Health Plans FAQ

1. I am currently covered under the School Board Retiree Plan for my Extended Health Care benefits.  I would like to apply for the RTO/ERO Health Plans.  When will my coverage commence?

   The RTO/ERO Extended Health Care benefits will commence the day after the termination of your previous coverage (your previous coverage can also be your spousal plan or another group insurance plan), provided you apply within 60 days of the termination.  The termination date of your previous coverage must be included on your application at the time of applying for coverage.  Note, to ensure there is no gap in your coverage, the group plan is effective the day following the termination of your other group plan regardless of when your application is received in the 60 day period.
    

2. My daughter is disabled and fully dependent on me.  Is she eligible for coverage as my dependent under the RTO/ERO Health Plans?

   Yes.  She is eligible for coverage as your dependent provided she is an unmarried person who was insured as a dependent prior to becoming functionally impaired and who is wholly dependent on you for support and maintenance within the terms of the Income Tax Act.
    

3. Will coverage be continued for my spouse and dependent children upon my death?

   Yes.  Coverage can be continued for your spouse and dependent children following your death, provided they are already enrolled at that time in the RTO/ERO Health Plans and premiums continue to be paid.
   
    

4. Can I cover my spouse and dependent(s) only?  I have full dentures and do not want dental coverage for myself.

   As the retired member is the primary participant, coverage is not available to the spouse/dependent without the member being covered.
   
    

5. I am the surviving spouse of a retired teacher who passed away.  I have remarried and would like to know if I can have my new spouse and his children enrolled into my existing RTO/ERO Health Plans coverage?

   Yes.  They can be enrolled provided they apply within the 60 day eligibility period.  The 60 day eligibility period means the new spouse and dependent children have 60 days from the date the surviving spouse remarries to apply for coverage without needing to provide medical evidence of good health.  If the new spouse and dependent children are enrolled after the 60 day eligibility period, they will be required to submit evidence of good health to the insurer for approval/declination under the RTO/ERO Semi-Private Hospital and Extended Health Care Plans, and the maximum benefit payable per person under the RTO/ERO Dental Plan during the first 12 months would be limited to $100.
   
    

6. If the maximum for a benefit is not used by one participant for a particular coverage, can that maximum be transferred to another participant who is covered under that Plan? For example, if I do not use the full $300 on my glasses can the difference be transferred to my spouse?

   No. Each eligible participant with benefit coverage is entitled to separate benefit maximums. Therefore, the claims that you submit to the RTO/ERO Health Plans are attributed to your  Plan’s maximums and the claims for your spouse and dependents are attributed to their Plan’s maximums.
   
    

7. Are my premiums tax deductible?

   You are entitled to a federal tax credit for medical expenses exceeding either 3% of your net income or $2,011, whichever is lower (2009 taxation year).  Private health-plan premiums are considered medical expenses, as are expenses not reimbursed by your private plan (such as the deductible and co-insurance).
   
    

8. I’m turning 65 this year, so I’ll be eligible for the provincial drug program.  Do I need to maintain my Extended Health Care coverage?

   Yes.  While the Ontario Drug Benefit (ODB) Program provides coverage for certain drugs, more than half of the drugs available in the Canadian market today are not covered by ODB. In addition, the RTO/ERO Extended Health Care Plan covers much more than prescription drugs.  For example:  vision care, 15 different paramedical practitioners, private duty nursing, and travel coverage (including trip cancellation and interruption/delay), just to name a few.

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