Group Insurance for Members

Transcription

1 Group Insurance for Members yourgroup insurance yourto/ero i

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3 Depuis 1968 À votre service...pour le soin de votre avenir. Since 1968 Here for you now... Here for your future. RTO/ERO is a leader in providing benefits to retired educators and support staff. Our plans are designed exclusively for retired teachers, school and board administrators, educational assistants, administrative professionals, custodians, university and college faculty, and support staff. 1

4 your questions and answers 2

5 Do I need insurance in my retirement? YES, educators and support staff spend an average of nearly 30 years in retirement. Government coverage can be limited and can change at any time, so it s important to have a group insurance plan that helps you to cover your healthcare costs and where you have an ongoing voice in how the plan is managed which you have with RTO/ERO. Am I eligible to join RTO/ERO s group insurance plans? YES, if you are a member of RTO/ERO, in good standing. How do I get coverage? Complete the enclosed application or visit our website to download and print it. What is covered? RTO/ERO offers a full suite of group insurance plans, which can be purchased separately: l3 Dental; l3 Extended Health Care (including comprehensive travel coverage); l3 Semi-Private Hospital and Convalescent Care; and l3 Supplemental Travel (for extended vacations). We also offer access to a complete range of individual insurance plans including: l3 Accidental Death & Dismemberment; l3 Hospital Money; l3 Home and Auto; l3 Long Term Care; and l3 Term and Guaranteed Life. When should I apply? Apply as soon as (or before) your group insurance coverage terminates. You are guaranteed acceptance only if you apply within 60 days of the termination date of another group insurance plan. After 60 days, you will be asked to complete a medical questionnaire, and you may be declined. Are members happy with their RTO/ERO Plans? Satisfaction score* 83% Completely satisfied 16% Mostly satisfied 1% Not satisfied *Goldfarb Intelligence Marketing; data collected from a random sample of members. The survey was conducted in

6 your group insurance perks l3 RTO/ERO is a non-profit organization and our unique plans are designed by members, for members. A provincial Health Services and Insurance Committee, made up of your peers, manages our insurance plans and responds to your needs; l3 Everyone receives the same coverage regardless of age; l3 You will receive top-of-the-line customer service in English and French, with dedicated teams to take care of your questions and concerns; l3 Single, couple or family coverage available; l3 Our plans are well-funded and have been around since 1984; l3 We respect your time and the environment. Our systems are designed so that many claims can be submitted electronically, payments are deposited to your bank account, and you can access your records online in real-time; and l3 Walk-in service is welcome in the Greater Toronto Area to assist members with administration and claim services. 4 RTO/ERO s Group Insurance Plan designs have evolved over the years with input from various sources, including its membership. The RTO/ERO Group Insurance Plans are more grounded to its membership s needs and feedback which provides a distinct advantage and is an important value-added component compared to most other competitors.* * According to a study conducted by independent firm Coughlin Employee Benefits Specialists in March 2011 yourgroup insurance yourto/ero

7 PHOTO: HUGH WESLEY Information contained in Health Matters is intended to be used for general information and should not replace consultation with health care professionals. Consult a qualified health care professional before making medical decisions or if you have questions about your individual medical situation. RTO/ERO makes every effort to ensure that the information in Health Matters is accurate and reliable, but cannot guarantee that it is error free or complete. RTO/ERO does not endorse any product, treatment or therapy; neither does it evaluate the quality of services operated by other organizations mentioned or linked to Health Matters. your health resources RTO/ERO group insurance plan details and forms: Departments Health Matters Health Matters Departments inside HSIC Chair s welcome...36 RTO/ERO travel coverage...36 Long-Term Care Insurance...37 Radon...38 Important information for Quebec residents...38 Media corner FAQs...41 A healthy note by Lori MacDonald-Blundon, Editor Welcome to the newest edition of Health Matters in Renaissance! As our Chair, Mark Tinkess notes in his message on page 36, the Fall 2012 RTO/ERO Senate voted to test pilot Health Matters in Renaissance for one year. We hope you like it! he theme for this edition of also help us to maintain a healthy insurance plans, travel knowing Renaissance is hobbies and pastimes, and you might wonder many illnesses such as diabetes and age. Our Extended Health Care Plan weight, thereby lowering our risk for they have access to superior cover- T how this relates to Health Matters. Our heart disease. It also has the ability includes travel coverage of 62 days hobbies and pastimes have the ability to make your insurance dollar go per person, per trip, as well as to positively affect our overall wellbeing and our health. Embracing and Researching your family history, tion/interruption/delay insurance and further. $6,000 per person, per trip cancella- expanding our interests stretches our renewed family connections, writing that book you ve had on hold for conditions with a very liberal medi- covers stable pre-existing medical minds and bodies, helps us to find new opportunities, and keeps us interested, active and engaged. embracing and learning new technol- Our RTO/ERO Group Insurance the last few years, taking a course, cal stability clause. RTO/ERO conducts over 30 retirement planning workshops (RPWs)* your mind and open you to new our members. Therefore, whether ogies, are all opportunities to exercise Plans are owned and managed by across the province every year for educators and educational support staff active and is a great physical activity. bers have identical coverage, the interests. Gardening keeps your mind they are 56 or 106, all insured mem- who are considering retirement. If you It also takes time to learn what plants same medical stability clause, and attended one of these, you would have grow in which growing zones, soil premium rates regardless of age an heard a key message: it s important to and sun conditions, and what to do extremely rare commodity in the retire to something, rather than from when critters inevitably invade (or, market of travel insurance! something. This is the time of your maybe that s just my garden). Perhaps Whatever your bliss may be, I life where you have the opportunity to your new bliss is cycling, or Nordic encourage you to continue to explore follow your bliss or to find it! pole walking, or working towards and follow it, wherever this may take These activities contribute to our besting the grandchildren on the you. I found mine it s RTO/ERO. healthy lifestyles and to overall wellness. Staying physically and mentally Many members discover or redis- * Please encourage your former col- Wii or Xbox Kinect. active helps to maintain our emotional well-being, reduce pain, and years of only being able to travel to attend one of our workshops. The cover travel as a new bliss, after leagues who are considering retirement potentially reduce our reliance on during peak holiday times. RTO/ERO 2013 RPW schedule is on our website medication. A healthy lifestyle can members who participate in our at Health Matters is a quarterly newsletter that features important health-related stories and information. Of all the insurance I have, the RTO/ERO Group Insurance Plan is the only one where I have a say in the improvements that can be made to the plan. That s because as an RTO/ERO member I own the plan and I like that. Roger LaLonde, member since 2002 Even though I could have stayed with my board plan when I retired, I opted for the RTO/ERO Extended Health coverage as it gave us the comfort and security we sought. When my husband died suddenly in 2001, I received back the cancellation money for a scheduled cruise. When I broke my ankle in Australia in 2003, I was flown home, following two surgeries and did not pay one cent out of my pocket. Mary Ellen Lawless, member since 1995 Join us. RTO/ERO is here for you Renaissance Spring

8 Group Insurance for retired educa Join the largest Canadian retired educator plan, providing health coverage to over 86,000 members and dependents. The RTO/ERO plan is owned and managed by RTO/ERO members. RTO/ERO Group Insurance summary: 6 Dental Plan Fee Guide l Provincial Fee Guide for General Practitioners. Basic and Preventive (85% reimbursement) l3 Unlimited annual maximum; l3 One standard oral examination, recall oral examination, polishing and fluoride applications every nine months; and l3 Other services, including fillings, x-rays and repairs/rebase/relining of existing dentures. Endodontics and Periodontics (80% reimbursement) l3 $850 annual maximum; and l3 Includes root canal therapy, treatment of bones and tissues, scaling and occlusal equilibration. Major Restorative (50% reimbursement) l3 $800 annual maximum for crowns, posts, onlays and inlays, including crowns on implants; and l3 $800 annual maximum for fixed bridges and partial dentures, including those on implants. Extended Health Care Plan Prescription Drug (85% reimbursement of ingredient costs) l3 $0 annual deductible; l3 $3,000 annual maximum per person, including $500 for erectile dysfunction medications; l3 Covers eligible drugs for all ages, including those not covered by the Provincial Drug Benefit Plan for those age 65 and over; and l3 The Ontario Drug Benefit Program deductible is reimbursed based on 85% of ingredient costs.

9 tors and educational support staff Paramedical Practitioners (80% reimbursement) l3 $1,000 annual maximum per person (for all practitioners combined); l3 Fifteen eligible practitioners: acupuncturists, chiropodists, chiropractors, dieticians, herbalists, homeopaths, naturopaths, nutritionists, osteopaths, physiotherapists, podiatrists, registered clinical psychologists, registered massage therapists, speech therapists and shiatsu therapists; and l3 Physician authorization is not required. Aids and Appliances (80% reimbursement) l3 Purchase or repair of hearing aids to a maximum of $1,000 overall, in any three calendar years; l3 Custom-made orthopaedic shoes and orthotics to a maximum of $500 in any two calendar years; l3 Prostheses including artificial limbs or eyes, or breast prosthesis (including three mastectomy bras per calendar year); l3 Supplies including trusses, splints, braces and casts; l3 Medical supplies, including surgical support stockings to an annual maximum of $400 per person, incontinence supplies up to an annual maximum of $500 per person, and post-surgical comfort and convenience items (e.g., sock reacher, shoe lacer) up to $200 per person in any two calendar years; and l3 Mobility aids including wheelchairs, canes, walkers, and crutches. Vision Care (80% reimbursement) l3 $325 maximum per person in any two calendar years; l3 Covers prescription eyeglasses, contact lenses, laser eye surgery, and corneal incision; l3 Eye examinations to a maximum of $90 for one eye exam every two calendar years. Eligible dependent children are covered on an annual basis; and l3 New lenses, if required due to eye surgery, are covered to a lifetime maximum of $325. 7

10 Group Insurance for retired educ New Diagnostic Services (80% reimbursement) l3 Diagnostic services, subject to your Government Health Insurance Plan offset. Private Duty Nursing (80% reimbursement) l3 Out-of-hospital registered nurse, registered practical nurse or licensed practical nurse up to $2,000 per insured person in any two calendar years. Transportation/Ambulance (80% reimbursement) l3 Licensed ground ambulance to local hospital when medically necessary for emergency treatment. Accidental Dental (80% reimbursement) l3 Dental treatment required due to an accidental blow to natural or artificial teeth. Educational Program (80% reimbursement) l3 Medically related education program(s) recommended by a physician, to a maximum of $200. Out-of-Province/Canada Travel (100% reimbursement) l3 $2,000,000 coverage for eligible emergency medical expenses per person/trip; l3 Unlimited number of trips, each up to 62 days in duration; l3 Emergency medical expenses incurred due to an accident or sudden illness while travelling outside your province of residence/canada; l3 Pre-existing medical conditions are covered, subject to a 90-day medical stability clause; and l3 $6,000 trip cancellation and interruption/delay per person/trip. Eldercare Select: l3 Expert guidance and support to address a specific eldercare challenge and develop a customized plan of action; l3 Access to 24/7 nursing and personal care in your or a loved one s home (costs for nursing or other care services referred through Eldercare Select are your responsibility); l3 25% discount off FirstWatch, a personal medical response system; and l3 Access to an online personal health record that allows tracking of health indicators, monitoring and trending those indicators. 8

11 ators and educational support staff Semi-Private Hospital and Convalescent Care Plan Semi-Private Hospital (95% reimbursement) l3 Unlimited maximum; l3 Daily semi-private room charges in a licensed hospital. Convalescent Home Care (80% reimbursement) l3 Home care following a 24 hour hospitalization up to $75/day, maximum of 30 days; l3 Home care following non-elective day surgery up to $75/day, maximum of three days; and l3 Temporary stay in a long term care facility following a 24 hour hospitalization, up to $75/day, annual maximum of 30 days. Supplemental Travel Plan l3 For individual trips that extend beyond the 62 days of travel coverage under the Extended Health Care Plan; l3 Covers a maximum trip duration of 212 days. For those who only need a few extra days of coverage, a five day unit is available immediately following the first 62 days of travel; and l3 Guaranteed acceptance for all Extended Health Care Plan participants. RTO/ERO Monthly Rates January 1 to December 31, 2014* Single Couple Family Extended Health Care $82.39 $ $ Semi-Private Hospital and Convalescent Care $14.60 $29.16 $34.28 Dental $54.04 $ $ * RTO/ERO is a group insurance plan and is therefore subject to provincial retail sales tax (8% in Ontario, 9% in Quebec). These rates exclude retail sales tax. Our Plans are eligible for CRA s medical expense tax credit. 9

12 Depuis 1968 À votre service...pour le soin de votre avenir. Since 1968 Here for you now... Here for your future. 18 Spadina Road, Suite 300 Toronto ON M5R 2S7 Tel: Toll free: ickr.com/photos/rto-ero ENG JOHNSON INC. - Plan Benefits Service 18 Spadina Road, Suite 100 Toronto ON M5R 2S7 Tel: Toll free: Fax: rto-ero@johnson.ca All photos are of RTo/ERo members.