Retiree Health Benefits Coverage: OTIP vs. RTO
(Cyndie Jacobs D13/16 ARM)
Choosing a health benefits plan for your retirement requires extensive research into the wide variety of plans available. For teachers and all others employed in the education sector, the process is simplified by having two prominent providers from which to choose: the Ontario Teachers Insurance Plan (OTIP) and the Retired Teachers of Ontario (RTO). Some members continue with their board plan for a specified period of time (usually age 65) or are covered on a spouse’s plan.
Almost 40 years ago, OTIP was created by the education community for the education community. Today, OTIP offers a full range of group and individual insurance products created to specifically address and satisfy the unique needs of the members of the education community. OTIP is governed, led and inspired by the four education affiliates and their local leaders who are daily champions for the employees of Ontario’s education communities. Two representatives from each of the four education affiliates sit on the OTIP Board of Trustees, ensuring all voices are considered.
ARM (Active Retired Members) retiree health plans, offered by OSSTF and administered by OTIP, offer flexible health, dental and travel insurance programs that are available to all members of the education community, and for those coming up for retirement or who are already retired. (NOTE: The three ARM plans are identical to the three RTIP (Retired Teachers Insurance Plan) plans in terms of coverage, but have different names.)
In contrast to other insurance providers, every dollar that OTIP makes is reinvested into providing new products and services to meet the needs of its members. Some of the valued extras available to ARM plan members include CAREpath (Cancer Assistance Program), Express Scripts Canada Pharmacy™ home delivery program, The Seniors’ Care Assistance Program™ and the Edvantage savings program. In contrast, profits made by RTO are sent by Johnson Inc. to RSA Group, a parent company in the United Kingdom. Essentially, with RTO, education stakeholders have no influence, whereas with OTIP, we own it.
As organizations, the main difference between OTIP and RTO is that OTIP is an insurance administrator, whereas RTO is a social organization and Johnson Inc. is the plan consultant. As such, RTO offers only one plan, while OTIP offers a greater range of plans based on an individual’s needs. Because our needs change as we age, the best advice is not to get locked in to any one plan. OTIP is the only insurance provider specifically for the education community that offers choice and flexibility to suit changing health and financial needs.
Here are the top reasons to switch to an ARM health plan:
- ARM plans adapt as requirements for health coverage change and there are three different plans with different levels of coverage suitable for spouses of different ages.
- There is significant flexibility with ARM plans and members can move between plans. Members are able to increase or decrease their coverage on January 1 each year without medical evidence. An increase to another plan, however, or an increase of more than one plan level requires medical evidence of insurability.
- A member can reduce their level of coverage any January 1 or especially at age 65, when the government starts to cover the cost of drugs.
- If a doctor prescribes a drug that is available both in a brand name and a generic, the lowest generic cost would be considered, unless no substitution is ordered from your doctor.
- ARM plans adapt based on what the provincial health plan (e.g. Ontario Health Insurance Plan) covers and provides. All of the plans are based on OHIP: OHIP pays first, then your ARM plan kicks in.
- For a couple over 65 (covered by the Ontario Drug Benefit Program - ODB), you can save $1,038 annually.
- Half of RTO’s insured members are over 65 and overpaying monthly premiums by a minimum of $24.82 per month.
- No medical evidence is required if you apply for an ARM plan within 60 days of your group health plan termination date.
- Reimbursement levels change between ARM plans depending on the coverage you require for your individual needs.
- Members are covered for travel in all ARM health plans.
- With deluxe travel insurance in every plan, members are covered for 95 consecutive days outside of Ontario with no additional premium and no age limit. Emergency medical expenses are covered up to $2 million Canadian per person, per trip.
- Members can extend the 95 days by returning to Ontario for at least 24 hours or by purchasing additional days through 21st Century Travel Insurance. As long as your ARM policy is in effect, the 95-day limit will begin the day you depart. Any medical conditions must be stable within the last 90 days prior to departure.
- If medications are required while travelling, the member pays and is later reimbursed. If a member is taken to hospital, all they require is their OTIP coverage card.
- With the Express Scripts Canada Pharmacy™ home delivery program, members receive 100% coverage for generic maintenance prescription drug expenses (or 90% for eligible brand name prescriptions); they can receive a 90-day supply for a single dispensing fee.
- Dental plans are the biggest difference between ARM plans and RTO. With ARM, you can opt in to a dental plan at any time, on the first day of the following month and you only need to remain in the plan for a minimum of one year. Reimbursement is based on current Ontario Dental Association (ODA) rates and members are eligible for double the scaling units.
- Members may submit claims online and be paid via direct deposit.
- Members diagnosed with cancer will have the guidance and support of a personal oncology nurse through CAREpath (Cancer Assistance Program).
- Members requiring support, resources and/or programs for seniors will have access to The Seniors’ Care Assistance Program™, provided by Bayshore Healthcare.
- Members whose adult children return to school full time are able to include them as ‘overage dependants’ until the age of 31.
- Education retirees are also eligible for competitive rates on home and auto insurance through OTIP. These combined discounts, along with flexible retiree health plan rates can mean significant annual savings.
To make the choice even easier, check out this chart, a visual comparison highlighting the differences between ARM plans and the RTO plan, including the related costs, time restrictions, eligibility requirements, annual maximums and reimbursement rates for each plan. The benefits are grouped into several different categories:
- Extended Health Care: Prescription Drugs, Vision, Paramedical Services
- Travel and Supplemental Travel
- Home Care: Includes Medical Aids, Equipment and Supplies
- Hearing Aids, Post-Surgical Items, Ambulance, Diagnostic Procedures, etc.
- Semi-Private Hospital
- Dental Care
Still need more reasons to choose ARM health plans?
- Your needs won’t remain the same throughout your retirement. ARM offers choice, flexibility and options
- OTIP Benefits Services is a dedicated team to provide members assistance with their benefits and plan inquiries
- No taxes
- 99% of our members stay with ARM for life
Some helpful links for the ARM Plans:
Visit www.otip.com/arm, for additional information on the ARM health insurance program.
If at any time you are having trouble understanding something, need help to make the best decision, and/or you would like to set up a new policy, please contact OTIP at 1-800-267-6847.