Your OSSTF ELHT Benefits Plan - YRDSB
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Your OSSTF ELHT
Benefits Plan
PUTTING YOU FIRST
As an OSSTF member, you may be eligible to The OSSTF ELHT Benefits Plan is a
plan tailor-made for eligible OSSTF
enrol in the OSSTF Employee Life and Health members and one that provides you
Trust (ELHT) Benefits Plan. The benefits plan and your family with valuable financial
includes: protection. For more information
about the benefits plan, including
who is eligible, enrolment deadlines,
• Basic Life and Basic Accidental Death and Dismemberment member contributions and FAQs, go
(AD&D) benefits for you to www.osstfbenefits.ca.
• Optional Life and Optional AD&D for you and your spouse, and
Once eligible members have enrolled,
an Optional Child Life benefit
full plan details, eligible expenses,
• Extended Health Care coverage (out-of-country travel included) exclusions, how to make claims, and
for you and your eligible family members the specifics of member premium
contributions are available on
• Dental coverage for you and your eligible family members OTIP’s secure member website at
Basic Life and Basic AD&D benefits are mandatory for all eligible www.otip.com.
active members regardless of full-time equivalent (FTE) level.
The benefit year starts September 1
Health and Dental benefits, and Optional Life and Optional and ends on August 31, except where
AD&D benefits are voluntary for all eligible active members. If otherwise indicated. The plan has no
you elect to participate in the Health and/or Dental benefits, you overall deductibles or waiting periods.
will be responsible for the payment of the required member Certain restrictions, limitations and
contributions from your eligibility date go forward. After your exclusions will apply.
election for participation in Health and/or Dental benefits has
been processed, eligible claims incurred on or after your ABOUT THIS GUIDE
eligibility date can be submitted for processing and payment.
This quick reference guide is intended
to provide you with a brief overview
ABOUT OSSTF BENEFITS of the OSSTF ELHT Benefits Plan and
The benefits plan is sponsored and managed by the OSSTF is not intended to be comprehensive.
Benefits ELHT. The ELHT Board of Trustees has representatives If there is a discrepancy between
from OSSTF, the Ontario Public School Boards’ Association and the information in this guide and the
the provincial government. The ELHT’s sole purpose is to provide benefits booklet, the terms and details
life, health and dental benefits to eligible plan members and their of the benefits booklet apply.
families. Learn more at www.osstfbenefits.ca.
1
OVERALL BENEFITS PLAN
Funding P Health and Dental premiums are 94% paid by the OSSTF ELHT for eligible active
1.0 FTE members
P Funding is pro-rated for eligible active members less than 1.0 FTE (the difference
in premium is member-paid)
P Basic Life and Basic AD&D premiums are 100% paid by the OSSTF ELHT
P Optional benefit premiums are member-paid
P If you are a long-term occasional (LTO) teacher, Adult Day teacher or long-term
assignment education worker, visit www.osstfbenefits.ca/faqs/#who-is-eligible to
learn more about your elibility
What you are P Mandatory Basic Life and Basic AD&D for all eligible active members
eligible for P Voluntary Health and Dental for all eligible active members
Lifetime maximum P Unlimited (except where stated)
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 assignment)
Benefits year P Starts on September 1 and ends on August 31, except where otherwise indicated
BASIC LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (AD&D)
Basic Life P 2x annual salary to $400,000 maximum
P 50% reduction at age 65
Basic AD&D P Coverage matches Basic Life amount
Member/Spousal P Member and Spousal Life and AD&D coverage up to $400,000
Optional Life and (units of $10,000)
Optional AD&D P Member-paid, based on gender and age
Child Optional Life P Child Optional Life coverage up to $25,000, member-paid
PRESCRIPTION DRUGS
P Pay-direct benefits card
P Prescription formulary, including life-sustaining drugs
P Mandatory generic substitution (lowest cost therapeutic equivalent drug)
P Mandatory participation in the Specialty Drug Care program
P Dispensing fee maximum based on reasonable and customary limits (currently $12)
P Maintenance medications limited to 6 dispensing fees/prescription/12 months
P Diabetic supplies (reasonable and customary costs)
P Preventive vaccines
P Fertility drugs up to $18,000 lifetime maximum
P Sexual dysfunction drugs $500/benefit year
VISION CARE HOSPITAL
P Glasses, contact lenses and laser eye surgery P Semi-private hospital room
P $500 maximum every 2 benefit years P Includes costs for semi-private room in private
P Eye exam once every 2 benefit years OHIP-funded facilities
2
PARAMEDICAL MEDICAL SUPPLIES AND SERVICES
($ Maximum/benefit year; reasonable and customary costs) Ambulance P Transport to nearest facility
Services must be provided by practitioners who are P Includes air ambulance
licensed, certified or registered with the appropriate Glucometers P Up to $150/benefit year
authority in the location in which the service was provided.
Hearing aids P Up to $4,000/4 benefit years
Chiropractor P Up to $750/benefit
year Orthotics P Up to $750/benefit year
Dietitian/Nutritionist P Up to $300/benefit Orthopaedic P Up to a maximum of 2 pairs/benefit
year combined shoes (custom) year, and up to a maximum of
Massage Therapist P Up to $750/benefit $500/pair
year (with doctor’s Orthopaedic P Up to $500/benefit year, including
referral) shoes (stock) modifications and adjustments
Naturopath P Up to $750/benefit Private duty P Up to $50,000/benefit year
year nursing
Osteopath P Up to $500/benefit Surgical P 6 pairs/benefit year
year Stockings
Physiotherapist P Up to $1,500/ Wigs P Up to $500/lifetime
benefit year
Podiatrist/Chiropodist P Up to $300/benefit
year combined
Psychologist P DENTAL INSURANCE
Psychotherapist P Fee guide P Current fee guide for general
practitioners for province of
Registered Family P
residence
Therapist
Basic Dental P 100% of check-ups, X-rays, fillings,
Registered Social Worker P Up to $2,000/ other
Registered Clinical P benefit year P Recall exams: once every 9 months
Therapist combined
P Full exams and X-rays once every
Registered Psychoanalyst P 24 months
Psychologist Associate P Periodontic/ P 100% of root canals and related
under supervision of a Endodontic services
Registered Psychologist services P 100% of scaling, root planing, gum
Speech-Language P treatments, etc.
Pathologist Up to $1,000/
benefit year P 10 units of scaling and root planing
Communicative Disorders P combined/benefit year
combined
Assistants
Major P 80% of crowns, bridges, inlays,
restorative onlays, dentures, $4,000 maximum/
services benefit year
P Crown, onlays or denture
TRAVEL MEDICAL (OUTSIDE OF CANADA) replacement once every 3 benefit
Emergency medical P 100% years
services P Up to 60 days/trip
P Implants are not eligible. If an
P $5 million lifetime implant is elected, and a denture
maximum/person or bridge would produce adequate
Referred medical services P 50% results for the condition, the plan
available in Canada P $3,000 maximum/3 will pay the cost of the expense and
calendar years any related services at a cost equal
to the least expensive cost of a
denture or bridge
Orthodontics P 50% coverage for adults and
The summary of benefits is also available on the children
OSSTF Benefits website at www.osstfbenefits.ca. P $3,500 lifetime maximum
3
What you can expect to receive over the next few weeks if
you are eligible for benefits:
IMPORTANT
ENROLLING IN THE PLAN
If you do not complete the enrolment by the
• Within 3-4 weeks of meeting your eligibility criteria, an date outlined in the enrolment email, you will
enrolment email from OTIP will be sent to your board only be covered for Basic Life and Basic AD&D
email address, inviting you to enrol in your new benefits benefits.
plan. You will have 31 calendar days from the date that
you receive this enrolment email to complete your You may also be considered a late applicant if
enrolment for yourself and your family members. you apply for Health and Dental benefits in the
future. As a late applicant, Dental benefits will
If you do not receive an enrolment email within 3-4 weeks
be subject to a $200 maximum for your first
of meeting your eligibility criteria, please contact OTIP
12 months of coverage.
Benefits Services at 1-866-783-6847.
For Health benefits, proof of good health
BENEFIT PREMIUMS (evidence of insurability) will be required for
During the enrolment process, any monthly premium assessment. If approved, Health benefits will be
implemented on the date of approval. However,
costs that you will be required to pay (if applicable) will
based on the assessment of the evidence of
be displayed. Once you complete your enrolment into the
insurability, Health benefits for yourself and/or
plan, your initial premium payment may include retroactive
your family members may be denied.
premiums owing from the date your coverage takes effect,
and the cumulative amount will be deducted. This may
happen depending on when your enrolment information
was received and processed.
or example, if you started an eligible permanent or long-term occasional
F
position/contract on February 4 and your member-paid monthly premium
is $55, your total premium payment in March will be $110.
If premiums are not received, your benefits coverage will be suspended.
YOUR BENEFITS CARD AND BOOKLET
After you have completed your enrolment:
• If you elected to participate in the Health benefits, your benefits card
will be mailed to you. If you would like to print a copy of your benefits
card prior to this, please follow the instructions in the enrolment email.
• You will be able to check out the full details of your benefits coverage
by accessing your benefits booklet in the My Library section of OTIP’s
secure member site.
ABOUT OTIP
The OSSTF ELHT 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 your benefits enrolment, administration and claims questions.
You can access and make changes to your benefits and submit claims through OTIP’s
secure member site. Learn more at www.otip.com.
QUESTIONS?
You can find answers to the most commonly asked enrolment questions at
www.otip.com/loginhelp. Further information about OSSTF Benefits and frequently asked
questions about the plan are available at www.osstfbenefits.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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