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Category Archive: News


  1. New Leave of Absence Legislation

    Ontario has made changes effective October 29, 2014, to the Employment Standards Amendment Act (ESA), through the addition of three new “leaves of absence” which have been designed to help families. There are a number of important items that as an employer you will want to be familiar with. For example, the Family Caregiver Leave has no requirement for the length of time an employee must be employed, while the Critically Ill Child Care Leave and Crime-Related Child Death or Disappearance Leave require an employee to be employed for 6 consecutive months to be eligible for these leaves. More details on these job-protected leaves are as follows.

    Family Caregiver Leave
    Up to eight weeks of unpaid, job-protected leave for employees to provide care or support to a family member with a serious medical condition. Family Caregiver Leave may be taken to provide care or support to certain family members for whom a qualified health practitioner has issued a certificate stating that he or she has a serious medical condition.
    Family Medical Leave is another job-protected leave available under the Employment Standards Act, 2000 (ESA) for employees with certain relatives who have a serious medical condition. One of the main differences between Family Caregiver Leave and Family Medical Leave is that an employee is only eligible for the latter if the family member who has a serious medical condition has a significant risk of death occurring within a period of 26 weeks.

    Eligibility
    All employees, whether full-time, part-time, permanent, or term contract, who are covered by the Employment Standards Act, may be entitled to Family Caregiver Leave.

    There is no requirement that an employee be employed for a particular length of time, or that the employer employ a specific number of employees for the employee to qualify for Family Caregiver Leave.

    Care or support includes, but is not limited to,: providing psychological or emotional support,; arranging for care by a third-party provider,; or directly providing or participating in the care of the family member.

    The specified family members for whom a Family Caregiver Leave may be taken are:
    • the employee’s spouse (including same-sex spouse)
    • a parent, step-parent or foster parent of the employee or the employee’s spouse
    • a child, step-child or foster child of the employee or the employee’s spouse
    • a grandparent or step-grandparent of the employee or the employee’s spouse
    • a grandchild or step-grandchild of the employee or the employee’s spouse
    • a spouse of a child of the employee
    • a brother or sister of the employee
    • a relative of the employee who is dependent on the employee for care or assistance.
    The specified family members do not have to live in Ontario for the employee to be eligible for Family Caregiver Leave.

    Critically Ill Child Care Leave
    Up to 37 weeks of unpaid, job-protected leave to provide care to a critically ill child.

    Eligibility
    Critically Ill Child Care Leave may be taken to provide care or support to a critically ill child of the employee for whom a qualified health practitioner has issued a certificate stating:
    1. that the child is a critically ill child who requires the care or support of one or more parents, and
    2. sets out the period during which the child requires the care or support.

    A “child” means a child, step-child, foster child or child who is under legal guardianship, and who is under 18 years of age.
    A “critically ill child” means a child whose baseline state of health has significantly changed and whose life is at risk as a result of an illness or injury. It does not include chronic conditions.
    All employees who have been employed by their employer for at least six consecutive months and who are covered by the Employment Standards Act, 2000 (ESA) may be entitled to Critically Ill Child Care Leave, whether they are full-time, part-time, permanent or term contract.

    Crime-Related Child Death or Disappearance Leave
    Unpaid, job-protected leave for parents whose child is missing or has died as a result of a crime.

    Eligibility
    Employees who have been employed by their employer for at least six consecutive months and who are covered by the Employment Standards Act, 2000 (ESA) are entitled to Crime-Related Child Death or Disappearance Leave if it is probable, considering the circumstances, that a child of the employee died or disappeared as a result of a crime.
    An employee is not entitled to this leave if the employee is charged with the crime or if it is probable, considering the circumstances, that the child was a party to the crime.
    “Child” means a child, step-child or foster child who is under 18 years of age.
    Generally speaking, crime means an offence under the Criminal Code of Canada.
    This information has been sourced from the Ontario Ministry of Labour website at http://www.labour.gov.on.ca/english/es/pubs/guide/caregiver.php

  2. Mental Health

    It is estimated that 1 in 5 people will experience mental health problems in any given year. The remaining 4 will have a friend, family member or colleague who will be challenged with mental health issues. In Canada, There are 500,000 Canadians absent from work every day. Mental Health is the number one cause of disability in Canada, accounting for nearly 30% of disability claims and 70% of total claims. Approximately 20% of people with a mental disorder have a co-occurring substance use problem. The estimated cost to the Canadian economy in terms of health care and lost productivity is $51 billion or $34 billion is the cost to the Ontario economy. According to the World Health Organization, depression will be the single biggest medical burden on health by 2020.

    In spite of the numbers affected, there is still a stigma associated to mental health. Only 50% of Canadians would tell friends or coworkers that they have a family member with a mental illness, compared to 72% who would discuss a diagnoses of cancer.

    Employers can assist by training their front line managers to recognize mental health issues and offer solutions for building a mentally healthy workplace culture, such as providing an Employee Assistance Program (EAP) which offers a large array of tools, information and support. This kind of benefit can educate and arm your managers on how to be more effective in addressing those situations and help to reduce the stigma surrounding mental illness.

    Employers should check their Employee Benefits provider websites as many insurance companies provide online information on their websites, as well as offer materials and webinars available for managers. Should you have difficulty locating resources, contact BIS for assistance.

  3. Biologic Drugs & Subsequent Entry Drugs

    Biologic drugs have been available in Canada and elsewhere since the 1970’s and are used to treat a wide variety of diseases, including cancer, rheumatoid arthritis, multiple sclerosis and diabetes. Health Canada defines a biologic as a product manufactured from animals or micro-organisms through the metabolic processes of the organisms themselves. They are inherently more complex than chemically synthesized pharmaceuticals and are much more difficult to produce. Examples of biologics include insulin, vaccines, blood components, protein hormones and gene therapy products.

    Biologic drugs currently comprise between 14 – 16 percent of the Canadian pharmaceutical market and cost the Canadian health care system more than $3 billion annually. However, despite their effectiveness, the extraordinarily high cost of biologics has been a barrier to increased use. For example, it can cost $30,000 annually to administer Remicade to a patient suffering from ulcerative colitis, or $17,000 each year to treat one patient with rheumatoid arthritis who is prescribed Enbrel.

    Regulatory agencies in Canada, the United States (US), the European Union (EU) and other developed countries have attempted to address the cost issue by allowing generic pharmaceutical companies to produce their own versions of previously approved, or reference biologics. Due to the complexity of these products, and the difficulties in producing exact replicas of a reference biologic, most countries have adopted terms other than bio-generics to describe them. Health Canada, which unveiled its regulatory framework in March 2010, has chosen the term Subsequent Entry Biologic (SEB). This new regulatory framework creates an opportunity for subsequent entry biologics to become as significant a therapeutic option as the small-molecule generics have become. However, SEBs are not interchangeable with the current biologic drugs offered and we will not see significant savings generated, such as we witnessed when generic drugs were introduced into the
    marketplace.

    The above is an important trend to consider when considering plan design alternatives.

  4. Ontario Trillium Drug Benefit

    You may be eligible for Ontario’s Trillium coverage if you do not have Drug benefits through a group plan, or if you have benefits but have exceeded the group plans annual drug or plan maximum. There is a requirement that the drug costs claimed must exceed 4% of your household total income to be considered eligible for coverage through this program.

    The Trillium program has an annual deductible, which is approximately 4% of your combined household income. This is paid in 4 instalments throughout the year. You may also have to pay a $2 per prescription deductible.

    Based on a $75,000 combined household income (including kids over 16), the deductible for Trillium would be $3,000 or $750 quarterly. In this instance, once your claims reach this $750 deductible, Trillium will provide coverage for the remainder. This coverage continues until the beginning of the next quarter when the deductible will need to be satisfied again.

    The claims year coincides with the Ontario Drug Benefit plan, which is August through July.

    Application kits for Trillium benefits may be obtained from most pharmacies or by calling 1-800-575-5385.

    Please consult the following website for further details.
    http://www.health.gov.on.ca/en/public/programs/drugs/programs/odb/opdp_trillium.aspx

  5. Benefit Awareness

    We are entering an interesting era in benefits with some group plan designs cemented in place through negotiated arrangements, and employers struggling to offer more for less. Few benefits address employees’ needs proactively, with the exception of a few. Most noteworthy is an Employee Assistance Program (EAP). Employee’s benefit with resources through a professional organization providing assistance when they need it, 24/7, in the way they choose to access it: online, telephone, or in person. The cost for such a program is small, especially when you consider the financial payback in fewer absence days and healthier employees. An Employee Assistance Program can be one of those few benefits that will give you back more than you will pay for it.

  6. New Hepatitis C treatment

    A new Hepatitis C treatment (Solvaldi), approved for use by Health Canada in December 2013, will have a significant impact on all insurance carriers and policyholder plans. This drug is reported to cure 90% of those suffering with Hepatitis C; an amazing medical breakthrough! But it comes at a cost to group plans with the expected cost for a minimum 12-week course treatment at $1,000 per pill, representing a total cost of $84,000. Having the right plan design, financial arrangement and advocate in place will be critical to how this evolution in medicine will impact your group plan.

  7. Beneficiary Designations

    When a plan enrolls with a new carrier, employees are required to complete a beneficiary designation on their insurance enrolment form. In doing so, they ensure their requests will be met in the event of a life insurance claim.

    For this reason, it is important employees are aware of a few important requirements when completing any beneficiary designation.

    • The beneficiary designation must bear an original signature in permanent ink and must be dated.
    • The insured employee must initial any beneficiary designations that include a change or correction. Whiteout changes are not accepted.
    • The beneficiary must be a person who is of legal age (18 or over), or, if the beneficiary is a minor, the employee must appoint a trustee to act on the minor’s behalf until the beneficiary reaches legal age.
    • It is important to remind employees on an annual or bi-annual basis to update their beneficiary designation to ensure information on record is current.

    Group Out of Country – Important Restrictions

    It is important to note a few significant limitations regarding most out-of-country insurance group policies. They may differ by provider, but for the most part contain the following restrictions you should be aware of:

    The number of days that you will be covered is typically limited per trip. For trips over 30 days, be sure to check with your provider.

    Most carriers today will include a pre-existing conditions or stability clause to ensure only healthy people who are not expected to have a health emergency are provided the coverage. Should you have a health condition, contact your carrier to confirm your eligibility for out-of-country coverage.

    Keep your travel information handy and be sure to let those travelling with you know where your documents are located. A great place is storing it with your passport.

    Should an emergency arise, be sure someone calls your out-of-country provider within 48 hours to reap the full benefits of what is offered and to ensure the service provider will intervene. This information is in your booklet and on your wallet card. Failure to do so can result in payment delays to your healthcare providers.



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231 Main Street West, Main Floor
Hamilton, ON
L8P 1J4
Phone: (905) 777-9990
Email: rmarsh@bisinc.ca