Download Group Insurance for Members 2016

Group Insurance
for Members 2016
Inside
RTO/ERO’s Group
Insurance Plans................4
RTO/ERO Group
Insurance Summary.........6
Rates................................9
How to join.....................10
Our strengths..................11
yourretirement
youRTO/ERO
www.rto-ero.org
your road to retirement
A
5
-10 years
before you retire
RETIREMENT
• Start thinking about your
retirement readiness.
B
E
1-5 years before you retire
Retirement!
• Attend a RTO/ERO Retirement Planning
Workshop. Check for dates and places near you.
Visit: www.rto-ero.org/rpw-schedule-list
RTO/ERO is here for you now, and here
for your future.
• Attend RTO/ERO events and get
involved
• Start travelling
• Volunteer
• Kick back and relax
• You are eligible to join RTO/ERO, if you are
retiring from the education community.
C
6 months before you retire
• Set up an appointment with your financial
planner and look into your pension, if you
have one.
• Consider your insurance needs:
www.rto-ero.org/group-insurance-plans
D
60 days before you retire
• Send in your RTO/ERO membership and group
insurance applications before your current
benefit plans end.
• Notify your employer that you intend to retire.
RTO/ERO’s Group Insurance Plans
Established in 1968 as a not-for-profit by the Ontario Teachers’ Federation,
RTO/ERO is a leader. Our plans are designed exclusively by and for retired
education employees. You spent your career covered by a group insurance plan,
and RTO/ERO has chosen to maintain this philosophy. We offer the largest
voluntary group insurance plans for retired education employees in Ontario.
What insurance does RTO/ERO offer?
RTO/ERO offers a full suite of group insurance plans. They may be purchased
separately or in combination. There are no levels or grades of coverage so each plan
participant has access to the same essential benefits as soon as they need them.
Dental
Extended Health Care (including
comprehensive travel coverage)
Semi-Private Hospital and
Convalescent Care
Supplemental Travel (for trips longer
than 93 days)
Plus a range of individual insurance plans:
Accidental Death & Dismemberment
Hospital Money
Home and Auto
Long Term Care
Term and Guaranteed Life
What are the strengths of RTO/ERO’s
Group Insurance Plans?
Do I need insurance in retirement?
Think about your average medical and dental costs at the start of your career.
Compare that to your expenditures today. On average, education employees
spend almost 30 years in retirement. It’s important to consider how your
expenses might change over this period.
Insurance should protect you against risk and healthcare needs can be
unpredictable. With RTO/ERO’s group insurance plans, every plan participant has
the same comprehensive coverage and pays the same premium, regardless of age.
This helps you to cover both foreseeable and unexpected costs.
As members own and manage the plans, those with your interests in mind make
the final decisions. This provides you with ultimate protection and peace of mind.
It’s another way RTO/ERO is here for you now, and here for your future.
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RTO/ERO is a not-for-profit organization, any surpluses are refunded back to
the group insurance plans
Our unique plans are owned and managed by members
Strength in numbers. Over 91,000 participants are insured
You have a voice — you can suggest plan changes through our Health Plans
Enhancement Submission service
Eight out of 10 teachers with a medical deduction from OTPP have chosen
RTO/ERO
99% of members are satisfied with the RTO/ERO Plans, based on a survey
conducted by Goldfarb Intelligence Marketing in 2012
A local health representative is there for you in each of the 48 districts
Everyone has access to the same coverage regardless of age
Single, couple or family coverage available
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RTO/ERO Group Insurance Summary
Dental Plan
Reimbursements are made according to the 2016 Provincial Fee Guide for
General Practitioners. All maximums are per insured person.
Basic and Preventive (85% reimbursement)
Unlimited annual maximum
One standard oral examination, recall oral examination, polishing and
fluoride applications every nine months
Other services, including fillings, x-rays and repairs/rebase/relining of existing
dentures
Endodontics and Periodontics (80% reimbursement)
$850 annual maximum
Includes root canal therapy, treatment of bones and tissues, scaling and
occlusal equilibration
Major Restorative (50% reimbursement)
There are two, separate maximums under the Major Restorative benefit:
$800 annual maximum for crowns, posts, onlays and inlays, including crowns
on implants
$800 annual maximum for fixed bridges and partial dentures, including those
on implants
Extended Health Care Plan
Includes out-of-province/Canada travel coverage for an unlimited number
of trips, each up to 93 days in duration, and guaranteed acceptance to the
Supplemental Travel Plan for extended vacations
Prescription drugs (85% reimbursement of ingredient costs)
$3,200 per calendar year, including sexual dysfunction medications and
diabetic supplies
Covers drugs that legally require a prescription, plus certain non-prescription
drugs. Brand covered if no generic is available, or with physician authorization
The $100 Ontario Drug Benefit (ODB) deductible is reimbursed based on
eligible drug ingredient costs
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Even if you are eligible for a Provincial Drug Benefit Plan, such as the ODB, it
is still essential to have a sizeable prescription drug maximum. The ODB covers
less than half the prescription drugs currently available on the Canadian market.
Some of these are classified as “limited use”. This means you must meet specified
criteria for the drug to be covered by the ODB.
Out-of-Province/Canada Travel (100% reimbursement)
Unlimited number of trips, each up to 93 days in duration
$2,000,000 for eligible emergency medical expenses per person/trip
Emergency medical expenses incurred due to an accident or sudden illness
while travelling outside your province of residence/Canada
Pre-existing medical conditions are covered, subject to a 90-day medical
stability clause
Air ambulance coverage
$6,000 trip cancellation and interruption/delay per person/trip
Paramedical practitioners (80% reimbursement)
$1,200 per calendar year (for all practitioners combined)
Fifteen eligible practitioners: acupuncturists, chiropodists, chiropractors,
dieticians, herbalists, homeopaths, naturopaths, nutritionists, osteopaths,
physiotherapists, podiatrists, registered clinical psychologists, registered
massage therapists, speech therapists and shiatsu therapists, as well as
acupuncture and foot care services provided by a registered nurse
Access this benefit without physician authorization
Vision care (80% reimbursement)
$400 every two years
Prescription eyeglasses, contact lenses, laser eye surgery, and corneal incision
Eye examinations to a maximum of $150 every two consecutive calendar years
Eldercare Select
Expert guidance and support to address a specific caregiving challenge and
develop a customized plan of action
Best Doctors
A suite of services enabling you to draw on the knowledge of the best medical
minds in the world to help you get the right diagnosis, the right treatment
and the right care
Aids and appliances (80% reimbursement)
Devices, including insulin pumps, CPAP machines, hearing aids, orthotics,
orthopaedic shoes, wheelchairs, walkers, prostheses and wigs
Accidental dental (80% reimbursement)
Dental treatment required due to an accidental blow to natural or artificial teeth
Additional benefits (80% reimbursement)
Includes: Medically related educational programs, diagnostic services, private
duty nursing, and ground/air ambulance transportation
Supplemental Travel Plan
The Supplemental Travel Plan provides flexible and affordable coverage for trips
that exceed 93 days to a maximum trip duration of 212 days for residents of
Ontario, Manitoba, New Brunswick, British Columbia and Newfoundland and
Labrador or 182 days for residents of all other provinces.
Guaranteed acceptance, without a medical questionnaire
Rates simply based on age and trip duration
Available exclusively to Extended Health Care Plan participants
Offers identical coverage as under the Out-of-Province/Canada Travel benefit
Semi-Private Hospital and Convalescent Care Plan
Coverage for the cost of a semi-private room, as well as assistance post-discharge
in a facility or in your own home with the activities of daily living, ambulation
and exercise, and homemaker services.
Semi-Private Hospital (95% reimbursement)
Unlimited maximum
Daily semi-private room charges in a licensed hospital
Convalescent Care (80% reimbursement)
Home care up to $75/day following:
A 24-hour hospital stay, maximum 30 days
Non-elective day surgery, maximum 3 days
Temporary stay in a long term care facility following a 24 hour hospitalization, up to
$75/day, maximum of 30 days per year.
RTO/ERO Monthly Rates – January 1 to December 31, 2016*
SingleCouple Family
Dental
$56.50$111.42$138.94
Extended Health Care
$88.17 $176.35 $211.64
Semi-Private Hospital and Convalescent Care$14.60 $29.16 $34.28
*RTO/ERO is a group insurance plan and is therefore subject to provincial retail sales tax
(8% in Ontario, 9% in Quebec). These rates exclude retail sales tax. Our Plans are eligible
for CRA’s medical expense tax credit.
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9
How to join
Our strengths
How do I get coverage?
You must be a member of RTO/ERO
to participate in our insurance plans.
Complete the enclosed application, or
visit our website to download and print
an application. You can also apply online:
You will speak with a real person and receive topof-the-line customer service in English and French,
with dedicated teams to take care of your enquiries;
www.rto-ero.org/our-health-plans
When should I apply?
Still working. You can apply as soon as
you know the date of your retirement
and the date that your existing group
insurance benefits terminate. The ideal time to apply is one to two months in
advance of the termination of your current coverage. Your RTO/ERO benefits
will begin the day after this termination date.
RTO’s group insurance plan is the best! Whenever I call
in to ask questions the staff are patient, helpful and very
knowledgeable. I’ve never had any trouble getting coverage.
Prescriptions, eyeglasses, dental work, ankle braces etc. are
approved quickly and easily. The forms I send in for physio
and alternative practitioners are speedily processed.
— Judith, District 16, Toronto
Already retired. If you are still covered by a group insurance plan (i.e. a board
or other employee plan), apply one to two months in advance of the date of
termination of your current coverage.
Without coverage or in an individual insurance plan. For both the Extended
Health Care Plan and Semi-Private Hospital and Convalescent Care Plan, you
will be asked to complete a medical questionnaire and your acceptance will be
subject to approval by the insurer.
Acceptance onto the dental plan is automatic. The maximum benefit payable
per person during the first 12 months is limited to $500. After this period,
participants can claim full benefits.
You are guaranteed acceptance only if you apply in advance of, or within the
60 days subsequent to, the termination date of another group insurance plan.
How do I pay for my insurance?
If your pension is with OTPP, premiums will be deducted directly each month.
All other plan participants will pay through monthly bank deduction.
Last business day of the month: Pension payments are made
5th day of each month: Premium is deducted from your bank account
If the application is received during the 60 days following termination of a
previous group insurance plan, coverage is effective the date following this
termination date and arrears premium will be billed.
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Walk-in service in downtown Toronto: your
questions answered in person and your application
can be processed while you wait;
Of all the insurance I have, the RTO/ERO Group
Insurance Plan is the only one where I have a say
in the improvements that can be made to the
plan. That’s because as an RTO/ERO member I
own the plan and I like that.
— Roger, District 27, Ottawa-Carleton
Walk-in service is welcome in the Greater
Toronto Area (Richmond Hill) for administration
and claim services.
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Provincial Office:
300 – 18 Spadina Road
Toronto ON M5R 2S7
Tel: 416-962-9463
Toll free: 1-800-361-9888
[email protected]
www.rto-ero.org
www.facebook.com/rto.ero
www.twitter.com/rto_ero
#chartmyadventure
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JOHNSON INC
Plan Benefits Service
100 – 18 Spadina Road
Toronto ON M5R 2S7
Tel: 416-920-7248
Toll free: 1-877-406-9007
Fax: 416-920-0939
[email protected]
www.johnson.ca/rto-ero
ENG 01.16