Benefit Changes

March 1, 2025

Plan Enhancements  


Accidental Death & Dismemberment (AD&D) – Basic and Optional


  • Critical Illness (CI) rider benefit on the member increasing from 10% to 15% of the volume of AD&D coverage to a maximum of $10,000.
  • Two (2) additional diagnoses have been added to the CI rider: Aplastic Anemia and Multiple Sclerosis. The CI rider benefit will now cover eight illnesses (Blindness, Life-threatening Cancer, Severe Burns, Heart Attack, Kidney Failure, Stroke, Aplastic Anemia and Multiple Sclerosis).
  • Eligible Spouse and Dependent Children are now included in the CI Rider when Optional AD&D Family plan is selected. The Spouse is covered for the same eight (8) CI conditions as the member. Eligible Dependent Children will be covered for Blindness, Life-threatening Cancer and Severe Burns. Coverage at 10% of the volume in place for AD&D Optional Family Plan to a maximum of $5,000.
  • The period of time to submit a notice of claim to Sutton Special Risk is increasing from 90 days to six (6) months from the date of diagnosis. Please call Target Benefit Administrators as soon as possible to submit a notice of claim.
  • Increase termination age from 65 to 70 for the Critical Disease rider. Critical Disease includes conditions such as ALS, Huntington’s Disease, Parkinson’s Disease, and Meningococcal Meningitis; a full list in covered in the booklet.

 



Critical Illness (CI) Optional


  • The survival period of 30 days from the date of diagnosis has been removed and claims may be made immediately upon diagnosis.
  • Addition of a hospital cash benefit of $50 per day up to a maximum of 30 days or $1,500 for members who are hospitalized for at least 48 consecutive hours with an eligible covered condition, reimbursable based on eligible expenses incurred.
  • Critical illness maximum on eligible Dependent Children increasing from $15,000 to $25,000.*In-force coverage for CI on Dependent Children will NOT automatically change. Please complete an OPP Association Group Insurance Form 800 to increase or change coverage.

 


2022

Plan Enhancements  

(effective January 1, 2022)


The OPP Association sponsored Basic Life and Accidental Death & Dismemberment (AD&D) policies of $6,000 is increasing to $10,000 along with extending the termination age to 75!


At retirement an additional $25,000 of AD&D coverage will be added at no cost to the member and will terminate at age 65


The OPPA will maintain these premiums for all members active and retired


Optional Basic Life and AD&D increase of $10,000 will also terminate at age 75


All Members not yet 65 at December 31st, 2021 will be eligible for this new program.

 


2021

Plan Enhancements  

(effective October 1, 2021)


Major Dental

 

  • Annual $2,000 coverage changing from per family to per person

 

 

Laser Eye Surgery

 

  • Removed from Vision Care benefit with a $1,500 Lifetime maximum

 

 

Vision Care

 

  • Eye Exams will now be reimbursed up to reasonable fees and are not part of the Vision Care maximum
  • Coverage increases from $375 to $425

 


2019
Psychology Benefit Enhancement (effective May 6, 2019)

Currently the extended healthcare benefit includes psychology services subject to an annual maximum of $3,500 with per half hour maximum of $75.
 
Both of these maximums have been removed. Coverage is now unlimited

2018
Psychology Benefit Enhancement (effective June 1, 2018)

Current coverage: $50 per half hour
New coverage: $75 per half hour
 
Current coverage: $1500 overall annual maximum
New coverage: $3500 overall annual maximum

Plan Enhancements (effective Mar 1, 2018)

Accidental Death & Dismemberment (AD&D) Critical Illness Rider
• Blindness and Severe Burns has been added to the existing covered Critical Illnesses; Heart Attack, Stroke, Life Threatening Cancer and Kidney Failure
 
Group Coverage Changes (effective April 1, 2018)
 
Out of Country Coverage
• The $200 per day cap to hospital room charges has been removed.
 
Diabetes Management
• Flash Glucose Monitoring System (FreeStyle Libre) will be covered for members and their eligible dependents who require insulin to manage their diabetes.

2017
Plan Enhancements (effective Mar 1, 2017)

Hospital Semi and Private Room
  • Increases from $200 up to $225

Paramedical
  • Increases from $35 up to $45

Vaccines
• Vaccine listing available under Resources

Global Medical Assist
• For additional information, see Plan Overview, under My Benefits

2014
Plan Enhancements (effective Jan 1, 2014)

Drug Dispensing Fee
  • Increases from $8 up to $10

Vision Care
  • Increases from $340 up to $375

Hearing Aids
  * Annual deductible reduces by 50%

2014
New Benefit (effective Jan 1, 2014)
Expert Medical Information and Opinions

2013 & 2014
Claim Processing Changes (effective dates - see below)
Health Care Management

Generic Drug Information

Drug Solution Tips