A retiree from the University of Waterloo will be eligible for Extended Health Care (EHC) coverage provided that he/she has ten years or more continuous service with UW immediately prior to retirement and will be taking an immediate pension. Coverage also depends upon the retiree being covered by a provincial health plan.
For those who are resident in Ontario, and covered by OHIP, there is no lifetime limit for in-Canada health expenses. Independent annual limits exist for certain categories of the EHC coverage. Out-of-Canada expenses are limited to a lifetime maximum of one million dollars. (If you live in Ontario and have no intention of moving, you don’t need to read any further).
- A UW pensioner, who lives in Canada, but outside Ontario, will have a lifetime limit on the EHC coverage. This limit is applied to each individual. For example, a pensioner and spouse will have equal and separate lifetime limits. The amount of the lifetime limit depends on which EHC plan you are covered under and when you retired.
- For those who retired before the end of 1995 and remained in the "old plan", the lifetime limit is $30,000 for all health expenses incurred inside and outside Canada.
- For those who retired from 1996 to June 6, 2000, or those who retired earlier and switched from the "old plan" to the "new plan", the lifetime limit is $40,000 for all health expenses incurred inside and outside Canada.
- For those who retired after June 6, 2000, the lifetime limit is $80,000 which includes a limit of $40,000 for out-of-Canada expenses.
- All those subject to these lifetime limits are strongly urged to obtain their own private out-of-country medical coverage when travelling outside Canada.
- The accumulated value of benefits, for comparison with the lifetime limits, starts when the UW pensioner moves out of Ontario and gets coverage from the plan of the new province of residence.
- A retiree may contact Great-West Life; our insurance carrier at 1-800-263-5742 to confirm how much has been paid out to date for their health claims. You will need to reference UW’s group #325156 and your employee ID number located on your health card.
- At the dates when they were set, these limits were intended to be such that no-one would exceed them, except where an out-of-Canada claim was involved. Up to now, there has been no such case. The Pension and Benefits committee has agreed to review plan limits to ensure that consideration is given to their adjustment if individuals are close to the maximum (where out-of-Canada claims are not involved). Annually, the committee will review a report from the insurer which shows how much retirees have used to date (top 3 individuals in each category without identifying those individuals).
- Anyone who believes they are close enough to their limit that adjustment is needed to avoid exceeding the limit, should contact the Benefits Coordinator, Human Resources ext. 36120.
Update The Human Resources people now refer to the three plan categories as the "old plan", the "grandparented plan" and the "active plan". In late 2006, the lifetime limit was increased for the grandparented plan from $40,000 to $50,000, including a $40,000 limit for out-of-Canada expenses. This adjustment arose after examination of the annual reports from the insurer, described above. Members of this group of pensioners, if resident in Canada outside Ontario, are still advised to obtain their own private out-of-country medical travel insurance.
