a Letter of Understanding is on file with the Policyholder.

The Contract

The Group Insurance Policy #22000, the member’s application for coverage (Enrollment Form) under the Writers' Coalition Program, Letters of Understanding with Participating Organizations, your Certificate of Insurance as issued by AFBS, AFBS’ Instrument of Incorporation and its by-laws and all amendments thereof, constitute the entire policy. Any changes, additions or amendments to the AFBS Instrument of Incorporation or its by-laws made subsequent to November 1, 2011 which is the issue date of Group Insurance Policy #22000 shall be binding and shall thereafter govern and control this policy in all respects.

All statements in the member’s application for coverage (Enrollment Form) shall be deemed representations and not warranties. No statement shall invalidate the policy or be used by AFBS to contest a claim unless it is contained in the application.

Incontestability

Any Certificate of Insurance issued shall be incontestable except for non-payment of premium after it has been in force for two (2) years from its Effective Date of Coverage. No statement relating to the insurability of any Insured Person may be used in contesting the validity of the insurance for which the statement was made after the insurance has been in force for a period of two (2) years during the Insured Person’s lifetime. However, AFBS may contest the validity of insurance for any Insured Person at any time in the event of fraudulent statements. In the absence of fraud, all statements made are deemed to be representations and not warranties.

Payment of Premium

Premiums are due in advance. Where the monthly pre-authorized debit mode has been elected by the member, each monthly premium withdrawal will be on the 15th of each month or the first business day thereafter.

A grace period of 31 days after the premium date is allowed for the payment of each premium due. During the grace period coverage remains in effect. If any premium remains unpaid at the time of its grace period, coverage will terminate immediately on the expiry of the grace period and as of the last date for which premium has been received.

Premium Rate Change

Premiums are based on the member’s age at the beginning of each Benefit Year. AFBS may change the age band premium rates charged for all insured members. The insured member’s monthly premium rate will change at the commencement of the next Benefit Year, as stated on the Certificate of Insurance, provided the member has received at least 30 days written notice in advance of the premium rate change.

Notice and Proof of Claim

Written proof of claim for health benefits must be given to AFBS within 90 days of the end of the Benefit Year in which the expense was incurred. However, when an Insured Person’s insurance terminates for any reason, written proof of claim must be given to AFBS not later than 30 days following the date of termination of insurance.

AFBS shall have the right to request a medical or dental examination, at its own expense, when and so often as may be reasonable. Payment of any claim will be made only to the member. Such payment shall fully discharge AFBS to the extent of such payment.

Legal Actions

No action or proceeding against AFBS in respect of claim made under Group Insurance Policy #22000 will be started within 60 days of the date on which initial proof or claim is provided to AFBS. No such action will be taken against AFBS more than one (1) year (or such longer period that is specifically required by law) after the end of the period within which the initial proof of claim is required by AFBS.

Subrogation (Third Party Liability)

In the event that benefits under this policy are payable with respect to an Insured Person and in the further event that such Insured Person has a right to recover damages from any individual or organization, AFBS will be subrogated in the amount of any benefits paid under this policy to the rights of recovery of the Insured Person against any such individual or organization. The Insured Person will reimburse AFBS in the amount of any benefits paid out of the damages recovered. Without limiting the generality of the foregoing, the term ‘damages’ will include any lump sum or periodic payments received on account of (i) past, present or future loss of income, and (ii) any other benefits, otherwise payable under this policy.

A member shall be required to notify AFBS immediately if he or his dependant commences an action against a third party which includes a claim for wage loss or for any other benefits, otherwise payable under this policy. The Insured Person’s solicitor shall represent the AFBS’ subrogated rights unless AFBS provides notice to appoint another solicitor to act on its behalf. AFBS reserves the right to commence an action to pursue the subrogated rights contained herein against the third party, in which event, the member agrees to fully co-operate with AFBS in pursuing claim against the third party.

The member shall be required to notify AFBS about any judgements or settlements of claims against a third party in the circumstances indicated above. The member shall also provide all records, transcripts, reports and information to AFBS that may be reasonably demanded with respect to the calculation or allocation of damages.

If a lump sum payment is made under judgement or settlement for loss of future income or for future periodic or lump sum benefits which would otherwise be payable under this policy, no further benefits will be paid under this policy until such time as the monthly or periodic benefits which would otherwise be payable under this policy equal the amount received in a lump sum.

If a claim for damages against a third party is settled before trial, AFBS shall be reimbursed the amount that reasonably reflects the loss of (i) past, present and future income, and (ii) any other periodic or lump sum benefits, that would otherwise be payable under this policy, notwithstanding the actual terms of the settlement.

Right of Recovery

Whenever payments have been made by AFBS for eligible expenses which in total exceed the maximum amount payable at the time of claim, AFBS shall have the right to recover such payment, to the extent of such excess, from one or more of the following, as determined by AFBS:

  1. the Insured Persons;
  2. any other insurance organization; and
  3. any other organization.