• Participation in the ORWP is a condition of membership in OREA, funded through OREA Dues, which now include premiums for the Program.

• Having 103,000 Members with a wide range of demographics allowed us to approach insurers as a large and identified “class” of people, which is very desirable for them because they can accurately calculate their risk. It basically means it gave us the clout to negotiate a great benefits Program in which everyone is automatically enrolled, even if they have a pre-existing condition, without having to take a medical test or answer an intrusive questionnaire.
• It meant we were able to get coverage for older Members that isn’t typically available, such as Critical Illness Insurance, up to age 70, and Out-Of-Country Emergency Medical Travel Insurance, up to age 80. There’s also coverage for those over 80, which is very rare, including Life Insurance, healthcare (including prescriptions up to $750/year, paramedical practitioners up to a combined limit of $750/year, medical services and supplies up to a combined limit of $500/year etc.), Accidental Death & Dismemberment, and a Member Virtual Care and Mental Health Program.
• Negotiating with insurers as a large “class” also allowed us to obtain a plan that costs a fraction of what a Member would be charged as an individual. If Members were opting out of the plan, we could no longer claim we’re an identified class and we’d lose our negotiating clout. The terms would not be as favourable, and the price would increase, which would undercut our goal of offering an excellent and affordable safety net for all.

• No one can be excluded from enrolling in the plan due to a pre-existing condition. However, the Program Administrator, CBS, has informed us that there are some provisions within the Critical Illness Insurance and Out-of-Country Emergency Medical Travel Insurance policies related to pre-existing conditions that may limit the eligibility for coverage and the payment of claims in certain situations. This is common practice in the insurance industry.
• With respect to Critical Illness insurance coverage, the Program Administrator advises that ORWP will not cover an Illness that was diagnosed prior to the coverage effective date, nor will it provide coverage for any illness for which the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within a 12-month period preceding the Insured Person’s Effective Date, or an illness or condition for which the Insured Person, during 12 months prior to the Effective Date of their coverage incurred medical expenses, received medical treatment, took prescribed drugs or medicine or consulted a Medical Doctor. The insurance company will assess whether an illness is covered at the time of claim.
• The Program Administrator has advised that Out-of-Country Emergency Medical Travel Insurance does not provide coverage for any treatment, investigation or surgery for a specific condition, which had caused a physician to advise you not to travel; any sickness or Injury that, at the time of departure, might reasonably be expected to require you to undergo treatment, investigation, surgery or hospitalization; or a medical condition that had deteriorated, or had to be treated or investigated in the 90 days immediately preceding your departure from the province or territory of residence.

• The Program took effect on January 1, 2024, for Ontario REALTORS^®.
• There is also the option for REALTOR^® family members, Member Board/Association staff, and Brokerage staff to join the Program as of January 1, 2024, at an additional cost to be paid directly to the Program Administrator, CBS, and remitted by them to the insurance carriers.
• The ORWP also provides options for Members looking for additional coverage at their own expense, which includes coverage options for dental, vision, and much more.
• Members interested in enhancing their Standard Plan coverage, or adding eligible dependents, can do so during the pre-approved enrollment period, from January 1, 2024, to February 29, 2024. Following this period, Members cannot adjust their coverage levels until the next enrollment period in 2025.
• For more information on the available optional plans, please visit www.orea.com/resources/REALTOR-Wellness-Program/ORWP-Plans (Member login is required.)

• Yes, the Program Administrator, Comprehensive Benefits Solutions (CBS) can be reached at 855-335-3070.

• The Insurance Carriers are as follows:
• Canada Life – Life Insurance
• AIG Canada - Critical Illness, Travel and AD&D Insurance
• Green Shield Canada – Healthcare
• Maple – Virtual Healthcare and Member/Family Assistance Program including Headspace App for all Members

• All questions specific to the coverage included in the ORWP should be sent to the Program Administrator, Comprehensive Benefits Solutions (CBS), at ProgramAdministrator@orwp.ca.
• Any challenges, issues, or complaints should also be directed to the Program Administrator.
• The Program Administrator, CBS, and/or Insurance Carrier(s) are responsible for maintaining minimum service level standards and industry best practices for providing information to OREA Members and Member Boards for any benefits related questions, and for claims adjudication or any other matters related to insurance coverage.

• OREA has hired a REALTOR^® Wellness Program Manager to lead the implementation, management, and enhancement of the ORWP.

• Member Boards enroll, and onboard Members joining at the local level and maintain a database of all Members joining, reinstating, transferring to/from the Member Boards, and terminating membership. Member Boards provide access privileges to MLS® for their Members and terminate Members who are not in good standing.
• In short, mainly because Individual Members make direct application to Member Boards and not OREA.
• Member Boards collect all our membership information – OREA doesn’t, so it is logical that they oversee this part.

• The plan is administered by several parties, including OREA, Member Boards, the Program Administrator, CBS, and our Program Insurance Carriers.
• Member Boards are primarily responsible for the collection of Member dues, and maintenance of Member records. They are also responsible for confirming Member eligibility to OREA and our Program Administrator.
• OREA is primarily responsible for the collection of dues from Member Boards, the payment of premiums to the Insurance Carriers, maintenance of Member records, and overall ORWP governance.
• The Program Administrator, CBS, is primarily responsible for maintenance of Member records, collection, and remittance of premiums for any voluntary plans, claims filing support of Life, AD&D, and CI claims, responding to Member inquiries (through a dedicated call centre and administrative system), acting as an advocate on behalf of Members, providing consulting advice to OREA on overall plan governance, and any other required services.
• Our Program Insurance Carriers are primarily be responsible for responding to Member inquires, providing tools and resources to Members to use their plan, and for the payment of claims. Personal and confidential information relating to the payment of claims will not be shared with OREA or Member Boards.

• Once your eligibility information is received from your Member Board and processed, you will receive an automated email invitation from the Program Administrator, Comprehensive Benefit Solutions (CBS). Invitations to begin the online enrollment process will be sent from January 8, 2024, onwards.
• This email invitation will provide you with sign-up instructions and a link to the ORWP Plan Member Portal, a secure website where you can complete your enrollment into the ORWP. During the 2024 Open Enrollment Period—which begins in January and ends on February 29, 2024—you will have the opportunity to upgrade your coverage and add eligible dependents online. You can also complete a digital beneficiary designation for your insurance programs. The onboarding experience will not require the completion of any forms or paperwork – it is all managed online.
• If you have paid your OREA dues, we expect to receive your eligibility information from your Member Board by early January. You’ll then receive an email to register for the ORWP Plan Member Portal. For today, there is no action required on your part until you receive the email to begin this registration process.

• Once your eligibility information is received from your Member Board and processed, you will receive a second automated welcome email from the Healthcare Insurance provider—that’s GreenShield. Welcome emails will also be sent from January 8, 2024, onwards.
• Your GreenShield welcome email will provide additional instructions for you to register an account on GreenShield+, the insurer’s secure and easy-to-use platform. Through GreenShield+, you will be able to:
• Access your digital benefits ID card, which you can present to the pharmacist when filling prescriptions, so they can directly submit your claim.
• Arrange for claim payments to be deposited directly into your bank account.
• Access your personal claims information, including a breakdown of how your claims were processed.
• Check your eligibility and coverage for health services or items to instantly find out what portion of a claim will be covered.
• Submit claims online (some claims can even be processed instantly if you are signed up for direct deposit).
• Search for a drug to get information specific to your own coverage (or coverage for your family).
• Search for GreenShield-vetted health providers in a particular location (within Canada) that will submit your claims for you.
• Print personal Explanation of Benefits statements for when you need to co-ordinate benefits through another plan.
• The GreenShield+ app is available via the Apple App Store and through Google Play. Once you receive your welcome invitation and have been enrolled in coverage, you will also be able to contact the GreenShield Customer Service Centre if you have questions or need help.
• If you have paid your OREA dues and have claims for eligible healthcare expenses incurred on or after January 1, 2024, but before you receive your welcome email and access to your digital ID card—please keep your receipts. You will be able to submit these online via GreenShield+ once you have set up your account.

• Based on specific provincial health insurance plan regulations, where a generic equivalent drug exists, reimbursement will only be made up to the cost of the lowest priced equivalent drug.
• If a medical practitioner indicates a brand name drug is medically required due to a serious medical reaction to at least two generic equivalent drugs, the Insurance Carrier must be provided with a copy of the “Health Canada Vigilance Adverse Reaction Reporting Form” (that can be obtained from the Health Canada website) completed by the medical practitioner, to determine eligibility for payment of the cost of the prescribed drug.

• Our health and prescription drug Insurance Carrier has confirmed that they cover more than 23,500 different medications under the ORWP.
• There will be more to come on how you can check eligibility of services or prescription drugs covered under this plan.

• The premium for the Standard Plan is $659.88 annually per Member and forms part of the OREA Dues, bringing the total annual OREA Dues to $769.88.
• This represents the $110 for current OREA Dues that have remained unchanged for the last 15 years, and $659.88 for the cost of the premium.
• The REALTOR^® Wellness Task Force worked diligently to ensure that the premiums for the Standard Plan are affordable.
• For comparison, the Program Administrator, CBS, has advised that if a healthy, non-smoking 50-year-old was looking for identical coverage on an individual basis, they would pay approximately $2,600. In this regard, the ORWP offers a savings of nearly $2,000 per person.
• The premium for the ORWP Standard Plan coverage is included in the OREA Dues for the year, billed on an advance basis as per the frequency (annually, semi-annually, quarterly, or monthly) determined by the Member Boards in Ontario.
• Any premium increase (annual or otherwise) for the Standard coverage of the ORWP shall be added to the OREA Dues, as approved by the OREA Board and without any further approval by the Assembly and paid to the insurance carrier(s) accordingly.
• The ORWP has a premium rate guarantee for the first two-three years, depending on insurance type. Thereafter, any premium increase will be subject to contract negotiations done by the Program Administrator, CBS, with the Insurance Carrier(s) on behalf of OREA, subject to the approval of the OREA Board of Directors.

• The increase became effective on January 1, 2024.

• The Program has a premium rate guarantee for the first two to three years, depending on the type of insurance coverage. Thereafter, any premium increases will be subject to contract negotiations done by the Program Administrator, CBS, with the Insurance Carrier(s) on behalf of OREA.
• If necessary, OREA will use RFPs to source the best rate and coverage, subject to the approval of the OREA BOD.
• Any premium increase (annual or otherwise) for the Standard Plan coverage will be billed along with OREA Dues by the Member Boards/Associations and paid to the insurance carrier(s) accordingly.

• The affordable cost for the Standard Plan of ORWP is based on the collective group of members with varying ages, demographics, etc.
• The cost of insurance for the older REALTORS^® is substantially higher and if separated, this group will need to pay much higher premiums, as advised by the Program Administrator, CBS.
• As a result, we negotiated an arrangement whereby older Members will not see an increase in costs as they age, and they will still have access to coverage that would be much more expensive, or not available, if a Member tried to buy it as an individual.
• The REALTOR^® Wellness Task Force wanted to ensure that the Standard Plan offers something for everyone.
• For example, the Standard Plan has Out-of-Country Emergency Medical Travel Insurance, which will provide the best value for travel for elderly REALTORS^®.
• Here are a few examples that our Program Administrator, Comprehensive Benefits Solutions Limited, provided for guaranteed-issue products offered in the marketplace¹:
• For a 65-year-old REALTOR^®, $50,000 of Life Insurance alone would cost them $1,456 per year, and the entire benefits package would cost $3,899 per year if they bought it on their own.
• For a 70-year-old REALTOR^®, $50,000 of Life Insurance alone would cost them $2,864 per year, and the entire benefits package would cost $5,126 per year if they bought it on their own.
• For an 80-year-old REALTOR^®, $50,000 of Life Insurance alone would cost them $5,366 per year, and the entire benefits package would cost $9,538 per year if they bought it on their own (excludes some benefits that not available at age 80).

¹ SOURCES – CANADIAN GROUP INSURERS

• There is no option for reduced premiums for those with spousal benefits.
• However, we would encourage those Members to utilize Coordination of Benefits (COB) to maximize their coverage with both plans.

• All Members of OREA will pay the same total annual premium, regardless of their age or coverage levels.
• The coverage costs of most ORWP benefits is driven significantly by the age of the membership, with Members over age 65 representing the highest risk profile (and cost) to the plan.
• Rather than implement an age-banded approach (where Members pay different annual premiums based on age), we felt that it was fairest to have a common annual premium for all Members.

• All the information on the ORWP, including details on optional plans, can be found at www.orea.com/resources/REALTOR-Wellness-Program/ORWP-Plans (Member login required). The Program includes coverage for:
• Life Insurance
• Critical Illness Insurance
• Out-of-Country Emergency Medical Travel Insurance
• Accidental Death and Dismemberment Insurance
• $2,000 worth of healthcare coverage, which includes prescription drugs, paramedical practitioners, medical services and supplies, and more.
• A Member Virtual Care and Mental Health Program
• There is no cash value¹ on this policy.
• The details of the insurance policies will be shared when available.

¹“Cash Value” is the portion of the policy that earns interest and may be available for you to withdraw or borrow against in case of an emergency. It is not available in a program like the ORWP.

• Members can maintain their other policy and the ORWP. They will be able to use the ORWP to supplement and top up what coverage they already have.
• Coordination of Benefits (COB) is a term that describes the order of how claims are submitted to each carrier for reimbursement. COB rules depend on the type(s) of coverage you have in place. For example:
• Member has other coverage through their partner:
• ORWP is the first payer for Member claims.
• The partners plan would be the second payer.
• Member has other group coverage through an employer that pre-dates January 1, 2024:
• Employer plan is the first payer.
• ORWP is the second payer.
• Member has retiree coverage through a former employer:
• ORWP is the first payer.
• Retirement plan is the second payer.
• Member has individual coverage on their own:
• ORWP is the first payer.
• Individual plan is the second payer.
• Please note – drug, dental, and other types of claims are often coordinated automatically at the point of sale, which would eliminate the need for the Member to manually submit claims to multiple providers.

• Example for a Member who has existing coverage through a partner, retiree coverage, or personal coverage:
• If you have a physiotherapy claim, it would be submitted to the ORWP plan first for reimbursement. Any unpaid amounts would be submitted to the secondary plan for reimbursement. An Explanation of Benefits (EOB) statement is a statement provided by your health insurance provider that describes what costs it will cover for any claims you have submitted. The insurance company sends you EOBs to detail and explain how your claims have been adjudicated.
• Example for a Member who has existing coverage through an employer:
• If you have a $1,000 drug claim of which 70%, or $700, is paid by a non-ORWP insurance plan, there would be an outstanding balance of $300.
• You would then submit that balance to the ORWP (along with an Explanation of Benefits statement) for payment. ORWP would pay the balance of the claim, subject to eligibility provisions, coinsurance levels, and available plan maximums, to the extent that the total payment received from the first payer plus the ORWP does not exceed more than 100% of the maximum allowable expense.
• In short, you get more with two plans than you would with one.

• Plan maximums¹ may include overall annual maximums as noted within plan provisions, as well as “Reasonable and Customary” limits.
• Reasonable and customary (R&C) limits refer to the maximum allowable amount that an insurance carrier or claims payor will reimburse on a particular service or item. This amount reflects the average cost associated with this service or product in a specific geographical region.
• Reasonable and Customary limits prevent excessive claims and keeps the fees and charges of the healthcare practitioners within reasonable limits. It reduces the costs of group benefit plans for plan members and ensure that any insurance fraud or abuse cases are avoided.
• It is important that plan members understand what reasonable and customary limits are for the various products and services covered under the plan.
• Members are encouraged to contact the insurance carrier before making claims for additional information.

• Drug, dental, and other types of claims are often coordinated automatically at the point of sale, which would eliminate the need for the Member to manually submit claims to multiple providers.
• Coordination of Benefits (COB) is used when someone is covered by more than one plan, and the plans work together to pay any claims. All insurers follow these rules to maximize benefits. There are different scenarios for how Coordination of Benefits works, including:
• Member is covered under OREA plan and as a dependent under spouse’s plan.
• Member is covered under OREA plan and another plan (either through an employer, as a retiree of another group, through individual insurance, and/or a government plan.)
• Spouse is covered under their benefit plan and as a dependent under Member’s plan (would need to add-on dependent coverage.)
• Dependent children have coverage under both Member and Spouse plans.

• Members can let their health care providers know that they have coverage through the ORWP. The provider will ensure that any claims processed on the Members’ behalf are processed correctly.

• No, the existence of the ORWP does not in any way limit a Member’s ability to access the TDP to cover their high-cost medications.
• The TDP is a publicly funded plan through the Ontario Ministry of Health and Long-Term Care. It is intended for Ontario residents who have high prescription drug costs in relation to their net household income.
• The TDP will provide coverage after you have used all other sources of insurance, and after you have spent a certain amount of out-of-pocket on eligible prescription drugs.
• All OREA Members would first submit their drug claims to the ORWP and/or any other private insurance plans they have in place.
• If they exhaust their private drug coverage, they can then apply to the TDP.