Group Insurance for Members 2016

Transcription

1 Group Insurance for Members 2016 Inside RTO/ERO s Group Insurance Plans...4 RTO/ERO Group Insurance Summary...6 Rates...9 How to join...10 Our strengths...11 yourretirement yourto/ero

2 your road to retirement A 5-10 years before you retire Start thinking about your retirement readiness. RETIREMENT B 1-5 years before you retire Attend a RTO/ERO Retirement Planning Workshop. Check for dates and places near you. Visit: You are eligible to join RTO/ERO, if you are retiring from the education community. C 6 months before you retire Set up an appointment with your financial planner and look into your pension, if you have one. Consider your insurance needs: D E Retirement! RTO/ERO is here for you now, and here for your future. Attend RTO/ERO events and get involved Start travelling Volunteer Kick back and relax 60 days before you retire Send in your RTO/ERO membership and group insurance applications before your current benefit plans end. Notify your employer that you intend to retire.

3 RTO/ERO s Group Insurance Plans Established in 1968 as a not-for-profit by the Ontario Teachers Federation, RTO/ERO is a leader. Our plans are designed exclusively by and for retired education employees. You spent your career covered by a group insurance plan, and RTO/ERO has chosen to maintain this philosophy. We offer the largest voluntary group insurance plans for retired education employees in Ontario. What insurance does RTO/ERO offer? RTO/ERO offers a full suite of group insurance plans. They may be purchased separately or in combination. There are no levels or grades of coverage so each plan participant has access to the same essential benefits as soon as they need them. Dental Extended Health Care (including comprehensive travel coverage) Semi-Private Hospital and Convalescent Care Supplemental Travel (for trips longer than 93 days) Plus a range of individual insurance plans: Accidental Death & Dismemberment Hospital Money Home and Auto Long Term Care Term and Guaranteed Life What are the strengths of RTO/ERO s Group Insurance Plans? Do I need insurance in retirement? Think about your average medical and dental costs at the start of your career. Compare that to your expenditures today. On average, education employees spend almost 30 years in retirement. It s important to consider how your expenses might change over this period. Insurance should protect you against risk and healthcare needs can be unpredictable. With RTO/ERO s group insurance plans, every plan participant has the same comprehensive coverage and pays the same premium, regardless of age. This helps you to cover both foreseeable and unexpected costs. As members own and manage the plans, those with your interests in mind make the final decisions. This provides you with ultimate protection and peace of mind. It s another way RTO/ERO is here for you now, and here for your future. RTO/ERO is a not-for-profit organization, any surpluses are refunded back to the group insurance plans Our unique plans are owned and managed by members Strength in numbers. Over 91,000 participants are insured You have a voice you can suggest plan changes through our Health Plans Enhancement Submission service Eight out of 10 teachers with a medical deduction from OTPP have chosen RTO/ERO 99% of members are satisfied with the RTO/ERO Plans, based on a survey conducted by Goldfarb Intelligence Marketing in 2012 A local health representative is there for you in each of the 48 districts Everyone has access to the same coverage regardless of age Single, couple or family coverage available 4 5

4 RTO/ERO Group Insurance Summary Dental Plan Reimbursements are made according to the 2016 Provincial Fee Guide for General Practitioners. All maximums are per insured person. Basic and Preventive (85% reimbursement) Unlimited annual maximum One standard oral examination, recall oral examination, polishing and fluoride applications every nine months Other services, including fillings, x-rays and repairs/rebase/relining of existing dentures Endodontics and Periodontics (80% reimbursement) $850 annual maximum Includes root canal therapy, treatment of bones and tissues, scaling and occlusal equilibration Major Restorative (50% reimbursement) There are two, separate maximums under the Major Restorative benefit: $800 annual maximum for crowns, posts, onlays and inlays, including crowns on implants $800 annual maximum for fixed bridges and partial dentures, including those on implants Extended Health Care Plan Includes out-of-province/canada travel coverage for an unlimited number of trips, each up to 93 days in duration, and guaranteed acceptance to the Supplemental Travel Plan for extended vacations Even if you are eligible for a Provincial Drug Benefit Plan, such as the ODB, it is still essential to have a sizeable prescription drug maximum. The ODB covers less than half the prescription drugs currently available on the Canadian market. Some of these are classified as limited use. This means you must meet specified criteria for the drug to be covered by the ODB. Out-of-Province/Canada Travel (100% reimbursement) Unlimited number of trips, each up to 93 days in duration $2,000,000 for eligible emergency medical expenses per person/trip Emergency medical expenses incurred due to an accident or sudden illness while travelling outside your province of residence/canada Pre-existing medical conditions are covered, subject to a 90-day medical stability clause Air ambulance coverage $6,000 trip cancellation and interruption/delay per person/trip Paramedical practitioners (80% reimbursement) $1,200 per calendar year (for all practitioners combined) 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, as well as acupuncture and foot care services provided by a registered nurse Access this benefit without physician authorization Vision care (80% reimbursement) $400 every two years Prescription eyeglasses, contact lenses, laser eye surgery, and corneal incision Eye examinations to a maximum of $150 every two consecutive calendar years Prescription drugs (85% reimbursement of ingredient costs) $3,200 per calendar year, including sexual dysfunction medications and diabetic supplies Covers drugs that legally require a prescription, plus certain non-prescription drugs. Brand covered if no generic is available, or with physician authorization The $100 Ontario Drug Benefit (ODB) deductible is reimbursed based on eligible drug ingredient costs 6 Eldercare Select Expert guidance and support to address a specific caregiving challenge and develop a customized plan of action Best Doctors A suite of services enabling you to draw on the knowledge of the best medical minds in the world to help you get the right diagnosis, the right treatment and the right care

5 Aids and appliances (80% reimbursement) Devices, including insulin pumps, CPAP machines, hearing aids, orthotics, orthopaedic shoes, wheelchairs, walkers, prostheses and wigs Accidental dental (80% reimbursement) Dental treatment required due to an accidental blow to natural or artificial teeth Additional benefits (80% reimbursement) Includes: Medically related educational programs, diagnostic services, private duty nursing, and ground/air ambulance transportation Supplemental Travel Plan The Supplemental Travel Plan provides flexible and affordable coverage for trips that exceed 93 days to a maximum trip duration of 212 days for residents of Ontario, Manitoba, New Brunswick, British Columbia and Newfoundland and Labrador or 182 days for residents of all other provinces. Guaranteed acceptance, without a medical questionnaire Rates simply based on age and trip duration Available exclusively to Extended Health Care Plan participants Offers identical coverage as under the Out-of-Province/Canada Travel benefit Semi-Private Hospital and Convalescent Care Plan Coverage for the cost of a semi-private room, as well as assistance post-discharge in a facility or in your own home with the activities of daily living, ambulation and exercise, and homemaker services. Semi-Private Hospital (95% reimbursement) Unlimited maximum Daily semi-private room charges in a licensed hospital Convalescent Care (80% reimbursement) Home care up to $75/day following: A 24-hour hospital stay, maximum 30 days Non-elective day surgery, maximum 3 days Temporary stay in a long term care facility following a 24 hour hospitalization, up to $75/day, maximum of 30 days per year. RTO/ERO Monthly Rates January 1 to December 31, 2016* Single Couple Family Dental $56.50 $ $ Extended Health Care $88.17 $ $ Semi-Private Hospital and Convalescent Care $14.60 $29.16 $34.28 * 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. 8 9

6 How to join Our strengths How do I get coverage? You must be a member of RTO/ERO to participate in our insurance plans. Complete the enclosed application, or visit our website to download and print an application. You can also apply online: When should I apply? Still working. You can apply as soon as you know the date of your retirement and the date that your existing group insurance benefits terminate. The ideal time to apply is one to two months in advance of the termination of your current coverage. Your RTO/ERO benefits will begin the day after this termination date. Already retired. If you are still covered by a group insurance plan (i.e. a board or other employee plan), apply one to two months in advance of the date of termination of your current coverage. Without coverage or in an individual insurance plan. For both the Extended Health Care Plan and Semi-Private Hospital and Convalescent Care Plan, you will be asked to complete a medical questionnaire and your acceptance will be subject to approval by the insurer. Acceptance onto the dental plan is automatic. The maximum benefit payable per person during the first 12 months is limited to $500. After this period, participants can claim full benefits. You are guaranteed acceptance only if you apply in advance of, or within the 60 days subsequent to, the termination date of another group insurance plan. How do I pay for my insurance? If your pension is with OTPP, premiums will be deducted directly each month. All other plan participants will pay through monthly bank deduction. Last business day of the month: Pension payments are made 5 th day of each month: Premium is deducted from your bank account If the application is received during the 60 days following termination of a previous group insurance plan, coverage is effective the date following this termination date and arrears premium will be billed. You will speak with a real person and receive topof-the-line customer service in English and French, with dedicated teams to take care of your enquiries; RTO s group insurance plan is the best! Whenever I call in to ask questions the staff are patient, helpful and very knowledgeable. I ve never had any trouble getting coverage. Prescriptions, eyeglasses, dental work, ankle braces etc. are approved quickly and easily. The forms I send in for physio and alternative practitioners are speedily processed. Walk-in service in downtown Toronto: your questions answered in person and your application can be processed while you wait; Judith, District 16, Toronto 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, District 27, Ottawa-Carleton Walk-in service is welcome in the Greater Toronto Area (Richmond Hill) for administration and claim services

7 12 Provincial Office: Spadina Road Toronto ON M5R 2S7 Tel: Toll free: #chartmyadventure JOHNSON INC Plan Benefits Service Spadina Road Toronto ON M5R 2S7 Tel: Toll free: Fax: ENG 01.16