From: John Meyer, Chair WURA Benefits & Pension Comm.; 3rd Rev. 4.17.02

A COMPARATIVE ANALYSIS OF INDIVIDUAL HEALTH BENEFIT PLANS FOR & FROM WURA

1. All $ figures below have been rounded up to the next whole $;
2. The required 8% provincial tax has NOT BEEN INCLUDED except where noted;
3. All premiums are MONTHLY premiums;
4. Since the DENTAL PLAN is a 50/50 shared benefit (Univ. & member), it is included in only in the current plan and not in the other plans excepted where noted;
5. Green-Shield reviews the claim record each year and determines any change in premiums by for April-May. Several of the premiums listed below are for 2001- 2002 but there is usually minor increases except for Greenshield
   
   

CURRENT UNIVERSITY-GREEN SHIELD PLAN:

Upon regular retirement (65 yrs), the retiree is given a opportunity to enrol in a special plan, group plan no. 5231, for retirees carried by the University and contracted to Green Shield. You have four options (SEE APPENDIX 1) of selecting various components, e.g., drugs, hospital, dental, travel. Presently, there is an open window for enrolling in the more expensive component, i.e., drugs. This plan is now available to an individual, couple, or a family. All the liability is carried by the Univ. Windsor. The DENTAL PLAN IS NOT under this plan but under the active Faculty plan and by means of the collective agreement (F 3bi, p. 127) is paid $50% by the University & 50% by the subscriber (2002 = $23.00/45.00/63.00)

Individual Couple Family

all included	$ 214	427	577
no drugs	71	142	185

Conditions:

* 8% prov. tax INCLUDED in Human Resource table (See APPENDIX 1)

* the retiree subscribers (12) to the drug component are so minimal that premiums must be high;

* the plan does have "luxury" items that most other plans do not have, e.g., over-the counter, paid deductibles including for ODB, 180 days out of province, no maximums for many components, an open OPT IN for drug component.

A "PROPOSED" (2003) UNIV.-GREEN SHIELD REDESIGNED RETIREE PLAN:

In order to lower premiums and include the drug component, Green Shield has prepared a proposal that requires the following premiums.

Individual Couple Family

all incl.

$ 180

$ 359

$ 460

Conditions:

* 8% prov. tax NOT INCLUDED;

* Includes: drugs, extended heath service (= EHS or EHB), semi-private, dental, travel, (usually 80%+ reimbursement; a few maximums);

* every subscriber must take the drug component;

* one window of opportunity to enrol;

* liability assumed by Green Shield rather than University as is currently the case;

* would include all current and future retirees;

** FURTHER REFINEMENTS WOULD REDUCE THE PREMIUMS BUT ADD LIMITATIONS:

Individual Couple

all -coverage

$ 135

$ 270

Conditions: subscriber pays dispensing fee, a $100 deductible; no over-counter, generic drugs first; $1200 max p.yr. drugs; 150 max on semi-priv. per day; & EHS (co-pay 10% + limit on physio $300 per yr. & chrio)

ALTERNATE HEALTH PLANS AVAILABLE TO ON A PRIVATE BASIS:

The following health benefit plans have been reviewed and compared. It should be noted that a retiree subscribing to his/her first retirement plan or a retiree changing from one plan to another normally has a limited window of opportunity, e.g. immediately upon Univ. retirement, or within 60/90 days when switching plans. Obviously, one would not want to be without the appropriate insurance for any period of time.

The following plans apparently pose no problem for academics retiring from an Ontario college or university. They are considered educators.

RTIP = Retired Teachers Insurance Plan: THE GOLD PLAN (drugs, hospital, ext. services, travel (NO dental as must pay Univ. for 50% co-pay; NO drugs at and after age 65 beginning Jan. of birthday year.)

Indiv. Couple Family

all exc. dental & drugs 65+

$ 60

$ 115

$ 145

* Includes: eye exam every two yrs., trip cancellation ($6000), hearing tests & aids $500 every 3 yrs., up to $200 every 3 yrs for vision care

* Limitations: couple rated on ages 65-69; 20% co-pay & maximums on EHS components, 60 days out-of-prov. travel but top-up at cost

OSSTF = Ontario Secondary School Teachers Federation: THE ARM (Active Retired Members Health Ins. Plan) Annual mem. fee required = $50.00 per yr.

Indiv. Couple Family

all except dental

$ 71

$ 142

$ 169

* Inc.: all as in other plans above;

* Limitations: drug max. of $1200 p.yr.; hearing ($400 max 3 yrs); vision max; travel = 60 days & top-up; cancellation ins. ($2000); max on some items

CURC = Comprehensive Union Retiree Coverage: PLAN F, carrier Green-Shield

Indiv. Couple Family

all except travel & dental

$ 72

$ 140

$ 170

* Includes: no co-pay required to maximum of covered benefit;

* Limitations: indiv. member fee = $25.00; NO travel ins. but can purchase at

CARP = Canadian Association of Retired Persons (annual membership fee including spouse = $25.00) - carrier Liberty Health

Combined dental*** & health: FOUR STAR PLAN (EHB, hospital, drugs, dental)

Indiv. Couple* Family**

all except travel

$ 92

$ 166

$ 193

* rated on ages of partner (here both in 65-69 range);

** rated as addition to couple rate on 1-2 children 5-20 yrs;

***this is a package that requires that dental benefits be included hence one could not make use of the dental component of the Univ-Green-Shield at 50/50.

CAA = Canadian Automobile Association: membership required ; carrier = Liberty Health: ENHANCED PLAN ( dental, EHB, hospital)

Indiv. Couple* Family**

all except travel

$ 79

$ 150

$ 181

* couple rated on ages of partners;

** rated as addition to couple rate on 1-2 children, 5-20 yrs.

*** limitations: as above plans

GREEN SHIELD: "Individual" PLAN 2 (drugs, EHB, semi- private)

Indiv. Couple Family

all except travel

$ 79

$ 153

$ 186

* Limitations: as some above, maximums on most items, some dependent on years in the plan; assume family is same as other plans = 1-2 children 5-20.

LIBERTY HEALTH INSURANCE: "flexcare" Plan: largest health insurer

Indiv. Couple

all except travel & drugs

$ 40

$ 80

ONTARIO BLUE CROSS Indiv. Couple

all except dental

$ 82

$ 162

* 80% to specified maximums for extended health; no drugs covered after 65, travel benefits limited to 15 days per trip for multiple trips.

CLARICA (+ SUN LIFE): Indiv. Couple

Clarica, includes dental

$ 82

$ 145

* 3 PLANS, "STANDARD" PLAN CITED: 70% drugs to $2000 per year; 75% extended health @20.00 per visit; 100% vision every 2 yrs; 70% dental to $750 max.; travel first 30 days per trip; hospital $175 max p.day for lst 30 days.

GREAT-WEST LIFE: Indiv. Couple

Basic Plan Direct, exc. dental & travel

91

164

* 5 PLANS & 3 CATEGORIES OF RATES, above is basic preferred rate, hosp. $175 p.d. up to 90 days; drugs 90% to max. $750 p.yr.; in-home nursing 36 mon., max. $3500 p.yr.; no vision, no hearing, no dental or travel, total max p.yr.$15,000

CONCLUSION: General Similarities of the health plans reviewed above:

1. eligibility is sometimes based on membership in an association, agency, etc. which requires a minimal annual fee sometimes including a written exam, and within 60-90 days of exit from another plan, e.g. the University Fac. Assoc. plan;
2. some plans use age categories to determine fees particularly in the "couple" category; "family" usually includes 1-2 dependents ages 5-20 or if they are full time in school that age range might be increased to 29-30;
3. all of the alternate plans listed above include various maximums on the components but they have been chosen on the basis of similar maximums and ranges, e.g., on semi-private hospital benefits it might range to max of $150-200 p. day for so many days per year;
4. % of reimbursement in most areas ranges from 70-100% & subscriber co-pays the remainder;
5. several plans and carriers are now providing identity smart cards in order that the provider (pharmacy) can immediately bill the account without paper claims;
6. plans are often "packaged" so that you cannot select various components;
7. plans that do include TRAVEL benefits are often limited to 15, 30, days per trip and offer a top off except for those teacher's plans noted above;
8. MOST INSURANCE CARRIERS ARE WILLING TO NEGOTIATE GROUP PLANS RESULTING IN LOWER PREMIUMS;
9. THOSE PAYING THEIR OWN PREMIUMS CAN DEDUCT THE ANNUAL COST AS MEDICAL EXPENSES AS WELL AS ANY PORTION NOT REIMBURSED BY A CARRIER WHICH MIGHT ALSO INCLUDE TRAVEL EXPENSES FOR TREATMENT.

1. SCHEMA OF MONTHLY PREMIUMS/RATES OF ALL REVIEWED PLANS (ABOVE):
   
   

Current Plan Indiv. ** Couple Family

drugs + all	$ 214	$ 427	$ 577
no drugs	$ 71	$ 142	185

GREEN SHIELD

UWINDSOR Individual Couple Family

Proposed luxury

$ 180

$ 359

$ 460

(BOTH exclude dental)

Individual Couple

Proposed Design Changes (max)

$ 135

$ 270

ALTERNATE PLANS: (all = every component except where indicated + 8% Prov. tax)

Individual Couple Family

RTIP - all-except dental & drugs after 65

$ 60

$ 116

$ 145

OSSTF-ARM- all ex. Dental

$ 71

$ 142

$ 169

CURC - all exc. Dental/travel

$ 72

$ 140

$ 170

CARP - all - exc. dental & travel

$ 92

$ 166

$ 193

CAA - all exc. travel

$ 79

$ 150

$ 181

Green Shield indiv. plan - all except travel

$ 79

$ 153

$ 186

Indiv. Couple

Manulife Financial: "Follow Me Plan", negotiated, all except dental & travel

$ 70

$ 125

Liberty Ins. "flexcare" plan Execept travel & dental

$ 40

$ 80

Ontario Blue Cross, except dental

$ 82

$ 162

Clarica, includes dental

$ 82

$ 145

Great-West Life, except dental & travel

86

155

APPENDIX 1:

2002-03, UNIVERSITY OF WINDSOR- FACULTY RETIREMENT GREEN SHIELD PLAN

COVERAGE	OPTION 1	OPTION 2	OPTION 3	OPTION 4
	TOTAL PACKAGE	NO DENTAL	NO DRUGS	DENTAL ONLY
INDIVIDUAL	$ 213.73	$ 190.99	$ 71.03	$ 22.74
COUPLE	427.43	381.96	142.03	45.47
FAMILY	577.15	514.63	184.73	62.52

APPENDIX 2

A COMPARISON OF POST RETIREMENT BENEFITS OF CANADIAN UNIVERSITIES OFFERING BENEFITS THROUGH COLLECTIVE AGREEMENTS

Compiled by John R. Meyer, rev. June, 2001 (from: COU & CAUT reports in 2000 (1999 stats); life insurance benefits not included as too much variance; HEALTH/DENTAL BENEFITS ONLY).

University Carrier Who Pays? Comments

Calgary	Johnson	Extended benefits ARTA	Prov. Teacher's Assoc.
Carleton	Clarica	Univ. = 100%	Min. employ of 5 yrs
Concordia	Clarica	50%/50%	Max=100,000 out prov
Guelph	Clarica	Health: mem 30%- Univ. 70%; dental 50/50%
Manitoba	Great-West	Univ. 100% , incl. dental	until 75 but 25k max
McGill	Aetna	50% / 50%	life, health, dental
McMaster	Clarica	Univ. = 100%	dental employer paid
Ottawa	Clarica	Per schedule of Ont.Munic.Ret.Organ	retiree= $35 S, $90 F
PEI, ('94)	Blue Cross	Univ. 100%
Queen's	Great-West Life	shared: Mem. pays $10 S, $30 F	add: Semi-priv. $12 S, 30 F
SimonFraser	Blue Cross	50%/50%	max=150k; ret. mem cat.
Toronto	Liberty	Univ.75%; Mem. 25%
Waterloo	Great-West	Univ. 100% , no dental	Limit on travel out, 60days
Western	Blue Cross	Univ.= 100%	travel ?
Wilfrid Laurier	Equitable Life	Univ. = 100% incl. dental;	2002 coll.agreement Major med.=$10,000 lifetime
York	Great-West Life	Univ.= 80%; MEM. pays month prem = $18 S, $ 34 F; dental= Univ.65%;Mem. 35%	annual deductible = 175 S, $275 F;
WINDSOR	Green Shield	Univ.= 50% dental ONLY	INFERIOR TO ALL OF ABOVE

*** The above table will be up-dated as relevant information appears from new "collective agreements".

RECOMMENDATIONS :

1. KEEP CURRENT "LUXURY" PLAN BUT GET MORE CONTRACTUAL SUBSIDIES IN NEXT COLLECTIVE AGREEMENT COMPARABLE TO MANY OTHER UNIVERSITIES (SEE APPENDIX 2 TABLE currently being monitored for any changes)

2. CONTINUE TO EXPLORE THE FEASIBILITY OF AN ACADEMIC RETIREES' NATIONAL OR PROVINCIAL PLAN THAT WOULD PROVIDE LOWER PREMIUMS.

This has already been suggested for the May 30-31, 02 meeting in Toronto of the Canadian College and University Retirees (presently called "CAERA". Perhaps OCUFA and COU should also be involved in this type of initiative.

3. CONTINUE THE FEASIBILITY STUDY OF THE 10 GREEN-SHIELD-UNIVERSITY HEALTH BENEFIT PLANS WITH AN OBJECTIVE OF A POTENTIAL FOR UNIFICATION OF PLANS AND THEREBY INCREASING VOLUME AND LOWERING PREMIUMS.