As long as the changes are made within 31 days of the major life event the following changes can occur:
If a teacher has health family coverage for their spouse and the teacher dies the spouse can keep the insurance and it is converted back to a single plan unless they have dependent children.
If both spouse were teachers and one retirees and they go on the active teachers plan as a family plan when the other teacher retires they can go to two single plans.
Vaccines must be done at pharmacy. Can’t be done at travel clinics. A doctor’s note is not required for any paramedical services (massage, physio, chiropractor, etc.).
|Coverage||– 80% of paramedical to a maximum of $70 per treatment ($56 reimbursement) 20 treatments per year with exception of Physiotherapy, which is unlimited|
| – 80% of most health care expenses|
i.e. Home R.N. maximum of $6,000 per calendar year, maximum reimbursement $4,800.
| – Vision care 80% for frames and lenses to a maximum of $200 |
($160 payment) per 24 consecutive months, 12 consecutive months if under age 18. Laser eye surgery 80% of $1,500 lifetime maximum ($1,200 reimbursement).
|– Prescribed drugs with 80%/20% maximum $10.00, co-pay with drug card (mandatory Generic Substitution). For members 65 years of age and older most drugs are covered through the provincial DECAP and not the PEITF plan.|
|– Psychologist 80% of $125 per treatment ($100 reimbursement) 20 treatments per year|
|– Vaccines 80% coverage of up to $500 per year. |
(Must be from a licenced pharmacy and not a travel clinic)
When members of the plan turn 65 if the drug is covered under the DCAP program it is not covered by the PEITF plan. If the drug is not covered under the DCAP program it is possible it may be covered under the PEITF plan. If it is also not covered under the PEITF plan the member will have to appeal to the DCAP program first and if it is still denied they can appeal to the PEITF plan.
The cost for prescriptions under the DCAP program is usually higher than under the PEITF program.