Extended health care plan

Medical coverage and benefits for retirees

Prescription drug coverage

The prescription drugs benefit covers drugs, sera, injectables, and compounds/mixtures with a Drug Identification Number (DIN) that require a prescription from a physician, dentist or practitioner and are dispensed by a licensed pharmacist.

  • $0 annual deductible
  • 85% reimbursement of ingredient costs
  • $3,400 annual maximum per person—we set the amount based on what members have needed
  • Reimbursement of Government Health Insurance Plan deductibles for prescription medications (e.g. ODB, RAMQ, and Fair Pharmacare)
  • Sexual dysfunction treatments and diabetic supplies for glucometers and insulin pumps are included
  • Option to arrange for a second 100-day drug supply if you’re taking an extended vacation
  • Express Scripts Canada Pharmacy, an optional online pharmacy with 24/7 pharmacist access and free home delivery

Paramedical practitioner coverage

Paramedical coverage includes non-surgical and surgical services. You don’t need a physician referral for services to be covered.

  • 80% reimbursement
  • $1,300 annual maximum per person for all practitioners combined
  • Covers 18 practitioners: acupuncturist, chiropodist, chiropractor, Dietician, herbalist, homeopath, naturopath, nutritionist, occupational therapist, osteopath, physiotherapist, podiatrist, psychotherapist, registered clinical psychologist, registered massage therapist, shiatsu therapist, social worker, speech therapist
  • Includes acupuncture and foot care services when provided by a registered nurse
  • Reflexology services are eligible when performed by one of the covered paramedical practitioners within their scope of practice

Vision coverage

The plan includes prescription glasses and contact lenses, laser eye surgery and corneal incision. Plus, support is available for vision training or remedial exercises not covered by government plans.

  • 80% reimbursement
  • $400 per person for prescription eyewear and laser surgery in any two consecutive years
  • $150 per person for eye exams in any two consecutive years, and per calendar year for dependent children
  • An additional lifetime limit of $400 per person for new lenses required within six months of eye surgery
  • Lifetime maximum of $300 per eye for cataract surgery costs that aren’t covered elsewhere in the Extended Medical Plan

Aids and appliances coverage

The plan covers the costs of aids and appliances prescribed by a physician. Government plans can help offset costs. Our claims team will review your quote to help you determine what will be covered so you understand expenses before making a purchase.

  • 80% reimbursement
  • Includes trusses, splints, braces, casts, crutches, canes, walkers, wheelchairs and hospital beds
  • Covers artificial limbs or eyes and breast prosthesis, including three mastectomy bras per year
  • $640 per year for wigs
  • Medical supplies including $400 per person, per year for surgical stockings, $750 per person, per year for incontinence supplies and up to $200 per person every two consecutive calendar years for post-surgical comfort and convenience items
  • $500 per person for custom-made orthopedic shoes every two consecutive calendar years
  • $1,100 per person for purchase or repair of hearing aids every three successive calendar years

Diagnostic services coverage

The plan covers diagnostic lab tests, including screening tests. The coverage helps offset the costs of tests not covered by government plans.

  • 80% reimbursement
  • $250 annual maximum per person

Additional coverage

Private duty nursing coverage

The plan covers medically necessary out-of-hospital nursing services. Additional related coverage is available through our Hospital and

  • 80% reimbursement
  • $2000 per person every two consecutive calendar years

Download complete coverage details

Transportation/ambulance coverage

The plan covers medically necessary ground and air transportation to a hospital.

  • 80% reimbursement
  • Includes one round trip per person per year for air transportation from your hospital to the nearest hospital able to provide treatment

Download complete coverage details

Education program coverage
  • 80% reimbursement
  • Includes medically-related program(s) recommended by a physician to an annual maximum of $200 per person

Download complete coverage details

Accidental dental coverage

The plan covers dental treatment required as a result of an accidental blow to natural or artificial teeth. For additional dental coverage, see our Dental Plan.

  • 80% reimbursement
  • Up to $1000 per person per calendar year

Download complete coverage details

Travel coverage

The travel plan covers emergency medical expenses during out of province and out of country trips, and trip cancellation and interruption costs. You’re covered for up to 93 days and can add a Supplemental Travel Plan for your extended trips.

  • 100% reimbursement
  • Up to $10 million for eligible medical emergency expenses per person, per trip
  • Unlimited number of trips
  • Up to $6000 for cancellation or interruption per person, per trip
  • Costs related to a pre-existing condition may be covered, subject to a 90-day medical stability clause

Download complete coverage details

More value added benefits

CloudMD

Have you ever experienced medical uncertainty? Perhaps you’ve wondered about a diagnosis or treatment plan for you or a loved one. Our partnership with CloudMD gives you and your family members access to the best medical minds in the world to help you make medical decisions with confidence.

CloudMD’s confidential services are available at no extra charge to participants of the RTOERO Extended Health Care Plan and their children (regardless of age), parents and parents-in-law. Your children, parents and parents-in-law do not have to be insured under the plan to be eligible for CloudMD services.

You will work with a CloudMD nurse care coordinator who gathers and retrieves your medical information, reviews it and sends it to the most appropriate physician for a comprehensive medical review and care plan.

Learn More
Express Scripts Canada Pharmacy®
Express Scripts Canada Pharmacy provides online pharmacy services 24/7. The service includes:
  • Free home delivery of your medication from Monday to Saturday
  • Automatic refills and renewal reminders
  • Automatic analysis and alert of potential drug interactions or concerns based on the allergy and health history you've shared
  • Access to on-call pharmacists 24/7
  • A convenient mobile app and website so you can manage your prescriptions in one place, anywhere, anytime
  • No more line ups or risks of missed doses
Learn more about Express Scripts Canada Pharmacy for RTOERO extended health care plan members.

Learn More

Convenience services
  • Claims can be submitted directly by the practitioner
  • Claim payments are deposited directly to your bank account
  • Email notification of your claim payments
  • Annual benefit statement and tax letter
  • 24/7, secure, online access to claims and benefit information
Monthly premium
Ontario* Quebec* All Other Provinces
Single $119.17 $120.27 $110.34
Couple $238.37 $240.57 $220.71
Family $286.06 $288.71 $264.87
*Where required by law, applicable taxes have been included in these monthly premium rates (8% in Ontario and 9% in Quebec).
Eligibility
Our medical insurance is popular among retired teachers and others who have retired from Canada’s education community, or who are still working and don’t have coverage through work. To be eligible for our group insurance coverage, you must
  • be an RTOERO member
  • live in Canada
  • be covered by a Government Health Insurance Plan (GHIP)
Coverage is also available for spouses and dependent children residing in Canada and covered by a GHIP. Full eligibility details
Two steps to seamless coverage and peace of mind
Start your application before you retire. You’ll be automatically approved for your insurance without the need for additional medical information as long as you apply within 60 days of your previous group insurance ending. Usually, that’s within 60 days of your retirement date. Step 1: Become an RTOERO Member Step 2: Complete the insurance application Not a member? Join now Apply for insurance
Applying late?
Did your previous group benefits end more than 60 days ago? Don’t worry – you can still be covered. Learn More

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