A&S Group & Business A&S Plans question: sick leave on the start date

A&SGroup & Business A&S Plans

Acme replaced its group LTD insurer, with the new plan starting 20 days after the old one ended. Mo was on sick leave on the start date but had been insured under the old plan. Can the new insurer exclude him?

A Only if he applies within 31 days
B Yes, if he has a pre-existing condition
C Yes, until he returns to work
D No, not just for being off work

Show the answer and explanation

Answer: D. No, not just for being off work

When a replacement group A&S contract is entered into within 31 days after the old one ends, people insured under the old contract who are in an eligible class are insured under the new one, and none can be excluded only because they were not actively at work on its effective date. They also get credit for deductibles already met. Source: Insurance Act (BC), RSBC 2012, c. 1, s. 116(4) (current to 6 Oct 2026; as at 12 Oct 2026); the other common-law provinces' Insurance Acts have the same uniform provision.

Common mistake

Applying actively-at-work rules to a replacement plan.

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Lena, 37, works for a Halifax software company that switched group health insurers on 1 July, with the new plan starting within 31 days of the old one ending. By June she had already met her $100 annual deductible under the old plan, which uses the same calendar year. She submits a prescription claim in August. What applies under the new plan?A Victoria engineering firm starts a new group disability and health plan on 1 June. Ana, one of its designers, has been on sick leave since mid-May recovering from surgery and is still off work on 1 June; she expects to return in July. The plan has a standard actively-at-work clause and is not replacing an earlier plan. When does her coverage start?Leah, 42, is a dental office manager in Moncton earning $1,000 a week in insurable earnings. She has no group disability plan at work. After knee surgery in March 2026 she is off work for 10 weeks, has a medical certificate and has more than 600 insured hours in the past year. What is her maximum weekly EI sickness benefit?

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Original study material mapped to the public CISRO curriculum; not a real test question.Not affiliated with CISRO, CCIR or any provincial insurance regulator. Verify figures and rules against current guidance before relying on them.