NEW - Questions related to COVID-19

  • What if I have a dependent child or overage dependant turning 21 and not in school or turning 25 and still in school and their appointments have been cancelled?

    Due to COVID-19, a one-time exception has been made to allow an Over Age Dependants (OADs) who turned 21 (not in school) or turned 25 (in school) or graduated (e.g. finished school in April or May and graduated) to access the benefits plan in the summer. This does not extend to life coverage or drug coverage, and is intended to allow access to the services and appointments that were not accessible due to COVID-19. The deadline for the extension for those eligible OADs is August 31, 2020 and no exceptions will be granted for claims or coverage incurred after that date. All eligible claims incurred on or before August 31, 2020 must be submitted and received by OTIP no later than September 15, 2020 in order to eligible for reimbursement. Questions about coverage and claims should be directed to OTIP Benefits Services at 1-866-783-6847.

    To be reimbursed for these eligible claims, the member will need to contact OTIP at 1-866-783-6847 to submit the claims manually. You will be required to pay for the service up front and will then be reimbursed according to the terms of the plan.

  • What if I was in an LTO teaching position which is ending by June 26, 2020?  I am eligible for the ELHT benefits plan and am enrolled.  What happens if my appointment(s) has been cancelled?

    Due to COVID-19, a one-time exception has been made to allow a member in an eligible LTO teaching position who enrolled in the ELHT plan on June 26, 2020 to access the benefits plan in the summer. This does not extend to life coverage or drug coverage, and is intended to allow access to the services and appointments that were not accessible due to COVID-19. The deadline for the extension for those eligible members is August 31, 2020 and no exceptions will be granted for claims or coverage incurred after that date. All eligible claims incurred on or before August 31, 2020 must be submitted and received by OTIP no later than September 15, 2020 in order to eligible for reimbursement. Questions about coverage and claims should be directed to OTIP Benefits Services at 1-866-783-6847.

  • My pharmacy normally dispenses my maintenance medication in 90 day refills, but now will only dispense 30 days at a time due to COVID-19. If I 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, 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 will be reinstated effective August 1, 2020, on a go forward basis.

    For more info about this temporary change to dispensing fees, click here.

  • Are OTIP and Manulife making extra money due to not having to pay so many claims right now?

    OTIP and Manulife receive an administration fee from the ELHT, and Manulife receives less than normal 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 members for claims) with the funding that is received.  Any money not required to pay certain types of claims right now stays in the ELHT plan to use for other benefits costs now and in the future.  This will help to further sustain the plan.

    While there have been certain decreased claims in dental, paramedicals and vision, there are other costs that have still been incurred including drugs, which makes up the largest percentage of paid claims.  The ELHT lifted the limit of maintenance drug dispensing fees while drugs are only being dispensed in 30 day refills between March 23 and August 1, 2020. In addition, the ELHT is already reimbursing eligible virtual paramedical appointments, and these claims will continue to increase.  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.   There has been an increase in claims during the summer as  providers have opened again.

  • Where else can I find up-to-date information related to my health and dental benefits and COVID-19?

  • I am finding that my mental health and/or that of my family has been impacted by the pandemic. Where do I find out about benefits-related resources to help support this?

    We know that many individuals and families have felt the additional stress of uncertainty as communities and organizations across the country work together to contain the spread of COVID-19.

     

    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.  Resources include information about accessing mental health services and crisis help lines, to tools for speaking to your children about COVID-19.

Eligibility

  • 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 includes basic life, health and dental, and AD&D. However, 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. 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 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 | Word

    Education Worker Plan Premiums: PDF | Word

  • 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 | Word

    Education Worker Plan Premiums: PDF | Word

    ** 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.

  • 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 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 | Word

    Education Workers Plan Premiums: PDF | Word

    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).

  • 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 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.
  • What about members who were on leave and unreachable during transition into the ETFO Benefits Plan?

    OTIP and ETFO are making every effort to ensure all eligible members receive sufficient notice to enrol in the ETFO Benefits Plan, including providing enrolment information via multiple communication channels such as mail and email.

  • 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 members will receive an invitation to enroll in the ETFO ELHT benefits plan within 2 – 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) require evidence of insurability.

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

    The ETFO provincial benefits plan provides coverage for LTO teachers based on the following eligibility criteria:

    • Assignment must be 90-consecutive calendar days or longer (except where there is currently a shorter eligibility rule in the collective agreement – e.g. currently 60-consecutive calendar days, the LTO teacher would be eligible);
    • Enrolment in the benefits plan is mandatory for 1.0 teacher in an assignment for 90 consecutive days or longer;
    • Benefits coverage will begin on the first day of a known 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
    Members in eligible 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.).

    Combining Permanent and LTO Contracts
    LTO eligibility rules may be combined with contract eligibility rules – for example, where a 0.5 contract member also has a 0.5 LTO 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 into 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 LTO in an eligible part-time FTE (e.g. 0.2, 0.5 FTE, 0.7 FTE, etc.), please see the documents below for premium costs:

    Teachers/LTO Plan Premiums:  PDF | Word

     

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 | Word

    Education Plan Premiums: PDF | Word

    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).

     

  • 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), 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 | Word

    Education Worker Plan Premiums: PDF | Word

    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).

    Members on Unpaid Leaves
    Members on an unpaid leave (including deferred or x/y leaves*, personal unpaid leaves, unpaid extended parental leaves, unpaid medical leaves) would be required to pay 100% of the monthly premiums to participate in benefits.  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.

    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.  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 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.

  • 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 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.

    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 | Word

    Education Worker Plan Premiums: PDF | Word

Change in Status

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

    Yes, members on all leaves 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, etc.).  Members on an unpaid 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 Leaves:

    Members who have maintained their benefits and are approved for LTD benefits will be eligible to have health and dental premiums paid by the ETFO ELHT for the first 24 months of their approved LTD claim (pro-rated for part-time).  If  a member is on unpaid medical leave prior to their LTD claim being approved, they would be required to pay the cost of the monthly premiums.  If the LTD 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 retroactive to April 1st, they would be refunded those health and dental premiums and the 24 month period would begin April 1st.

    If a member continues on LTD after the 24 month period and is still a permanent employee of the board, 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 | Word

    Education Worker Plan Premiums: PDF | Word

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

    If an assignment is extended to 90 consecutive calendar days or longer, the member will be eligible to enrol in the Plan retroactively to the first day of their assignment. Standard premium contribution rules will apply. The extension be of the original LTO to be eligible.

    For example, no premium contribution is required by an LTO Teacher working in a 1.0 FTE assignment of 90 consecutive calendar days or longer; an LTO Teacher working in a 0.5 FTE assignment who voluntarily opts into health and/or dental benefits will be required to pay 50% of the premium for health and dental. If premium is required, it will be retroactively assessed through payroll.

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

    To be eligible for ELHT benefits, an LTO must be at least 90 days or longer.  A new LTO 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 a 90-consecutive calendar day LTO Teacher assignment gets shortened unexpectedly?

    If a 90-consecutive calendar day 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.

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

    Benefits coverage will cease for an LTO assignment that ends on the last day of the school year.

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

    For members who have been in 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, benefits will be reinstated in September when the new assignment begins.

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

    LTO Teachers with a 90-consecutive calendar day assignment or longer who go on statuatory leave (maternity, parental or WSIB) will be eligible for participation in the ETFO ELHT plan until the end of their LTO assignment based on their FTE assignment

  • For an LTO teacher who ends and begins an assignment in the same school year, what happens to the record of their claims from the first assignment?

    LTO Teachers beginning a new 90 consecutive calendar day 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.

  • 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 then contact the member via email to ensure necessary changes are processed.

  • I am a permanent member and am in the ETFO ELHT plan. If I retire on June 30, 2020, when will my ETFO ELHT benefits end?

    Benefits terminate at 11:59 p.m. the day an eligible member retires or resigns. 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.

  • 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 currently on a leave of absence and has waived their benefits for the duration of their leave, they will be eligible to enrol when they actively return to work. They will have 31 days after their return date to 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) and WSIB, members will pay for health and dental benefits on an FTE pro-rated basis (e.g. if a member is 1.0 FTE the ELHT will pay 100% of the premium; if a member is 0.5 FTE 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) a member must pay 100% of the premium.

    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 | Word

    Education Worker Plan Premiums: PDF | Word

  • 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.

  • If the Board doesn’t have my email address, how will OTIP and the ETFO ELHT communicate with me?

    If a member’s email information is not on file, OTIP will mail communications to the member’s home address on file. All members will be encouraged to provide and update their email address when they are transitioned into the plan to ensure efficient ongoing plan communications.

  • 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.

Medical and Treatment Coverage

  • 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.

     

  • 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.

    Members who are actively enrolled in the ETFO ELHT health plan do have coverage in the case of a medical emergency.  For more information, click here.

  • Do members receive a drug card?

    Yes, all eligible ETFO Benefits Plan members will receive a new pay-direct benefits card. 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?

    Largely, diabetic supplies and equipment which were considered under a prior plan will continue to be considered under the new Plan. Some supplies require a doctor’s recommendation. During the transition period, if a member contacts OTIP, a request will be made to transfer medical information across from the prior plan, and eligible claims will be paid.

  • 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.

  • I am worried my expensive medications will not be covered. Will prior approved exceptions for a specialized prescription drug be transitioned into this plan?

    Most drugs that are not ‘over the counter’ are covered under the Plan, although there are some exceptions. Some eligible drugs require completion of a prior authorization form by a physician to determine if the drug will be covered. During the transition period, OTIP will accept previous proof of approval of specialized drugs. This proof can include a receipt showing that the specialty drug was covered under the previous plan.

    Proof of approval from the prior carrier must be received within 90 days from the transition date.

    Newly prescribed drugs that require prior authorizations will require the appropriate forms to be completed by a physician to determine if the drug will be covered, as will prior authorization drugs used by a newly eligible member of the plan (e.g. new hire).

  • What if I cannot take a generic form of a particular drug for medical reasons?

    The Plan also has a mandatory generic requirement. However, if a member or their dependant cannot take a generic drug for medical reasons (e.g. allergy to a filler in the generic drug; experience side-effects), members are able to appeal using a one-page medical form to be completed by their treating physician and submitted to OTIP for review. Please click here to download the form.

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?

    Yes, OTIP will calculate any premium contributions required by active members and provide this information to boards for payroll deduction. Members who are working a 0.3 or less and who are enroled in the plan will be billed directly by OTIP.

    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.  In addition, members who are on a partial leave (e.g. 1.0 FTE but working 0.8 and on a 0.2 unpaid leave) will also be billed directly each month, rather than having payroll deductions.

    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 | Word

    Education Worker Plan Premiums: PDF | Word

  • 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

Enrolment and Changes

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