* 0.5 part-time Member cost or 1.0 refers to a Member on a full-time non-statutory/unpaid leave
Rates include taxes. Rates are subject to change annually.
2. Administrative Plan/Practice Changes to the ETFO ELHT Benefits Plan – Effective September 1, 2022
The ETFO ELHT Board of Trustees is entrusted with the care and financial accountability of the ETFO ELHT Teacher/LTO Benefits Plan. As such, the Board of Trustees regularly monitors the Benefits Plans relative to available funding and makes plan adjustments as needed, to ensure we are providing valuable benefits to members within the available funding. The funding is negotiated by the parties to the agreement (i.e., ETFO, Crown, OPSBA).
With this in mind, the ELHT Board of Trustees is always reviewing the plans for ways to make administrative changes or implement best practices that allow plan coverage to be maintained to support plan members and their families. As a result, the following changes will be implemented effective September 1, 2022.
For more details about the below changes, please click here.
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Implement reference-based pricing on proton pump inhibitors
- Switch from reference biologic drugs (Humira, Enbrel, Lantus) to biosimilar drugs
- Change the Coordination of Benefits (COB) rules from reimbursement based on submitted amount to reimbursement based on eligible amount
- Remove Dukoral from list of eligible drugs
- Implement a surgical stocking preferred provider program
- No longer allow lump sum payments for orthodontics
- Switch from payroll deductions to pre-authorized deductions (PAD) for member-paid benefits
- Further expand practitioners covered under the psychology/counselling paramedical benefit (effective retroactive January 1, 2022)
3. Teacher/LTO Benefits Plan Contingency Plan
As per the 2019-2022 ETFO Central Agreement, the ETFO ELHT Board of Trustees is required to make changes to the Teacher/LTO Benefits Plan should the three-year valuation projections show the claims fluctuation reserve falling below the required 8.3% threshold. As you know, last year’s valuation did show that the plans would fall below the 8.3% threshold before 2023.
The Board of Trustees completed preliminary Contingency Plans with options to reduce plan benefits and/or introduce a member-paid premium share if the 2022-2023 Central Negotiations do not result in the required increases to funding. The Board of Trustees will revise the preliminary Contingency Plans in June once the 2022 valuation has been completed and will share the updated plans with the Parties to the Trust Agreement (ETFO, OPSBA, the Crown) in late June. A summary of the Contingency Plans will also be shared with ETFO ELHT Plan Members no later than September 2022. Any additional changes to the benefits plan beyond administrative changes will be contingent on the outcome of Central Negotiations, and if required, are not expected to be implemented prior to September 1, 2023.
4. ETFO ELHT Annual Plan Member Meeting - Save the Date
The Board of Trustees for the ETFO Employee Life and Health Trust (ELHT) invites you to attend the 4th ETFO ELHT Annual Plan Member Meeting, scheduled for September 22, 2022 at 4:30 p.m. This will be a virtual meeting, and all ETFO members who are eligible for the ETFO ELHT Benefits Plan may participate through a live audio stream. The ELHT Board of Trustees will provide their yearly update based on the 2021 Annual Report, which is also posted on the website by June 30, 2022. A reminder with the meeting link will be sent to members in early September.
