Your ETFO Employee Life and Health Trust (ELHT) Benefits Plan
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Your ETFO Employee
Life and Health Trust
(ELHT) Benefits Plan
ABOUT THIS GUIDE
This quick reference guide is intended
to provide you with a brief overview
of the ETFO ELHT Benefits Plan and
is not intended to be comprehensive.
If there is a discrepancy between
the information in this guide and the
benefits booklet, the terms and details
of the benefits booklet apply. Please
refer to the benefits booklet for full
As an ETFO member, you may be eligible to plan terms and details.
enrol in the ETFO Employee Life and Health
Trust (ELHT) Benefits Plan. This benefits Once eligible members have enrolled,
full plan details, eligible expenses,
plan includes: exclusions, how to make claims,
and the specifics of member premium
• Basic Life and Basic Accidental Death and Dismemberment contributions are available on
(AD&D) for you, Optional Life and Optional AD&D for you and OTIP’s secure member website at
your spouse, and an Optional Child Life benefit. www.otip.com.
• Extended Health Care coverage (out-of-country travel
included) for you and your eligible family members. While you are eligible for coverage
under the plan, the benefit year starts
• Dental coverage for you and your eligible family members.
September 1 and ends on August 31,
except where otherwise indicated.
ABOUT THE ETFO ELHT
The ETFO ELHT Benefits Plan is sponsored and managed by It is always recommended that eligible
the ETFO ELHT, which consists of representatives appointed members confirm coverage before
by your union (ETFO), the Ontario Public School Boards’ incurring significant cost claims.
Association, and the provincial government. The ETFO ELHT’s
sole purpose is to provide life, health and dental benefits to
eligible plan members and their dependants. The plan has no waiting period for new
eligible members. Certain restrictions,
You can visit www.etfo-elhtbenefits.ca to learn more about the limitations and exclusions will apply.
ETFO ELHT and the benefits plan.
1
OVERALL BENEFITS PLAN
Funding P Health, Dental, Basic Life and Accidental Death and Dismemberment (AD&D)
premiums are 100% paid by the ETFO ELHT for eligible active 1.0 FTE permanent
members and eligible 1.0 FTE long-term occasional (LTO) teachers
P Funding is pro-rated for active members less than 1.0 FTE (the difference in premium
is member-paid)
P Optional benefit premiums are member-paid
Who is eligible P Eligible active permanent ETFO teachers and education workers
P LTO teachers in eligible LTO positions
What you are P Mandatory Basic Life and AD&D for eligible active permanent members and eligible
eligible for LTO teachers
P Mandatory Health and Dental for eligible active 1.0 FTE members
P Voluntary Health and Dental for eligible active permanent members and eligible LTO
teachers working less than 1.0 and for members on non-statutory leaves
Lifetime P Unlimited (except where stated)
maximum
Reimbursement P 100% (except where stated and subject to reasonable and customary limits when
provided by a licensed practitioner)
End of coverage P Benefits coverage ends the earlier of: (1) when the member retires/resigns or (2) they
are no longer eligible (e.g. end of eligible LTO position)
Benefits year P Starts on September 1 and ends on August 31, except where otherwise indicated
LIFE AND ACCIDENT INSURANCE
Basic Life P 1x annual salary to $400,000 maximum
P 50% reduction at age 65
Basic AD&D P Coverage matches Life amount
P 50% reduction at age 65
Member/ P Member/Spousal Optional Life and AD&D coverage up to $400,000 (units of $10,000)
Spousal P Member-paid, based on gender and age
Optional Life
P Member Optional Life and Optional AD&D coverage
and AD&D
P Spousal Optional Life and AD&D coverage ends when the member retires, or spouse
reaches age 65, whichever comes first
Child Optional P Child Optional Life coverage up to $25,000, member-paid
Life
PRESCRIPTION DRUGS
P Pay-direct benefits card
P Mandatory generic substitution (lowest cost therapeutic equivalent drug)
P Mandatory use of Bayshore Pharmacy Services for specialty drugs
P $2 deductible/prescription and $11 dispensing fee maximum
P 10% pharmacy markup fees, up to a maximum of $250
P Maintenance medications limited to 5 dispensing fees/prescription/12 months
P Diabetic supplies (reasonable and customary costs)
P Preventive vaccines
P Fertility drugs up to $12,000 lifetime maximum
2
PARAMEDICAL MEDICAL SUPPLIES AND SERVICES
($ Maximum/benefit year; reasonable and customary costs) ($ Maximum/benefit year; reasonable and customary costs)
Services must be provided by practitioners who are
Ambulance P Transport to/from nearest facility
licensed, certified or registered with the appropriate
authority in the location in which the service was provided. P Includes air ambulance
Chiropractor P Glucometers P $150/benefit year
$1,000 combined
Osteopath P Hearing aids P $1,000/5 benefit years
Massage Therapist P $1,000 (doctor’s
Orthotics P $350/benefit year
referral required)
Naturopath P $1,000 Orthopaedic P 2 pairs/benefit year
shoes (custom) P $500 maximum/year
Physiotherapist P
Athletic Therapist P $1,000 combined Orthopaedic P $500/benefit year for
shoes (stock) modifications and adjustments
Occupational Therapist P
Private duty P $50,000/benefit year
Podiatrist/Chiropodist P $450 combined nursing
Psychologist P Surgical Stockings P 6 pairs/benefit year
Psychotherapist P Wigs P $500 lifetime maximum
Registered Family P
Therapist $1,500 combined
Registered Social Worker P
DENTAL INSURANCE
Clinical counsellor P
Fee guide P Previous year’s fee guide for
Psychoanalyst P general practitioners for province
Speech-Language P of dental practice
Pathologist Basic Dental P 100% of check-ups, X-rays,
Communicative P $1,000 combined fillings, other
Disorders Assistants P Recall exams: once every 9
Audiologist P months for adults, 6 months for
children under 19
P Full exams and X-rays once every
VISION CARE 24 months
Periodontic/ P 100% of root canals and related
P Glasses, contact lenses and laser eye surgery
Endodontic services
P $500 maximum/2 benefit years (1 benefit year services P 100% of scaling, root planing,
for children under 18)
gum treatments, etc.
P Eye exam once every 2 benefit years; included
P 10 units of scaling and root
within overall $500 vision care maximum
planing combined/benefit year
Major P 60% of crowns, bridges,
restorative dentures, inlays, onlays
HOSPITAL services P $2,000 maximum/benefit year
P Semi-private hospital room P Crown, onlays or denture
P Includes costs for semi-private room in private replacement once every 5
OHIP-funded facilities benefit years
P Dental implant only covered at
the lowest cost of an alternative
treatment option (e.g. crown,
TRAVEL MEDICAL (OUTSIDE OF CANADA) bridge, denture)
Emergency medical P 100% Orthodontics P 50% coverage for adults
services P Up to 60 days/trip and children
P $5 million lifetime P $3,500 lifetime maximum
maximum
Referred medical services P 50%
not available in Canada P $3,000 maximum/ This summary of benefits is also available on the
ETFO ELHT website at www.etfo-elhtbenefits.ca.
3 calendar years
3
What you can expect to receive over the next
few weeks if you are eligible for benefits:
ENROLLING IN THE PLAN
Within 3-4 weeks of meeting your eligibility criteria, an
enrolment email from OTIP will be sent to your board email
address, inviting you to enrol in your new benefits plan. You
must complete the enrolment within 31 days of receiving
the enrolment email to avoid being denied coverage under
the plan.
If you do not receive an enrolment email within 3-4 weeks of
meeting your eligibility criteria, please contact OTIP Benefits
Services at 1-866-783-6847.
BENEFIT PREMIUMS
During enrolment, any monthly premium costs that you will IMPORTANT
be required to pay (if applicable) will be displayed online.
Your benefits coverage and any applicable member-paid If you do not complete your enrolment by
monthly premiums will be retroactive to the day your the deadline indicated in the enrolment
eligibility criteria were met. email, you will be set up with the default
For example, if you started an eligible permanent or long- coverage determined by the rules laid out
term occasional position/contract on February 4 and your in your benefits plan. The default coverage
member-paid monthly premium is $55, your total premium may be minimal, or in some cases, result in
payment in March will be $110. no coverage.
If applicable, retroactive cumulative premiums will
You may also be considered a late applicant
be deducted from your payroll 1-2 months after your
if you apply for Health and Dental benefits
enrolment. If premiums are not received, your benefits
in the future. As a late applicant, Dental
coverage will be suspended.
benefits will be subject to a $200 maximum
for your first 12 months of coverage.
YOUR BENEFITS CARD AND BOOKLET
After you have completed your enrolment: For Health benefits, proof of good health
• If you elected to participate in the Health benefits, your (evidence of insurability) will be required for
benefits card will be mailed to you. If you would like to assessment. If approved, Health benefits will
print a copy of your benefits card prior to this, please be implemented on the date of approval.
follow the instructions in the enrolment email. However, based on the assessment of the
evidence of insurability, Health benefits for
• You will be able to check out the full details of
yourself and/or your family members may
your benefits coverage by accessing your benefits booklet
be denied.
in the My Library section of OTIP’s secure member site.
Your benefits plan is administered by OTIP (Ontario Teachers Insurance Plan). OTIP is a
not-for-profit organization dedicated to Ontario education workers; created and governed
by Ontario’s four education affiliates. OTIP Benefits Services Representatives are available
to assist you with benefits enrolment and administration. You can also access and make
®
changes to your benefits and submit claims through OTIP’s secure member website. Learn
more at www.otip.com.
QUESTIONS?
You can find answers to the most commonly asked questions about the benefits plan at
www.otip.com/loginhelp. Further information about the ETFO ELHT and frequently asked
questions about the plan are available at www.etfo-elhtbenefits.ca.
If you have any questions after receiving your enrolment information, please contact OTIP
Benefits Services at 1-866-783-6847.
4 04/2021
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6
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