Your ETFO Employee
Life and Health Trust
(ELHT) Benefits Plan
ABOUT THIS GUIDE
This quick reference guide is intended
to provide you with a brief overview
of the ETFO ELHT Benefits Plan and
is not intended to be comprehensive.
If there is a discrepancy between
the information in this guide and the
benefits booklet, the terms and details
As an ETFO member, you may be eligible to of the benefits booklet apply. Please
enrol in the ETFO Employee Life and Health refer to the benefits booklet for full
plan terms and details.
Trust (ELHT) Benefits Plan. This benefits
plan includes: Once eligible members have enrolled,
full plan details, eligible expenses,
exclusions, how to submit eligible
• Basic Life and Basic Accidental Death and Dismemberment
claims, and the specifics of member
(AD&D) for you, Optional Life and Optional AD&D for you and
premium contributions are available on
your spouse, and an Optional Child Life benefit.
OTIP’s secure member website at
• Extended Health Care coverage (out-of-country travel www.otip.com.
included) for you and your eligible dependants for eligible and
medically necessary expenses.
While you are eligible for coverage
• Dental coverage for you and your eligible dependants for under the plan, the benefit year starts
eligible necessary expenses. September 1 and ends on August 31,
except where otherwise indicated.
ABOUT THE ETFO ELHT
It is always recommended that eligible
The ETFO ELHT Benefits Plan is sponsored and managed by
members confirm coverage before
the ETFO ELHT, which consists of representatives appointed
incurring significant cost claims.
by your union (ETFO), the Ontario Public School Boards’
Association, and the provincial government. The ETFO ELHT’s
sole purpose is to provide life, health and dental benefits to The plan has no waiting period for new
eligible plan members and their dependants. eligible members. Certain restrictions,
limitations and exclusions will apply.
You can visit www.etfo-elhtbenefits.ca to learn more about the
ETFO ELHT and the benefits plan.
1
OVERALL BENEFITS PLAN
Funding P Health, Dental, Basic Life and Accidental Death and Dismemberment (AD&D)
premiums are 100% paid by the ETFO ELHT for eligible active 1.0 FTE permanent
members and eligible 1.0 FTE long-term occasional (LTO) teachers
P Funding is pro-rated for active members less than 1.0 FTE (the difference in premium
is member-paid)
P Optional benefit premiums are member-paid
Who is eligible P Eligible active permanent ETFO teachers and education workers
P LTO teachers in eligible LTO positions
What you are P Mandatory Basic Life and AD&D for eligible active permanent members and eligible
eligible for LTO teachers
P Mandatory Health and Dental for eligible active 1.0 FTE members
P Voluntary Health and Dental for eligible active permanent members and eligible LTO
teachers working less than 1.0 and for members on non-statutory leaves
Lifetime P Unlimited (except where stated)
maximum
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 position)
Benefits year P Starts on September 1 and ends on August 31, except where otherwise indicated
LIFE AND ACCIDENT INSURANCE
Basic Life P 1x annual salary to $400,000 maximum
P 50% reduction at age 65
Basic AD&D P Coverage matches Life amount
P 50% reduction at age 65
Member/ P Member/Spousal Optional Life and AD&D coverage up to $400,000 (units of $10,000)
Spousal P Member-paid, based on gender and age
Optional Life
P Member Optional Life and Optional AD&D coverage
and AD&D
P Spousal Optional Life and AD&D coverage ends when the member retires, or spouse
reaches age 65, whichever comes first
Child Optional P Child Optional Life coverage up to $25,000, member-paid
Life
PRESCRIPTION DRUGS
P Pay-direct benefits card
P Mandatory generic substitution (lowest cost therapeutic equivalent drug)
P Mandatory biosimilar substitution
P Mandatory participation in the Specialty Drug Care program
P Prior authorization required for specialty drugs and specific diabetic drugs
P $2 deductible/prescription and $11 dispensing fee maximum
P 10% pharmacy markup fees, up to a maximum of $250
P Maintenance medications limited to 5 dispensing fees/prescription/12 months
P Diabetic supplies (reasonable and customary costs)
P Preventive vaccines
P Fertility drugs up to $12,000 lifetime maximum
2
PARAMEDICAL MEDICAL SUPPLIES AND SERVICES
($ Maximum/benefit year; reasonable and customary costs) ($ Maximum/benefit year; reasonable and customary costs)
Services must be provided by practitioners who are
Ambulance P Transport to/from nearest facility
licensed, certified or registered with the appropriate
authority in the location in which the service was provided. P Includes air ambulance
Chiropractor P Glucometers P $150/benefit year
$1,000 combined
Osteopath P Hearing aids P $1,000/5 benefit years
Massage Therapist P $1,000 (doctor’s
Orthotics P $350/benefit year
referral required)
Naturopath P $1,000 Orthopaedic P 2 pairs/benefit year
shoes (custom) P $500 maximum/year
Physiotherapist P
Athletic Therapist P $1,000 combined Orthopaedic P $500/benefit year for eligible
shoes (stock) modifications and adjustments
Occupational Therapist P
only
Podiatrist/Chiropodist P $450 combined Private duty P $50,000/benefit year
Psychologist P nursing
Psychotherapist P Surgical Stockings P 6 pairs/benefit year
Registered Family P Wigs P $500 lifetime maximum
Therapist $1,500 combined
Registered Social Worker P
Clinical counsellor P DENTAL INSURANCE
Psychoanalyst P Fee guide P Previous year’s fee guide for
general practitioners for province
Speech-Language P
of dental practice
Pathologist
Basic Dental P 100% of check-ups, X-rays, fillings,
Communicative P $1,000 combined other
Disorders Assistants Recall exams: once every 9 months
P
Audiologist P for adults, 6 months for children
under 19
Full exams and X-rays once every
P
24 months
VISION CARE
Periodontic/ P 100% of root canals and related
P Glasses, contact lenses and laser eye surgery services
Endodontic
P $500 maximum/2 benefit years (1 benefit year services P 100% of scaling, root planing, gum
for children under 18) treatments, etc.
P Eye exam once every 2 benefit years; included 10 units of scaling and root planing
P
within overall $500 vision care maximum combined/benefit year
Major P 60% of crowns, bridges, dentures,
restorative inlays, onlays
services P $2,000 maximum/benefit year
HOSPITAL Crown, onlays or denture
P Semi-private hospital room P
replacement once every 5
P Includes costs for semi-private room in private benefit years
OHIP-funded facilities Dental implant only covered at
P the lowest cost of an alternative
treatment option (e.g. crown,
bridge, denture)
TRAVEL MEDICAL (OUTSIDE OF CANADA) Orthodontics P 50% coverage for adults
Emergency medical P 100% and children
services P Up to 60 days/trip P $3,500 lifetime maximum
P $5 million lifetime Lump sum payments made in
maximum advance are not eligible
Referred medical services P 50%
not available in Canada P $3,000 maximum/ This summary of benefits is also available on the
ETFO ELHT website at www.etfo-elhtbenefits.ca.
3 calendar years
3
What you can expect to receive over the next
few weeks if you are eligible for benefits:
ENROLLING IN THE PLAN
Within 3-4 weeks of meeting your eligibility criteria, an
enrolment email from OTIP will be sent to your board email
address, inviting you to enrol in your new benefits plan. You
must complete the enrolment within 31 days of receiving
the enrolment email to avoid being denied coverage under
the plan.
If you do not receive an enrolment email within 3-4 weeks of
meeting your eligibility criteria, please contact OTIP Benefits
Services at 1-866-783-6847.
BENEFIT PREMIUMS
During enrolment, any monthly premium costs that you will IMPORTANT
be required to pay (if applicable) will be displayed online.
Your benefits coverage and any applicable member-paid If you do not complete your enrolment by
monthly premiums will be retroactive to the day your the deadline indicated in the enrolment
eligibility criteria were met. email, you will be set up with the default
For example, if you started an eligible permanent or long- coverage determined by the rules laid out
term occasional position/contract on February 4 and your in your benefits plan. The default coverage
member-paid monthly premium is $55, your total premium may be minimal, or in some cases, result in
payment in March will be $110. no coverage.
If applicable, retroactive cumulative premiums will be
You may also be considered a late applicant
deducted from your bank account 1-2 months after your
if you apply for Health and Dental benefits
enrolment. If premiums are not received, your benefits
in the future. As a late applicant, Dental
coverage will be suspended.
benefits will be subject to a $200 maximum
for your first 12 months of coverage.
YOUR BENEFITS CARD AND BOOKLET
After you have completed your enrolment: For Health benefits, proof of good health
• If you elected to participate in the Health benefits, your (evidence of insurability) will be required for
benefits card will be mailed to you. If you would like to assessment. If approved, Health benefits will
print a copy of your benefits card prior to this, please be implemented on the date of approval.
follow the instructions in the enrolment email. However, based on the assessment of the
evidence of insurability, Health benefits for
• You will be able to check out the full details of
yourself and/or your family members may
your benefits coverage by accessing your benefits booklet
be denied.
in the My Library section of OTIP’s secure member site.
Your 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 benefits enrolment and administration. You can also access and make
®
changes to your benefits and submit claims through OTIP’s secure member website. Learn
more at www.otip.com.
QUESTIONS?
You can find answers to the most commonly asked questions about the benefits plan at
www.otip.com/loginhelp. Further information about the ETFO ELHT and frequently asked
questions about the plan are available at www.etfo-elhtbenefits.ca.
If you have any questions after receiving your enrolment information, please contact OTIP
Benefits Services at 1-866-783-6847.
4 07/2023
Exclusive Perks & Promotions for OTIP Members
As a member of the Ontario education community, you make a difference. At OTIP, we exist to make
a difference in your life by helping you protect the things you care about: your family, your health,
your home, and your car.
Check out our latest contests, promotions and exclusive offers:
Wellness programs Exclusive discounts on car and
We understand that your wellness journey is uniquely your home insurance, and more!
own. You and your eligible family members can access our
wellness programs and resources, available 24/7 and 100% We’ll shop the market to find the best insurance policy that fits your
confidential. individual needs, as well as your budget. Plus get a $20 gift card
when you get a quote!
With our wellness programs, you can:
Get a quote at:
Do a self-assessment to understand your risk for mental health OTIPinsurance.com/insurancediscounts
disorders. Get started with FeelingBetterNow®. or call 1-844-291-7231
Manage stress, anxiety, burnout, and depression.
Learn how with Starling Minds. Don’t forget to mention the
gift card offer.
Get support for alcohol/substance use.
Check out ALAViDA TRAiL.
You can access these wellness
programs and resources at:
OTIP.com/OTIP-Wellness-Programs
Stay current Sweepstakes
Be the first to know about OTIP’s new contests, special offers, insurance Participate in our latest giveaway for a chance to win BIG!
news and more. Subscribe to our electronic communications!
Enter today: OTIP.com/sweepstakes
Subscribe today: OTIP.com/opt-in
Exclusive Perks & Promotions for OTIP Members
Let’s recognize and celebrate together
You can help recognize outstanding members in our education community by
nominating them for an OTIP award.
OTIP Support Staff Worker Awards
OTIP Teaching Awards
We also offer academic bursaries of $1,500 to students
attending post-secondary school in the fall.
Visit OTIP.com/Why-OTIP/Giving-Back to find out more about
these programs.
Discover Edvantage, your Retire with RTIP
exclusive savings program! RTIP offers the most flexible retiree health, dental, and travel
insurance for the Ontario education community. Learn more about
Planning a vacation or renovating your home? Looking for a break your options and transition to retirement with our free webinars,
on your phone bill? Edvantage can help you save on these and so in-person retirement workshops, and valuable online resources.
much more!
Visit OTIP.com/plan-with-RTIP
Start saving today: to learn more, register for a workshop,
Edvantage.ca/save-today or apply for a plan online.
Check out OTIP.com for additional insurance products and services.
Life Leisure Products Identity Theft Travel Self-Service Tools
09/2023
