Extended Health Care Plan

Actively managing your health is a part of a healthy lifestyle. RTO/ERO is committed to ensuring that our members and their dependents have access to the best possible health and travel coverage for their insurance dollar.  With premium rates and coverage the same for all ages, coverage for prescription drugs, educational programs, paramedical practitioners and travel for trips up to 62 days each, maintaining a healthy lifestyle just got a little bit easier.

As with all of our group plans, coverage is available to you, your spouse and your dependent children. Please see the eligibility section for details.

RTO/ERO members own and manage this group plan, regularly reviewing the coverage and rates to ensure the best value for money. RTO/ERO is a not-for-profit organization. Surpluses above and beyond reserve requirements are “refunded” to the RTO/ERO Health Plans and become part of RTO/ERO’s Health Premium Stabilization Fund.
 

There are many services aimed at making your Extended Health Care Plan coverage more convenient, including:

• Direct payment to pharmacies (drug card)
• Claim payments deposited directly to your bank account
• Electronic notification of your claim payments
• Annual Benefit Statement and Tax Letter
• Secure, online access to claims and benefit information
• Walk-in service for administration and claim services in the Greater Toronto Area

See the Extended Health Care Plan summary of benefits below or review the full Plan information document (PDF). And remember, each and every RTO/ERO District has a District Health Services and Insurance representative to assist members. That's just another way RTO/ERO is “Here for you now, Here for your future.”

Prescription Drug Benefit

• $0 annual deductible
• $2,600 annual maximum per person
• 85% reimbursement of ingredient costs
• Covers eligible drugs for all ages, including those not covered by the Provincial Drug Benefit Plan for participants and dependents age 65 and over
• The $100 Ontario Drug Benefit Program deductible is reimbursed based on 85% of ingredient costs
• Covers erectile dysfunction drugs to an annual maximum of $350 per person

Paramedical Practitioners Benefit

• 80% reimbursement
• $900 annual maximum per person (for all practitioners combined)
• Covers 15 practitioners: acupuncturists, chiropodists, chiropractors, dieticians, herbalists, homeopaths, naturopaths, nutritionists, osteopaths, physiotherapists, podiatrists, psychologists, registered massage therapists, speech therapists and shiatsu therapists
• Physician authorization is not required

Aids and Appliances Benefit

• 80% reimbursement
• Covers the purchase or repair of hearing aids up to a maximum of $1,000 overall, in any three consecutive calendar years
• Custom-made orthopaedic shoes and orthotics up to a maximum of $500 per person, in any two consecutive calendar years
• Prostheses including artificial limbs or eyes, or breast prosthesis (including two mastectomy bras per calendar year)
• Supplies including trusses, splints, braces and casts
• Medical supplies, including surgical support stockings up to an annual maximum of $300 per person, incontinence supplies up to an annual maximum of $500 per person, and post-surgical comfort and convenience items (e.g., sock reacher, shoe lacer) up to $200 per person in any two consecutive calendar years
• Mobility aids including wheelchairs, canes, walkers, and crutches

Vision Care Benefit

• 80% reimbursement
• $300 maximum per person in any two consecutive calendar years
• Covers eyeglasses, contact lenses and laser eye surgery
• Eye examinations subject to a maximum of $90 for one eye exam every two consecutive calendar years. Eligible dependent children are covered on an annual basis
• New lenses, if required due to eye surgery, are covered up to a lifetime maximum of $300 per person

Diagnostic Services Benefit

• 80% reimbursement
• Covers diagnostic services, subject to your Government Health Insurance Plan offset
• Diagnostic procedures, including PSA testing for cancer, and radiology

Private Duty Nursing Benefit

• 80% reimbursement
• Covers out-of-hospital registered nurse, registered practical nurse or licensed practical nurse up to $1,500 per insured person in any two consecutive years

Transportation/Ambulance Benefit

• 80% reimbursement
• Covers licensed ground ambulance to and from a local hospital when medically necessary for emergency treatment

Accidental Dental Benefit

• 80% reimbursement
• Covers dental treatment required directly as a result of an accidental blow to natural or artificial teeth

Educational Program Benefit

• 80% reimbursement
• Covers medically related program(s) recommended by a physician, to an annual maximum of $200 per person

Out-of-Province/Canada Travel Benefit

• 100% reimbursement
• $1,000,000 coverage for eligible medical emergency expenses per person/trip
• Covers an unlimited number of trips, each up to 62 days in duration
• Emergency expenses incurred due to an accident or sudden illness while travelling outside your province of residence/Canada
• Pre-existing medical conditions are covered, subject to a 90-day medical stability clause
• $6,000 trip cancellation and interruption/delay per person/trip