Health & Dental Insurance

Ensure that you, your dependants, and your employees are protected from the high costs of health care. The Ontario Pharmacists Association’s Health and Dental Plus is a group insurance plan that provides comprehensive coverage that is surprisingly affordable.

Why should I choose health and dental insurance from the Ontario Pharmacists Association?

The Ontario Pharmacists Association’s group health and dental insurance provides broad and affordable coverage. Some of the benefits you will enjoy through our Health and Dental Plus program include:

  • extended coverage for hospital and medical expenses over and above the amounts paid by OHIP, including 100 per cent coverage for semi-private hospital accommodation 
  • emergency health care outside Ontario
  • dental care
  • prescription drug coverage 
  • prescription eye glasses or contact lenses
  • basic life insurance
  • dependant life insurance
  • accidental death and dismemberment coverage for the primary insured.

When you choose OPA insurance, you are getting a program developed for pharmacists, by pharmacists. Our program is managed and underwritten by reputable insurers, and administered and overseen by the Ontario Pharmacists Association, so you receive personalized service from us. If you have questions about your coverage or if you ever need to make a claim, we’re here to help.

Disclaimer

This represents a simplified summary of the health and dental insurance plan. The actual terms and conditions of the insurance contract and the coverage are determined by the Master Policy, which is kept at the OPA office.

Where can I find out more about what specifically is covered?

Please contact us directly at:

Ontario Pharmacists Association
Phone: 416-441-0788 option 2
Toll free: 877-341-0788
Fax: 416-441-0474
Email: Insurance

Who is eligible for this insurance?

The Ontario Pharmacists Association's health and dental insurance is available to:

  • members under age 65 who work a minimum of 20 hours a week on a regular full-time basis
  • non-pharmacist/non-technician employees of members who are under age 65 and work a minimum of 20 hours a week on a regular full-time basis.
Expanded eligibility offering is available to
  • member who stopped working and is about to have his/her employer plan terminated, or  
  • member, who is either not working or is over age 64, and whose spouse is about to have  employer coverage terminated 
Click here to learn more if you are under age 70.
Click here to learn more if you are over age 69.

Who manages OPA’s health and dental insurance program?

The Ontario Pharmacists Association’s Health and Dental Plus program is managed by Crain & Schooley Financial, one of Ontario’s largest insurance brokerage and risk management firms. They have been in the business since 1954 and have been providing service to OPA and its members since 1985.

Who underwrites the health and dental insurance?

The Ontario Pharmacists Association’s Health and Dental Plus program is underwritten by Desjardins Financial Security, a member of the Desjardins-Laurentian Life Group (DLLG), a holding company which consolidates all the life and health insurance activities of the Mouvement Desjardins. As a partner in DLLG’s Group Network, Desjardins Financial Security is the seventh largest group insurer in Canada.

Who administers the program?

Maximum Benefit/Johnston Group Inc. administers the claims and billing payments for the Health and Dental Plus program.

Who oversees the program?

The program is overseen by the Ontario Pharmacists Association’s insurance committee, a group of pharmacists representing you and your insurance needs.

Who do I contact for more information or forms?

For more information or forms, contact:

Ontario Pharmacists Association
Phone: 416-441-0788, 1-877-341-0788 option 2
Fax: 416-441-0474
Email: Insurance

How can I obtain a quote?

Please contact:

Ontario Pharmacists Association
Phone: 416-441-0788 option 2
Toll free: 877-341-0788
Fax: 416-441-0474
Email: Insurance

How do I apply?

Download the Health and Dental Plus enrolment form, print it out, and complete and sign the form. Faxed, scanned, or photocopied applications will not be accepted. 

Important notes:

  • Be sure to include the name of a beneficiary in the beneficiary designation area. This plan includes life insurance and accidental death and dismemberment insurance, and where a beneficiary is not named, there will be a delay in receiving the proceeds (as they will go through probate, rather than an immediate payment of the claim to the beneficiary).
  • Please indicate the policy’s effective date — either the first day of the current month, or the first of any subsequent month.
  • Complete the pre-authorization debit terms and conditions and include a void cheque for the account from which your monthly premiums will be withdrawn.
  • You must be enrolled in the Health and Dental Plus to be eligible for drug coverage.
  • Non-pharmacist/non-technician employees must have the enrollment form signed by the sponsoring pharmacist.
  • Complete the coordination of benefits area in full.

Mail the original copy of the completed form to:

Insurance Department
Ontario Pharmacists Association
375 University Avenue, Suite 800
Toronto, ON M5G 2J5

Do not send premium payments with your enrolment form. Include a void cheque for the bank account from which the automatic monthly payments are to be made.

If you prefer to be billed for your monthly premium payment, an invoice will be sent under separate cover by Maximum Benefit/Johnston Group Inc.

You will receive an acknowledgement from the Association within five business days of receipt of the form. Maximum Benefit/Johnston Group Inc. will subsequently mail the certificate of insurance, details of the coverage, and claim forms.

What forms of payment do you accept?

Monthly premiums may be paid via automatic withdrawal from a chequing account or a cheque may be mailed with the monthly invoice.

When should I make a claim?

Claims, with original receipts, should be submitted only after the monthly premium has been paid. All claims must be submitted within 365 days of the date the expense was incurred.

If you terminate your coverage, you must submit notice and written proof of claims within 120 days of the date the expense was incurred.

How do I make a claim?

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Beneficiary change 

Change request – health and dental

Debit pre-authorization 

Direct deposit authorization 

Extended health claim 

Health and Dental Plus enrolment form

Nursing Care Questionnaire

Over-age dependant coverage request

Evidence of insurability for adding prescription drugs

Who do I contact for more information or forms?

For more information or forms, contact:

Ontario Pharmacists Association
Phone: 416-441-0788, 1-877-341-0788 option 2
Toll free: 877-341-0788
Fax: 416-441-0474
Email: Insurance

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