Plan Sustainability

  • Does the ETFO ELHT plan only cover the cost of eligible biosimilar drugs when there is one for an originator biologic drug? What if I cannot take the biosimilar form of a particular drug for medical reasons?

    Yes, the ETFO ELHT Plan has a mandatory biosimilar drug requirement. This means that if there is a biosimilar drug related to a biosimilar  originator drug, the plan will reimburse the biosimilar drug.  A plan member may choose to continue on the brand name drug, but the plan will not cost any of the cost of the biologic drug when their is a biosimilar drug alternative.  Approved biosimilar drugs are considered by the government to be safe and effective alternatives.  If a new biosimilar drug becomes available where one was not available before, plan members or their dependants will be required to switch to the biosimilar drug in order to have coverage of the drug.

    In rare cases, a plan member or their dependant may have tried the biosimilar drug and is unable to tolerate it for medical reasons (e.g. experienced side-effects).  In cases such as this, plan members are able to appeal using a medical form to be completed by their treating physician and submitted to OTIP for review. To access a copy of the biosimilar medical exception form, please contact OTIP at 1-866-783-6847.

  • Why is it important for plan members to be good consumers to help protect the sustainability of the benefits plan?

    Working together for sustainable benefits

    The ETFO ELHT group benefits plan is the result of looking at everyone’s needs, and developing one comprehensive plan that best fits the plan membership as a whole. This means offering optimal benefits coverage to eligible plan members, and helping to protect you and your eligible dependants’ access to meaningful and sustainable benefits coverage for years to come.

    Your plan is overseen by the Board of the ELHT and is administered by OTIP, a not-for-profit organization dedicated to Ontario education workers. Together, our goal is to ensure that this plan continues to meet the needs of plan members while at the same time remaining financially sustainable.

    This is where you as a plan member can help. Being a smart consumer is the number one way you can assist us in achieving a balanced benefits plan that provides long-term sustainability:

    • Taking the time to do some comparison shopping before filling a prescription or purchasing items or services can help reduce your out-of-pocket expenses for items such as costs of treatments and services and dispensing fees.
    • Also be aware of the paramedical providers’ marketing campaign of ‘use it or lose it’. Maximizing all of your benefits, if not medically necessary, can negatively impact the health and sustainability of your plan.

    If the claims and expenses exceed the benefits funding that the ELHT receives, the result could be reduction of benefits coverage and/or implementation of premium shares or coinsurance.

    Use it Well

  • Does the ETFO ELHT have an anti-fraud policy?

    Yes, the ETFO ELHT has an Anti-fraud Policy (TP-025)This policy is also posted in the Our Board page of the website under Policies.

    Benefits fraud and abuse can put the ETFO ELHT plan at risk and has negative consequences for the sustainability of your benefits plan. Fraud and abuse can lead to higher costs, reduced coverage, or both. While some consider benefits fraud a victimless crime, it impacts every member of the ETFO ELHT benefits plan. It also directly impacts the ability of your ETFO ELHT to provide optimum coverage amounts and maintain overall plan sustainability.

    Help us protect your plan from benefits fraud

  • Does the ETFO ELHT plan only cover the cost of eligible generic drugs when there is one for a brand drug? What if I cannot take a generic form of a particular drug for medical reasons?

    Yes, the ETFO ELHT Plan has a mandatory generic drug requirement. This means that if there is a generic drug related to a brand name originator drug, the plan will reimburse the cost of the generic drug.  A plan member may choose to continue on the brand name drug, but will be required to pay the difference between the generic drug and the brand name drug. Approved generic drugs are considered by the government to be interchangeable.  If a new generic drug becomes available where one was not available before, plan members or their dependants will be required to switch to the generic drug in order to have full coverage of the drug.

    In rare cases, a plan member or their dependant may have tried the generic drug and is unable to tolerate it for medical reasons (e.g. allergy to a filler in the generic drug; experience side-effects).  In cases such as this, plan members are able to appeal using a one-page medical form to be completed by their treating physician and submitted to OTIP. Please click here to download the form (703kB PDF).  Manulife will review the form and communicate whether an exception has been granted due to medical necessity.

Eligibility

  • I am a new eligible member (e.g. newly hired permanent Teacher, DECE, PSP, ESP or eligible LTO Teacher). How will I know how to enroll in the plan?

    Newly eligible members (e.g. a newly hired permanent Teacher, DECE, PSP, ESP or an LTO Teacher in an eligible 90+ day LTO) will receive an email invitation to enroll I the ETFO ELHT benefits plan, usually within 2 – 4 weeks of their eligibility date once the board has provided OTIP with all required data. For example, an eligible member whose eligible assignment start date is the first day of the school year should receive the their email to their board email address before the end of September. If you are eligible and have not received your email invite within four weeks, please contact OTIP at 1-866-783-6847 to inquire.

    Eligible members have 31 days from the date the enrolment email invite is received to complete the required enrolment on OTIP’s secure member portal. Eligible members who do not complete their enrolment within that time will be considered a “late applicant” and will be required to provide medical evidence of insurability to enrol. Enrolment by late entrants is subject to approval of medical evidence and can result in limits to coverage and/or denial of coverage.

    Premiums:

    If you are in an eligible 1.0 FTE position, there is no cost for health, dental, basic life and AD&D coverage while you are actively at work.  If you are working in an eligible part-time FTE position, you are required to pay a pro-rated premium (e.g. 0.5 FTE would pay 50% of the monthly premium; 0.2 FTE would pay 80% of the monthly premium, etc.) if you wish to participate in benefits.

    If you are an eligible part-time member (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.), please see the documents below for information about pro-rated premiums:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

    Alternately, plan members who are working in part-time assignments may opt out of benefits.  If they opt out, they can only opt back in without medical evidence of insurability within 31 days of a change in FTE (i.e. increase or decrease) or experiencing a life event (e.g. marriage/common law qualification, birth/adoption, loss of spousal benefits).

  • Who is eligible for ETFO ELHT benefits?

    To be considered eligible to participate in the ETFO ELHT benefits plan, you must be one of the following:

    • a permanent ETFO Teacher
    • a permanent ETFO Education Worker
    • an ETFO member working in an eligible LTO position (i.e. 90 consecutive calendar days or longer in most cases)

    Please note that daily Occasional Teachers, non-permanent Education Workers, and retired ETFO members are not eligible to participate in the ETFO ELHT Plans.

  • What is the deadline to submit an eligible health and dental claim?

    As outlined in the ELHT benefits booklet found online in the OTIP member portal, the claims submission deadline is one year from the date a specific claim was incurred as long as you are still an active permanent member.  For example, an eligible claim incurred on October 19, 2021 must be submitted for reimbursement no later than October 18, 2022, as long as you are still an eligible ELHT plan member.

    Members who have retired, resigned, or who were in an eligible LTO, have one year from the date an eligible claim was incurred OR 90 dates after their end/retirement date (whichever is earlier).  For example, a member who retires on June 30, 2021 or ends their eligible LTO on June 30, 2021 has until September 28, 2021 (90 days after June 30, 2021) to remit eligible claims incurred between September 27, 2020 and June 30, 2021.

    Just a reminder that benefits coverage always ends at 11:59 pm on the last day that you are eligible for benefits.  A member who retires or ends an eligible LTO on March 31 has their benefits terminated at 11:59 pm on March 31.  They would have until June 29 to remit eligible claims under the same rules as above.

     

  • Do I need a valid OHIP number to be eligible for the plan?

    Yes, plan members and their dependants (i.e. eligible spouse/common-law partner, eligible children) who are living in Canada must have active provincial coverage (i.e. OHIP for those living in Ontario; RAMQ in Quebec) to be eligible for the ELHT plan.  A member (or their dependants) who does not have provincial coverage is excluded under the plan.  If they qualify for provincial coverage at a later date, they are able to opt into the plan within 31 days of receiving the provincial coverage (i.e. receive their OHIP/RAMQ coverage).  For information about eligibility and applying for OHIP coverage, please visit the Ontario government website at https://www.ontario.ca/page/apply-ohip-and-get-health-card.

  • How do I add an eligible dependant (i.e. spouse/partner, eligible child) to my benefits plan?

    Eligible members may change from single to family benefits and/or add an eligible partner or child to the health and dental plan without evidence of medical insurability if they experience a life event/change (e.g. birth/adoption of a child, marriage/common law qualification, loss of spousal benefits) or have an increase or decrease in FTE (e.g. increase from 0.5 to 0.7 or 1.0; decrease from 0.9 to 0.6; etc.)  if completed within 31 days of the event and while the member is actively at work.

    For more information about life/events and how to add an eligible dependant (i.e. spouse, eligible child), click here.

  • I am an ETFO member and have been laid off by my Board. If I am on my Board's recall list, am I still eligible to participate in the ETFO ELHT Benefits Plan?

    Members on a Board Recall List 
    Eligible ETFO members who have been laid off and are on their board’s recall list are eligible to participate in the ETFO ELHT benefits plan, if they were enroled in the plan immediately preceding their lay off.  They are eligible for up to 24 consecutive months while on the recall list and would be required to pay 100% of the monthly premiums to participate in benefits.  Alternately, plan members on the recall list can opt out of benefits for the period of the recall, but would only be permitted to opt back in when they return to a permanent position or to an eligible LTO. **

    Once the eligible member begins on the recall list, OTIP will send information regarding arranging premium deductions.  For example, an eligible ETFO member who is laid off effective September 1st will receive correspondence within 2-3 weeks of that date.

    For information regarding the approximate cost of monthly premiums, members can view here:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

    ** Members who opt out of the benefits plan while on the recall list can only opt back within 31 days of returning to a permanent assignment or eligible LTO.

    Link to more information about layoffs and benefits.

  • Is the ELHT plan mandatory for 1.0 Teachers, DECEs, PSPs, ESPs and eligible 1.0 Long Term Occasional Teachers?

    Coverage under the ETFO Benefits Plan is mandatory for permanent teachers, DECEs, PSPs and ESPs, and eligible long-term occasional teachers working in a 1.0 full-time equivalent position (FTE).

    Mandatory coverage for 1.0 FTE members includes basic life, health and dental, and AD&D. However, 1.0 FTE members with spousal coverage may waive the health and dental coverage. Eligible members on a non-statutory approved leave may elect to continue to participate in the benefits on a 100% paid basis (i.e. plan member pays 100% of the premium cost).

    Eligible part-time members may elect to participate in the benefits plan on a pro-rated premium basis (i.e. 0.5 members pay 50% of the monthly premium; 0.2 members pay 80% of the monthly premium; etc.).  If a part-time member does not opt into the plan when they are first eligible, that cannot opt in without evidence of medical insurability until they have a life event (e.g. marriage/divorce/common-law qualification, birth/adoption, etc.) or have a change in their FTE.  If they have a change, they must contact OTIP within 31 days if they wish to opt in at that time.

    If you are an eligible part-time member (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.), please see the documents below regarding premiums costs:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

     

  • Is there a deadline or time limit for changing my benefits from single to family or for adding a dependant partner or child to my ETFO ELHT benefits plan?

    Eligible members may change from single to family benefits and/or add an eligible partner or child to the health and dental plan without evidence of medical insurability if they experience a life event/change (e.g. birth/adoption of a child, marriage/common law qualification, loss of spousal benefits) or with an an increase or decrease in FTE (e.g. increase from 0.5 to 0.7 or 1.0; decrease from 0.9 to 0.6; etc.)  if completed within 31 days of the event and while the member is actively at work. An eligible member who has opted out of the health and dental plan may also opt back into within 31 days of a life event/change (e.g. FTE increase or decrease, birth/adoption of a child, marriage/common law qualification, loss of spousal benefits) and while the member is actively at work. For more information about life/events and how to add an eligible dependant (i.e. spouse, eligible child), click here.

    For further clarification, please note that:

    • If a plan member opted out of the benefits plan while on leave, they cannot opt back into the plan while on their leave.
    • If a plan member misses the 31 day window to opt into the plan, they will be considered a late entrant and will be required to provide medical evidence to the insurer to apply.  The application may be approved, denied, and/or subject to coverage limitations.
    • If a plan member misses the 31 day window to add an eligible dependant, that dependant will be considered a late entrant and the member will be required to provide medical evidence to the insurer to add that dependant(s).  The application may be approved, denied and/or subject to coverage limitations.  For example, a plan member is married on July 15th and wishes to add their new spouse.  The member must add the spouse no later than August 16th to avoid medical evidence of insurability.  After August 16th, the plan member would be required to provide medical evidence for their new spouse and the spouse could be approved, denied, and/or have coverage limitations for a period of time.
  • Can temporary or occasional DECE/ESP/PSP members pay in the plan?

    Temporary or Occasional DECE/ESP/PSP members, including those in long-term occasional positions, are not eligible to participate in the ETFO ELHT provincial benefits plan.

    OTIP is working on a restructuring of the Occasional Education Employee Plan to provide educational workers options for individually elected benefit coverage. Information will be available on OTIP’s website once they are able to restructure that plan.

  • Do I need to provide evidence of insurability to be eligible for the ETFO ELHT Benefits Plan?

    At the transition, all eligible ETFO members and their eligible dependants were invited to enrol in the ETFO Benefits Plan without medical evidence of insurability provided the enrolment process was completed within 31 days from their transition start date. For example, ETFO members who transitioned were required to complete their enrolment online within 31 days of their start date (e.g. November 1, 2016, February 1, 2017, April 1, 2017, June 1, 2017 or August 1, 2017)

    Eligible members may have future opportunities to make changes to basic components of the plan (health and dental) without evidence of medical insurability if they experience a life event/change (e.g. increase in FTE, birth/adoption of a child, marriage/common law qualification, loss of spousal benefits) if completed within 31 days of the event and while the member is actively at work. For more information about life/events, click here.

    Newly hired eligible members will receive an invitation to enroll in the ETFO ELHT benefits plan within 3 – 4 weeks of their eligibility date. Those members have 31 days to opt into health, dental, and basic life and AD&D coverage without medical evidence of insurability. After 31 days, medical evidence is required and can result in limits to coverage and/or denial of coverage. Optional life and AD&D coverage (e.g. Supplemental, Optional, Optional Spousal/Child) always require evidence of insurability.

  • I am a permanent member and am in the ETFO ELHT plan. If I retire on June 30, 2024, when will my ETFO ELHT benefits end?

    When does my ELHT plan end?

    Benefits terminate at 11:59 p.m. the effective date an eligible member retires or resigns. For example, if a member retires or resigns on January 31, their benefits would terminate at 11:59 p.m. on January 31. If a member retires or resigns on June 30, their benefits would terminate at 11:59 p.m. on June 30. If a member retires or resigns on August 31, their benefits would terminate at 11:59 p.m. on August 31, etc.

    For more details, please read this article.

Long Term Occasional Teacher Eligibility

  • How does eligibility work for Long Term Occasional (LTO) teachers?

    The ETFO ELHT benefits plan provides coverage for Occasional Teachers based on the following eligibility criteria:

    • LTO teaching assignment must be 90-consecutive calendar days or longer (except in a few instances where there was a shorter eligibility rule in the previous local collective agreement – e.g. 60-consecutive calendar days, the LTO teacher in that local would be eligible);
    • Enrolment in the benefits plan is mandatory for 1.0 teacher in an LTO assignment for 90 consecutive days or longer;
    • Benefits coverage will begin on the first day of a known 90+ calendar assignment and coverage will cease upon termination of the assignment; and
    • Must be one continuous assignment of at least 90 consecutive calendar days (e.g. a 45-day assignment followed by another 45-day assignment will not constitute eligibility).

    Part-time Pro-rated Premiums
    Occasional Teachers in eligible LTO assignments where the FTE is less than 1.0 and who voluntarily opt into health and/or dental benefits will be required to pay health and dental premiums on a pro-rated basis (e.g. 0.6 FTE would be required to pay 40% of the monthly premium for health and dental; 0.2 FTE would be required to pay 80%, etc.), retroactive to the first day of the eligible LTO assignment.

    Combining Permanent and LTO Contracts
    LTO eligibility rules may be combined with contract eligibility rules – for example, where a 0.5 permanent teacher also has a 0.5 LTO teaching assignment of 90 consecutive days or longer, the member may combine eligibility and premium share to receive full benefits coverage with no member contribution for the duration of the LTO assignment. Following the completion of the LTO assignment, should the member voluntarily opt to maintain health and/or dental benefits, the member will be responsible for paying 50% of the premiums for health and dental as required by the eligibility rules for part-time permanent employees.

    Premiums
    If you are an Occasional Teacher in an eligible part-time FTE (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.) LTO assignment, please see the documents below for premium costs:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

     

     

  • What if an Occasional Teacher's LTO assignment is extended to 90 consecutive calendar days or longer?

    If an LTO assignment is extended to 90 consecutive calendar days or longer, the Occasional Teacher will be eligible to enrol in the Plan retroactively to the first day of their assignment. Standard premium contribution rules will apply. The extension must be of the original LTO to be eligible.  For example, a 60 calendar day LTO assignment followed immediately by a new 30+ calendar day LTO assignment does not qualify as an eligible LTO.

    For example, no premium contribution is required by an Occasional Teacher working in a 1.0 FTE LTO assignment of 90 consecutive calendar days or longer; an Occasional Teacher working in a 0.5 FTE LTO assignment who voluntarily opts into health and/or dental benefits will be required to pay 50% of the premium for health and dental. (0.7 FTE would pay 30%, etc.) If premium is required, it will be retroactively assessed through direct withdrawal (PAD) from the member’s bank account once they are enrolled.

    Claims for eligible expenses incurred will be honoured back to the first day of the eligible LTO assignment. Therefore, members are encouraged to keep their receipts if they expect their LTO assignment may be extended.

    To be eligible for ELHT benefits, an LTO assignment must be at least 90 days or longer.  A new LTO assignment which is shorter than 90 days (e.g. 45 days, etc.) will not be eligible for benefits, even where it follows an eligible 90 day LTO.

  • What if an Occasional Teacher's eligible 90-consecutive calendar day LTO assignment is shortened unexpectedly?

    If a 90-consecutive calendar day LTO assignment gets shortened unexpectedly then coverage will cease upon termination of the assignment. Members will not be required to repay any claims that were paid to them while coverage was in force. For example,  an Occasional Teacher accepts an LTO assignment on October 1st and it has a known end date of May 15th which has been reported by the board to OTIP.  The permanent teacher returns to their position earlier than expected on December 5th, so the LTO position ends at the end of the day on December 4th.  The Occasional Teacher/LTO’s benefits would be terminated on December 4th at 11:59 p.m.

  • Will coverage continue over the summer for an Occasional Teacher who works in an eligible LTO assignment until the end of the school year?

    ELHT benefits coverage will cease for an Occasional Teacher when the LTO assignment ends on the last day of the school year or the last day of the eligible LTO assignment, whichever date comes first.

  • Will coverage continue over the summer for an Occasional Teacher who ends their eligible LTO assignment at the end of the school year and begins an assignment replacing the same teacher in September?

    For Occasional Teachers who have been in LTO assignments of 90 consecutive calendar days or longer which conclude at the end of the school year, benefits coverage will cease on the last day of the school year. If the new assignment replacing the same teacher in September is known to be at least 90 consecutive calendar days or longer from the September start date, benefits will be reinstated in September when the new assignment begins.

  • If an Occasional Teacher with a 90-consecutive calendar day LTO assignment or longer goes on a statutory leave (maternity, parental, ESA leave) will they be eligible for benefits while on statutory leave?

    Occasional Teachers with a 90-consecutive calendar day LTO assignment or longer who go on statutory leave (maternity, parental, ESA leave) will be eligible for participation in the ETFO ELHT plan until the end of their LTO assignment based on their FTE assignment.  For example:  An occasional teacher accepts an LTO from September 7 – May 15.  If this occasional teacher in an eligible LTO begins a 12 or 18 month statutory pregnancy/parental leave on January 6, they would continue to have benefits until 11:59 pm on May 15.  If the LTO position ends early (e.g. on March 31), the benefits would end at 11:59 pm on the earlier end date.

  • For an Occasional Teacher who begins and ends two different eligible LTO assignments in the same school year, what happens to the record of their claims from the first assignment?

    Occasional Teachers beginning a new 90 consecutive calendar day LTO assignment will be notified by OTIP that they are eligible to re-enrol in the ETFO ELHT Plan. The member will be covered using the same certificate number and all claims records will remain attached to that member. For example, if the member completes a September 5 – December 20 eligible LTO assignment, benefits will end at 11:59 p.m. on December 20.  If a new eligible LTO assignment is accepted and lasts January 25 – May 31, the member will receive another enrolment email from OTIP and benefits will begin again January 25 using the same OTIP ID number.  Yearly coverage limits will be reduced by any claims amount that were accessed during the September 5 – December 20 period of benefits.  Lifetime maximum coverage (e.g. orthodontics) and 2-year benefits (e.g. vision) coverage will be reduced by any previous amounts as well.

Change in Status

  • Am I eligible to participate in the benefits plan if I am on an approve LTD or WSIB leave?

    Yes, members on all board-approved leaves of absence are eligible to participate in benefits as long as they had active benefits immediately prior to beginning their  leave (e.g. deferred or x/y leave, unpaid medical leave, unpaid personal leave, approved LTD leave, WSIB leave, etc.).  Members on an unpaid/deferred/x/y leave must pay 100% of their monthly health, dental, life and AD&D premiums if they wish to continue to participate in benefits.  If a member opts out at the beginning of their leave, they would not be eligible to opt back into the plan until they return to active work.  

     

    Approved LTD and WSIB Leaves:

    Eligible members who have maintained their benefits and are approved for LTD benefits or WSIB will be eligible to have health and dental premiums paid by the ETFO ELHT for the first 24 months of their approved LTD claim or WSIB leave (pro-rated for part-time) as long as they maintain ELHT eligibility (i.e. WSIB/LTD – permanent board employee; WSIB – teacher while in an eligible LTO).

    If  an eligible member is on unpaid medical leave prior to their LTD/WSIB claim being approved, they would be required to pay the cost of the monthly premiums.  If the LTD/WSIB claim is approved retroactively, premiums that the member paid during that period would be refunded.  For example, if a member exhausted their paid sick leave (STD) on March 31st, they would pay monthly health and dental premiums beginning April 1st if they wished to continue those benefits.  If they are subsequently approved for LTD/WSIB retroactive to April 1st, they would be refunded those health and dental premiums and the 24 month period would begin April 1st.

    If an eligible member continues on LTD or WSIB after the 24 month period and is still a permanent employee of the board (or in an eligible LTO for WSIB), that member may still participate in benefits by paying 100% of the cost.  Please see the documents below for the cost of monthly premiums:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

  • How does OTIP know when a member is eligible to enrol or if their employment status changes?

    The boards are responsible for providing Human Resources Information Systems (HRIS) data to OTIP on a bi-weekly basis that will identify when a member is eligible to enrol in the plan or if their eligibility changes. As the Plan administrator, OTIP will  contact the member via email once the board has sent updated information to OTIP.  Members will be required to log into their secure OTIP member portal to make their selections (e.g. opt to maintain benefits while on leave or opt out; opt into benefits when there has been an increase in FTE, etc.)  Please note that work status changes can take up to 2-4 weeks to process – changes to benefits and any applicable premiums will be retroactive to the first day of the change.

  • I am a permanent member and am in the ETFO ELHT plan. If I retire on June 30, 2024, when will my ETFO ELHT benefits end?

    When does my ELHT plan end?

    Benefits terminate at 11:59 p.m. the effective date an eligible member retires or resigns. For example, if a member retires or resigns on January 31, their benefits would terminate at 11:59 p.m. on January 31. If a member retires or resigns on June 30, their benefits would terminate at 11:59 p.m. on June 30. If a member retires or resigns on August 31, their benefits would terminate at 11:59 p.m. on August 31, etc.

    For more details, please read this article.

  • If I am approved for an unpaid leave of absence but have waived my benefits while on leave, when can I opt back into the benefits plan?

    If an eligible member is on a leave of absence and has waived their benefits for the duration of their leave, they will be eligible to reinstate the same level of benefits when they actively return to work, including when they return to partial work. They will have 31 days after their return date to re-enrol in benefits without medical evidence of insurability.

  • If I am approved for an unpaid leave of absence, am I eligible to continue in the plan while I am on leave?

    Members in a permanent position may continue coverage for an approved unpaid leave of absence on a 100% member paid basis. During a statutory leave such as statutory pregnancy/parental leave (not unpaid/extended parental leave), members will pay for health and dental benefits on an FTE pro-rated basis (e.g. if a member is 1.0 FTE and is on a statutory leave the ELHT will pay 100% of the premium; if a member is 0.5 FTE and is on a statutory leave the member will pay 50% of premium if the member voluntarily opts into health and/or dental benefits). During a non-statutory leave (e.g. unpaid medical leave, x/y leave, personal leave, extended parental leave, etc.) a member must pay 100% of the premium. If you are on a partial unpaid leave (e.g. 0.5 unpaid leave and 0.5 actively back at work you would pay 50% of the monthly premium for the 0.50 unpaid leave portion).  Alternately, plan members on an unpaid leave can opt out of benefits for the period of the leave, and opt back in when they return to work.**

    ** Members who opt out of the benefits plan while on leave can ONLY opt back within 31 days of returning to their paid assignment, including when they return to partial return to active work.

    Please see the documents below for information about premiums rates if you wish to maintain benefits while on an approved leave:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

     

  • If I was not eligible for enrolment at the time of my local’s transition into the plan, how will I be notified if I become eligible after the transition date?

    ETFO members will be notified by OTIP when they are eligible to enrol for benefits coverage in the Plan. OTIP will send an email to the member’s board email address and the member will be required to log in to OTIP’s secure website to complete their enrolment online within 31 days of the date they first became eligible.  For example, if a member was on a leave when their board transitioned into the ELHT in 2016/2017 and they had opted out of their board benefits during their leave, they would become eligible for the ELHT benefits plan once they had returned to work.  Once the board notified OTIP of the change in work status (i.e. on leave to active), OTIP would send an email to the member as per above.

  • Who is an eligible dependant?

    Your legal spouse, or person continuously living with you in the role like that of marriage partner for at least 12 months is eligible.

    The ETFO ELHT defines eligible dependants as:

    • Your natural or adopted child, stepchild or foster child who is:
      • Unmarried
      • Under age 21 or under age 25 if a full-time student
      • Not employed on a full-time basis; and
      • Not eligible for coverage as a member under this or any other Group Benefit Program.

    A step child must be living with the member to be eligible. A child who is incapacitated due to a mental or physical disability on the date they reach the age when they would otherwise cease to be an eligible dependant will continue to be eligible.

  • Will a child who is covered under my current plan as an overage dependant student be transferred into the plan?

    The student status of a member’s dependants will not be transferred into the new ETFO Benefits Plan. All members will be required to indicate the status of a dependant student during the enrolment process. Therefore, members are encouraged to complete their enrolment before their coverage start date to ensure that they and their dependants have the full coverage they require and to minimize any disruption to claims processing.

  • How does a plan member get coverage confirmation for a dependant student who requires proof of coverage for their post-secondary institution including waiving coverage by that institution?

    Under the Plan, overage dependants are covered while they are enroled full-time at a post-secondary institution until their 25th birthday. Plan members requiring proof of insurance coverage for their overage dependants should visit the OTIP member portal. Once there, select the “My Benefit” site and you will be able to print off a coverage summary. This can be provided to the post-secondary institution as proof of coverage.

Premiums

  • I am in an eligible part-time (e.g. 0.2, 0.5, etc.) position. Am I required to pay monthly premiums to access health and dental benefits?

    Yes.  All eligible members who are working part-time are required to pay a pro-rated premium (e.g. 0.5 FTE would pay 50% of the monthly premium; 0.2 FTE would pay 80% of the monthly premium, etc.) if they wish to participate in benefits.

    If you are an eligible part-time member (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.), please see the documents below for information about pro-rated premiums:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

    Alternately, plan members who are working in part-time assignments may opt out of benefits.  If they opt out, they can only opt back in without medical evidence of insurability within 31 days of a change in FTE (i.e. increase or decrease) or experiencing a life event (e.g. marriage/common law qualification, birth/adoption, loss of spousal benefits)

  • Why am I issued a T4A? Where can I access my T4A?

    Why am I issued a T4A?

    A T4A slip is a statement of  benefits (e.g. Basic Life, Accidental Death and Dismemberment). This is issued by OTIP, the plan administrator of your ETFO Employee Life and Health Trust Benefits Plan.  If  you have Basic Life and Basic Accidental Death and Dismemberment (AD&D) and are actively at work, those benefits are paid for by your Employee Life and Health Trust (ELHT).  If you had this coverage at any time between January 1 – December 31, 2023, a T4A slip for these taxable benefits will be created for you if the taxable amount is more than $25.  These taxable benefit amounts were calculated based on the premiums paid by your ELHT for the tax year (January to December) and should be claimed on your 2023 tax return.  (Prior to 2017, these amounts would have been reported to you on your T4 slip from your school board/employer as a taxable benefit.)
    NOTE:  If you are a Quebec resident, we will send you a letter with information on the health and dental premiums for Revenu Quebec’s tax requirements.

    Where can I access my T4A?

    Beginning with this year’s T4A (2023), you will only be able to access your T4A digitally by visiting the OTIP secure member site.**  This change was communicated to plan members by OTIP on February 5, 2024.  You can get your current T4A slip securely online through the OTIP’s secure member site from February 28 to May 1 each year.  After May 1, you can visit the Canada Revenue Agency to access your T4A slip.

                   **The exception is those plan members that have recently retired and those plan members on a leave – those T4As will be mailed by February 29, 2024.  

    To access your T4A tax slip online:

    1. Go to www.otip.com and click Log in.
    2. Select Health and Dental from the drop-down menu and log in.
    3. Click Access your T4A slip.

    You can also visit OTIP’s T4A FAQ on the OTIP website.

  • If I am not in an eligible full-time (i.e. 1.0 FTE) assignment or if I am on an unpaid leave (e.g. deferred or x/y leave, personal leave, extended parental leave, unpaid medical leave, LTD/WSIB after 24 months), what are the costs of monthly pro-rated premiums?

    As members log into OTIP’s secure website to review and validate their coverage information, any required member contributions will also be displayed. Members can also view the supplemental life, extended health and dental premiums here:

    If you are an eligible part-time member (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.), please see the documents below:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

    Eligible Part-time Members
    Members who are in eligible part-time assignments pay pro-rated premium (e.g. 0.5 FTE would pay 50% of monthly premiums; 0.7 would pay 30% of monthly premiums) if they wish to participate in benefits. Alternately, plan members who are working in part-time assignments can opt out of benefits.  If they opt out, they can opt back in without medical evidence of insurability within 31 days of a change in FTE (i.e. increase or decrease) or experiencing a life event (e.g. marriage/common law qualification, birth/adoption, loss of spousal benefits).

    Eligible Members on Unpaid Leaves
    Eligible members on an unpaid leave (including deferred or x/y leaves*, personal unpaid leaves, unpaid extended parental leaves, unpaid medical leaves, LTD after 24 months, WSIB after 24 months) would be required to pay 100% of the monthly premiums to participate in benefits.  If you are on a partial unpaid leave (e.g. 0.5 unpaid leave and 0.5 actively back at work you would pay 50% of the monthly premium for the 0.50 unpaid leave portion).  Alternately, plan members on an unpaid leave can opt out of benefits for the period of the leave, and opt back in when they return to work.**

    *Some exceptions due to local collective agreement language when leave was approved prior to transition.

    Eligible Members on Statutory Leaves
    Members on an eligible statutory leave, including statutory maternity, statutory parental leaves and other statutory ESA leaves (e.g. Infectious Disease Emergency Leave (IDEL), Domestic or Sexual Violence, Critical Care Leave (Adult or Child), Child Death Leave, etc.) continue to have access to funded benefits on the same basis as when they are actively at work as long as they continue to satisfy ELHT eligiblity (i.e. permanent board employee or a teacher while in an eligible LTO).  Part-time members who are on a statutory leave continue to have premiums funded on a pro-rated basis (e.g. 0.5 FTE on a statutory maternity/parental leave or critical care leave would continue to pay 50%) if they wish to participate in benefits during the statutory portion of their leave. Alternately, part-time plan members can opt out of benefits for the period of the leave, and opt back in when they return to work.**

    ** Members who opt out of the benefits plan while on leave can ONLY opt back within 31 days of returning to their paid assignment, including when they return to partial return to active work.

     

  • Do I have to pay a premium share under this plan if I am an eligible 1.0 member?

    No. There is no premium share for health, dental, basic life and basic AD&D coverage for an active eligible 1.0 member under this plan while they are actively at work or on a statutory leave.  Members who are working part-time are required to pay a pro-rated premium (e.g. 0.5 FTE would pay 50% of the monthly premium; 0.2 FTE would pay 80% of the monthly premium, etc.) if they wish to participate in benefits.  Optional life and optional AD&D (e.g. supplemental member, optional member, spousal or child) are always 100% member paid benefits.

    If you are an eligible part-time member (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.), please see the documents below:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

     

    ** As always, plan members on an unpaid leave (e.g. unpaid medical leave, extended parental leave, x/y leave, personal leave, etc.) are required to pay 100% of the monthly premium if they wish to maintain health, dental, and life benefits during their unpaid leave.

Questions related to COVID-19

  • Did OTIP and Manulife make extra money due to not having to pay so many claims during the COVID-related closures in the spring/early summer of 2020?

    The simple answer is no.  OTIP and Manulife receive an administration fee from the ELHT, and both OTIP and Manulife received a lower level of fees than normal during COVID-19 closures as their administration fee is based on paid claims (i.e. fewer claims = lower fees).  The ETFO ELHT health and dental plan is not an insured plan.  This means that the ELHT actually pays claims (i.e. we reimburse Manulife for each dollar that they reimburse plan members for claims) with the funding that is received.  Any money not required to pay certain types of claims during the COVID-related closures stayed in the ELHT plan to use for other benefits costs now and in the future.  This helped to further sustain the plan.

    While there were certain decreased claims in dental, paramedicals and vision, there were other costs that were still incurred at the usual volumes/costs including drugs, which make up the largest percentage of paid claims.  The ELHT lifted the limit of maintenance drug dispensing fees while drugs were only being dispensed in 30 day refills between March 23 and August 1, 2020. In addition, the ELHT was already reimbursing eligible virtual paramedical appointments, and these claims increased in 2020, and will continue to allow members to more easily access these providers.  There will also be some other increased costs due to COVID-19, which may potentially include out of country claims, hospital charges, and increased life insurance claims.   Claims increased during Summer 2020 as  providers opened again, and have now returned or surpassed pre-COVID claims levels.

  • I know that the ELHT allowed maintenance medication to be refilled every 30 days beginning in March 2020, due to the Canadian Pharmacists Association implementing limits due to COVID. Has the maintenance drug refill limit returned to 90 days? If I now exceed the 5 dispensing fee limit, does that mean that I will have to pay for the extra dispensing fees?

    In March 2020, the Canadian Pharmacists Association made the decision regarding the 30 day limit to preserve the supply of medication during this unprecedented time.  In response, your ETFO ELHT temporarily turned off the limit on the number of dispensing fees per 12-month period for maintenance medications. This is to ensure members can continue to access the medications they need, without incurring the full cost of the additional dispensing fees.

    In June 2020, the Ontario Government and Pharmacists Association announced that the 30 day dispensing limit could be lifted.  As a result, the 5 dispensing fee limit per 12-month period for maintenance medications were reinstated effective August 1, 2020, on a go forward basis.

     

Medical and Treatment Coverage

  • Does the ETFO ELHT plan only cover the cost of eligible biosimilar drugs when there is one for an originator biologic drug? What if I cannot take the biosimilar form of a particular drug for medical reasons?

    Yes, the ETFO ELHT Plan has a mandatory biosimilar drug requirement. This means that if there is a biosimilar drug related to a biosimilar  originator drug, the plan will reimburse the biosimilar drug.  A plan member may choose to continue on the brand name drug, but the plan will not cost any of the cost of the biologic drug when their is a biosimilar drug alternative.  Approved biosimilar drugs are considered by the government to be safe and effective alternatives.  If a new biosimilar drug becomes available where one was not available before, plan members or their dependants will be required to switch to the biosimilar drug in order to have coverage of the drug.

    In rare cases, a plan member or their dependant may have tried the biosimilar drug and is unable to tolerate it for medical reasons (e.g. experienced side-effects).  In cases such as this, plan members are able to appeal using a medical form to be completed by their treating physician and submitted to OTIP for review. To access a copy of the biosimilar medical exception form, please contact OTIP at 1-866-783-6847.

  • Where can I find information or resources related to mental health resources?

    ETFO ELHT Benefits:

    Eligible ETFO ELHT plan members have access to counselling coverage under the ETFO ELHT.

    OTIP Website:

    In addition, OTIP has compiled and posted a list of resources on their website to help connect plan members with other resources that may be helpful to support mental health and wellness.  Whether it is access to mental health services, crisis help lines, or tools for speaking to your children about anxiety and dealing with change, we are here to support you.

  • I am traveling out of country on a vacation. Do I have health coverage if I have a medical emergency and require medical treatment while I am out of the country.

    Plan members who Canadian residents and are actively enrolled in the ETFO ELHT health plan do have coverage in the case of an unforeseen medical emergency while travelling outside of Canada.

    Details of your travel coverage can be found in your benefits booklet (found on the OTIP website in your secure plan member portal) under the Out-of-Province/Out-of-Canada section that covers topics such as:

    • Emergency Travel Assistance
    • Medical Emergency Assistance
    • Non-Medical Assistance
    • Health Advice and Assistance
    • Pre-existing conditions/stable medical conditions**
    • How to Access Emergency Travel Assistance – Your Benefits Card

    This coverage is for emergency medical assistance and does not include trip cancellation coverage.

    Visit the travel section on OTIP’s website for tips, or  contact OTIP at 1-866-783-6847.

    ** If you have a known medical condition or are within the last four weeks of a pregnancy, it is strongly recommended that you review the information related to pre-existing conditions and medically stable definitions and contact OTIP at 1-866-783-6847.

  • Where can I view the ETFO ELHT benefits booklet?

    For a benefits-at-a-glance summary of the benefits, please click here.

     Once you are enrolled in the ETFO ELHT benefits plan, you can log into OTIP’s secure member website at otip.com to access the ETFO ELHT Benefits Booklet:

    1. Click Log in on the top-right corner of www.otip.com.
    2. Select Health and Dental from the drop-down menu and log in.
    3. After you have logged in, select Benefits Booklet (plan details) from under My Library.

    Specific detailed questions about coverage can be directed to OTIP at 1-866-783-6847.

    * Please note that deductibles and other reasonable and customary (R&C) limits may apply.

    * It is always recommended that you check your eligibility and coverage with OTIP prior to accessing services and providers, particularly for higher cost benefits.  A pre-determination or estimate should be submitted prior to beginning treatment for higher cost benefits.

     

  • Do members receive a drug card?

    Yes, all eligible ETFO Benefits Plan members receive a new pay-direct benefits card when they enrol. Additional benefits cards can be printed online from your profile on the OTIP portal:

    1. Log in to the portal
    2. Select “My Claims”
    3. Select “my profile” along the top menu bar
    4. Select “my benefits card”
    5. Click on the sample card
    6. Print
  • Are all eligible paramedical claims fully covered under this plan?

    Eligible paramedical claims are covered up to reasonable and customary limits. Reasonable and customary (R&C) refers to the maximum allowable amount that an insurer will reimburse on a service or item. This is an approach by insurers to limit allowable costs for some services within a plan without providing a fixed hard cap. For example, if the reasonable and customary cost for a service is $90 per visit or per hour and the provider bills $120 per visit or per hour, only $90 will be reimbursed.  A listing of reasonable and customary limits for paramedical services can be found in the ‘My Claims’ section of your member secure area of the OTIP website at www.otip.com. A list of eligible paramedical services/providers (e.g. physiotherapy, registered massage therapist, psychologists, etc.) is available in the benefits booklet found in the secure OTIP portal.

  • Are my diabetic supplies covered?

    A wide range of diabetic medications, supplies and equipment are eligible for some coverage under the ELHT Benefits Plan. Please note that:

    1. Medication to treat type 1 or type 2 diabetes is subject to approval and plan members/dependants may be required to use first line therapies before second line therapies may be considered for coverage;
    2. Some diabetic supplies require a doctor’s recommendation and/or be required to provide proof of access to the Ontario Provincial Assistive Devices Program (ADP) prior to being approved for reimbursement.

    Plan members with questions about coverage for diabetes medications, supplies and equipment can contact OTIP at 1-866-783-6847.

  • Do I have to provide a doctor’s note for massage therapy?

    A doctors referral for message is required once every 12 months. For massage therapy claims submitted online, members will be required to check a box stating they have obtained a medical doctor’s referral for massage therapy before they submit a claim and are required to keep their doctor’s note in their personal files. All insurance claims will be subject to audit as determined by Manulife.

  • Does the ETFO ELHT plan only cover the cost of eligible generic drugs when there is one for a brand drug? What if I cannot take a generic form of a particular drug for medical reasons?

    Yes, the ETFO ELHT Plan has a mandatory generic drug requirement. This means that if there is a generic drug related to a brand name originator drug, the plan will reimburse the cost of the generic drug.  A plan member may choose to continue on the brand name drug, but will be required to pay the difference between the generic drug and the brand name drug. Approved generic drugs are considered by the government to be interchangeable.  If a new generic drug becomes available where one was not available before, plan members or their dependants will be required to switch to the generic drug in order to have full coverage of the drug.

    In rare cases, a plan member or their dependant may have tried the generic drug and is unable to tolerate it for medical reasons (e.g. allergy to a filler in the generic drug; experience side-effects).  In cases such as this, plan members are able to appeal using a one-page medical form to be completed by their treating physician and submitted to OTIP. Please click here to download the form (703kB PDF).  Manulife will review the form and communicate whether an exception has been granted due to medical necessity.

Enrolment and Changes

  • I am a new eligible member (e.g. newly hired permanent Teacher, DECE, PSP, ESP or eligible LTO Teacher). How will I know how to enroll in the plan?

    Newly eligible members (e.g. a newly hired permanent Teacher, DECE, PSP, ESP or an LTO Teacher in an eligible 90+ day LTO) will receive an email invitation to enroll I the ETFO ELHT benefits plan, usually within 2 – 4 weeks of their eligibility date once the board has provided OTIP with all required data. For example, an eligible member whose eligible assignment start date is the first day of the school year should receive the their email to their board email address before the end of September. If you are eligible and have not received your email invite within four weeks, please contact OTIP at 1-866-783-6847 to inquire.

    Eligible members have 31 days from the date the enrolment email invite is received to complete the required enrolment on OTIP’s secure member portal. Eligible members who do not complete their enrolment within that time will be considered a “late applicant” and will be required to provide medical evidence of insurability to enrol. Enrolment by late entrants is subject to approval of medical evidence and can result in limits to coverage and/or denial of coverage.

    Premiums:

    If you are in an eligible 1.0 FTE position, there is no cost for health, dental, basic life and AD&D coverage while you are actively at work.  If you are working in an eligible part-time FTE position, you are required to pay a pro-rated premium (e.g. 0.5 FTE would pay 50% of the monthly premium; 0.2 FTE would pay 80% of the monthly premium, etc.) if you wish to participate in benefits.

    If you are an eligible part-time member (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.), please see the documents below for information about pro-rated premiums:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

    Alternately, plan members who are working in part-time assignments may opt out of benefits.  If they opt out, they can only opt back in without medical evidence of insurability within 31 days of a change in FTE (i.e. increase or decrease) or experiencing a life event (e.g. marriage/common law qualification, birth/adoption, loss of spousal benefits).

  • How do I add an eligible dependant (i.e. spouse/partner, eligible child) to my benefits plan?

    Eligible members may change from single to family benefits and/or add an eligible partner or child to the health and dental plan without evidence of medical insurability if they experience a life event/change (e.g. birth/adoption of a child, marriage/common law qualification, loss of spousal benefits) or have an increase or decrease in FTE (e.g. increase from 0.5 to 0.7 or 1.0; decrease from 0.9 to 0.6; etc.)  if completed within 31 days of the event and while the member is actively at work.

    For more information about life/events and how to add an eligible dependant (i.e. spouse, eligible child), click here.

  • Is there a deadline or time limit for changing my benefits from single to family or for adding a dependant partner or child to my ETFO ELHT benefits plan?

    Eligible members may change from single to family benefits and/or add an eligible partner or child to the health and dental plan without evidence of medical insurability if they experience a life event/change (e.g. birth/adoption of a child, marriage/common law qualification, loss of spousal benefits) or with an an increase or decrease in FTE (e.g. increase from 0.5 to 0.7 or 1.0; decrease from 0.9 to 0.6; etc.)  if completed within 31 days of the event and while the member is actively at work. An eligible member who has opted out of the health and dental plan may also opt back into within 31 days of a life event/change (e.g. FTE increase or decrease, birth/adoption of a child, marriage/common law qualification, loss of spousal benefits) and while the member is actively at work. For more information about life/events and how to add an eligible dependant (i.e. spouse, eligible child), click here.

    For further clarification, please note that:

    • If a plan member opted out of the benefits plan while on leave, they cannot opt back into the plan while on their leave.
    • If a plan member misses the 31 day window to opt into the plan, they will be considered a late entrant and will be required to provide medical evidence to the insurer to apply.  The application may be approved, denied, and/or subject to coverage limitations.
    • If a plan member misses the 31 day window to add an eligible dependant, that dependant will be considered a late entrant and the member will be required to provide medical evidence to the insurer to add that dependant(s).  The application may be approved, denied and/or subject to coverage limitations.  For example, a plan member is married on July 15th and wishes to add their new spouse.  The member must add the spouse no later than August 16th to avoid medical evidence of insurability.  After August 16th, the plan member would be required to provide medical evidence for their new spouse and the spouse could be approved, denied, and/or have coverage limitations for a period of time.

Transitioning to the ELHT

  • When did the locals transition into the plan?

    Wave 1 – November 2016: Halton, Kawartha Pine Ridge, Ottawa Carleton, Peel, Rainbow, Renfrew, Simcoe County, Thames Valley and Waterloo Region district school boards.

    Wave 2 – February 1, 2017: Algoma, Bluewater, Niagara and Ontario North East district school boards.

    Wave 3 – April 1, 2017: Avon Maitland DSB, Durham DSB, Durham CDSB, Grand Erie DSB, Greater Essex County DSB, Hamilton-Wentworth DSB, Limestone DSB, Toronto DSB, Toronto CDSB, Trillium Lakelands DSB, Upper Grand DSB, Bloorview School Authority and John McGivney Children’s Centre School Authority.

    Wave 4 – June 1, 2017: Hastings-Prince Edward DSB, Lambton Kent DSB, Keewatin-Patricia DSB, Lakehead DSB, Moosonee, Moose Factory, Near North DSB, Rainy River DSB, Superior-Greenstone DSB, Upper Canada DSB, York Region DSB, Campbell Children’s School Authority, KidsAbility Education Authority, Niagara Peninsula Children’s Centre School Authority and Penetanguishene Protestant Separate School Board.

    Wave 5: Eligible Retirees – TBD

  • In comparing my previous board benefits plan to this plan, some coverages decreased while others increased. How was this plan determined?

    The funding that was negotiated allows for a comprehensive overall plan for the majority of ETFO members and is meant to address changing health and dental needs throughout a member’s career. Benefits should be viewed over the course of a career. As members progress through their career, their benefit needs and/or priorities change. What’s important to a member in a benefit plan at a certain date in time may be very different at another date in time and therefore focusing on one specific benefit does not reflect the overall quality of the Plan. An improvement for many members is an expanded scope of paramedical coverage. The inclusion of occupational therapy, nutritionists, registered social workers, family therapists and athletic therapists was new for many plan members.

  • Does the ELHT Plan have an impact on employee assistance programs?

    The ELHT Plan does not include employee assistance programs (EAP). Boards are required to continue any programs they have in place.

  • My partner and I are both ETFO members in the same board. In the past, we have not both been able to hold our own family benefits. Under the ETFO ELHT plan, can we each enrol and coordinate benefits between the plans?

    Yes, under the ETFO ELHT Plan, two ETFO members can enrol in their own plans and list each other as dependants.

  • What happens to my life insurance? I used to have more than 1x salary life insurance.

    Members are guaranteed to maintain their previous levels of life insurance without providing evidence of medical insurability. Anything in addition to the 1x salary basic life that is part of the ETFO Benefits Plan would be 100% member paid. Member paid life insurance is a non-taxable benefit and as a result, the benefit amount paid to your estate is not subject to income tax.

  • When is evidence of insurability required?

    If you currently do not have more than the 1x salary basic life, evidence of insurability will be required.

    

If you currently have more than the 1x salary basic life and want to add supplemental coverage and/or implement or increase your option life coverage amount, you will need to provide evidence of insurability. You will need to provide that evidence within 31 days from the transition start date of the Plan. OTIP will ensure that deadline is extended if you did not receive an OTIP enrolment email or your personal information on the OTIP portal was inaccurate and resulted in the inability to select insurance.

  • Where premium deductions apply, are premiums deducted from payroll? What if I am on an unpaid leave?

    Effective September 1, 2022, premium deductions will no longer be made through payroll deduction.  If a plan member has premium deductions while actively at work or on leave, OTIP will calculate any premium contributions required and will deduct those premiums directly via bank account once per month.

    In order to facilitate the deductions, plan members on a full-time unpaid leave who elect to continue participation in the benefits plan will be required to provide pre-authorized debit (PAD) information and will be billed directly each month.  Members working in an eligible part-time LTO teacher assignment or in a permanent part-time position who opt into benefits will also be required to provide PAD information and will be billed directly each month while they are eligible for benefits.

    If you are an eligible part-time member (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.) or are on a non-statutory leave (e.g. deferred or 4/5 leave, unpaid medical leave, personal leave, etc.), please see the documents below for information about premium costs:

    *Teachers/LTO Plan Premiums:  PDF (262kB)| Word (168kB) 

    *Education Plan Premiums: PDF (266B)|  Word (198kB) 

    *The above premium rate documents are effective September 1, 2023 and are subject to change annually at renewal.

  • Do claims activity under a member’s previous board plan have an impact on eligibility for claims under the Plan? (e.g. will the new orthodontic or vision care maximum benefit automatically apply to all?)

    Except for orthodontic coverage, claims activity under a member’s previous plan does not have an impact on eligibility for claims under this plan.

  • Is there an appeal process for the plan?

    Yes, the trustees of the ETFO ELHT have approved an ongoing appeal process.

    Standard Process in Appealing a Claim

Questions?


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