Prescription Drugs
Eligibility
If you belong to one of the following groups of Ontario residents and you have valid Ontario Health Insurance (OHIP), you are eligible for drug coverage under the ODB Program:
- People 65 years of age and older
- Residents of long-term care facilities
- Residents of Homes for Special Care
- People receiving professional services under the Home Care program
- Trillium Drug Program recipients
In addition, if you are receiving social assistance (Ontario Works or Ontario Disability Support Program assistance), you are eligible for ODB coverage.
Prescription Drugs for age 65 and over
The Ontario Drug Benefit Plan (ODB) is the first payor for prescription drugs for those aged 65 and over. Should you enroll in an individual health care plan that insurance provider would be the second payor. What this means is much of your prescription drug costs should be submitted to and be reimbursed by ODB (speak to your pharmacist) and the residual balance, in the form of deductibles, dispensing fee caps and other such items can then be claimed under your new individual policy, or if none exists then paid by you.
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Process to follow for claiming prescription drug benefits
As the dependent is over the age of 65, the pharmacist has to process the claim through the provincial plan first. This is done online. Once the claim is processed through OHIP any residual amount not paid is sent through to Sun Life for payment (same process as coordination between two employer plans). All this is done by the pharmacist online.
If a pharmacist is unable to file a claim, they should contact the Pharmacist Help Line at 1-800-668-1608 for assistance.
Effective September 1, 2005, ALL College employees who retire prior to age 65 will no longer be pooled with active employees for retiree benefit premium rating purposes. This will have the effect of increasing the premiums for those currently considering early retirement.
If you have retired after August 31, 2005, there will be a choice of 3 Extended Health Care Plans for Retirees. Plan 1 will be a merged plan, where coverage will be the same as the current coverage for active employees and premiums will depend on whether the individual has reached age 65. Alternative Plan 2 will provide similar coverage with certain items removed or reduced and Alternative Plan 3 will provide significantly reduced coverage and premiums will not depend on an individual’s age.
To enroll in the New Retiree Benefit Plan, Sun Life requires proof of age of both the Employee and their Spouse. This is because the Plan is an age-driven, where premiums are based on age. Please submit a photocopy of your driver’s license, birth certificate, Old Age Security Card, or Passport as proof of age and identity. Although Algonquin College may have birthdates in existing employee profiles, we do not have documents of this nature on file.
Please note: As of September 1, 2005, Retirees aged 65 and over can only maintain $10,000 of Basic Life Insurance. Duration of coverage is lifetime for Administrative and Support Staff Retirees and up to age 75 for Academic Staff Retirees.
Please review the Retiree Benefit information posted below. For general questions please contact Human Resources at 613-727-4723, ext. 7660 or 7660@algonquincollege.com. You may also contact the College Compensation & Appointments Council directly at:
Tel.: 416-325-2914
Fax: 416-325-2917
Web: http://www.thecouncil.on.ca/articles/139
Mail: 2 Carleton Street, Suite 1102, Toronto, ON, M5B 1J3