RTO/ERO Group Benefits Update

RTO/ERO Group Benefits Program
Régime collectif d’avantages sociaux d’ERO/RTO
ADMINISTERED BY / ADMINISTRÉ PAR
Dear Participant:
Our Plans continue to be the most successful retired educator insurance program in Canada.
We are proud to say that over 70,000 RTO/ERO members and dependents participate in our
Health Plans. We believe that the high level of participation indicates the importance of the
RTO/ERO Health Plans to our members.
Over the past several years, we have continued to improve the Health Plans, balanced with
prudent rate adjustments. We are pleased to announce further coverage enhancements again
this year, based on your suggestions. Rates will be maintained for the Semi-Private Hospital
Plan, and will increase by 5% for Extended Health Care and 2% for the Dental Plans. Please
see inside for further details.
Our Plan Administrator, Claims Payor and Consultant, Johnson Inc., is committed to serving
you. Their promise to you is “never less than our very best”.
2011
update
RTO/ERO’s mission is to provide a most cost effective, high quality and competitive group
health insurance plan while meeting the needs of the majority of the membership. The Health
Services & Insurance Committee is committed to ensuring that the RTO/ERO Health Plans
are here for you now… here for your future.
Sincerely,
Joan Murphy
President
inside
Daisie M. Gregory
Chair, Health Services and Insurance Committee
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What’s New for 2011
Did You Know?
RTO/eRO Health plans
Monthly premium Rates
assistive Devices
program
Convenience Services
New Booklets
Reminder
Important Contact
Information
What’s New for 2011
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Rates
Coverage Changes
The monthly premium rates for
the Extended Health Care Plan
will increase by 5% and the Dental
Plan will increase by 2%. The rate
adjustments are intended to balance
the increased costs under these
Health Plans. The Semi-Private
Hospital Plan monthly premium
rate remains unchanged.
We are pleased to advise of the
following plan enhancements which
will be effective January 1, 2011.
Over the last few years, rate changes
have been effective February
1st. This year, the rate change is
effective January 1, 2011. This
effective date is also used for the
plan enhancements. Going forward,
using a common effective date will
help eliminate any confusion the
two different effective dates may
have caused.
As your premiums are deducted
from your pension/bank account
one month in advance of coverage,
your December 2010 deduction will
reflect the new premiums.
Extended Health Care Plan
• PrescriptionDrugbenefit
maximum will increase to $2,500
per calendar year.
• TheParamedicalPractitioners
maximum will increase to
$800 per insured person per
calendar year for all practitioners
combined.
• VisionCarebenefitforeye
exams will increase to $90 for
one exam every two consecutive
calendar years for you and your
spouse and each calendar year for
dependent children.
Dental Plan
• Reimbursementwillbeupdated
to the 2011 Fee Guide for
General Practitioners.
New Booklets
Monthly
Premium
Rates
Semi-Private
Hospital Plan
Single
$17.07
Couple
$34.11
Family
$40.09
Extended Health
Care Plan
Single
$76.51
Couple
$153.03
Family
$183.65
Dental Plan
Single
$54.04
Couple
$106.57
Family
$132.89
Rates are effective January 1,
YournewRTO/EROGroupBenefitsProgramBookletsare
2011. Where required by law,
coming! In late January, the booklets will be mailed along with
Retail Sales Tax will be added
the Renaissance, Winter 2011 edition. Watch your mail for this
important information.
to these monthly premium rates
(currently 8% in Ontario and
9% in Quebec).
reminder
The deadline for the submission of claims is the end of the calendar year following the year
in which the expense was incurred. If you have any unpaid claims from 2009, please ensure
they are submitted to Johnson Inc., by December 31, 2010.
Did You Know?
• Youcanbringyourclaimto
theJohnsonInc.PlanBenefit
Claims, Richmond Hill office
and they will process it while you
wait. Office hours are Monday to
Friday, 8:30 am to 4:30 pm. See
“Important Contact Information”
on page 4 for the address.
• Ifyouaretakinganextended
vacation and require more
than a 100 day supply of your
prescription medication, you
can obtain up to a total 200
day supply by completing a
“VacationSupply”formfrom
Johnson Inc. The total cost of the
prescription counts towards the
calendar year maximum in the
year that the drugs are purchased.
For example, if you purchase
a 200 day vacation supply in
November 2010, your claim will
be applied to the 2010 calendar
year maximum only. If you
reach your 2010 calendar year
maximum, the unpaid balance
cannot be deferred to the 2011
calendar year maximum.
• TheRTO/EROHealthPlans
may be continued for surviving
spouses and dependent children
following the death of an
RTO/ERO member. Coverage
continues for as long as premiums
are paid and the spouse/child
continues to qualify for coverage.
Uponnotificationofamember’s
death, Johnson Inc. will send
the required paperwork to the
surviving spouse for completion.
• TheRTO/EROExtended
Health Care Plan includes an
EducationalBenefit.Thisbenefit
provides 80% reimbursement
for the costs of medically
related educational programs
recommended by a physician, to
an annual maximum of $200 per
person. For example, if someone
is diagnosed with diabetes, their
physician may recommend that
they attend a course to educate
them on how to manage and live
with their condition.
• Annually,JohnsonInc.provides
RTO/ERO Health Plan
participantswithaBenefits
Statement and a Statement of
Premiums and Claims for Income
TaxPurposes.TheBenefits
Statementsummarizesthebenefits
available to you, those in which
youareenrolled,andconfirms
your monthly insurance premium
deductions. The Statement of
Premiums and Claims for Income
Tax Purposes summarizes the
total premiums you paid as well
as the total claims submitted
and reimbursed, for you and
your dependents, in the previous
calendar year. Your premiums,
as well as your out-of-pocket
expenses (claims submitted minus
claims paid) may be eligible to be
claimed on your Income Tax as a
medical expense.
Assistive Devices Program
The Ontario Ministry of Health
and Long-Term Care provides the
Assistive Devices Program (ADP)
for Ontario residents who have
a physical disability lasting six
months or longer. The program
providesfinancialassistancefor
the purchase of assistive devices,
which meet an individual’s own
special requirements.
To claim through ADP, you
must be initially assessed through
a medical specialist or general
practitioner. Usually, a registered
ADP authorizer assesses you and
prescribes appropriate equipment
or supplies. If you are eligible,
the authorizer will complete the
application form and submit it to
ADP for review.
Over 8,000 items are covered.
Some examples are prostheses,
wheelchairs, monitors and test
strips for insulin-dependent
diabetics, hearing aids,
respiratory equipment, visual and
communication aids.
Eligible equipment must
be purchased from an ADP
registered vendor. At the time of
purchase, the vendor usually bills
ADP directly for their share of
the cost.
As with the eligibility, ADP
coverage levels vary. Depending
on the device being purchased,
ADP can cover up to 75% of the
costorafixeddollaramountup
to a maximum contribution. Any
remaining amount after ADP
has paid its portion will be your
responsibility. If you are enrolled
in the RTO/ERO Extended
Health Care Plan, you may be
eligible for reimbursement under
theAids&Appliancesbenefit.
For further information about the
ADP, visit the ministry website at
www.health.gov.on.ca/en/.
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RTO/ERO
Health Plans
Our Mission Statement
• TheHealthServicesand
Insurance Committee of the
Retired Teachers of Ontario
will provide a most cost
effective, high quality and
competitive Group Health
Insurance Plan that meets
the needs of the majority of
the membership.
Our History
• TheHealthPlansareowned
and managed by RTO/ERO.
• JohnsonInc.operatesasour
Plan Administrator, Claims
Payor and Consultant.
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How We Operate
• RTO/EROHealthServices
and Insurance Committee
meetsfivetimesayearand
updates the RTO/ERO
Executive and Senate.
• EachofourDistrictshasa
District Health Services and
Insurance Representative to
assist members.
• Ratesandbenefitsarethe
same for everyone, regardless
of age.
• RTO/EROisanotfor-profitorganization.
Surpluses above and beyond
reserve requirements
are “refunded” to the
RTO/ERO Health
Plans and become part
of RTO/ERO’s Health
Premium Stabilization Fund.
Convenience Services
As a participant in the RTO/ERO Health Plans, you have access to the
following convenience services:
• DrugCard–yourpharmacist
can bill Johnson Inc. directly for
your eligible prescription drug
expenses.
email,anotificationthatyour
claim has been paid and the
deposit amount, as well as an
explanationofbenefits.
• ElectronicDentalClaims–your
dental office can send your claim
to Johnson Inc. electronically.
The settlement of your account
with your dentist remains your
responsibility.
• MembersOnlyWebsite–using
your user name and password,
you can access your real-time
information, from the comfort
ofyourhomecomputer–day
or night. Here you can print
personalized claim forms and
view your claims history as well
as a history of all letters Johnson
Inc. has sent to you, including
yourBenefitsStatementand
Statement of Premiums and
Claims for Income Tax Purposes.
• DirectDeposit–claimpayments
can be deposited directly to your
bank account.
• ElectronicNotificationofClaims
Payment–youcanreceive,by
Important Contact Information
Johnson Inc.
Mondial assistance
Service:
416.920.7248 (Toronto area)
1.877.406.9007 (toll free)
416.920.0939 (fax)
[email protected] (email)
From Canada or the U.S.:
1.800.249.6556 (toll free)
Service Address:
Johnson Inc.
plan Benefit Service
18 Spadina Road, Suite 100a
Toronto ON M5R 2S7
Claims:
905.764.4888 (Toronto area)
1.800.638.4753 (toll free)
905.764.4041 (fax)
From Other Countries:
519.742.6683 (ask the
operator to reverse the charges)
519.742.8553 (fax)
Mailing Address:
Mondial assistance
p.O. Box 277
Waterloo ON N2J 4a4
RTO/eRO Health
Committee
Claims Address:
Johnson Inc.
plan Benefit Claims
1595 16th avenue, Suite 700
Richmond Hill ON L4B 3S5
[email protected]
18 Spadina Road, Suite 300
Toronto ON M5R 2S7
att’n: Health Committee Chair
416.962.9463 (Toronto area)
1.800.361.9888 (toll free)
416.962.1061 (fax)
Johnson Inc. Website:
www.johnson.ca
RTO/ERO Website:
www.rto-ero.org
GB UpDaTe 11/10