FAQ - Medical and Dental
The policy number for ACTIVE members is 44501 and for RETIRED/SURVIVING members is 6772.
The ID number for ACTIVE members is their WIN ID and for RETIRED/SURVIVING members is their Client ID with the Ontario Pension Board.
New Hire: Insured benefits will be effective on the first of the month coinciding with or following two months of continuous service.
Example:
Date of Hire: April 5
Effective Date of Insured Benefits:
May 1 (member has 2 months continuous service on date of hire)
July 1 (member did NOT have 2 months of continuous service on date of hire)
Direct Hire/Amalgamated members: Insured benefits coverage is effective on the date of hire.
Retired members: Insured benefits coverage is effective the 1st day of the following month after retirement.
If your spouse/partner has a benefit plan, your claim expenses can be submitted to both plans based on the Coordination of Benefit (COB) rules. Claims must be submitted to your own plan first (primary) and then any balance remaining may be submitted to the secondary plan.
The secondary plan assesses any unpaid portion, provided they are eligible expenses. Eligible expenses are as defined in each carrier’s contract.
Claims for children are submitted first to the plan of the parent whose birth date falls earliest in the calendar year. For blended families, please contact Target Benefit Administrators for assistance at 1-888-660-6055 or at 416-740-1335 or via e-mail at target@wlvinc.com
Anytime there is a change in group insurance coverage for member’s spouse or dependents you must update your file. The Insured Benefit/Drug Card Change form (Form 820) may be used and is available via the OPP Association website at www.oppa.ca by clicking on “Benefits” and click “Target Benefits Forms Library”.
For special coordination, please contact Target Benefit Administrators for further information at 1-888-660-6055 or at 416-740-1335 or via e-mail at target@wlvinc.com
Pre-determination of benefits is providing an estimate of the cost of a proposed course of treatment to Canada life to determine eligibility. Submission may be done by paper claim or through GroupNet (My Canada Life at Work) for Plan Members. This process is recommended if the cost of the service or product (dental, orthotics, etc.) is $200.00 or greater. Canada Life will confirm if the service is an allowable claim under the plan and the dollar amount that would be reimbursed.
Your provider may be able to submit your claim directly to Canada Life.
Member E-claims can also be submitted through GroupNet (My Canada Life at Work) for Plan Members at www.canadalife.com
Use the GroupNet (My Canada Life at Work) app and submit claims through your mobile device.
Health and Dental paper claims and original receipts are mailed to:
Canada Life Assurance Company
London Benefit Payments
PO Box 5111, Station B
London, ON N6A 0C6
Direct reimbursement to a provider may be available if the provider allows that option. If your claim is submitted through GroupNet (My Canada Life at Work) you must be signed up for direct deposit. If you submit paper claims, you may opt for reimbursement by cheque or direct deposit.
Members can register for direct deposit once you have signed in on Canada Life’s secure website at www.canadalife.com or by contacting Target Benefit Administrators for a direct deposit form. https://www.canadalife.com/
Check through the GroupNet App(My Canada Life at Work) or once you have signed in on Canada Life’s secure website at www.canadalife.com to view the status of your claim.
For further assistance contact Target Benefit Administrators 1-888-660-6055 or at 416-740-1335 or via e-mail at target@wlvinc.com
Canada Life will provide an Explanation of Benefits by mail or through GroupNet (My Canada Life at Work). You may contact Canada Life at 1-800-957-9777 to inquire about the reason for the denial and if further investigation is required you may contact Target Benefit Administrators at 1-888-660-6055 or at 416-740-1335 or via e-mail at
Dental benefits cease on the date of resignation and health benefits cease at the end of the month of the resignation date.
FAQ - Group Insurance Benefits
For information regarding Active and Retired Members insurance options please review the Plan Overview available via the OPP Association website at www.oppa.ca by clicking on “Benefits” and click “Benefits Resources” and select “Member Benefit Services (Target Benefit Administrators) “and select “My Benefits”
Active members can add or increase optional life insurance policies except during specific leave of absences. Medical underwriting (Evidence of Insurability) may be required, unless within 31 days of a new hire or life event; marriage, divorce, birth, adoption, or death of a dependant. It is advisable to contact Target Benefit Administrators to review your file at 1-888-660-6055 or 416-740-1335 or via e-mail at target@wlvinc.com
Complete the OPPA Group Insurance form (Form 800) and if applicable the Evidence of Insurability form (Form 300-employee or Form 400-spouse/partner) located in the “Forms Library” section of the Member Benefit Services area on the OPPA website at www.oppa.ca. www.oppa.ca
The effective date for insurances not requiring Evidence of Insurability will be the first of the month following the date the original form is received by Target Benefit Administrators. The effective date for insurances requiring evidence of insurability will be the first of the month coinciding with or following the date coverage is approved by the insurance provider.
Members must contact Target Benefit Administrators at 1-888-660-6055 or 416-740-1335 or via e-mail at target@wlvinc.com
All updates to beneficiaries are effective on the date of signing the applicable form. Target Benefit Administrators MUST receive the original OPPA Group Insurance Form as soon as possible after it is signed. It is recommended that members maintain a copy of the form for their records.
The primary beneficiary would receive the insurance proceeds upon the death of the insured. If the primary beneficiary is deceased at the time of the death of the insured, then proceeds are paid to the contingent beneficiary. If there is no contingent beneficiary listed, the insurance proceeds will be payable to the estate.
If there is no contingent beneficiary listed, the insurance proceeds will be payable to the estate.
Revocable beneficiaries can be changed at any time. Irrevocable beneficiaries cannot be changed unless written consent is provided from the Irrevocable Beneficiary.
FAQ - Service Questions
Contact Target Benefit Administrators at 1-888-660-6055 or 416-740-1335 or via e-mail at target@wlvinc.com
Members may contact Target Benefit Administrators at 1-888-660-6055 or 416-740-1335 or via e-mail at target@wlvinc.com
New hires/transfers from fixed-term to regular status with the OPP/transfers from fixed-term or regular status within the Ontario Public Service:
Provide to the OPP Association via mail at 119 Ferris Lane, Barrie, ON L4M 1Y1 or e-mail to benefits@oppa.ca
Active or Retired members:
Provide to Target Benefit Administrators via mail at 401-5100 Orbitor Dr. Mississauga, ON L4W 4Z4 or e-mail to targetforms@wlvinc.com
Original form with inked signature always accepted. Photocopy, facsimile or electronic transmission will be accepted if they include an “INKED” signature. Digital signatures will not be accepted.
E-mail completed forms to targetforms@wlvinc.com
Members must first provide Payroll Operations Branch, Ontario Shared Services, 777 Memorial Avenue, Orillia, ON L3V 7V3 a completed WIN Employee Data Change Form (including WIN ID) and a copy of their SIN card or SIN letter which shows their name change. The name in WIN must reflect the members current legal name that is on their SIN card/letter. Any questions can be directed to the OPS Service Centre at 1-888-996-7772 or at opssc@ontario.ca Members must then complete the OPPA Group Insurance Form (Form 800) located in the “Forms Library” section of the Member Benefit Services area on the OPPA website at www.oppa.ca. Target Benefit Administrators must receive the original (with an INKED signature) of the OPPA Group Insurance Form or a photocopy, facsimile or electronic transmission of the form as soon as possible after it is signed. Digital signatures will NOT be accepted. www.oppa.ca
Active members with WIN access update their address and contact information on WIN. Active members without WIN access contact the Ontario Shared Services Contact Centre at 416-326-9300, 1-866-979-9300 or at askoss@ontario.ca
Retired/Surviving members contact Target Benefit Administrators at 1-888-660-6055, 416-740-1335 or target@wlvinc.ca and also complete an OPB1004 – Retired Member Information Change Form which is available on the OPB’s website at www.opb.ca
Active/Retired/Surviving members should also advise the OPP Association at 1-800-461-4282, 705-728-6161 or at oppa@oppa.ca if contact information has changed.
Active members will need to provide your WIN number and Retired/Surviving members will need to provide your OPB Client ID number.
FAQ - Travel Assist
• Assistance in locating hospitals, clinics and physicians
• Liaise with treating hospital and arrangements to return to home
• Medical Advisors
• Advance payment when required for hospital admission
• Helping to locate qualified legal assistance, local interpreters and appropriate services for replacing lost passports
• Assisting unattended children
• Return of vehicle
• Medical evacuation
• Travelling companion expenses
• Repatriation – in the event of death while traveling, assistance with arrangements for preparing and transporting remains
Travel Assistance is available for emergency medical situations anywhere in the world, including Canada if you are travelling more than 500km from home.
For additional details refer to the Travel Assistance Overview located via the OPP Association website at www.oppa.ca by clicking on “Benefits” and click “Benefits Resources” and select “Member Benefit Services (Target Benefit Administrators)” and select “My Benefits”.
Be prepared with as much of the following information as possible:
• your name
• employer’s name
• policy number (44501 for Active members) and (6772 for Retired members)
• ID number (WIN for Active members) and (Client ID# for Retired members)
• Travel Assist ID number (870)
• a description of the situation
• phone number to reach you for follow-up with information and/or questions during your case.
You may be asked the following questions:
• Are you in pain now?
• When did your symptoms first begin?
• Are you alone or are you with a traveling companion?
• Do you need help getting to a doctor or hospital?
Out of Province coverage refers to travelling to a difference province within Canada other than your home province. Most provinces and territories have reciprocal billing arrangements for insured hospital and physician services. Contact provincial healthcare for specific details. Out of Country coverage refers to medical insurance coverage outside of Canada.
If you are traveling outside of Canada for business, vacation or education and have maintained provincial healthcare coverage, you and if applicable your spouse and eligible dependent children are covered for unforeseen medical emergencies which may arise.
An unforeseen medical emergency is:
• A sudden and unexpected injury/illness;
• The onset of a condition not previously known or identified prior to departure from Canada; or
• An unexpected episode of a condition known or identified prior to departure from Canada, meaning it would not have been reasonable to expect the episode to occur while travelling outside of Canada
The medical treatment includes the initial emergency until return to Canada is possible:
• Physician fees
• Diagnostic x-ray and laboratory services
• Hospital room fees
• Medical supplies provided during a covered hospital confinement
• Paramedical services provided during a covered hospital confinement
• Hospital outpatient services and supplies related to and required as a result of the medical emergency
• Prescription medication as a result of the medical emergency
The following out-of-country expenses are not covered:
• Expenses related to pregnancy or delivery within 9 weeks from expected due date of pregnancy or at any time prior to the 9th week if the patient’s Canadian physician considers the pregnancy a high risk
• Scheduled testing and/or treatment of a condition even if deemed urgent, when the patient’s medical condition permits a return to Canada
• Continued or ongoing medical care following an emergency outside Canada, if the patient’s medical condition permits a return to Canada for treatment
• Cosmetic, investigational and/or experimental treatment
• Trip cancellation, trip interruption or loss or damage of baggage
The out-of-country benefit pays for medical emergencies which cannot be reasonably anticipated, based on the member’s medical experiences in the 90 days leading up to their departure from Canada.
If a person was suffering from symptoms before departure from Canada, Canada Life may request medical documentation to determine if it could have reasonably been anticipated that the person may require medical treatment while outside Canada.
The intent is not to find ways to decline valid claims. Rather this ensures that only claims for medical expenses which truly could not have been reasonably anticipated by the patient are processed.
The plan does not provide for non-emergency services acquired while outside Canada. Plan members are encouraged to purchase a sufficient supply of prescription medications before leaving Canada.
In a situation where prescription medication is lost or stolen, eligibility would be assessed by Canada Life.
The only exclusions under this category are:
• Persons who are receiving a sponsorship or are paid in some manner to participate in the activity, example: competitive sport competitions, activity guide or instructor
• Rescue missions where the patient is not injured or requiring acute medical attention in a hospital setting
War, Riot, Insurrections
Coverage is not available to anyone who is actively participating in an act of war, civil unrest and insurrection.
Travel Advisories *
The out-of-country plan does not distinguish coverage eligibility if travelling to a travel advisory region. Canada Life will uphold all coverage and assess claims.
Pandemic *
Coverage does not exclude emergency medical treatment related to a Pandemic. The pre-existing clause applies.
*If a person travels outside of Canada during a Pandemic or to a country where there is a Travel Advisory, treatment for an unexpected medical emergency will be assessed like any other claims under the plan.
If electing to travel in these situations, there may be difficulties in obtaining medical treatment and Travel Assistance may be refused entry. Canada Life advises adherence to the travel advisories and warnings from the Government of Canada.
This is no lifetime maximum or maximum on days you can travel, as long as
you continue to reside in Canada and your provincial health care coverage is in place.
The Out of Country coverage policy provides coverage for the initial emergency until you can return to Canada. If you return to your vacation residence and experience a related medical event to the initial emergency, expenses may not be covered.
• Ongoing or follow up appointments and/or scheduled treatments
• Treatment that is not required immediately following the emergency - for example, surgery may be scheduled out of country, but the patient is stable enough to be returned to Canada for treatment
• Member has not maintained provincial health coverage
• Canada Life ID benefits card
• Travel assist card, available from GroupNet (My Canada Life at Work) for plan members or through the GroupNet mobile app.
• Confirmation of medical coverage letter, available from GroupNet (My Canada Life at Work) for plan members or through the GroupNet mobile app.
• Printout of your eligible dependents from GroupNet (My Canada Life at Work) for plan members
• Provincial health card
• Valid passport
Travel Assistance should be contacted before obtaining treatment when possible. The Travel Assistance team will assist in finding a hospital, clinic or physician for treatment. When the medical emergency requires immediate transportation to a medical facility, it is understood that Travel Assistance would be contacted after treatment has begun.
As soon as possible, contact Travel Assistance. The phone numbers are included on the Travel Assistance Card available through GroupNet for plan members or the GroupNet mobile app. The contact numbers on the Travel Assistance card should be used in the event of an emergency only.
From Canada or the U.S: 1-855-222-4051
Cuba: 1-204-946-2946 *
All other countries: 1-204-946-2577 *
*Submit long-distance charges to Canada Life for reimbursement.
Be prepared with as much of the following information as possible:
• Patient name and member name (if not patient)
• Active members - policy number 44501 & WIN ID Number
• Retired members & Survivors – policy number 6772 & OPB Client ID
• Travel Assistance contract number 870
• A description of the medical emergency
• Phone number to reach you for follow-up and/or questions during your case.
You will be given a case number for reference. A multilingual Assistance Coordinator will render whatever assistance is necessary, and an Emergency Response Team will monitor your case until the situation is resolved.
When possible, the travel assistance department will arrange direct billing between the provider of the service and Canada Life. Out of Country and Provincial Health Care Authorization paperwork is still required. If you receive invoices directly, forward to Canada Life with your case number on all receipts and invoices.
When you contact Canada Life or Travel Assistance at the time of emergency, a claim form package will be sent to your Canadian home address for completion upon your return to Canada.
If you have not received a claim package or did not call at the time of your emergency and/or prefer to file your claim while you are outside your home province you may visit www.canadalife.com to obtain required forms.
Note: Each Province has set submission deadlines for Out of Country claims. Depending on the Province in which you reside, it is advisable that you confirm with your provincial health care provider (i.e. OHIP for Ontario) when claims need to be submitted by to avoid out of pocket expenses.
Standard practice is to assess with the foreign exchange at the time of claim processing. However, if a member provides the exchange that was used at the time of payment with supporting documentation, Canada Life will use the amount indicated by the plan member.
401-5100 Orbitor Dr.
Mississauga, On, L4W 4Z4
P: 1-888-660-6055
F: 416-740-2291
All Rights Reserved | WLV Inc. | Target Benefit Administrators Ltd.