Group Insurance for Members

Transcription

1 Group Insurance for Members yourretirement YOURTO/ERO Depuis 1968 Since 1968 À votre service...pour le soin de votre avenir. Here for you now... Here for your future. i

2 Inside About us...1 Your Group Insurance strengths...4 Your health resources...5 Group Insurance coverage...6 Rates...9 ii

3 Depuis 1968 Since 1968 À votre service...pour le soin de votre avenir. Here for you now... Here for your future. About us... Established in 1968 by the Ontario Teachers Federation, RTO/ERO has become 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 yourquestions and answers 2

5 Why is a group insurance plan important? As an active educator or support staff, you spent your career insured by a group insurance plan. This provided you with the ultimate protection; knowing that participants spoke with one voice and those with your interests in mind owned the plan. With RTO/ERO, as a plan participant, you have a voice in how the plan is managed. RTO/ERO is the only voluntary insurance plan available in Ontario, designed by education retirees, that chose to maintain coverage on a group insurance basis. 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. How do I get coverage? Complete the enclosed application or visit our website to download and print it. What insurance does RTO/ERO offer? 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? You can apply as soon as you know the date of your retirement and the date that your existing group insurance benefits terminate. Your RTO/ERO benefits will begin the day after the termination of your current coverage. You are guaranteed acceptance only if you apply within 60 days of the termination date of another group insurance plan. If you apply after 60 days or you are joining from an individual insurance plan, you will be asked to complete a medical questionnaire and will be subject to approval. Are members happy with their RTO/ERO Plans? 99% of members are satisfied with the RTO/ERO Plans, based on a survey conducted by Goldfarb Intelligence Marketing in

6 your group insurance strengths l3 Strength in numbers. The majority of education retirees choose RTO/ERO s Group Insurance Plans and 99% of them are happy with their choice; l3 RTO/ERO is a not-for-profit organization and our unique plans are owned and managed by our members. A Health Services and Insurance Committee, comprised exclusively of your peers, controls our insurance plans and responds to your needs; l3 Our plans are well-funded and have been around since 1984; l3 Everyone benefits from the same coverage regardless of age; l3 Single, couple or family coverage available; l3 You will speak with a real person and receive top-of-the-line customer service in English and French, with dedicated teams to take care of your enquiries; l3 Most claims can be submitted electronically, payments are deposited to your bank account, and you can access your information online in real-time; and l3 Walk-in service is welcome in the Greater Toronto Area to assist members with administration and claim services. 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

7 your health resources RTO/ERO group insurance plan details and forms: Departments Health Matters Health Matters Departments inside Going on vacation? Time to prepare your home!...36 Travelling with medication...37 RTO/ERO TRAVEL Q&A...38 MyMedRec: Canada s leading healthcare organizations develop mobile app MyMedRec can: metabolism, growth and development, Keep medication and tissue function, and mood. immunization records up to date; The condition robbed Ms. Smith Help you administer your and of her mobility until she got on a your family s medication safely; regime of medications that not only Remind you when to take and fill got her out of a wheelchair but, quite prescriptions; and frankly, saved her life. MyMedRec Share information with health ensures she takes and monitors the professionals via . medications she needs to replace the With an easy-to-use interface that hormones her body doesn t produce. puts medication and immunization MyMedRec has been an excellent information at a person s fingertips, tool to help me keep track of my MyMedRec is helping Canadians take medications and set reminders for the better control of their healthcare. ones I may forget, says Ms. Smith. Available for iphone, Android Available globally, MyMedRec has devices and BlackBerry10, MyMedRec been developed by seven of Canada s is a free app that empowers people leading healthcare organizations to use their smartphones as a tool Canada s Research-Based to better manage a wide range of Pharmaceutical Companies (Rx&D); information that will help them the Canadian Nurses Association; the and their healthcare professionals Canadian Pharmacists Association; of the app is its adaptability; there administer their medications safely the Canadian Medical Association; the are so many options, you can really and appropriately. personalize it to meet your needs. Institute for Safe Medication Practices I manage multiple medications Affecting one in every 200,000 people, Congenital Panhypopituitarism is a Canada; the Victorian Order of Nurses; that I take six times throughout and the Best Medicines Coalition to the day, says Maureen Smith, an condition where the pituitary gland fails ensure patients and their healthcare Ottawa resident who is living with a to produce growth hormone and, as the teams have all the information they rare disorder known as Congenital master gland, stimulate all the endocrine need, when they need it. Panhypopituitarism. The best feature hormones, regulate body functions like Continued on page 36 Health Matters is a quarterly newsletter that features important health-related stories and information. PHOTO: JOSEPH MICHAEL HOWARTH Stress and health...39 Older travellers...40 The truth about generic drugs...41 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, and 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. Scan this QR code with your smartphone to view Health Matters in the Members Centre. 34 Renaissance Fall 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. 5

8 Group Insurance coverage for retired Join Canada s largest retired educator plan, providing health coverage to over 89,000 members and their families. The RTO/ERO plan is owned and managed by RTO/ERO members. RTO/ERO Group Insurance summary (all maximums listed below are per insured person): 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; l3 Other services, including fillings, x-rays; and l3 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 Drugs (85% reimbursement of ingredient costs) l3 No deductible; l3 $3,100 maximum per calendar year, including sexual dysfunction medications; l3 Covers eligible prescription drugs for all ages, including those not covered by the Provincial Drug Benefit Plan for anyone age 65 and over; and

9 educators and educational support staff l3 The Ontario Drug Benefit Program deductible is reimbursed based on 85% of ingredient costs. Paramedical Practitioners (80% reimbursement) l3 $1,100 maximum per calendar year (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. Vision Care (80% reimbursement) l3 $375 maximum in any two consecutive calendar years; l3 Covers purchase or repair of prescription eyeglasses, contact lenses, laser eye surgery, and corneal incision; l3 Eye examinations to a maximum of $90 for one eye exam every two consecutive 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 $375. Eldercare Select l3 Expert guidance and support to address a specific caregiving 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. Educational Program (80% reimbursement) l3 Medically related education program(s) recommended by a physician, to a maximum of $200 per calendar year. 7

10 Group Insurance coverage for retired 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 93 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. Aids and Appliances (80% reimbursement) l3 Purchase or repair of hearing aids to a maximum of $1,000 in any three consecutive calendar years; l3 Custom-made orthopaedic shoes and orthotics to a maximum of $500 in any two consecutive 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 a maximum of $400 per calendar year, incontinence supplies up to a maximum of $500 per calendar year, and post-surgical comfort and convenience items (e.g., sock reacher, shoe lacer) up to $200 in any two consecutive calendar years; and l3 Mobility aids including wheelchairs, canes, walkers, and crutches. 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 in any two consecutive 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. 8

11 educators 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 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, maximum of 30 days per calendar year. Supplemental Travel Plan l3 For individual trips that extend beyond the 93 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 93 days of travel; and l3 Guaranteed acceptance for all Extended Health Care Plan participants. RTO/ERO Monthly Rates January 1 to December 31, 2015* Single Couple Family Dental $55.12 $ $ Extended Health Care $84.78 $ $ 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. 9

12 Depuis 1968 Since 1968 Provincial Office: 18 Spadina Road, Suite 300 Toronto ON M5R 2S7 Tel: Toll free: À votre service...pour le soin de votre avenir. Here for you now... Here for your future JOHNSON INC. - Plan Benefits Service 18 Spadina Road, Suite 100 Toronto ON M5R 2S7 Tel: Toll free: Fax: healthbenefits@johnson.ca All photos are of RTO/ERO members. 10 ENG 01.15