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Health Plans for Retired Educators

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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:

• Extended Health, Semi-Private Hospital and Dental Plans, all offered independently so you pay only for what you need,

• Premium rates and benefits that are the same at any age

• Single, couple or family coverage

Semi-Private Hospital Plan

• Semi-Private Hospital Benefit

  • 90% reimbursement

  • Unlimited maximum

  • Covers the daily semi-private room charges in a licensed hospital
     

• Convalescent Home Care Benefit

  • 80% reimbursement

  • Covers home care following a hospitalization of at least 24 hours, up to $50/day, maximum of 30 days

  • Includes one day of home care following non-elective day surgery up to a maximum of $50

Dental Plan

• Fee Guide

  • 2008 Provincial Fee Guide
     

• Basic and Preventive Benefit

  • 85% reimbursement

  • Unlimited annual maximum per person

  • Includes one standard oral examination, cleaning and recall examinations every nine months, in addition to other services
     

• Endodontics and Periodontics Benefit

  • 80% reimbursement

  • $850 combined annual maximum per person
     

• Major Restorative Benefit

  • 50% reimbursement

  • $700 annual maximum per person, for crowns, including those on implants

  • $700 annual maximum per person, for fixed bridges and partial dentures, including those on implants

Supplemental Travel Plan

• Provides for additional coverage beyond the 62 days automatically covered under the Extended Health Care Plan

• Guaranteed acceptance for all Extended Health Care Plan participants

• 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

• Prescription Drug Benefit
  
  $0 deductible

• $2,100 annual maximum per person

• 85% reimbursement of ingredient costs

• Covers eligible drugs for all ages, including those not covered by the Provincial Drug Benefit Plan for participants and dependents age 65 and over

• The $100 Ontario Drug Benefit Program deductible is reimbursed based on 85% of ingredient costs

• Covers erectile dysfunction drugs to an annual maximum of $350 per person

Paramedical Practitioners Benefit

• 80% reimbursement

• $700 annual maximum per person (for all practitioners combined)

• Covers 15 practitioners including acupuncturists, chiropodists, chiropractors, dieticians, herbalists, homeopaths, naturopaths, nutritionists, osteopaths, physiotherapists, podiatrists, psychologists, registered massage therapists, speech therapists and shiatsu therapists

• Physician authorization is not required

Aids and Appliances Benefit

• 80% reimbursement

• 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

• Custom-made orthopaedic shoes and orthotics up to an annual maximum of $500 per person

• Prostheses including artificial limbs or eyes, or breast prosthesis (including two mastectomy bras per calendar year)

• Supplies including trusses, splints, braces and casts

• 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

• Mobility aids including wheelchairs, canes, walkers, and crutches

Vision Care Benefit

• 80% reimbursement

• $225 maximum per person in any two consecutive calendar years

• Covers eyeglasses, contact lenses and laser eye surgery

• 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

• New lenses if required due to eye surgery are covered up to a lifetime maximum of $225 per person

Diagnostic Services Benefit

• 80% reimbursement

• Covers diagnostic services, subject to your Government Health Insurance Plan offset

• Diagnostic procedures, including PSA testing for cancer, and radiology

Private Duty Nursing Benefit

• 80% reimbursement

• Covers out-of-hospital registered nurse, registered practical nurse or licensed practical nurse up to $1,500 per insured person in any two consecutive years

Transportation/Ambulance Benefit

• 80% reimbursement

• Covers licensed ground ambulance to and from a local hospital when medically necessary for emergency treatment

Accidental Dental Benefit

• 80% reimbursement

• Covers dental treatment required directly as a result of an accidental blow to natural or artificial teeth

Educational Program Benefit

• 80% reimbursement

• Covers medically related program(s) recommended by a physician, to an annual maximum of $200 per person

Out-of-Province/Canada Travel Benefit

• 100% reimbursement

• $1,000,000 coverage for eligible medical emergency expenses per person/trip

• Covers an unlimited number of trips, each up to 62 days in duration

• Emergency expenses incurred due to an accident or sudden illness while travelling outside your province of residence or outside Canada

• Pre-existing medical conditions are covered, subject to a 90-day medical stability clause

• $6,000 trip cancellation per person/trip

• $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).

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.