We offer flexibility when it comes to choosing the right plan design and benefit options to offer your staff. Let's build a program unique to your needs and budget.
What's In a Plan
A Group Insurance plan typically consists of 2 components. The Core Benefits, and the Extended Coverage. All eligible employees or members of the class need to enroll in the core benefits of the plan. Plan members can choose to opt out of the Extended Coverage, if they have coverage through their spouse or through a private plan.
Core Benefits
Paired with Accidental Death and Dismemberment Insurance. Plan designs can include a flat amount, or can be based off multiples Annual Income. A group employee benefits plan does not replace a life insurance policy, but can be used in tandem with a private policy to reduce costs and provide sufficient coverage.
Accidental Death and Dismemberment (AD&D) are paired with Life Insurance and are structured in the same fashion. The benefit offers coverage for loss of limb, blindness, deafness, or accidental death.
Life insurance for eligible dependents under the covered plan member. This typically is the employees spouse and their children/ dependents. Coverage can range from $25,000 to $2,500 per dependent.
Disability is classified into two categories:
Short Term
Referred to as Short Term Disability or as a Weekly Indemnity, and covers your employees for loss of weekly income up to a maximum of 26 weeks. Short term can be paired with Long Term Disability, if the disability is going to keep the employee away from work for a longer period of time.
Long Term Disability
Long Term Disability offers monthly payments to your employee for any long term illness or injury in the event they qualify and cannot work. Long Term Disability usually has a waiting period before taking effect, and works in tandem with WCB.
Upon diagnosis of a serious or life threatening illness, a Critical Illness benefit will provide the employee a lump sum tax-free payout once the survival period has been satisfied. A typical policy can have a survival period of between 30 to 180 days.
Extended Coverage
A drug plan can range ffrom 70% to 100% co-insurance (Coverage). The plans generally have a maximum amount per person per year. Any employee who is on an expensive drug, or will reach their limit, can go onto an extended or addon plan. Please call our office for more information on these options. Most plans can also offer direct billing from the pharmacy, to eliminate upfront costs to your employees.
Extended Health Care is a term to cover additional services not covered by the provincial health plan. Services include ambulance, semi-private and private hospital rooms, medical equipment and supplies, and emergency travel insurance.
Paramedical services are usually included in Extended Health Care. These include visits to licensed practitioners such as, Massage Therapists, Chiropractors, Psychologists, Acupuncturist, Dieticians, and naturopaths. Different insurance carriers will cover different specialists, and typically give a maximum amount per specialist per calendar year.
Some times covered in Extended Health Care, vision can be an addon or a separate option. Vision amounts are usually calculated for a 24 month period, and cover regular checkups and the purchase of glasses frames, lenses and contacts.
Dental Coverage is typically broken down into 2 categories:
Basic Dental
Basic Dental services are regular checkups to the dentist. They include, cleaning, exams, pictures, scaling, and polishing.
Major Dental
Major Dental options can be added to a plan, which include coverage for crowns, bridgework, dentures, and inlays.
Orthodontics Services which cover braces are usually an additional addon to a plan. Most carriers require you to have a minimum number of staff to get Orthodontic coverage. The number changes from 5+ employees to 10-15+ employees depending on the insurer.
Plan Types
Traditional Plans
Traditional plans are rated based on usage (experience). The insurance company sets up the plan to try and bring in more premiums then it pays out. This is done by monitoring the Loss Reserve Ratio or the Percentage of premiums vs claims made. Under a traditional plan, premiums may decrease or increase at renewal, as the insurance company adjusts the rates to keep the ratio stable. Ratios can fluctuate depending on the carrier from as high as 70% to 90%.
Pooled Plans
Pooled plans combine a basket of companies to help mitigate heavy claims. Pooled plans will typically start with higher rates to a Traditional Plan, but will have more favorable renewals. By having multiple companies involved in the pool, sudden increases in plan usage, will not affect the premiums as much. This is a great option for companies that will have heavy claims made on their plan, since they will not see heavy premium increases at renewal time.
Administrative Service Only
Commonly referred to as ASO. Under an ASO plan, the insurance company only collect an administrative charge from the company. The premiums it collects are pooled for the company to make claims with. Reserves belong to the company and will need to be increased if they drop to low. The rates on an ASO plan are typically the lowest in the industry, since the company carries the risk of insuring the plan. ASO plans are a great option for larger companies, that can spread the risk.
Additional Coverage Options & Services
Employee Assistance Programs
An Employee Assistance Program can offer assistance to plan members and their dependents that cover initial counselling sessions or help finding the right care providers. This is a confidential service designed to support the employee and aims to support mental health and healthy lifestyles.
HRIS Systems
Human Resource Information Systems allows employees and employers interact through a simple technology platform or app. This can help manage tasks such as onboarding, HR functions, time tracking, and can even be connected to your benefits administration and payroll making for an easy and streamlined tool to manage your entire team.
Health Spending & Wellness Accounts
Health Care Spending Accounts are pre-set accounts (amount set by the employer) that allow employees to choose how they spend the non-taxable funds. Typically these funds can be used for additional health services or products. Have a look HERE to see what’s covered.
Wellness Accounts encourage employees to live active healthy lifestyles. Different from the above, these taxable funds can be spent on eligible expenses like gym memberships, or even personal development.
