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Tag Archive: plan

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

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    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 smarsh@bisinc.ca or 905-777-9990, ext. 200

  5. New Hepatitis C treatment

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    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.



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