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Tag Archive: group benefits plan

  1. Pharmacogenetics: What is it, and what does it have to do with your benefits?

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    Pharmacogenetics: What is it




    1. the branch of pharmacology concerned with the effect of genetic factors on reactions to drugs

    What you need to know about pharmacogenetics

    Pharmacogenetics: Have you heard this new term being mentioned in different health discussions? It’s one of the latest evolutions in drug tests, and it has now reached the group benefits arena. This advance now enables testing to determine a person’s genes’ response to a drug, before actually taking the drug.

    Pharmacogenetics is the study of inherited genetic differences in our drug metabolic pathways. It’s one of those differentiating factors that impacts one person’s response to a drug versus another’s. So, while doctors previously prescribed on the basis of age, gender, weight, liver and kidney function, pharmacogenetics enables doctors to select the best medication and dose for a given patient using genetic data. Doctors can now identify genes that cause serious side effects, and as a result, can avoid such outcomes by determining if their patient has a specific gene. It’s thanks to the sharing of scientific results from institutes that have, for many years, studied the effects of genes and medications that we have this advance in pharmacogenetic testing.

    When pharmacogenetic testing makes sense

    The use of pharmacogenetic testing is becoming a very helpful tool for individuals for whom higher-cost drugs are prescribed as an option to improve outcomes. In fact, in the group benefits arena, some carriers are beginning to implement this testing as part of their process.

    Costs for pharmacogenetic testing (PGx) range from $250 to $500, based on our research in Canada. You can request a PGx test from an online provider, or you can ask a healthcare professional to order the test. Some pharmacies may assist in ordering this test when a physician has requested a change in prescription. Some group benefit plans may even cover the cost when a doctor requests the test, depending on a plan’s laboratory diagnostic testing coverage. Healthcare Spending Accounts (HCSA) should allow this expense when it is requested by a physician. Best to inquire with your provider, in advance, what restrictions and coverage are provided in your plan.

    It’s important to be aware of this evolution in testing, especially when you may be struggling with finding the right drug for a condition. Where group benefits are concerned, don’t be surprised if you get asked to participate in this type of testing before a carrier confirms acceptance of a high cost drug; the goal being to get the right drug at the right time for the right person.

    For more information on what pharmacogenetic testing means to your group benefit experience, please contact Rosemary Marsh at 905-777-9990, ext. 202 or via email at Our expertise is your advantage!

  2. Problems with group benefits you might have forgotten about

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    Forgotten problems with group benefits

    We often discuss some of the more common challenges surrounding group benefits. While these problems are important, there are also a few lesser-known issues that are just as crucial to keep in mind.

    Let’s take a look at four problems with group benefits you might have forgotten about:

    Keep your contract current and up-to-date

    If you think your insurance carrier will just pay any claim because you’re paying the premium, guess again. If the contract isn’t right, the carrier has the right to refund the premium and leave the claimant responsible for the uninsured liability.

    Be honest and up front with your broker so the issues can be addressed in advance of any claim issues.

    Attention to details matters

    Some may think that benefits are no big deal. But, there are many legal implications today that hinge on the finer details, and these easily-missed details may surprise you.

    Watching television commercials about how convenient it is to buy insurance online with no fuss — just click-click and you’re done — make us uneasy. That’s because there’s so much that you don’t know you’re missing when you remove personal interaction. This void can become a major issue when it’s time to file a claim.

    We would never recommend the click-click approach and group benefits are the very same. In managing the little details, your broker can ensure there are no surprises that could be costly.

    Your calendar is a valuable tool

    There are certain events that need to be managed closely: salary changes, when to add a new employee, when to terminate benefits, and when to send out disability claim forms, to name just a few. Use your calendar to ensure you address all those to-do’s.

    Missed deadlines can evolve into issues that have the potential to be very costly and could even cause your employees hardship. Try setting an event notification on your computer or phone’s calendar to remind you of these important items.

    Value the role your benefits administrator plays

    The whole experience of a group insurance plan centers on the abilities of the plan administrator. While the administrator may have many other functions, their role in the group plan will have the greatest effect on the employees’ benefit experience.

    It’s for this reason we suggest that administrators take the time to familiarize themselves with the insurance carrier’s “online how-to” sections and tutorials, rather than attempting to figure things out on the fly. Outcomes will be improved for both your administrator and your employees. As busy as we all are, sometimes, taking the time now can save us from having to spend even more time and money in the long run.

    For more information on how you can enhance your group benefit experience, please contact Rosemary Marsh at 905-777-9990, ext. 202 or via email at Our expertise is your advantage!

  3. Is cheating your group insurance plan fraud?

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    You bet it is, and carriers are — understandably — doing more than ever to educate employees that cheating your group insurance plan is fraud and will not be tolerated.

    In fact, these more aggressive actions by carriers have resulted in employees being charged, and employers in turn are terminating employees who cheat their group plans. In other words, there are real, and severe, consequences for cheating.

    Never before has the industry put more focus on insurance plan fraud prevention than what you’re seeing today. Ads appear on television, in magazines and in publications educating employees that any fraud is unacceptable and illegal. Carriers are investing heavily in fraud prevention as well, through the programing of algorithms in their claims systems to detect unusual activity.

    Many carriers have increased their staff in this area as well; in some carrier operations, staffing in insurance plan fraud departments has jumped from 4 to 80 employees over the past five years. Add to this more sophisticated hiring practices where past police and investigative personnel form part of the insurance carriers’ team, and you can see how seriously carriers are taking their efforts to reduce fraudulent claims usage.

    What does this mean to you as an employer? Fraud costs your plan money and while your carrier is doing everything they can to ensure they address all that fraud does to your plan, there are actions you can take as an employer to protect the financial interests of your plan. The three key areas of focus are as follows:

    Time – take the time to treat your group plan like the important budget item it is. Too often employers don’t have or take the time to even review their plan as an important budgetary cost item. This is one of the costliest ways to manage your benefits program. As with any unaddressed budgetary item in your organization, costs will rise, and group benefits are no different.

    Expertise – finding the right partner to help you manage through the tumultuous group benefits arena will save you time and money. A qualified broker partner will know how a group plan works both in underwriting and in practice and will be able to delve into what your plans drivers are, to manipulate the outcomes, and align it with the goals of your organization. A good broker partner will be nimble in offering creative solutions that will address the long-term impact of your plan financially as well as competitively.

    Communication – never has communication been more important to group benefits than it is today. It’s really the key to your benefit results. Communicating between all stakeholders can greatly influence outcomes. Add to that the importance of communicating well to your employees from the onboarding stage and ongoing. Doing this right and in a format that suits your organization and your employees will domino the effects of offering a group benefits program and can improve your financial outcomes.

    For more information on how to trump up your group benefit experience, please contact Rosemary Marsh at 905-777-9990, ext. 202 or via email at Our expertise is your advantage!


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