Author: Glen Jackman

Prescription Drug Benefits 

Drug plans are one of the main attractions in a benefit package for a plan member and is one of the most highly used benefits by two thirds of plan members. A range of drug plan and drug formularies can be tailored to suit your organization’s needs; allowing you to better manage your prescription drug benefits versus costs while still providing your plan members with coverage they value.

You may choose from plan designs offering a range of coverage, including the following managed drug plan:

Prescription drug plan:  Prescription drugs are a fast-rising cost component of group healthcare claims due to cut-backs in government-sponsored plans, Canada’s aging population and the introduction of new, more expensive drugs. The plans provide coverage for drugs that require a prescription for dispensing or for sale; which includes some life-sustaining drugs which may be available without a prescription; or may include or exclude over-the-counter drugs.

Claims Payment Options:  You can choose the method of claims payment your plan members will use for their drug purchases.

Reimbursement: This is the traditional payment option where plan members pay for their prescriptions at the time of purchase and submit their claims on paper for later reimbursement.

Pay-Direct Drug Card: This system allows for on-the-spot claims processing of prescription drugs at almost any pharmacy in Canada. A plan member presents his or her card to the pharmacist, who submits the claim electronically. The plan member’s eligibility and drug coverage is confirmed and he or she pays only the portion not covered by the plan.

Deferred drug card: This system is similar to on-the-spot processing of prescription drugs submitted electronically by the pharmacist at the point of sale. The plan member pays for his or her prescriptions and is reimbursed by cheque once a dollar-amount or time-period threshold is reached.

Note: Plans and coverage will also vary depending on the carrier used.

Group Benefits Overview 

We understand that your business is unique; whether you have ten or thousands of people working for you. Group Benefits typically include life, disability, health, and dental insurance coverage and many include other benefits such as Accidental Death and Critical Illness insurance, Health Spending Accounts and wellness programs. The advantage to the employer is that these benefits attract and retain quality employees. When corporations aim to acquire top employee talent they often are drawn to provide a superior employee benefits package.

What are the benefits for your business? A well-designed group insurance plan tailored to your employees adds exceptional value to your total compensation package. Often the best employees view their benefit plan as a major reason why they stay with their current employer.

 Comprehensive group insurance plan can help you to:

• Attract high-quality employees
• Imparts trust that your company cares about family values and health
• Maximizes loyalty and reduces turnover
• Encourages a healthy work environment
• Improves productivity while it reduces absenteeism
• Pays compensation in a tax-effective manner
• Sets you apart from your competitors

Benefits for your employees:  Group insurance plans can offer financial and health solutions to your employees and their families in many areas including:

• Prescription drug care
• Dental care
• Supplementary medical services
• Life Insurance
• Accidental death and dismemberment insurance
• Disability – Income Replacement Plans
• Critical Illness Plans
• Hospitalization

Every group has unique requirements. Group benefit plans vary depending on the size of the group, your business objectives and financial budget. Once assessed, we will recommend a plan that makes the most sense for your business. You can also address any challenges you’ve had with your current group insurance carrier as we work with them to help resolve any issues. Prior to your policy’s renewal date, we ensure that your policy continues to meet your company’s and employees’ needs while you continue to receive coverage, service and pricing from your carrier.

Let us evaluate the market for you. We will submit a request-for-proposal to all potential insurance carriers to obtain the best plan at the most affordable price. Once you decide to move to another carrier, we will help you transition as we become your new benefits consultant. You will receive personal assistance during the entire transition. We will keep in touch with you on a regular basis to stay up-to-date on what’s important to your business and employees and act as your liaison with your carrier when necessary.  We work for you and in your best interest.

Keeping cost to a minimum. You can choose to fully cover the cost of insurance or share it with your employees. Moreover, you can offer your employees the opportunity to purchase individual life, disability and critical illness coverage. Individual insurance provides enhanced life and health coverage where long-term ownership via portability is valued by certain employees.  We will help you determine a plan that minimizes the cost impact on your company and will continue to advocate for you each time your plan is renewed, to ensure you still receive the best rates possible.

Note: Plans and coverage vary depending on the carrier used.

Extended Health Care
Extended Health Care benefits, also referred to as major medical benefits, are designed to supplement existing provincial hospital and medical insurance plans. The benefit provides for reimbursement of expenses and services not covered by existing government plans. Extended Health Care benefits can be divided into several categories which include:

• Hospital coverage
• Drug coverage
• Medical supplies and equipment
• Paramedical services
• Out-of-province coverage
• Other health care benefits

The plan may include a deductible and/or a coinsurance factor (e.g. 75% reimbursement for prescription drugs), and maximums (e.g. $500 per calendar year for chiropractor).

Vision Care

Vision care is not a fairly common feature of many benefit plans. This optional benefit provides coverage for eye examinations, eyeglasses, contact lenses and laser eye surgery, whereas safety glasses and prescription sunglasses are generally excluded. Vision care can be included in most benefit plans just by inquiring through your benefits broker.

Group Life Insurance Benefits

When defining solutions that truly fit your business needs we will look at:

– Stronger service that works with you. We work with you to reach your service requirements.

– Fitting your flexible needs. Regardless of your group’s size—from five to thousands—we can design a benefits plan that fits.

The following areas are generally considered in a benefit plan relating to Group Life Insurance.

Employee Basic Life

Basic life insurance pays a contract-specified amount in the event of the death of an employee from any cause. Premiums paid by the employer on behalf of the employee are a taxable benefit; however, benefits received are non-taxable. Some of the main features of a basic group life plan are:

Benefit Schedule: The amount of coverage is generally based on either the employee’s earnings or salary (e.g. 1 x salary, 2 x salary, etc. ) or a flat amount from  $25,000 to $500,000.

Non-Evidence Maximum (NEM):  This is the minimum amount of coverage for which all employees are eligible (subject to income requirements). This is a great benefit for employees who may not qualify for an individual life insurance policy.

Waiver of Premium Continuance of Life Insurance coverage while premiums are waived is generally available to employees age 65 or younger, under the regular care of a physician, who become totally and permanently disabled for a period, typically 4 months.

Waiver of Premium Conversion Privilege If a plan is to terminate when an employed no longer qualifies for coverage as an employee, the conversion privilege allows the policy to be convertible without medical evidence to a permanent plan owned by the insured according to plan specifics.

Dependent Basic Life

Dependent Basic Life is a flat coverage offered to the spouse and dependent children of an employee; the spouse’s coverage is generally higher than that available for children for whom it becomes effective at live birth or 14 days after birth and continues until the child is 21 years of age (25 years if in full-time attendance at school or university).

Employers can share paying the premium, or have employees entirely pay; the benefit is payable to the covered plan member upon the death of the dependent.

Benefit Amount:  Generally $5,000 is the face amount of coverage for a spouse; $2,500 per a dependent child; or $10,000 for a spouse and $5,000 per dependent child; while higher amounts may be available.

Employee (and Dependent) Optional Life Benefit

This benefit allows employees and sometime the spouse and/or the children (referred to as Dependent Optional Life); to supplement and pay for more life insurance coverage over that which is provided by their benefit plan (some as high as an extra $1,000,000). Medical evidence is required and coverage usually ceases at age 65 or the employee’s retirement.

Accidental Death & Dismemberment (AD& D)

This benefit provides protection where an employed plan member incurs a loss, or loss of use of: life, limb, sight, hearing, and/or speech due to an accidental injury (usually on a flat amount of coverage e.g. $25,000, $50,000, $100,000 or as a multiple of salary, e.g. 1 x salary, 2 x salary).  This benefit may also be referred to as “double indemnity insurance” as it doubles the benefit for plan members who die as a result of an accident. 24-hour coverage is common covering accidents that occur both on and off the job; though coverage can be provided on a 24-hour non-occupational basis.
AD & D frequently covers both “loss”(meaning an actual severance) and “loss of use”(meaning total and irrecoverable loss of use).