Employment Insurance Regulations (SOR/96-332)

Application

61 This Part applies where insured persons, who are employed by an employer and are covered by a plan that meets the requirements of section 63, 64, 65 or 66, benefit from a reduction of the employer's premium in an amount at least equal to five-twelfths of the reduction.

Reduction of Employer's Premium Rate

• 62 (1) Subject to subsection (2), an employer's premium rate fixed under section 68 of the Act shall be reduced, in respect of insured persons employed by that employer who are covered by a plan that meets the requirements of section 63, 64, 65 or 66 and is a qualifying plan pursuant to subsection 67(3), by the percentage by which

  • (a) the experience cost ratio calculated under subsection (3) in respect of each category of insured persons covered by such a plan

  is less than

  • (b) the first payer cost ratio calculated under subsection (4) for all insured persons.

• (2) An employer's premium rate fixed under section 68 of the Act shall not be reduced in respect of

  • (a) an insured person who is not covered under a plan;

  • (b) an insured person who is covered under a plan that does not meet the requirements of section 63, 64, 65 or 66; or

  • (c) an insured person whose eligibility to use days of paid sick leave is deferred under a plan that meets the requirements of section 65 or 66.

• (3) For the purpose of determining the experience cost ratio for a year, the Commission shall, in respect of each category of insured persons covered by plans that meet the requirements of section 63, 64, 65 or 66, divide

  • (a) the average cost of benefits paid under section 12 and paragraph 18(1)(b) of the Act to insured persons whose interruption of earnings was by reason of illness, injury or quarantine

  by

  • (b) the average amount of the yearly insurable earnings for the insured persons,

  with both averages being taken over the three years ending concurrently with the second year preceding the year for which the calculation is made.

• (4) For the purpose of determining the first payer cost ratio for a year, the Commission shall, in respect of all insured persons, divide

  • (a) the average cost of benefits that would have been paid under section 12 and paragraph 18(1)(b) of the Act to insured persons whose interruption of earnings was by reason of illness, injury or quarantine, as estimated by the Commission, if benefits payable under a group sickness or disability wage-loss indemnity plan or paid sick leave plan were disregarded for the purpose of determining benefits otherwise payable to persons under the Act,

  by

  • (b) the average of the yearly insurable earnings for the insured persons,

  with both averages being taken over the three years ending concurrently with the second year preceding the year for which the calculation is made.

Standards

63 A Weekly Indemnity Plan shall meet the following requirements:

• (a) an insured person who is employed by an employer and covered by the plan becomes eligible to claim benefits under the plan in respect of an illness or injury on or before the first day of the month following

  • (i) the last day of a period of not more than three months of continuous employment beginning on the day of commencement of the employment, or

  • (ii) if the plan is based on an hour-bank principle, the day on which the person has an accumulation of not more than 400 hours of active employment;

• (b) if an insured person is required to serve an elimination period during which no benefit is payable under the plan, that period does not exceed seven consecutive days beginning with the first day of the period of incapacity due to illness or injury;

• (c) benefits are paid in full under the plan regardless of

  • (i) the amount of the benefits that are payable to an insured person under the Act, and

  • (ii) the amount of the benefits, payable from any other source, that do not constitute earnings under section 35;

• (d) the benefits payable to an insured person under the plan are equivalent to an amount that is equal to or greater than 55% of the insured person's normal weekly insurable earnings;

• (e) subject to the elimination period referred to in paragraph (b), full benefits payable to an insured person under the plan are reinstated

  • (i) in the case of the recurrence of an illness or injury, after three months of active employment following their most recent absence due to that illness or injury or, where the plan is based on an hour-bank principle, after the accumulation of the first 400 hours of active employment by that person following their most recent absence due to that illness or injury, and

  • (ii) in the case of a new illness or injury, after one month of active employment following their most recent absence due to another illness or injury or, where the plan is based on an hour-bank principle, after the accumulation of the first 150 hours of active employment by that person following their most recent absence due to another illness or injury;

• (f) in any case not referred to in paragraph (e) and subject to the elimination period referred to in paragraph (b), benefits are payable under the plan in respect of an illness or injury until the earliest of

  • (i) the end of a period of at least 15 weeks during which the benefits are paid,

  • (ii) the end of the period of incapacity due to the illness or injury,

  • (iii) the date the insured person retires, and

  • (iv) the date of the insured person's separation from employment for any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury; and

• (g) the only conditions precluding the payment of benefits under the plan to an insured person to whom they would be otherwise payable are conditions that preclude payment to an insured person

  • (i) who is not under the care of a licensed physician,

  • (ii) whose illness or injury is covered by federal or provincial laws respecting workers' compensation, the Canada Pension Plan or An Act respecting the Québec Pension Plan, where amounts paid under those laws or Acts constitute earnings under section 35,

  • (iii) whose illness or injury is intentionally self-inflicted,

  • (iv) whose illness or injury results from service in the armed forces,

  • (v) whose illness or injury results from war or participation in a riot or in a disturbance of the public order,

  • (vi) who becomes ill or is injured during a leave of absence or a period of paid vacation,

  • (vii) who is in receipt of benefits under section 22, 23, 23.1, 23.2 or 23.3 of the Act,

  • (viii) whose illness or injury is sustained while committing a criminal offence,

  • (ix) who is engaged in employment for a wage or profit during any period for which the person claims benefits under the plan,

  • (x) who becomes ill or is injured after having lost employment by reason of a stoppage of work attributable to a labour dispute at the place where the person was employed, if the person's right to benefits under the plan is reinstated on their return to active employment,

  • (xi) who is an inmate of a prison or similar institution,

  • (xii) who is not entitled to benefits payable under the Act because the person is not in Canada,

  • (xiii) whose illness results from the use of drugs or alcohol and who is not receiving continuing treatment for the use of drugs or alcohol,

  • (xiv) whose illness or injury, resulting from a motor vehicle accident, is covered by a provincial plan described in paragraph 35(2)(d),

  • (xv) who is receiving a retirement pension from the employer,

  • (xvi) who is absent from work because of plastic surgery performed solely for cosmetic purposes, except where the need for surgery is attributable to an illness or injury, or

  • (xvii) who, in the case of a recurring disability, is receiving benefits under a group long-term disability plan that contains a reinstatement provision, where the reinstatement period under that plan does not exceed six months.

64 A Special Weekly Indemnity Plan shall meet the following requirements:

• (a) the plan must be provided or financed, in whole or in part, by an employer that is Her Majesty in right of a province, a provincial Crown corporation, a municipal authority or a public authority of a province or an institution primarily controlled, supported or financed by a province;

• (b) the plan must satisfy all the requirements of section 63, except the requirements of paragraphs 63(e) and (f);

• (c) subject to the elimination period referred to in paragraph 63(b), full benefits payable under the plan to an insured person are reinstated after one month of active employment following their most recent absence due to illness or injury; and

• (d) in any case not referred to in paragraph (c) and subject to the elimination period referred to in paragraph 63(b), benefits under the plan are payable with respect to the insured person's illness or injury until the earliest of

  • (i) the end of a period of at least 52 weeks during which the benefits are paid,

  • (ii) the end of the period of incapacity due to the illness or injury,

  • (iii) the date the insured person retires, and

  • (iv) the date of the insured person's separation from employment resulting from any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury.

65 A Cumulative Paid Sick Leave Plan shall meet the following requirements:

• (a) the plan must satisfy all the requirements of section 63, except the requirements of paragraphs 63(e) and (f);

• (b) the plan must credit an insured person covered by the plan, after the completion of the period referred to in subparagraph 63(a)(i) or after the accumulation of the number of hours referred to in subparagraph 63(a)(ii), with one or more days of paid sick leave for each subsequent full month of active employment, of which at least one day per month is available only for the insured person’s illness or injury, while the insured person remains at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act or while the insured person is providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult;

• (c) notwithstanding paragraph (b), the plan may

  • (i) allow the paid sick leave credit referred to in that paragraph to be prorated in relation to the total period of active employment in a month,

  • (ii) preclude the accumulation of paid sick leave for a month in which the insured person has not been actively employed for at least twice the number of hours in the insured person's normal work week, and

  • (iii) allow the insured person to use paid sick leave while remaining at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act or while providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult.

• (d) where eligibility to use paid sick leave is deferred in the case of an insured person who is employed on a temporary basis or is serving a probationary period, it cannot be deferred for a period greater than 12 months beginning on the day the insured person commences employment or joins the plan;

• (e) the days of paid sick leave available only in respect of the insured person’s illness or injury, or while the insured person remains at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act or while the insured person is providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult, that are not used for those purposes must be accumulated at the rate prescribed in paragraphs (b) and (c), and the maximum number of days of paid sick leave that may be so accumulated is not less than 75 working days; and

• (f) subject to the elimination period referred to in paragraph 63(b), benefits are payable under the plan with respect to the insured person's illness or injury until the earliest of

  • (i) the end of a period of at least 75 working days during which the benefits are paid,

  • (ii) the end of the period of incapacity due to the illness or injury,

  • (iii) the exhaustion of all accumulated paid sick leave,

  • (iv) the date the insured person retires, and

  • (v) the date of the insured person's separation from employment for any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury.

66 An Enhanced Cumulative Paid Sick Leave shall meet the following requirements:

• (a) the plan must satisfy all the requirements of section 65, except the requirements of paragraph 65(b), subparagraph 65(c)(i) and paragraphs 65(e) and (f);

• (b) the plan must credit an insured person covered by the plan, after the completion of the period referred to in subparagraph 63(a)(i) or after the accumulation of the number of hours referred to in subparagraph 63(a)(ii), with one and two thirds or more days of paid sick leave for each subsequent full month of active employment, of which at least one and two thirds days per month are available only for the insured person’s illness or injury, while the insured person remains at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act or while the insured person is providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult;

• (c) notwithstanding paragraph (b), the plan may allow the paid sick leave credit referred to in that paragraph to be prorated in relation to the total period of active employment in a month;

• (d) the days of paid sick leave available only in respect of the insured person’s illness or injury, while the insured person remains at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act, or while the insured person is providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult, that are not used for those purposes, must be accumulated at the rate prescribed in paragraphs (b) and (c), and the maximum number of days of paid sick leave that may be so accumulated is not less than 125 working days; and

• (e) subject to the elimination period referred to in paragraph 63(b), benefits are payable under the plan with respect to the insured person's illness or injury until the earliest of

  • (i) the end of a period of at least 125 working days during which the benefits are paid,

  • (ii) the end of the period of incapacity due to the illness or injury,

  • (iii) the exhaustion of all accumulated paid sick leave,

  • (iv) the date the insured person retires, and

  • (v) the date of the insured person's separation from employment for any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury.

• 67 (1) A plan that meets the requirements of section 63, 64, 65 or 66 shall be evidenced by a formal written commitment, including one or a combination of any of the following:

  • (a) a union or association agreement;

  • (b) an industry-wide plan;

  • (c) a private carrier insurance policy;

  • (d) an undertaking contained in an employees' handbook;

  • (e) a board of directors' resolution that has been implemented;

  • (f) an undertaking contained in a personnel policy bulletin; or

  • (g) a memorandum or other document addressed to employees by their employer.

• (2) Subject to section 71, if a plan referred to in section 63, 64, 65 or 66 becomes a qualifying plan or ceases to be a qualifying plan under subsection (4) at any time during the year for which a reduction of the employer’s premium rate is made under subsection 62(1), the reduction shall apply to the number of months in the year during which the plan is a qualifying plan.

• (3) A plan is a qualifying plan when it satisfies all the requirements of subsection (1) and section 63 or 64 or, subject to subsection (5), section 65 or 66.

• (4) For the purpose of determining when a plan becomes or ceases to be a qualifying plan under this Part, where the plan becomes or ceases to be a qualifying plan

  • (a) on or before the 15th day of a month, it shall be considered to have done so on the first day of that month; and

  • (b) after the 15th day of a month, it shall be considered to have done so on the first day of the following month.

• (5) A plan referred to in section 65 or 66 is considered to be a qualifying plan as of the date an application is made for a reduction of the employer's premium or the date it becomes a qualifying plan under subsection (4), whichever is later, if, on that date, each insured person covered by the plan is credited

  • (a) in the case of a plan referred to in section 65, with a number of days of paid sick leave equal to 72 minus the maximum number of days that could have been accumulated by the insured person since its commencement or during the six years preceding that date, whichever is the shorter period; and

  • (b) in the case of a plan referred to in section 66, with a number of days of paid sick leave equal to 120 minus the maximum number of days that could have been accumulated by the insured person since its commencement or during the six years preceding that date, whichever is the shorter period.