ARM Prestige Elite - Coverage for "catastrophic" health care expenses

Effective January 1, 2008, OTIP will offer coverage for catastrophic health care expenses – those that can devastate a family’s finances – through ARM Prestige Elite.

 

Exclusive to retired members of Ontario’s education community under the age of 65, this new coverage option is ideal for those who are looking for additional protection from unforeseen health care expenses associated with acute sickness, serious accident or medical emergency.

 

ARM Prestige Elite offers:

 

  • The comprehensive extended health care benefits of the ARM Prestige plan ($500 prescription drug maximum), including travel coverage and the option to add one of three choices for hospital accommodation coverage. ARM dental coverage can be added to the ARM Prestige Elite plan at any time.
  • 100% coverage, with no annual maximum, for generic and name brand prescription drugs, when eligible claims exceed $4,500 per calendar year.
  • An additional $25,000 in combined coverage per calendar year, to a $100,000 lifetime maximum, for home care, private duty nursing, durable medical equipment (wheelchairs, etc.) and prosthetic appliances when paid claims exceed $7,500 per calendar year.
  • Unlimited chiropractor and physiotherapist coverage for 12 consecutive months following an accident that requires a hospital stay of at least 24 hours. Members are eligible for this compensation once the $700 paramedical services maximum has been reached. Documentation of a 24-hour hospital stay will be required for claims to be reimbursed under this benefit.

 

All benefits are paid at the reasonable and customary level, and are coordinated with any other health plan coverage you may have.

 

ARM Prestige Elite Rates

The following monthly rates for ARM Prestige Elite apply from January 1 to December 31, 2008:

 

Single: $62.81                                                  Couple: $117.05                                             Family: $134.27

 

Coverage Termination

Termination for ARM Prestige Elite coverage falls on the January 1 renewal, following the insured’s 65th birthday. From the time you turn 65 until the end of the calendar year, you will have the option to reduce your coverage to any other ARM health plan. If you do not make a selection by the end of that year, you will remain in the ARM Prestige plan ($500 prescription drug maximum).

 

After age 65, many of your prescription drugs will be covered by the Ontario Drug Benefit (ODB).

 

Additional Resources for Catastrophic Health Care Expenses

Residents of Ontario who have high medical expenses also have access to the Trillium Drug Plan. Trillium application kits are available at your local pharmacy, or by calling 1-800-575-5386. The application form and guide are also available online:

 

 

The Assistive Devices Program (ADP) covers over 8,000 separate pieces of equipment or supplies in the following categories:

 

  • prostheses,
  • wheelchairs/mobility aids and specialized seating systems,
  • enteral feeding supplies,
  • monitors and test strips for insulin-dependent diabetics (through an agreement with the Canadian Diabetes Association),
  • insulin pumps and supplies for children,
  • hearing aids,
  • respiratory equipment,
  • orthoses (braces, garments and pumps),
  • visual and communication aids,
  • oxygen and oxygen delivery equipment, such as concentrators, cylinders, liquid systems and related supplies, such as masks and tubing.

 

Grants are provided for ostomy supplies, breast prostheses and for needles and syringes for insulin-dependent seniors.

For more information, call the Assistive Devices Program at 1-800-268-6021 (toll-free in Ontario only). In Toronto, call 416-327-8804, or to use TTY, call 1-800-387-5559.

 

OSSTF   60 Mobile Drive, Toronto, ON   M4A 2P3   1-800-267-7867  |  www.osstf.on.ca
OTIP   125 Northfield Drive West, PO Box 218 Waterloo, ON   N2J 3Z9   1-800-267-6847  |  www.otip.com