OTIP met with ETFO ELHT Chair Brenda Abrams and outgoing Executive Director, Suzanne Gill to learn more about the ETFO ELHT benefits plan and how plan decisions are made.
Here’s what they shared with us.
What is the role of the Trust?
The ETFO Employee Life and Health Trust (ETFO ELHT) was established in 2016 to provide long term sustainable Life Insurance, Accidental Death and Dismemberment, and Health and Dental benefits coverage for eligible ETFO members. Two plans were established: one for eligible ETFO Teachers and Long-Term Occasional Teachers, and one for permanent ETFO Education Workers (DECEs, ESPs, PSPs). The ETFO ELHT mission is to provide health benefits on a sustainable, efficient, and cost-effective basis. The ETFO ELHT Board of Trustees make plan design, funding, and administrative decisions to ensure the sustainability of the plan, and the long-term health and well-being of all plan members and their eligible family members. The Trustees are committed to plan members and operating the plan with integrity, transparency, and excellence.
How are the ETFO ELHT Plans Governed?
The ETFO ELHT Plans are governed by the ETFO ELHT Board of Trustees. The Board consists of nine voting members, who are responsible for operating and ensuring the financial sustainability of the ETFO ELHT plans. Five members of the Board of Trustees are appointed by ETFO, and the other four by OPSBA and the Crown. Meet the current Board of Trustees.
How are the ETFO ELHT Plans Funded?
ETFO Benefits Plans are funded by negotiated full-time equivalent (FTE) funding levels from the Government as well as pro-rated premium contributions from plan members who are working part-time or on unpaid leaves.
The negotiated FTE funding is the major source of the funding of the plans. The ETFO Central Agreements for both Teachers and Education Workers for the period of September 1, 2022, to August 31, 2026, were ratified by the ETFO membership in late 2023. These central agreements outline the required FTE funding to be paid by boards/school authorities for the period of September 1, 2022, to August 31, 2026.
Depending on the type of coverage, a plan member’s work status and FTE, there may be some required premium contributions to participate in some coverage:
Basic life and AD&D coverage is mandatory for all full-time and part-time eligible plan members while actively at work and there is NO COST while actively at work.
- Plan members pay 100% of the premium for plan member, spousal and child optional life and AD&D benefits that they elect to participate in.
- Full-time active plan members (1.0 FTE) have health and dental coverage at NO COST while they are actively at work.
- Plan member premium contributions toward the health and dental benefits are pro-rated for part-time plan members and plan members on non-statutory leaves who wish to participate in the plan.
Plan member premiums are subject to change on an annual basis at renewal. An illustration of the member premium contributions towards health, dental, and life and AD&D coverage is posted on the ETFO ELHT website at ETFO ELHT Member Premium Contributions.
How does the Trust consider the health and well-being needs of its members when making plan decisions?
The ETFO ELHT Trustees regularly review the plans to understand how they are meeting the needs of plan members within the available funding. Ensuring that benefits can be maintained is always the goal of the ETFO ELHT. As reported in the most recent ETFO ELHT Annual Report, in the face of inflation and cost challenges, the Board of Trustees continues to look for structural improvements to address plan sustainability and deliver essential benefits. Comprehensive research, ethical decision-making and continuous review are key components to our approach.
Since the inception of the ELHT in 2016, creative administrative solutions have been implemented in order to reduce costs while maintaining highly important coverage. For example, supporting and utilizing the new not-for-profit pharmacy MemberRx to provide specialty drugs and services will significantly reduce pharmacy fees. The ELHT has also adopted health care standards in the use of generics and biosimilar drugs. The Trustees thank all participating plan members for their patience with the transition and their understanding that these decisions help support the prudent financial management of the Plans. These strategies help to preserve existing coverage and avoid reduction of coverage and/or the implementation of premium shares.
The ETFO ELHT is also committed to keeping plan members updated and providing notice of any plan design or administrative changes to the plan, through eNewsletters and the ETFO ELHT website.
What benefits does the plan offer? Is my family covered?
The ETFO ELHT is proud to offer comprehensive health and dental benefits and insurance and AD&D coverage to our plan members and their eligible family members.
Here’s a snapshot summary of the benefits you receive as an eligible ETFO member when you have enrolled in the ETFO ELHT benefits plan. The detailed ETFO ELHT benefits booklet is available on the OTIP plan member secure site once you are enrolled. We always recommend that you confirm eligibility and reimbursement levels of benefits before incurring claims, and seek a predetermination or estimate especially for higher cost items.
Mental health is critically important to a person’s overall health and well-being. How does the Trust support the mental health of plan members?
We understand that mental health is a journey unique to each person. As such, we work to provide benefits coverage that is meaningful when and wherever you need it most, while ensuring the sustainability of the plan. The ETFO ELHT Health Care Benefit has expanded the mental health practitioners covered under the plan to provide better access. The plan provides coverage for the services of the following registered practitioners: Psychologist, Psychotherapist, Registered Family Therapist, Registered Social Worker, Registered Clinical Therapist, Registered Psychoanalyst, and a Psychologist Associate under supervision of a Registered Psychologist. Reasonable and customary expenses for these licensed practitioners are eligible up to $1,500 per benefit year per each covered plan member and each eligible dependant.
In addition, OTIP also offers free wellness programs to all plan members. These wellness programs are digital, available 24/7 and are 100% confidential.
Health and Dental care services can be very expensive. Do you have any advice for plan members to help to keep health and dental care more affordable under the plan?
ETFO ELHT encourages members to “USE IT WELL” to protect your plan for when you need it, your family needs it, and your ETFO colleagues need it.
Here’s how you can help:
- Before you spend your money, check your benefits booklet for full coverage details and don’t be shy about shopping around for the best value.
- Use the plan for what is medically necessary. That is what the plan is for
- Research your options and get an estimate. An estimate or pre-determination will help to prevent any unnecessary out-of-pocket expenses.
- Choose providers who focus on helping you stay healthy and well and meet your needs.
- Check the delisted providers list at otip.com to make sure that your providers are in good standing and your claims will be paid.
Any last advice or tips for plan members?
Get to know your ETFO ELHT benefits plan. Go to the ETFO ELHT website, www.etfo-elhtbenefits.ca, and log in to the plan member portal through otip.com to get information. It’s your plan, and together we have the shared responsibility to maintain the long-term sustainability of the plan.
And on a final note…
ETFO ELHT Executive Director
On a final note, we would like to provide an update on the ETFO ELHT Executive Director role. After a transition period in November, Suzanne Gill will be leaving her role as ETFO ELHT Executive Director, and Derek Hulse will be taking over as Executive Director.
Suzanne was hired by ETFO Provincial to assist with the implementation of the new ETFO Employee Life and Health Trust benefits plans, and then hired by the ETFO ELHT in the role of Executive Director in 2016. While there were challenges during transition, Suzanne says she has felt privileged to support plan members while leading the operation of such a new and innovative benefits model. She appreciated the support of the ETFO ELHT Board of Trustees and the ELHT’s many service providers, particularly OTIP and Manulife. With the ELHT well established, Suzanne is confident in handing over the role to Derek and is looking forward to retirement.
Derek brings his experience from a variety of roles in ETFO Local and Provincial Offices, with extensive experience with and knowledge about benefit plans, negotiations, and funding. He has worked with the ELHT’s third party administrator, the Ontario Teachers Insurance Plan (OTIP RAEO), as well as acting as an ETFO ELHT Trustee from 2017-2019. Derek looks forward to beginning his role in November.
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