District 3 Algoma. October 7, Presented by: David Brawley

Transcription

1 District 3 Algoma October 7, 2014 Presented by: David Brawley

2 RTO/ERO Group Insurance Plans Semi-Private Hospital and Convalescent Care Extended Health Care (including travel) Supplemental Travel (for trips over 62 days) Dental Care

3 Semi-Private Hospital and Convalescent Care Daily semi-private room charges in a licensed hospital (95% reimbursement) Convalescent Care (reimbursed at 80% to a maximum of $75 per day) Home care following a stay in the hospital for up to 30 days per incident Home care following non-elective day surgery for up to 3 days per incident Temporary stay in a long term care facility following a hospital stay for up to 30 days per calendar year

4 Extended Health Care Prescription Drugs (85% Reimbursement) Eligible drugs, including those not covered by the Provincial Drug Benefit Plan $3,000 per person/year Brand or generic Paramedical Practitioners (80% Reimbursement) 15 different practitioners covered $1,000 per person/year Referral not required

5 Extended Health Care Aids & Appliances (80% Reimbursement) Orthotics - $500 per person/two years Hearing Aids - $1,000 per person/three years Three mastectomy bras per year Vision Care (80% Reimbursement) Eyewear, laser eye surgery and corneal incision - $325 per person/two years Eye exams - one exam per person to $90/two years

6 Extended Health Care Plus these additional benefits (80% Reimbursement) Accidental Dental Diagnostic Services Education Program Private Duty Nursing Transportation/Ambulance

7 Extended Health Care Eldercare Select Personal, custom care plan for you, your spouse or loved ones Expert support 24/7 Registered Nurse guides you through the healthcare maze Written, proactive, planning guide available Discount on FirstWatch Visit

8 Extended Health Care Out-of-Province/Canada Emergency Medical Up to 62 days per trip 100% of eligible expenses, up to $2,000,000 per person per trip $6,000 trip cancellation/interruption per person per trip New for 2014 Added benefit to send travelling companion to accompany a surviving spouse home from a trip. Additional Hotel and Meal Expenses eligible under Trip Interruption claims

9 Supplemental Travel Plan Designed for trips longer than 62 days Same travel coverage as the Extended Health Care Plan 100% reimbursement for eligible expenses Maximum trip length of 212 days Competitive, age-based rates Guaranteed acceptance no medical questionnaire!

10 Travel Stability Clause Your medical emergency is not sudden and unforeseen in the following circumstances: a) Any cancer, heart or lung condition for which, in the 90 days prior to your date of: Departure Initial booking (applicable to trip cancellation)* Any payment (applicable to trip cancellation)* You were awaiting or have received the outcome of medical tests (except routine monitoring), the results of which show irregularities or abnormalities; You required future investigation of your medical condition (except routine monitoring), consultation with a physician, or treatment or surgery recommended by a physician and/or planned before your trip.

11 Travel Stability Clause (cont d) b) Any condition for which you were admitted to a hospital for a period of at least 24 hours in the 90 days prior to the date of: Departure Initial booking (applicable to trip cancellation)* Any payment (applicable to trip cancellation)* c) Any medical condition or surgery that you contemplated or reasonably foresaw the need to seek or receive treatment or surgery in the 90 days prior to the date of: Departure Initial booking (applicable to trip cancellation)* Any payment (applicable to trip cancellation)* d) Any condition for which you have been advised by a physician not to travel. * Under Trip Cancellation, payments made when your condition was stable will be considered for reimbursement.

12 Travel Stability Clause (cont d) Case 1 Member spends Thursday evening in the emergency room at their local hospital with a severe gallbladder attack. Member flies to Florida on Saturday. Tuesday, he is rushed to the hospital with severe pain. He needs gallbladder surgery & is not stable to return home. The plan would have covered this incident in the past. Case 2 You are scheduled for surgery sometime in August. Doctor s office will call when the date is confirmed. You want to get away this summer so you book a trip to South Carolina. Your doctor s office calls and your surgery is scheduled for July 10. You now need to cancel your non-refundable trip. You call Allianz and open a Trip Cancellation claim for $3,400. This type of claim will no longer be paid.

13 Dental Basis for payment 2014 Dental Association Fee Guide for General Practitioners Covered expenses Basic and Preventive Endodontic and Periodontic Major Restorative

14 Dental Basic and Preventive (85% Reimbursement) Fillings, exams, x-rays, repair/rebase/reline of existing dentures - No annual maximum Endodontic and Periodontic (80% Reimbursement) Root canal, tissue and bone treatments - $850 per person/year

15 Dental Major Restorative (50% Reimbursement) Crowns, posts, onlays and inlays - $800 per person/year Fixed bridges and partial dentures - $800 per person/year Crowns and bridges on implants are covered

16 Convenience Services Direct claims submission from your pharmacy, dentist, select paramedical and vision practitioners Claim payments direct to your bank account notification of your claim payment Annual benefit statement and income tax expense summary letter Access to Members Only website Fully bilingual services

17 Did you know? Over 86,000 insured people, across Canada 9 in 10 satisfied members Largest voluntary benefit plan for education sector retirees in Canada 8 in 10 OTPP health benefit deductions are RTO/ERO

18 Questions?

19 Thank you.