Security, Health and Wellness: All about your employee benefits Presented by: Kelly Long, Manager, Benefit Solutions, AOMBT Janet Tunney, Client Relationship Specialist, Equitable Life
About the AOM Benefits Trust Manages and administers a benefits plan on behalf of midwives, AOM employees, AOMBT employees, Toronto Birth Centre staff and practice administrative staff Accept midwives benefits funding (currently 20%) and steward these funds, including group retirement savings 2
Your benefits program
Eligibility Actively employed for 3 consecutive months (waiting period) Be actively at work Work a minimum 16 hours per week Be under the age of 65 Dependents may be covered under two-party or family coverage: Legal spouse or common law partner (12 months) Dependent children under the age of 21; 25 if the dependent is a full time student or permanently incapacitated (if they became so under 21 or while an eligible student) 4
Your benefits program Health, dental and travel benefits Life, Critical Illness and AD&D insurance Long-term disability 5
Health and travel benefits Prescriptions Hospital Covered at 80%, until you have paid $1,200 out-of-pocket per year. After $1,200, prescriptions are covered at 100%. Dispensing fees are capped at $8 per prescription. Mandatory generic drug program in effect as of April 1 st, 2015 100% coverage for a semi-private room. Paramedical services Effective April 1 st, 2015, covered at 100% for the first $750 per year. After the first $750, claims are covered at 80%, up to a maximum of $2,500 per year. There is no maximum per paramedical discipline; you can use your maximum paramedical coverage on one practitioner or on several. Covered services: Acupuncturist, Chiropractor, Physiotherapist, Massage Therapist, Psychologist, Osteopath, Naturopath, Speech Therapist, Chiropodist/Podiatrist, Athletic Therapist, Audiologist, Dietician, Social Worker/Counsellor. Medical supplies Covered at 100% - maximums vary. Example: $500 per 60 months for hearing aids, $450 per 3 calendar years for custom-made orthotics. Vision Eye exams performed by a licensed optometrist, ophthalmologist or physician are covered at 100% once every 24 months (age 21+) or once every 12 months (under 21). 6
Travel benefits Coverage for a maximum of 180 days, up to $5,000,000 per lifetime for emergency services required as a result of emergency illness or injuries that occur while travelling outside the province/country Includes: hospital services, emergency transportation, diagnostic laboratory tests and x-rays, emergency dental treatments and reimbursement of prescriptions The insurance carrier will make every effort to pay the hospital/provider directly. There may be situations, particularly when travelling outside of Canada or the US, in which the hospital or provider will not accept payment from the insurance carrier and may require a deposit or full pre-payment from the plan member. If you require emergency medical care while travelling, contact Allianz as soon as possible the phone number is on your Equitable wallet card Travel coverage brochure Allianz travel app (free) 7
Dental benefits Basic services Major services Covered at 100%, to a maximum of $2,000 per calendar year. Recall exams once every 5 months. Basic services include diagnostic, preventive, routine restorative (such as fillings), routine surgical, endodontic (such as root canals) and periodontal (such as gum scaling). Major services are covered at 50%, to a maximum of $2,000 per calendar year. Major services include dentures, bridges, crowns, inlays and onlays. Orthodontics Orthodontic services are covered at 50%, to a maximum of $2,500 per lifetime. All services, including dental and paramedical, are subject to reasonable and customary maximums. Before proceeding with any significant or non-routine dental work, it is recommended that plan members contact Equitable Life to confirm coverage. 8
Income protection (insurances) Basic life insurance Optional life insurance Accidental death & dismemberment (AD&D) Optional AD&D Basic critical illness Optional critical illness Two times annual earnings to a maximum of $250,000. At age 65, the coverage reduces by 50%. Coverage terminates at age 70. Plan members have the option of purchasing additional life insurance in units of $10,000, to a maximum of $250,000, for either themselves and/or their eligible spouse. Two times annual earnings to a maximum of $250,000 following a loss or severe injury caused by accidental means. Coverage terminates at age 70. Plan members have the option of purchasing additional AD&D coverage for themselves, their eligible spouse/partner and/or child(ren). Coverage provides a lump payment of $10,000 to a plan member after confirmed diagnosis of a critical condition covered under the plan. Coverage terminates at age 65. Plan members have the option of purchasing additional critical illness coverage for themselves, their spouse and child(ren). Long-Term Disability Plan members are eligible for long-term disability with coverage of 60% of monthly earnings to a maximum of $3,500 per month. 9
AOMBT benefit plan changes Effective April 1 st, 2015 Finding balance between comprehensive coverage and financial sustainability of the plan Changes based on analysis of usage and AOMBT values of equity and choice
Prescription drug changes Mandatory generic substitutions program Generics undergo same rigorous Health Canada review process and contain same active ingredients as brand name Brand-name drug can be purchased, however, reimbursement up to cost of generic drug only Allergic or other reactions must be reported to Health Canada (adverse drug reaction form), which is submitted to Equitable Life for approval 11
Prescription drug changes cont d $8 dispensing fee cap Dispensing fees set by pharmacy Can use pharmacy of choice; reimbursement up to $8 Mail-order pharmacies: Equitable Life partners with Pharmex Direct 100 day supply for maintenance drugs Managed formulary remains in effect 12
Paramedical plan changes First $750 (per calendar year) covered at 100% Claims above $750 covered at 80% $100 physiotherapy session - plan member pays $20 Maximum remains $2,500 for all disciplines; allowing flexibility/choice
Resources to help you
midwivesbenefits.ca 15
How can I invest ethically without compromising my retirement? What benefits will I be eligible for when I retire? What should I do to prepare for an audit? How can I access the Home Buyer s program? What is income splitting? What s the difference between actively and passively managed funds? How much of my earnings should I be saving to pay my taxes? What is riskreturn ratio? Is it better to lease or buy a vehicle? How can I check the qualifications of my financial advisor? Should I have all of my investments with one company? How do I pay tax in installments? How often should I be reviewing my investments? What s better, an annuity or a RRIF? What is debt consolidation? Got financial questions? Ask the Expert. Ask the Expert is an online library providing timely, credible and unbiased information about financial issues. Submit your own questions and have them answered anonymously by our team of subject-matter experts, or check out the answers in our searchable library. Because you can t make an informed choice without information. midwivesbenefits.ca/ask
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Contact the AOM Benefits Trust Toll-free in Ontario: 1.866.418.3773 Tel: 416.425.9974 Fax: 416.921.6556 Email: midwivesbenefits@aom.on.ca Web: midwivesbenefits.ca Follow us on Twitter: @midwifebenefits Visit our website for access to forms, presentations and other resources. 25
Contact Equitable Life Tel: 1.800.265.4556 Fax: 1.888.505.4373 Website: www.equitable.ca Claims website: www.equitablehealth.ca If you have questions about your claims or specific aspects of the benefits plan, contact Equitable Life. 26
Thank you! Questions?