OMERS Form 143 Plan Benefits User Guide

: June 16, 2024
: OMERS

Table of Contents

SECTION 1 – MEMBER INFORMATION
SECTION 2 – REASON FOR REQUEST
SECTION 3 – SUPPORTING INFORMATION
SECTION 4 – EMPLOYMENT INFORMATION – to be completed for all requests
SECTION 5 – AUTHORIZATION – to be completed for all requests
GENERAL INFORMATION
Documents / Resources

Form 143 Plan Benefits
User Guide

Request for an OMERS plan benefit (for employer use only)
Use this form in the event of a member’s termination of employment, disability, retirement or death. Please see Employer Instructions for more details.
Complete Sections 1 to 3. Please sign in Section 4 to authorize the request.
To help us serve you better, submit your documents quickly and securely using the e-access portal. Start a new conversation, attach your files, and submit.
Providing OMERS with your personal information is considered consent for its use and disclosure for the purposes set out in our Privacy Statement, as amended from time to time. You can find out more about our collection, use, disclosure and retention of personal information by reviewing our Privacy Statement at www.omers.com.
Did you know you can do most of your OMERS administration online with e-access?
It’s secure and includes tip and validations to make your reporting quick and easy.

SECTION 1 – MEMBER INFORMATION

to be completed for all requests

Group Number……..
First Name……….
OMERS Membership Number……..
Date of Birth (m/d/y)………
Middle Name Last Name……….
Phone………..

SECTION 2 – REASON FOR REQUEST

Please choose one of the following options (in bold). If reason for request is Disability or Retirement complete part 3, Supporting Information. See Employer Instructions for more details.
Termination – Select this option if the member terminated employment.
Is the termination the result of a divestment? No Yes — If yes, please complete Form 182 – Divestment information – member.
Disability – Select to request a disability benefit for a member. Complete all applicable fields.
Annual rate of contributory earnings at date member last contributed (see Employer Instructions)
$……….
If the member’s employment status was other-than-continuous full-time, enter % of fulltime hours OR number of months member works each year. (Exclude period each year the member didn’t work.)
Period each year the member didn’t work (generally applies to school boards)

% of full time hours	Months worked per year
From (m/d/y)	To (m/d/y)

or

Has the member applied for a Workplace Safety and Insurance Board (WSIB) benefit?
Yes – What is the status of the claim? Approved

Monthly benefit amount

S

Declined Under appeal Pending approval
No – Please advise OMERS if the member applies for a WSIB benefit in the future.

Has the member applied for long-term disability (LTD)?

Yes – Approved Declined Under appeal Pending approval
No
Did the member contribute to OMERS for the disability elimination period?
Yes – Include elimination period contributions, earnings and service with data reported on page 3.
No
Retirement – Select if the member is retiring
The member will receive a benefit more quickly by completing the Advance Election option on Part B.
Death – Select if the member is deceased. Complete all applicable fields.

Date of Death (m/d/y)

Is there an eligible spouse? Yes No I don’t know
Are there eligible children? Yes – Please provide each child’s first and last name and date of birth (if known) on a separate page.
No I don’t know
Claimant or other person we can contact:

First Name	Middle Name	Last Name

Apt/Unit	Address	City

Phone	Email

Relationship to member:

Spouse Child Beneficiary Other

Specify

Additional spousal information (if applicable):

Spouse’s social insurance number (optional)	Date of Birth (m/d/y)

SECTION 3 – SUPPORTING INFORMATION

to be completed if member is retiring

Marital status of the member as at the date of retirement

Single Married Common-law Separated Divorced
Spouse Information

First Name	Middle Name	Last Name

Date of Birth (m/d/y)

SECTION 4 – EMPLOYMENT INFORMATION – to be completed for all requests

See Employer Instructions for more details.

Date employment ended (m/d/y)

If this request is for a disability benefit, please indicate the last day the member worked.
If there is a difference between the date employment ended and the date contributions ended, please indicate:

Date contributions ended (m/d/y)

Specify

and provide a reason for difference: Sick pay Vacation pay Leave of absence Other

Group Number	OMERS Membership Number

Employment status change
Complete this section only if the member’s employment status changed in the last six years and you have not reported it to OMERS. If you’re not sure whether the status change was reported to OMERS, use e-access to check the member’s record.
Date status changed (m/d/y)
New employment status: Continuous full-time Other-than-continuous full-time
Record the member’s contributory earnings, credited service and contributions under each status during the year the employment status changed.

Contributory earnings	Full-time	Other-than-continuous full-time
Credited service (months)
Contributions

Recent earnings and service information
Please complete the following information for this calendar year and last year. Do not record last year’s information if you’ve already reported it through the e-Form 119 process. If you wish to revise previously reported information, please indicate above the column. Include any disability elimination period the member purchased but do not include any broken service or pregnancy/parental leave that was purchased.
I am revising information that was previously reported through the e-Form 119 process.

This year (y)	Last year (y)
Contributory earnings*
---	---
Credited service (months)
Pension adjustment (PA)
Primary Plan RPP contributions
Primary Plan RCA contributions
Number of pay periods

December event with carry-forward pay
*If the difference between this year’s and last year’s contributory earnings is more than 20%, what is the reason for the difference?
Retroactive pay (please complete the next section)
Other – Specify

Group Number	OMERS Membership Number

Retroactive pay:
Complete this section only if the member received retroactive pay in the last six years and you have not reported it to OMERS.
Year retroactive payment was made
Please provide the breakdown of the amount that was applied to each year:

Year	Amount
Total amount

SECTION 5 – AUTHORIZATION – to be completed for all requests

By signing below, I certify that all of the information in this form is true and accurate.

Employer Name	Contact
Title	Phone
Fax	Email

Signature of Authorized Signing Officer
Date (m/d/y)

GENERAL INFORMATION

General Information
Complete Form 143 – Request for an OMERS plan benefit in the event of a member’s termination of employment, disability, retirement or death.

For a retirement claim, the form can be submitted up to 60 days before the retirement date.
Whenever possible, wait until you have final earnings and service information before submitting the Form 143.
Do not use this form for a member who is:
on a disability waiver of contribution; use Form 158 – Employment change/benefit request;
terminating as the result of a divestment; use Form 182 – Divestment information – member.
Please notify us of any eligible service the member may have.
If the member was on a pregnancy/parental leave or had broken service, include any outstanding leave period election forms.

Important – Supplemental Plan
If you are requesting a benefit for a Supplemental Plan member, please use e-Form 143 in e-access.

SECTION 2 – REASON FOR REQUEST
Disability

In the Annual rate of contributory earnings at date member last contributed field, enter the actual contributory earnings salary rate immediately before the member became disabled. Do not annualize the salary for other-than-continuous full-time (OTCFT) members.
The contributory earnings salary rate of the member shall be deemed the annual rate of contributory earnings for which the member last made contributions.
The credited service entered in % of full-time hours or Months worked per year field must correspond with the Annual rate of contributory earnings. (This field applies to OTCFT members only.)
Example: Enter $25,000 for 10.66 months worked per year or $25,000 for 88.83% of full-time hours.
If the member chooses the OMERS disability pension, it may reduce any LTD payment. If the member is also receiving WSIB payments, the OMERS disability pension may be reduced. Please see the online Employer Administration Manual for details.

Retirement

If you select this option for a member who is not yet eligible to receive a pension, we’ll process the request as a termination. The member will receive a Pension Options form. One of the options will be to take a pension at a later date once they become eligible.

SECTION 3 – SUPPORTING INFORMATION
Retirement-date spouse

If the member has a legal or common-law spouse on the date that his or her first pension payment is due and the spouses are not living separate and apart, that person is the “retirement-date spouse” and eligible for spousal survivor benefits, provided the or she has not waived rights to survivor benefits.

SECTION 4 – EMPLOYMENT INFORMATION
Disability elimination period

The disability elimination period information should be submitted with the Form 143.

Contributory earnings
Include:

deemed earnings for purchased disability elimination periods
retro payments (provide details of the retro payment in the next section)

Do not include:

annualized earnings (CFT or OTCFT members)
deemed earnings for leave periods

Credited service

Enter credited service calculated to two decimal places.
Include credited service for purchased disability elimination periods.
Do not include credited service for purchased leave periods. Leave periods must be reported using Form 165 – Leave period reporting/ election.

Pension adjustment (PA)

For PA purposes, assume the member will purchase a period of leave which is covered under the Employment Standards Act (ESA) and is single contribution cost for the member (employer matching) unless you have a signed election form declining the purchase.
Do not include broken service (excluding ESA single contribution cost leaves) in the PA unless the member has elected to buy all or part of the leave.
If the member reached 35 years of credited service prior to January 1, 2021, calculate the PA based on service up to the date the member reached 420 months of credited service. If the member reached 35 years before the year you are reporting, the PA is zero.

Important! OMERS has removed the 35-year cap for members with less than 35 years of credited service as of January 1, 2021.

For a member who is on a disability waiver of contribution, report a PA only for the purchased elimination period and portions of the year that the member was actively working. Do not report a PA for the disability waiver period – OMERS reports the PA for this period.
If the member is deceased, enter a PA of zero in the year of death.

Contributions (Primary Plan RPP and RCA)

Enter registered pension plan (RPP) contributions in the Primary Plan RPP field and Retirement Compensation Arrangement contributions in the Primary Plan RCA contributions field.
Include contributions for purchased disability elimination periods.
Do not include contributions for purchased leaves (broken service and pregnancy/parental leaves).
Include contributions deducted from retro payments. (Use the contribution rate for the year to which the retro payment applies.)

For December events with earnings paid in the following year (carryforward), check the December event with carry-forward pay box. Also include on a separate page (or in the chart) a breakdown of contributory earnings and contributions paid each year.

Example:
A member terminates on December 31, 2020, but is paid for the last week of December in 2021. Indicate the contributory earnings and contributions paid in 2020 and paid in 2021 separately.
F143 Employer Instructions – Jan. 2021