ETFO ELHT COVID-19 Update: Re-Opening of Regulated Health Professionals

June 11, 2020

The following message from ETFO ELHT was originally sent to members as COVID-19 Update #3.

As the situation with COVID-19 continues to evolve, the ETFO Employee Life and Health Trust (ELHT) continues to work closely with OTIP, our plan administrator, to make proactive and responsible decisions that are grounded in care for our members and the long-term sustainability of our benefits plan.
On Wednesday, May 27, the provincial government announced that Ontario’s regulated health professionals can gradually reopen their in-person offices if approved by their governing bodies. This includes chiropractors, dentists, massage therapists, optometrists and psychologists. Visit the full list of regulated health-care providers.
Health care providers are still encouraged to limit the number of in-person visits and must complete a risk assessment to comply with the requirements set out by the Government of Ontario.
Despite service providers being given the green light to re-open their offices, how quickly they are able to begin treating patients, and how many patients they will be able to treat in their new reality remains a question. Modifications to their processes and physical workspace, as well as the need for limited protective equipment will most likely mean a slow and gradual return to business as usual for most of these practitioners.

Claims reminders as services re-open

As health services slowly re-open, please keep the following in mind:

If your normal provider is unable to accommodate your need for an appointment, please exercise caution when selecting an alternative provider. Some service providers are considered delisted by the insurer, Manulife. This means that claims submitted for services provided by a delisted provider would not be covered under your plan. To view a list of delisted providers:

Log in at www.otip.com
Click on My Claims
Scroll to the bottom of the page and go to the Wellness centre
Click on View list of providers not covered

Be sure to check this list to minimize delays to your claims.

Review your benefits booklet in the OTIP secure area to find out:

Which services you have coverage for
If a doctor’s note/referral is required
The maximum dollar amount covered for each benefit year

Check your available balances for different provider types (paramedical, dental, vision) for the remainder of the benefit year.
Submit your claims online. Many claims can be submitted online for a wide variety of service providers. Members are reminded that they must keep their receipts on file. Review the complete list on otip.com.

Rescheduling of cancelled appointments

Some members may find their benefits coverage ending soon due to a retirement, an eligible LTO contract ending, or an overage dependant who is covered under their plan will no longer be eligible (e.g. turning 21 and not in school or turning 25). The ETFO ELHT is making exceptions in these cases to allow plan members to complete procedures that were previously booked but could not be finished due to the withdrawal of services by various healthcare practitioners due to COVID-19 and submit them for reimbursement (e.g. previously booked dental procedures). This information was reported to members in the ETFO ELHT COVID-19 Update #2, emailed on May 7^th. For additional information, please visit the COVID-19 FAQs posted on the ETFO ELHT website.
If this applies to you, all rescheduled appointments must be completed by August 31, 2020 to be considered eligible for reimbursement.
Please contact OTIP Benefits Services at 1-866-783-6847 to provide appropriate documentation from the provider that indicates the cancelled and rescheduled appointment dates once services resume including the patient name, original appointment date, and service that was originally booked. OTIP will provide a reference number that will be needed when the claim is submitted for reimbursement.

Moving forward

There is no doubt the next few weeks and months will continue to bring change and uncertainty. Please visit www.otip.com/coronavirus for information on common questions related to your coverage and COVID-19, .
For questions related to your coverage, claims and enrolment, please call OTIP Benefits Services at 1-866-783-6847 or email at your convenience by: