Principals/Vice-Principals (P/VP)
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Benefits Plan changes coming
September 1, 2025
New for September 1, 2025
Each year, the Trustees review the Plan’s financial position and make decisions that will best position the Plan for the future. This year’s benefit changes, taking effect September 1, 2025, are:
Prescription drugs
- Reducing coverage for prescription drugs from 100% to 90%.
- Adding a new protection feature called an “annual out-of-pocket maximum”. This means if you are “out of pocket” $1,000 on prescription drugs, the Plan will pay 100% of your remaining prescription drug claims for that Plan Year.
This is a “per person” maximum (i.e., $1,000 for you, $1,000 for your spouse, and $1,000 for each of your dependent children).
The $2 per script deductible continues to apply for each claim and will count toward the out-of-pocket maximum.
- Introducing prior authorization (i.e., a formal approval process) for Plan Members who previously did not have to go through this process for certain weight loss drugs. This applies to those taking off-label Ozempic and Rybelsus, and Saxenda, Contrave, and Xenical.
Note: affected Plan Members will receive a separate communication from Canada Life with instructions for next steps, which will include a transition period up to November 1, 2025.
Paramedical services
For mental health services from a Psychologist/Social Worker, Marriage & Family Therapist, and Psychotherapist:
- Increasing the annual combined coverage from $1,300 to $1,400 per person.
For services from an Acupuncturist, Chiropodist/Podiatrist, Naturopath, Dietician, Chiropractor, Osteopath, Registered Massage Therapist, and Speech Therapist/Speech Language Pathologist:
- Increasing the annual combined coverage from $1,300 to $1,500 per person.
- Adding a “per practitioner type” maximum of $550 per person. This means, for example, if you use massage therapy, your limit per year will be $550, but you would still have $950 available to use on other eligible services.
Health Care Spending Account (HCSA)
- Removing the HCSA benefit, which means you will not receive the $250 to your HCSA for the Plan Year starting September 1, 2025.
Still have a balance in your HCSA? You can use these credits for eligible services up to August 31, 2025, if claims are received no later than the end of November 2025.
What’s driving the changes?
The reality is – claim costs are rising faster than funding increases.
Following a global pandemic that no one could have predicted, we’re seeing new trends emerging, potentially forever changing people’s needs and the way they use benefits.
More Plan Members and their families are using their benefits, and each claim costs more than it did before. At the same time, the government funding that pays for these benefits has seen only a slight increase. As you can imagine, when costs go up faster than funding increases, the Plan can quickly become imbalanced, and that can put the Plan’s future at risk.
Here’s a snapshot of claim costs over the past three years, where we’re seeing an increase in every category. Between 2022 and 2024, the Compound Annual Growth Rate was 8.53%.
|
Drugs
|
Dental
|
Paramedical
|
Vision
|
Other health
|
|
|---|---|---|---|---|---|
| 2024 | $18,286,249 | $18,033,241 | $10,431,996 | $3,250,646 | $2,370,830 |
| 2023 | $17,264,150 | $16,829,557 | $9,545,905 | $3,245,030 | $2,074,971 |
| 2022 | $15,872,149 | $15,449,138 | $8,266,520 | $2,931,451 | $1,944,188 |
We’re not alone in facing these challenges. Across our sector, other benefit plans are seeing the same trend: rising claim volumes and higher claim costs, which are putting pressure on limited funding. As a result, many plans – like ours – are being forced to make tough decisions now, including reducing benefits.
As Trustees, we have a responsibility to protect the Plan, not just for today, but going forward. If funding levels don’t increase, we may be faced with making these kinds of difficult decisions again next year and the years after that.
What are we doing to help?
We understand that the impact of these changes, as well as understanding and keeping track of them, can be frustrating. We are emphasizing clear and timely communication. The Trustees have also implemented operational efficiencies, reducing Plan administration expenses from 4.2% of total costs in 2022 to 3.6% in 2024. However, because the Plan’s administrative costs are only 3.6% of total costs, these measures aren’t enough to address the funding shortfall caused by rising claim costs.
What can you do to help?
Group benefits are built on the idea of working and benefiting together. Review these simple tips on how to make the most of your benefits while also helping to protect the Plan for everyone.
Answering your questions
To help you better understand what’s happening, we’ve included a few frequently asked questions below. We’re also planning to host a series of Town Halls this fall, where you’ll have a chance to hear directly from the Plan’s Trustees, ask questions, and share what’s on your mind.
Frequently asked questions
Q1. Why are our benefits getting reduced again?
A1. The number of claims submitted and the average cost per claim are increasing, which has led to costs going up at a higher rate than funding from the Government.
ONE-T’s Funding Policy requires the Plan to maintain a level of reserves, and to do this, given the current reality, benefit reductions are necessary.
Q2. How do our benefits compare to Teachers’ plans?
A2. The ONE-T Benefits Plan provides better benefits in certain areas and lower benefits in others. For example, some other plans have required members to pay a share of premiums since 2018, while ONE-T only started this practice for P/VP Plan Members in 2025. ONE-T also provides coverage for obesity drugs, subject to a preauthorization process, while none of the teacher plans offer this benefit.
Q3. We have the highest funding, so why do our benefits continue to get reduced?
A3. There are certain factors specific to P/VP Plan Members that we believe contribute to higher costs, including:
- Many Plan Members with Family coverage
- High average number of dependents per Family
- Higher than average age of Plan Members
- Higher than average “per Plan Member” benefits costs
These factors help demonstrate that, even with the highest “per FTE” funding amount, it does not necessarily mean benefits will be better – with greater need comes greater cost.
Q4. Do the P/VP Associations get a say on plan design changes?
What about Plan Members?
A4. ONE-T meets with the P/VP Associations each spring to discuss plan design – this year, we met on at least five occasions, given the magnitude of change required. ONE-T Trustees value and consider the input from all interested parties; however, it is ultimately the Trustees who bear the responsibility of making the difficult choices around plan design.
In the past, ONE-T has surveyed Plan Members about needs and priorities, and we’re planning another survey in 2026. Data from surveys is helpful, but not always a direct driver of plan design changes. While we strive to address Plan Members’ needs, we must make plan design decisions that best spread out the impact across all Plan Members and protect our most vulnerable Plan Members, too.
Q5. Does ONE-T have any say in how much “per FTE” funding we receive?
A5. No. The Trustees must work with the funding that is provided and are not involved in funding discussions. ONE-T is independent from the P/VP Associations, Trustee Associations, and the Crown, and can’t advocate on behalf of any of these parties.
Q6. How is ONE-T funded?
A6. It can be helpful to think of ONE-T like a bank account. Funding comes into “the account” from the Crown and is then used to operate and deliver benefits under the Plan. Almost all Crown funding is the result of a grant, which is currently $7,260 per
Full-Time Equivalent Position (FTE). Total Crown funding in 2024 was approximately
$58 million.
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