Pensions and Benefits

Plan comparison chart: post-retirement benefits for members of the OPTrust pension plan

The chart below compares the post-retirement benefits available to OPTrust members under the current plan – “Plan A” – and under the alternative plan – “Plan B” – negotiated between OPSEU and the Ontario government.

Drugs

PRB Plan A – Legacy (Current) Plan

  • 90% coverage
  • Drug card
  • Generic pricing – purchased product cost
  • Deductible: $3.00/DIN
  • Unlimited coverage – no annual maximum

PRB Plan B

  • 90% coverage, reduced to 75% coverage at the age of ODB eligibility for eligible submitted drug costs to maximum $10,000/yr (out of pocket cap annual cap - $1,000/yr up to the age of ODB eligibility, and $2,500/yr after the age of ODB eligibility) per covered person
  • Drug card
  • Mandatory lowest-cost, immediately available generic product pricing
  • Deductible: $3.00/DIN
  • Maximum of six (6) dispensing fees per year per maintenance prescription drug claim unless a physician specifically prescribes otherwise
  • Exclusion of coverage for ODB deductibles
  • Any drugs that are currently being covered are grandparented
  • Catastrophic Drug Coverage (CDC) – This plan will pay 100% of eligible drugs costs above the annual cap.

Hospital

PRB Plan A – Legacy (Current) Plan

  • $120/day – Semi-Private/Private room

PRB Plan B

  • $120/day – Semi-Private/Private room

Paramedical

PRB Plan A – Legacy (Current) Plan

  • Massage therapist, Physiotherapist, naturopath, osteopath, chiropractor and podiatrist: $25 per visit to max $1200/yr. per patient, provider
  • Psychologists & Speech Therapists: $25 per half  hour visit, with a $1400 calendar year maximum applicable

PRB Plan B

  • Combined Maximum: 100% of eligible claim cost to maximum $500/year per person – all providers – no per visit max

Vision Care

PRB Plan A – Legacy (Current) Plan

  • Max $340, + cost of one routine eye exam/24 months
  • Deductible: $10/Single, $20/Family – combined with Hearing Aids

PRB Plan B

  • Max $340, + cost of one routine eye exam/36 months. With exam coverage ending at age of ODB eligibility
  • Deductible $10/single, $20/family – combined with Hearing Aids

Hearing Aids

PRB Plan A – Legacy (Current) Plan

  • Max $1200/4 years, $10 deductible per person, family coverage $20 deductible maximum

PRB Plan B

  • Max $900/4 years. Deductible: $10/single, $20 family – combined with vision care

Orthotic Appliances and Orthopaedic Shoes

PRB Plan A – Legacy (Current) Plan

  • Orthopaedic Shoes: 75% of the cost of 1 pair/repair to max $500/yr.
  • Orthotic Appliances: 100% of cost to a max $500/yr.

PRB Plan B

  • 80% of the cost of 1 pair/repair – of each product – to a maximum of $500/yr., per product

Diabetic Appliances & Supplies

PRB Plan A – Legacy (Current) Plan

  • Blood Glucose Monitor - $400/4yrs
  • Insulin Infusion Pump: $2000/5 yrs.
  • Jet Injectors: $1000/life
  • Appliances related supplies: $2000/year

PRB Plan B

  • Blood Glucose Monitor - $400/4 yrs.
  • Insulin Infusion Pump: $2,000/5 yrs.
  • Jet injectors: $1,000/life
  • Appliances related supplies: $2,000/year

Private Duty Nursing

PRB Plan A – Legacy (Current) Plan

  • Covered at 100% - subject to reasonable and customary charge

PRB Plan B

  • 75% to $20,000 annual maximum

Other Health Services/Supplies

PRB Plan A – Legacy (Current) Plan

  • Covered at 100% - subject to reasonable and customary charges – unless otherwise specified. Items include: ambulance services, wheelchair rentals, hospital bed rental/purchase, casts, braces, prosthetics, etc.

PRB Plan B

  • 75% reimbursement – unless otherwise specified. Standard coverage services/supplies – subject to reasonable and customary charges

Dental

PRB Plan A – Legacy (Current) Plan

  • Deductible $50/Yr. - Single or Family
  • Basic Dental: 85% coverage - Unlimited
  • Dentures/Major Restorative:   Dentures: 50% to $3000 lifetime/person
  • Dentures/Major Restorative: Major Restorative: 50% to $2000/Yr./Person
  • Orthodontic: 50% to max $3000/lifetime per child age 6-18
  • Dental claims paid on ODA Fee Guide,  Subject to a one (1) year lag

PRB Plan B

  • Deductible - None
  • Basic Dental: 75% to max $1,500/year per insured
  • Dentures/Major Restorative: Not Covered
  • Orthodontic: Not Covered
  • Dental claims paid on ODA Fee Guide,  Subject to a one (1) year lag

Emergency Out of Province/Out of Country Coverage

PRB Plan A – Legacy (Current) Plan

Coverage for eligible medical expenses incurred due to emergency during temporary absences out-of-province – within Canada - Unlimited

PRB Plan B

No additional coverage beyond OHIP.


Optional Upgrade Package (100% Retiree Paid) – Plan A – available as of April 1, 2017

Emergency Out of Province/Out of Country Coverage

Coverage at 100% to a lifetime maximum of $1M for eligible medical expenses incurred due to emergency or unexpected sudden illness during temporary absence outside Canada, over and above OHIP out-of-country and standard health plan terms. 90-day trip maximum.

Global Medical Assistance (GMA) – Travel Assistance Plan

A complement to the Out of Province/Out of Country coverage that provides 24 hour access to medical assistance via a worldwide communications network that locates providers, obtains carrier approval of covered services including hospital payment, evacuation, transport/lodging for family member, return to home. Caps and conditions apply.

Catastrophic Drug Coverage (CDC)

100% coverage for eligible drug expenses in excess of an annual plan threshold or $10,000 in eligible submitted drug expenses per year, per patient.


Optional Upgrade Package (100% Retiree Paid) – Plan B – available as of April 1, 2017

Emergency Out of Province/Out of Country Coverage

Coverage at 100% to a lifetime maximum of $1M for eligible medical expenses incurred due to emergency or unexpected sudden illness during temporary absence outside Canada, over and above OHIP out-of-country and standard health plan terms. 90-day trip maximum.

Global Medical Assistance (GMA) – Travel Assistance Plan

A complement to the Out of Province/Out of Country coverage that provides 24 hour access to medical assistance via a worldwide communications network that locates providers, obtains carrier approval of covered services including hospital payment, evacuation, transport/lodging for family member, return to home. Caps and conditions apply.

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Publication Date: 

Wednesday, November 16, 2016 - 2:30pm