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Category Archive: News

  1. As an employer, do your group benefits expose you to legal risk?

    Do your group benefits expose you to legal risk?

    Technological innovations have made group plan administration easier than ever. With online enrolment and online claims processing and billings, both you and your employees can interact and manage your benefits plans anytime, anywhere.

    But with this evolution, there has been a shift in where the burden of responsibility and liability lies. While employers have empowered their people to self-manage many aspects of their benefits plans, employers still maintain responsibility should any issues arise, and naturally, there can be legal implications. The shift to a do-it-yourself model has been great, but you are still responsible for ensuring your people know how to use their benefits plans and what their coverage entails.

    There are many responsibilities to consider, but for this article we have focused on the following three main areas:

    • Enrolment forms
    • Life events
    • Staying current

    Always get complete, accurate enrolment forms

    It may sound simple, but having every employee complete an enrolment form is a critical piece of the administration puzzle. This one document ensures the employee is enrolled, registers a legal beneficiary in the event of death, and binds the carrier to insure all those listed in the document. Without this document properly completed and submitted within 31 days of being eligible for the group plan, there can be carrier denials that may cause the employee to pursue legal action, depending on the situation.

    Stay on top of life events

    A “life event” is a term insurance carriers use and is a key rule within a group insurance plan. Life events allow an employee to make changes without any medical questions asked, such as a change in marital status, an addition to the family, or when a spouse has a job change that affects benefits. Carriers will allow these changes to be made as long as they are considered a life event, by the carrier’s definition, and they were advised within 31 days of the change. Failure to provide proper notice can result in denial. When this occurs, the employer can be at fault and could be legally liable. It’s for this reason that employee education is important: it ensures that employees are aware of the requirement, and protects employers as it confirms that they have done their part to assist employees in managing this detail.

    Keep employee and beneficiary information current

    Enrolment forms include both the beneficiary and the income, two key pieces of information that should be updated regularly. The income reported on group insurance plans can affect the level of insurance for life insurance, AD&D and short- or long-term disability, if applicable, and requires regular updates to ensure there are no errors concerning employee information. Errors can cause an issue at claim time that is easily avoided if administration updates are part of the employer’s process. All employee beneficiary designation forms should be updated regularly to ensure they reflect the employee’s current intent. Making this a part of an annually scheduled process to remind employees of their responsibility to update their beneficiary goes a long way in reducing any legal liability for an organization.

    It’s surprising just how important that enrolment form is! If you’d like to discuss this or any of the other due diligence items we regularly review with our clients, please contact Steve Marsh at Business Insurance Services or 905.777.9990, ext. 200.

  2. Three reasons why group benefits are so costly — and how you can address them

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    Group benefit costs continue to rise, but that’s not something you don’t already know. What you might not realize is why.

    Naturally, there are many varying reasons for general rate adjustments, and we don’t need to discuss the various justifications for why health and dental costs are on the rise. But it is worth reviewing the deeper-seeded components that factor in to plan costs — especially because, as an employer, you have some measure of control over these costs.

    Let’s take a look at three of them:

    Plan Design. This could be the greatest factor in why your costs are going up. If your plan is above industry norms, you will be attracting more claims from employees but also from their dependents, as under coordination of benefits (where a couple both have coverage), you will pay what other plans wouldn’t. Have you safeguarded against abuse and over-utilization in your plan? We are living in changing times, so if your group plan hasn’t changed, you are going to have more financial pressure than you can may be able afford. The changes we are talking about are not the typical benefit cutbacks, but rather a more forensic approach to benefit design that explores what your employees truly need. This type of review will reinforce the sustainability of your group plan.

    Claims Usage. The cost of your plan is directly correlated to claims paid. This requires us to focus on specific benefits, such as your health and dental, as these typically represent 60% of your total group benefit budget. And while this ties directly into the plan design you offer, it is also impacted by the mindset of your employees. Some employees will treat their group plan as an entitlement, with little regard for how the plan is used as it is company money, not their own. For this reason, engaging employees in the relationship between claims and costs and arming them with knowledge about why it is in their best interest to always be an aware consumer, even when it concerns their benefits, is critical to improving the results of your group plan. Corporate culture can have a significant bearing on your ability to partner with your employees and impact your bottom line.

    Carrier Costs. Have you noticed how complicated group benefits are getting? This confusion can frustrate employers and encourage rash decision-making over detailed analysis. However, a carrier’s costs can absolutely be an important factor in the group benefit cost conundrum, and avoiding it can quickly exacerbate the costs. Only through in-depth analysis by a group insurance expert/advisor can you confirm if you are paying too much for your plan. You can always market your group plan to test for competitiveness, but unless your advisor knows how the pricing of a plan works, you are likely boomeranging back to the same scenario, with a bad first renewal. So scrutiny of all the components of your plan’s costs is required to ensure you are obtaining real savings and can avoid the costly process of switching carriers cyclically.

    If you would like to explore the unique tools we use to address these key group benefit factors, please contact Steve Marsh at Business Insurance Services or 905.777.9990, ext. 200, today.

  3. Virtual Doctor Services: Are You Ready to Offer This Benefit to Your Employees?

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    We’re living in an era where things change fast! We’ve seen it as technological advances are made in so many areas, from home appliances and automobiles to communications. Medical services are no exception, as we’re currently seeing the emergence of virtual doctor services.

    The concept is just as you’d surmise, given the name. Where offered, an employee has access to a doctor, via video, on their phone or using their computer. Some insurance carriers have aligned themselves with a specific provider, but where a carrier does not offer this option, it can be purchased direct from a provider of virtual doctor services. There are many different options, and pricing for this new benefit can be just as varied, ranging from $3.00 to $15.00 per employee, per month.

    Ultimately, the level of service and attention to detail will differentiate one virtual provider from another. However, when looking to add this new benefit to your plan, the key is knowing what services a provider offers and how they impact an employee’s current medical provider. Only private virtual doctor services work outside of the Ontario Health Insurance Plan (OHIP) and as a result, virtual visits to a doctor have no impact on the employee’s family doctor OHIP billing. This type of provider is more costly, but also seems to provide the highest level of service.

    With hospital emergency room wait times ballooning and some geographical regions having wait lists for family doctors, it’s no wonder this benefit evolution has occurred. One provider’s experience shows 40-50% of employees with this benefit will use a virtual doctor app on their phone. Those who have used the service love its convenience and found the level of care excellent. They found it easy, timely and efficient to get an answer, and appreciated the convenience of having their prescriptions sent right to their local pharmacy for quick pick-up. In many cases, easily resolvable health issues that previously required taking time off work and a longer duration of suffering were quickly addressed and remedied. The service is quick to refer employees when situations require more direct medical attention, but many needs can be addressed using this application.

    This kind of virtual service will have a profound impact where family doctors are not readily available and should also reduce employee absenteeism and improve productivity. Some employers even look at this as a hiring benefit to attract new talent. The key is to fully understand the services offered to your employees to ensure the cost/benefit analysis is aligned with your corporate philosophy. For more information on what your options are, contact Rosemary Marsh at Business Insurance Services today.

  4. If you have travel coverage in your group plan, do you need to buy individual travel coverage for your trip?

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    Travel coverage has evolved of late. This is in part due to the world becoming a smaller place and many of us travelling more frequently. We are often asked whether employees should buy individual travel coverage or rely on the group plan’s travel coverage. All plans differ and so the key is to know what your plan provides and what the stability clause is in any travel plan.

    Stability Clause: This terminology refers to what criteria a carrier uses to access if an employee is medically safe to travel. The most common stability clause requires that an employee must be medically stable for the 90 days prior to travelling. This sometimes means no substantial change in medication, no unconfirmed test results, no health conditions not yet fully diagnosed. If an employee cannot meet the carrier’s definition of medically stable, he or she will not pass the stability clause and will not have travel coverage for any pre-existing condition.

    For the above reason, there is no straight answer to the travel question, Should you or shouldn’t you buy extra coverage? It all depends on your medical situation and the restrictions within your group travel policy.

    Please note, should an employee have a pre-existing condition that disallows his/her group travel coverage, there is an individual travel policy where stability is measured in the 7 days prior to travel. So be sure to inquire by contacting your travel carrier to better understand your plan’s medical limitations, should you be concerned. Better to know up front what you are and are not covered for to allow you to explore your travel coverage options.

    If you’d like more information on options to consider when you have a pre-existing condition, please contact Steve Marsh at or 905-777-9990, ext. 200

  5. Don’t have time to manage your benefits? Too busy doing other, more important things? Does it really matter to your bottom line?

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    We are living and working in fast times. With the technological revolution, it is no surprise that we often hear clients say that they just don’t have time to manage their benefits the way they would like to. Yet consider that group benefits cost an employer, on average, $3,500 per employee per year. With inflation this number is fast approaching $4,000 per employee per year, so maybe the question should be: How much are benefits affecting your bottom line?

    The real issue is how to find the time. This is where a trusted advisor can assist your organization. Someone who understands the group insurance business from the insurance carrier side, inside and out, and who can do the leg work that is required to ensure your plan is well designed, managed and negotiated, is key. Find a broker who will spend the time to analyze your group plan and understand your corporate culture and who is willing to invest the time needed to create the best group benefit solution for you and your employees.

    A seasoned group insurance advisor should understand how the insurance carrier/ industry and benefits work and be able to educate you and your employees by simplifying the information in written form, in person or via a multi-media format. We call this cutting through the benefit noise. Understanding group insurance doesn’t have to be complicated as long as a broker you trust is advocating for you and keeping watch over your numerous priorities in order to protect the interests of your organization.

    If you’d like to learn more about what we do for our clients and the creative ideas we implement to protect their plans, please contact Steve Marsh at or 905-777-9990, ext. 200.

  6. What you need to know about cannabis

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    There is so much updated information to share about cannabis. With this in mind, the following is a short summary of the most important things you need to know.

    In most organizations, human resource professionals are adding cannabis to their policies and procedures. It falls in line with other procedures already established under substance abuse. For the most part, pundits suggest little will change in recreational cannabis usage after legalization, but only time will tell.

    Understanding more about cannabis is important to developing your policy. Cannabis has more than 85 molecules or active ingredients, but the two most popular and talked about are THC and CBD. THC (tetrahydrocannabinol) is the molecule within cannabis that provides the hallucinogenic properties or what is referred to as the high. CBD (cannabidiol) does not contain hallucinogenic properties, which is why someone can medically be using cannabis and still be fit to drive.

    Cannabis does not yet have a Drug Identification Number (DIN) or Natural Product Number (NPN). As a result, it is not regularly included under a carrier’s formulary group drug plan. A few carriers have added a cannabis benefit that will allow an employer to add cannabis to their healthcare plan. To date those carriers are Sun Life, Green Shield and Manulife; Great West Life and GroupHEALTH have announced they will add this benefit in January 2019. A cannabis benefit could range between $1,500 and $6,000 per person, per year and requires a prescription to be eligible, but only for certain, specific medical conditions as defined by each carrier. By restricting this benefit to only certain medical conditions, the carrier is preventing the plan from reimbursing for recreational cannabis use.

    For those employers who have a Healthcare Spending Account (HCSA), the Canada Revenue Agency does allow cannabis and cannabis seeds to be reimbursed as an eligible expense, when prescribed by a doctor.

    With this new cannabis industry erupting, we will continue to see things evolving in this arena. For this reason, please note the above summary reflects information as at October 15, 2018. For more updates or advice on how to engineer your organization’s response to this upcoming change, please contact Steve Marsh at or 905.777.9990, ext. 200.

  7. ASO Pros and Cons June 2018

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    Pros and Cons of ASO

    Employers often hear about group insurance concepts that are not as familiar to them. This review is designed to assist in understanding a complex concept: ASO. Every group insurance plan is in the form of a contract. The most common contract for health and dental benefits is an insured group contract. Another option is an ASO (Administrative Services Only) contract. What does an ASO contract mean? Exactly what it states: this type of group contract includes only the administrative services of the insurance carrier to adjudicate claims. An ASO, therefore, has no insurance element included for health and dental benefits. There are times when an ASO makes perfect sense, but there are also times when employers should avoid this type of contract. To assist employers in finding the right group insurance contract to fit their goals and needs, we have outlined the main pros and cons of an ASO.


    Cost: Under an ASO contract, the cost the carrier charges for running the plan can be lower by a few percentage points. This cost is often referred to as the Breakeven (BE) or Target Loss Ratio (TLR).

    Surpluses: Under an ASO arrangement, there can be surpluses paid back to the employer if the premiums paid are not fully consumed by the ASO charge for adjudicating the claims and the actual costs of the claims. Surpluses can develop and grow over time if the plan is properly funded.

    Flexibility: There can be more flexibility with an ASO contract to pay claims that are not technically eligible under the normal terms of an insured health and dental contract. This occurs because the carrier has no risk in making exceptions to an ASO contract since the employer pays 100 of the cost.

    Reserve flexibility: Some ASO contracts will exclude reserve requirements. Traditional insured plans establish a reserve or slush fund to pay for the late claims, referred to as run-off, that will be received by the carrier after the employer termination date of the contract. Under most ASO contracts, a reserve is not required. For this reason, an ASO contract can reduce costs when compared to an insured contract. Note that some carriers can offer special arrangements allowing an insured contract to include this same advantage.


    Deficits: When claims are higher than the premiums that have been paid into an ASO contract, a deficit will occur. The insurance carrier will require this deficit to be paid immediately. When there is no surplus in an ASO, it can be alarming to employers, especially if they haven’t clearly understood this risk. It is for this reason that historically only larger employers were considered for ASO contracts. But today, many advisors prospecting clients will use an ASO approach to attack the cost of an insured group plan, without addressing the possibility of having to pay back a deficit on demand. This is a critical reality as there is no negotiating the claims cost of an ASO contract.

    Cost Fluctuations: Under an ASO contract, there is no negotiating with a carrier to spread the cost impact over a longer period of time. In an ASO, the claims costs equal the premium−no discussion.

    Plan maximums: Critical to a successful ASO contract is either a spread of risk (through the volume of a larger number of employees) and/or plan design features that control costs. For this reason, implementing maximums and caps on benefits is essential to protecting against the growing issue of rising claims costs. This doesn’t always suit employer visions for their benefits plan, but it is a critical component to ensuring long-term success under an ASO contract.

    Carrier focus: Given that the carrier is responsible only for the paying of claims, there can be less concern for the trends and mechanics of a plan, as the carrier does not share in the financial outcomes. Employers will be required to become more engaged and scrutinizing to ensure their interests are served, to ensure a plan runs well from all aspects.

    Pooling charges: Pooling is a type of claims cost-share between the employer and the carrier and is incorporated into almost all plans today. It is designed to share the risk of higher cost claims. Under all plans, it is either included in the healthcare rates or separately priced as its own benefit, depending on the carrier. Each carrier has a different pooling threshold. Some carriers offer pooling protection beginning at claims totalling $10,000 per person per year, while others have increased their threshold for pooling claims to $15,000 per person per year. The higher the pooling threshold number, the more financial exposure an employer has. The number of claims being pooled today is increasing exponentially due to the rising cost of drugs. This trend has resulted in significant increases in all pooling arrangements with all carriers. However, the ASO pooling charge is the most expensive given the carrier must bear the full brunt of the pooling claims exposure alone, as ASO contracts do not qualify under the industry pooling EP3 arrangement (the industry pool where all carriers participate); other insured plans do qualify. Consequently, ASO pooling charges are higher and are seeing even more substantial increases than traditional insured plans.

    For more information on the above, or to get answers to any questions you may have regarding ASOs, please contact Rosemary Marsh, Managing Partner, Business Insurance Services,, or contact any BIS team member at

  8. 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.

    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.

    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.

    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

  9. 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.

  10. 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

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


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231 Main Street West, Main Floor
Hamilton, ON
L8P 1J4
Phone: (905) 777-9990