Resources

What is the Prior Authorization Program?

December 19, 2018

Your benefits plan is designed to provide you and your family with financial protection for a variety of medical expenses, including prescription drugs. The Prior Authorization Program helps to manage drug costs while continuing to provide you with access to appropriate drug therapy. The program validates that the drug is prescribed for its intended use […]

What is mandatory generic substitution?

December 19, 2018

To help manage the costs associated with prescription drugs, your benefits plan includes mandatory generic substitution. With a mandatory generic drug plan, any prescribed drug cost cannot exceed the price of the lower cost alternative drug, which is typically a “generic” drug. If the drug you are prescribed is a “brand-name drug,” and there is […]

Understanding limits on pharmacy mark-ups and dispensing fees

December 19, 2018

Your pay-direct benefits card makes it easy and convenient when filling a prescription. Your drug claim gets processed right at the pharmacist’s counter and instantly you are told the amount paid by your plan and any amount owing. How did the pharmacy determine this amount for your drugs? Why is it important to have limits […]

Welcome to Your Benefits!

June 8, 2018

Welcome to the first edition of Your Benefits! This new e-newsletter is designed to provide you with relevant and meaningful information about your ETFO ELHT benefits plan. Provided to you by the ETFO ELHT and OTIP, we know how important benefits coverage is to you and your family, and we are here to help!

Understanding Reasonable and Customary Limits

June 6, 2018

You have heard the term reasonable and customary (R&C) limits, but what are they, and how do they work? In the simplest terms, R&C limits refer to the range of typical fees for comparable services or equipment in a given geographical area.

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