Frequently Asked Questions - Retiree Health Insurance - RTIP Gold Elite

For more information on submitting drug and health claims under RTIP Gold Elite, please read the RTIP Gold Elite Claim Process document. You can continue to use the Extended Health Benefit Claim Form to manually submit claims.

For prescription medications, we encourage you to use your OTIP benefits card whenever possible. The benefits card allows you to pay-direct; meaning your claim is automatic. At the time of purchase, you pay only your portion of the prescription cost, the dispensing fee and any remaining deductible. Using your benefits card will automatically update OTIP's system with your deductible accumulations.

No, please continue to use the current OTIP Extended Health Benefit Claim Form.

The RTIP Gold Elite plan covers drugs, medicines, and injected allergy sera and insulin that are:

• listed in the Insurer's formulary, and which
• by law require a prescription from a physician or dentist, and which
• are dispensed by a duly licensed pharmacist, physician, dentist or hospital

Any drugs not included in the Insurer's formulary can be claimed on your income tax return as a medical expense.

Dental coverage can be added to your RTIP Gold Elite plan at any time.

If you forgo the hospital coverage under RTIP Gold Elite at enrollment, evidence of insurability is needed to add hospital coverage at a later date.

Online, you can view accumulations used to satisfy the $700 deductible for chiropractor and physiotherapy and the $7,500 deductible for private duty nursing, home care, medical aids, equipment and supplies, and prosthetic appliances. Once the deductible is satisfied, the claims accumulated toward the RTIP Gold Elite deductible cannot be viewed online. You will not be able to view accumulations toward the $25,000 calendar year or $100,000 lifetime maximums.

Please note: drug accumulations cannot be viewed online. If you would like information on your drug accumulations, please call OTIP benefits services at 1-866-783-6847.

As you submit claims for these benefits, they will accumulate towards the combined maximum of $7,500 in paid claims and will be recorded on our systems. You can submit your receipts as you receive them, rather than sending them all at once after you have reached the $7,500 deductible.

The $4,500 drug deductible is based on the calendar year; therefore, your drug claim accumulations reset to $0 as of January 1 each year.

Yes; you will continue to receive 100% reimbursement for your physiotherapy and chiropractor claims until 12 consecutive months after the date of your first claim.

Any expense incurred over the calendar year maximum of $25,000 should be claimed on your income tax as a medical expense.

You can still make claims for other expenses under the remaining RTIP Gold Elite plan benefits.

Any expense incurred over the lifetime maximum of $100,000 should be claimed on your income tax as a medical expense.

You can still make claims for other expenses under the remaining RTIP Gold Elite plan benefits.

RTIP Gold Elite plan coverage terminates at the end of year in which you turn 65. At that time, you can move to another RTIP plan of your choice. If you do not choose a new plan by the end of that year, your coverage will default to the RTIP Gold plan with the $500 drug maximum.

Moving to another RTIP plan would be considered a decrease in coverage. Decreases can only be made on January 1 of each year.

You can choose to terminate your RTIP Gold Elite plan at the end of any month. If you want to decrease your coverage to another RTIP plan, that change can only be made on January 1. The RTIP Gold Elite plan automatically terminates at the end of the year when you turn 65.