RTO/ERO Group Insurance Benefits. District 3 - Algoma May 5, 2015

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1 RTO/ERO Group Insurance Benefits District 3 - Algoma May 5, 2015

2 The Roles Manulife Financial (Partial Risk Underwriter) Johnson Inc. (Administrator, Claims Payor & Consultant) RTO/ERO (own and manage our Plans)

3 Semi-Private Hospital and Convalescent Care Convalescent Care (80% reimbursement, maximum $75/day) Home care - 30 days following a 24 hour hospital stay or 3 days following non-elective day surgery Temporary stay in a long term care facility - 30 days per calendar year following a 24 hour hospital stay * Please contact Johnson Inc. Claims to obtain an authorization form prior to incurring any expenses.

4 Dental Plan New for 2015 Reimbursement updated to the 2015 Fee Guide * Dental pre-treatment estimate required if work is expected to exceed $600

5 OHIP Coverage Drugs Available in Canada Covered by Trillium/ODB

6 Extended Health Care Prescription Drugs New for 2015: Maximum increased to $3,100 Mandatory generic substitution Eligible drugs: all prescription drugs, including those not covered by the Provincial Drug Benefit Non-prescription drugs and supplies required due to colostomy, ileostomy, cystic fibrosis, diabetes, heart disease or Parkinson s * Dispensing fees - vary by pharmacy * Prescription drugs - no need to submit receipt for the dispensing fee & 15% co-payment

7 Extended Health Care Vision Care (80% Reimbursement) New for maximum increased to $375/two years for glasses, sunglasses, contact lenses or laser eye surgery One exam, maximum $90/two years Paramedical Practitioners (80% Reimbursement) New for maximum increased to $1,100 per year Physician s referral not required 15 different practitioners covered * Medical aids & equipment must be purchased through a registered ADP vendor.

8 Eldercare Select Added to the Extended Health Care Plan in 2014 Addresses care giving challenges faced by members Expert support of a registered nurse 24/7 Personal, custom care plan for you, your spouse or loved ones Written, proactive, planning guide available Discount on FirstWatch - personal medical response system Assistance with accessing benefits (provincial & federal), locating community and volunteer organizations, seniors health & safety information

9 Out-of-Province/Canada Travel Benefit New for days coverage per trip Coverage: Unlimited number of trips per year $6,000 trip cancellation/interruption and delay per person per trip

10 Supplemental Travel Plan Guaranteed acceptance - No medical questionnaire Plans from 5 days to 119 days available, up to a maximum trip length of 212 days May apply for coverage while travelling Competitive, age-based rates Rates are not based on medical history Are you and your spouse in different age bands? Member younger - purchase couple coverage based on member s younger age Spouse younger - purchase 2 single plans based on each of your ages

11 Stability Clause Effective January 1, 2014, the stability clause was expanded to exclude coverage for 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)

12 Stability Clause What does this mean? The Stability Clause was expanded from cancer, heart or lung conditions to any condition. Why was this changed? Members should travel when they are healthy. Previously, members with unstable, serious health conditions (other than cancer, heart or lung) were able to travel. Claims affect the plan rates for everyone.

13 Example Member spends Thursday evening in the emergency room at his 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. How much does this surgery and medical care cost? $25,000 - $49,000 $50,000 - $74,000 $75,000 - $100,000 Would this be an eligible claim under the Out-of-Province/Canada Travel Benefit?

14 In Case of a Medical Emergency Allianz must be notified within 48 hours of the emergency, preferably in advance of treatment. If not, payments will be limited to $2,000 per person per insured trip. If you are medically incapacitated and unable to contact Allianz, someone else must call Allianz on your behalf as soon as reasonably possible.

15 Proof of Departure Claims Process All insured participants must have their own proof Must prove when last in province of residence (not Canada) Examples - boarding pass, credit card receipt & statement, signed paramedical receipt Send all claim forms to Allianz (not Johnson Inc.) Allianz will perform any Coordination of Benefits with other plans, such as OHIP, on your behalf. Allianz often encounters delays obtaining member s medical history from their physician in Canada.

16 Before You Travel Allianz s pre-trip planning assistance: Travel advisories, required inoculations, currencies, visa requirements Allianz s emergency contact phone number(s) How to call out of the country you are visiting (for example, required country codes, how to call from local telephones or your personal cell phone, etc.)

17 Reminders Online claim submission - submit claims through the Johnson Inc. Members Only website Electronic claim submission - certain paramedical and vision practitioners can electronically submit your claim Direct deposit of claim reimbursements into your bank account and notification * Claims must be submitted by the end of the following calendar year

18 Reminders Spousal authorization - privacy legislation Surviving spouse coverage

19 Did You Know Plan design evolves to meet the changing needs of RTO/ERO members Health Plan Enhancement Submission 89,000 insured members and their families across Canada 99% of insured members maintain coverage for life Largest voluntary benefit plan for education sector retirees in Canada 8 in 10 OTPP health insurance deductions are for RTO/ERO s Group Insurance Benefits

20 Administration/coverage/Supplemental Travel information: Johnson Inc. Service Claim questions: Johnson Inc. Claims Pre-trip assistance: Contact Information Allianz Global Assistance

21 Questions?

22 Thank you!