RTIPGuide. For retiree health, dental & travel insurance

Transcription

1 For retiree health, dental & travel insurance Insurance solutions for the education community 2015 RTIPGuide What's inside?» Five health plans to choose from» How to decide which plan you need» Special services and extra benefits» Make an easy transition from any group plan to RTIP» Application form 1

2 Insurance solutions for the education community Our Story When someone chooses to be an educator, they re choosing more than a career. They re choosing a life a life dedicated to putting others first. Our name is OTIP Our initials stand for Ontario Teachers Insurance Plan. What we stand for is putting educators first. Educators are our reason for being helping them protect the things they care about is what gets us out of bed in the morning, and it s what makes us look forward to tomorrow. It s been like that since day one. Almost 40 years ago, a group of like-minded individuals came together to create OTIP. They strongly believed the insurance needs of Ontario s educators would be better served by a not-for-profit insurance advocate that was part of the education community; an insurance advocate with the determination, skill and vision to work with the best insurance companies to shape and innovate products and services specially built for educators. Today, we proudly offer a full range of group and individual insurance products that all share one thing in common. They were created to specifically address and satisfy the unique needs of our members. What s inside How to decide which plan you need... 4 Eligibility and when medical evidence is required... 5 RTIP Gold Elite... 6 RTIP Plus... 8 RTIP Gold RTIP Basic RTIP Deluxe Travel RTIP Dental Why? Because we believe that insurance built around our members is the best insurance of all. At OTIP, we don t have a profit motive. We have something more inspiring: a putting educators first motive. The proceeds we generate by meeting the needs of our members and going beyond expectations enable us to continually develop new and better ways to protect what matters to them most. OTIP is proudly governed, led and inspired by the four education affiliates and their local leaders who daily champion the employees of Ontario s education communities. Being affiliate-led means we understand, like no other, the needs and hopes of our members. Every product and service we offer has been shaped and improved by this deep understanding. And that will always be true. Our commitment to insurance built around our members doesn t stop at retirement. OTIP s health, dental and travel insurance is the most flexible program available to the retired education community. Because when you retire, you want insurance coverage that is tailored to you. Plan Comparison Chart Rate Comparison Chart Application Form Important services included in all RTIP Plans Why choose RTIP (Retired Teachers Insurance Plan)? No age restrictions and no membership fees. Five health care plans to choose from, with four different prescription drug maximums and the freedom to increase or decrease your coverage at your next renewal.* Deluxe travel insurance is included in every RTIP plan and provides coverage for trips up to 95 consecutive days! You have the option to add dental coverage at any time, without penalty. Online claims are easy! Submit your claims online and your reimbursement will be deposited directly into your bank account. Complimentary access to these important services: CAREpath the Cancer Assistance Program. Express Scripts Canada Pharmacy a home delivery program that covers 100% of your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). Edvantage savings, contests and special events. See pages for more information about these programs. Flexibility is important. Your needs will change throughout your retirement, so having the freedom to increase or decrease your coverage is very important. It is especially important once you turn 65, because the Ontario Drug Benefit Program (ODB Program) may cover the majority of your prescription drug costs. RTIP gives you the flexibility to decrease your prescription drug coverage at your next renewal (January 1)*, therefore reducing your monthly premiums. Don't pay for more prescription drug coverage than you need! For more information about the ODB Program, visit and search ODB Program. * Once you decrease your health coverage, you must wait two years before you are able to increase your coverage again. An increase to the Gold Elite plan or an increase of more than one plan level requires medical evidence of insurability. Gold Elite is the only RTIP plan with an age limit. Once you turn 65, this plan terminates, and you are automatically enrolled in the RTIP Gold plan (with a $750 drug maximum), unless you select a different RTIP plan. For more information, Phone: Online: 2 please contact OTIP. Mail: 125 Northfield Drive West, PO Box 218, Waterloo ON N2J 3Z9 RTIP plans are underwritten by Manulife Financial. 3

3 How to decide which plan you need 1 How old are you? What are your current annual prescription drug costs? Under age 65? If you haven t kept track of the cost of your prescription drugs don t worry! Call your pharmacist to determine the total annual cost of your prescription drugs. Match your current annual prescription drug costs to the RTIP plan with the closest annual prescription drug maximum. Plan Annual prescription drug max. What else is included? Go to: RTIP Gold Elite Unlimited Page 6 RTIP Plus $3,000 Page 8 RTIP Gold $1,500 RTIP Gold $750 Page 10 RTIP Basic $750 Page 12 Now that you ve selected the appropriate plan based on your annual prescription drug costs find your plan in this book and use this checklist to further customize your coverage. Choose single, couple or family coverage. Ensure the monthly premiums fit your budget. Review and understand your prescription drug coverage. Age 65 or older? If you are 65 or older and living in Ontario with a valid Ontario health card you are eligible for the Ontario Drug Benefit (ODB) Program. This program may cover the majority of your prescription drug costs. Call your pharmacist to determine the annual cost of your prescription drugs that are not covered under the ODB Program. Use that number to find the coverage that is right for you. My current annual prescription drug costs (not including dispensing fees) are: $ Remember, you re not locked in! We offer multiple plans because we know your needs will change throughout your retirement, and when they do, you'll be able to increase or decrease your coverage at your next renewal (January 1).* What else is important to you? Travel Insurance Coverage for trips up to 95 consecutive days is included in every RTIP health plan! Vision Care Paramedical Services (Chiropractic, Physiotherapy, Acupuncture, etc.) Hospital Accommodation Included in some plans or your choice to add. Dental Coverage Always optional. Add it at any time without penalty. Complete the application form on page 19 or visit rtip.com to apply online today! Who is eligible for RTIP? All retired Ontario education employees, their families and survivors are eligible to apply for coverage under a RTIP plan. There is no age restriction to join RTIP. You must reside in Ontario and be covered under OHIP at the time of application. Have a dependant? Members unmarried, unemployed children under the age of 21 (under 31 if attending school fulltime) are eligible for dependant coverage under a RTIP plan. There is no age limit for unmarried, dependant children who are incapable of selfsustaining support due to a mental or physical disability that occurred prior to age 21. Keep in mind, any two family members can qualify for couple coverage. If you do not have an eligible spouse, you and your dependant child can qualify for couple rates. What retirement stage are you at? I ve set my retirement date. I ve recently retired. This is the best time to apply! I'm already retired and want to switch from a different group health benefits plan. I have not been covered under a group health benefits plan in the last 60 days. Apply before your current health coverage ends to ensure your RTIP coverage is ready when you need it. Applying early also ensures that your benefits card is in your hands when your coverage begins. Medical evidence is not required unless you are applying for the RTIP Gold Elite plan.* No medical evidence* is required if you apply for a RTIP plan within 60 days of your group health plan termination date. If you want to switch to RTIP (even from another retiree group health benefits plan), you can apply within 60 days of your current group health plan termination date, without providing medical evidence.* There is no age restriction to join RTIP. See the outside back cover for more reasons to make the easy switch to RTIP. If you apply for any retiree health plan more than 60 days after your health coverage ends, medical evidence is required. Is medical evidence required when you apply? NO NO NO YES If at any time you are having trouble understanding something or making the best decision, call us at and we'll help you find the right coverage. I m still working or I m semi-retired. Even if your current health plan is not terminating, you can still apply for a RTIP plan to coordinate benefits. Medical evidence is required. YES * Once you decrease your health coverage, you must wait two years before you are able to increase your coverage again. An increase to the Gold Elite plan or an increase of more than one plan level requires medical evidence of insurability. *A medical evidence of insurability form is required to apply for, or increase to, the Gold Elite plan. 4 5

4 RTIP Gold Elite It s a reality that some families have catastrophic medical expenses. In response to this need, OTIP created the RTIP Gold Elite plan. Available to all retired members of Ontario s education community under the age of 65, this plan is designed to provide insurance protection from significant health care expenses. With RTIP Gold Elite, you can afford to treat your condition while protecting your family s finances and your retirement plan. A medical evidence of insurability form is required to apply for, or increase to, the Gold Elite plan. This plan covers: (For more details, see the Plan Comparison Chart on pages ) Prescription drugs First $500 Next $4,000 After $4,500 UNLIMITED Eligible prescription drug expenses are reimbursed at 80% until you have received a total payment of $500 per person, You pay for the next $4,000 in eligible prescription drug expenses per person, 100% of eligible prescription drug expenses are reimbursed with no annual maximum. When each calendar year is up, the process begins again. OR when you use the Express Scripts Canada Pharmacy home delivery program, you receive 100% coverage for your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). See page 22 for details. You are responsible for dispensing fees. Sexual dysfunction drug coverage is included up to $500 per person. Remember to claim your unreimbursed medical expenses on your income tax return, including the $4,000 deductible, your premiums, and all other out-of-pocket expenses for the calendar year. RTIP Gold Elite Also included at no additional cost: Combined coverage for: Home care Private duty nursing Medical aids equipment & supplies Prosthetic appliances Once paid claims exceed $7,500, you are reimbursed at 100% to a combined maximum of $25,000 per person, per calendar year, to a lifetime maximum of $100,000. Paramedical services to a combined maximum of $1,250 per person, RTIP Gold Elite also offers unlimited chiropractic and physiotherapy coverage for 12 consecutive months following an accident that requires a hospital stay of at least 24 hours. Members are eligible once the $1,250 paramedical maximum has been reached. Vision care 100% reimbursement to $250 per person in any two calendar years. Deluxe travel insurance for trips up to 95 consecutive days! Details on page 14. Access to CAREpath Cancer Assistance Program and Edvantage rewards program. Details on pages 22 and 23. You can choose to add: Eligible expenses are reimbursed at 80% until you have received a total payment of $7,500 per person, Hospital coverage Your choice of unlimited or $100 per day semi-private hospital accommodation. See coverage and premium chart to the right. RTIP dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. Gold Elite You can choose to add: Monthly Premiums (including deluxe travel insurance) Single $95.06 Couple $ Family $ Monthly Hospital Accommodation Premiums Coverage $100 per day Unlimited semi-private Single $12.89 $21.06 Couple $23.40 $40.32 Family $29.09 $51.00 Note: Plan change required at age 65 The Ontario Drug Benefit covers many prescription drug costs for Ontarians once they turn 65. Because of this, the RTIP Gold Elite plan terminates at age 65, and members are automatically enrolled in the RTIP Gold plan (with a $750 drug maximum), unless they select a different RTIP plan. 6 7

5 RTIP Plus This comprehensive plan provides $3,000 in prescription drug coverage per person, per calendar year. With superior health care coverage, unlimited semi-private hospital accommodation and deluxe travel insurance built in, it is the choice of many education employees. This plan covers: (For more details, see the Plan Comparison Chart on pages ) Prescription drugs $3,000 drug maximum Eligible prescription drug expenses are reimbursed at 85% to a maximum of $3,000 per person, No deductible. Sexual dysfunction drug coverage is included up to $750 per person. You are responsible for dispensing fees. Save more money when you use the Express Scripts Canada Pharmacy home delivery program for your maintenance prescription medications. You receive 100% coverage for your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). See page 22 for details. Also included at no additional cost:»paramedical» services to a combined maximum of $1,250 per person, Vision care to $375 per person in any two calendar years. Unlimited semi-private hospital accommodation. Diabetic supplies 85% reimbursement to $1,000 per person, Deluxe travel insurance for trips up to 95 consecutive days! Details on page 14. Access to CAREpath Cancer Assistance Program and Edvantage rewards program. Details on pages 22 and 23. You can choose to add: RTIP dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. Our most POPULAR PLAN! Plus Monthly Premiums (includes unlimited semi-private hospital accommodation and deluxe travel insurance) $3,000 drug maximum per person, per calendar year Single $ Couple $ Family $ RTIP Plus 8 9

6 RTIP Gold RTIP Gold is the perfect plan for members who need less prescription drug coverage but still want all of the other comprehensive health care services and deluxe travel insurance. With two prescription drug limits to choose from and the option to add dental and/or hospital coverage, RTIP Gold is our most flexible plan. Customize your coverage. This plan covers: (For more details, see the Plan Comparison Chart on pages ) Prescription drugs Choose your maximum $1,500 drug maximum $750 drug maximum Eligible prescription drug expenses are reimbursed at 80% to a maximum of $1,500 per person, No deductible. Sexual dysfunction drug coverage is included up to $750 per person. You are responsible for dispensing fees. Eligible prescription drug expenses are reimbursed at 80% to a maximum of $750 per person, Save more money when you use the Express Scripts Canada Pharmacy home delivery program for your maintenance prescription medications. You receive 100% coverage for your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). See page 22 for details. Also included at no additional cost:»paramedical» services to a combined maximum of $1,250 per person, Vision care 100% reimbursement to $250 per person in any two calendar years. Diabetic supplies to $1,000 per person, Deluxe travel insurance for trips up to 95 consecutive days! Details on page 14. Access to CAREpath Cancer Assistance Program and Edvantage rewards program. Details on pages 22 and 23. You can choose to add:»hospital» coverage Your choice of unlimited or $100 per day semi-private hospital accommodation. See coverage and premium chart to the right. RTIP dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. This plan is the most popular choice for members over age 65 because most of their drugs are covered under the ODB Program. Only OTIP helps you save by giving you choices. Gold You Monthly Premiums (including deluxe travel insurance) $1,500 or $750 drug maximum per person, per calendar year Drug maximum $1,500 $750 Single $65.82 $51.60 Couple $ $97.30 Family $ $ can choose to add: RTIP Gold Monthly Hospital Accommodation Premiums Under age 65 Age 65 or older Coverage $100 per day Unlimited semi-private Single $12.89 $21.06 Couple $23.40 $40.32 Family $29.09 $51.00 Single $24.43 $40.88 Couple $45.33 $77.91 Family $56.79 $

7 RTIP Basic If you are looking for a lower-cost health care plan, RTIP Basic may be right for you. This option is most suited for those who require limited prescription drug coverage, do not require vision or hearing care benefits, and may be purchasing a plan mainly to coordinate benefits with another health care plan. This plan covers: (For more details, see the Plan Comparison Chart on pages ) Prescription drugs $750 drug maximum Eligible prescription drug expenses are reimbursed at 80% to a maximum of $750 per person, An annual deductible of $100 applies for single coverage and $200 for family and couple coverage. RTIP Basic Sexual dysfunction drug coverage is included up to $750 per person. You are responsible for dispensing fees. Save more money when you use the Express Scripts Canada Pharmacy home delivery program for your maintenance prescription medications. You receive 100% coverage for your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). See page 22 for details. Also included at no additional cost:»paramedical» services to a combined maximum of $750 per person, $100 per day in semi-private hospital accommodation. Vision tests are covered, however, vision care coverage is not included. Hearing tests are covered, however, hearing aid coverage is not included. Diabetic supplies to $750 per person, Deluxe travel insurance for trips up to 95 consecutive days! Details on page 14. Access to CAREpath Cancer Assistance Program and Edvantage rewards program. Details on pages 22 and 23. You can choose to add: RTIP dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. Basic Monthly Premiums (includes deluxe travel insurance and hospital accommodation) $750 drug maximum per person, per calendar year Single $46.76 Couple $87.13 Family $

8 RTIP Deluxe Travel Insurance Included in all RTIP plans at no additional cost Our deluxe travel insurance offers comprehensive coverage and is included in all RTIP health care plans at no additional cost. So in most cases, you will not need to purchase travel insurance when travelling outside the province or country. RTIP Dental Coverage Optional RTIP dental coverage can be added to any of our health care plans, or purchased alone, at any time. RTIP s dental plan covers regular examinations and preventive care in addition to many more substantial procedures, as outlined below. Reimbursement is based on the current year s Ontario Dental Association fee guide for general practitioners. Coverage includes: Coverage includes: Emergency medical treatment Coverage up to $2 million per person, per trip while travelling outside your province of residence. Coverage is effective for trips up to 95 consecutive days, with an unlimited number of trips per year. Trip cancellation and/or trip interruption Coverage up to $6,000 per person, per trip, for pre-paid, non-refundable, unused expenses if you are unable to travel or continue to travel due to death, illness, or serious injury to yourself or a member of your immediate or extended family (as defined in the contract). Trip cancellation and trip interruption coverage are not available if you depart prior to the effective date of your RTIP policy. However, in the event of trip interruption, return airfare is covered if the expense is incurred after the effective date of your RTIP policy. 24-hour emergency assistance While you are away, 24-hour emergency assistance is always available. Services include arranging for: payment to health care providers, medical referrals, transportation, notification of physician and family, and local care of dependants. If you are hospitalized and your dependant children and/or grandchildren under the age of 16 are left unattended, their return home will be coordinated and paid for. If necessary, a qualified escort will accompany the dependant children, and the escort's expenses for roundtrip transportation will be paid. Before you decide to travel: If you depart on your trip prior to the effective date of your RTIP policy, your coverage will begin the day your RTIP policy comes into effect. The 95-day limit will begin on the day you depart. Claims adjudication uses a standard administrative practice to determine if an insured member was clinically stable at the time of the incident. Because decisions on the eligibility of a claim are made after the claim has been submitted, OTIP cannot guarantee before you leave that claims related to your pre-existing medical condition will be covered. As with any insurance plan, it is important to check the details of your contract to ensure you are protected. Complete details of the coverage and exclusions under the RTIP deluxe travel insurance plan can be found online at Access to a competitive top-up travel insurance program for trips over 95 consecutive days through 21st Century Travel Insurance. Find out more at or call 21st Century Travel Insurance at Basic and preventive care * 80% coverage for dental examinations, extractions, fillings, X-rays, scaling (16 units of time), cleaning and preventive procedures with no overall maximum. Coverage for recall examinations is limited to nine months from last appointment. Basic restorative care * 80% coverage for root canals (endodontics) and gum disease treatments (periodontics), up to a combined annual maximum of $750. Major restorative care * 50% coverage for crowns, bridges, implants and dentures, up to a combined annual maximum of $700. Denture care * 80% coverage for rebasing and relining of upper and lower dentures, up to a maximum of one treatment per year. *terms and conditions of coverage apply Monthly Dental Premiums Single $61.59 Couple $ Family $ No penalty You may add dental coverage to your plan at any time. If you initially forego this option and apply for coverage at a later date, there is no penalty or restriction period before you can claim full benefits. The only requirement is that you remain enrolled for at least 12 months after adding dental care to your plan. If you decide to cancel your dental coverage after the minimum 12-month requirement, you must wait 24 months before you can repurchase this benefit. Beware of dental plans with late-entry penalties and restrictions. Many dental insurance plans impose waiting periods or restrictions before full benefits can be claimed

9 RTIP Plan Comparison Chart Note: All coverage is per person, unless stated otherwise. Benefit Coverage Information RTIP Gold Elite RTIP Plus RTIP Gold RTIP Basic Prescription Drugs Annual maximums All prescription drug maximums are per person, You are responsible for dispensing fees. Initial $500 Unlimited annual prescription drug maximum once annual claims deductible is met. $3,000 Your choice of: $1,500 $750 $750 Deductible You are responsible for $4,000 in eligible prescription drug expenses per person, per calendar year. No deductible. No deductible. Single $100, Couple and Family $200 per calendar year. Reimbursement Percentage of reimbursement of prescription drug costs. of prescription drug costs for the first $500 in eligible claims. After $4,500 in eligible expenses has been reached, 100% reimbursement with no annual maximum. 85% 80% 80% Sexual dysfunction Included in annual drug maximum up to $500. Included in annual drug maximum up to $750. Included in annual drug maximum up to $750. Included in annual drug maximum up to $750. Express Scripts Canada Pharmacy home delivery program Save more money when you use the Express Scripts Canada Pharmacy home delivery program for your maintenance prescription medications. You receive 100% coverage for your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). Paramedical Services Coverage for the services of any of the following licensed, certified or registered practitioners (payable only after your provincial health insurance plan maximum has been reached, if applicable): Chiropractor, Podiatrist, Chiropodist, Osteopath, Registered Massage Therapist*, Psychologist, Registered Family Therapist, Registered Social Worker, Physiotherapist, Speech Pathologist, Nutritional Counselling provided by a Dietician, Homeopath, Naturopath, Shiatsu Therapist*, Reflexology performed by a Reflexologist, Acupuncture performed by a Chiropractor, Physiotherapist, Naturopath or Acupuncturist. *Massage therapy and Shiatsu services require written authorization by an attending physician. to a combined maximum of $1,250 Gold Elite Only: 100% reimbursement of eligible charges for Chiropractor and Physiotherapist services for 12 consecutive months, once the $1,250 paramedical services maximum has been reached. Documentation of a 24-hour hospital stay will be required. of eligible charges up to a combined maximum of $1,250 of eligible charges up to a combined maximum of $1,250 of eligible charges up to a combined maximum of $750 Vision Care Coverage for purchase and repair of prescription lenses and frames, prescription sunglasses, contact lenses or laser eye surgery. 100% reimbursement to $250 in any 2 calendar years. of eligible charges up to $375 in any 2 calendar years. 100% reimbursement of eligible charges up to $250 in any 2 calendar years. Not available. Additional coverage following cataract surgery Coverage for intraocular lens implants, contact lenses or eyeglasses following cataract surgery. 100% reimbursement to a maximum of $250 per surgery. to a maximum of $375 per surgery. 100% reimbursement to a maximum of $250 per surgery. to a maximum of $200 per surgery. Diabetic Supplies Coverage for diabetic needles, syringes and testing supplies. These maximums are separate from the annual prescription drug maximums. to a maximum of $1,000 85% reimbursement of eligible charges up to a maximum of $1,000 per calendar year. of eligible charges up to a maximum of $1,000 per calendar year. to a maximum of $750 Hearing Aids Reimbursement of eligible charges for purchase and repair of hearing aids following an application to the Assistive Devices Program. 100% reimbursement to $1,000 every 3 calendar years. 100% reimbursement to $1,000 every 3 calendar years. 100% reimbursement to $1,000 every 3 calendar years. Not available. Custom-made Orthotics Custom-made orthotics must be prescribed by a physician or podiatrist/ chiropodist and requires a biomechanical exam and gait analysis. of eligible charges to a maximum of $500 (limited to 1 pair) in any 2 calendar years. of eligible charges to a maximum of $500 (limited to 1 pair) in any 2 calendar years. of eligible charges to a maximum of $500 (limited to 1 pair) in any 2 calendar years. of eligible charges to a maximum of $450 (limited to 1 pair) in any 2 calendar years. Custom-made Orthopaedic Shoes/Boots Modifications and adjustments only to stock-item orthopaedic boots/shoes are eligible. of eligible charges to a maximum of 2 pairs of eligible charges to a maximum of 2 pairs of eligible charges to a maximum of 2 pairs of eligible charges to a maximum of 2 pairs Incontinence supplies Must provide written authorization by an attending physician. to a maximum of $750 to a maximum of $750 to a maximum of $750 to a maximum of $200 Support Stockings Coverage for surgical support stockings. Minimum mmhg compression factor. to a maximum of $950 to a maximum of $950 of eligible charges up to a maximum of $950 per calendar year. to a maximum of $750 Hospital Accommodation Included with all hospital accommodation benefits, when a semi-private room is not available, the hospital cash benefit will provide $10 per day to a maximum of $100 per stay to cover expenses such as parking, telephone and television rentals. Choice of unlimited semi-private coverage or $100 per day to be used towards the cost of semi-private or private room accommodation. Unlimited semi-private accommodation. Choice of unlimited semi-private coverage or $100 per day to be used towards the cost of semi-private or private room accommodation. $100 a day towards the cost of semiprivate or private room accommodation. Included in all RTIP Plans Deluxe Travel Insurance Our deluxe travel insurance offers comprehensive coverage and is included in all RTIP health care plans at no additional cost. Coverage is effective for trips up to 95 consecutive days, with medical emergency coverage up to $2 million per person, per trip. You may be reimbursed for up to $6,000 for trip interruption or cancellation coverage. See page 14 for details. Vision Tests Vision tests are covered at a rate of 80% to a maximum of $125 in any 2 calendar years. Heidelberg Retina Tomograph (HRT) exams are covered at a rate of 80% to a separate maximum of $125 in any 2 calendar years. Hearing Tests Hearing tests are covered at a rate of 100% to a maximum of $75 Sleeping Aids of eligible charges, coverage for the remaining 25% of the cost of a Continuous Positive Air Pressure unit (CPAP) following application to the Assistive Devices Program. Supplies for the CPAP unit are covered as follows: Mask, headgear, hose cannula and pillow once every 12 months. Filters maximum of 3 packages of 5 every 12 months. Humidifier once every 24 months. Comfort & Convenience Items of eligible charges, up to $200 per person, per calendar year for post-surgical supports (Obus Forme, bath aids, etc.) recommended by your physician following surgery (includes out-patient treatment, e.g., day surgery) provided purchase takes place within 30 days of returning equipment provided through an equipment loan program such as CCAC, Red Cross, etc. Diagnostic Services of eligible charges. Coverage for tests not performed in a hospital but under the direction of a physician (e.g., CEA cancer level, CA 125 for women and PSA for men). Dental Accident of eligible charges. Coverage for damage caused by a direct accidental blow to the mouth. This benefit does not apply to injuries caused by an object placed wittingly or unwittingly in the mouth. Ambulance Services for costs that exceed your provincial health insurance plan s limit. Private Duty Nursing Home Care Medical Aids, Equipment & Supplies of eligible charges. Coverage for the services of a Registered Nurse (RN), a Registered Practical Nurse (RPN), Registered Nursing Assistant (RNA) or Licensed Practical Nurse (LPN), up to $2,000 per person every calendar year. to a maximum of $75 per day, for a maximum of 30 days following an active, acute care hospital stay for a minimum of 24 hours, and a maximum of 3 days following non-elective day surgery. To cover charges for convalescent home care provided in own home, mainly for the purpose of assistance with activities of daily living. of eligible charges, ongoing coverage for medical necessities such as hospital beds, crutches and canes, oxygen equipment, etc., as well as medical aids and supplies, including surgical bandages, dressings, grab bars, commodes, etc., with written authorization by an attending physician. Gold Elite Only: Once paid claims exceed $7,500, you are reimbursed at 100% to a combined maximum of $25,000 per person, per calendar year, to a lifetime maximum of $100,000. See page 6 for details. Prosthetic Appliances of eligible charges. Coverage includes artificial limbs and eye replacements, splints, torso casts, cervical collars, braces (once every 24 months per body part), etc. Wigs covered to a lifetime maximum of $

10 RTIP Rate Comparison Chart Monthly Health Care Premiums RTIP Gold Elite (Under age 65) Initial $500 Annual Drug Maximum Then $4,000 deductible Following that UNLIMITED RTIP Plus RTIP Gold RTIP Basic $3,000 Annual Drug Maximum (Includes unlimited semi-private hospital accommodation coverage.) $1,500 Annual Drug Maximum $750 Annual Drug Maximum $750 Annual Drug Maximum (Includes $100 a day semi-private hospital accommodation coverage.) Single $95.06 $ $65.82 $51.60 $46.76 Couple $ $ $ $97.30 $87.13 Family $ $ $ $ $ RTIP Application Form Benefits are administered by OTIP and underwritten by Manulife Financial. Section A General Information Please return to: 125 Northfield Drive West PO Box 218 Waterloo ON N2J 3Z9 Phone: Fax: Please print using ballpoint pen. Date of Birth (mm/dd/yy) Applicant s Last Name First Name Middle Initial mm dd yy Address Apt. Gender City/Town Province Postal Code Home Telephone No. Alternate Telephone No. Address I prefer all correspondence in: m English m French Optional coverage: You can choose to add hospital coverage to RTIP Gold Elite (Under age 65) and RTIP Gold health plans. Monthly Hospital Accommodation Premiums Coverage $100 per day Under age 65 Unlimited semi-private $100 per day Age 65 or older Unlimited semi-private Single $12.89 $21.06 $24.43 $40.88 Couple $23.40 $40.32 $45.33 $77.91 Family $29.09 $51.00 $56.79 $98.50 First Name & Middle Initial (Provide last name if different from applicant) Spouse/Partner Dependant Child Dependant Child Dependant Child Coordination of Benefits (COB) Are you, your spouse or dependants covered under any other plan? Section B Eligibility m yes m no Date of Birth (mm/dd/yy) mm dd yy mm dd yy mm dd yy mm dd yy Gender Complete if you have an eligible dependant student over the age of 21 School Year Start School Year End Name of other insurance company Policy/Group # ID/Certificate # Name of School Optional coverage: You can choose to add dental coverage to any RTIP health plan. Monthly Dental Premiums Single Couple Family I wish to be covered under a RTIP plan starting: mm 01 yy Within the last 60 days: If you select any of the three options below, please complete the policy information box, indicated by the yellow arrow. m I have been insured as an active member under a group health benefits plan. m I have been insured as a retired member under a group health benefits plan. Plan Termination Date: mm dd yy Plan Termination Date: mm dd yy $61.59 $ $ Any two family members can qualify for couple coverage. If you do not have an eligible spouse, you and your dependant child can qualify for couple rates. Limit one policy per member. Provincial Sales Tax (PST) and Harmonized Sales Tax (HST) are NOT applicable to RTIP premiums. The premiums listed in the 2015 RTIP Guide to Retirement are effective from January 1, 2015 to December 31, The RTIP Guide to Retirement is a summary of the important features of each of our plans, and does not constitute a contract. Once you enroll, we will provide you with a contract containing the specific terms and conditions. Only the terms and conditions of the contract are binding. m My current health plan is not terminating and I am looking to coordinate my benefits. Policy/Group No: Insurance Company Name: m I have not been covered under a group health benefits plan in the last 60 days. Please call OTIP for a medical evidence of insurability form and complete the policy information box below. Identification/Certificate No: Please call OTIP for a medical evidence of insurability form. m If you wish to receive s about OTIP's products services or promotions, please check here

11 Section C Coverage Selection (Please select your options below and fill in the appropriate information.) RTIP Gold Elite* m Single m Couple m Family Health Care (coverage for catastrophic expenses available until age 65, includes deluxe travel) $ Hospital Accommodation (Optional) Daily Max: m $100 m Unlimited Semi-Private $ Dental Coverage (Optional) m Single m Couple m Family $ Total Premium (add all choices) $ *A medical evidence of insurability form is required to apply for the Gold Elite plan. RTIP Plus m Single m Couple m Family Health Care $3,000 prescription drug max. $ (includes prescription drug coverage beyond age 65, deluxe travel and unlimited semi-private hospital) Dental Coverage (Optional) m Single m Couple m Family $ Total Premium (add all choices) $ RTIP Gold m Single m Couple m Family Health Care m $1,500 prescription drug max. m $750 prescription drug max. $ (includes prescription drug coverage beyond age 65 and deluxe travel) Hospital Accommodation (Optional) Daily Max: m $100 m Unlimited Semi-Private $ Dental Coverage (Optional) m Single m Couple m Family $ Total Premium (add all choices) $ RTIP Basic m Single m Couple m Family Health Care $750 prescription drug max. $ (includes prescription drug coverage beyond age 65, deluxe travel and $100 per day hospital coverage) Dental Coverage (Optional) m Single m Couple m Family $ Total Premium (add all choices) $ RTIP Dental Coverage Only m Single m Couple m Family $ Monthly Premium Combining home and auto isn t always a good idea Section D Authorization & Payment Method (Please select ONE payment method and sign accordingly.) I hereby apply for benefits coverage ( Coverage ) and certify that the information provided is true and complete. I authorize OTIP and its Insurer to collect, use, maintain and disclose my personal information, including personal health information ( Information ), relevant to this application, for the purposes of evaluating my eligibility to the plan, benefits plan administration, providing me with ongoing services, protecting us both from error and fraud and complying with various legal requirements ( Purposes ). I am authorized to consent to the collection, use, maintenance and disclosure of Information pertaining to my Dependant(s) (spouse/child), if applicable, for the Purposes. I agree that the Information in this application will be shared with the Insurer and any Coverage shall not become effective until approved by the Insurer. I agree that my Coverage may be denied or terminated at any time as a result of any false, incomplete, or misleading information having been provided in support of this application. This authorization shall remain valid unless cancelled by me in writing. m METHOD A Automatic monthly pension deduction for those in receipt of a pension from the Ontario Teachers Pension Plan Board I hereby apply for coverage under the Retired Teachers Insurance Plan with OTIP and direct the Ontario Teachers Pension Plan Board to deduct and remit premiums from my pension for my contribution towards the cost of this benefit contract. I consent to the collection, use and disclosure of any information required to administer the program including personal information such as my social insurance number. SIN # X Signature X Date OR m METHOD B Monthly pre-authorized payment plan I hereby authorize OTIP to withdraw premium payments from my account on or about the first day of each month. OTIP may terminate coverage should a withdrawal be refused for any reason and the financial institution shall in no way be held liable should such an event occur. This authorization shall remain valid unless cancelled by me in writing, subject to providing notice of five days. I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD agreement. To obtain more information about my recourse rights, I may contact my financial institution or visit Type of Account: m Savings m Chequing A void cheque MUST accompany this application. Is this a joint account requiring only one signature? m Yes m No If both signatures are required, both persons must sign this form. Signature of Account Holder(s): X X Date Except when it comes to getting up to 50% off home insurance An exclusive offer for retired education employees Some things are better together. Like purchasing both your car and home insurance from OTIP. When you do, you will save up to 50% on your home insurance. Call or visit to complete a quote This is a one-time discount (of up to 50%) and is only applicable to new multi-line home and auto policies underwritten by Traders General Insurance Company, part of the Aviva Insurance Company of Canada. OTIP and Aviva have the right to withdraw this offer 20 at any time. Must reside in Ontario to be eligible for this discount. 21

12 Your access to exclusive rewards Canada-wide SaVinGS on: Travel and Entertainment Home, Auto & Electronics Clothing and Gifts Finance and Insurance Health and Wellness Education PLUS access to over 45 Partners... Subscribe today to Edvantage e-news to stay up to date on new and exciting offers and contests RTIP Guide - Edvantage Ad.indd 1 10/29/2014 3:09:54 PM Another reason why being a RTIP member is better. According to the Canadian Cancer Society, Canadians aged represent almost 70% of all new cancer cases. The highest proportion of those new cases occurs in the age group. It s an unfortunate reality that cancer affects so many families, and we understand the importance of providing support to those affected. As a RTIP member, if you or a qualified family member is diagnosed with cancer, your CAREpath personal oncology nurse will expertly guide and support you through every step of your cancer experience, from diagnosis through treatment and into post-treatment living. For more information about CAREpath, visit and click the CAREpath link. The Express Scripts Canada Pharmacy RTIP s home delivery program Answers. Guidance. Support. Stretch your prescription drug benefit dollars further when you use the Express Scripts Canada Pharmacy TM home delivery program for your maintenance prescription medications those drugs that you take to treat ongoing medical conditions, such as asthma, diabetes or high cholesterol. How can you save money? More great benefits include: 1. When you use this home delivery program, you receive 100% coverage for your generic maintenance prescription drug expenses (or 90% of brand name prescriptions). Convenience Your medications delivered via free standard shipping directly to your home or to any address that you designate in Canada*. Request prescription transfers, renewals and refills online, by phone or by mail. GET YOUR MONEY BACK FASTER! RTIP members can conveniently and securely submit claims online at Your reimbursement will be deposited directly into your bank account. It s the fastest and easiest way to receive reimbursement for your claims! You can also choose to receive alerts when your claim has been reviewed and access the status of current 2. You can receive up to a 90-day supply of your maintenance and previously submitted claims. prescription medications for a single dispensing fee of only Peace of Mind Auto refills and refill reminders take the guesswork $ $$$$$$$$ 9 that s less than the average dispensing fee in Canada. out of refilling prescriptions so that you don t need to worry about Another great reason to choose RTIP. running out of your maintenance medication. 3. The Express Scripts Canada Pharmacy will work with you and *This program is not currently available to residents in Quebec. your doctor to choose safe, approved, lower-cost medications, where possible. You can also use the online tool to find an For more information about the Express Scripts Canada equivalent drug that will cost you less! Pharmacy and its services, visit or call

13 Do your RTO colleagues know? Your colleagues can maintain their RTO social organization membership and make the easy switch to a RTIP health, travel and dental plan with no medical, no age restrictions and save! What could you do with an extra $500 a year? Too many education employees choose the same retiree health plan just because their colleague did but not all education employees have exactly the same needs! It s never too late to switch, even if they re over age 65. Tear out this card and share it with a colleague or member of RTO! The switch to RTIP is easy! Retirement should be stress free! If you are currently covered under a different retiree group health benefits plan, our representatives will ensure a smooth transition to the RTIP plan of your choice, with coverage in place and ready to use the very next month with no interruption of benefits and no medical evidence (excluding Gold Elite). How can RTIP save you money? Once you turn 65, the Ontario Drug Benefit Program (ODB Program) may cover the majority of your prescription drug costs. Only RTIP offers the flexibility to decrease your prescription drug coverage, therefore reducing your monthly premiums, while still maintaining other important health care coverage above and beyond prescription drugs. Don t pay for more prescription drug coverage than you need! Don t worry even after you switch to RTIP, you re not locked in! We offer multiple plans because your needs may change throughout your retirement and when they do, you can increase or decrease your coverage at your next renewal (January 1)*. Learn more about all the options and flexibility that RTIP offers at or call us at and we ll answer your questions or recommend options that best suit your individual needs. 24 * Once you decrease your health coverage, you must wait two years before you are able to increase your coverage again. An increase to the Gold Elite plan or an increase of more than one plan level requires medical evidence of insurability. Insurance solutions for the education community