Understanding Your Vision Care Coverage

December 11, 2019

The ETFO ELHT Benefits Plan is designed to keep your eyes healthy so you can stay productive at work and in life.

What your plan covers

Here is a summary of your vision care under the ETFO ELHT Benefits Plan:

  • You or any eligible family member over the age of 18 covered under your plan have a total of $500 for one eye exam, prescription glasses, contact lens and/or laser eye surgery combined, every two benefit (policy) years.
  • Any eligible family member aged 17 and under covered under your plan, have a total of $500 for one eye exam, prescription glasses, contact lens and/or laser eye combined, every benefit (policy) year.

You can check your benefits booklet for full details about your vision care coverage.

Your benefit (policy) year is September 1 to August 31.

The vision care benefit is tracked based on the current and previous school year.

The benefit year is important in understanding how eligible claims will be reimbursed and how the two benefit years reset for your vision care.

Here is an example for you or any eligible family member over the age of 18.

If your ETFO ELHT benefits coverage became effective September 1, 2018 and you have made the following vision purchases:

Example Vision Purchases
(Scroll bar at bottom of table.)
Purchase date Claim amount Reimbursed amount
Purchase #1 December 1, 2018
(2018-19 benefit year)
$300 $300
Purchase #2 February 1, 2020
(2019-20 benefit year)
$200 $200
Purchase #3 June 5, 2020
(2019-20 benefit year)
$200 $0
Total $700 $500

Calculating how much you will be reimbursed:

Based on the above purchases, you add everything up in the previous school year (September 1, 2018 – August 31, 2019) and the current school year (September 1, 2019 – August 31, 2020). Since Purchases #1 and #2 equals a total of $500 in vision care products, you will not be reimbursed for your June 5, 2020 purchase (Purchase #3), as you have used up your vision care benefit for the two benefit years.

Calculating the TOTAL ELIGIBLE AMOUNT for the new benefit year:

It is now the 2020-21 school year, and you are ready to make Purchase #4.

What would your total eligible amount be?

For the 2020-21 school and benefit year (September 1, 2020 – August 31, 2021), the total eligible amount will be $300 for vision care reimbursements, because you claimed $200 in the 2019-20 benefit year.

Here is how you calculate your total eligible amount:

How you calculate your total eligible amount
(Scroll bar at bottom of table.)
Total maximum allowed for vision care Total amount reimbursed in the previous benefit year = Total eligible amount for new benefit year
Example calculation
(Scroll bar at bottom of table.)
$500 $200
(Reimbursed to you in 2019-20 benefit year for Purchase #2)
= $300

OTIP Benefits Services is here to help you review your benefits. You can always check your available balance for your vision care in My Claims, after logging in to OTIP’s secure member site.

TIP: Before you buy your vision care products and services, you can submit an estimate to see if they will be reimbursed in the current benefit year. You can also contact OTIP Benefits Services at 1-866-783-6847 for assistance.

Caring for your eyes and your ELHT benefits plan

The ETFO ELHT Benefits Plan offers optimal benefits coverage to eligible members, helping to protect your and your family’s access to meaningful and sustainable benefits coverage like vision care for years to come.

This is where you 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, services and products like glasses.

Also be aware of some service providers who may encourage you to ‘use it or lose it’ when it comes to your benefits coverage. Maximizing all your benefits coverage, if not medically necessary, can negatively impact the health and sustainability of the benefits plan for all members and their eligible dependants.

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