Boards and School Authorities have been provided with a OSSTF New Hire Letter (226kB PDF) and the OSSTF Benefits at a glance (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.
In families with two working adults, it is common to have access to more than one health plan. There may be some overlap in the types of benefits and/or services they cover.
Co-ordination of benefits is how insurance companies co-ordinate benefits and claim payments when you have coverage under more than one group health plan. This procedure, set out by the Canadian Life and Health Insurance Association (CLHIA), establishes which plan pays first and how benefits are calculated when a person makes a claim to more than one group plan, either as a member or as a dependant (spouse or child).
How does co-ordination of benefits help you and your plan?
By co-ordinating your plans together:
Ready to co-ordinate your benefits plans?
For more information on co-ordination of benefits, you can check out:
You can now check to see what specific brands and models of orthopaedic shoes may be covered by your OSSTF Benefits Plan. To see this list, log in to My Claims.
Before you purchase orthopaedic shoes:
The list is available in English only.
As we approach the end of the year, please be mindful of some service providers’ marketing campaign to ‘use it or lose it’. These campaigns are designed to serve the providers who promote them, however using benefits that are not medically necessary does not serve to protect the overall health of your plan.
Benefits like massage therapy and orthotics have balances that reset every benefit year to ensure proper care as necessary for plan members and their families. However, if it is not medically necessary, maximizing all of your benefits will negatively impact the long-term sustainability of the benefits plan, and may affect everyone’s ability to access necessary benefits in the future. Therefore, your responsible use of the plan is in the best interests of yourself, your family and fellow plan members.
To help manage the costs associated with prescription drugs, the OSSTF Benefits Plan includes mandatory generic substitution.
With a mandatory generic drug plan, any prescribed drug cost cannot exceed the price of the lower cost alternative drug, which is typically a “generic” drug.
*Reasonable and customary will be applied to the eligible amount
Here’s an example1 of how mandatory generic substitution works:
|1Examples and pricing are based on the Ontario
market and provided by My drug plan tool. Prices
are estimates only, regional differences may vary,
and include some drug mark-ups. If you are
eligible for a dispensing fee, it will be included in
the drug cost shown in My drug plan.2As per your benefits plan, you are reimbursed for
the lowest cost alternative (generic drug).
When filling a prescription – speak up!
In many provinces, pharmacists will automatically dispense the generic alternative as part of their standard practice unless the prescribing doctor has indicated that “no substitutions” should be made. If your doctor has indicated “no substitution,” you can ask your pharmacist to dispense the generic drug – or you can accept the brand-name drug, and pay the price difference between the brand-name and the generic drugs.
If you share in either the cost of your plan or the cost of your prescription, switching to generics may help you and your plan save some money!
Use My drug plan to look for generic drug options
My drug plan is a user-friendly, drug lookup tool (found in My Claims quick links). It can help you to manage your drug costs especially because you have a mandatory generic drug plan. You can find out if a generic drug is available or if prior authorization is needed. A drug library is also right at your fingertips.
In some instances, you may experience an adverse reaction to the generic drug, or it is therapeutically ineffective. When this happens, medical evidence can be submitted to support why the brand-name drug is being prescribed. To get approved for a brand-name drug, you need to complete the Request for Approval of Brand-Name Drug form, have it signed by your doctor and return it to the address on the form. If approved, you will be paid back* the cost of the brand-name drug.
*Before you get any money back, reasonable and customary limitations, coinsurance\reimbursement, deductibles and/or maximums apply as per the terms and conditions in each plan (refer to your benefits booklet).
Myth: Brand-name drugs are safer and more effective than generic drugs.
Fact: Generic drugs are every bit as safe and effective as brand-name drugs. In fact, they are equivalent to the brand version in dosage, safety, strength, quality, the way they work and the way they’re taken.
Brand-name and generic drugs have one important thing in common: they’re designed to heal us or make us feel better. And one of the big differences between these drugs is the cost. To help manage drug costs while ensuring you and your family have access to appropriate drug therapy, your benefits plan includes mandatory generic substitution.
What is a generic drug?
Generics are similar, not identical, to brand-name drugs.
When a new drug is developed, found to be safe and effective, and finally approved, it’s usually patented. The patent protects the new drug from being copied for a period of 20 years. The new drug is marketed and sold only by the pharmaceutical company that developed it. When the patent-protected period ends, other companies can produce and sell the same drug as generic equivalents. Because the brand-name drug has already been proven, companies can save research and development costs and afford to charge less for the generic drug.
There may be many generic versions of the brand-name drug. Next time you are prescribed a drug by your doctor or visit your pharmacist to fill a prescription, consider asking the following questions:
Win-win situation: Your plan and generic drugs
With mandatory generic substitution in your drug plan, any prescribed drug cost cannot be more than the price of the lower cost alternative drug (generic drug).
In some instances, you may experience an adverse reaction to the generic drug, or it is therapeutically ineffective. When this happens, medical evidence can be submitted to support why the brand-name drug is being prescribed. To get approved for a brand-name drug, you need to complete the Request for Approval of Brand-Name Drug form (www.otip.com/forms), have it signed by your doctor and return it to the address on the form. If approved, you will be paid back the cost of the brand-name drug.
Check your benefits booklet to learn more about your drug coverage or call OTIP Benefits Services at 1- 866-783-6847.
The Safety and Effectives of Generic Drugs, Government of Canada, https://www.canada.ca/en/healthcanada/services/healthy-living/your-health/medical-information/safety-effectiveness-generic-drugs.html, 2012
To ensure you get a suitable custom-made orthotic, it’s important to ask questions and keep yourself informed throughout the purchasing process.
Under the OSSTF Benefits Plan, your coverage for casted, customer-made orthotics is: up to a maximum of $750 per plan year (an approved diagnosis from either a physician or a podiatrist/chiropodist is required.) The plan year is September to August.
Custom-made orthotics are prescribed by specific health-care professionals, which include physicians, podiatrists and chiropodists. They will diagnose whether or not an orthotic would be beneficial to your situation. The prescribers and providers are licensed and governed by either a provincial or national body, and are subject to standards of practice. This, along with each body’s Code of Ethics, helps ensure their accountability and your protection.
For all Canadian provinces, except Quebec*, podiatrists, chiropodists, pedorthists are recognized as foot care specialists.
After being prescribed an orthotic, you’ll need to visit one of the providers listed above for an assessment. A provider will guide you through an extensive evaluation to ensure an orthotic is the best option and that it’s properly designed. You should expect the orthotic provider to perform the following:
Medical history review: A complete investigation and documentation of your medical history, symptoms and previous injuries. The provider will also take into consideration your lifestyle (occupation and activities) as well as your current and past footwear (fit, style, wear and pattern).
Examination: A hands-on evaluation of the lower limbs including foot structure, alignment, strength, range of motion, soft-tissue damage as well as identifying any abnormalities.
Gait analysis: The provider will observe you walking to identify accommodations or abnormalities (e.g. whether you favour one leg or the other).
Orthotic evaluation: The provider will determine treatment options and explain how the treatments will address your specific needs.
Casting: A proper cast is essential to create a truly custom-made orthotic as it ensures that your orthotic is made with all of the contours and structure of your foot. Casting techniques include: foam box casting, plaster of paris slipper casting, contact digitizing and laser scanning.
Manufacturing: For an orthotic to be claimed under your benefits plan, it must be constructed from scratch and fabricated directly from your mould. You can expect at least one week between your initial assessment and your fitting appointments. Orthotics that are not manufactured specifically to your needs can result in pain by overstressing your muscles, bones and joints.
Dispensing: Custom-made orthotics should be fitted specifically for you and your footwear. The provider should evaluate how you walk while wearing the orthotics. You should also be offered a follow-up appointment within 2-6 weeks of receiving your orthotics.
Education: The provider should educate you on things like breaking in your new orthotics, lifespan, and how they should fit. You should also be made aware of any warning signs that the orthotics are not working properly and instructed to return if you experience any problems.
Please note that some of the examples listed above may not pertain to your benefits plan. Consult your benefits booklet for details.
*For the province of Quebec a foot orthotist or an orthotist prosthetist working in a laboratory accredited by the Québec Ministry of Health and Social Services and who is a member of the Order of Professional Technologists of Quebec and a podiatrist are the eligible providers of orthotics.
The 2017-2018 Annual Report is now available by clicking here (3MB PDF).
September 1 was the first financial renewal of the OSSTF Benefits Plan. Future renewals are scheduled for each September 1st going forward; however, rate and/or plan design changes can be implemented at any time throughout the benefit year, in order to sustain the plan over the long term.
The Trustees of the OSSTF ELHT have been working with OTIP (the Third-Party Administrator), Manulife (the provider of the life insurance, health and dental benefits) and Teachers Life (the provider of the Accidental Death and Dismemberment Benefits) to set the benefit rates as of September 1, 2018.
As the plan matures, the OSSTF ELHT will be better able to assess claim patterns. The current claims experience of the OSSTF ELHT for health and dental benefits reflects higher than anticipated claiming patterns by members. If these high claiming patterns continue, it may be necessary to increase the rates and member contributions towards the benefits and/or to implement cost containment strategies into the plan prior to, or at next renewal.
The OSSTF ELHT was negotiated for OSSTF members. It provides a full and comprehensive benefits program to cover the health needs of members and their dependents. The long-term sustainability of the plan is one of the OSSTF ELHT’s major priorities so it is important that members are aware of these potential future challenges.
If you have any questions please contact Donna Morrison, Executive Director at firstname.lastname@example.org.
In the insurance world, a life event simply means a change in your personal situation that can make you eligible for a special enrolment period in your group health, dental and life benefits plan.
Events, like marriage, the birth of a baby, adoption or legal custody of a child, divorce, the death of a spouse/partner or dependant or a spouse/partner losing benefits coverage, might allow you to enrol, or change your current benefits coverage, providing you do so within a certain time frame (i.e. within 31 days).
For example, a member currently has single coverage and gets married or has a baby. Given this life event, the member can now change their coverage from single to family and add their new dependant to their benefits coverage, providing they do so within 31 days of the wedding, or the birth/adoption of the child.
In another example, a member may have turned down health and/or dental coverage during their enrolment because their spouse/partner had benefits. A few months later, their spouse loses that coverage due to a change in employment, or maybe passes away. This would entitle the member to a special enrolment period where they could add coverage for health and/or dental coverage, so long as the enrolment was completed within the required timeframe of 31 days.
Making life event changes is easier than ever using OTIP’s secure member site.
The 31-day window is your special enrolment period for life events. If you miss it, in other words you do not apply for benefits for yourself or an eligible dependant during that time, you are considered to be ‘a late entrant’. This means that you will be required to complete an Application for Insurance and Evidence of Insurability, which determines proof of good health. Therefore, it is critical that you make these important changes within the 31-day timeframe, otherwise coverage may be denied for you and/or your dependant.
OTIP is here to help! If you have questions about qualifying life events, or how to make changes to your benefits coverage, please contact OTIP Benefits Services at 1‑866‑783‑6847.
R&C limits refer to the maximum allowable amount that an insurance carrier will reimburse on a particular service or item. This amount usually reflects the typical cost associated with this service or product in a specific geographical region.
R&C limits are most noticeable in paramedical practitioners (chiropractor, physiotherapist, massage therapist, etc.) and medical service providers. Why? Unlike physicians and hospital services, paramedical and medical service providers do not have to adhere to a provincial fee guide, and are instead free to charge whatever they choose for their services and supplies.
Let’s use an example. Sera hurts her back, and seeks the services of a chiropractor. This particular chiropractor charges $200 for an initial consultation; however, the R&C limit for this service in Ontario is $180. When Sera submits her claim, Manulife, our insurance carrier, will use their R&C limit to determine her claim reimbursement. In this case, Sera would be reimbursed $180, and would be out of pocket the other $20.
Higher rates drive higher plan costs. R&C limits are important to ensure claims to your benefits plan are not excessive. Therefore, smart shopping on your part for health-care products and services helps by not only reducing your out-of-pocket expenses, but also helping to reduce benefits plan costs. R&C limits also help reduce the likelihood of benefits fraud or abuse. Together, this means a healthier plan with more sustainable benefits.
To view Manulife’s R&C amounts:
Since R&C limits may change over time without notice, please review this information before starting a new medical treatment, or using a new paramedical or medical service provider. OTIP is also here to help. If you have questions about R&C limits, or how they might impact you, call OTIP at 1‑866‑783‑6847.
Did you know under the OSSTF Benefits Plan, your coverage for surgical stockings is: up to a maximum of six (6) pairs per plan year on a reasonable and customary basis? The plan year is September to August.
To avoid delays in processing your surgical stocking claims, please complete and sign the Extended Health Care Claim form and attach the following information:
Ensure all applicable sections of the claim form are completed and include copies of primary payment if coordination of benefits (COB) is required. Please send this information as instructed on the form.
If you have either lymphedema or a hypertrophic scar, you can apply for coverage with the Assistive Devices Program (ADP).
ADP’s allowance is 75% of the cost of:
NOTE: Varicose veins, diabetes, thromboses are not eligible under the ADP.
To apply to the ADP, please work with your service provider. If the ADP does not cover the full cost of your expense, you can submit the remainder to OSSTF Benefits Plan via My Claims or completing the Extended Health Benefit Claim form (776kB PDF).
Questions about the ADP? You can learn more at: Garments, pumps and braces.
We are pleased to announce that your OSSTF Benefits Plan now includes psychotherapy.
Psychotherapy is a term that covers all talking therapies and the many associated approaches/methods. Psychotherapists are mental health professionals who use “talking therapy” or counselling to help people work through difficult issues, rather than medications or physical interventions. People generally see psychotherapists when their problems affect their day-to-day living.
Psychotherapy will be added to your plan at 100% coverage up to $2,000 per Plan Year combined for services of a psychologist, marriage and family therapist, social worker and psychotherapist. All psychotherapists must be licensed and registered in the province of coverage and all claims are subject to reasonable and customary charges.
Additional questions? For more detailed information on this new benefit, please review your benefits booklet located in My Claims. If you have any questions about your benefits plan, or if a claim would be eligible for coverage, please contact OTIP Benefits Services at 1-866-783-6847.
The information contained in this website is for general information purposes only. The information is provided by OSSTF Benefits and while we endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information, products, services, or related graphics contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk. All information on this website is subject to change without notice.