The OPA Secure Health Plan is made available to all OPA members as a tool to help protect you and your family from unforeseen medical expenses. We currently have a substantial portion of the membership participating in the current plan, and starting July 1, 2018 all members have a renewed opportunity to benefit from such protection.
What is changing?
There are two major changes taking place effective July 1, 2018:
- Annual deductibles are being introduced
- Prescription Drug deductible of $1,000 per single/family per calendar year
- Combined $300 Health and Dental deductible per single/family per calendar year
The new OPA Secure Health Plan ensures that members have access to coverage that will protect them financially in case of catastrophic medical expenses by:
- Keeping the plan viable long-term by allowing members to be “self-insured” the first $1,000 per family of Prescription Drug expenses, and the first $300 per family of Health and Dental expenses
- Providing a comprehensive catastrophic coverage package for expenses beyond the deductibles at a fair and reasonable price to all members
What is not changing?
Beyond the changes described above, coverage, co-insurance and maximums of all benefits available under the current OPA Secure Health Plan will remain the same.
The new OPA Secure Health Plan will also continue to include Life, Dependent Life, AD&D and Travel Insurance coverage.
For a schedule of the benefits, current and new, please see the Table of Benefits. In addition, the Optional Life, Optional AD&D and Optional Critical Illness remain in place and available to members at any time. Details on these optional plans can be located at OPA's insurance section: https://www.opatoday.com/professional/insurance
Table of Benefits
Are there any changes to the premium?
Yes, the premium for the new plan effective July 1, 2018 will change. The change will depend on your current coverage. For a view of the new premium schedule, please see the Table of Benefits.
If you are currently participating in the plan, you will receive further details of the change in premium that is applicable to you through the plan administrator, Maximum Benefit, when you receive your billing for the month of May.
As a member currently participating in the plan, do I need to do anything?
You are not required to do anything. Closer to the change date you will receive a confirmation of your new monthly premium on your billing from Maximum Benefit, your plan administrator. We encourage you to contact OPA with any questions regarding your coverage and premium.
What happens to previously approved pre-determinations?
If you have already received approval on a pre-determined treatment plan, it will continue to be honoured based on the coverage in place at the time of the approval.
What happens to our current maximums and current balances on the maximums?
The maximums on the benefits will refresh for the July 1 effective date. Please note, however, that all maximums and deductibles will be pro-rated for the six-month period from July 1 to December 31, 2018. Not all maximums will be prorated.
On January 1, 2019 all deductibles and maximums will be refreshed in full.
What are my options if I no longer want to participate in the plan?
You have the option to cease coverage if you so choose. Please contact OPA for details if you no longer want coverage under the plan.
Why should I participate in this plan?
Coverage for health and dental expenses come in many different sizes variations, both in terms of coverage and cost. The choices are there, and it’s up to you to decide which option suits you best. OPA’s intent is to make available a plan that will be there for our members when they need it the most — a time when some plans may no longer provide the coverage you need.
According to the Canadian Institute for Health Information study conducted in 2016, health spending in Canada was projected to reach $228.1 billion, which averages to about $6,299 per Canadian1. The study continues to say that 70% of this amount is paid for through public funding, which leaves the remainder to be paid by private insurance (12%), by Canadians themselves (out-of-pocket 15%), or through other sources of funding (3%). This means that the average Canadian can expect to spend roughly $1,701 per year in healthcare expenses, with about $945 of this amount remaining out-of-pocket. Keep in mind this cost is per individual – not family. Multiply this times by the number of people in your family, and keepkeeping in mind that this is an average expense, and you could be looking at significantly higher costs.
1 National Health Expenditure Trends, 1975 to 2016 (CIHI)