Benefit Changes

January 1, 2026

Plan Enhancements  

Paramedical – the per visit paramedical cap will be increased from $45 per visit to $75 per visit, with the addition of Occupational Therapist to the existing list of eligible practitioners. Annual maximum of $1,200 per eligible practitioner remains in place.

Diabetic – Coverage for Continuous Glucose Monitoring Machines (CGM) will be included as part of the existing Insulin Infusion Pump coverage to the existing maximum of $3,000 every five (5) years per eligible person

Vision Care – Coverage for vision care will increase from $425 to $600 every 24 months, per eligible person, with a separately funded eye exam which is subject to reasonable and customary charges.

Hearing Aids – Coverage for hearing aids will increase from $1,000 to $1,500 every three (3) years, per eligible person.

Dental Benefits (Major Dental Care Coverage) – Major dental care coverage will increase from $2,000 per member to $2,500, at the existing reimbursement of 60% which remains unchanged.

NEW

(Applicable to active members only those under insured policy- 44501):

Health Care Spending Account (HCSA) 

• Effective April 1, 2026: one account totalling $650 per eligible employee annually.
• Effective January 1, 2027: one account totalling $800 per eligible employee annually.
• Effective January 1, 2028: one account totalling $1,000 per eligible employee annually.

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