ARTA Retiree Benefits Plan Effective January 1, Health Wise Plus (formerly Enhanced

Transcription

1 PUBLIC SECTOR

2 ARTA Retiree Benefits Plan Effective January 1, 2013 The Health & Dental Plan renews automatically on September 1 every year. There are a number of voluntary benefits options available to you through the ARTA Retiree Benefits Plan; please review this document carefully to ensure you choose the plan that best suits your needs. In order to be eligible for ARTA benefits, you must apply for and participate in all eligible Provincial Health and Drug Plans as ARTA Extended Health Care is second payor to any Provincial Plan. To make the ARTA benefits options easier to identify, ARTA has renamed their benefits plans as follows: The Core Extended Health Care plan option will be known as Health Wise The Enhanced Extended Health Care plan option will be known as Health Wise Plus The Core Extended Health Care, plus Travel plan option will be known as Total Health The Enhanced Extended Health Care, plus Travel plan option will be known as Ultimate Health Health Wise (formerly Core Extended Health Care) 80% coverage for eligible expenses up to a maximum of $10,000 per insured per calendar year (other inside limits apply): Direct pay prescription drugs: calendar year maximum of $1,200 or $2,000 per insured (If $2,000 maximum is chosen, you must remain at this coverage level for a minimum 24 months prior to changing to $1,200 max) Accidental dental (maximum $1,000) Medical aids and appliances Ambulance service and diagnostic services Vision care ($400 per two (2) calendar years) Hearing aids ($600 per three (3) calendar years) Private duty nursing ($3,000 per three (3) years) Eldercare, including personalized eldercare reports, eldercare phone consultations/case management, Firstwatch Personal Response Systems discount, First Health Advantage Network Care, and the Eldercare Select website. Eldercare is a Canadian company. All personal information is securely stored in Canada. Paramedical services: Chiropractor, physiotherapist, athletic therapist, and massage therapist expenses of $600 combined per year Psychologist (including MSW/RSW), speech therapist, naturopath, acupuncturist, osteopath, and podiatrist/chiropodist $225 for each specialty Prescribed health educational programs ($100/year) Private or semi-private hospital (100% up to $100/day) Home care ($50/day, up to 10 days after hospital stay) Best Doctors coverage of InterConsultation Service, FindBestDoc TM Service, Best Doctors 360, and FindBestCare. Medical conditions diagnosed in the 12 months prior to the effective date are not eligible until you have been covered by the plan for at least six (6) months. Best Doctors is a global network with access to 50,000 medical specialists. Personal information is securely stored in both Canada and the United States. Best Doctors does not share any medical information with ARTA or its plan administrator, ASEBP. For more information, visit HEALTH WISE MONTHLY PREMIUMS Single $94.00 Couple $ Family $ Single $ Couple $ Family $ Health Wise Plus (formerly Enhanced Extended Health Care) This plan offers the same benefits as the Health Wise Plan, except: Vision care ($500 per two (2) consecutive calendar years) Hearing aids ($800 per three (3) consecutive calendar years) Chiropractor, physiotherapist, athletic therapist, and massage therapist expenses combined maximum of $700 per year 50% coverage for defined lifestyle (hair loss & ED) prescription drugs, to an annual maximum of $150 HEALTH WISE PLUS MONTHLY PREMIUMS Single $ Couple $ Family $ Single $ Couple $ Family $ Updated December 2012

3 Total Health (formerly Core Extended Health Care Plan with Out-of-Province and Out-of-Country Emergency Medical Travel) This plan offers the same benefits as the Health Wise Plan, plus the following emergency travel coverage: 100% coverage for sudden and unforeseen eligible emergency medical travel expenses Lifetime maximum of $2,000,000 per insured Multiple trips up to 62 days duration Hospital accommodations and physicians services Private duty nursing ($5,000 per calendar year) Drugs/diagnostic services/aids and appliances Accidental dental ($1,000 per calendar year) Paramedical services (three (3) practitioners - $225/year) Emergency transportation (ground, air) Trip cancellation/interruption ($6,000 per trip per insured) Vehicle return/return of dependent children Repatriation of deceased member TOTAL HEALTH MONTHLY PREMIUMS UNDER AGE 75 Single $ Couple $ Family $ Single $ Couple $ Family $ AGE 75 TO 84 Single $ Couple $ Family $ Single $ Couple $ Family $ AGE 85+ Single $ Couple $ Family $ Single $ Couple $ Family $ Ultimate Health (formerly known as Enhanced Extended Health Care Plan with Out-of-Province and Out-of-Country Emergency Medical Travel) This plan offers the same benefits as the Health Wise Plus Plan, plus the following emergency travel coverage: 100% coverage for sudden and unforeseen eligible emergency medical travel expenses Lifetime maximum of $2,000,000 per insured Multiple trips up to 62 days duration Hospital accommodations and physicians services Private duty nursing ($5,000 per calendar year) Drugs/diagnostic services/aids and appliances Accidental dental ($1,000 per calendar year) Paramedical services (three (3) practitioners - $225/year) Emergency transportation (ground, air) Trip cancellation/interruption ($6,000 per trip per insured) Vehicle return/return of dependent children Repatriation of deceased member ULTIMATE HEALTH MONTHLY PREMIUMS UNDER AGE 75 Single $ Couple $ Family $ Single $ Couple $ Family $ AGE 75 TO 84 Single $ Couple $ Family $ Single $ Couple $ Family $ AGE 85+ Single $ Couple $ Family $ Single $ Couple $ Family $ The travel component of the Total Health and Ultimate Health benefits plans is underwritten by SSQ Financial Group, with travel assistance provided by AXA Assistance. AXA Assistance 24-hour Centre For emergency travel assistance, contact AXA Assistance s dedicated ARTA phone line immediately: Canada/USA (Toll-free): Other Locations (Call Collect): The Alberta Retired Teachers Association Public Sector

4 Supplementary Travel Insurance to Extend a Single Trip beyond 62 Days If you require more than the 62-day base travel included with the Total Health or Ultimate Health plan, you may purchase additional supplemental coverage in 15-day units. It is best to arrange for supplemental coverage where needed before your departure by contacting ASEBP via the information provided at the end of this document. Stand-alone Annual Trip Cancellation/ Interruption/Delay Insurance Designed for retirees who still have Extended Health Care coverage, without a Trip Cancellation/Interruption benefit through their employer s plan Annual multi-trip coverage: no medical required, rates are pro-rated for the next renewal and paid monthly Coverage up to $6,000 per insured person per year; $400 for lost or delayed baggage Up to $1,000 of coverage for loss of, or damage to, your baggage and personal effects by reason of theft, burglary, fire, or transportation hazards during your covered trip Dental Care Plan Options OPTION A 80% Basic/preventative services (no annual maximum): one (1) oral exam per year, eight (8) units of scaling and/or root planing per year, and four (4) units of dental facility fees for surgical removal of teeth 80% Minor restorative: endodontics/periodontics combined to a calendar year maximum of $750 50% Major restorative: calendar year maximums are $700 for crowns/posts/inlays/onlays (combined) plus $700 for bridges/dentures/implants (combined) MONTHLY PREMIUMS: Single $57.00 Couple $ Family $ OPTION B 80% Basic/preventative (no annual maximum) 80% Minor restorative (calendar year maximum $750) Major restorative procedures are not covered MONTHLY PREMIUMS: Single $46.00 Couple $91.75 Family $ OPTION C 65% Basic/Preventative (No annual maximum) 65% Minor restorative (calendar year maximum $750) Major restorative procedures are not covered MONTHLY PREMIUMS: Single $34.75 Couple $69.25 Family $82.50 Payment for dental plan expenses will be based on the ARTA Dental Benefit List, effective January 1 each year. Other ARTA-Sponsored Plans Guaranteed life insurance up to $25,000 Term life insurance up to $150,000 (medical required) Long term care (medical required) Home and auto Insurance Great discounts for ARTA members Premium Payments Bank deductions are withdrawn on the 10th for each month for coverage for the current month. For example, January 10th deductions are for January coverage. For plan members who have their premiums deducted automatically from their pension, there will be no change in when premium payments occur. Retail Sales Tax is added to the premiums where required by law (8% for Ontario residents, 9% for Quebec residents). Supplementary Travel Insurance premium basis changes effective January 1, any retroactive premiums paid in lump sum with balance of payments amortized over the balance of the plan year. Important Notes Apply for coverage within 60 days of losing your existing employer group coverage to avoid having to submit medical evidence for eligibility. After 60 days, applications require medical evidence of insurability and you may be declined coverage. You may not have a gap in coverage following termination from your employer group coverage to participate without medical evidence. For complete Health and Dental Plan details, please refer to the governing documents and Benefits Booklet available online at Updated December 2012

5 NOTES The Alberta Retired Teachers Association Public Sector

6 Updated December 2012 NOTES

7 CONTACT US For more information on the Public Sector Retiree Benefits Plan, sponsored by ARTA, please contact: ALBERTA SCHOOL EMPLOYEE BENEFIT PLAN, ARTA S PLAN ADMINISTRATOR Suite 700 Weber Centre 5555 Calgary Trail Edmonton, AB T6H 5P9 Phone: Administration toll-free: ARTA (2782) Claims Toll-free: ARTA (2782) arta@asebp.ab.ca AXA ASSISTANCE EMERGENCY TRAVEL PROVIDER EFFECTIVE JANUARY 1, 2013 Toll-free in Canada/U.S.: From any other country, call collect: FOR TRAVEL CLAIMS INCURRED PRIOR TO JANUARY 1, 2013, CONTACT SIGMA ASSISTEL (UNTIL MARCH 31, 2013) AT: Toll-free in Canada/U.S.: From any other country, call collect: TW INSURANCE BROKERS ARTA-SPONSORED HOME AND AUTO INSURANCE Phone: TW4-ARTA ( ) ALBERTA RETIRED TEACHERS ASSOCIATION Room 409, Barnett House Street NW Edmonton, Alberta T5N 2R Toll-free (Canada only): Fax: info@arta.net The Alberta Retired Teachers Association Public Sector

8 Updated December 2012