Effective April 1, 2019, OHIP+ will no longer provide drug coverage for individuals under the age of 25 who have access to private insurance. Therefore, prescription drug claims for children and youth 24 years of age and younger with private plan coverage will have to be submitted directly to their private plan. Click here for details!

Description of Critical Illness Benefit

The Critical Illness Benefit provides financial assistance in the event you are diagnosed with one of the covered illnesses. The benefit is designed to alleviate some of the financial stress resulting from a critical illness at a time when the focus should be on recovery. There is no restriction on the use of the benefit; you can use it in any way that will meet your particular needs.

This benefit is available only to Active Members under the age of 70. This benefit does not apply to retirees or Dependents.

Benefit Amount

You are covered for a flat amount of $30,000 which is referred to as the Principal Sum. The amount payable for a critical illness will be reduced by 50% if an insured member is age 65 or older on the date the benefit becomes payable.

A Second Event Benefit may be payable equal to the Principal Sum, subject to certain conditions as described under the Second Event Benefit.

Benefit Payment Conditions

Payment of benefits upon the first diagnosis of the critical illnesses listed below is subject to the following:

  • the insured member survives for at least 30 days after diagnosis of a covered Critical Illness;
  • the diagnosis is made within Canada;
  • the diagnosis is made while the insured member’s coverage is in force under the policy;
  • payment is not precluded by any general or specific exclusion or limitation set forth in the policy or any failure to meet any condition precedent set out below; and
  • once 100% of the Maximum Benefit Amount has been paid, coverage terminates and no further benefits are payable, except as described under Second Event Benefit.

Second Event Benefit

If the insured member is diagnosed with Cancer for which the Principal Sum has been paid and the insured member has thereafter been considered actively at work for at least 90 days and is then diagnosed with a Heart Attack, Stroke or Coronary Artery Bypass, Alzheimer’s Disease, Coma, Loss of Sight, Speech or Hearing, Motor Neuron Disease, Multiple Sclerosis, Parkinson’s Disease, Quadriplegia, Paraplegia, Hemiplegia, Severe Burn, then a Second Event Benefit equal to the Principal Sum will be payable. The Second Event Benefit is subject to the insured member surviving 30 days after the diagnosis of the second event.

If the insured member is diagnosed with Heart Attack, Stroke, Coronary Artery Bypass for which the Principal Sum has been paid and the insured member has thereafter been actively at work for at least 90 days and is then diagnosed with Cancer, Alzheimer’s Disease, Coma, Loss of Sight, Speech or Hearing, Motor Neuron Disease, Multiple Sclerosis, Parkinson’s Disease, Quadriplegia, Paraplegia, Hemiplegia, Severe Burn or Stroke, then a Second Event Benefit equal to the Principal Sum will be payable. The Second Event Benefit is subject to the insured member surviving 30 days after the diagnosis of the second event.

The Second Event Benefit is payable only once. Payment of the Second Event Benefit will represent full and final discharge of all claims under the Critical Illness Benefit.

Diagnostic Requirements

The insurer reserves the right to have any Critical Illness diagnosis reviewed by a physician of its choosing. In the event of any dispute or disagreement regarding the appropriateness or correctness of the diagnosis, the insurer shall have the right to request an examination of either the insured member or the evidence used in the arriving at such diagnosis by an independent acknowledged expert selected by the insurer in the applicable field of medicine. The opinion of such expert as to such diagnosis shall be binding on both the insured member and the insurer.

The specifics of your Critical Illness Coverage are detailed in a separate brochure.

This website describes the conditions of eligibility, coverage and claims procedures under the Teamsters and Toronto Ready Mix Producers Benefit Plan Fund. The Board of Trustees are solely responsible for establishing the eligibility rules of the Trust Fund.

Downloads

Claim Forms:

Brochures:

Others:

*Please note that some changes were made to the booklet after April 2018 and these have been highlighted in red for your information.

Teamsters and Toronto Ready Mix Producers Benefit Plan Fund
c/o Benefit Plan Administrators
90 Burnhamthorpe Road West, Suite 300
Mississauga, Ontario L5B 3C3