ARTICLE 14 BENEFIT PLANS
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14.01 Group Insurance and Health Plans
Effective 1 June 2001 the following Group Insurance and Health
Plans are available in accordance with procedures as required by
the Insurance Policies to all full-time and part-time
Teachers.
Any change in the procedures in effect at the time of signing the
collective agreement shall not have the effect of increasing the
limitations on the eligibility of Teachers to participate in the
plans.
(a) Group Life Insurance (compulsory) providing
$45,000 coverage. Accidental Death and Dismemberment Insurance
(compulsory) providing $15,000 coverage.
Teachers who were previously entitled to Group Life Insurance
providing coverage of 3 times salary may elect to continue that
coverage under the Group Life plan at the same amount, with the
Teacher paying 100% of the difference in the premium above the
$45,000 coverage. Teachers who elect not to continue this
higher coverage shall forfeit their right to continue this
coverage.
(b) Health Insurance, (including Vision Care at
$250/2 years. Effective September 1, 2010, Vision Care at
$250/2 years including up to $100 for eye examinations)
(compulsory, optional to Teachers covered by a spouse employed by
the Board). Claims for brand name drugs with an equivalent
generic drug will be reimbursed at the level of the generic
drug.
(c) Dental Care Plan (compulsory, optional to
Teachers covered by a spouse employed by the Board) to provide
check-ups once every nine (9) months.
Basic Plan (includes Caps and Crowns - $1,200 annual maximum), plus
50% co-insurance for:
(1) Major Restorative Services - ($1,300 annual
maximum per insured person);
(2) Orthodontic Services ($1,000 annual maximum
per insured person).
ODA Schedule - On 1 January of each year the previous year's ODA
schedule will be in effect.
(d) Optional Term Life up to $300,000 for
Teacher/spouse and up to $25,000 for dependent children. The
Teacher shall pay 100% of premium cost.
(e) Optional Accidental Death and Dismemberment
Insurance of up to $250,000 for the Teacher, up to half of the
Teacher's insured amount for the Teacher's spouse and up to
$250,000 for family coverage, all of which can be obtained in
$5,000 increments. The Teacher shall pay 100% of premium
cost.
Teachers employed as of 31 March 1999 who were covered by the
benefits provisions in the collective agreement between the Ottawa
Board of Education and the Branch Affiliates of the Federation of
Women Teachers' Association of Ontario and the Ontario Public
School Teachers' Federation and who elected not to enrol in the
optional benefits provided for under the group health and dental
plans in the applicable collective agreements, shall continue to be
exempted from the mandatory enrollment requirement for the health
and dental plans offered under this collective agreement.
These Teachers shall not be required to enroll in the health and
dental plans under this collective agreement.
However, if at any time, a Teacher elects to enrol in any of these
plans (either single or family level coverage) during the annual
open enrollment period or is required to enrol as a result of the
Teacher no longer being covered by another benefit plan, it is
understood and agreed that the Teacher shall forfeit his/her exempt
entitlement with respect to that particular benefit plan and must
thereafter remain enrolled, at least at a level of single coverage,
in accordance with the provisions in this collective
agreement.
Except where otherwise expressly stated, and subject to 14.02 and
14.04, the Board shall contribute 85% of premiums.
14.02 Eligibility for Benefits
All Teachers shall be eligible for the benefit plans in accordance with Article 14.01 and the applicable policies.
Teachers who are covered by this agreement and who are employed
on less than a full-time basis shall be eligible for benefits
listed in Article 14.01 and the Board shall pay the prorated cost
in the same ratio as the part-time employment bears to full-time
employment, with the Teacher paying the balance.
Notwithstanding the above, part-time Teachers entitled to receive
full Board contributions (85%) based on status of 0.5 or more as of
25 January 1999, shall continue to be entitled to full
contributions as long as the Teacher continues to teach half-time
or more.
Part-time Teachers whose status is less than 0.5, shall be entitled
to participate in the benefit plans as outlined herein or have the
option at the time of hiring not to enroll in the health and dental
plans until such time as their contract status becomes at least 0.5
or more. Similarly, Teachers who, as the result of a contract
reduction drop below half-time, have the option of withdrawing from
the health and dental plans.
While on Leave:
Teachers absent on leave with pay, including paid sick leave, or
OCETF administered LTD, will continue to be covered by benefits,
with the Board contributing its portion of premiums.
Teachers absent on authorized leave without pay may continue to
participate in benefits during the period of such leave provided
the Teacher pays the entire cost of premiums quarterly or annually
in advance.
Teachers absent on a Teacher-Funded Leave will have benefits
(including OCETF administered LTD) continued as provided for under
the terms of Article 22.
Opting Out of Health and Dental Coverage
Effective September 1, 2009 full-time and part-time (status .5
or greater) Teachers may elect to opt out of the Health Insurance
and Dental Care Plan identified in Article 14.01 b) and c)
respectively, by providing a written waiver attesting to spousal
coverage.
Teachers who opt out, would be eligible to apply for health and
dental plan coverage under the Board's plans if they have a life
event, provided the application for coverage is received within 31
days of the life event.
Changes in Coverage
Teachers are entitled to request changes to coverage status,
(i.e. family to single or single to family) in the event of a life
event, provided the application for coverage is received within 31
days of the life event.
For the purposes of this article, a life event is defined as
follows: change in marital status, including death of a spouse,
birth or adoption of a child, dependent ceases to qualify as a
dependent, or death of a dependent.
In addition, in the case of Teachers who have elected to opt out of
health or dental plan coverage based on spousal waiver, "life
event" also includes a loss of spousal coverage (i.e. where a
spouse changes employment or becomes ineligible for
coverage).
If the application for change in coverage is received after 31 days
of the life event, the employee, and each dependent for whom the
employee is seeking coverage, must provide evidence of insurability
for the health coverage and will be considered a late entrant for
dental coverage, which shall mean limited dental coverage for the
first year.
14.03 Positive Enrolment
Compulsory positive enrolment will ensure that the co-ordination
of benefits is correctly administered by the health, vision care
and dental insurer. Positive enrolment will apply to any Teacher
enrolled in family health, vision or dental coverage.
As required by the insurance carrier under Positive Enrolment, the
following information or information of a similar nature will be
required to be submitted to the insurer:
(a) effective date of coverage of Teacher;
(b) level of coverage;
(c) Teacher name, date of birth, and Teacher
identification number;
(d) name of spouse (as defined by the policy),
date of birth and whether the spouse has Employer health, vision
care and/or dental coverage, and if so, on a single or family
basis, name of spouse's Employer, plan or policy number, name of
insurer;
(e) for each eligible dependent child as defined
by the policy, name, date of birth, and whether the child is a
full-time student, or disabled and incapable of self-sustaining
employment.
Dependent claims will not be processed until the insurer receives
the required information. The insurer must be informed of any
changes to the dependent information within 31 days of the
change.
14.04 Long Term Disability Insurance
The parties recognize the OCETF Administered LTD Plan and agree
there shall continue to be cooperation between the Board, the Plan
Administrator and the Policy Holder in the administration of the
plan. The parties agree that no changes will be made to the
LTD Plan that impact on costs to the Board without the prior
agreement of the Board.
Long Term Disability Insurance is compulsory to new and existing
enrolled members. Teachers shall pay 100% of the premium
cost.
14.05 Benefit Plan Policies
The Board will provide the Bargaining Unit with all portions of
insurance policies relevant to its membership upon receipt of a
written request to do so. The Board undertaking to provide these
copies is subject to the availability of the information from the
insurer (excluding LTD).
The Bargaining Unit undertakes to provide the Board with the
relevant portions of any policy or policies it may enter into on
its own behalf upon receipt of a written request from the Board to
do so. This undertaking is also subject to the availability of the
information from the insurer.
14.06 Benefits Review Committee
There shall be a Benefits Review Committee comprised of two
representatives for the Board and two representatives for the OCETF
to review benefit plan levels and performance. The Committee
shall meet quarterly during the regular business day.
The OCETF will meet with Board representative(s) as per the Terms
of Reference of the Benefits Review Committee.
The Terms of Reference, shall be reviewed annually by the parties, taking into account any recommendations made for change by the committee.
