Frequently Asked Questions
The following Frequently Asked Questions (FAQs) highlight some of the questions that members have asked regarding the new ETFO ELHT Benefits Plan. Please note that these FAQs will be updated on a regular basis as required.
Updated January 9, 2017
The ETFO provincial benefits plan will provide coverage for Long Term Occasional (LTO) Teachers based on the following eligibility criteria:
What if an LTO Teacher assignment is extended to 90 consecutive calendar days or longer? If an assignment is extended to 90 consecutive calendar days or longer, the member will be eligible to enrol in the Plan retroactively to the first day of their assignment. Standard premium contribution rules will apply. E.g. No premium contribution is required by an LTO Teacher working in a 1.0 FTE assignment of 90 consecutive calendar days or longer; an LTO Teacher working in a 0.5 FTE assignment who voluntarily opts into health and/or dental benefits will be required to pay 50% of the premium for health and dental. If premium is required, it will be retroactively assessed through payroll. Claims for eligible expenses incurred will be honoured back to the first day of the assignment. Therefore, members should be encouraged to keep their receipts if they expect their assignment may be extended. What if a 90 consecutive calendar day LTO Teacher assignment gets shortened unexpectedly? If a 90 consecutive calendar day assignment gets shortened unexpectedly then coverage will cease upon termination of the assignment. Members will not be required to repay any claims that were paid to them while coverage was in force. Will coverage continue over the summer for an LTO Teacher who works until the end of the school year?Benefits coverage will cease for an LTO assignment that ends on the last day of the school year.
Will coverage continue over the summer for an LTO Teacher who ends their assignment at the end of the school year and begins an assignment replacing the same teacher in September? For members who have been in assignments of 90 consecutive calendar days or longer which conclude at the end of the school year, benefits coverage will cease on the last day of the school year. If the new assignment replacing the same teacher in September is known to be at least 90 consecutive calendar days or longer, benefits will be reinstated in September when the new assignment begins. If an LTO Teacher with a 90 consecutive calendar day assignment or longer goes on a statutory leave (e.g. maternity, parental or WSIB), will they be eligible for benefits while on statutory leave? LTO Teachers with a 90 consecutive calendar day assignment or longer who go on a statutory leave (maternity, parental or WSIB) will be eligible for participation in the ETFO ELHT Plan until the end of their LTO assignment based upon their FTE assignment as set out in #5 above. For an LTO Teacher who ends and begins an assignment in the same school year, what happens to the record of their claims from the first assignment? LTO Teachers beginning a new 90 consecutive calendar day assignment will be notified by OTIP that they are eligible to re-enrol in the ETFO ELHT Plan. The member will be covered using the same certificate number and all claims records will remain attached to that member.
Retirees are eligible to participate in the ETFO Benefits Plan if they are:
If retirees are segregated in a separate pool under the current board plan, will they continue to be segregated under the new Plan? There have been no decisions made yet regarding the eligibility rules and enrolment process for retirees, however, the retiree plans are expected to stand on their own and will not be subsidized by the ETFO ELHT. When will retirees be transferred into the ETFO ELHT? Based on the central agreement, eligible retirees are expected to transition into the ETFO ELHT no later than August 31, 2017. When will retirees learn more information? All involved parties are evaluating current arrangements in board plans and further details will be shared once retiree eligibility and enrolment are determined. It is anticipated that more information will be available in the spring.
Your legal spouse, or a person continuously living with you in a role like that of a marriage partner for at least 12 months, is eligible. The ETFO ELHT defines eligible dependants as:
A step child must be living with the member to be eligible. A child who is incapacitated due to a mental or physical disability on the date they reach the age when they would otherwise cease to be an eligible dependant will continue to be eligible.
To make the transition as smooth as possible, OTIP is making every effort to obtain as much information from prior carriers as possible regarding banking information, coordination of benefits, dependant information, claims history, etc. However, not all information will be readily available. As ETFO members transition into the ETFO benefits Plan, members will be required to review, validate and provide updated personal information including:
If OTIP is not provided with complete information from the previous carrier, there may be some processing delays (e.g. an eligible dependant or pre-determination approval of upcoming expenses may not have been included in the transition data). Be assured, however, that OTIP will be working with the ETFO ELHT to ensure that eligible members receive the coverage they are eligible for. All members are encouraged to keep copies of any previous documentation (e.g. pre-determination approvals) related to their benefits.
During the transition window, your existing life coverage currently provided in the previous plan can be rolled over with no evidence of insurability required. For example:
When is evidence of insurability required? If you currently do not have more than the 1x salary basic life, evidence of insurability will be required.If you currently have more than the 1x salary basic life and want to add supplemental coverage and/or implement or increase your option life coverage amount, you will need to provide evidence of insurability. You will need to provide that evidence within 31 days from the transition start date of the Plan. OTIP will ensure that deadline is extended in the event that you did not receive an OTIP enrolment email or your personal information on the OTIP portal was inaccurate and resulted in the inability to select insurance.
Paramedical claims are covered up to reasonable and customary limits. Reasonable and customary (R&C) refers to the maximum allowable amount that an insurer will reimburse on a particular service or item. This is an approach by insurers to limit allowable costs for some services within a plan without providing a fixed hard cap.
For example, if the reasonable and customary cost for a service is $100 per visit and the provider bills $120 per visit, only $100 will be reimbursed.