ARM Guide For retiree health, dental & travel insurance 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 ARM» Application form 1
What s inside How to decide which plan you need...4 Eligibility and when medical evidence is required...5 ARM Prestige Elite....6 ARM Original...8 ARM Prestige...10 ARM Economy...12 ARM Deluxe Travel...14 ARM Dental...15 Plan Comparison Chart...16 Rate Comparison Chart...18 Application Form...19 Important services included in all ARM Plans...22 OSSTF offers retiree health insurance coverage to all education workers regardless of affiliate membership. The ARM health plans are administered by OTIP (Ontario Teachers Insurance Plan). For more information, please contact OTIP. Phone: 1.800.267.6847 Online: Mail: www.otip.com/arm 125 Northfield Drive West PO Box 218 Waterloo ON N2J 3Z9 2 ARM plans are underwritten by Manulife Financial.
Why choose ARM? No age restrictions. 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 ARM plan and provides coverage for trips up to 75 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 90% of your maintenance prescription drug expenses. Edvantage discounts, contests and special events. See pages 22-23 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. ARM 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 www.health.gov.on.ca 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 Prestige Elite plan or an increase of more than one plan level requires medical evidence of insurability. Prestige Elite is the only ARM plan with an age limit. Once you turn 65, this plan terminates, and you are automatically enrolled in the ARM Prestige plan (with a $750 drug maximum), unless you select a different ARM plan. When you purchase an ARM health plan, you are automatically enrolled in the ARM Organization (established by OSSTF). A $50 fee is charged by OSSTF and deducted annually with your January health plan premium. If you join ARM mid-year, the fee is waived until the following January. More information about the ARM Organization is available on page 23. 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. 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: $ 2 Match your current annual prescription drug costs to the ARM plan with the closest annual prescription drug maximum. Plan Annual prescription drug max. What else is included? Go to: ARM Prestige Elite Unlimited Page 6 ARM Original $3,000 Page 8 ARM Prestige $1,500 ARM Prestige $750 Page 10 ARM Economy $750 Page 12 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).* 3 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. Find out what's included and what's optional Travel Insurance Coverage for trips up to 75 consecutive days is included in every ARM 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. 4 Complete the application form on page 19. If at any time you are having trouble understanding something or making the best decision, call us at 1-800-267-6847 and we'll help you find the right coverage. * Once you decrease your health coverage, you must wait two years before you are able to increase your coverage again. An increase to the Prestige Elite plan or an increase of more than one plan level requires medical evidence of insurability. 4
Who is eligible for ARM? All retired Ontario education employees, their families and survivors are eligible to apply for coverage under an ARM plan. There is no age restriction to join ARM. 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 full time) are eligible for dependant coverage under an ARM 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? Is medical evidence required when you apply? I ve set my retirement date. This is the best time to apply! Apply before your current health coverage ends to ensure your ARM 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 ARM Prestige Elite plan.* NO I ve recently retired. No medical evidence* is required if you apply for an ARM plan within 60 days of your group health plan termination date. NO 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. If you want to switch to ARM (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 ARM. See page 21 for more reasons to make the easy switch to ARM! If you apply for any retiree health plan more than 60 days after your health coverage ends, medical evidence is required. NO YES I m still working or I m semi-retired. Even if your current health plan is not terminating, you can still apply for an ARM plan to coordinate benefits. Medical evidence is required. YES *A medical evidence of insurability form is required to apply for, or increase to, the Prestige Elite plan. 5
ARM Prestige Elite It s a reality that some families have catastrophic medical expenses. In response to this need, OTIP created the ARM Prestige 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 ARM Prestige 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 Prestige Elite plan. This plan covers: (For more details, see the Plan Comparison Chart on pages 16-18.) 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, per calendar year. You pay for the next $4,000 in eligible prescription drug expenses per person, per calendar year. 100% of eligible prescription drug expenses are reimbursed with no annual maximum. When each calendar year is up, the process begins again. OR you are reimbursed at 90% for your maintenance prescription medication if you use the Express Scripts Canada Pharmacy home delivery program. See page 23 for details. You are responsible for dispensing fees. Sexual dysfunction drug coverage is included up to $500 per person. 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 of eligible charges up to a combined maximum of $1,000 per person, per calendar year. ARM Prestige 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 $1,000 paramedical maximum has been reached. Vision care 100% reimbursement of eligible charges up to $250 per person in any two calendar years. Deluxe travel insurance for trips up to 75 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, per calendar year. Hospital coverage Your choice of unlimited, $100 per day or $75 per day semi-private hospital accommodation. See coverage and premium chart to the right. ARM dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. 6 APPLICATION FORM p page 19
Remember to claim your medical expenses not reimbursed under your medical plan on your income Remember tax return, to including claim your the $4,000 unreimbursed deductible and medical all other out-of-pocket expenses expenses on your income and premiums tax return, for the including calendar the year. $4,000 deductible, your premiums, and all other out-of-pocket expenses for the calendar year. ARM Prestige Elite Prestige Elite Monthly Premiums (including deluxe travel insurance) Single $81.08 Couple $152.63 Family $174.58 PST & HST do not apply. You can choose to add: Monthly Hospital Accommodation Premiums Coverage $75 per day $100 per day Unlimited semi-private Single $11.46 $15.06 $21.06 Couple $20.66 $27.48 $40.32 Family $25.61 $34.20 $51.00 PST & HST do not apply. Note: Plan change required at age 65 The Ontario Drug Benefit Program covers many prescription drug costs for Ontarians once they turn 65. Because of this, the ARM Prestige Elite plan terminates at age 65, and members are automatically enrolled in the ARM Prestige plan (with a $750 drug maximum), unless they select a different ARM plan. 7
ARM Original 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 16-18.) Prescription drugs $3,000 drug maximum Eligible prescription drug expenses are reimbursed at 85% to a maximum of $3,000 per person, per calendar year. 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 are reimbursed at 90% and you can receive up to a 90-day supply for one low $9 dispensing fee. See page 23 for details. Also included at no additional cost: Paramedical services of eligible charges up to a combined maximum of $1,000 per person, per calendar year. Vision care of eligible charges up to $375 per person in any two calendar years. Unlimited semi-private hospital accommodation. Diabetic supplies 85% reimbursement of eligible charges up to $1,000 per person, per calendar year. Deluxe travel insurance for trips up to 75 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: ARM dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. 8 APPLICATION FORM p page 19
ARM Original Our most POPULAR PLAN! Original Monthly Premiums (includes unlimited semi-private hospital accommodation and deluxe travel insurance) $3,000 drug maximum per person, per calendar year Single $104.10 Couple $204.60 Family $245.61 PST & HST do not apply. 9
ARM Prestige ARM Prestige 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, ARM Prestige is our most flexible plan. Customize your coverage. This plan covers: (For more details, see the Plan Comparison Chart on pages 16-18.) 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, per calendar year. Eligible prescription drug expenses are reimbursed at 80% to a maximum of $750 per person, per calendar year. 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 are reimbursed at 90% and you can receive up to a 90-day supply for one low $9 dispensing fee. See page 23 for details. Also included at no additional cost: Paramedical services of eligible charges up to a combined maximum of $1,000 per person, per calendar year. Vision care 100% reimbursement of eligible charges up to $250 per person in any two calendar years. Diabetic supplies of eligible charges up to $1,000 per person, per calendar year. Deluxe travel insurance for trips up to 75 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, $100 per day or $75 per day semi-private hospital accommodation. See coverage and premium chart to the right. ARM dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. 10 APPLICATION FORM p page 19
ARM Prestige 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. Prestige Monthly Premiums (including deluxe travel insurance) $1,500 or $750 drug maximum per person, per calendar year Drug maximum $1,500 $750 Single $64.56 $50.12 Couple $121.94 $94.51 Family $149.45 $114.75 PST & HST do not apply. You can choose to add: Monthly Hospital Accommodation Premiums Under age 65 Age 65 or older Coverage $75 per day $100 per day Unlimited semi-private Single $11.46 $15.06 $21.06 Couple $20.66 $27.48 $40.32 Family $25.61 $34.20 $51.00 Single $22.63 $28.70 $40.88 Couple $41.84 $53.40 $77.91 Family $52.36 $66.95 $98.50 PST & HST do not apply. 11
ARM Economy If you are looking for a lower-cost health care plan, ARM Economy 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 16-18.) Prescription drugs $750 drug maximum Eligible prescription drug expenses are reimbursed at 80% to a maximum of $750 per person, per calendar year. An annual deductible of $100 applies for single coverage and $200 for family and couple coverage. 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 are reimbursed at 90% and you can receive up to a 90-day supply for one low $9 dispensing fee. See page 23 for details. Also included at no additional cost: Paramedical services of eligible charges up to a combined maximum of $750 per person, per calendar year. $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 of eligible charges up to $750 per person, per calendar year. Deluxe travel insurance for trips up to 75 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: ARM dental coverage You can add this at any time, without penalty. Coverage and premium details on page 15. 12 APPLICATION FORM p page 19
ARM Economy Economy Monthly Premiums (includes deluxe travel insurance and hospital accommodation) $750 drug maximum per person, per calendar year Single $46.26 Couple $86.22 Family $106.73 PST & HST do not apply. 13
ARM Deluxe Travel Insurance Included in all ARM plans at no additional cost Our deluxe travel insurance offers comprehensive coverage and is included in all ARM 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. 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 75 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 ARM policy. However, in the event of trip interruption, return airfare is covered if the expense is incurred after the effective date of your ARM policy. Before you decide to travel: If you depart on your trip prior to the effective date of your ARM policy, your coverage will begin the day your ARM policy comes into effect. The 75-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 ARM deluxe travel insurance plan can be found online at www.otip.com/arm. 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. Access to a competitive top-up travel insurance program for trips over 75 consecutive days through 21st Century Travel Insurance. Find out more at www.otip.com/arm or call 21st Century Travel Insurance at 1-800-567-0021. 14
ARM Dental Coverage Optional ARM dental coverage can be added to any of our health care plans, or purchased alone, at any time. ARM 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: 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. 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. 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 $62.58 Couple $122.87 Family $149.94 PST & HST do not apply. 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. 15
ARM Plan Comparison Chart Note: All coverage is per person, unless stated otherwise. Benefit Coverage Information ARM Prestige Elite ARM Original ARM Prestige ARM Economy Prescription Drugs Annual maximums All prescription drug maximums are per person, per calendar year. You are responsible for dispensing fees. Initial $500 per calendar year. 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 are reimbursed at 90% and you can receive up to a 90-day supply for one low $9 dispensing fee. See page 23 for details. 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, Social Worker (MSW), 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. of eligible charges up to a combined maximum of $1,000 per calendar year. Prestige Elite Only: 100% reimbursement of eligible charges for Chiropractor and Physiotherapist services for 12 consecutive months, once the $1,000 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 $1,000 per calendar year. of eligible charges up to a combined maximum of $1,000 per calendar year. of eligible charges up to a combined maximum of $750 per calendar year. Vision Care Coverage for purchase and repair of prescription lenses and frames, prescription sunglasses, contact lenses or laser eye surgery. 100% reimbursement of eligible charges up 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. of eligible charges up to a maximum of $1,000 per calendar year. 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. of eligible charges up to a maximum of $750 per calendar year. Hearing Aids Reimbursement of eligible charges for purchase and repair of hearing aids following an application to the Assistive Devices Program. 100% reimbursement of eligible charges up to $1,000 every 3 calendar years. 100% reimbursement of eligible charges up to $1,000 every 3 calendar years. 100% reimbursement of eligible charges up 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 per calendar year. of eligible charges to a maximum of 2 pairs per calendar year. of eligible charges to a maximum of 2 pairs per calendar year. of eligible charges to a maximum of 2 pairs per calendar year. Incontinence supplies Must provide written authorization by an attending physician. of eligible charges up to a maximum of $750 per calendar year. of eligible charges up to a maximum of $750 per calendar year. of eligible charges up to a maximum of $750 per calendar year. of eligible charges up to a maximum of $200 per calendar year. 16
Support Stockings Coverage for surgical support stockings. Minimum 20-30 mmhg compression factor. of eligible charges up to a maximum of $950 per calendar year. of eligible charges up to a maximum of $950 per calendar year. of eligible charges up to a maximum of $950 per calendar year. of eligible charges up to a maximum of $750 per calendar year. 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 $75 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 $75 or $100 per day to be used towards the cost of semiprivate or private room accommodation. $100 a day towards the cost of semiprivate or private room accommodation. Included in all ARM Plans Deluxe Travel Insurance Our deluxe travel insurance offers comprehensive coverage and is included in all ARM health care plans at no additional cost. Coverage is effective for trips up to 75 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 per calendar year. 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. Prestige 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 $750. 17
ARM Rate Comparison Chart Monthly Health Care Premiums ARM Prestige Elite (Under age 65) ARM Original ARM Prestige ARM Economy Initial $500 Annual Drug Maximum Then $4,000 deductible Following that UNLIMITED $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 $81.08 $104.10 $64.56 $50.12 $46.26 Couple $152.63 $204.60 $121.94 $94.51 $86.22 Family $174.58 $245.61 $149.45 $114.75 $106.73 Optional coverage: You can choose to add hospital coverage to ARM Prestige Elite (Under age 65) and ARM Prestige health plans. Monthly Hospital Accommodation Premiums Coverage $75 per day Under age 65 $100 per day Unlimited semi-private $75 per day Age 65 or older $100 per day Unlimited semi-private Single $11.46 $15.06 $21.06 $22.63 $28.70 $40.88 Couple $20.66 $27.48 $40.32 $41.84 $53.40 $77.91 Family $25.61 $34.20 $51.00 $52.36 $66.95 $98.50 Optional coverage: You can choose to add dental coverage to any ARM health plan. Monthly Dental Premiums Single Couple Family $62.58 $122.87 $149.94 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. Provincial Sales Tax (PST) and Harmonized Sales Tax (HST) are NOT applicable to ARM premiums. The premiums listed in the 2014 ARM Guide to Retirement are effective from January 1, 2014 to December 31, 2014. The ARM 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. 18
ARM Application Form Please return to: 125 Northfield Drive West PO Box 218 Waterloo ON N2J 3Z9 Phone: 1.800.267.6847 Fax: 1.888.646.3842 Benefits are administered by OTIP and underwritten by Manulife Financial. Please print using ballpoint pen. Section A General Information 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. Email Address I prefer all correspondence in: m English m French First Name & Middle Initial (Provide last name if different from applicant) Date of Birth (mm/dd/yy) Gender Complete if you have an eligible dependant student over the age of 21 Spouse/Partner mm dd yy School Year Start School Year End Name of School Dependant Child mm dd yy Dependant Child mm dd yy Dependant Child mm dd yy Coordination of Benefits (COB) Are you, your spouse or dependants covered under any other plan? m yes m no Name of other insurance company Policy/Group # ID/Certificate # Section B Eligibility I wish to be covered under an ARM plan starting: mm 01 yy Within the last 60 days: m I have been insured as an active member under a group health benefits plan. Plan Termination Date: mm dd yy m I have been insured as a retired member under a group health benefits plan. Plan Termination Date: mm dd yy m My current health plan is not terminating and I am looking to coordinate my benefits. If you select any of the three options below, please complete the policy information box, indicated by the yellow arrow. Please call OTIP for a medical evidence of insurability form and complete the policy information box below. Policy/Group No: Identification/Certificate No: Insurance Company Name: m I have not been covered under a group health benefits plan in the last 60 days. m To receive an annual income tax receipt indicating the amount of premiums you paid for your ARM health and dental coverage, please check here. Please call OTIP for a medical evidence of insurability form. m From time to time, OTIP may send you information on our products, services and promotions. If you are not interested in receiving this information, please check here. 19
Section C Coverage Selection (Please select your options below and fill in the appropriate information.) ARM Prestige 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 $75 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 Prestige Elite plan. ARM Original 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) $ ARM Prestige 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 $75 m $100 m Unlimited Semi-Private $ Dental Coverage (Optional) m Single m Couple m Family $ Total Premium (add all choices) $ ARM Economy 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) $ ARM Dental Coverage Only m Single m Couple m Family $ Section D Authorization & Payment Method (Please select ONE payment method and sign accordingly.) Monthly Premium 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 Active Retired Members health 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 www.cdnpay.ca. 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 20
Tell your colleagues why you ve chosen ARM 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. The switch to ARM 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 ARM 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 Prestige Elite). How can ARM save you money? Once you turn 65, the Ontario Drug Benefit Program (ODB Program) may cover the majority of your prescription drug costs. Only ARM 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 ARM, 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 ARM offers at www.otip.com/arm or call us at 1-800-267-6847 and we ll answer your questions or recommend options that best suit your individual needs. * Once you decrease your health coverage, you must wait two years before you are able to increase your coverage again. An increase to the Prestige Elite plan or an increase of more than one plan level requires medical evidence of insurability. Insurance solutions for the education community 21
Another reason why being an ARM member is better. According to the Canadian Cancer Society, Canadians aged 50-79 represent almost 70% of all new cancer cases. The highest proportion of those new cases occurs in the 60-69 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 an ARM 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 www.otip.com/arm and click the CAREpath link. Answers. Guidance. Support. ARM members have free access to Edvantage! Edvantage is a rewards program exclusive to Ontario s education community. With Edvantage you have access to great savings, exciting contests and special events! Planning a trip? Save on transportation, accommodation and all the fun in between. Achieve balance. Enjoy discounts on GoodLife Fitness memberships, hearing aids, glasses and more! From Internet to insurance, it s all here. Find exclusive rates on the products and services you use every day. 22Visit www.edvantage.ca/retiree for more information and a full list of partners. Administered by
Active Retired Members (ARM) Organization Retirement does not mean leaving Keep this link strong In 1996, OSSTF (Ontario Secondary School Teachers Federation) established a new type of membership specifically for Active Retired Members (ARM). The ARM Organization allows retired members to remain actively involved with their colleagues politically and socially. Local ARM chapters across the province provide members with opportunities to gather for social and informative events and political action activities. Active retirement offers an opportunity for continuing involvement with OSSTF at both the local and provincial levels. The experience, skills and abilities of retired members are valuable resources to advance the interests of active and retired members and the school community. A council is elected to represent their interests provincially in OSSTF. Why join ARM? Provincial mailings such as OSSTF Education Forum, Update and the Pocket Planner Newsletters to inform members about pension, legal and financial matters Retirement information Pension information Edvantage Program Local social and other community activities It s fun to stay in touch with former colleagues! Information Online ARM Organization Chapters ARM Health Plan Workshops and Seminars Visit www.osstf.on.ca and click on the ARM logo. For more information on the ARM Organization, please contact the OSSTF Provincial Office at: OSSTF Provincial Office 60 Mobile Drive Toronto ON M4A 2P3 416.751.8300 1.800.267.7867 www.osstf.on.ca For more information on the ARM health plans, please contact OTIP at: 125 Northfield Drive West PO Box 218 Waterloo ON N2J 3Z9 519.888.9683 1.800.267.6847 www.otip.com The Express Scripts Canada Pharmacy ARM's home delivery program 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? 1. You ll be covered for up to 90% of ingredient costs more than if you were to fill your prescription at a retail pharmacy. 2. You can receive up to a 90-day supply of your maintenance prescription medications for a single dispensing fee of only $ 9 that s less than the average dispensing fee in Canada. 3. The Express Scripts Canada Pharmacy will work with you and your doctor to choose safe, approved, lower-cost medications, where possible. You can also use the online tool to find an equivalent drug that will cost you less! More great benefits include: 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. Peace of Mind Auto refills and refill reminders take the guesswork out of refilling prescriptions so that you don t need to worry about running out of your maintenance medication. *This program is not currently available to residents in Quebec. For more information about the Express Scripts Canada Pharmacy and its services, visit www.member.express-scripts.ca or call 1-855-550-6337. 23
OTIP Offers Home & Auto Insurance Too! Retirement comes with many lifestyle changes that we d like to reward you for. No longer commuting to work? Mortgage finally paid off? Proud of your long-standing clean driving record? Well, there s a discount for that! With a wide selection of products, services and discounts, we ll ensure you spend less time hunting for insurance and more time enjoying your retirement. We don t stop with your car and home insurance; we ll help you find coverage for your boat, ATV, cottage, motorhome, motorcycle, snow machine, Jet Ski, and so much more. So leave the work to us. CALL OTIP TODAY AND FIND OUT HOW YOU CAN SAVE! 24 1.800.267.6847 www.otip.com/retiree Auto Home Life Retiree Benefits INSURANCE