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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 Ottawa Carleton ETFO/FEEO 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 Ottawa Carleton ETFO/FEEO 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 Ottawa Carleton ETFO/FEEO 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 Ottawa Carleton ETFO/FEEO to review benefit plan levels and performance.  The Committee shall meet quarterly during the regular business day.

The Ottawa Carleton ETFO/FEEO 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.

14.07    For the purposes of benefits, the definition of spouse shall be the same as the definition contained in the Group Insurance and Health Plans in accordance with procedures as required by the Insurance Policies.  The definition shall be provided to the Bargaining Unit in accordance with Article 14.05, published in the benefit booklet, and published by Ottawa Carleton ETFO/FEEO.

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