Group Insurance
Questions and Answers
How are Premiums Paid?
Premiums are automatically deducted during 24 of the 26 pay periods for teachers on regular payroll. Information on the pay stubs clearly shows the amount of premium for each option.
Is Coverage Under the NLTA Insurance Plan Compulsory?
- Any teacher may choose to remove himself/herself from any benefit by completing the appropriate “opting out” form. However, before doing so, teachers are urged to contact the NLTA office or Johnson Inc. for consultation, since the coverage for the premiums offered can rarely be found in non-group plans. The NLTA negotiates coverage and premiums for a group of over 14,000 members, not on a one-to-one basis, as exists in the open market. Also, remember that for the basic plan, government contributes to a portion of the premium.
If I Opt Out, Can I Re-enter the Plan?
YES, but with the following conditions: evidence of medical insurability must be provided, or for dental, a penalty imposed.
Can I Continue Coverage When I am on Approved Unpaid Leave?
YES, but it is the teacher’s responsibility to action the following: (a) pay the required NLTA membership fee for the period of leave, and (b) arrange to pay the required premiums by contacting the Plan Administrator, Johnson Inc. Remember that while you are on unpaid leave, there is no pay from which the premiums can be deducted and payment of premium by bank deduction must be arranged with Johnson Inc. Failure to follow the steps in (a) and (b) will result in termination of coverage and a teacher would have to apply to re-enter the plan. Evidence of medical insurability must be provided and approved by the underwriter.
Does the Government Contribute to the Basic Plan Premiums While I am on Unpaid Leave?
For maternity/parental/adoption leave for up to 52 calendar weeks – YES. For all other unpaid leaves – NO. Teachers must pay premiums for all benefits, including the government’s contributions for A1, A3 and B.
If I Change Status, are my Dependents Covered?
YES. A change from single to dependent status will normally take place automatically if the plan administrator, Johnson Inc., is informed within 31 days of such change. Check your pay stubs and premium rates to confirm status. This is your responsibility. The computer system cannot identify teachers as married to each other. Premiums will not be refunded retroactively beyond the current insurance year in which Johnson Inc. was informed of the change in status.
What is my Coverage Under the Basic Plan?
A1 – Term Life, provides for a benefit to your designated beneficiary of two times your annual salary/pension at the time of death. After age 65, coverage is reduced to $15,000. A3 – Accidental Death and Dismemberment, to age 65 provides for a benefit of two times your annual salary/ pension at the time of death. Dismemberment benefits, hospital indemnity and other benefits are based on the policy. Coverage ceases at age 65. B – Health insurance, covers 80 percent of eligible costs and 100 percent of the ingredients of prescription drugs at generic pricing levels. Teachers pay the dispensing fee only and any markup. See Option B of the Group Insurance Overview for details or contact the Claims Department at Johnson Inc. A health insurance card will be issued.
How do I Name a Beneficiary for Life Insurance Policies?
Beneficiary forms are provided at the time of being insured. If you have not filled one out, or have forgotten whom you named, or wish to change your beneficiary, please contact the Plan Administrator, Johnson Inc. It is the teacher’s responsibility to name a beneficiary. Failure to do so will result in the death benefit being paid to your estate. In this instance, the person(s) whom you might have wished to assign your life insurance may have a lengthy waiting period to retrieve benefits, especially if there is no will.
What is the Purpose of the Health Insurance Card?
This card is provided as a service to all insured members for the purpose of purchasing eligible prescription drugs. Upon presentation to the pharmacist, a teacher is required to pay only the dispensing fee and any markup. The plan will pay 100 percent of the cost of the ingredients at the generic pricing level. Most drugs which are considered prescription by law will be covered (with limits on sexual dysfunction and fertility drugs). The card is valid in all provinces in Canada.
What about Dental Insurance?
It is the teacher’s responsibility to familiarize him/herself with those dental benefits which are not covered. For the Dental plan, teachers are advised to submit a treatment plan to the Plan Administrator, Johnson Inc., before procedure is performed if expenses are expected to exceed $300. No application is necessary. Permanent and replacement teachers are automatically enrolled in the Dental plan, but the premiums are paid in full by the teacher. Not all dental procedures are covered. For major expensive procedures, you are advised to get an estimate and check with Johnson Inc.
Dental Claims Procedures
Please note the additional option available for the payment of dental claims as follows:
- Present your NLTA Group Insurance card to your dentist.
- If your dentist accepts direct payment from Johnson Inc., then any eligible expenses will be submitted directly to Johnson Inc.
- However, if your dentist does not accept direct payment, you may pay in full and submit a completed Standard Dental Form (available at your dentist’s office) to the Claims Department at Johnson Inc.
Is there Insurance for Substitute Teachers?
YES, by application to the Plan Administrator, Johnson Inc. Health and Dental insurance coverage is identical to the plan for regular teachers. The Life and Accidental Death benefits are currently capped at $15,000 each. No medical evidence is necessary if the application is made within 31 days of the first day of substitute teaching. In order to maintain eligibility from one year to the next, a substitute must have taught at least ten days the previous year, and at least once before November 30th of the current year. All substitute teachers may also purchase additional Life and Accident insurance under Options A2 and A4 and Voluntary Critical Illness, under CV, CS and CC.
Premiums cannot be deducted from a substitute teacher’s cheque. Arrangements must be made with the Plan Administrator, Johnson Inc., for premium payments. Contact the Plan Administrator for applications and a program booklet.