Group Insurance or Employee Benefit Plans
Group insurance for your employees should be tailored to your company and reinforce your culture. Whether you are adding a benefits plan to attract and retain staff or looking at changing your plan due to cost factors, The Benefits Edge is your best benefits advisor.
Did you know that benefit plans provide a good ROI? “Businesses that offer health benefits experience lower rates of absenteeism. Employees with access to benefits take, on average, 25% fewer sick days than those without coverage.” (Source: Canadian Life and Health Insurance Association) Benefit plans can also help your workforce be healthier. “Health benefits contribute to overall employee wellness. 64% of employees say that benefits encourage them to lead healthier lives.” (Source: Sanofi Canada Healthcare Survey)
Flexibility is a key feature for some employee groups. A Health Spending Account and/or Wellness Account are great ways to offer flexibility to a group insurance plan and allow employees to spend their benefit dollars on the features they prioritize.
How Group Insurance and Benefit Plans Work
Thinking of adding a benefit plan for the first time? Group insurers have rules that plan administrators and companies need to know. We help you choose the right plan at the right price and ensure you know the rules to keep the benefit plan stable, without headaches!
Setting Eligibility Criteria
If you are offering a Benefit plan, you set the criteria for eligibility. Full-time only? Part-time included? How many hours do employees need to work to qualify for the benefit plan? Mandatory enrolment is essential to keep the plan stable. Employees who have Health and/or Dental coverage through their spouse can opt out of those benefits but need to be enrolled in the Group Life and the Long Term Disability benefit if offered. In a traditional benefit plan, employees cannot purchase top-up coverage however, some insurers offer plans that allow some flexibility in plan design.
HSAs
A growing trend in Group Benefits is to offer a Health Spending Account and/or Wellness Account to give the employees a discretionary fund they can use to pay deductibles, coinsurance, extra Health or Dental coverage over the plan maximums. If the insured plan does not cover Vision Care or eyewear, for example, the employees can use the H.S.A. to reimburse those expenses. No Major Dental or Orthodontia on the plan? The H.S.A. can pay those expenses as well. Wellness Accounts are discretionary funds the employee can use to reimburse items not considered medical expenses by CRA but which could influence a healthy lifestyle, for example: gym memberships, vitamins, fitness equipment like a bicycle, golf clubs, kids soccer fees, teeth whitening, cosmetic enhancement and fun activities like a spa day, vacation, Disney tickets, theatre subscription, gardening plants, doggie daycare etc.
Since Wellness expenses are not considered CRA eligible medical expenses, the reimbursement for these items is a taxable benefit to the employee whereas Health and Dental plan expenses are non-taxable. Many employers favour Health Spending Accounts because there is no cost increase for Health or Dental inflation at plan renewal. You decide on the amount of the H.S.A. or W.S.A. amount and it is finite. Once the employee uses up the funds, the amount will only be replenished at the next plan anniversary.
Advantages of a Group Benefit Plan or an Individual Health Plan
Uniform Coverage
The goal of a group benefits plan is to provide financial assistance or a safety net for employees who need medical or dental treatment to recover when ill or retain their health by being proactive with their health needs. While individual employee needs may be different, Group Insurance provides uniform coverage for all employees at a less expensive cost than if individuals were to purchase Individual Health Plans. The biggest advantage of Group Insurance is that all eligible employees are accepted into the plan without medical questions. Individual Health plans with high maximums and generous coverage, generally, require disclosure of prescriptions, medical treatment and conditions that may be excluded by the insurer as a pre-existing condition. Individual plans do however allow the employee to choose the level of coverage they desire and when paired with a Health Spending Account, can be a great alternative to a Group Insurance plan.
Greater Selection of Benefits
Portability is another factor to consider; group coverage is tied to employment, while individual coverage is independent of the workplace. When an employee leaves a group plan, they can opt to apply for an Individual Health plan offered by many insurers which covers pre-existing conditions, however these plans will have more restrictive benefit maximums than the group plan they had with their employer. At The Benefits Edge, we look for the best plan for the individual and their budget. Whether the employee has been terminated, is retiring or is exiting the group plan for any reason, we can perform a survey to offer the employee choices for Individual Health coverage.
Cost-Effective
Group coverage is usually less expensive than individual coverage with economies of scale. A group plan is available from 2 employees plus and the cost is dependent on the number of employees, the demographics of the employee group, the industry, the plan design and at renewal, the cost of claims made during the year. Some employers have their employees pay a portion of the insurance premium which reduces the employers overall cost of the plan. When using Individual Health plans instead of Group Insurance, employers can assume the cost of a defined level of coverage and employees can choose to top-up for a higher level at their own expense.
Overall, while individual health insurance may provide control and portability, group coverage offers a greater selection of benefits, accepts all health risks and is often more cost-effective.
How Group Insurance Plans Have Changed
Employees and workplaces have changed and so have benefit plans! If your group health insurance plan has not been reviewed by The Benefits Edge Insurance, one of the top benefits brokers in Ontario, it may be outdated, your premiums may have escalated out of control and you may not be offering a competitive plan to attract and retain your employees.
Benefits
Traditional group health insurance plans have become stale to many employees who care more about pro-active health and wellness and “feel good” benefits. While most plans still offer some prescription drug coverage, paramedical practitioner coverage and a Dental plan, the culture of your workplace may dictate a plan design that offers higher emphasis on complimentary coverage and health plan options.
Affordability
Many small employers and start-ups assume they cannot afford a benefit plan due to their size or budget, but the options available in this marketplace can provide good coverage for even the smallest budget. There are more options available than ever before for designing a plan that is meaningful, fits your workplace’s culture, and is sustainable for the long-term.
Plan Strategies
Designing a plan strategy has become essential to ensuring cost sustainability over time and several plans now offer some reassurance with pooling claims. Many Health and Dental expenses within group plans increase at a faster rate than the Consumer Price Index (CPI), and business owners need advice to make sure they are choose an appropriate plan for their budget.
Common Concerns
Some common concerns with group benefit insurance include Cost Management, Compliance with Group Insurance “rules” and taxation, Employee Satisfaction and Retention, Effective Plan Communication and Engagement and Attractiveness in Talent Acquisition. Addressing these concerns requires strategic planning, ongoing evaluation and collaboration with benefit providers to optimize benefit offerings while aligning with the employers benefits goals and workforce needs.
New Offerings in the Benefits Industry
- Virtual Care, Tele-Health and Online Health Assessment Tools
- Group Critical Illness Insurance coverage
- Health Spending Accounts and Wellness Accounts
- Mental Health Care Consultative Services
- Second Opinion Services for Serious Illness Diagnosis
- Employee Assistance Plans for a Mental Health, Financial and Legal concerns in the family
- Web-Based Wellness Resources
Web-based administration applications have made it possible for real-time enrolment of new employees, terminations, and changes to employee information. Many insurers offer smartphone applications for submitting claims, reviewing claims history, find health practitioners, print benefit information, claim forms, member cards, and access health awareness resources through an employee web portal.
Trust In The Benefits Edge Insurance for Reliable and Comprehensive Insurance Plans
Is your benefit plan still relevant to your current needs? If your company has had the same plan for an extended period of time and the goals and design considerations are no longer apparent, it may be time to conduct a review with The Benefits Edge Insurance, provider of top-quality group health insurance in Ontario. Whether you need assistance with your benefits strategy or finding the right benefits provider for your company, we are happy to help. If you are a foreign company starting a Canadian division or have a few employees in Canada, let us help you design a plan for your Canadian employees.
Give us a call for a plan assessment and cost/benefit analysis, and we’ll make sure your employees get great coverage they can trust in that are designed to fit your budget!
Group Insurance or Benefit Plans
In a recent survey, employers ranked the top items that are most important when making decisions regarding a benefit plan. The top 4 in order are:
- Overall price of the plan
- Level of protection for the employees
- Cost/Benefit Analysis of Various plan options
- Flexibility of the plan
Group benefit plans have evolved over the years to provide benefits to smaller employers and benefits are available even for just 2 employees. If your company is small and cost is an issue, be assured there are more options than ever before to co-ordinate a plan to meet your budget.
Plan design strategy has become very important to provide sustainable cost for benefit plans. Many costs within the benefit plan can rise at a faster rate than CPI and business owners need advice to ensure they are choosing plan options and a budget appropriate for their company. Some topical questions for the current environment are: Will we cover medical cannabis under the Benefit Plan? Should we have a Prescription Drug maximum on our plan? Do we extend benefits past age 65/70 until retirement? Should we cover Wellness Items under our Health Spending Account and which ones? Do we have a combined maximum for Paramedical Practitioners under the plan? Should we allow Adult Orthodontia? The answers to these questions requires some discussion and may be made on a case by case basis.
Plans have changed in recent year to now include Group Critical Illness, Tele-Health, Employee Assistance Plans, Web-based Wellness Resources, Health spending Accounts, Mental Health Care consultative services, Second Opinion Services for serious illness diagnosis, Cancer assistance plans and Online Health Assessment Tools to name a few.
Administration through web-admin applications has facilitated real-time enrolment of new employees, terminations and employee information changes. Smart phone applications for submitting claims are a new feature with some insurers and you can use a debit type card for expenses with another insurer.
Employees can view their claims history on line with some insurers, print benefit information, claim forms, member cards and access health awareness resources through an employee web portal.
The benefits industry has evolved to make benefits more flexible, administration easy and quick and employee access simple and robust with information and assistance. Has your plan evolved along with it? Do you have a plan designed for yesterday or today? If you have a benefit plan that has been in place for a long time and the objectives and design reasons aren’t clear anymore, perhaps its time for a review. Give us a call for a plan assessment and cost/benefit analysis.
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