RTIP health plan application form

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Select a plan

Choose the plan that's right for you. (Select one)

RTIP Gold 750

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RTIP Gold 2500

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RTIP Plus 4000

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Please make a selection

Do you need dental coverage?
Yes No

NOTE: the selection made for dental coverage will also apply for any spouse or dependants added to the plan.

Please make a selection

Would you like to register for Active Retired Members (ARM)?

Yes ($50 annual fee applies) No

Please make a selection

By adding an ARM membership to your RTIP plan, you can stay connected with other retired educators through social, political, and other engaging events. ARM is administered by OSSTF but open to all retired education employees. Learn more.

Who's applying?

Name :

First Name Please enter a value

Last Name Please enter a value

Date of Birth :

Day

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Month

Please make a selection

Year

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Sex :

Sex

Please make a selection

*Address :
You must reside in Ontario and be covered under OHIP at the time of application.

House/Apt # Please enter a value

Street Address Please enter a value

City/Town Please enter a value

*Postal Code Invalid Postal Code

Contact :

Phone number

Please enter a value

Email Invalid email id

Note: We will use this email address to provide plan information, RTIP newsletters, and annual renewal communications. Please provide an email address that you will have access to after you retire.

How did you hear about RTIP? :

Walk Into Retirement Workshop or Webinar
OTIP Promotion (Email, Social Media, Online Ad)
Your Board/Affiliate
OTIP Benefit Services
OTIP Website
Edvantage Perks
Word of Mouth/Referral
Other
Please make a selection Please enter a value

If you wish to receive emails about OTIP's products, services or promotions, please check here. />

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Add family members to your plan?

Add your spouse or child(ren) to your plan, or click NEXT to continue.

Add a spouse

Name:

First Name Please enter a value

Last Name Please enter a value

Date of Birth :

Day

Please make a selection

Month

Please make a selection

Year

Please make a selection

Sex:

Sex

Please make a selection

Add a dependant

Name:

First Name Please enter a value

Last Name Please enter a value

Date of Birth :

Day

Please make a selection

Month

Please make a selection

Year

Please make a selection

This child is 21 or older.
Please input their education information to see if they’re eligible.

Name of School Please enter a value

School Year Start Please make a selection

School Year End

Please make a selection

Sex :

Sex

Please make a selection

Add another dependant

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When do you want your RTIP coverage to start?

Day

Please make a selection

Month

Please make a selection

Year

Please make a selection

Coordination of Benefits (COB) allows you to submit your eligible expenses under more than one plan.

For You:

As of your RTIP plan start date, will you be covered under any other health or dental plans?

Yes
No

Please make a selection

Name of Insurance Company Please enter a value

Policy/Group # Please enter a value

ID/Certificate # Please enter a value

Are you currently covered by a health benefits plan or were covered within the last 60 days?

Yes

Yes, and I will continue to be covered after my RTIP plan start date

Please provide the following details about your current plan :

Name of Insurance Company Please enter a value

Policy/Group # Please enter a value

ID/Certificate # Please enter a value

When will your coverage under this plan be terminating?

Day

Please make a selection

Month

Please make a selection

Year

Please make a selection

If you decide to cancel your coverage after 12 months, you must wait 24 months before you can apply for RTIP coverage again.
If you have any questions on your eligibility, please call 1-800-267-6847 to speak with an OTIP Life and Living Benefits sales representative.

Since you will still be covered under another group plan after your RTIP plan start date, there will be some limitations to your coverage in lieu of providing medical evidence. These limitations do not apply if there is a life event.

Since you’re applying for RTIP coverage more than 60 days after your previous group insurance ended, there will be some limitations to your coverage in lieu of providing evidence of insurability.

• You may apply for the Gold 750 plan.
• You must stay enrolled in the Gold 750 plan for a minimum of 12 months. You will have the option to move to the Gold 2500 plan effective January 1 following 12 months of coverage.
• If you decide to cancel your coverage after 12 months, you must wait 24 months before you can apply for RTIP coverage again.

If you have any questions on your eligibility, please call 1-800-267-6847 to speak with an OTIP Life and Living Benefits sales representative.

For your dependant(s):

As of your RTIP plan start date, will your spouse, , be covered under any other health or dental plans?

Yes
Yes, same as above
No
Please make a selection

Name of Insurance Company Please enter a value

Policy/Group # Please enter a value

ID/Certificate # Please enter a value

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Summary and Payment Details

Note: To finalize your application you must complete this page and click “Submit” within 10 minutes, otherwise you will have to start the application over.

Policy Coverage

Coverage Plan :

Dependant(s) :

Dental :

Your total Monthly Premium is
$0.00

Your total health is
0.00

Your total dental is
0.00

Note: if you selected to join Active Retired Members (ARM), you will be billed $50 separately at your renewal next January.

Ready to enrol?

Enter your payment method. (Choose one)

Automatic monthly pension deduction from Ontario Teachers’ Pension Plan (OTPP)

Monthly pre-authorized payment plan

Note: this option is only available for OTPP pensions. If you are with OMERS or another provider, you must select the pre-authorized payment plan option.

Name of Pensioner : Please enter a value

I hereby apply for coverage under the Retired Teachers Insurance Plan with OTIP and direct the Ontario Teachers’ Pension Plan Board to deduct and remit premiums from my pension for my contribution towards the cost of this benefit contract. I understand and accept that premium amounts are subject to changes I elect and/or upon the renewal of my benefit contract and that OTIP will automatically apply and deduct the new premium amount from my pension and I agree to waive any other notice of premium changes. If my payment is rejected for any reason, I understand I will be notified and any outstanding amounts will be automatically deducted from my pension the following month. I consent to the collection, use and disclosure of any information required to administer the program including personal information such as my social insurance number (SIN).

Please make a selection

Name of Account Holder : Please enter a value

Financial Institution/Bank number : Please enter a value

Transit number : Please enter a value

Account number (Please DOUBLE check all digits are accurate as depicted on your void cheque) : Please enter a value

I (the “payor”) hereby authorize OTIP to withdraw monthly premium payments from my account on or about the first day of each month as well as any revised payment amounts or any other amounts that may be due and owing by me. If my payment is returned by my financial institution, for any reason, not limited to non-sufficient funds, I understand that an administrative fee for each payment returned may be added to the outstanding balance owed. If my payment is returned or stopped, I understand I will be notified and any outstanding amounts will be automatically withdrawn from my account the following month. OTIP may terminate coverage should a withdrawal be refused for any reason and the financial institution shall in no way be held liable should such an event occur. I understand and accept that premium amounts are subject to changes I elect and/or upon the renewal of my benefit contract and that OTIP will automatically apply and deduct the new premium amount from my account and I agree to waive any other notice of premium changes. This authorization shall remain valid unless cancelled by me in writing, subject to providing notice of ten (10) business days prior to the next deduction from my account. I understand that cancellation of this authorization does not relieve me of my obligation to pay all amounts that may be owing to OTIP by a method that is satisfactory to OTIP. I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this pre-authorized debit agreement. To obtain more information about my recourse rights, I may contact my financial institution or visit www.cdnpay.ca. I warrant OTIP on a continuing basis that all persons authorized to sign on this Personal PAD account have authorized this agreement, agreed to all terms therein, and that the information provided with regard to this Personal PAD Account are accurate and complete. I undertake to notify OTIP of any changes to my chequing/savings account information, including change of name, at least ten (10) business days prior to the next Personal PAD from my account.

Please make a selection

Authorization, Terms and Conditions:

Authorization
I hereby apply for benefits coverage (“Coverage”) and certify that the information provided is true and complete. I authorize OTIP and its Insurer to collect, use, maintain and disclose my personal information, including personal health information (“Information”), relevant to this application, for the purposes of evaluating my eligibility to the plan, benefits plan administration, providing me with ongoing services, protecting us both from error and fraud and complying with various legal requirements (“Purposes”). I am authorized to consent to the collection, use, maintenance and disclosure of Information pertaining to my spouse/child covered under this plan, if applicable, for the Purposes. I agree that the Information in this application will be shared with the Insurer and any Coverage shall not become effective until approved by the Insurer. I agree that my Coverage may be denied or terminated at any time as a result of any false, incomplete, or misleading information having been provided in support of this application. This authorization shall remain valid unless cancelled by me in writing.

Terms of Purchase
Any purchase of insurance from this OTIP site will be subject to the applicable laws and the terms and conditions of the contract of coverage as issued by OTIP and/or the Insurer.

Privacy and Security
Although OTIP’s security efforts are consistent with industry practice in Canada, your complete privacy, confidentiality and security is not yet possible over the Internet and therefore, cannot be guaranteed. As a result, OTIP shall not be responsible or liable or held accountable for any harm or loss or any damages resulting whatsoever from your transmission of any information to OTIP.

Information Accuracy
The content on OTIP’s site is for informational purposes only, and should not be interpreted as a recommendation for any specific product or service, use or course of action. It's not intended to be used as a substitute for financial, legal, accounting, tax, or other professional advice or services, so please don't rely on it for these purposes. OTIP is unable to guarantee that the information contained on this site is accurate at all times or suitable for any particular purpose and OTIP makes no express or implied representations or warranties about the information. OTIP will not be responsible for any reliance you or any other party might place upon the information has a negative result for you or them, and OTIP will not be responsible for any damages you or others might suffer, even if we had been warned of the possibility of these damages. Use of this Site shall be on an "as is" basis and entirely at your own risk.

No Liability
OTIP, its affiliated companies, its officers, directors, trustees, agents or employees, or any other person associated with the creation of this site, shall not be liable or responsible for any harm, loss or damage (whether arising in contract, tort, negligence, or otherwise) that may arise in any connection with use of this site, including any direct, indirect, special, third party, or consequential damages.

Customer Information
You agree that all information you provide to OTIP and its insurer(s) in any connection with this site is true, accurate and complete in all ways and you acknowledge that OTIP and its insurer(s) relies on that information to provide you with information and/or insurance coverage.

Notice
These terms are specific to the purchase of a policy or for providing OTIP with information about you with your intent to purchase a policy, all whether or not a policy is issued to you. These terms are not a contract of, or for, insurance and no guarantee is given to you that a policy of insurance will be issued. If a policy of insurance is issued to you by an insurer upon application approval, actual terms and conditions regarding that policy will be detailed in the policy. It contains important information concerning details, terms, conditions and limitations. Please read the policy carefully upon receipt.

Medically Underwritten
If the plan is "medically underwritten" or "requires a medical questionnaire" as Evidence of Insurability, you must disclose any medical condition, injury or illness that occurred or existed on or before the date of your application, regardless of whether you went to see a doctor about the condition or were given a diagnosis, or whether or not you believe that it is important. The premium charged could be subject to adjustment or the benefits offered could be subject to modification or declined based on you, and your families, medical background. This will be determined after an evaluation of the information provided on the medical questionnaire, if one is required as part of the application process.

Effective Date of Coverage
Coverage is effective following the approval of the application on the first day of the month as selected by you on the application form.

Accept terms and conditions

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