Your Questions

The OSSTF Employee Life and Health Trust(ELHT)is the sponsor of the OSSTF Benefits Plans. The OSSTF ELHT Trustees manage and govern the OSSTF Benefit Plans in the best interest of the plan beneficiaries.  The OSSTF ELHT was established in accordance with the provisions of the 2015 OSSTF Central Agreements for Teachers/Occasional Teachers and Education Workers. On October 6, 2016, an Agreement and Declaration of Trust was signed between her majesty the Queen in right of Ontario as represented by the Minister of Education(crown), Ontario Public School Boards’ Association and OSSTF. The ELHT Board of Trustees has representatives from OSSTF, the Ontario Public School Boards’ Association and the provincial government. The ELHT’s sole purpose is to provide life, health and dental benefits to eligible plan members and their families.  View the OSSTF ELHT Model here. (2MB PDF)

• Learn more about our governance structure
• Meet our OSSTF Benefits Trustees and Staff Members

See our infographic on how these parties work together to support the OSSTF ELHT Benefit Plans: OSSTF UnderstandingYourBenefits EN

Negotiated FTE (Full Time Equivalent) funding is used to fund the Basic Life and AD&D (Accidental Death and Dismemberment) premiums for eligible active members and the majority of the funding for health and dental benefits. Eligible members on a non-statutory approved leave may elect to continue to participate in the benefits plan on a 100% member-paid basis.

Basic Life and AD&D benefits are 100% funded by the OSSTF ELHT and mandatory for all eligible active members regardless of their FTE level. The plan also includes Voluntary Life Insurance and Accidental Death and Dismemberment Benefits for members and their spouses as well as child optional life benefits on a voluntary 100% member paid basis.

Participation in the health and dental benefits is voluntary. The negotiated FTE funding pays 94% of the premium for 1.0 FTE active members with the member responsible for 6% of the premium. There is an additional pro-rating of member contributions for members with a less than 1.0 FTE.

The chart below provides a summary of estimated costs for full and part-time participating members based on the rates at inception of the plan:

During the enrolment process, members can see the cost of their benefit selections, which will help them make informed decisions on their coverage.

Effective February 1st, 2024 all plan members whose benefit coverage selections require member contributions will make these payments by direct billing.

As outlined in the OSSTF ELHT 2023 Annual Report the change to direct billing of required member premium contributions for all eligible OSSTF members offers the following advantages:

• For direct billing, the calculation of the amount to be taken from the member’s bank account is done around the 3rd or 4th business day of the current month. This is at least 2 weeks later than the timing of reporting payroll deduction premium payments to boards, which makes the premium amount that is billed to the member more accurate and up to date.
• Under the current payroll deduction process, payroll schedules vary by board and bargaining unit. Some boards take deductions from one pay a month; others take pro-rated deductions from each pay of the month. Direct billing pre- authorized deductions (PAD) will take monthly member contributions on the 10th day of each month.
• 10 month pay schedules are in place for some bargaining units where members have benefit eligibility for the full 12-month basis. A process had yet to be set up each year for double payroll deductions (typically for May and June) to collect premiums for July and August. Direct bill PAD will collect monthly premiums each month annually, including the summer months.
• If a member has a status change during the period that the double deductions are being processed a retroactive reconciliation must be completed by OTIP, which results in the member owing additional premiums or being owed a premium refund. An example of this is when a member retires effective at the end of June, but the double member contributions were deducted during May and June. When the retirement is reported to OTIP, a reconciliation of the overpaid premium for July and August needs to be completed and the overpayment needs to be refunded to the member who is no longer on the board’s payroll. This will not apply under Direct Bill PAD as double deductions will no longer be taken.
• The transition between payroll deduction for active and direct bill for members on leave is confusing to members. Under direct billing PAD, members will still have the election to continue all or only some of their benefits during an approved leave of absence, and reinstatement of any suspended benefits upon their return to active duties, but the method of collecting member premium contributions will not change.
• Many times, the change from active to not active or vice versa is reported close to or past the start date of the leave, or the start date of return to active duties. This results in required retroactive status changes and a reconciliation of premium collected via payroll deduction and Direct bill PAD because of the reported change in status.
• It is essential for the Plans to be properly funded and that includes accurate, member premium payments. Direct billing PAD helps to ensure, in a timely manner, that the Plans receive the proper premium payments from members and that members are not overpaying or underpaying.

At this point in time credit card payment of member contributions towards the benefits is not available.  Alternate payment methods will continue to be investigated going forward.

During the enrolment process, if a plan member elects to participate in benefits that are partially (health and/or dental benefits) or fully (Optional Life benefits) member paid, a PAD authorization for the payment of plan member contributions from their bank account is required. Plan member contributions from the effective date of coverage will be withdrawn from the plan member’s bank account on the 10th calendar day of each month, or the next business day after the 10th of the month. Your first deduction may include retroactive premiums, depending on the timing of when the PAD information was received and processed.

If OTIP does not have your current email information on file, they will mail communications to your home address on file. Be sure to update your email address when you enrol to ensure efficient ongoing plan communications.

To view your current home and email address:

1. Go to www.otip.com and click Log in.
2. Select Health and Dental from the drop-down menu and log in.
3. After you have logged in, click My Claims.
4. My profile tab and click Update in the Address heading or Email field.

Note: If your home mailing address is incorrect, please contact your school board.

A T4A slip is a statement of benefits (e.g. Basic Life, Accidental Death and Dismemberment) which is issued to you by OTIP, the plan administrator of your OSSTF Employee Life and Health Trust Benefits Plan. Basic Life and Accidental Death and Dismemberment Benefits (AD&D) are provided for all eligible members. The premiums for this type of benefit coverage are paid for you by the OSSTF ELHT while you are an active member or on a statutory leave and as such is a taxable benefit. If premiums for Life and AD&D benefits were paid for you by the OSSTF ELHT for any period during a calendar year and are more than $25, you will be issued a T4A which reflects the amount of premiums paid and should be claimed on your tax return for that year.

NOTE:  If you are a Quebec resident, OTIP will also send you a letter with information on the health and dental premiums for Revenu Quebec’s tax requirements.

For members who received a hard copy of the T4A in previous years, a T4A tax slip will no longer be automatically mailed in February in accordance with the guidelines outlined by the Canada Revenue Agency (CRA) for T4A distribution. For eligible members, you will now receive access to a digital T4A on OTIP’s secure site from late February to May 1st each year. Once your digital T4A slip is posted, you will be able to download a copy to keep on file or print, if you wish. OTIP also directly provides the CRA with a copy of your T4A each year.

Exceptions: Plan Members will be mailed a hard copy of the T4A via Canada Post to their address on file with OTIP by the end of February for the previous year if:

• They are on leave or retired, and/or
• They do not have access to the OTIP secure member site due to termination.

To access your T4A tax slip online:

1. Go to www.otip.com and click Log in.
2. Select Health and Dental from the drop-down menu and log in.

Click Access your T4A slip.

Note:  For Quebec residents, the letter with information on the health and dental premiums for Revenu Quebec’s tax requirements will be posted with the T4A slips. For the 2023 tax year, this letter will also be sent via Canada Post for affected members residing in Quebec.  

Questions? You can find more information and frequently asked questions regarding T4As at www.otip.com/T4AFAQ. If you require assistance, please contact OTIP Benefit Services at 1-866-783-6847.

Participation in the health and dental benefits is voluntary. 1.0 FTE active Members who select health and dental benefit coverage are responsible for paying 6% of the associated premiums. There is an additional pro-rating of member required premiums for members with a less than 1.0 FTE.

You will find a breakdown of how member required premiums for health and dental coverage change according FTE here View the illustration (173kB PDF) 

Note: The amounts displayed are monthly premium amounts and will apply from the member’s eligibility date going forward. This could result in retroactive premium being owed by the member dating back to their eligibility date.

You can also log into OTIP’s secure member site to review and validate your current coverage information. Any required member contributions will also be displayed.

It is the position of the OSSTF ELHT that employers will report all eligible member’s FTE on a semester basis. If an eligible permanent contract member has selected health and/or dental coverage and their FTE work schedule is different in each semester the member required monthly premiums they pay in each semester will also be different.

For example, if a 0.5 FTE permanent contract teacher has all their assigned duties in one semester with no duties in the other, they are still eligible to participate in the OSSTF Benefit Plans for the entire school year. If the member has selected health and/or dental benefits, then during the semester they are working they would be reported as working 1.0 FTE and they would pay 6% of the health and/or dental premium costs. During the semester they are not working but remain in their 0.5 FTE permanent contract position they would be reported as working 0.0 FTE and will receive an FTE decrease event from OTIP via email where the member could elect to either continue or suspend their health and/or dental benefits. The member would be required to make this election within 31 days of receiving of receiving the email from OTIP. If the member elected to continue participation in the health and/or dental benefits, they would be required to pay 100% of the health and/or dental premium costs.  If the member chooses to suspend health and/or dental benefits, then no premiums are required. In this case, as long as the member returns to active duties for the next semester, they would receive a new enrolment event to allow for reinstatement of health and/or dental benefits provided the member completes the election within 31 days of receiving the enrolment event. If the member is unable to return to active duties, then their health and dental benefits would remain suspended.

It is also important to note that if after receiving the new enrolment event the member misses the 31-day deadline then their benefits would remain suspended, and the member would need to be actively at work and experience a new Life/Work event to be eligible for a new enrolment event. A Life/Work event includes a increase  in FTE, a newly eligible dependent, a loss of spousal coverage, etc.

Similarly, if a 0.5 FTE permanent contract teacher works 0.333 FTE in one semester followed by 0.667 FTE in the next semester, then during the semester they are working 0.333 FTE if they select health and/or dental coverage they would be responsible for paying 66.7% + 6% of the premium costs. If they choose not to participate in the health and or dental benefits during this semester then no premiums are required. In this case at the beginning of the next semester when their FTE increases to where they are now working 0.667 FTE, they would receive a new enrolment event from OTIP via email where they could now elect to participate in health and or dental benefits and pay 33.3% + 6% of the health and/or dental premium costs. The member would again be required to make this election within 31 days of receiving the email from OTIP.

For eligible Permanent contract members to continue health and/or dental benefit coverage over the entire benefit year, the member required premiums will also apply during the summer months.

Unless the member retires or resigns prior to the end of the school year, eligibility and member required premiums for the summer months will be based on the permanent contract member’s semester FTE status on the last day of the school year.

OSSTF Teacher and Education Workers with long term assignments of 90 calendar days or longer are eligible for participation in the OSSTF ELHT benefit plan for the duration of their long-term assignment. Therefore, the Board will report a member’s eligible long-term assignment FTE in conjunction with their permanent contract FTE and the total FTE will be used to determine the level of member required premiums for health and/or dental benefit coverage.

For example, in a semester where a member is working in a 0.667 FTE contract position and is assigned a 0.333 FTE long term assignment of 90 calendar days or longer, the board will be instructed to report them as working 1.0 FTE. In this case they would only pay 6% of the required premium for health and/or dental coverage for the duration of the long-term assignment. When the long-term assignment ends the member can continue their health and/or dental benefit coverage, but the level of member required premium would be based on their remaining 0.667 FTE contract position and therefore be 33.3% +6%.

Here is a snapshot of the benefits you receive as an eligible OSSTF member. For a full breakdown of benefits go to OTIP’s secure member website.

Yes, all eligible OSSTF Benefits Plan members who participate in the health benefits will receive a new pay-direct benefits card. Members who elect single coverage will be provided with one card and members who elect family coverage will be provided with two cards. Additional benefits cards can be printed online at www.otip.com.

Drug coverage for plan members and/or their eligible dependants is an important and valued part of the OSSTF ELHT benefits plan. Drugs, including preventative vaccines must be prescribed by a licensed physician or dentist and be dispensed by a licensed pharmacist to be eligible for coverage. Over the counter medicines that do not require a prescription and are not dispensed by a pharmacist are not eligible for coverage. For example, commencing April 1, 2024, Dukarol which is a preventive over the counter oral vaccine, and available for purchase by members without a prescription will not be eligible for reimbursement under the OSSTF ELHT benefits plan.

For a list of types of eligible paramedical practitioners, please refer to your benefits booklet on the OTIP secure member site. Eligible expenses are for the actual services of an eligible licensed paramedical practitioner and not for items dispensed and/or additional testing completed.

Paramedical claims for the eligible practitioners are covered up to reasonable and customary (R&C) limits and up to the specified maximums indicated in the benefit booklet per benefit year (September 1^st to August 31^st). 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. For more information, read our newsletter on Understanding Reasonable and Customary limits.

Largely, diabetic supplies and equipment are eligible under the OSSTF Benefits Plan. Some supplies require a doctor’s recommendation. It is recommended that you contact OTIP Benefits Services at 1-866-783-6847 to inquire about eligibility in advance of making a purchase.

Claims can be submitted by:

• The service provider (e.g. pharmacist, dentist, paramedical practitioner, etc.)
• Using My Claims
• Completing the Extended Health Benefits Claim Form (776kB PDF) and mailing it OTIP Health Claims
• Completing the Standard Dental Claim Form (691kB PDF) and mailing it to OTIP Health Claims
• Completing the Out-of-Province Claim Form (710kB PDF) and mailing it to OTIP Health Claims

Most drugs that are not “over the counter” are covered under the OSSTF Benefits Plan. Some drugs may require completion of a FACETs Authorization Form. NOTE: Completion of this form is not a guarantee of approval.

How to access the OTIP Drug Prior Authorization Program

If you or a family member covered under the OSSTF Benefits plan, need to seek approval for a specialty drug under the OSSTF ELHT Benefits Plan, simply follow the steps below:

1. Log in to Health and Dental at www.otip.com.
2. Under My Library, open the Resources tab.
3. Click on the Drug Prior Authorization Form link.
4. Click on Find my form.
5. Select OSSTF Employee Life and Health Trust Benefits Plan.
6. Search for the most applicable form based on your medication name.
7. Fill out the form with your physician and send to FACET using the contact information outlined on the form.

The OTIP Drug Prior Authorization Program website can also be accessed directly by both members and physicians at pa.otip.com.

If you are unsure about whether a medication requires prior authorization, use the Drug Lookup Tool in My Claims to search for the name of your medication. The Drug Lookup Tool will provide details on whether the medication is immediately covered by your plan or if it requires prior authorization.

If all of the information required by the FACET team is provided, a decision about the coverage of a drug requiring prior authorization will be made within two business days. Where additional information may be required, a decision will be made within five business days 99% of the time.

Once the prior authorization decision has been made, you and your physician will be notified by the FACET team and provided with the specific rationale used to make the final decision.

More information about the program can be found in the FAQ section of the OTIP Prior Authorization Program website.

MemberRx

The OSSTF Employee Life and Health Trust (OSSTF ELHT) has designated MemberRx as the exclusive pharmacy distributor for certain high-cost specialty medications. This means that certain specialty drugs will only be covered under your OSSTF ELHT benefits plan if they are dispensed to you by MemberRx. 

• If you or your eligible dependant(s) require one of these specialty drugs, your prescriptions will be sent directly to MemberRx through the FACET Prior Authorization program.

Through the MemberRx pharmacy model, expensive pharmacy and specialty medication costs will be minimized which will help in supporting the sustainability of the OSSTF ELHT benefits plan so that the OSSTF ELHT can continue to provide the best coverage for the specialty medications that plan members and their eligible family members need, at the best value. 

Questions?

• To learn more about MemberRx, visit www.memberrx.ca

A doctor’s note is required for massage therapy each 12 months. When you submit your massage claim online via My Claims, you will be required to check a box stating that you have obtained a doctor’s note for massage therapy. You are required to keep the doctor’s note in your personal files, in case your claim is subject to an audit by Manulife.

To avoid large out-of-pocket expenses that may not be covered by the OSSTF Benefits Plan, we recommend that you submit a pre-determination to OTIP prior to the expenses being incurred. Please contact OTIP Benefits Services at 1‑866‑783‑6847 for more details.

The OSSTF Benefits Plan has a mandatory generic requirement.

If you or your dependant cannot take a generic drug because of an adverse reaction or therapeutic failure, you can request your physician to complete the Request for Approval of Brand-Name Drug Form (689kB PDF) and submit it to OTIP Health Claims for review.

This form is also available at wwww.otip.com/forms.

NOTE: Completion of this form is not a guarantee of approval.

Yes. The Appeal Process is designed to allow a member to seek further clarification when their benefit claim has been partially or totally declined and they are unclear about or disagree with the reason for the claim denial. In the initial claim adjudication and at every step of the Appeal process the claim is reviewed and a decision to approve or decline coverage is reached based on whether it is an eligible expense according to the provisions (i.e.plan design) of the benefit contract. You can view the step-by-step appeal process (150kB PDF) here.

There is no process for a member to request coverage on an exception basis for an expense that is not eligible for coverage according to provisions of the benefit contracts. The benefit contract outlines the types of drugs, services and supplies that are eligible for coverage and available to all eligible members of the benefit plan. It ensures that all members are treated in a fair, consistent and equitable fashion. To provide coverage for a drug, service or supply which is not listed as an eligible expense in the contract for one member could subject the OSSTF ELHT Board to accusations of discrimination when another request is declined. The OSSTF ELHT board is responsible for operating the OSSTF Benefits Plan and ensuring its financial sustainability. Adhering to the benefit plan contract provisions also allows the OSSTF ELHT Board to determine the cost of running the benefit plan and therefore its future sustainability.

The only way to provide coverage for new drugs, services or supplies not currently eligible for coverage would be to amend the benefit plan designs such that all eligible members of the benefit plans would have access to the new type of coverage.

The OSSTF ELHT Board has a Funding and Plan Design Modelling and Compliance Committee which meets approximately 3-4 times a year to look at current plan costs, funding and to review plan design. The OSSTF Benefits Advisory Workgroup also meets at least twice a year and serves to provide input to the Committee in this regard. All members will be informed when any plan design changes are implemented by the OSSTF ELHT.

• Contract Teachers and Education Workers
• Eligible Long Term Occasional (LTO) Teachers who have an assignment of 90 calendar days or longer
• Eligible Adult Day Teachers who have an assignment of 90 calendar days or longer
• Eligible Long Term Assignment Education Workers who have an assignment of 90 calendar days or longer

Retirees: Eligible retirees will be eligible to participate in the OSSTF Benefits Plan if they are were covered in a board-owned retiree plan at the transition date for active members of their bargaining unit into the OSSTF Benefits Plan and still have coverage in a board-owned retiree plan.

The transition of the coverage for eligible retirees into the OSSTF Benefits Plan is being worked on. All involved parties are evaluating current arrangements in board plans and details will be shared once further information is available.

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.

Your natural or adopted child, stepchild, or foster child, who is:

• Unmarried;
• Under age 21, or under age 25 if a full-time student;
• Not employed on a full-time basis; and
• Not eligible for coverage as a member under this or any other Group Benefit Program.

A step child must be living with you 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.

Life events such as the birth of a child, marriage and common law must be reported within 31 days of the event, otherwise may be subject to late applicant restrictions. Please refer to the FAQ section – Change in Status for more information.

Daily Occasional Teachers are not eligible to participate in the OSSTF Benefits Plan. OTIP currently provides an OCM (Occasional Casual Member) plan which provides optional benefits plan that Daily Occasional Teachers may be eligible to elect to pay and participate in if they wish. For more information, please contact OTIP Benefits Services at 1-866-783-6847.

Eligible members are eligible immediately upon their start of an active eligible assignment. There is no waiting period.

All eligible OSSTF members and their eligible dependants were invited to enrol in the OSSTF Benefits Plan without medical evidence of insurability for Basic Life & AD&D, Optional Dependent Life, and Health and Dental benefits provided the enrolment process was completed within 31 days from the date that they receive the invitation to enrol.

For member Optional Life the first $10,000 of coverage is available without medical evidence of insurability if applied for within the first 31 days of eligibility. Enrolment in all other member and spousal optional life is subject to approval of evidence of insurability before going into effect.

The Boards are responsible for providing Human Resource Information System (HRIS) data to OTIP on a regular basis that will identify when a member is eligible to enrol in the plan or if there are eligibility changes. Once the Board provides this information to OTIP, eligible members will be notified by OTIP when they are eligible to enrol for benefits coverage in the OSSTF Benefits Plan. OTIP will send an email to the member’s Board email address and the member will be required to log in to the OTIP’s secure website to complete their enrolment online within 31 days of the date that they received the invite. If the member does not complete their enrolment within the specified time, new health care coverage and/or coverage changes will be subject to approval by the insurer along with any required new proof of good health and dental coverage would be subject to a $200 maximum in the first 12 months of coverage.

OTIP is working with the Boards to get the member data on a regular basis. Once the member data has been received by OTIP, an invitation to enrol will be sent to eligible members as soon as possible.

You will always have 31 days from the date that you receive your invitation to complete your enrolment.

The effective date of the coverage will always be the same as the eligibility date. Therefore, eligible claims incurred on or after the eligibility date will be honoured once the enrolment is complete. It also means that you will be responsible for any member portion of the health and dental premium retroactive to the eligibility/effective date.

OTIP is working with the Boards/School Authorities to obtain data on new hires as soon as their employment status is known. Once OTIP receives the data, they will load the data into the OSSTF Benefits Administration System which will prompt an enrolment invite being sent to the member. Members will have 31 days from the date of this enrolment event email being sent to make their coverage elections.

Boards and School Authorities have been provided with a OSSTF New Hire Letter (226kB PDF) and the OSSTF At a glance benefits (6MB PDF) that they are encouraged to pass on to new hires. New members are encouraged to access these documents for their enrolment questions, or to call OTIP Benefits Services at 1-877-783-6847 if they do not receive their enrolment invite or if they need assistance in the enrolment process.

The waiver of life insurance premium is provided to ensure that the amount of life coverage you had when you became disabled can be maintained (even if there are changes in your plan), at no cost to you. Essentially, the insurance company will “lock-in” your life coverage and forgo future premiums while you are disabled–even if the policy is terminated or a change in insurance carrier takes place. The disability waiver feature differs from company to company, but typically expires at the earlier of recovery or age 65. The waiver of life insurance premium terminates when you no longer meet the terms of the contract including the definition of disability, termination age, etc.

Eligible Long Term Occasional Teachers or Long Term Assignment Education Workers are not eligible for the waiver of life insurance premium.

If you filed a claim and were approved for a waiver of life insurance premium under your previous plan, your life insurance will continue to be provided by your previous plan at no cost to you, as long as you continue to be eligible based on the terms of the previous contract. As life insurance is being maintained under the previous plan, you will see that both your salary and your life insurance amounts under the provincial plan are set at zero (0) dollars.

The OSSTF Benefits Life Insurance Contract requires that you must be actively at work for benefits coverage to become effective. If you were not actively at work on the date your coverage would normally become effective, your coverage will take effect the day you are actively at work.

However, if you were not approved for a waiver of life insurance premium under your previous plan, and you or your Board maintained your life insurance coverage while you were disabled on a premium-paying basis, the amount of life coverage that you had with the previous carrier will be provided under the OSSTF Benefits Plan.

If your date of disability is prior to the transition date, we encourage you to apply for a waiver of life insurance premium under your previous plan. There may be a deadline to apply for this benefit and we recommend that you contact your previous carrier as soon as possible to ensure your life coverage can be maintained at no cost to you.

Once you have actively returned to work, you will be eligible for the amount of coverage available under the OSSTF Benefits Plan.

If you were participating in the health and/or dental benefits as of the transition date, you are eligible for the continuation of benefits. Standard eligibility rules in the OSSTF Benefits Plan for the first 24 months of an LTD claim includes:

• Members are eligible for the same level of benefits funding as an active member (i.e. a 1.0 FTE disabled member would be responsible for 6% of the health and dental premium).
• Member contribution for disabled members with less than 1.0 FTE is pro-rated.
• After the first 24 months, eligible members can choose to continue benefits coverage (premiums are 100% member-paid).
• Standard termination rules apply (i.e. benefits would terminate at retirement).

If you are a disabled member who did not participate in the health and/or dental benefits prior to the start date of your LTD claim, you will not be eligible for enrolment in these benefits until you have actively returned to work.

OTIP continues to validate information and process updates for all members on LTD. While we update your information should you have any questions, please email OTIP at OTIP_onLeave_Contact@otip.com or contact OTIP Benefits Services at 1‑866‑783‑6847.

If you have questions with your life coverage provided under the waiver of life insurance premium provision with the previous carrier, please contact them directly or your benefits administrator.

When you are approved for a leave from your permanent position, you are eligible to continue all or some of the benefits that are available as an active member; but, on a 100% member paid basis.  When OTIP receives notification from your board of the approved personal leave, it will be loaded into the system and you will receive a leave election communication from OTIP.  You have 31 days from receipt of this communication to make your elections to continue all or some of the benefits.  The monthly premium amounts that will apply are indicated when you are making this election.  

Members on an approved leave who elect to continue participation in the OSSTF Benefits Plan will be required to provide pre-authorized debit information and authorization and will be billed directly.  

If at any point during the leave from your permanent position you commence an LTO or LTA position that meets the eligibility requirements of the OSSTF Benefits Plan for assignments that are 90 calendar days or longer, you will be eligible for funding towards the benefits for the duration of the LTO or LTA position.  The member contributions will be based on the full time equivalent (FTE) status of your LTO or LTA assignment.

When the board reports the eligible LTO or LTA position to OTIP, you will receive a benefits election opportunity by email.  You will have 31 days from the event effective date to make your elections for benefits without restrictions.  The coverage elections will remain in force for the duration of the assignment.  

Member contributions are illustrated here:  View the illustration (173kB PDF)

Your benefit eligibility for the LTO or LTA position will cease at the end of the assignment.  If you remain on leave from your permanent position, you will have the opportunity to continue benefits on a 100% member paid basis for the remainder of the leave period.  

Upon your return to active duties of your permanent position you will be eligible for reinstatement of your benefits if you did not continue them during the leave period.  It is important to note that you must return to active duties in order to be eligible for the reinstatement of benefits that were not continued during a leave period.

If you experience a Life/Work event, you may enrol in the health and dental benefits or make changes without evidence of medical insurability. These Life/Work events may include:

• increase in FTE
• birth/adoption of a child
• marriage/common law qualification
• loss of spousal benefits

You will need to complete your enrolment or make changes within 31 days of the Life/Work event.

Note: Eligibility requirements are based on the member being actively at work or while on a qualifying statutory leave.

Newsletter – Life events and your benefits coverage

As Basic Life Insurance and Accidental Death and Dismemberment coverage is mandatory for all eligible members this coverage is automatically in place effective the date of member eligibility once OTIP receives the HRIS data from the employer.

As participation in the health and dental benefits is voluntary, if a member does not elect to participate in the plan within 31 days of receiving their initial invite but wishes to join the plan at a later date without a Life/Work event taking place, they will be considered a late applicant. This means that dental benefits will be subject to a $200 maximum in the first 12 months of coverage, and that Extended Health Care benefit would have to be applied for with evidence of insurability. The Health Care coverage will not be in place until the evidence of insurability is approved, and the coverage could be denied.

Note: These “late applicant” rules also apply to eligible dependants if application is not made within 31 days of initial eligibility or an eligible Life/Work event.

Yes, eligible permanent members who are a currently approved LTD claimant or a new LTD claimant who is approved for LTD benefits after transition into the ELHT program who were participating in health and/or dental benefits prior to becoming disabled are eligible to continue their coverage. For eligible permanent members on an approved LTD leave, the ELHT will cover the cost of benefits premiums at the same level of premium that the member was paying as an active member (i.e. 6% for a 1.0 FTE member, and pro-rated for less than 1.0 FTE members) for the earlier of the first 24 months of the claim or until the member’s LTD claim is closed. If the LTD leave continues beyond 24 months, a member may continue coverage on a 100% member paid basis.

Benefits terminate at 11:59 p.m. the day an eligible member retires or resigns.

For example, if you retire or resign on February 1st, your benefits would terminate at 11:59 p.m. on February 1. If a you retire or resign on June 28, your benefits would terminate at 11:59 p.m. on June 28. If you retire or resign on August 31, your benefits would terminate at 11:59 p.m. on August 31, etc.

Eligible permanent contract members may continue benefit coverage that is in force prior to the leave of absence.

During a statutory leave such as maternity/parental leave, members will pay for health and dental benefits on the same basis as they did as active, i.e. FTE pro-rated basis (e.g. if a member is 1.0 FTE the member will pay 6% of the health and dental premium; if a member is 0.5 FTE the member will pay 50% + 6% of the health and dental premium). These premiums will be deducted from the member’s bank account by direct billing. Basic life and Accidental Death and Dismemberment premiums will continue to be paid by the OSSTF ELHT.

Eligible members on non-statutory approved leave may choose to continue their participation in Basic Life and Accidental Death and dismemberment (AD&D), Health and Dental benefits, Optional member and Spousal Life and AD&D and Optional Child life by paying 100% of the associated premiums by direct billing from their bank account.

For reference here are the current premium costs for teachers and for education workers.

Note:  These rates are subject to change at any time.  Most often rates change at renewal, which is scheduled for September 1^st of each year.

Members are encouraged to contact OTIP Benefits Services at 1-866-783-6847 for assistance during their leave election of benefits.

If an eligible member is currently on a leave of absence and has waived their benefits for the duration of their leave, they will be eligible to enrol when they actively return to work. You will have 31 days after your return date to reinstate your benefits without medical evidence of insurability.

For active duties in a newly eligible position or an increase in FTE, the eligible member has 31 days from receiving the enrolment invite from OTIP to elect to participate in the health and/or dental benefits without late applicant restrictions. The enrolment invite will be sent to the member’s board email address, unless the member had previously indicated an alternate preferred email address on the OTIP Administration System. If a member does not elect to participate in the health and/or dental benefits within 31 days of receiving the invite for a newly eligible position or an increase in FTE, a new enrolment opportunity will not be available until there is a new Life/Work event. A Life/Work event includes an increase in FTE, a newly eligible dependent, a loss of spousal coverage, etc.  New application would have to be made within 31 days of the Life/Work event.  If this 31-day deadline is not met, the member’s future application for participation in the health and/or dental benefits would be processed as a late applicant. As a late applicant dental coverage is subject to a maximum of $200 for the first 12 months of coverage and health care coverage would only be implemented if evidence of insurability (statement of health) for the member and/or their dependents is submitted and approved. For members and/or dependents whose evidence of insurability is approved, the coverage would be implemented on the date of approval. For members and/or dependents whose evidence of insurability is declined health coverage will not be implemented.

If a member has selected health and/or dental coverage and their FTE decreases, they will receive an FTE decrease notice from OTIP. In this case, the member can elect to continue with their current Health and/or Dental benefit coverage or opt out of either or both. The decrease in the members FTE does not open a new enrolment opportunity.

If you have any questions, or require assistance in this regard, please contact Donna Morrison at donna.morrison@osstfbenefits.ca or Dayle Whittaker at dayle.whittaker@osstfbenefits.ca.

• For LTO members who are eligible for participation in the OSSTF Benefits Plan, their coverage will terminate at the end of their LTO assignment. LTO members are not eligible for coverage over the summer months.
• For permanent teachers, as long as their employment status does not change, they are eligible for continued coverage over the summer months, with no change to the member contribution for July and August.
• For permanent teachers who are laid off at the end of this school year, benefit eligibility and funding continue for July and August. Commencing at the beginning of the new school year, members on a recall list are eligible to continue to participate in the plan on a 100% member paid basis for up to 24 months. Members on permanent lay off are eligible to continue to participate in the plan on a 100% member paid basis for up to 6 months.
• For members who retire or terminate their employment, coverage will cease at the date of their retirement or resignation. For example, if the retirement or resignation date is June 28th, coverage will cease as of midnight on this date and will not continue over the summer months.

• Eligible OSSTF Education Workers on a temporary long term assignment of 90 days or longer are eligible for participation in the OSSTF ELHT for the duration of their assignment and coverage will terminate at the end of their temporary Long Term Assignment. LTA members are not eligible for coverage over the summer months unless their assignment continues over the summer months.
• For permanent Education Workers who are laid off at the end of this school year (i.e. after summer lay off) benefit eligibility and funding continues until August 31. Commencing September 1, members on a recall list are eligible to continue to participate in the plan on a 100% member paid basis for up to 24 months. Members on permanent lay off are eligible to continue to participate in the plan on a 100% member paid basis for up to 6 months.
• For members who retire or terminate their employment, coverage will cease at the date of their retirement or resignation. For example, if the retirement or resignation date is June 28th, coverage will cease as of midnight on this date and will not continue over the summer months.

Permanent members not working during the summer continue to be eligible for coverage and are responsible for the same level of member contribution that they paid in June.

This does not apply to:

• Long Term Occasional Teachers
• Long Term Assignment Education Workers unless their assignment of 90 calendar days or longer includes active duties in the summer months 
• Members who are retiring or terminating their employment prior to the summer break.

Upon receiving notice of lay-off from the board, OTIP will suspend the benefits as of the lay-off date and send the member a benefits election where the member can elect to either continue benefits or have them suspended until return to active duties.

Members can elect participation in all of the benefits that they were covered for as active, or they can elect to participate in only one or more of the benefits.

If the member elects to continue benefits, the member will be asked for banking information, so that the monthly premium towards the benefits will be withdrawn directly from the member’s bank account.

The election for the continuation of benefits must be completed within 31 days of receiving the benefits election from OTIP.  If this 31 day deadline is missed benefits remain suspended.  If benefits are suspended, either due to the missed enrolment opportunity, or at the member’s specific election, they cannot be reinstated until the member returns to active duties.

For reference here are the current premium costs for teachers and for education workers.

Note:  These rates are subject to change at any time.  Most often rates change at renewal, which is scheduled for September 1^st of each year.

Members are encouraged to contact OTIP Benefits Services at 1-866-783-6847 for assistance during their lay-off election of benefits.

Answer:

OSSTF Benefits has been set up to allow that permanent members, whose positions are made redundant, are eligible to continue their benefits on a 100% member paid basis.  This includes the Life Insurance and AD&D (Accidental Death and Dismemberment) Benefits as well as the Health and Dental Benefits at the same level that they were covered for as an active member.

Members can elect participation in all of the benefits that they were covered for as active, or they can elect to participate in only one or more of the benefits.

For example, if a member is participating in all benefits as active, they can elect to continue:

• Life and AD&D only, and suspend health and dental, or
• Health benefits only and suspend the life insurance and AD&D and dental benefits, or
• Any other variance on benefits that they were participating in while active.
• This applies to the Optional Member Life & AD&D as well as the Optional Spousal Life & AD&D benefits, or Dependent Child Life Insurance Benefits, i.e. they can be continued on a 100% member paid basis or suspended.

If a member elects for the suspension of one or all of their benefits, they are eligible for reinstatement of these benefits without restrictions or evidence of insurability upon their return to active duties.  If they do not return to active duties, then benefits cannot be reinstated.

The maximum time duration for benefits to be continued during a lay-off is:

• Up to a maximum of 24 months from the lay-off date for a member who is on a recall list.
• Up to a maximum of 6 months from the lay-off date for a member who is indefinitely laid off and not on the recall list.

Note:  The 24 month and 6 month maximum coverage periods cannot be combined.

For reference here are the current premium costs for teachers and for education workers.

Note:  These rates are subject to change at any time.  Most often rates change at renewal, which is scheduled for September 1^st of each year.

Members are encouraged to contact OTIP Benefits Services at 1-866-783-6847 for assistance during their leave election of benefits.

Yes, under the OSSTF Benefits Plan, you are both eligible to enrol and list each other as dependants; thereby, you will have the ability to coordinate claims between both plans.

NOTE: Since health and dental is voluntary coverage, members can choose to opt out of the plan. If you opt out of the coverage, the only way to be eligible for re-enrolment without restrictions is to do so within 31 days of a Life/Work event (e.g. increase in FTE, birth/adoption of a child, marriage/common law qualification, loss of spousal benefits).

Yes, as outlined in the OSSTF ELHT Agreement and Declaration of Trust, OSSTF benefits has adopted a Funding Policy.

The Funding Policy outlines the framework for the prudent long-term financial management of the Trust. The purpose is to guide the Trustees’ decision-making process in regard to the Trust’s funded status so as to achieve the Trust’s primary goal that its assets and expected contributions to the Trust are sufficient to meet obligations as they fall due.

The Funding Policy is reviewed at least annually by the OSSTF ELHT Board of Trustees.