Did you know that sight makes up a significant portion of our sensory intake? As one of our strongest senses, it’s important to make sure that our eyes are in good health. But, for many Canadians, trips to the eye doctor fall by the wayside.
Your Employee Life and HealthTrust (ELHT) benefits plan is designed to keep your eyes healthy so you can enjoy all of life’s precious moments.
What your plan covers
It’s important to check your benefits booklet for full details about your vision care coverage under your ELHT benefits plan.
If you or your eligible family members are over the age of 18, reimbursement of vision care expenses is calculated by including expenses incurred in the current and previous benefit period, depending on your vision reimbursement period (benefit year or calendar year). For eligible family members under the age of 18, vision care expenses are calculated by including expenses incurred in the current benefit period.
Your plan’s benefit period is important in understanding how eligible claims will be reimbursed.
- A benefit or plan year run from September 1 to August 31
- A calendar year run from January 1 to December 31
IMPORTANT: Before you buy your vision care products and services, we encourage you to submit an estimate to see if they will be reimbursed in the current benefit period.
How to calculate your total eligible vision care amount:
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Age 18 or older
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Vision Care Maximum Benefit
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-
(less)
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Total amount reimbursed in the current and immediately preceding benefit year or calendar year
|
=
(equals)
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Total eligible amount for new benefit period
|
|
Under the age of 18
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Vision Care Maximum Benefit
|
-
(less)
|
Total amount reimbursed in the current benefit year or calendar year
|
=
(equals)
|
Total eligible amount for the current benefit period
|
Here are some examples for you and/or any eligible family members:
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If your ELHT benefits plan covers a combined total maximum of $500 for vision care coverage, the following EXAMPLES would apply:
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Your benefit period is every TWO benefit years
If you were reimbursed $200 in the previous benefit year of September 1 to August 31, you have $300 of eligible amount remaining.
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Your benefit period is every TWO calendar years
If you were reimbursed $100 in the previous calendar year of January 1 to December 31, you have $400 of eligible amount remaining.
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|
Your benefit period is every benefit year
If you were reimbursed $100 during the current benefit year of September 1 to August 31, you have $400 of eligible amount remaining for the current benefit year.
|
Your benefit period is every calendar year
If you were reimbursed $200 during the current calendar year of January 1 to December 31, you have $300 of eligible amount remaining for the current calendar year.
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NOTE: Eye exams are subject to the reasonable and customary rates and/or limited to the maximum amount covered as per your plan. Check the delisted providers list to avoid the disappointment of declined eligible expenses and to ensure your new or current provider/supplier is in good standing.
Caring for your eyes and your ELHT benefits plan
Your ELHT benefits plan offers optimal benefits coverage to eligible members, helping to protect you and your family’s access to meaningful and sustainable benefits coverage like vision care for years to come.
This is where you can help. To assist us in achieving a balanced benefits plan that provides long-term sustainability, we recommend taking the time to do some comparison shopping before filling a prescription or purchasing items or services. This can help reduce your out-of-pocket expenses for items such as costs of treatments, services and products like glasses.
Also be aware of some service providers who may encourage you to ‘use it or lose it’ when it comes to your benefits coverage. Maximizing all your benefits coverage, if not medically necessary, can negatively impact the health and sustainability of the benefits plan for all members and their eligible dependants.
We’re here to help
To learn more about vision care options under your ELHT benefits plan, check your benefits booklet. You can also check your available balances for your vision care in My Claims, after logging in to OTIP’s secure member site.
Questions? Visit the OTIP Help Centre or call OTIP Benefits Services at 1-866-783-6847.