The following Frequently Asked Questions (FAQs) are based on the general guidelines of the OSSTF Benefits Plan. Keep in mind there may be some variances for members due to red circling or the benefits effective date, for example. For specific member inquiries, please contact OTIP Benefits Services at 1‑866‑783‑6847 for information to your specific situation.
Note: These FAQs will be updated on a regular basis.
Please refer to our glossary of terms for reference.
AD&D – Accidental Death and Dismemberment is provided to eligible members in an amount equaling Basic Life Insurance and Optional Member and Spousal Life Insurance Benefits. This means that if an insured member or covered spouse dies due to an accident, both the Life Insurance Benefits and AD&D benefits would be paid to the beneficiary.
ADP – Assistive Devices Program. The Assistive Devices Program (ADP) is a government sponsored plan that contributes towards the cost of customized equipment for people with long-term physical disabilities, like wheelchairs and hearing aids and specialized supplies, such as those used with ostomies.
Where an expense is ADP eligible, ADP is the first payer. Typically, the service provider will submit to ADP directly for their contribution and bill the member the balance. This allows the member to submit the portion of the cost not being reimbursed by ADP to the OSSTF Benefits Plan for consideration.
Beneficiary – The person that you name to receive a payment from your insurance policy. If you do not name a life insurance beneficiary, the payment goes to your estate.
Benefit Year – For the OSSTF Benefits Plan, a benefit year is defined as September 1st to August 31st.
Contingent Beneficiary – You can name a secondary or contingent beneficiary who would receive the benefit if there is no primary beneficiary alive when the benefit is paid.
Coordination of benefits (COB) – It’s common to have access to more than one health and dental plan in families with two working adults. The two plans may have slightly different levels of coverage and provide different service options. Under COB, insurance companies share the responsibility of paying for eligible health and dental expenses by determining which of these plans is primary and which is secondary. The primary plan considers the claim first and the unpaid balance is then considered by the secondary plan. Benefits are coordinated between the two plans to ensure that you receive reimbursement for up to 100 % of your eligible expenses. The details of the COB provisions are included in your benefits booklet on the OTIP secure member site.
Delisted Providers – Manulife is committed to protecting their clients and their members from benefits fraud and abuse. As part of this ongoing commitment, reviews of service providers are routinely conducted. If a review reveals concerns surrounding business practices and/or potential fraud, claims will no longer be processed or reimbursed for services from these providers. This is referred to as delisting. Manulife has conducted an extensive review into the business practices of the service providers listed below. As a result, they have been delisted and claims from these service providers are no longer eligible for reimbursement, effective the date indicated. You can view a detailed list of providers under My Claims on your OTIP member site.
ELHT – Employee Life and Health Trust
FTE – Full Time Equivalent, e.g. a full-time member has a 1.0 FTE, while a 2/3 member would have a .667 FTE.
Life Change Event – A change in your personal situation and/or in your coverage status.
Examples:
If a life change event occurs, you will be able to enrol in the OSSTF Benefits Plan or elect benefit selections to ensure that the plan continues to meet you and your family’s needs. You need to complete your enrolment or make changes to your benefits coverage within 31 days from the date of change. Be sure to reference the FAQ section – Change in Status for more information.
Manulife Audits – Manulife regularly audits members and providers. This is part of the claims adjudication process and ensures that expenses being claimed are eligible. From time to time members will be asked to provide further back-up or additional information after submitting a claim. This is a standard part of the audit process and is in place as one of the tools to contribute towards the long-term sustainability of the OSSTF Benefits Plan. Member compliance with these requests is a required. For specific inquiries in this regard, please contact OTIP Benefits Services at 1-866-783-6847.
Paramedical Practitioners – For a complete list 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.
Who Owns and Controls the OSSTF Benefits Plan
As negotiated in the 2015 Central Agreement, on October 6, 2016, an Agreement and Declaration of Trust (3MB PDF) 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. Learn more about Our Governance.
| Plan Role | Authority |
|---|---|
| Plan sponsor |
OSSTF Benefits is made up of a Board of Trustees. The Trustees manage and govern the OSSTF Benefits Plan in the best interests of the members. The Trustees will also make a range of plan design, funding, administrative and investment decisions on their behalf. |
| Plan administrator | OTIP (Ontario Teachers Insurance Plan) is the third-party administrator (TPA) for the OSSTF Benefits Plan.
If you have questions about enrolment, eligibility, life coverage, premium costs, benefits coverage or claims, call OTIP Benefits Services at 1-866-783-6847, Monday to Friday from 8 a.m. to 7 p.m. |
| Health & Dental Claims Payer & Life Insurance Benefits Insurer | Manulife is the health and dental claims payer for the OSSTF Benefits Plan as well as the insurer of the Life Insurance benefits.
If you have questions about your benefits coverage or claims, call OTIP Benefits Services at 1-866-783-6847 |
| Accidental death and dismemberment (AD&D) | Teachers Life is the AD&D claims payer and insurer for the OSSTF Benefits Plan.
If you have questions about your AD&D coverage, please call OTIP Benefits Services. |
Who are the OSSTF Benefits Trustees and Staff Members?
How is the OSSTF Benefits Plan funded?
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.
| Benefit | Eligible Active Member/ Eligible Member on Statutory leave |
Eligible Member on non-Statutory leave | ||||
|---|---|---|---|---|---|---|
| Member Pays | Trust Pays | Mandatory/ Voluntary | Member Pays | Trust Pays | Mandatory/ Voluntary | |
| Basic Life and Accidental Death and Dismemberment (AD&D) | 0% | 100% | Mandatory for all eligible active members regardless of their FTE level. | 100% | 0% | Voluntary |
| Optional Member and Spousal Life and AD&D | 100% | 0% | Voluntary | 100% | 0% | Voluntary |
| Optional Child Life | 100% | 0% | Voluntary | 100% | 0% | Voluntary |
| Health and Dental | 6% for 1.0 FTE eligible members. Pro-Rated for less than 1.0 FTE eligible members. | 94% for 1.0 FTE eligible members. Pro-Rated for less than 1.0 FTE eligible members. | Voluntary | 100% | 0% | Voluntary |
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:
| 1.0 FTE | 0.667 FTE | 0.5 FTE | 0.333 FTE | ||
|---|---|---|---|---|---|
| Health | Single | $7.61 | $47.32 | $67.24 | $87.16 |
| Family | $19.03 | $118.31 | $168.10 | $217.89 | |
| Dental | Single | $4.01 | $24.91 | $35.39 | $45.87 |
| Family | $10.02 | $62.27 | $88.48 | $114.68 | |
During the enrolment process, members can see the cost of their benefit selections, which will help them make informed decisions on their coverage.
If the Board does not have my email address, how will OTIP and the OSSTF Benefits communicate with me?
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:
Note: If your home mailing address is incorrect, please contact your school board.
If I am not in a 1.0 FTE assignment, what are the costs of monthly pro-rated premiums?
You can log into OTIP’s secure member site to review and validate your coverage information. Any required member contributions will also be displayed.
Note: The amounts displayed are monthly premium amounts and will apply from the eligibility date go forward. This could result in retroactive premium being owed by the member from the eligibility date go forward. You will find a breakdown of your View the illustration (173kB PDF).
Do members receive a drug card?
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.
Are paramedical claims fully covered under the OSSTF 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 1st to August 31st). 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.
Are my diabetic supplies covered?
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.
How do I submit a claim?
Claims can be submitted by:
I’m worried that my expensive medications will not be covered. Will prior authorization of drugs be required?
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:
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.
Access your medications more easily with Bayshore Pharmacy
Manulife, the insurer, has partnered with Bayshore Pharmacy Services to bring the Specialty Drug Care program (SDC) to OSSTF members. This program will help you manage your specialty medications by delivering them directly to you, providing a 24/7 pharmacy hotline, and phone support with a dedicated nurse.
Beginning September 1, 2020 all new and existing claimants starting a new specialty drug will be administered through the SDC program. This will ensure OSSTF members get access to their medications quickly and have access to the advice and support they need.
NOTE: If you are already receiving specialty drugs, you can continue to purchase as you have been. Or, if you would like to switch to the new program, please contact OTIP Benefits Services at 1-866-783-6847.
Do I have to provide a doctor’s note for massage therapy?
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.
When should I submit a pre-determination of a claim?
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.
What if I cannot take a generic form of a particular drug for medical reasons?
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.
Is there an appeal process for the OSSTF Benefits Plan?
Yes. You can view the step-by-step appeal process.
Who is eligible for participation in the OSSTF Benefits Plan?
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.
Who are eligible dependants under the OSSTF Benefits Plan?
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:
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.
Are Daily Occasional Teachers eligible for benefits in the Plan?
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.
Can a teacher in a .5 permanent contract and a .5 eligible LTO position (same person) get full benefits coverage?
If a .5 permanent teacher also has an eligible 0.5 LTO teaching assignment, the member may combine eligibility and premium share to receive full benefits coverage with a 6% member contribution towards health and dental benefits for the duration of their LTO assignment.
After the LTO assignment is complete, the permanent member can continue to participate in the health and dental benefits. The member will be responsible for paying the pro-rated premium share (i.e. 50% + 6% of the premiums for health and dental) as required by the eligibility rules for contract employees.
When will my eligibility for coverage start?
Eligible members are eligible immediately upon their start of an active eligible assignment. There is no waiting period.
Do I need to provide evidence of insurability to be eligible for the OSSTF Benefits Plan?
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.
When will eligible members receive their invitation to enrol?
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.
What if I was eligible but did not receive my invite until a later date?
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.
When will New Members receive their enrolment invite?
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.
How is this process communicated to new hires?
Boards and School Authorities have been provided with a OSSTF New Hire Letter (226kB PDF) and the OSSTF At a glance benefits (168kB 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.
Does OSSTF Benefits provide a Health Spending Account (HSA)?
Effective September 1, 2020 a one-time $1,000.00 contribution has been made to a Health Spending Account (HSA) for all eligible OSSTF Benefits Education Workers.
Eligibility is based on the member being a permanent OSSTF Education Worker on the dates that (1) the OSSTF Central Agreement for Education Workers was ratified, May 22, 2020, and (2) the implementation of the HSA benefit, September 1, 2020.
Click here for further information on the HSA.
What is a waiver of life insurance premium?
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.
I recently joined the OSSTF Benefits Plan and was receiving LTD benefits at the time. What happens to my life insurance?
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.
What if the previous life contract that I was covered under did not include waiver of life insurance premium provision? What if I missed the deadline to make application for the waiver of life insurance premium benefit? What if I was not approved for a waiver of life insurance premium under my previous plan?
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.
I was going on LTD just prior to the transition. What do I do?
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.
When will I receive the amount of life coverage available through the OSSTF Benefits Plan?
Once you have actively returned to work, you will be eligible for the amount of coverage available under the OSSTF Benefits Plan.
If I was disabled as of the transition date, am I eligible for health and dental benefits through 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:
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.
When will my information be updated?
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.
I have a permanent position that I take a personal leave from so that I can be active in a long term occasional (LTO) teaching position or a long term assignment (LTA) education worker position. What happens to my benefits?
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.
When will I be eligible to make changes to my coverage?
If you experience a life change event, you may enrol in the health and dental benefits or make changes without evidence of medical insurability. These life change events may include:
You will need to complete your enrolment or make changes within 31 days of the life change event.
Note: Eligibility requirements are based on the member being actively at work or while on a qualifying statutory leave.
What if I want to make a change to my coverage that does not coincide with a life change event?
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 change 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 change event.
Am I able to continue benefits plan coverage if I am on an approved LTD claim?
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.
I am a permanent member and participate in the OSSTF Plans Plan. If I retire in February or June, when will my OSSTF Benefit Plan end?
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.
If I am approved for an unpaid leave of absence – am I eligible to continue in the OSSTF Benefits Plan while I am on leave?
Permanent members may continue 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).
During a non-statutory leave (e.g. unpaid medical leave, extended parental leave) a member must pay 100% of the premium for a full time leave, or a pro-rated member contribution during a part time leave.
For reference here are the current premium costs for teachers and for education workers.
If I am approved for an unpaid leave of absence but have waived my benefits while on leave. When can I opt back into the benefits plan?
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.
Where premium deductions apply, are premiums being deducted from payroll? What if I’m on an unpaid leave?
Premium contributions for active members are standardly calculated by OTIP and provided to your employer/board for payroll deductions. View the illustration (173kB PDF).
Members who are in a 0.3 FTE position or less and who are enrolled in the OSSTF Benefits Plan will be billed directly by OTIP.
Members on a leave who elect to continue participation in the OSSTF Benefits Plan will be required to provide pre-authorized debit information and will be billed directly.
For newly eligible bargaining units whose members became eligible after the initial transition into the plan (i.e. benefits for the members of the newly eligible bargaining units after June 1, 2017) will be required to provide pre-authorized debit information and will be billed directly for the member portion of the premium.
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 will be billed directly.
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 1st of each year.
Members are encouraged to contact OTIP Benefits Services at 1-866-783-6847 for assistance during their leave election of benefits.
How will it work if my permanent position schedule differs by semester?
The position of the OSSTF ELHT is that if an eligible permanent member has different work schedules by semester, that employers report the members eligibility on a semester basis.
For example, if a contract teacher who is in a 0.5 FTE position and works 1.0 one semester and no duties for the other, they are eligible for participation in the OSSTF Benefits Plan for the entire school year. If the member elects to participate in the health and/or dental benefits during semester while they are working 1.0 duties, they would be responsible for paying 6% of the health and/or dental premium costs. During the semester not working, but still in the 0.5 FTE permanent position but with no active duties, the member would remain eligible for participation in the OSSTF Benefits plan but would be responsible for paying 100% of the premium.
Similarly for a contract teacher who is in a 0.5 FTE position and works .333 one semester and .667 the other, if the member elects to participate in the health and/or dental benefits while working .333 duties they would be responsible for paying 66.7% + 6% of the premium costs. If the member elects to participate during the second semester while working .667 duties, they would be responsible to pay 33.3% + 6% of the health and/or dental premium costs.
For active duties in a newly eligible position or an increase in FTE, the eligible member has 31 days from receiving the invite from OTIP to elect to participate in the health and/or dental benefits without late applicant restrictions. The member has the option of changing their coverage when there is a change in their FTE. If a member’s FTE decreases, the member can opt out of benefits, but the decrease in the members FTE does not open a new enrolment opportunity. If a member does not 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 change event. A life change 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 change event. If this 31 day deadline is not met, the member’s 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) were submitted and approved. If the evidence of insurability is approved, the coverage would be implemented on the date of approval. The evidence of insurability for members and/or their dependents could be denied.
Unless the member retires or resigns prior to the end of the school year, eligibility and member contributions for the summer months will be based on the permanent member’s status at the last day of the school year.
There is the understanding that this is being handled differently by some boards/school authorities who are reporting FTE on an annualized basis. OSSTF Benefits is working with OTIP, who is working with the boards/school authorities to have FTEs reported on a semester basis. With currently changing school schedules due to COVID-19, there is awareness that not all boards are able to accommodate the semester reporting at this time.
If you have any questions, or require assistance in this regard, please contact Donna Morrison at donna.morrison@osstfbenefits.ca.
Teachers and LTOs
Education Workers
Summer Deductions for Members on a 10-month payroll schedule
As group insurance rates are payable monthly, it is necessary for members on less than a 12 month pay schedule to have double payroll deductions made for the payment of the member contribution towards the premium for the summer months.
Is summer coverage available during the summer break?
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:
If I am Laid-Off, How Does the Election of the Continuation of My Benefits Work?
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 1st 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.
Are Permanent Members Eligible for Continuation of Benefits During a Period of Lay-Off?
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:
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:
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 1st of each year.
Members are encouraged to contact OTIP Benefits Services at 1-866-783-6847 for assistance during their leave election of benefits.
My partner and I are both OSSTF members in the same board. Can we both enrol in the OSSTF Benefits Plan and coordinate benefits between the plans?
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 change event (e.g. increase in FTE, birth/adoption of a child, marriage/common law qualification, loss of spousal benefits).
Does OSSTF Benefits have a Funding Policy?
Yes, as outlined in the OSSTF ELHT Agreement and Declaration of Trust, OSSTF benefits has adopted a Funding Policy.
What is the Purpose of the 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.
Is the Funding Policy Subject to Change?
The Funding Policy is reviewed at least annually by the OSSTF ELHT Board of Trustees.
Be sure to visit the Resources page of this website to learn more about the OSSTF Benefits Plan. Our newsletters include information on reasonable and customary limits, beneficiary designations, travel coverage, benefits fraud and much more.
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