A comprehensive group plan can help attract, retain & reward employees for their loyalty to your business. We work with the largest group of insurers in the industry to provide you with the right group benefit plan for your business. Group benefit plans can be designed for companies with as few as three employees & can be tailored to suit your company's individual needs.
Employee benefits represent a significant financial obligation to the plan sponsor while playing an important role, alongside government-sponsored benefit programs, in providing for the well-being of employees and their families. We understand that the company has unique objectives. Recognizing this diversity, we strive to find tailored and flexible solutions. We are committed to ensuring that plan sponsors and employees get the best value for their benefit dollars.
Our services include:
- Needs Analysis
- Plan Design
- Plan Implementation
- Administrative Support
- Claims Resolution
- Renewal Rate Analysis
- Cost Containment
- Plan Marketing
- Group Retirement
Group Life Insurance
Basic life insurance pays a pre-specified amount (as defined in the contract) in the event of the death of an employee from any cause. The rates are revised annually (yearly renewable term) and are based on the demographics of the group. Premiums paid by the employer on behalf of the employee are a taxable benefit, however, benefits received are non-taxable.
The Short-Term Disability or Weekly Indemnity benefit is designed to compensate an employee for income lost as a result of short-term absences from work from an accident or sickness.
The benefit schedule is generally based on a percentage of the employee's pre-disability weekly gross earnings. When determining an appropriate benefit schedule, the tax status of the STD benefit must be considered. Unless the plan member is paying the entire STD premium, the benefit will be taxable when received. The STD benefit will also be non-taxable when the employer pays the premium on behalf of an employee, but the amount of the paid premium is treated as taxable income to the employee.
The benefit period is the maximum amount of time for which STD benefits are payable.
Common benefit periods are 15 weeks (to coincide with the E.I. Sickness Benefit period), 17 weeks and 26 weeks. The STD benefit period is generally integrated with the Long-Term Disability (LTD) benefit.
An extended illness or injury can create a significant financial hardship. Although employees will often express a greater demand for more visible benefits, a Long-Term Disability benefit is far more important in protecting the financial well-being of employees.
The elimination or waiting period is the period of time that the claimant must be disabled before receiving benefits. The most common elimination period is 17 weeks so that the LTD benefit integrates with the Employment Insurance (EI) plan.
The benefit schedule is generally based on a percentage of the employee's pre-disability gross earnings. When determining an appropriate benefit schedule, the tax status of the LTD benefit must be considered. Unless the plan member is paying the entire LTD premium, the benefit will be taxable when received.
Extended Health Care Benefits, also referred to as major medical benefits, are designed to supplement existing provincial hospital and medical insurance plans. The benefit provides for reimbursement of expenses and services not covered by existing government plans. Extended Health Care Benefits can be divided into several categories which include:
- Hospital coverage
- Drug coverage
- Medical supplies and equipment
- Paramedical services
- Out-of-province coverage
- Other health care benefits
Prescription drugs account for the largest item of an employer's total costs for a health care plan, typically accounting for 60%-80% of the claims.
There are three common methods of designing a drug plan:
- Prescription only drug plans which only provide coverage for drugs and medicines which require a written prescription from a physician or dentist.
- Prescribed drug plans cover all prescribed medications including over-the-counter drugs.
- Hybrid drug plans cover all drugs requiring a prescription and certain prescribed drugs that do not legally require a prescription. Different drug formularies are available, which list specific drugs and medicines covered under a drug plan.
There are two basic methods of reimbursing drug claims:
- Reimbursement plans, where the person insured pays the pharmacist for the drugs and submits the bill to the insurer for reimbursement.
- Pay direct drug plans, where the person insured presents a drug insurance card to the pharmacist who, in turn, bills the insurer directly.
This benefit covers charges, including X-rays, of the following paramedical practitioners:
Chiropractor, osteopath, naturopath, podiatrist, acupuncturist, masseur, speech therapist, psychologist, psychoanalyst (Quebec only), and physiotherapist.
Reimbursement is subject to an annual maximum (commonly $500 per practitioner per calendar year). Reimbursement is based on the "reasonable and customary" charges for the insured's province of residence. Most services require a physician's referral.
Dental care benefits provide comprehensive dental services and supplies for plan members and their eligible dependents. The type and scope of dental services covered under a dental plan varies; however, dental care services are generally grouped into three major categories:
Basic services include coverage for diagnostic and preventative treatments, such as dental examinations, X-rays, cleanings, topical application of fluoride, oral hygiene, fillings, scaling of teeth.
Major restorative services include coverage for dentures, crowns, inlays, onlays and bridgework.
Orthodontic services include coverage for procedures and appliances, such as braces, wires, space maintainers and other mechanical aids required to straighten teeth and correct other defects.
The dental services are generally divided into several levels of coverage. At each level, a variety of plan design features, such as co-insurance, deductibles and maximums are available.
Health Care Spending Accounts (HCSA)
A Health Care Spending Account (HCSA), also known as a Health Spending Account (HSA), is an individual employee account that provides reimbursement for eligible health care expenses or other benefits that are not covered under provincial health insurance plans or other benefit plans sponsored by the employer. A Health Spending Account can be implemented on a stand-alone basis within a traditional benefit plan or part of a flexible benefits plan.
Spending accounts can sometimes be the answer to situations where an employer wants to give employees increased involvement and more choice in their benefits while also limiting its financial responsibility.
Health Care Spending Accounts that are provided on a stand-alone basis are funded entirely by the employer. Each member of a class receives an equal allocation of funds from the employer.
Cost Plus is an arrangement to provide a facility for payment of legitimate expenses not covered by the insured benefit program. Cost Plus claims are those expenses over the present policy limits which a client wishes to have covered. To be eligible, they must qualify as an eligible medical and dental expense under the income tax act.
As an example, assume a plan member had a $5000 vision claim and the vision plan did not provide enough coverage. If the plan sponsor decided it wished to reimburse the plan member through Cost Plus, the transaction would be as follows:
Plan member pays claim of $5000
Plan sponsor pays insurer: $5000 for claim
$250 Administrative Fee
$340 Provincial Sales Tax
Reimbursement to plan member from insurer: $5000
At first glance, one might look at the above calculations and ask why the plan sponsor wouldn't pay the plan member $5000 directly and avoid $590 in fees and taxes. The reason being is that a payment directly to the plan member would be treated as income and therefore fully taxable. By using Cost Plus, the reimbursement to the plan member becomes non-taxable in the same manner as eligible expenses covered by the benefit plan.
A Cost Plus arrangement can be set up with an insurer on a fee per claim basis. Insurers generally charge an administrative fee ranging from 10% to 15% of the amount claimed (which often includes the Premium Tax).