Overall Benefits Plan

Transcription

1 Overall Benefits Plan Who is eligible Mandatory Health and Dental for 1.0 FTE members Voluntary Health and Dental for permanent members and eligible LTOs working less than 1.0 and for members on non-status leaves Mandatory Basic Life and AD&D for all active permanent members and eligible LTOs. Available to all teachers. Mandatory basic life insurance. Accidental Death and Dismemberment was available, at the teacher s expense.

2 Medical Supplies and Services Ambulance Transport to/from nearest facility Includes air ambulance same Glucometers $150/benefit year No limit Hearing Aids $1000/ 5 benefit years $1500/ 5 benefit years Orthotics $350/ benefit year One pair per calendar year Orthopaedic Shoes (custom) Orthopaedic Shoes (stock) Two pairs/benefit year $500 max/pair $500/benefit year for modifications and adjustments

3 Medical Supplies and Services Private Duty Nursing $50 000/benefit year No limit Surgical stockings 6 pairs /benefit year $250 Wigs $500 lifetime max same

4 Paramedical ($max/benefit year) No per visit fee cap No deductible $50/visit max $10/individual, $20/family ded. Chiropractor/ Osteopath $1000 combined/benefit year $450 each Dietician/Nutritionist $500 combined/benefit year No coverage Massage Therapist $1000/ benefit year (doctor s referral required) $450/ benefit year (no referral required) Naturopath $1000/ benefit year $450 Physiotherapist/ Athletic Therapist/ Occupational Therapist $1000 combined Physiotherapist - $450 Athletic Therapist, Occupational Therapist - no coverage

5 Paramedical ($max/benefit year) No per visit fee cap No deductible $50/visit max $10/individual, $20/family ded. Podiatrist/ Chiropodist Psychologist, Marriage and Family Therapist, Registered Social Worker Speech-Language Pathologist, Communicative Disorders Assistants, Audiologist $450 combined/benefit year same $1500 combined/benefit year $450 $1000/ combined/ benefit year Speech therapy - $450/ benefit year Audiologist - no coverage

6 Hospital Hospital room semi-private Private room Semi-private room in private OHIP-funded facilities (for example, the Shouldice Hospital, Homewood covered Covered

7 Vision Care Glasses, contact lenses, laser eye surgery Eye exams $500 max/2 benefit years (1 benefit year for children under 18) Laser eye surgery is included in this. Once every 2 years, cost is included in the above $500 max $500 max /2 benefit years ($250 /year for children under 18) Laser eye surgery - one time payment of $725 Once every 24 months Visual Training $200 lifetime Visual therapy and remediation exercises under care of opthamologist - no limit

8 Travel Medical (out of Canada) Emergency medical services 100% Up to 60 days/trip $5 million lifetime max 100% with some limitations Up to 180 days/trip $5 million lifetime max

9 Life and Accident Insurance Basic Life 1x annual salary to $ max combined 50% reduction at age 65 Ends at retirement $ or 1,2,3,4x salary as selected by teacher Upon retirement, until age 65 members could remain in plan Supplemental Life Accidental Death and Dismemberment Option of 1 or 2x annual salary to $ max comb. 50% reduction from age 65 Maximum combined with Basic Life Ends at retirement Member paid Coverage matches Life 50% reduction from age 65 Ends at retirement or age 70 (whichever comes first) Additional coverage to max of $ available. Combined max $ Max $ Member paid Medical evidence required

10 Life and Accident Insurance Spousal/ Partner Optional Life and AD&D Child Optional Life - Spousal Optional Life and AD&D coverage up to $ Spousal Optional Life ends at member s retirement or when spouse reaches age 65, whichever comes first - Spousal Optional AD&D ends when member retires or reaches age 70, or spouse reaches 65, whichever comes first - Child Optional Life coverage up to $25 000, member-paid - AD&D available to teachers, to a max of $ , member paid - Spousal optional life insurance available up to $ Dependent Optional life coverage available up to $ Coverage remains upon retirement, until age 65. Member paid

11 Prescription Drugs Pay direct benefits card Yes Yes Deductible $2 deductible/prescription $10/year per person $20/year per family Dispensing fee max $11 Not specified Limits Maintenance medications limited to 7 dispensing fees/prescription/12 months Also included Diabetic supplies, preventative vaccines, Fertility drugs up to $ lifetime max. Diabetic supplies, vaccines, fertility drugs (no limit), anti-obesity drugs

12 Dental Insurance Basic dental 100% of check ups, x-rays, fillings, other Recall exams: every 9 months - adults Every 6 months - children under 19 Full exams and xrays once every 24 months Same Full xrays, exams every 3 years Periodontic/ Endodontic services 100% of root canals and related 100% of scaling, root planing, gum treatments, etc. 14 units of scaling and root planing combined/benefit year Same 8 units every 12 months

13 Dental Insurance Major restorative services Orthodontics 60% of crowns, bridges, dentures, implants, inlays, onlays $2000 max/benefit year Crown, onlays or denture replacement once every 5 benefit years Dental implant max: lowest cost alternative treatment option 50% coverage for adults and children $3500 lifetime max 50% of costs No maximum 50% $3000 lifetime max