Anytime a new hire joins a group benefit plan, they are often subject to the standard pre-existing clause condition. This clause ensures that if the plan member incurs a claim related to their pre-existing medical condition, this claim will not be covered by their insurer. This is straightforward when taking new hires into consideration, but what about those that return from long term leave?
Plan members who stopped making contributions to their benefits during their leave would be treated as a new hire when they re-enroll in the group plan. This implies that they now have to re-satisfy their pre-existing clause for which carries serious implications especially for women returning from mat leave.
For instance, let’s consider a scenario where a woman is treated for postpartum depression during her mat leave and returns to work after being treated and deemed ready to work by her doctor. Shortly after returning from mat leave, she is diagnosed again with depression for an unrelated reason and must go on disability leave. Although this second diagnosis would count as a legitimate disability, due to her previous postpartum condition, it would be considered as a pre-existing condition and the employee would not be eligible for disability.
Since 2017, Dave Patriarche, president of Mainstay Insurance Brokerage Inc. has been leading the charge towards change by contacting major health insurers regarding their long term disability policies, specifically for women returning from mat leave.
As of the start of this year many major health insurers have begun shifting away from resetting the pre-existing clause in the case of maternity leave. Women covered by these insurers — which include the Co-operators Group Ltd., Desjardins Insurance, Empire Life Insurance Co., iA Financial Group, Manulife Financial Corp., RBC Insurance and Sun Life — will retain the same benefits they had before after they return from mat leave.
Further to this change, Patriarche has asked the CLHIA to develop a new guideline on the practice to bring the remaining insurers across the country into alignment.
Although these are great and positive strides that will impact families across the country, industry experts still recommend those planning mat leave to continue to pay into their disability insurance as disability can occur during and after their mat leave.