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Health Plans for
Retired Educators

This document in PDF format here (~602kb)
Health & Insurance Benefits for Members of The Retired
Teachers of Ontario
COMPREHENSIVE, COMPETITIVE &
AFFORDABLE
Since 1968, RTO/ERO has been the official voice and only organization
dedicated to promoting and protecting the interests of retired members of the
Ontario Teachers' Pension Plan (OTPP) and the only
organization dedicated to promoting and protecting their interests.
RTO/ERO's strength is in its numbers. As a member you have influence. Our
58,000 members enable us to advocate on your behalf on pension, educational,
health, environmental, social and seniors' issues.
Your RTO/ERO full membership fee is only $1.20 per $1,000 of gross pension,
and the Ontario Teachers' Pension Plan will conveniently deduct it each January
from your annual pension. There is a variety of Associate Membership categories
available as well, including those for educational support staff, and college
and university faculty. For further information, contact RTO/ERO.
Johnson Inc. serves as Consultant, Administrator and Claims Payor for RTO/ERO's
Health Plans.
For further information on membership and for eligibility requirements
to enrol in our Health Plans, please contact RTO/ERO at 416.962.9463 or
1.800.361.9888; or visit www.rto-ero.org.
For further information about how to enrol in our Health Plans, please
contact Johnson Inc. at 416.920.7248 or 1.877.406.9007; or view the Health &
Insurance Plans link on the RTO/ERO website at
www.rto-ero.org.
Join your colleagues and
have access to the largest retired educator health plan in Canada.
RTO/ERO provides a cost effective, high quality and competitive Group Health
Insurance Plan that meets the needs of the majority of the members. The plans
are affordable, well-established and financially stable.
The Health Plans are owned and managed by our members, administered by
Johnson Inc., and underwritten by Manulife Financial.
Full and Associate RTO/ERO members who permanently reside in Canada are
eligible to participate in our Health Plans.
The Plans include a full spectrum of benefits including Extended Health Care,
Semi-Private Hospital and Dental coverage which can be purchased separately as
needed. Coverage is available in the following categories:
• Single (member only)
• Couple (member plus one dependent – either spouse, partner or a dependent
child)
• Family (member plus two or more dependents)
Dependents include a legal, common-law or same-sex spouse; or dependent
children up to age 21 or age 30 if they are unmarried and in full-time
attendance at a post-secondary institution.
Health Plans for Retired Educators
and Educational Support Staff
Highlights of the Plans
- Guaranteed acceptance with no medical evidence required or late
restrictions applied if you enroll within 60 days of the termination of:
- School Board plan
- Spouse's or other group plan
- any other group plan
- RTO/ERO Health Services and Insurance Committee meets regularly to oversee
the operation of the Health Plans
- Each of our Districts has a Health Services and Insurance representative
to assist members
- Reserves
are owned by RTO/ERO
- Surpluses have been established to protect the Health Plans in the case of
a Pandemic
- Surpluses above and beyond reserve requirements are "refunded" to the
Health Plans for plan improvement and premium stability
- Premium rates and coverage are the same for all ages
- Members range in age from 50 to over 100 and 99% keep their plans for life
- Convenience services include:
- Direct drug payment to pharmacies (drug card)
- Electronic submission of dental claims
- Claim payments deposited directly to your bank account
- "Members Only" website at www.johnson.ca
- Annual Benefit Statement/Premiums and Claims Summary Letter
- Walk-in service for administration and claim services
The largest Canadian retired
educator plan providing with over
63,000 members and dependents.
A Plan
that is owned and managed by RTO/ERO members.
The largest Canadian retired educator plan providing health
coverage for over 65,000 members and dependents. A Plan that is owned and
managed by RTO/ERO members.
RTO/ERO provides:
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Extended Health, Semi-Private Hospital and Dental Plans, all
offered independently so you pay only for what you need,
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Premium rates and benefits that are the same at any age
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Single, couple or family coverage
Semi-Private Hospital Plan
Dental Plan
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Fee Guide
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Basic and Preventive Benefit
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85% reimbursement
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Unlimited annual maximum per person
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Includes one standard oral examination, cleaning and recall
examinations every nine months, in addition to other services
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Endodontics and Periodontics Benefit
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Major Restorative Benefit
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50% reimbursement
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$700 annual maximum per person, for crowns, including those on
implants
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$700 annual maximum per person, for fixed bridges and partial
dentures, including those on implants
Supplemental Travel Plan
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Provides for additional coverage beyond the 62 days
automatically covered under the Extended Health Care Plan
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Guaranteed acceptance for all Extended Health Care Plan
participants
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Available in 15 day units up to a maximum trip duration of 212
days for residents of Ontario, Newfoundland and Labrador (182 days for residents
of all other provinces)
Extended Health Care Plan
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Prescription Drug Benefit
$0 deductible
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$2,100 annual maximum per person
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85% reimbursement of ingredient costs
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Covers eligible drugs for all ages, including those not covered
by the Provincial Drug Benefit Plan for participants and dependents age 65 and
over
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The $100 Ontario Drug Benefit Program deductible is reimbursed
based on 85% of ingredient costs
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Covers erectile dysfunction drugs to an annual maximum of $350
per person
Paramedical Practitioners Benefit
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80% reimbursement
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$700 annual maximum per person (for all practitioners combined)
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Covers 15 practitioners including acupuncturists, chiropodists,
chiropractors, dieticians, herbalists, homeopaths, naturopaths, nutritionists,
osteopaths, physiotherapists, podiatrists, psychologists, registered massage
therapists, speech therapists and shiatsu therapists
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Physician authorization is not required
Aids and Appliances Benefit
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80% reimbursement
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Covers the purchase or repair of hearing aids up to a maximum of
$600 for one and $750 for two, in any three consecutive calendar years
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Custom-made orthopaedic shoes and orthotics up to an annual
maximum of $500 per person
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Prostheses including artificial limbs or eyes, or breast
prosthesis (including two mastectomy bras per calendar year)
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Supplies including trusses, splints, braces and casts
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Medical supplies, including surgical support stockings up to an
annual maximum of $300 per person, incontinence supplies up to an annual maximum
of $400 per person, and post-surgical comfort and convenience items (e.g., sock
reacher, shoe lacer) up to $100 per person in any two consecutive calendar years
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Mobility aids including wheelchairs, canes, walkers, and
crutches
Vision Care Benefit
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80% reimbursement
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$225 maximum per person in any two consecutive calendar years
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Covers eyeglasses, contact lenses and laser eye surgery
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Eye examinations subject to a maximum of $50 for one eye exam
every two consecutive calendar years. Eligible dependent children are covered on
an annual basis
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New lenses if required due to eye surgery are covered up to a
lifetime maximum of $225 per person
Diagnostic Services Benefit
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80% reimbursement
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Covers diagnostic services, subject to your Government Health
Insurance Plan offset
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Diagnostic procedures, including PSA testing for cancer, and
radiology
Private Duty Nursing Benefit
Transportation/Ambulance Benefit
Accidental Dental Benefit
Educational Program Benefit
Out-of-Province/Canada Travel Benefit
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100% reimbursement
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$1,000,000 coverage for eligible medical emergency expenses per
person/trip
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Covers an unlimited number of trips, each up to 62 days in
duration
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Emergency expenses incurred due to an accident or sudden illness
while travelling outside your province of residence or outside Canada
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Pre-existing medical conditions are covered, subject to a 90-day
medical stability clause
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$6,000 trip cancellation per person/trip
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$6,000 trip interruption per person/trip
Monthly Rates
February 1, 2008 to January 31, 2009 inclusive
| 2008 Premiums* |
Single |
Couple |
Family |
| Semi-Private |
$18.07 |
$ 36.10 |
$ 42.42 |
| Extended Health Care |
$66.14 |
$132.29 |
$158.76 |
| Dental |
$49.47 |
$ 97.55 |
$121.65 |
| * These amounts do not include Retail Sales Tax
(8% in Ontario). |
| 2008 Premiums* |
Single |
Couple |
Family |
| Semi-Private |
$19.52 |
$ 38.99 |
$ 45.81 |
| Extended Health Care |
$71.43 |
$142.87 |
$171.46 |
| Dental |
$53.43 |
$105.35 |
$131.38 |
| * These amounts do include Retail Sales Tax
(8% in Ontario). |

Suite 300, 18 Spadina Road, Toronto, ON M5R 2S7
416.962.9463 - 1.800.361.9888
www.rto-ero.org
Here for you now ...
Here for your future.
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