Mount Sinai Hospital Benefits - Ontario Nurses' Association

DECISION
After carefully considering the evidence and submissions of the parties I
conclude, based on the particular facts of this case, the Grievance must be
allowed.
The issue to be decided is whether the level of benefits was decreased
when Great-West Life was substituted for Sun Life as the carrier for the
Hospital’s extended health and dental benefit plans. The determination of this
issue is dictated by comparing the level of benefits provided under each
respective carrier’s plan. More specifically, the issue focuses on comparing the
level of benefits for private nursing care services provided under each carrier’s
plan.
The clear language of the Sun Life Plan supports the Union’s position. The
Extended Health Provision includes a number of general exclusions. These
general exclusions are incorporated into the exclusions for specific benefits by
including the following language
“expenses incurred under any of the conditions listed on the Extended
Health Provision page as an Exclusion.”
See for example the exclusions found within the specific benefits at pages N-2,
0-1, P-i, Q-4, and QI-5.
The specific exclusion for chronic or custodial care facilities under the
Extended Health - Hospital Benefit found at page P-I has not been incorporated
as an exclusion that would apply to the private nursing care services benefit
under the Extended Health - Supplementary Health Care Benefit at page Q-2.
Ms. Fagan’s testimony regarding the application of the language under the
Sun Life Plan is consistent with my interpretation that the private nursing care
14