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 and 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 and 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.