EDUCATION SECTOR. ARTA Retiree Benefits Plan Effective September 1, 2014

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1 EDUCATION SECTOR ARTA Retiree Benefits Plan Effective September 1, 2014 In order to be eligible for coverage under the ARTA Retiree Benefits Plan, you must apply for and participate in all public Provincial Health and Drug Plans for which you are eligible, as ARTA s Extended Health Care is second payor to any Provincial Plan. The Health and Dental Plans renew automatically on September 1 every year. There are a number of voluntary benefit 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. The ARTA Retiree Benefits Plan is a member-based plan available to ARTA members in good standing. To find out how to become an ARTA member, please contact us. You will find our contact information on page 8 of this brochure. Our partners:

2 Extended Health Coverage** Per insured person Benefit choice locked in? No Yes, for 24 months Overall coverage level, unless otherwise indicated 80% 80% Overall maximum per calendar year $10,000 $10,000 Direct pay drugs: maximum per calendar year ($2,000 maximum is locked in for 24 months) $1,200 or $2,000; LCA applies $1,200 or $2,000; LCA applies Accidental dental maximum per calendar year $1,000 $1,000 Defined lifestyle prescription drugs (hair loss, E.D.) maximum per calendar year N/A 50%, $150 Vision care: maximum per 24 rolling months $425 $550 Hearing aids: maximum per 36 rolling months $700 $900 Paramedicals: chiropractor, physiotherapist, athletic therapist, massage therapy, psychologist (includes MSW/RSW), speech therapy, naturopath, acupuncture, osteopath, podiatrist/chiropodist: combined maximum per calendar year Medical aids, appliances, ambulance, diagnostics (maximums noted in plan text)* Private duty nursing: maximum per three (3) consecutive calendar years* Prescribed health education programs: maximum per calendar year* Private or semi-private hospital room: 100% coverage Home care: maximum 10 days after hospital stay* $1,000 $1,200 Included Included $3,000 $3,000 $100 $100 $100/day $50/day $100/day $50/day Emergency Travel Insurance None None *Some of the services covered under your benefit plan require pre-approval from the plan administrator, ASEBP. **For more information and plan details, please refer to the plan text document located online at under Benefit Programs, Plan Text Document/Contracts. Monthly Premiums HEALTH WISE HEALTH WISE PLUS $1,200 drug maximum per calendar year $2,000 drug maximum per calendar year HEALTH WISE EHC CORE HEALTH WISE PLUS EHC ENHANCED Single $74.25 $95.25 Couple $ $ Family $ $ Single $ $ Couple $ $ Family $ $ Page 2 Updated June 2014

3 Extended Health Coverage** Per insured person Benefit choice locked in? No Yes, for 24 months Overall coverage level unless otherwise indicated 80% 80% Overall maximum per calendar year $10,000 $10,000 Direct pay drugs: maximum per calendar year ($2,000 maximum is locked in for 24 months) $1,200 or $2,000; LCA applies $1,200 or $2,000; LCA applies Accidental dental maximum per calendar year $1,000 $1,000 Defined lifestyle prescription drugs (hair loss, E.D.): maximum per calendar year N/A 50%, $150 Vision care: maximum per 24 rolling months $425 $550 Hearing aids: maximum per 36 rolling months $700 $900 Paramedicals: chiropractor, physiotherapist, athletic therapist, massage therapy, psychologist (includes MSW/RSW), speech therapy, naturopath, acupuncture, osteopath, podiatrist/chiropodist: combined maximum per calendar year Medical aids, appliances, ambulance, diagnostics (maximums noted in plan text)* Private duty nursing: maximum per three (3) consecutive calendar years* Prescribed health education programs: maximum per calendar year* Private or semi-private hospital room: 100% coverage Home care: maximum 10 days after hospital stay* TOTAL HEALTH EHC CORE TRAVEL $1,000 $1,200 Included Included $3,000 $3,000 $100 $100 $100/day $50/day ULTIMATE HEALTH EHC ENHANCED TRAVEL $100/day $50/day Emergency Travel Insurance Included Included The travel component of the Total Health and Ultimate Health plans is underwritten by SSQ Financial Group, with travel assistance provided by AXA Assistance. AXA Assistance is a Canadian company. All personal information is securely stored in Canada. Monthly Premiums TOTAL HEALTH ULTIMATE HEALTH $1,200 drug maximum per calendar year $2,000 drug maximum per calendar year Single $94.75 $ Couple $ $ Family $ $ Single $ $ Couple $ $ Family $ $ Page 3 The Alberta Retired Teachers Association Education Sector

4 Emergency Travel Insurance Included with the Total Health and Ultimate Health plans 100% coverage for sudden and unforeseen eligible emergency medical travel expenses Lifetime maximum of $2 million per covered person Multiple trips each with a duration of 92 days Hospital accommodations and physicians services Private duty nursing ($5,000 per calendar year) Drug/diagnostic services/aids and appliances Accidental dental ($1,000 per calendar year) Paramedical services (three (3) practitioners - $225/ year) Emergency transportation (ground and air) Trip cancellation/interruption ($6,000 per trip per insured) Vehicle return/return of dependent children Repatriation of deceased member Proof of date of departure and date of return to your province of residence may need to be provided to ASEBP and/or AXA Assistance Supplementary Travel Insurance to Extend a Single Trip Beyond 92 Days If you require more than the 92-day base travel included with the Total Health or Ultimate Health plans, 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 on the last page of this brochure. If you try to extend your coverage before you reach the 92-day base travel limit and you have a claim on file for your current trip, you may not be granted an extension. Requests for Supplementary Travel Insurance extensions received after the 92-day base travel limit has passed will be declined. ADDITIONAL DAYS (TOTAL DAYS) ANNUAL PREMIUM SINGLE COUPLE FAMILY 15 (107) $166 $332 $ (122) $355 $710 $ (137) $497 $994 $1, (152) $650 $1,300 $1, (167) $816 $1,632 $1, (182) $993 $1,986 $2, (197) $1,183 $2,366 $2, (212) $1,387 $2,774 $2,993 Page 4 Updated June 2014

5 Dental Coverage** Per insured person Benefit choice locked in? Basic/preventive includes: one (1) exam per year; eight (8) units scaling and/or root planing per year; four (4) units of facility fees for surgical extracts. Examples include examinations, x-rays, cleaning and polishing, fillings, extractions, etc. Minor restorative includes: endodontics/ periodontics. Examples include root canal treatment, gingival curettage, etc. Major restorative includes: crowns/posts/inlays/ onlays. Examples include crowns on natural teeth, etc. Major restorative includes: bridges/dentures/ implants. Examples include implants, crowns on implants, partial and full bridges, partial and full dentures, etc. OPTION A OPTION B OPTION C Yes, for 24 months. Option can be increased at any time, but you must wait 24 months to lower or opt out of coverage. 80% 80% 65% 80% 80% 65% 50% None None 50% None None MAXIMUM (SAME FOR EACH OPTION) Unlimited; inside limits apply $750 per calendar year Combined $700 per calendar year Combined $700 per calendar year **For more information and plan details, please refer to the plan text document located online at under Benefit Programs, Plan Text Document/Contracts. Payment for dental plan expenses will be based on the current ARTA Dental Benefit List, effective January 1 of each year. Monthly Dental Premiums OPTION A OPTION B OPTION C Single $57.25 $46.75 $35.00 Couple $ $93.25 $70.00 Family $ $ $83.75 Stand-Alone Annual Trip Cancellation/Interruption Insurance Designed for retirees who have Extended Health Care coverage without a Trip Cancellation/Interruption benefit (such as Health Wise and Health Wise Plus). 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 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. Coverage must be in place prior to booking a trip. Available by contacting an ARTA Benefit Plan Coordinator at Other ARTA-Sponsored Plans Great discounts for ARTA members for: Term life insurance up to $150,000 (medical required) Home and auto insurance Available by contacting TW Insurance Brokers at Page 5 The Alberta Retired Teachers Association Education Sector

6 Premium Payments Bank deductions are withdrawn on the 10th of each month for coverage during the current month. For example, January 10th deductions are for January coverage. Retail Sales Tax is added to the premiums where required by law (8% for Ontario residents, 9% for Quebec residents). Supplementary Travel Insurance premium is amortized over the balance of the plan year. Important Information Apply for coverage within 60 days of losing your existing employer group coverage to avoid having to submit medical evidence for eligibility and to prevent a gap in coverage between your employer s plan and the ARTA Retiree Benefits Plan. After 60 days, applications require medical evidence of insurability and you may be declined coverage. If your existing group health care plan does not have emergency travel you will need to complete the medical evidence of insurability forms to apply for this coverage with ARTA. Serving You The ARTA Benefit Plan Coordinator team is the primary point of contact for all plan members, providing you with accurate information about the ARTA Retiree Benefits Plan s comprehensive benefits coverage through phone conversations, s and face-to-face interactions. If you would like to contact an ARTA Benefit Plan Coordinator, our contact information is provided under ASEBP (ARTA s plan administrator), on the back of this brochure. Accessing Your Benefits We are pleased to offer you easy online access to your ARTA Retiree Benefits Plan through the online ARTA Members Health Care Account. To register for an account, simply visit click on the ASEBP logo with the title Members Health Care Account located underneath and follow the steps to register. The ARTA Members Health Care Account provides you with access to a variety of self-serve features, such as requesting or printing your ARTA Benefits ID card, updating your banking information and address and you can also view claims history and your coverage details. Making a Claim PROVIDER PAID: Claims can be submitted directly online to the ARTA Retiree Benefits Plan from a health care provider, such as pharmacist, dentist or chiropractor. Check with your health care provider first to ensure they are set up for direct billing services. You can also submit claims through the assignment of benefits process. Simply complete the section titled Assignment of Benefits on the applicable ARTA claim form and attach the original invoice from your health care provider. We will pay your provider, to the plan maximums allowed, directly on your behalf, minimizing your out-of-pocket costs. MEMBER PAID: And, of course there is the traditional method where original receipts are submitted with the applicable claim form. Reimbursement is made directly to your bank account within three (3) weeks. For assigned and traditional claims, please mail forms to ASEBP at the address located on the back of this brochure. Page 6 Updated June 2014

7 PREMIUM CALCULATION WORKSHEET This worksheet can be used to assist you in calculating your personal premium amount for the benefits you wish to enrol in. This may be helpful when completing the application form and is for your personal use only. After your application is approved, a Benefit Confirmation letter will be sent to your attention outlining the actual premium being charged for your benefits. BENEFIT PLAN DRUG MAX. COVERAGE LEVEL MONTHLY COST Health Wise $1200 $2000 Single Couple Family Extended Health Care (Select one only) Health Wise Plus Total Health $1200 $2000 $1200 $2000 Single Couple Family Single Couple Family Ultimate Health $1200 $2000 Single Couple Family $ (A) Dental (Select one only) Option A Single Couple Family Option B Single Couple Family Option C Single Couple Family $ (B) Monthly Cost (A+B) $ Sales tax applies to members living in Ontario (8%) and Quebec (9%). SUPPLEMENTARY TRAVEL (Complete if you are extending your travel coverage for a single trip beyond 92 days) Tentative Travel Dates Total # of Days Coverage Level Cost Monthly Cost Departure: Return: Single Couple Family /12 = $ (C) Note: To make the cost of purchasing additional travel coverage more manageable, premium payments are amortized over the policy year. However, if you purchase your Supplementary Travel Insurance after September 1, you may have an initial lump sum payment which covers premiums from September to the month in which you purchased your coverage, with the remaining premiums being amortized over the rest of the policy year. Calculate first month s premium: September to = # of months X $ = (month requested) (monthly cost line C above) $ (D) First Month s Premium (A+B+D): $ Ongoing Monthly Premium (A+B+C): $ Sales tax applies to members living in Ontario (8%) and Quebec (9%). Page 7 The Alberta Retired Teachers Association Education Sector

8 CONTACT US For more information on the Education Sector Retiree Benefits Plan, sponsored by ARTA, please contact: For ARTA membership inquries, please contact: ALBERTA RETIRED TEACHERS ASSOCIATION Room 409, Barnett House Street NW Edmonton, Alberta T5N 2R Toll-free (Canada only): Fax: For ARTA Retiree Benefits Plan coverage and claims, 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 For emergency travel assistance and travel claims, please contact: AXA ASSISTANCE EMERGENCY TRAVEL ASSISTANCE PROVIDER Toll-free in Canada/U.S.: From any other country, call collect: For home, auto and life insurance, please contact: TW INSURANCE BROKERS ARTA-SPONSORED HOME AND AUTO INSURANCE Phone: TW4-ARTA ( ) Page 8 Updated June 2014