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Category: Emloyee Benefits

Inclusive Benefits: Weight Management and Chronic Disease Support

Posted on by Immix Group

Weight Management as a Benefits Priority: What Canadian Employers Need to Know

Obesity in Canada: A Rising Concern for Employers

Excess weight and obesity now affect roughly one in three Canadians, a trend that continues to rise and presents growing challenges for both employees and employers seeking to foster a healthy workforce.

Over the past couple of years, weight loss medications have come into the spotlight and at the Immix Group we have heard from employers and plan members seeking information on drugs from Ozempic to Saxenda and more. 

Not only is this a new FAQ for our team, it’s a topic of discussion with our supplier partners, as they navigate the inclusion or exclusion of these sought after medications.

This raises an important question for organizations:

“As an employer, what is the right and sustainable way to handle obesity and weight management in our benefits plan?” 

In recent years, insurance providers have begun to address weight management more directly, offering employers multi-pronged approaches that go beyond traditional “healthy living” campaigns. These initiatives now include targeted programs, therapies, and prescription medications for weight management, bringing the topic more openly into discussions about employee health.

Why Employers Should Think about Weight Management Within Benefits Programs

Supporting weight management in the workplace is more than a wellness initiative—it’s a strategic investment in employee health, productivity, and organizational culture. Nearly one in three Canadians is affected by excess weight or obesity, which the Canadian Medical Association (CMA) recognizes as a chronic, relapsing disease with complex causes, including genetics, environment, metabolism, and behaviour and not merely a lifestyle choice. This distinction matters because it underscores that obesity requires ongoing management, much like diabetes or hypertension, and has measurable implications for employers.

 

The impact of obesity on the workplace is significant

Productivity and absenteeism: Obesity and related comorbidities are strongly linked to increased absenteeism and reduced productivity (presenteeism). Employees managing obesity-related conditions may need more time off or may be less able to perform at full capacity.

Mental health: Employees living with obesity are more likely to experience stress, depression, and anxiety. Workplace stigma can exacerbate these mental health challenges, further affecting engagement and performance.

Comorbidities and health costs: Obesity is associated with numerous chronic conditions, including:

    • Type 2 diabetes
    • Hypertension
    • High cholesterol
    • Fatty liver disease
    • Heart disease
    • Sleep apnea
    • Certain cancers
    • Depression and anxiety

Because chronic diseases drive significant costs in benefit plans, addressing obesity proactively can help control long-term healthcare spending, including both medical claims and drug coverage inflation.

Why it makes sense for employers to invest:

  • It’s a chronic disease, not a personal failing: Recognizing obesity as a medical condition shifts the focus from blame to support, promoting an inclusive and compassionate workplace.
  • Measurable ROI: Programs that help employees manage weight can reduce absenteeism, enhance productivity, and lower health-related costs over time.
  • Culture and engagement: Supporting employee well-being—including weight management—demonstrates that the organization values health, inclusivity, and mental wellness. This can boost morale, retention, and overall workplace engagement.

Investing in weight management is therefore both a human and business imperative. By addressing obesity in a structured and supportive way, employers can help employees improve their health, mitigate chronic disease risks, and ultimately create a more productive and resilient workforce. Beyond the business case, it is an investment in employee wellbeing and reflects an organization’s commitment to being inclusive and caring.

 

Solutions for Employers: Supporting Weight Management Through Benefits

Effectively addressing weight management in the workplace requires a multi-faceted approach. Weight gain is influenced by numerous factors beyond diet and physical activity, including stress, genetics, medications, environmental conditions, and socio-economic circumstances. Employers who recognize these diverse influences and provide comprehensive benefits are better positioned to support employee health, productivity, and engagement.

Prescription Weight-Loss Medications

Prescription medications for chronic weight management have become an increasingly visible part of benefits discussions. While many group insurance contracts explicitly exclude anti-obesity drugs, employers can request coverage for these medications with some providers (usually at an additional cost).

The number of prescriptions for weight-loss drugs in Canada has grown dramatically: from 250,000 in 2019 to 2.7 million in 2023, an 82% annual increase, largely due to the wider availability of new medications. Costs are rising correspondingly, with weight-loss drugs representing a growing share of employer drug plans.

Key medications available in Canada include:

Weight loss medications work similarly to reduce appetite, increase feelings of fullness, and slow stomach emptying. Some work in the brain or digestive pathways.

  • Saxenda (liraglutide) – GLP-1 receptor agonist, daily injection. Approved for chronic weight management since 2015. Similar to the diabetes drug Victoza but at a higher dose. Often available under employer drug plans.
  • Mounjaro / Zepbound (tirzepatide) – Dual GIP/GLP-1 receptor agonist, weekly injection. These are the same molecule, but different brands. Zepbound is approved for chronic weight management and type 2 diabetes (as of July 2025) whereas Mounjaro is only approved by Health Canada for type-2 diabetes. Stated to produces more weight loss than Saxenda or Ozempic. 
  • Contrave (naltrexone + bupropion) – Oral medication, taken twice daily. Targets brain pathways affecting appetite and cravings. Approved for chronic weight management.
  • Xenical (orlistat) – Lipase inhibitor, oral, taken three times daily with meals. Reduces fat absorption; gastrointestinal side effects possible. Approved for chronic weight management.
  • Wegovy (semaglutide) – GLP-1 receptor agonist, weekly injection. Same active ingredient as Ozempic but approved specifically for chronic weight management.
  • Ozempic (semaglutide) – GLP-1 receptor agonist, weekly injection. Approved for type 2 diabetes; often used off-label for weight loss but not approved for this use in Canada.

 

Ozempic is likely the most well-known of these drugs but it must be stressed that like others, it is not approved as a weight loss medication in Canada; it is a Special Authority Drug used in the treatment of Type 2 diabetes. Only those who are approved via the Special Authority process in BC are eligible for coverage for Ozempic.

Which weight loss drugs are covered by which insurance providers in Canada?

Like many aspects of an employee benefits program, the exact coverage under an employer plan depends on the plan design selected by the employer and the policy of insurer. Some providers have chosen to exclude specific drugs. Reasons vary, but generally, insurers will often exclude a drug if there is an alternative drug they feel has the same efficacy.

Obesity Canada states that fewer than 20% of private insurance plans cover obesity medications.

Coverage for these medications varies by plan and insurer, and access can be complex. Employers should work closely with their benefits advisory team to ensure there is clear understanding of options.

For example, RBC Insurance for October 2025 removed weight loss drugs as part of standard drug coverage, however they can still be included as an optional add-on. To include coverage they advised a 2.25% increase to EHC rates for $2K annual maximum reimbursement.

Pacific Blue Cross currently takes a similar approach, in that it is an add-on to a standard drug formulary.

These two insurers differ with the specific drugs they will cover, however, please note that we expect many changes in this area of benefits in upcoming years.

 

Non-Drug Supports: Supporting the Whole Person

Weight management is more than medication. Effective benefits programs integrate resources that address the physical, psychological, and lifestyle factors influencing weight. These may include:

  • Paramedical services: Coverage for dietitians, psychologists/CBT, physiotherapists, and kinesiologists to support nutrition, emotional health, and physical activity.
  • Employee and Family Assistance Programs (EFAP): Counseling, stress management, and resources for emotional eating or obesity-related challenges.
  • Health spending accounts (HSA) or wellness accounts: Can be used for personal trainers, gym memberships, fitness equipment, or wellness programs.
  • Equipment and medical supplies: Coverage for CPAP machines for sleep apnea, diabetes monitoring equipment, or other obesity-related medical devices.
  • Healthy Living Rewards Programs: many programs exist or can be managed in-house to encourage and reward employees to make healthy choices. Step challenges, sleep or nutrition-based activities all can play a role.

 

By offering a comprehensive, multi-pronged benefits approach, employers can help employees manage weight safely and sustainably, reduce absenteeism and presenteeism, improve mental health, and support an inclusive, caring workplace culture. These strategies not only improve employee well-being but can also deliver measurable ROI by reducing chronic disease-related costs and supporting long-term productivity.

 

Solutions:

Effectively addressing weight in the workplace requires looking beyond diet and exercise alone. Numerous factors contribute to weight gain, including stress, genetics, medications, environmental influences, and socio-economic conditions. Recognizing these diverse influences is key to designing benefits that genuinely support employees’ health and well-being.

Plan design, risk and fairness: what employers should think about before deciding on weight loss drug coverage

At the Immix Group, our perspective is that employers should cover weight loss medications as part of a comprehensive benefits program. While there is a cost to including these drugs, it can be argued that supporting weight loss through medications can have a positive impact on overall health, especially considering the comorbidities that accompany obesity.

Balancing fairness, access, and plan sustainability

The cost of a benefits program can be a significant investment for businesses. By working with your advisor to thoughtfully design coverage, employers can:

  • Support employee health with access to clinically approved therapies
  • Reduce long-term health costs associated with obesity-related comorbidities
  • Promote equity and inclusivity in their benefits offering

 

Insurer safeguards and clinical criteria

Making the decision as an employer to include obesity management medications does not mean that all employees will suddenly have full access to these drugs and therapies. Insurers commonly use prior authorization and clinical criteria to manage plan risk. These may include:

  • Minimum BMI thresholds or documentation of weight-related comorbidities
  • Verification of medical necessity by a healthcare provider
  • Defined treatment plans or monitoring requirements

 

These safeguards help control costs while ensuring medications are used appropriately for those with a clinically recognized need.

As mentioned previously, currently fewer than 20% of plans include weight loss medications, despite the fact that obesity is recognized as a chronic, relapsing disease with significant health consequences. Our opinion at the Immix Group is that employers must tread carefully when choosing to exclude specific items, therapies or drugs. Structured, evidence-based coverage can strike a balance between access, fairness, and sustainability.

 

Communicating Weight-Management Benefits Thoughtfully: Tips for Employers

It’s important to remember that stigma surrounding obesity remains a serious concern. Many individuals who struggle with weight face misunderstandings or judgment that can negatively affect both their mental and physical health. A thoughtful benefits strategy must therefore balance effective interventions with support and sensitivity, creating an environment where employees can pursue healthier lifestyles without fear of bias or shame.

As employers consider how to support obesity management within their benefits program, communication must be clear, neutral, and sensitive. Because obesity is a chronic, relapsing condition, framing it as part of your broader health and chronic-disease strategy—rather than a lifestyle issue—is key to reducing stigma.

Consider the following, as you decide your approach as an employer:

  • Use simple, respectful language such as “obesity management” or “clinically appropriate treatment,” and avoid framing weight as a matter of willpower or personal choice. Reinforce that your intention is to support employee health, not appearance.
  • Be transparent about what is and isn’t covered, and why. Coverage depends on insurer policy, clinical criteria, and plan sustainability; explaining this context helps set expectations and ensures employees understand that decisions are made fairly and consistently.
  • Privacy is essential. Clarify that accessing treatment is voluntary, confidential, and determined between the employee, their healthcare provider, and the insurer—not the employer.
  • Finally, emphasize a whole-person approach. Weight is influenced by many factors, and support often extends beyond medication. Highlight available resources such as dietitians, psychologists, EFAP services, wellness or health spending accounts, and coverage for conditions linked to obesity. Positioning these supports together reinforces that your benefits program aims to meet employees where they are and provide meaningful, respectful care across the full spectrum of health needs.

 

Work with your advisor to develop an effective, thoughtful strategy

Addressing weight management within a benefits plan requires balancing employee health needs with plan sustainability, fairness, and evolving insurer policies. With obesity recognized as a chronic disease—and new therapies reshaping expectations—employers should consider a comprehensive approach that includes medication coverage, non-drug supports, and sensitive communication that reduces stigma and protects privacy. Because coverage options, clinical criteria, and cost impacts differ widely across insurers, employers should work closely with a knowledgeable benefits advisor. At the Immix Group, we help you navigate plan design, assess risks, and build an approach that supports employees while keeping your program sustainable.

Key takeaways:

  • Obesity is a chronic disease affecting one in three Canadians and has significant workplace impacts, including absenteeism, mental health, and comorbidities.
  • Supporting weight management through benefits is both a health and business strategy, improving productivity, engagement, and long-term costs.
  • Coverage options vary widely by insurer and plan; prescription medications may be included as an optional add-on with clinical criteria.
  • Non-drug supports—such as dietitians, mental-health resources, EFAP, and wellness accounts—are critical for a whole-person approach.
  • Employers should work closely with a benefits advisor to design fair, sustainable, and inclusive weight-management programs.

FAQ’s:

Why should employers address weight management in their benefits plan?
Obesity is a chronic disease linked to productivity loss, absenteeism, mental health challenges, and comorbidities. Supporting employees’ weight management is both a health and business investment.

Which weight-management medications are available and covered in Canada?
Health Canada has approved drugs including Saxenda, Zepbound, Wegovy, Contrave, and Xenical for chronic weight management. Drugs such as Ozempic are approved by Health Canada only for type 2 diabetes; use for weight loss is off-label. Coverage varies by insurer and plan, often requiring prior authorization and clinical criteria.

Are weight-loss drugs included in most private insurance plans?
No. Fewer than 20% of Canadian private plans cover obesity medications, and coverage may require additional costs or optional plan add-ons.

What non-drug supports can employers provide for weight management?
Supports include dietitians, psychologists/CBT, physiotherapists, kinesiologists, EFAP services, health or wellness spending accounts, and coverage for obesity-related medical equipment.

How should employers communicate weight-management benefits to employees?
Use neutral, non-stigmatizing language, emphasize health rather than appearance, explain what is covered and why, maintain privacy, and highlight a whole-person approach.

 

Read More:

 Managing your obesity | Obesity Canada

Obesity in adults: a clinical practice guideline | CMAJ

Managing Obesity: A Shared Commitment

Managing obesity: a shared commitment

Weight Management Program Teladoc Medical Experts

GLP-1 Drug Coverage Continues to Rise in Canada

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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Six Common Benefits Plan Mistakes that can Cost Employers

Posted on by Immix Group

by Lindsay Byrka, CFP® Vice President, Immix Group

 

Part of our role as benefits advisors in Canada is advising employers on their responsibilities when it comes to the ongoing management of their benefits program–enrolment, terminations, updates, communication to employees, taxation of benefits and rules for benefits under the Employment Standards Act here in Canada.

When we first work with a new client, our benefits audit often uncovers the cumulative impact of administrative oversights, errors, or misunderstandings. These mistakes can have serious consequences: wasted benefit dollars, gaps in coverage, higher premiums, non-compliance with contracts, and in the worst cases, the death or disability of an employee who believed they were insured when they were not.

Below are six common pitfalls that can create serious problems for your benefits program.

1: Lack of Diligence with Daily Benefits Administration: Missed Enrolments, Late Enrolments, Failure to Terminate Benefits

There can be serious repercussions to not being timely with administration. And while Employers will often blame the employee for not completing their side of the enrolment process, it is ultimately the employer’s responsibility to ensure the rules of enrolment are followed.

  • Employees must be added and removed from the benefits plan based on the timelines laid out in the insurance contract.
  • Following enrolment rules protects the plan from anti-selection — when someone waits to sign up for coverage until they anticipate a large claim. This drives up claims costs and breaches your contract with the insurer.
  • Most programs have a waiting period (often three months) before benefits start, with a typical 30-day grace period for enrolment; some providers allow for longer than this.
  • If a member is not enrolled on time, they are deemed a late applicant which is an official term describing someone who has been enrolled after the expiration of the grace period. Late applicants may be subject to medical underwriting and may be denied coverage. Insurers all follow similar guidelines.

Not ensuring an enrolment is processed in time can have legal consequences

In a well-known case, the employer was found liable for not enrolling an employee on time, who later died. The court found that the employer did owe a duty of care and had implied contractual obligations. The employer should have provided the employee with sufficient information about the coverage, timelines and consequences of failing to apply. Damages were reduced by 50% due to the finding that the employee was partially responsible for not completing the enrolment document on time.

Terminations must also be processed on time

It is common to discover through a benefits audit that members are still active on the program, who should have been terminated. When a termination needs to be backdated, most insurers have a maximum number of months for which they will refund premiums. Former employees often continue to claim under their former employer’s benefits program. And, commonly, premiums will only be backdated to the date of the last claim. The impact of untimely administration on a group plan can be costly.   

How can employers ensure diligent benefits administration?

  • Train plan administrators thoroughly to ensure they understand rules and potential repercussions
  • Use of checklists for onboarding and offboarding and HRIS alerts if available
  • Working closely with benefits advisors for support and education
  • Review invoices regularly for accuracy

2.Not Adhering to Eligibility Rules: Who is on your Benefits Plan?

Unfortunately, it’s very common to learn an employer has been paying premiums and absorbing claims for people who are not eligible to be insured on the benefits program. This includes:

  • Part-time employees not meeting the minimum hours
  • Former employees
  • Seasonal employees
  • Contractors who are ineligible
  • Ex-spouse/partner(s) dependent children
  • People who do not meet the definition of a ‘dependent’ for the purposes of benefits coverage (i.e. extended family members, cousins, nieces, nephews etc.)
  • People who are in some way connected, but are not actively employed and working for the plan sponsor

Conversely, eligible employees are sometimes not enrolled due to misunderstanding rules or opting out when participation is mandatory.

Is it Dishonesty or a Lack of Understanding?

In some instances, ineligible members are on plans due to dishonesty on the part of the employee or employer, but more often, it’s a lack of understanding of the rules. For example, we often learn of people ‘opting out’ of the benefits plan when the program requires mandatory participation.

While there are ways to structure programs to accommodate things such as reduced participation levels or classes for contractors, this has to be done intentionally and with the insurer’s approval. Depending on the structure of your organization, it can be worth conducting an audit to investigate and uncover any ineligible members or eligible but not enrolled employees.

There can be major repercussions to ignoring eligibility criteria.

We encountered a scenario where a former owner of a small business was kept on the benefits program under a handshake agreement. This person was no longer officially affiliated with the company. When he passed away, his family was expecting to receive the large life insurance payment through the group benefits program. Through the life insurance claim, it was discovered that this person was not eligible for the program. Despite the premiums being paid for many years, the claim was denied.

How to avoid eligibility issues:

  • Understand the eligibility requirements and rules, per your contract. If contractual changes need to be made, work with your advisor to create classes, change hours or otherwise adapt the program.
  • Designate a time for plan administrators to periodically review who is insured. Plan renewal or the beginning of the year are good times to do a deep dive on enrolment.
  • Regularly review of invoices is critical to ensure enrolment and billing accuracy.

3. Failing to Regularly Update the Insurance Provider and Advisor with Current Information

In addition to keeping on top of enrolments, terminations and eligibility criteria, it’s important to keep on top of other changes. Plan administrators need to provide the following, either annually or when the change occurs:

  • Updates related to the company structure; affiliated companies, name changes etc. Employees must be paid through the company named as plan sponsor or listed as an affiliated entity.
  • Updates to salaries, to ensure salary-based benefits are properly calculated.
  • Updates to occupation titles, and accordingly, the correct class of benefits for the member.
  • Proper adherence to rules surrounding benefits and maternity leave
  • Any changes to dependents (new spouse or child, student status).
  • Correct hours worked to ensure ongoing eligibility.
  • Updates to company banking to ensure premiums are paid, to avoid claims payment suspension.
  • Contribution amounts for group savings plans and health spending accounts.
  • Beneficiary designations; it’s crucial to remind employees to ensure the correct person is named.

How employers can prevent negative outcomes from outdated information:

  • Ensure all changes to business structure are communicated in a timely manner.
  • Plan administrators must routinely remind employees to report changes using checklists.
  • Of particular importance, regularly remind members to review beneficiary designations.

Failing to ensure members have an updated named beneficiary can have dramatic consequences.

At the Immix Group, we routinely learn of situations where the person named as the beneficiary is no longer the correct person (typically, an ex-spouse or partner). We have witnessed countless situations where an ex-partner received notable sums of money in death benefits or RRSP funds due to an outdated beneficiary designation on record. This is despite the existence of a current spouse and children for the deceased plan member, and a Will.

Unfortunately, a named beneficiary is legally entitled to the funds; it is nearly impossible to reverse. While we hope the recipient will ‘do the right thing’ and pass the funds to the family, this rarely happens. It’s very emotional, and totally avoidable.

Not updating salaries on a routine basis can impact member benefits.

In a similar situation, an employer failed to submit salary updates for multiple years. A member went on Long Term Disability and was dismayed to learn their monthly benefit was based on a salary that was significantly lower than their current earnings. The result was receiving $3,000 a month in LTD instead of $4,500 per month, an impactful difference to the disabled claimant.

This leads us to the next common pitfall; not properly educating staff on their coverage details.

4.Poor Communication of Plan Design Features and Processes

Employers may find themselves at risk if they fail to properly communicate their employee benefits plan design features to their employees. This could lead to employees bearing costs out-of-pocket, when this could be prevented. In an extreme scenario, employees who are misled with regards to coverage could potentially pursue legal action against their employer.

Some common areas where misunderstanding can lead to out-of-pocket expenses:

  • Emergency out-of-country travel claims: First, ensure you understand any pre-existing conditions clauses within your group benefits policy before you travel, to avoid a denied claim. Second, ensure a claim is opened immediately. Paying out-of-pocket can result in reimbursement being less than expected and can be very time-consuming. Insurance carriers often negotiate lower claim costs when working directly with the medical facility and will also coordinate payment with the provincial plan in the employee’s province of residence, where applicable. You want to engage the travel insurance provider at the earliest opportunity, to have the smoothest outcome.
  • Pre-Authorization for costly services: always obtain a pre-authorization for more expensive items such as certain dental work, custom braces, or where otherwise required by your insurance provider.
  • Duration limits for coverage: there are many benefits that have time limits attached to reimbursement eligibility. Two common areas are routine dental visits (dental recall is typically 6 months, but 9 months is sometimes used) and vision care, which commonly provides a dollar amount per 24 months period. In addition to this, many other items have time durations imbedded into the benefits coverage.

How can employers ensure employees understand the details of their coverage?

  • Ensure routine Employee Education Sessions are held to relay important details of coverage and processes to staff.
  • Education sessions should be held at minimum on an annual basis.
  • Ensure distributed documents and forms are up to date.

5. Not Paying Attention to Payroll Deductions and the Tax Status of Benefits

In Canada, benefits are taxed differently depending on who pays the premium (employer or employee via payroll deduction).

There are two things to consider- whether the premium is a taxable benefit to the employee (included on the T4 and taxed as income) or whether the payment of a benefit itself would be taxed in the hands of an employee receiving the benefit.

Most employers aim to organize payroll deductions to avoid taxable benefits, where possible. Looking to the most common benefits on a typical benefits program, the taxation is as follows:  

  • Life Insurance, Accidental Death and Dismemberment, Dependent Life Insurance and Critical Illness insurance: Any benefit paid is not taxable, regardless of who pays the premium. If these benefits are Employer-paid, the premium is a taxable benefit for the employee.
  • Short Term Disability and Long Term Disability: Any premium paid by the Employer is not a taxable benefit to employee. If the Employer pays the premium, the benefit in the event of a claim is taxable as income to the employee.
  • Extended Health Care and Dental Care: Regardless of who pays the premiums, the benefits are not taxable.

Read more in our Taxation of Benefits Guide, including how different types of Health and Wellness Spending Accounts are taxed.

Oversight of payroll deduction details can have a negative tax implication.

Consider the scenario where the employee is paying a certain percentage of the premium as a payroll deduction. It is possible the payroll deduction could be inadequate to cover the full Long Term Disability premium, thereby leaving the employee potentially exposed to a taxable benefit in the event of a claim.

How can you prevent these costly taxation mistakes?

  • Consider the tax status of each benefit line when organizing cost-sharing arrangements.
  • Work with benefits advisors, payroll providers and accountants to ensure intended tax consequences are in order.
  • Simply reviewing the invoice in detail can shed light on potential issues with taxation.

6. Failure to Examine Rates, Premiums or Fees Associated with your Benefits Program

Most employers are aware that their benefits program undergoes an annual renewal, where the pricing is set for the year ahead. But are employers pay close attention to the details?

It is common to overlook certain details of the total cost of your benefits program.

  • Paying for benefits that are not used; this often comes in the form of add-on services or programs that may not have much value, such as a second Employee and Family Assistance Program, when the extended health benefit already includes a plan
  • Not paying close attention to the rate adjustments; are you having open and transparent conversations with your benefits advisor as to the rate adjustments, and why they are being implemented?
  • Third party administration fees; are you paying additional fees for administration that may be unnecessary? Partnering with the right benefits advisor or provider may eliminate the need for an additional TPA.
  • High advisor commissions; what commissions are being paid to your advisor? Commissions can vary and different levels are appropriate depending on the value provided by the broker, but advisors should be willing to disclose their compensation to their clients.

Partnering with a Qualified Advisor helps Employers to Avoid Costly Benefit Plan Oversights

At Immix Group, we handle the daily details of benefits administration and often catch errors or concerning situations before they escalate. Still, the accuracy and effectiveness of a plan ultimately depend on employers providing timely, truthful, and accurate information. Without the guidance of a qualified advisor, employers take on unnecessary risks, since we don’t expect SMBs to become benefits experts on their own.

A strong advisor provides more than just plan design — they act as a resource for training, reminders, reviews, and ongoing support for HR and plan administrators. This diligence helps save money and prevent costly mistakes. By partnering with the Immix Group, organizations gain the expertise and human support needed to avoid common pitfalls and ensure their benefits plan runs smoothly and cost-effectively.

Key Takeaways

  1. Stay on top of administration – Process enrolments, terminations, and updates on time to avoid denied coverage, legal issues, and wasted premiums.
  2. Follow eligibility rules – Only cover employees and dependents who meet plan criteria; audit regularly to prevent costly mistakes.
  3. Keep information current – Update business ownership details, salaries, dependents, job titles, and beneficiary designations to ensure benefits are accurate and payouts go to the right people.
  4. Communicate clearly – Educate employees on coverage, limits, and claim processes to prevent confusion, out-of-pocket costs, and legal risk.
  5. Manage payroll and tax implications – Ensure deductions and benefit arrangements are accurate to avoid creating unintended taxable benefits.
  6. Review rates, premiums, and fees – Monitor plan costs, adjust unnecessary services, and confirm advisor commissions to keep your benefits program cost-effective.

FAQ’s

  1. How can employers ensure timely enrolments and terminations?
    Employers should use onboarding and offboarding checklists, HRIS alerts, and work closely with their benefits advisor. Regularly reviewing invoices helps catch errors and ensures coverage starts and ends on time.
  2. How do employers ensure only eligible employees are covered?
    Understand the plan’s eligibility rules and conduct periodic audits. Confirm hours worked, employment status, and dependent eligibility. Adjust plan classes or participation levels with insurer approval if needed.
  3. What information should employers keep updated?
    Keep salaries, job titles, company structure, dependents, contribution amounts, and beneficiary designations current. Accurate information prevents reduced benefits, overpayments, or misdirected funds.
  4. How can employers ensure employees understand their benefits?
    Hold annual education sessions and provide clear, up-to-date guides. Highlight important processes such as pre-authorizations, emergency travel claims, and coverage limits to avoid confusion and out-of-pocket costs.
  5. How do employers avoid payroll and tax mistakes?
    Review payroll deductions and the tax treatment of each benefit. Collaborate with advisors, payroll providers, and accountants to ensure employees aren’t unintentionally exposed to taxable benefits.
  6. How can employers prevent overpaying for the plan?
    Regularly examine total costs, including add-on services, third-party administration fees, and advisor commissions. Transparency and guidance from a qualified advisor help keep the benefits program cost-effective.

Read More:

A Better Way to Do Benefits – Latest News from Immix Group

Your 2025 Employee Benefits Audit Checklist – Latest News from Immix Group

Taxation of Employee Benefits in Canada | Optimize Group Benefits

Understanding Travel Insurance – Latest News from Immix Group

2006 ABQB 146 (CanLII) | Grams (Estate of) v. Maple Leaf Metal Industries Ltd. | CanLII

2014 ONCA 123 (CanLII) | Baradaran v. Tarion Warranty Corporation | CanLII

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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What BC Employers Need to Know About Canada’s New Government Health Care Changes

Posted on by Immix Group

At the Immix Group, every government announcement on healthcare changes sparks the same question from plan sponsors: “Will this shift claims away from our group benefits plan and reduce claim costs?”

 

by Lindsay Byrka, CFP® Vice President, Immix Group

Canada is known for universal healthcare, but each province and territory administers its own plan. While medically necessary hospital and physician services are covered nationwide, provinces decide eligibility and additional coverage. Coverage is based on residency and is portable within Canada. Funding comes from the federal government via the Canada Health Transfer.

For example, eye exam coverage for children varies: most provinces cover it, but a few leave the cost to private plans or individuals. So, while healthcare is universal, coverage differences exist, and some services remain the responsibility of private insurance or individuals.

Government coverage updates often attract media attention, and employers may assume this reduces the role of group benefits. Historically, shifts have gone both ways, but recent changes have increasingly shifted coverage back to the government.

Loosely, the Canada Health Act prohibits coverage or services for items already covered by public healthcare to avoid a two-tiered system. Group benefits plans and their offerings fall under ‘private insurance.’  Generally speaking, the plans are complementary – insurers do not need to cover and cannot cover these items.

This article walks through significant recent changes, provides an overview of these changes, their potential impact on employee benefits programs, and what employers need to know.

Canada Dental Care Plan (CDCP)

The Canadian Dental Care Plan (CDCP) launched the end of 2023. After some initial hiccups mostly centered around the hesitancy of dentists to sign up due to unclear terms and conditions surrounding claims reimbursement, these issues appear to have been worked out. Reportedly 98% of dentists now care for patients under the CDCP. With the latest expansion, nearly 5M Canadians now have approved applications. The program is adjudicated by SunLife Financial.

 

Does the Federal Canadian Dental Care Plan replace coverage through an employer-sponsored group benefits plan?

No. To qualify, you must have no access to any coverage including a private plan, employer’s plan or through a Health Spending Account. This program is designed for lower income individuals and families without access to coverage.

 

Could an employer terminate their dental coverage in order to shift this expense to the government?

The likely effect would be very few eligible employees, and coverage would be far less than under a typical group benefits program. The CDCP provides limited coverage, to a limited segment of people, based on family income:

  • 40% coverage for family income at $80-$90K
  • 60% coverage for family income at $70-$80K
  • 100% coverage for family income under $70K

As indicated, there is coinsurance, and additional fees may be required. Coverage is limited to certain items, most of which are basic services attached to preventative oral care. Higher cost items including crowns require preapproval and may or may not be covered. More costly items like dental implants are not included.

 

Employer Requirement to Report Dental Care Eligibility on T4s

Beginning for 2023, employers were required to indicate one of five codes in a new Box 45 on T4 Slips, indicating status as of December 31 of the tax year: 

    1. No access to any dental coverage
    2. Coverage for the employee only
    3. Coverage for employee, spouse, and dependents
    4. Coverage for employee and spouse only
    5. Coverage for employee and dependents only

This caused a lot of confusion initially, and at the Immix Group we answered many questions as to the notations, especially surrounding the timing. This is now a requirement each tax year.

 

What is the Impact of the Canada Dental Care Plan on Employee Benefits Programs? 

In short, the rollout of the Federal Dental Program has not had a notable impact on employer programs. Within our block of business, no changes were made to any plans due to the CDCP. The biggest impacts on dental costs to employers remain the same: higher costs charged by dentists (inflation, advances in technology etc), an aging population and workforce with higher needs, and greater adherence to a routine visitation schedule.

National Pharmacare Initiative: Continued Expansion

What is Bill C-64 and why should it matter to Employers?

We’ve received a lot of questions about the new Pharmacare plan, and whether this will mean a reduction in employer extended health care costs. Bill C-64 is a step towards a national universal pharmacare (i.e. drug coverage). In short, it authorized the federal government’s funding (via the provinces/ territories) to provide coverage for prescription contraceptives, hormone replacement therapy and diabetes medication and supplies.

The long-term goal is to achieve universal, single-payer coverage for a wider range of prescription medication. A national pharmacare program could help ensure that all Canadians have access to the medications they need, regardless of their income or where they live. The initial focus is on providing these medications free or at low cost, eliminating the need to coordinate with private insurance plans for these specific items. Several areas have recently been addressed which have received a lot of attention.

Prescription Birth Control and Hormone Replacement Therapy

 

Does government coverage for contraception and hormone replacement therapy medications replace employer-sponsored coverage?

As coverage is rolled out region by region, yes, it should mostly cover medications previously covered via employer group benefits plans.

Since April 2023 in BC, prescription birth control has been covered at the point of service, nearly eliminating the need for private reimbursement. There are a few medications that may not be covered, but generally, this was a broad change. Other provinces are now phasing in similar coverage as part of the pharmacare framework. Because BC already rolled out coverage for prescription contraceptives, the new funding will be directed towards hormone replacement therapy (HRT) in BC.

 

What is the Impact on Group Benefits Plans and Employers of Government Funded Prescription Birth Control:
Employers do not need to take action to remove specific drugs from their plans. As governments roll out these changes (as we already saw in BC), insurance carriers will adapt their coverage, ensuring private and group benefits programs no longer cover these items.

Financially, the effect may be minor—contraception and HRT tends to be lower-cost in the overall drug landscape, but this will differ depending on the demographics of your group.  

 

Family Planning and Fertility Benefits

While the Federal government has indicated the intent to expand coverage related to “fertility care, reproductive health, and family-building support” current coverage is via the provinces and territories and differs significantly.

As of July 2, 2025, for eligible applicants, BC funds one standard IVF cycle for ages 18-41. This new government coverage is income tested, looking to household income, and providing the maximum following benefits, for one IVF cycle and related medications:

  • Under $100K, $19K
  • $100K-$150K, $14,250
  • $150K-$200K, $9,500
  • $200K to $250K, $4,750

Over $250K of family income, no coverage is available via the BC government. It’s worth noting there are other common family-building/ fertility expenses beyond IVF such as egg / sperm freezing, IUI, and more, which remain outside the scope of government coverage.

 

What does the new BC IVF coverage this mean for employers and their group benefits plans?

At this point, not a lot. While it’s a small win for families who have struggled to conceive and the new government coverage in BC is a step in the right direction, this doesn’t mean much for employer cost shifting.  Most benefits programs offer very limited or no coverage at all for expenses related to fertility treatments. If some coverage is in place, it’s inadequate compared to actual costs for full circle fertility treatments such as In-Vitro Fertilization.

As the actual costs typically far exceed the combination of government and any available employer coverage, this is still an area where we feel most people will experience a large financial gap in coverage.

Diabetes Medications & Devices

The new Federal pharmacare initiative has also authorized coverage for eligible diabetes medication and supplies. This is being rolled out at different times, depending on the province or territory. Many provinces have signed agreements and some were in effect for mid 2025 (Manitoba, PEI). As of August 2025, some agreements are still pending, while Alberta has indicated they will opt out.  

For British Columbia, the expected timeline is:

  • Starting March 1, 2026: 100% public coverage for eligible diabetes medications (for both Type 1 and Type 2 diabetes)
  • Starting April 1, 2026: Expanded coverage for diabetes devices and supplies, including items such as glucose monitors and test strips.

Similar to what we already saw with prescription contraceptives, it’s expected costs will be covered at point of sale without copay or deductible.

 

Does the federal pharmacare agreement relating to diabetes treatments replace coverage through an employer-sponsored group benefits plan?

We expect to see a reduction in diabetes related expenses on employer plans. Diabetes medications represent roughly 15% of drug plan spending by dollars, largely driven by rising demand and the adoption of higher-cost therapies. With pharmacare coverage rolling out, employers may benefit from reduced claims for this therapeutic category.

Again, exact covered drugs and supplies will differ by province. While core medications like insulin and metformin will certainly be included, it is not yet clear whether newer, higher-cost therapies (such as GLP-1s like Ozempic and Trulicity) will be covered in full, and the extent or timing of coverage for supplies like insulin pumps, blood glucose monitors and test strips, per region.

 

Do Employers need to make changes to benefits plans due to the roll out of government coverage for diabetes treatments?  

As we saw with prescription birth control, insurance carriers will adjust eligible drugs under employer group benefits plans to coordinate with changes in provincial coverage, as these changes roll out. Employers and advisors will not need to take on the task of ensuring no duplication of coverage.

Service Canada Employment Insurance Extension for Sickness Benefits  

What change was made to Service Canada EI Sickness Benefits?

Service Canada expanded the benefit duration for EI Sickness benefits to 26 weeks effective for December 18th 2022. Previously, coverage was 15 weeks after a 2-week waiting period (17 weeks total).

 

Why does the change to EI Sickness Benefits duration have a potential impact on employer sponsored group benefits programs?

This is because of the alignment of benefit timing. Long Term Disability coverage is typically provided through group benefits programs, and LTD has traditionally aligned with the end of the old EI Sickness benefit duration, commencing after 119 days (i.e 17 weeks).

It is worth noting that insured STD is not very common with SMBs. Less than half offer this, and coverage is more common with larger employers. Most smaller companies rely on EI Sickness for this pre-LTD period.

 

Do Employers need to adjust Long Term Disability plan waiting periods due to the change to EI Sickness Benefits?

Shifting to a longer waiting period has not made sense in most instances. Under a properly set up LTD plan, LTD should pay a great percentage of income replacement and an overall higher amount of benefit per month than under EI Sickness, which is limited to 55% of weekly earnings, to a max of $695 taxable (2025). LTD is usually 67% of pre-tax earnings, to a maximum, most commonly received tax free due to employee-paid premiums.

The premium reduction offered by insurance carriers to extend the group LTD waiting period from the usual 119 days to 182 days is very minor (2-3%), meaning it was overall more beneficial to have disabled plan members move more quickly to Long Term Disability.

At the Immix Group, across our block of business, we did not see employers make the switch to a longer group Long Term Disability elimination period. While we have established new group benefit plans since this time with 6-month LTD waiting periods, and these groups are usually smaller and with average incomes on the lower end.

 

Awareness and Communication is Key

Recent government health care changes are a positive step toward expanding access, and employers may see some costs shift away from their plans, potentially reducing claim expenses. Coverage varies by province and income level, so employers should stay aware of changes in their region. Generally, employers don’t need to amend their benefit plans; the key is staying informed—understanding how new programs work, how eligibility is determined, and how these changes interact with group benefits. Staying up to date helps employers maintain strong, competitive programs.

 

 

Key Takeaways

Employee benefit plans still essential – Government programs add safety nets but don’t replace group benefits. Expansions to government coverage will reduce some costs for some employers.

Dental plan impact minimal – CDCP is only for those without private coverage or access to coverage; employers must now report dental access on T4s.

Expanded Pharmacare rollout – Contraceptives, HRT, and diabetes drugs/devices are shifting to public coverage region by region; insurers will adjust automatically.

IVF coverage in BC – While federal coverage is still in the works, BC now funds one income-tested IVF cycle. However, due to the high costs and since most benefits plans offer little or no fertility coverage, the result is expected to be a minimal impact on employer plans.

EI sickness extension – Benefits extended to 26 weeks, but most employers haven’t changed LTD plans since LTD remains stronger.

Awareness is key – No major plan changes needed; employers should focus on communicating what new coverage means for employees.

FAQ’s

Does the Canadian Dental Care Plan replace employer dental coverage?
No. It only covers those without private or employer-sponsored dental coverage, and provides limited benefits based on income.

Do employers need to change their benefit plans because of expanded national Pharmacare coverage?
No. Insurers will automatically adjust plans as coverage rolls out for contraceptives, HRT, and diabetes medications/devices.

What does BC’s new IVF coverage mean for employers?
BC now funds one IVF cycle, with income-tested eligibility. However, costs usually exceed government support or traditional coverage under benefits plans, so there is minimal impact on employer plans.

Can employers expect cost savings from these government changes?
Potentially. Some costs may shift from employer plans to government programs, which could reduce claim expenses.

Read More

Canadian Dental Care Plan – Dental Benefits Guide – Canada.ca

National pharmacare in B.C. – Province of British Columbia

Universal Access to Contraception and Diabetes Medications and Increased Access to Diabetes Devices and Supplies, Canada-British Columbia Funding Agreement – Canada.ca

Free contraceptives – Province of British Columbia

Government of Canada improves sickness benefits under the Employment Insurance system – Canada.ca

EI Sickness Benefit – How much you could receive – Canada.ca

Canadian Dental Care Plan – Do you qualify – Canada.ca

Federal Funding – Canadian Fertility & Andrology Society

Publicly funded in-vitro fertilization (IVF) program – Province of British Columbia

Supporting Women at Every Stage: How Employee Benefits Can Make a Difference – Latest News from Immix Group

Dental Care Measures Act – T4 and T4A Updates – Canada.ca

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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Your 2025 Employee Benefits Audit Checklist

Posted on by Immix Group

by Lindsay Byrka, CFP® Vice President, Immix Group

When we first begin working with a new employer to review their benefits offering, it involves a bit of detective work. We need to uncover why you’re not fully satisfied with your benefits program, and why you’ve come to us for a second opinion.

Employers often sense that the plan needs adjustments but aren’t sure how to pinpoint the issues. Perhaps there are obvious areas where the plan falls short, but the solutions are unclear. And sometimes it’s as simple as not feeling the value is there, for the premiums that are being paid.

This is where Immix’s employee benefits audit comes in. Our goal is to uncover the answers to a range of key questions and to provide a clear, detailed review of your benefits program.

In this article, we’ll walk you through what it looks like to have an independent benefits advisor conduct a full audit of your employee benefits program.

Staff Satisfaction with the Program: Does your Team Feel it Meets their Needs?

We want you to love your plan. While this is one of Immix Group’s taglines, it’s a genuine sentiment! When we’re first speaking with an employer, we need to know:

  • Have you surveyed employees about their benefits? Do people like the plan? Are there common areas identified as “missing pieces”?
  • Is claiming easy or are they constantly running into problems?  
  • Do they understand what their plan covers?
  • Have you quantified the value of the plan as part of total compensation?

Conducting an employee benefits satisfaction survey can be eye-opening. It’s very common for this to reveal a lack of understanding as to the scope of available coverage. These “ghost benefits” – which look good on paper but go unused- are often the result of communication gaps. The value of a benefits plan is seriously eroded if people don’t understand what they have.

Employee benefits education sessions go a long way, and the Immix Group recommends everyone in our Client Community take advantage of our offer to run these important sessions every year or so!

Employee surveys allow employees to be heard, and to assist employers and advisors in fine-tuning coverage to truly meet people’s needs. Staff feedback is incorporated into Immix Group’s benefits audit and helps shape our recommendations.

Plan Design & Coverage Flexibility: Is the Plan Design Effective?

Benefits programs need to evolve—not just to keep pace with inflation, but to address changing needs, emerging trends, and new coverage areas in health and wellness. And, they need to evolve as your business changes.

Reviewing the details of the coverage is an integral part of Immix Group’s employee benefits audit process. We review contracts and booklets line by line and will address (using benchmarking information) areas we feel are outdated or fall short against industry and competitive norms. As well, we need to know:

  • What is the goal of the plan? Is it important to you that the program reflects the company’s values and philosophy? For example, do you embrace ‘one plan for all,’ or does it align more with your organization to implement benefits classes for different levels of staff?
  • When the program was put in place, what was the process in determining the plan design?
  • When was the plan design last reviewed in detail, and have changes been made to the coverage?
  • Is the coverage set up properly from a tax perspective (in particular, the Long-Term Disability)?
  • Are you offering employees flexibility and choice as part of the benefits offering?

Whether it’s addressing women’s health, fertility, or expanding access to mental health practitioners, the reality is that a robust benefits program today looks very different than it did a decade ago. Sometimes a simple tweak (expanding eligible paramedical practitioners, for example) goes a long way to improving employee satisfaction with the program. A detailed benchmarking report is a key element of Immix Group’s health benefits audit.

Claims Analysis: Understanding Exactly what your Employees are Claiming

Related to the program design is delving into the breakdown of claims. Immix Group emphasizes the importance of claims transparency—not just for financial reasons, but because ongoing analysis helps guide plan design and provides insight into the health needs and usage patterns of the staff.

Part of the Immix Group’s benefits audit report is an analysis of your historical claims experience, typically looking back 2-4 years. We break down:

  • Which benefits are being used and not used?
  • What takeaways can be made from the claiming patterns, and how does your group compare to industry averages?  
  • Are there areas where members are consistently maxing out their coverage?
  • What is the average cost per certificate year over year? Is it rising? How does this break out by category?
  • What are the key therapeutic categories and could these be strategically addressed?

Our benefits audit report lays out the information clearly, so you can gain a clear understanding of the claims composition for your group.

Financial Analysis of your Benefits Program

One of the most common reasons we are approached to conduct a benefits plan audit is to review the employee benefits plan pricing. A financial audit of your benefits program pricing by an independent benefits advisor can reveal whether you are overpaying for your benefits. This involves far more than simply requesting quotes from competing insurance carriers.

Our in-depth review of pricing seeks to determine all factors related to your bottom line:

  • Review of the cost adjustments over the past several years, analysing the annual rate adjustments per benefit line
  • Analysis of the rates for the pooled benefits, and whether they are accurate based on your demographics and plan design
  • Detailed analysis of the expense factors on your plan (target loss ratio, admin charges, advisor commissions)

All of the above leads to the answer of the key question: Are you overpaying for your benefits program?

Employee Benefits Program Marketing: Obtaining Quotes from Competitors

Based on the results of our benefits audit, we usually have a clear sense as to whether the pricing is fair. Regardless, we may suggest marketing the program with alternative insurance providers to see the rates they will offer.

As well, pricing is just one element of a plan, and moving carriers can be desired for other reasons such as obtaining certain plan design features, better tech offerings, or a better service and member engagement experience.

As independent benefits advisors, we have freedom to survey the market and obtain quotes from a wide range of providers.

Service & Advisory Support: Are you Getting the Support you Need?

Are you totally happy with both your advisor and your insurance provider? Advisor roles vary significantly; some stay behind the scenes and only appear at renewal time. In contrast, the Immix Group takes the opposite approach, and we encourage our Client Community to see us as their benefits partner.

One of the nicest things to hear from our Client Community is along the lines of ‘you make my life so much easier’. This is music to our ears, because our role extends far beyond presenting the benefits renewal report. We handle the daily administration of the program, as an extension of your HR team.

When it comes to the Immix Group’s benefits audit, we want to understand:

  • Are you receiving the support you need, from your advisor?
  • Are they making pricing, plan design and other relevant factors clear and understandable?
  • Is your insurance provider making it easy for employees to understand their plan, and adjudicate claims?
  • Are they using modern technology?

A benefits program should never be ‘set it and forget it’! We want you to have a flexible benefits plan, that can shift to meet your needs. The Immix Group strives to be your partner in guiding you through this process, with an eye on both sides- the financial aspect of the program as well as the member and plan administrator service experience.  

A Benefits Audit by an Independent Employee Benefits Advisor

The feeling that you are overpaying for benefits, that you are not getting value for the premiums, or that money is in some way falling through the cracks is something that keeps business owners awake at night.

While it’s simple to obtain a variety of quotes from competing carriers with a range of lower premium options, they don’t tell you much, other than the fact that another carrier is willing to buy your business with lower rates.

An Immix Group benefits audit goes far beyond basic plan marketing. As we said earlier, ‘We want you to love your plan!’ and we mean it. To us, this means every aspect from coverage that meets people’s needs, to a user-friendly claims experience, to transparency and fairness when it comes to the pricing of the program. If you’d like to have your own plan reviewed, we’re happy to help. Here’s what you can expect:

  • Understandable snapshot of your program structure; benefits, administrative and financial
  • Summary of key takeaways from plan members
  • Benchmarking of plan design
  • In depth review of claims usage
  • Historical rate review/ analysis of costs

Quick Self-Assessment:

Before diving into the full audit, here’s a simplified checklist to help you uncover potential issues right away. Use it as a strategic snapshot of what we examine during our full Benefits Audit:

Download the 2025 Benefits Audit Checklist

Key Takeaways:

  1. Survey staff and improve benefits communication. Surveys and education boost engagement and help tailor coverage to real needs.
  2. Update plan design for flexibility and relevance. Ensure employee benefits plan design reflects current health trends, offers flexibility, and reflects business goals and values.
  3. Analyze claims data to guide plan changes. Claims analysis reveals usage patterns and provides value insight as to beneficial changes.
  4. Review costs to ensure fair, transparent pricing. Pricing analysis that looks to historical rate adjustments and administrative costs helps answer the key question: ‘are we overpaying?”
  5. Ensure strong advisor and carrier support. Proactive, supportive advisors and modern service platforms ensure the smooth ongoing management of your program and a positive member experience.

Read More:

The ‘ghost benefits’ gap: How employers can ensure their offerings are used, understood by employees | Benefits Canada.com

What You Need to Know When Considering a Switch in Employee Benefits Providers – Latest News from Immix Group

One size fits all? Not when it comes to employee benefits. – Latest News from Immix Group

8 Reasons for Increases to your Employee Benefit Plan Premiums    – Latest News from Immix Group

Employee benefits: What you need to know about discounted group benefits pricing – Latest News from Immix Group

Your Benefits, Your Way: The “101” on Health and Wellness Spending Accounts

A Better Way to Do Benefits – Latest News from Immix Group

Mental Health Support: A Simple Guide to Providing Mental Health Coverage within your Employee Benefits Program – Latest News from Immix Group

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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A Better Way to Do Benefits

Posted on by Immix Group

A Better Way to Do Benefits: Independent, Canadian, and Client-First

As an independent, Canadian-owned firm, we’re free to build custom benefits solutions based solely on what’s right for your business.

 

by Lindsay Byrka | B.A., B.Ed, CFP® | Vice President

The Immix Group Employee Benefits is Canadian and Independent

One thing that sets the Immix Group apart—especially in today’s world of frequent mergers and acquisitions—is our independence! We likely don’t talk about it enough, but did you know the Immix Group is a 100% independent, Canadian-owned and operated company? While the name The Immix Group Employee Benefits Ltd. was established in 2010, our roots date back over four decades.

Unlike the majority of our competitors who operate as subsidiaries of large corporations (usually American), we understand what it’s like to run an SMB in Canada.  This means we can relate to the experience of our clients, many of whom are owner-operators. We know they need to focus on their own business. When it comes to their benefits, they need a partner they trust, with expertise, access to the market, and the capability to support the ongoing management of the program.

The Immix Group is an extension of your team

Many of our smaller clients don’t employ HR professionals—or if they do, they prefer those team members to focus on other human resource activities, not benefits administration.

Even for the larger firms we work with who employ robust HR teams, they may not have the bandwidth or desire to administer their benefits, or to delve into understand the intricacies of pricing, plan design elements or other related aspects of an employee benefits program.

So why is it advantageous for SMBs to partner with benefits advisors who also provide administration services?

Because benefits administration doesn’t need to be an added burden for internal teams. With the right support in place, questions get answered faster, errors are avoided, and employees get the help they need—without the runaround.

A small company with around 35 employees had their payroll administrator also managing the benefits plan. While they were an experienced and capable administrator with deep knowledge of the company’s industry, employee benefits were not their area of expertise. Despite basic training on the insurer’s plan admin site, they regularly ran into confusing and complex situations—late applicants, dependent eligibility, billing confusion—and didn’t always know how to proceed.

While the company had an advisor, their role was limited to higher-level items (renewals, plan design changes, escalated situations) rather than the day-to-day. Employees were told to call 1-800 numbers for help, which left everyone frustrated. When the Immix Group came on board, this relieved them of this aspect of their week, freeing them up to focus on other higher-value activities to support the firm.

At Immix Group, we don’t expect your internal team to become benefits experts. That’s our job.

At Immix Group, we handle the daily benefits admin—so your team doesn’t have to. We resolve issues quickly, support employees directly, and keep your plan running smoothly.

For those in our Client Community, if you’re not already taking advantage of the Immix Group’s ability to handle your benefits administration, please reach out! We administer benefits for about 75% of those in our Client Community, but we’d love to see that number reach 100%. Providing daily benefits administration is included when you work with the advisors at the Immix Group; we do not charge additional third-party admin fees.

When it comes to your benefits program, one size does not fit all.

Expertise when it comes to benefits administration is just one part of the equation. Our process most often begins with collaborating with your team to design a program that meets the unique needs of your group of employees.

A mini case study: One of our long-time clients is comprised of nearly 100% women employees. They wanted to address the needs of their staff in a meaningful way, acknowledging that women have unique life experiences and needs. We collaborated with their team- starting with an employee survey- to implement benefits that included enhanced fertility and family planning coverage, additional mental health support (higher practitioner limits, enhanced EFAP with CBT), and a generous flexible spending account open to taxable benefits such as childcare, fitness and kids’ sports fees. On top of this, a robust virtual healthcare program to ensure the many busy moms in their employee base had access to virtual healthcare visits for themselves and their family members, as needed.

Whether it’s getting the right cost sharing formula in place, executive disability coverage, or robust flex spending, fertility and family planning benefits, a program can be tailored to meet your desired outcomes. We believe your benefits program should reflect the values and philosophy of your company, and that in doing so, it enhances culture.

Choosing the right provider for your programs enhances the employee experience

The Immix Group has longstanding and ever-expanding relationships with a myriad of insurance and investment providers. Because we are free to use the full range of industry suppliers, both large and small, this gives us flexibility and freedom to get it right.  

Because the Immix Group is independent, we have the freedom to share the details

When it comes to their group benefits plan, one concern most Canadian business owners have is over-paying for their benefits. There is the perception that insurance is often ‘money down the drain’. This is why transparency matters so much to us; we believe that you should understand where your benefits dollars are going, and the breakdown of premiums and claims.

So how can small and medium-sized businesses ensure they are not overpaying for benefits? By working with providers who are transparent when it comes to the financial details. It doesn’t have to be complicated, rather, it should be clear. We believe that employers should be able to see the financial elements such as where the claims dollars are directed and expenses on the program.

In contrast to how the Immix Group manages our pools, many other providers do not share details.

Despite some progress in the industry with a general movement towards greater transparency, many benefit providers still withhold claims data—especially in pools or association plans. These often come with preset plan designs and pricing that adjusts based on the performance of the overall group, not your individual company. In these cases, you typically can’t customize your plan or access your own claims breakdown.

Without that transparency, it’s hard to make informed decisions. Worse, you may face cost increases that don’t reflect your company’s actual usage.

If you’d like the Immix Group to take a second look at your benefits plan, please reach out! We love to hear from you.

Have questions or ready to take the next step?
Connect with our team today — we’d love to hear from you.

Key Takeaways 

Independent and Canadian-Owned: The Immix Group is 100% Canadian and independently owned, allowing us to prioritize client needs.

Custom-Tailored Plan Design: Unlike many providers, Immix can design flexible benefits programs—including pricing, plan structure, and rate guarantees—tailored to the unique needs of small and medium-sized businesses.

Hands-On Benefits Administration: Immix supports day-to-day benefits administration for clients, helping reduce internal workload, resolve issues quickly, and improve the employee experience.

Transparency for Pricing and Claims Data: The Immix Group believes in full financial transparency, ensuring clients understand where their benefits dollars go—unlike many pooled or association plans that limit access to claims data.

An Extension of your Team: With a high-touch service model and expert advice, Immix acts as an extension of your team, building benefits programs that reflect your company’s values and support your workforce.

FAQ’s

Being independent means the advisor is not tied to a specific insurer or provider. This means access to a broad range of suppliers, and the ability to fully customized benefits programs for our clients.

Some do, the Immix Group does not, and includes ongoing daily benefits administration as part of our high touch service protocol.

Lack of claims data limits your ability to make informed decisions about your benefits plan. It can also result in unfair rate increases. Immix ensures full transparency so you can evaluate performance and adjust your plan accordingly.

Read More:

One size fits all? Not when it comes to employee benefits. – Latest News from Immix Group

What You Need to Know When Considering a Switch in Employee Benefits Providers – Latest News from Immix Group

Understanding Cost-Sharing in Employee Benefits – Latest News from Immix Group

A Proven Strategy for Containing Employee Benefit Plan Costs – Latest News from Immix Group

The value of employee benefits inside a broker-managed benefits pool, especially during times of uncertainty – Latest News from Immix Group

At Immix, our role goes far beyond the pricing of your program. – Latest News from Immix Group

The major impact of small businesses in Canada: Small Business, Benefits and COVID19 – Latest News from Immix Group

Top 8 FAQs for Business Owners when Implementing an Employee Benefits Plan – Latest News from Immix Group

Immix Pool – Working Together for a Better Benefits Plan | Immix Group

 

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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Not Eligible for Employee Benefits? Four Types of Coverage the Self-Employed Should Consider

Posted on by Immix Group

Learn the four essential coverages every freelancer, consultant, and contractor in Canada should know — and how to get protected fast.

by Lindsay Byrka | B.A., B.Ed, CFP® | Vice President

If you’re self-employed in Canada, you may be one illness, dental emergency, or unexpected injury away from a serious financial setback. Without the safety net of employee benefits, even routine health expenses can feel overwhelming.

So, what are your options?

At Immix Group, we work with hundreds of small business owners, contractors, and consultants across Canada — many of whom don’t qualify for traditional benefit plans. Whether you’re just starting out or managing a thriving independent business, protecting your health, income, and business continuity is one of the smartest investments you can make.

Just because you’re self-employed doesn’t mean you can’t access insurance protection similar to what is offered under an employee benefits program.

You might be a contractor and not eligible for benefits, a self-employed professional, or an owner-operator of a small business.

There are a few key areas where it is important to ensure you have adequate coverage in place. Our focus is on areas that are commonly covered through an employer-sponsored plan, plus the often-overlooked business overhead expense insurance.

The Reality for Self-Employed Canadians

Why Going Without Coverage Can Cost More Than You Think

 

A recent statistic in the March 2025 Labour Force Survey noted that in Canada most self-employed individuals are not covered by health, dental and disability insurance, despite experiencing more financial risk than employees and being generally more vulnerable to changing economic conditions.

Specifically, in looking at those who are “incorporated without employees”, around 25% have disability insurance, ~37% have a dental plan, and ~45% have extended healthcare.

It is not surprising that self-employed workers with “larger and more established businesses” are more likely to have insurance in place. However, the number is still under 50%!

  • Only 25% of self-employed Canadians have disability insurance
  • 37% have a dental plan
  • 45% have extended health coverage

Extended Health and Dental Care

What Self-Employed Canadians Need Most — and Often Miss

If you are self-employed, we recommend exploring these key areas:

  • Extended Health and Dental Care
  • Health Spending Accounts
  • Disability Insurance
  • Business Overhead Expense Insurance

While the Immix Group focuses on working with Canadian small and medium sized businesses with employees, many of those in our Client Community are self-employed. Often, we work with these clients to put protections in place similar to those under robust employer-sponsored programs.

Without an employer plan, most people pay out of pocket — and often overpay.

Extended Health and Dental Care plans are easy to implement

This is the most obvious missing piece as this coverage forms the cornerstone of many employee benefit programs. Specifically, the most highly claimed items are:

  • Prescription drugs
  • Vision expenses such as glasses and contact lenses
  • Professional practitioners (massage, physio, chiropractor, mental health therapists etc)
  • Dental care expenses

Many individuals and families without extended health and dental coverage absorb these costs out-of-pocket as the cost per item tends to be low to moderate. However, these expenses can add up, especially if a medical or dental concern arises that requires ongoing treatment. Transferring the risk for these expenses to an insurance provider is prudent financial planning.   

As well, extended health care nearly always includes coverage for emergency medical expenses incurred while traveling out of country. This is a huge perk and for many people the inclusion of this item alone makes it worth the cost.

Keep in mind with these plans, you are never locked into a long-term contract. You pay month to month and can cancel at any time. If your business grows and you add employees, you may wish to shift to a more formal employee benefits program.

Whether you’re managing family expenses or just want to avoid surprise bills, transferring these risks to a trusted insurance provider can be a smart part of your financial planning.

Ready to compare your options?

Explore Individual Health Plans Built for Self-Employed Canadians

No pressure — just a chance to see what’s possible, at your own pace.

Health Spending Accounts: a tax-advantaged approach

Tax-Smart Coverage That Flexes with Your Needs

Even if you decide to establish an insured extended health and dental program, you may have medical and dental expenses beyond the reimbursement limits of your plan. This is quite common, with things such as major dental procedures, orthodontics or practitioner visit costs exceeding common coverage limitations. Or, if you don’t have any insured coverage at all for certain items. This is where a Health Spending Account, a form of a private health services plan (PHSP), may be a good option.

When structured correctly per the CRA, eligible medical and dental expenses and associated administrative costs are deductible to the business. This may offer significant savings compared with paying for the same expenses with after-tax personal dollars.

In a recent article, we provided the “101” on Health Spending Accounts. While these are often an employee benefit most commonly acting to supplement an insurance plan, the same concept can be used by self-employed individuals who meet the right criteria. It is important to understand how the CRA views these accounts, to ensure you are onside with all rules.

We are happy to help you navigate whether establishing a Health Spending Account is the right approach for you. Our provider of choice is myHSA, where you can find great information on these plans.

Curious if an HSA is the right fit for your business structure?

 Explore Your Options with Immix Group

 

Disability insurance is “income replacement” coverage

Protecting Your Income When Life Takes a Turn

It is referred to as “income replacement” insurance for a reason.  In the event you become sick or injured and you’re no longer able to work, disability insurance provides an ongoing monthly benefit payment intended to replace your lost earnings. For many small business owners or self-employed professionals, staying healthy is essential to the business continuing to produce revenue.  

If you are self-employed, you may not be eligible for any EI Sickness benefits via Service Canada, to which employees are usually entitled. This provides 55% of weekly earnings, up to a maximum, for up to 26 weeks for eligible applicants. For those who are self-employed, you have to opt into this program and pay premiums, and meet certain requirements to be eligible.

It’s essential to protect yourself in this area. As we have written about extensively in the past, disability insurance is commonly overlooked and misunderstood, despite how crucial it is to ensure you are adequately covered. It’s a key component of comprehensive group benefits programs.  If you do not have any form of disability insurance in place, we highly recommend discussing this with a qualified advisor.

Common Questions About Disability Insurance

If you’re not part of an employee benefits plan, you may have no income support unless you’ve opted into EI. Disability insurance fills that gap, replacing a portion of your income so you can focus on recovery — not just bills.

Not at all. Most claims come from everyday issues — like back injuries, anxiety, or health conditions that affect office workers, creatives, and consultants alike.

It depends on your age, income, and coverage preferences — but many clients are surprised at how affordable it is. Often, it costs less than expected and can save you from months of lost income.

If you’re medically unable to work, your plan provides monthly payments to help you manage life’s essentials — rent, groceries, business expenses, and more.

That’s where we come in. At Immix Group, we’ll walk you through the options and help you find coverage that matches your needs — without overpaying.

Want to see how disability coverage could protect your income?

 Explore Individual Disability Plans with Immix Group

It’s simpler and more flexible than you might think.

Business Overhead Expense Insurance  

What Is BOE Insurance — and Who Needs It?

 

For business owners, a product exists called Business Overhead Expense (BOE) insurance which is exactly as it sounds: BOE covers ongoing fixed expenses such as rent, utilities and property taxes.

RBC Insurance provides this coverage, which is for those whose income depends on their ‘personal and regular attention’ to duties and who bear the cost of maintaining the expenses named above. The policy pays while you are disabled (per the contract wording) and therefore unable to continue in your business and generate income. While BOE is similar individual disability insurance in that the triggering event for payment is becoming disabled, the key difference is BOE is designed to cover the business’s operating expenses while individual disability coverage is intended to replace personal income.

Business owners can be considered, and loosely speaking, up to 10 employees although the requirement is that the loss of the insured is deemed to have an economic impact (i.e. other employees could not just take over and maintain revenue). Typical examples are doctors, lawyers, accountants or the principal owner/operator of a closely held business.

How It Works

  • You become medically unable to work
  • You make a claim and if medically approved
  • Your BOE policy kicks in
  • It pays the bills that keep your office open until you can return

You can think of it as business continuity protection — helping ensure that the business you’ve built doesn’t go on pause just because you need to.

 

Why are more self-employed individuals and small business owners not insuring themselves?

The Truth: It’s Easier — and More Affordable — Than You Might Think

 

People are quick to ensure professional liability insurance is in place, and that their physical premises or any needed equipment are insured. So why not these areas? The primary reasons people state for not pursuing insurance are “cost and complexity.”

The Immix Group is an independent, Canadian small business and we work closely with hundreds of small businesses- we understand the need to carefully consider all costs. However, it can be far less expensive than you think to put in place these protections. Working with an advisor to gain an idea as to the cost of various scenarios is a good starting point.

Concerned about complexity? That’s what qualified advisors do best: make things simple and understandable.

 

Smart Planning Starts with a Conversation

Insurance isn’t just about checking a box — it’s about protecting what you’ve built.

At Immix Group, we believe that including coverage for your health, income, and business operations is simply smart business planning. Whether you’re just starting your self-employed journey or scaling an established practice, the right protection can offer peace of mind and long-term stability.

You don’t have to figure it out alone — we’re here to help you navigate the options, make sense of the fine print, and choose a plan that fits your needs and budget.

Have questions or ready to take the next step?
Connect with our team today — we’d love to hear from you.

Key Takeaways for Self-Employed Canadians

Many self-employed professionals and contractors go without the kind of insurance coverage that’s typically built into employee benefits — leaving them financially vulnerable to health expenses, dental costs, or income loss due to illness.

In fact, fewer than half have any coverage at all:

  • 45% have extended health care
  • 37% have dental insurance
  • Only 25% carry disability protection

That’s a big gap, especially considering the higher financial risk that comes with working independently.

Here’s what you need to know:

  • Extended Health and Dental Care is a strong starting point. It can cover essentials like prescriptions, vision care, dental work, and visits to practitioners like physiotherapists and mental health therapists — including emergency medical travel.
  • Health Spending Accounts (HSAs) offer a tax-smart way to manage eligible medical and dental costs, either on their own or as a supplement to insured plans.
  • Disability Insurance helps replace your income if you can’t work due to illness or injury — particularly important for those who may not qualify for EI Sickness Benefits.
  • Business Overhead Expense (BOE) Insurance ensures your business bills (rent, internet, utilities) are covered if you’re temporarily unable to run things yourself.

So, what holds people back?

Most often, it’s the perception that insurance is too expensive or too complex. The truth? Many plans are simpler — and more affordable — than you might think.

With the right guidance, you can put flexible, easy-to-understand coverage in place that fits your life, your work, and your budget.

Because smart insurance planning isn’t just about protection — it’s about peace of mind for your family, your income, and your future.

FAQs About Insurance for Self-Employed Canadians

Yes. Even if you’re not eligible for an employee benefits plan, you can get extended health and dental insurance privately. This type of coverage helps pay for things like prescription drugs, dental, vision care, and visits to practitioners like chiropractors, massage therapists and physiotherapists.

An HSA is a tax-advantaged way to adjudicate CRA-eligible medical and dental expenses. If set up properly, you can deduct these costs through your business. This will save you money compared to paying out-of-pocket personally.

Disability insurance protects your income if you become sick or injured and can’t work. This is a common inclusion under employee benefits programs in Canada.

BOE insurance helps cover fixed business expenses (like rent and utilities) if you can’t work due to disability. It’s especially useful for professionals or small business owners who play a key role in keeping their business running.

Not necessarily. Many plans are more affordable than expected, and generally speaking, you can cancel or adjust them anytime. Qualified benefits advisors like those of us at the Immix Group can help simplify the process and find the right coverage for your needs and budget.

Further Reading & Trusted Resources

Looking to explore the data or dive deeper into how benefits impact self-employed Canadians? These trusted sources offer valuable context:

Statistics Canada

A national snapshot showing how few self-employed Canadians are covered by insurance — and why that matters.

The Daily — Labour Force Survey, March 2025

New 2025 Data Reveals Majority of Self-Employed Canadians Lack Basic Insurance Coverage

More Canadians need disability leave and fewer have coverage – The Globe and Mail

A revealing look at rising disability needs and gaps in coverage across Canada’s workforce.

Incorporated self-employed workers with employees more likely to be covered by private insurance in March

Data showing that even incorporated professionals often lack sufficient protection.

Private Health Services Plan – Canada.ca

CRA guidance on how HSAs work for small business owners.

EI Sickness Benefit – How much you could receive – Canada.ca

Check your eligibility and potential income support if you can’t work due to illness.

Ready to Explore What Coverage Could Look Like for You?

 

We know it’s a lot to take in. That’s why we’re here — to help you navigate your options, simplify the process, and find coverage that fits your life, your work, and your budget.

Whether you’re just getting started or want a second look at your current setup, we’re happy to help — no pressure, just personalized support.

Start exploring health, dental, and income protection plans today:

Visit Our Individual Plans Page

Or, if you’d rather talk it through:
Connect with Our Team — we love to hear from you.

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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Unmasking Mental Health: From Awareness to Action

Posted on by Immix Group

by Lindsay Byrka | B.A., B.Ed, CFP | Vice President

Mental Health Awareness Week in Canada takes place the first full week of May. This year’s theme—Unmasking Mental Health— is a reminder that behind every desk are real people with real challenges, struggles, and emotions—often not visible or obvious to those around them.

As described by the Canadian Mental Health Association, many who live with mental health challenges hide behind a ‘mask’ in order to protect themselves from judgement and discrimination. This is a heavy burden to bear.

There’s No One-Size-Fits-All—For Benefits or for People

At the Immix Group, we often say, “No two companies are the same—so why should their employee benefits programs be the same?” This belief extends to mental health support as well. Every organization is unique. That means their approach to mental health and wellness must be too.

As an independent employee benefits consulting firm based in Vancouver, we’ve seen the value of proactive planning. Resilient companies don’t just react—they design their programs to prevent issues before they escalate, and that starts by tailoring your plan to fit your people.

A Thoughtful Plan Design with Comprehensive Mental Health Supports

While we recognize that there is more to a healthy workplace than the benefits offering, this is the area where the Immix Group provides our expertise. At the Immix Group, we work with organizations to build custom employee benefits packages that include proactive and preventative offerings including:

  • Flexible benefits that allow employees the autonomy to direct dollars to where they are most needed
  • Ongoing employee wellness initiatives; access to varied resources, webinars, specialized practitioners and more
  • Enhanced offerings for mental health practitioners that include a full range of providers
  • Access to mental health resources including the many resources contained within robust Employee & Family Assistance Programs
  • Methods and funding to support physical activity and social connection
  • Financial well-being through group savings programs and financial literacy education opportunities
  • Clear and compassionate return-to-work pathways

The best prevention is a plan rooted in your culture, values, and people. These supports might not always be visible—but their impact is.

Start with Clear, Consistent and Open Communication

It is essential to clearly communicate the many mental health resources available to members through the various elements of their benefits offering. Many people are simply unaware of the supports that exist. Simply reminding and assisting employees with accessing the resources available to them goes a long way.  

Additionally, creating a safe environment starts with open communication. Encourage employees to share concerns early and reach out for support; that simple shift can mean the difference between a short-term challenge and a long-term leave.

Mental Health Claims Make up over a Third of Disability Claims

However, despite the best efforts of organizations to offer support to employees, disability claims will inevitably occur. Mental health now accounts for over one-third of disability claims in Canada, with conditions like anxiety, depression, and stress-related disorders among the top causes of both short- and long-term absences.

In short, mental illnesses are medical conditions that can affect people in many ways—impacting thought processes, emotions, behaviours, sense of self, relationships, and the ability to cope with stress. These challenges can, in turn, influence a person’s capacity to work and engage socially. (Government of Canada, 2023).

Even if a claim begins as physical, mental health concerns can become part of the picture over time. While these claims can be complex, the good news is that carriers and providers have made significant strides in how they approach mental health claims.

Early Intervention is Key

The statistics are clear: the first 30-60 days of a leave are a pivotal window. Prolonged silence or disconnection can complicate recovery, deepen isolation, and extend absences.

Whether through HR, managers, or a disability support partner, reaching out isn’t just a formality—it’s a signal of care. It keeps the door open for return and reduces the mental health strain of feeling “out of sight, out of mind.” Key strategies to support recovery from day one:

  • Maintain consistent, supportive and appropriate communication—don’t go silent
  • Build confidence in the disability management process with clear plans and shared understanding
  • Help employees feel tethered to their purpose, team, and workplace

The goal is to help employees on leave feel engaged. Once disengagement sets in, recovery becomes harder—for the employee and the organization.

The Cost of a Disengaged Leave

According to Service Canada, extended leave can cause employees to lose their sense of structure, identity, and connection. From a business standpoint, the cost is also significant—emotionally (for example, the impact on coworkers) and financially (lost productivity, hiring and training a replacement).

Industry data shows that after 6 months on leave, the chance of an employee returning to work drops to 20%. After 11 months, it drops to just 2%. In short, the longer someone is off work, the less likely they are to return. 

Let’s be clear: the goal is not to rush anyone back to work who is not medically ready. Employees who meet the definition of disability are rightfully entitled to benefits. But it’s essential to balance recovery with strategic engagement—so when they are ready, they feel connected and the path back is clear.

Plan Proactively: Support Your People and Your Organization

For the small and mid-sized businesses with whom we work, while they may not have a robust HR department, they can still implement a basic checklist of touch points to ensure connection is maintained. And they can work with our team at the Immix Group for guidance every step of the way.  

For larger organizations, it may make sense to partner with a speciality provider in this area, and to implement a formal Early Intervention Program (EIP). A provider with whom the Immix Group works is Acclaim Ability Management . Organizations like Acclaim make a measurable difference. Their specialized services include:

  • Early clinical intervention
  • Mental health triage and support
  • Guided communication strategies between employer and employee
  • Coordinated return-to-work planning

Companies like Acclaim don’t just manage claims—they manage the experience, from the first day of leave to the first day back. Their support ensures the process is human, effective, and efficient.

Return to Work with Support and Compassion

Research shows that returning to work as soon as possible—when medically appropriate—can support faster recovery and improve overall well-being. Benefits of an early, supported return include:

  • Aiding rehabilitation and mental health recovery
  • Preserving income and independence
  • Reducing long-term incapacity and isolation
  • Strengthening confidence and self-worth

For employers, it’s important to communicate clear expectations and be ready to offer modified duties and timelines. Having the employee come back under a modified return-to-work plan can greatly improve their chances of returning to their pre-disability functions.

Engagement Matters at Every Stage

To sum it up, support shouldn’t start at diagnosis or when an employee takes leave, and it shouldn’t end when someone returns to work. True support and engagement means:

  • Aligning your benefit offerings with your values
  • Regularly sharing resources and mental health supports
  • Creating a culture where asking for help is safe
  • Maintaining connection through leave and reintegration

When employees know your support is real, they feel seen, supported, and secure.

More Than Just a Benefits Program

At the Immix Group, we design benefits programs that do more than check a box. We build plans that connect, protect, and reflect your people. Because when your people feel supported, your business is too.

Curious to know if your employee benefits program is aligned with your organization’s unique needs? Email info@immixgroup.ca today or call (604) 688-5559 to speak with an Immix team member today; we love to hear from you!

Top 8 FAQ’s

The theme is Unmasking Mental Health—a reminder that behind every desk are real people with real challenges, struggles, and emotions.

Because no two companies—or their people—are the same. A tailored approach ensures your plan actually fits your team and their needs.

Proactive supports include flexible benefits, wellness initiatives, enhanced mental health practitioner access, EFAP resources, funding for physical/social activity, and financial literacy education.

Many employees are unaware of available resources. Open, consistent communication helps ensure supports are actually used—and that people feel safe asking for help.

Mental health conditions now account for over one-third of disability claims in Canada, with anxiety, depression, and stress-related disorders being top causes.

The first 30–60 days are critical; staying connected shows care, prevents isolation, and helps pave the way for a successful return.



The longer someone is off, the less likely they are to return. After six months, return-to-work chances drop to 20%; after eleven months, just 2%.

With clear expectations, modified duties, and compassionate communication. Support that begins early makes all the difference in recovery and reintegration.

Top 5 key takeaways:

  • Mental health support should reflect your company culture. A plan rooted in your organization’s values and people—not just policy—drives real results.
  • Employee engagement begins before a leave and continues through reintegration. True support spans the full recovery journey, not just the crisis moment.
  • Small and mid-sized businesses can still implement effective mental health strategies. Even without large HR teams, consistent check-ins and partnering with experts like ourselves, the Immix Group, makes a difference.
  • Carriers and providers are evolving in their approach to mental health. Claims may be complex, but modern tools and strategies make them more manageable and human-centered.
  • Mental health is both a human and business priority. The emotional and financial cost of disengagement is high—but preventable with thoughtful planning.

Read More

How Disability Management Fast-tracks Employee Health & Return to Work            

Early Intervention and Return to Work Program for supervisors – Province of British Columbia

Support for Recovery – Canada.ca

Acclaim Ability Management

Canadian Mental Health Association

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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Supporting Women at Every Stage: How Employee Benefits Can Make a Difference

Posted on by Immix Group

The Workplace Has Changed—Have Your Benefits?

by

March 8th is International Women’s Day, described as a day to “recognize and celebrate the social, economic, cultural and political achievements of women and girls.” This year’s theme is “Accelerate Action.” With this in mind, we wanted to highlight how employers can take action to design thoughtful benefits programs that support women at every stage of life.  Please note, while these areas are not exclusive to women, they more commonly affect women, and are more accessed by women.

Women are a driving force in today’s workforce, yet too often, employee benefits have not evolved to meet women’s needs. From starting a family to navigating fertility treatments, returning to work, or managing perimenopause and menopause, the right support can make all the difference.

While we have come a long way from a time when prescription contraceptives were excluded under benefit programs to having these covered by the government, there is still a long way to go.

The good news, as we wrote in our latest Key Conversations in Benefits article, is that 2024 saw women’s health at the forefront of many conversations.

 

Family planning and fertility support  

Specifically, we are seeing insurance carriers address what they are calling ‘family planning’ benefits, which include coverage for: 

  • Fertility drugs
  • In Vitro Fertilization
  • Intra-uterine insemination
  • Egg freezing
  • Adoption fees
  • Surrogacy costs

One in six couples faces fertility challenges; quite simply, it’s a common medical situation where both men and women may need to take medication or undergo procedures. Unfortunately, financial support via a benefits program is typically lacking; treatments are costly and rarely covered.

Depending on the provider, these expenses may not even be an option for the plan sponsor to include. If available, the coverage often needs to be explicitly added.  Typically, where coverage for “fertility” is available, drugs related to fertility treatments have been covered, while procedure costs have been excluded. Most carriers include an annual or lifetime reimbursement limit that falls far short of average expenses.

We believe that fertility coverage should be included in all benefits programs as an embedded coverage line.  Companies that offer fertility coverage see higher employee satisfaction and reduced turnover—especially among higher-level professionals delaying parenthood due to career demands.

Taking it a step further than the financial element, progressive companies are providing support not only in the form of insurance coverage for related drugs and procedures but also in time off and flexibility for the medical procedures and health impacts that can accompany those undergoing fertility treatments.

The recent announcement by the BC government regarding the funding of IVF (one round) is positive news and will provide great support to those facing infertility. Related to this, the BC government has covered prescription birth control since April 2023. The federal government is seeking to do the same across Canada.

 

Maternity and parental leave benefits

Canada has a reputation for excellent support and federal protections for parents who wish to take maternity and parental leave with the birth or adoption of a child. Employment Insurance, however, provides just 55% of earnings to a maximum taxable weekly payment (the same as EI).

Depending on your family situation and the cost of living in your location, many families are unable to make ends meet with one parent receiving just EI payments.

It is worth noting that more and more men and non-birthing partners are taking parental leave (47% as of 2022), but it is still primarily mothers who are taking leave (for example, 94% of mothers vs 47% of their partners claimed or intended to claim parental benefits in 2022).

 

Top-up pay during maternity and parental leave

More progressive companies offer top-up pay to supplement Employment Insurance payments. There are many reasons for this, including supporting mental and financial wellness, attraction and retention, and organizational culture. While this can be costly, it is ultimately an investment in the employee.

There are many creative ways to structure this; there can be the requirement to return to work for a minimum duration (or owe back the funds), partial top-ups (i.e. an additional amount of pay, but not to full income), or top-up for a limited time (this is often aligned to the maternity/ medical portion of leave).

For employers, there is no requirement to register a top-up plan with the CRA as in the past (i.e. it will not claw back EI to pay top-up to an employee on parental leave).

Despite the many benefits of offering this support, only around 58% of companies provide some form of top-up program, and this is generally limited in duration and amount.

 

Continuity of benefits during parental leave

While off on leave, employees are still considered ‘active employees’ meaning they have the right to continue to participate in benefits programs.

Employers are required to keep employees on employer-paid benefits while on maternity or parental leave. Generally, if employees are paying a portion of the premiums, they are able to opt out of benefits and return without penalty when they are back at work (i.e. the waiting period or pre-existing conditions period would not apply to them). It is a common practice for employers to collect post-dated cheques in order to have employees continue to cover their share of the cost if there is no pay to deduct from.

Our recommendation is always for employees to try to keep their benefits intact while on leave, to continue to support health and well-being. We encourage employers to facilitate this the best they can.

 

Returning to work after children

According to Statistics Canada, only 66% of mothers return to full-time work after parental leave. Proactive support during this major life change can significantly boost employee satisfaction and loyalty. Companies with better parental benefits see higher retention and smoother transitions back to work. Flexibility goes a long way!

Offering new parents hybrid work options, flexible hours and flexible benefits, all play a role in supporting this time of life. For example, many parents struggle to find appropriate daycare; employers ultimately benefit from being understanding and flexible with timelines, while setting boundaries that work for both parties. Generally speaking, it is more advantageous in the long term to offer flexibility in support of an excellent employee, than force a situation that will result in them leaving their job.

Employers should also remind parents about the support offered within an Employee & Family Assistance Program. One of our own staff members here at the Immix Group found himself overwhelmed with the ‘terrible twos’ and found that the assistance offered via the EFAP was extremely beneficial!


Mid-life women – support during perimenopause and beyond

Women, 50% of the workforce, will experience menopause, yet only 1 in 5 Canadian companies have policies to support it. (Menopause Foundation of Canada, 2023)

In the years leading up to menopause (which is technically one day!) is peri-menopause, a long transition period where women’s bodies may experience a myriad of symptoms which can be quite debilitating. Leading benefits plans include:

  • Coverage for hormone therapy, medical consultations, and mental health support
  • Menopause-inclusive sick leave for severe symptoms
  • Workplace education programs to foster awareness

Ignoring peri-menopause and menopause in benefits planning can lead to absenteeism, productivity loss, and increased turnover among experienced employees.

One piece of good news is the government has announced funding for hormone replacement therapy (HRT) in BC beginning in April 2025, which can be very effective in assisting women in managing symptoms during this period.

 

Health & wellness spending accounts to offer flexibility and choice

At the Immix Group, we are strong believers in the value of Health & Wellness Spending Accounts, as a supplement to an insured benefit program.

In addition to medical expenses, a flex spending account can provide reimbursement for other “wellness or lifestyle” expenses, on a taxable basis. Families are supported with the ability to claim for childcare, children’s sports, doulas, lactation and sleep consultants, and a myriad of other related expenses that would not normally be reimbursable under a group extended healthcare program. Mid-life women can access products, medications and therapies to assist in relieving symptoms (CBT, weight training, supplements etc). A Health Spending Account also offers valuable dollars towards mental health practitioners, which are easily exhausted within a traditional benefits program.

 

Investing in Women’s Health is Investing in Your Workforce

Comprehensive benefits that address family planning, parental leave, mid-life health, and overall wellness can have a profound impact on employee satisfaction, retention, and productivity.

As we recognize International Women’s Day and this year’s theme of “Accelerate Action,” now is the time for employers to take a closer look at their benefits programs. Are they truly meeting the needs of today’s workforce? Thoughtful updates to parental leave policies, fertility benefits, and menopause support aren’t just perks—they’re essential to fostering an inclusive, high-performing workplace.

At the Immix Group, we believe that benefits should evolve alongside the people they serve. Interested in discussing how your organization can lead the way in supporting women’s health and well-being? Reach out to us at info@immixgroup.ca or (604) 688-5559  – we love to hear from you!

Top 8 FAQ’s

Women make up a significant portion of the workforce, yet traditional benefits have not always addressed their needs. Thoughtful coverage leads to higher employee satisfaction, retention, and overall well-being.

Some plans offer coverage for fertility drugs, IVF, IUI, egg freezing, adoption fees, and surrogacy costs. However, these are emerging benefits, often add-ons, and usually require employer selection.

Employers can supplement Employment Insurance (EI) payments with top-ups, which may cover a portion of the employee’s salary for a set period. This helps ease financial strain during leave.

Perimenopause and menopause can impact work performance, yet few companies provide coverage for hormone therapy, medical support, or flexible sick leave. Addressing this gap helps retain experienced employees.

These accounts allow employees to claim medical and wellness expenses beyond standard benefits, including for mental health, child care, and menopause-related therapies.

Yes, BC’s government recently announced funding for one round of IVF and hormone replacement therapy (HRT) starting in 2025, but workplace benefits remain crucial for ongoing support.

Offering flexible, customizable plans—including support for family planning, parental leave, and mid-life health—ensures benefits meet the needs of a diverse workforce.

Companies that proactively support women’s health see increased employee satisfaction, reduced absenteeism, stronger retention, and a more inclusive workplace culture.

7 Key Takeaways

  1. Women’s health is still underrepresented in employee benefits: While progress has been made, many benefits plans do not fully address key health challenges that disproportionately affect women, such as fertility treatments, parental leave financial support, and menopause-related health issues.
  2. Family planning benefits are becoming more common, but coverage is limited: Some employers now offer fertility coverage (for drugs, treatments, adoption, and surrogacy), but coverage caps often leave employees with significant out-of-pocket expenses. Companies that offer comprehensive fertility benefits see higher employee satisfaction and better retention rates.
  3. Returning to work after parental leave is a major transition: Only 66% of mothers return to full-time work after parental leave. Flexible work arrangements, hybrid options, and support resources can ease this transition, reducing employee turnover.
  4. Menopause support in the workplace is long overdue: Despite menopause affecting half the workforce, only 20% of companies offer support. Expanding benefits to include hormone therapy, mental health support, and menopause-friendly sick leave can improve employee well-being and productivity.
  5. Health & Wellness Spending Accounts provide much-needed flexibility: HSAs and WSAs allow employees to tailor benefits to their unique needs, covering costs for childcare, mental health support, menopause treatments, and more. These accounts are a cost-effective way for employers to enhance their benefits offering.
  6. Investing in women’s health is investing in your workforce: Companies that proactively expand benefits for family planning, maternity leave, menopause, and wellness foster a healthier, more engaged workforce. As workplaces evolve, benefits should too—supporting employees at every stage of life leads to better retention, morale, and long-term success.

Read More

Key Conversations in Benefits 2024 – Latest News from Immix Group

The HER-BC Report – Women’s Health Research Institute

Save the date for International Women’s Day 2025 events – Canada.ca

International Women’s Day 2025

Partners’ uptake of parental benefits: An upward trend?

Making the case for top-up plans | Canadian HR Reporter

Governments of Canada and British Columbia partner to improve contraception and diabetes coverage for residents – Canada.ca

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Latest Insights

Key Conversations in Benefits 2024

Posted on by Immix Group

Key Conversations in Benefits 2024

Once again, this year, we have compiled the top conversations in benefits, from our perspective as benefits advisors. These are the topics we heard about the most in the news, from our supplier partners, and that members of our Client Community inquired about most often.

Each year, our Key Conversations in Benefits article proves to be very popular! This year, we will cover:

  1. Inflation and Rising Claim Costs
  2. Health & Wellness Spending Accounts
  3. Women’s Health
  4. Changes to Government Coverage
  5. Pharmacogenetics
  6. Mental Health Supports
  7. Financial Literacy
 

Inflation is Still Impacting Benefit Costs

While we saw interest rates decrease in 2024 multiple times, and inflation supposedly contained, benefits program renewals in 2024 still felt the impacts of increased claims due to rising costs.

The plan renewals in 2024 saw pricing based on claims experience partially from 2024, 2023, 2022, and in some cases 2021. In analyzing experience data, we saw rising costs for claims across practitioners (physiotherapy, massage, chiropractic, equipment and most notably dental claims due to fee guide increases).  Compounding this, we saw the Reasonable & Customary limits (the maximum amount reimbursed per visit) increased by insurance providers, a measure intended to cover more of the true cost of the claim. The impact of this is higher claims in dollars for a group, even if the number of visits remained the same.

The result of increased claims is often increased premiums, although, of course, this depends on the break-even mark for the insurer.

The good news? We are seeing a tapering off – at least within our block of business- of rising costs. We are hopeful that 2025 plan renewals will see more typical adjustments.

 

 

Health & Wellness Spending Accounts

Inquiries about flexible Health & Wellness Spending Accounts were more frequent than ever in 2024! The popularity of these plans is not surprising, and many employees have come to see this as a typical inclusion under an employee benefits program.

A flex spending account is a great way to address generational differences, to offer ‘more’ to certain people, or even to provide customized coverage for a particular category of expenses. For those with just a couple of employees (or, incorporated individuals) a Health Spending Account is also a great option.

For Employers, the fact that the cost is predictable is one of the most desirable features of a Health Spending Account. Because you are pre-defining the allowable total annual spending per employee, you’re able to offer flexibility and choice, but at a maximum known cost for the business.

The good news for employers is that the implementation and administration of these plans are incredibly simple, and administrative costs have remained low.

We will be putting out a “Health & Wellness Spending Account 101” in 2025 to answer all your key questions, but in the meantime, please see our website for more information. 

 

 

Women’s Health at the Forefront of Conversation

This was a topic brought up not only by our clients (we had many inquiries about fertility coverage, for example) but also the subject matter at many industry seminars this year.

In particular, the Immix Group had the opportunity to attend an event where we heard directly from those involved in the “HER” study or the “Health and Economics Research on Midlife Women in British Columbia.” The HER-BC Report – Women’s Health Research Institute

The statistics this study revealed are actually quite shocking, revealing the impacts on health and well-being for mid-life women in perimenopause and menopause. In particular, the economic impacts that were highlighted were very eye-opening to many in the room; women turning down promotions, stepping down to a lower position or leaving the workforce altogether.

The takeaways from our perspective in the benefits world? We can play a role in ensuring benefit programs offer effective support for women, in particular, mid-life women. Solutions were highlighted, including the fact that Cognitive Behavioural Therapy has been found to be a leading treatment for women experiencing the symptoms of perimenopause and menopause. Things such as CBT, hormone replacement therapy and even flexibility when it comes to the work environment, hours and required dress while on the job all play a role.

Adjacent to this are conversations surrounding fertility coverage and hormone replacement therapy, which we will detail below.

 

 

Shifting Costs back to the Government

From our perspective, potentially the most impactful conversation of 2024 was the announcement of funding from the federal government to cover diabetes medications and prescription birth control through provincial medical plans. As BC already made the move to cover birth control back in 2023, in BC these funds will be used for hormone replacement therapy medications. Additionally, BC will cover one round of In-Vitro Fertilization (IVP).

B.C. pharmacare deal will cover diabetes meds, hormone therapy | CBC News

Publicly Funded IVF Program – Province of British Columbia

This could be significant for employers; depending on your demographics and drug spending, the result could be a notable reduction in the cost of drug claims running through the Employer’s benefit program. 

We are uncertain at this point as to the drugs that will be covered; as with the April 2023 implementation of government coverage for birth control, we expect the listing of covered medications to be robust, but not 100%.

Lastly, as we’re on the topic of government coverage, the Canadian Dental Care Plan (CDCP) is now in its second year. The program received a lot of media attention due to the initial small percentage of dental offices who signed up to participate in this plan, citing concerns relating to their ability to be reimbursed quickly and fairly. With some changes- notably, to allow for direct billing to the provider SunLife- participation reached over 75% late in 2024.

 

 

Is Personalized Medicine the Future of Medicine?

It’s been many years now since pharmacogenetics first came up in employee benefits conversations. If you’re unfamiliar with the term, in short, pharmacogenetics refers to how our genes affect the way our bodies respond to medications.

According to a popular provider, Pillcheck, this “provides insights about each patient’s predicted response to various medications, enabling you to narrow the potential treatments to those most likely to be safe, tolerable, and effective for the individual.”

Personalized medicine simply means choosing or avoiding certain medications, based on your own genetic profile, with the goal of finding those that will provide you with the desired effect. What does this mean and why are benefits providers interested in this? 

We know that people often need to try multiple medications before landing on one that works well for them; this is especially true for certain drug categories, for example, medications used to treat mental health conditions. In getting straight to the drug that is most likely to work the best, there is less waste of; time, money and medications, and most importantly, improved health outcomes.

For insurance providers and in turn, employers who ultimately bear the cost of claims, covering the cost of this testing makes financial sense.

Manulife Financial has an excellent overview online, where they state: “Over the past 2 years, we ran a Personalized Medicine pilot program. After getting their results, 44% of people in the program changed their medication or dosage. These changes led to better health outcomes.”

Coverage under a benefits program is available but not common yet. Please note in most instances pharmacogenetic testing could be claimed via a Health Spending Account.

 

 

Mental Health Support Remains at the Forefront

Offering appropriate support for mental wellbeing continues to be a huge conversation – in fact, it’s woven through most other areas whether it’s drug costs/ pharmacogenetics, women’s health, financial literacy, benefits plan design, or disability claims.

We continue to see claims for mental health practitioners increase. For example, within our Pacific Blue Cross block of business, we have seen the percentage of total paramedical practitioner claims under the “Psychology/ Clinical Counsellors” benefit increase as follows:

  • 2016: 5.86%
  • 2018: 5.7%
  • 2020: 9.29%
  • 2022: 9.5%
  • 2024: 11.5%

What we thought of as a ‘Covid phenomenon’ is now the routine inclusion of these practitioners in the top-five. We are encouraged to see providers expand their listing of covered practitioners in order to increase access for members, both from an availability standpoint and financially speaking.

Additionally, many benefits plan sponsors are carving out practitioner coverage in this area, offering more dollars towards mental health practitioners, acknowledging that this area not only costs more per-visit, but usually requires ongoing care, in contrast to other practitioners which may be used on a more acute basis.

We have written about how to develop a comprehensive mental health support program that utilizes an Employee & Family Assistance Program, insured coverage and flexible spending coverage, and additionally, an employer-sponsored group savings plan.

 

 

Financial Literacy, Financial Resilience and the Employer’s Role

As mentioned above, mental well-being is woven through many areas of the benefits world. Why is this? Quite simply, Employees continue to report “finances” as their number one source of stress. Explore our many articles on this topic; as we write, Employers can play a pivotal role in assisting employees in this area.

Each November, we highlight the Government of Canada’s theme for Financial Literacy Month. Fittingly, this year it was “Money on your Mind; Talk about It” acknowledging the stress, shame and embarrassment that can come with financial difficulties. Talking money builds financial confidence and leads to better outcomes; their stated goals are to “strengthen financial literacy and build financial resilience.”

This is a frequent topic of conversation for us, with Employers seeking to implement or expand Group Savings Plans, organize education sessions, and take advantage of our partnership with our sister company, Ciccone McKay Financial Group in order to provide employees with one-on-one financial planning assistance.  

Related to this, Employers reached out more than ever in 2024 to inquire about cost-sharing of employee benefits premiums. We continue to assist with making fair and logical changes that address the taxation of benefits while falling within the 50% rule followed by insurers.

 

 

That’s a Wrap for 2024!

It’s clear 2024 has brought several important shifts in the employee benefits landscape, driven by rising costs, evolving wellness needs, and growing demands for flexibility. From the ongoing impact of inflation on claims to the increasing focus on mental health support, financial literacy, and personalized medicine, benefits programs are becoming more personalized and comprehensive.

With that being said, we’re eager to see which trends will continue to shape the benefits landscape and what new developments 2025 has in store for us. In particular, we will be keeping an eye on drugs coming off patent, and the expected impact of the government taking on new medications, most notably, for diabetes.

Be sure to keep up with our monthly articles to stay updated throughout the year on the latest trends, insights, and conversations for all things employee benefits.

If you’d like to review your employee benefits program and ensure it’s in line with the latest trends and offerings, reach out today to us at info@immixgroup.ca or (604) 688-5559, as always – we love to hear from you!

Top 6 FAQs About Key Conversations in Benefits 2024

Health & Wellness Spending Accounts offer employees flexibility to address unique needs, generational differences, and specific expenses. Employers benefit from predictable costs since annual spending limits are pre-defined. These accounts are simple to implement, have low administrative costs, and continue to grow in popularity across organizations.

Benefits programs can provide support for mid-life women through coverage for treatments like Cognitive Behavioural Therapy (CBT), hormone replacement therapy, and flexibility in work environments. With research like the HER-BC Report bringing attention to the economic impacts of perimenopause and menopause, employers are recognizing the importance of tailoring benefits to meet these needs.

Pharmacogenetics examines how an individual’s genetic profile affects their response to medications. By identifying the medications most likely to work, it reduces trial-and-error, improves health outcomes, and saves costs for employers and insurers. Coverage for pharmacogenetic testing is not yet common but can often be claimed through Health Spending Accounts.

Mental health claims have steadily increased, with practitioners now ranking among the top-five for paramedical claims. Employers are carving out larger mental health coverage amounts and exploring comprehensive mental health programs that include Employee & Family Assistance Programs (EFAP), insured coverage, and flexible spending options.

Financial stress continues to be the number one source of stress for employees. Employers can play a pivotal role by offering group savings plans, organizing financial education sessions, and partnering with providers like Ciccone McKay Financial Group to provide one-on-one financial planning support. Additionally, fair cost-sharing of benefit premiums can address concerns related to taxation.

In its second year, the CDCP has seen increased participation from dental offices, with over 75% signing on in 2024. This improvement is largely due to changes like enabling direct billing through providers like SunLife. While the plan still receives some negative attention, it has made strides in addressing earlier concerns about reimbursement.

Key Takeaways:

  1. While inflation has eased in Canada, its effects continue to ripple through employee benefits programs. Rising claims, service costs, and premiums are putting pressure on employers to adapt their plans while maintaining affordability and value for employees.
  2. Benefits plans are evolving to include support for women’s mid-life health concerns, such as hormone replacement therapy. This shift highlights the importance of offering more inclusive and tailored coverage options.
  3. Recent government initiatives, such as funding for diabetes medications and IVF in British Columbia, may reduce claims under employer-sponsored plans. We are optimistic these changes will not only support employees but also help employers control costs.
  4. With mental health claims continuing to rise, employers are enhancing coverage and exploring innovative solutions to support employee well-being. Additionally, financial wellness programs, such as group savings plans and financial education sessions, are helping address financial stress among employees.

Read more:

The HER-BC Report – Women’s Health Research Institute

B.C. pharmacare deal will cover diabetes meds, hormone therapy | CBC News

Publicly Funded IVF Program – Province of British Columbia

Personalized Medicine Program – Group benefits | Manulife

Financial Well-being: Valuable Resources through our Partnership with Ciccone McKay Financial Group – Latest News from Immix Group

Dig Deeper into Disability Insurance

Mental Health Support: A Simple Guide to Providing Mental Health Coverage within your Employee Benefits Program

3 Action Steps Employers Can Take to Reduce Employee Financial Stress and Increase Financial Literacy

Money on your Mind; Talk about It

cost-sharing of employee benefits premiums.

Refer patients for pharmacogenetic testing

Dentists hesitant to sign up for federal dental plan; seniors advised to look at all options | Globalnews.ca

Pillcheck – Optimize your medications with DNA-guided therapy

Personalized Medicine Program – Group benefits | Manulife

Understanding Cost-Sharing in Employee Benefits – Latest News from Immix Group

Your One-Stop Guide: Exploring Key Themes in Employee Benefits

 

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Latest Insights

Your One-Stop Guide: Exploring Key Themes in Employee Benefits

Posted on by Immix Group

A Guide to Immix Insights Articles

Are you wondering what we’ve been writing about? Perhaps you haven’t had time to read the articles, but you’re hoping to gain some information on a particular topic.

At the Immix Group, we strive to provide articles spanning a range of topics that are important to those in our Client Community. Recently, we have had some members of our Client Community reach out asking us to send them directly to a specific article they remembered reading, that they wanted to revisit.

With 2024 coming to an end, it occurred to us that many people might benefit from a ‘round up’ guide to the many Immix Insights articles we have written over the years. We hope you find this useful!

 

Group Savings Programs: Helping employees plan for their financial futures

We are passionate about helping employees to grow not only their retirement savings accounts, but their financial literacy skills.  We have written extensively on the many and varied benefits of an employer-sponsored group savings plan:

The common theme? You can help your employees relieve their greatest stress-their finances- through an employer-sponsored Group Savings Program.

Most recently, for November’s Financial Literacy Month, we highlighted our partnership with our sister company Ciccone McKay Financial Group, who provide valuable financial planning resources and products to members of the Immix Group Client Community. Read about how to access these services in our article: Financial Well-being: Valuable Resources through our Partnership with Ciccone McKay Financial Group.

 

Understanding Pricing of Employee Benefits Programs

When it comes to pricing, we know you have a lot of questions. How does it work, why do the rates change, and most importantly, is there a better option out there? We have written extensively on how employee benefits programs are priced including related information on the various funding options for programs and the taxation of benefits.

We believe that pricing should be transparent- you should understand where your benefits dollars are going, and the value you are getting for the premiums you pay.

 

The Immix Group’s Unique Broker-Managed Pools

Unique to the Immix Group, we have discussed our popular broker-managed pricing pools, which are structured to extend flexibility, transparency and choice to plan sponsors, but within the protection of a pricing pool. The primary goals, however, are reduced administration charges and accordingly, long-term cost containment.

In addition to cost controls, paramount to our philosophy is exceptional, hands-on support for our Client Community. As we often say, we consider ourselves an extension of your HR team.

 

Exploring Your Options: Marketing your benefits program

Are things not quite right with your benefits program? Or, is it time to test the waters and see what’s out there? We’re happy to take a look at your program and offer a free review, and for those in our Client Community, we’re happy to shop the market on your behalf! We work with all the major (and many of the smaller) providers in Canada. But a quote for benefits isn’t just about looking at the bottom line; we’ve written about what to look for, given the many nuances of the marketing process.

More importantly, you will notice we emphasize the importance of working with a trusted advisor to guide you through the many intricacies of a comprehensive employee benefits program, as well as the importance of regularly assessing whether your program aligns with your organization’s values and purpose for the plan. 

 

Exploring Plan Design and Changes

Things change- your business, the economy, government healthcare. If your benefits program is beginning to feel inadequate, it may be time for a small tweak or even a total overhaul.

The articles below explore the importance of surveying your staff and updating coverage to meet current standards while addressing the unique needs of your demographics—key steps to standing out as an employer. We also emphasize the value of regularly assessing whether your program aligns with your organization’s values and the purpose behind the plan.

 

Laying the Foundation: Setting up a new plan

Just getting started? We know that the decision to implement benefits is tricky. Is your company large enough, can you afford it, how does it all work? We’ve got you covered, and have written about the many considerations that relate to getting started.

You will notice that we have included articles written about the popular Health & Wellness Spending Accounts, which continue to be a great option for small businesses wishing to provide flexible healthcare spending dollars to employees, at a predictable cost.

 

Mental Health Support for Employees  

Especially since the pandemic, we have seen an upsurge in requests for enhanced mental health support within employee benefits programs. But what does this mean? What really is effective, and what are employees seeking?

Employee and Family Assistance Programs play a vital role in supporting employee mental well-being, but simply paying for this program is not enough. Read about how to communicate the plan to staff, ensure plan members know how to access practitioners within their plan, and other ways you can support your team in this area.   

We have included our articles on Virtual Health, as these articles highlight online mental health support programs.

 

Special Topics: Disability Insurance, Travel Coverage, Fraud in Employee Benefits and More

 

Travel Insurance: What to know before takeoff

One of the things that comes up frequently when we conduct an employee education session is the inclusion of emergency out-of-country travel insurance in most extended healthcare plans. Employees are often not aware of this coverage and have many questions surrounding limitations, exclusions, the duration of coverage and what to do in the event of a claim.

 We’ve laid out the answers to all the FAQ’s in these articles.

 

Disability Insurance: The most misunderstood area of employee benefits

Despite its importance, one of the most overlooked areas of insurance- and employee benefits- is disability insurance. Disability insurance plays a critical role in protecting employees and their families when the unexpected happens.

Over the years, we’ve provided insights on how to ensure the right coverage is in place, understanding the differences between group long term disability and individual disability insurance, and most importantly, the options available to address the diverse needs of today’s workforce.

 

Working from Home: Is this an “employee benefit”?

Although COVID-19 is behind us, “WFH” is here thttps://canadianfamilyoffices.com/o stay. Employees have embraced the flexibility and balance it offers, while employers are navigating the impact on productivity, collaboration, and workplace culture.

 

This topic continues to make headlines for numerous reasons, from its influence on employee satisfaction to its role in attracting top talent.

 

Employee Benefits Fraud: it’s more common than you think!

Fraudulent activity within employee benefits programs can be costly and damaging. These articles provide valuable insights into recognizing, preventing, and addressing benefits fraud, helping businesses protect their assets and maintain a secure benefits program

Most people are shocked to learn how common benefits fraud is, and the many varied ways your program may be vulnerable.

 

Key Conversations: Yearly recaps

Lastly, “Key Conversations in Benefits” remain our most popular articles! Stay tuned for January’s article, which will highlight the main topics of 2024.

In the meantime, feel free to see what has made the headlines over the past years, what has stayed, and what has evolved in the world of employee benefits.

 

That’s a Wrap for 2024!

As 2024 draws to a close, we hope the insights we’ve shared throughout the year have been both helpful and informative in navigating the world of employee benefits.

Whether you’re revisiting familiar ideas or seeking new perspectives, these articles are great to explore when reflecting on your current plans or considering fresh approaches for the year ahead. We have some great articles planned for 2025 and look forward to sharing them!

As always, if you have any questions, feel free to reach out to us at info@immixgroup.ca or give us a call at (604) 688-5559 – we love to hear from you!

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Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Latest Insights

Financial Well-being: Valuable Resources through our Partnership with Ciccone McKay Financial Group

Posted on by Immix Group

By: The Immix Group in partnership with Ciccone McKay Financial Group

November marks Financial Literacy Month in Canada, and this year’s theme, “Money on Your Mind. Talk About It!”, focuses on encouraging open conversations about personal finances. This month, we want to highlight how employers can support their employees’ financial well-being, beyond standard employee benefits, through the unique access that members of the Immix Group Client Community have to our sister company, Ciccone McKay Financial Group.

 

What is Financial Literacy and Why is it Important?

Financial literacy refers to the ability to understand and manage personal finances effectively. It goes beyond just earning a paycheck—it’s about empowering individuals with the knowledge, resources, and confidence to manage their financial health today and for the future. Financial literacy encompasses:

  • Knowing how to budget and save
  • Managing debt effectively
  • Planning for retirement and other long-term goals
  • Making informed financial decisions

For employees, mastering these skills can significantly reduce financial stress, improve focus at work, and contribute to overall well-being. With financial concerns consistently ranking as the #1 stressor for Canadians, it’s clear that promoting financial literacy can have a substantial impact on an individual’s mental and financial health.

 

Supporting Employee Financial Well-Being

At the Immix Group, we recognize that financial wellness plays a critical role in an employee’s overall well-being, and supporting this goes beyond just offering competitive pay and comprehensive employee benefits. While there are many ways you can increase financial wellness through employee benefits such as group savings programs and health/wellness-related resources, we believe that knowledge is the ultimate power when it comes to financial wellness. This is where financial literacy steps in.

In all of our education sessions and update meetings, we consistently emphasize the resources available to your team through our sister company, Ciccone McKay Financial Group. The goal of this article is to provide an in-depth look into the financial services our sister company, Ciccone McKay Financial Group, offers to members of the Immix Group Client Community, the type of support your employees can expect to receive, and how to get started.

 

Immix Group’s Background in the Financial Services Industry

Established in 2003 (but with roots dating back much further!), Ciccone McKay Financial Group has been providing tailored wealth management services, with a strong focus on helping individuals and organizations protect, preserve, and grow their wealth. The Immix Group- which focuses on employer-sponsored benefits programs– was established as a separate company in 2010 but existed previously as a division of Ciccone McKay Financial Group. Thus, our ties are strong!

Today, we still share an office meaning the Immix Group team and the Ciccone McKay team are able to collaborate and leverage the varied experience and specializations of the entire team. Across both the Immix Group team and the Ciccone McKay team we hold a wide range of highly regarded credentials in the financial services industry such as the Certified Financial Planner (CFP) designation and Trust & Estate Practitioner (TEP). This deep financial expertise is a valuable resource to your business and employees.

 

Resources Available to members of the Immix Group Client Community via Ciccone McKay Financial Group

As a member of the Immix Group Client Community, your team has access to the seasoned professionals at Ciccone McKay Financial Group. This includes personalized financial services (see in next section) and educational workshops such as:

  • Financial Planning 101: Building a Balanced Financial Portfolio
  • Setting Financial Goals: Short, Mid, and Long-term Strategies
  • The Power of RRSPs: How to Maximize Savings
  • Your Health is Your Wealth: Exploring Critical Illness, Disability, and Long-Term Care Options
  • Individual Pension Plans (IPPs): Supercharged RRSPs for Business Owners & Executives

These customized workshops aim to provide knowledge, actionable advice, and help your employees gain the confidence they need to take control of their financial future. Interested in arranging an educational workshop for your organization? Click here to contact us and organize a session for your team!

 

The Support Your Employees Will Receive from Ciccone McKay Financial Group

While the employee benefits program provides a strong foundation for financial health, every employee is different, and customization is required in the form of additional insurance and investment strategies and products. 

Through Ciccone McKay, your employees can access a range of financial services, including:

  • Insurance Products (e.g., Life, Disability, Critical Illness)
  • Registered Investment Accounts (Setting Up RRSP, TFSA, and RESP Accounts)
  • Non-registered Investments (Virtual Bank Accounts)
  • Manulife One (Mortgage Banking Account)

 

Here’s how your employees can get started with a Ciccone McKay advisor:

  1. Let’s get in touch: Reach out to your Immix Group service contact person with the employee’s contact information and a brief description of the assistance they’re seeking.
  2. Advisor match: We’ll pair them with an advisor from the Ciccone McKay team who best fits their needs.
  3. Introduction call: The advisor will reach out to schedule a brief introductory call or virtual meeting to assess the employee’s financial situation and needs.
  4. Strategy Discussion: Depending on their needs, the advisor may have an in-depth conversation to discuss products and solutions.
  5. Ongoing engagement and follow-up: The advisory team will provide clear guidance and regular updates, ensuring a seamless process every step of the way.

We encourage plan administrators and HR teams to share this resource with your employees. It’s an excellent way to add value to your employee benefits package and show your team that their financial well-being is a priority.

For easy sharing, we’ve attached a one-pager that outlines this service.

Sharing link: One Page Summary for Sharing

Feel free to distribute it to your employees directly. If you have any questions or need more information, don’t hesitate to reach out. As always love to hear from you!

Did you know?

  • Personal finances and workload remained the top two main sources of stress for Canadians. (Benefits Canada Survey)
  • Only 13% of employee benefits plans include financial support programs (Benefits Canada Survey)
  • 40% of Canadians Report their financial situation as poor or fair. (View the report)

Additional Resources:

Financial Literacy Month: Money on your mind? Talk about it!

Financial Literacy Month in Canada

Promotional toolkits for financial literacy and consumer protection

Introduction to Ciccone McKay Financial Group

One size fits all? Not when it comes to employee benefits.

Money remains the top source of stress for Canadians

Financial stress and its impacts

Three Reasons to Implement a Group Savings Plan

A Step-by-Step Guide to Individual Health & Dental Plans

Mental Health Support: A Simple Guide to Providing Mental Health Coverage within your Employee Benefits Program

Meet the Immix Group Employee Benefits Team

Immix Group – Education Session Available

Contact the Immix Group

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Expanding into Canada

Posted on by Immix Group

Expanding into Canada? What Non-Canadian entities need to know when implementing an Employee Benefit program in Canada

Key Takeaways

  1. A typical employee benefits plan in Canada includes life insurance, extended health care, dental care, and often additional offerings like disability insurance, health spending accounts and retirement savings plans.
  2. The healthcare component of employee benefit programs is complementary to the coverage provided via provincial coverage, under Canada’s universal healthcare system.
  3. Navigating provincial regulations and employment standards is critical, making it important to work with licensed advisors who understand the Canadian market.
  4. Offering a robust benefits package is key to attracting and retaining skilled employees in Canada’s competitive job market.
  5. Customizing benefits to meet the specific needs of your Canadian workforce and industry will help ensure your company’s long-term success in Canada.

This year alone, the Immix Group, based out of Vancouver, British Columbia, has set up employee benefit programs for businesses head-officed in multiple countries around the world. Whether you’re in Australia, Singapore, Ireland, or the United States, there are key pieces of information to know if you are setting up a Canadian entity.

Companies are driven to expand into Canada by many factors including market opportunities, economic conditions, and strategic considerations. In particular, the highly educated, diverse workforce makes Canada an attractive location for companies, often at a lower cost than expansion to comparable locations.  

To be competitive and successful in this expansion, companies must consider providing the right set of employee benefits for their Canadian employees. And this involves understanding the legal requirements and offering the right benefits. Here’s a list of key things to help you navigate the process:

 

The Basics: Canada has a Universal Healthcare System

Canada has universal healthcare, which is adjudicated provincially; this means coverage differs slightly depending on the province or territory of residence of your employees. All employees must be residents in order to qualify for provincial healthcare.

The reason this is important is that employer-sponsored extended health and dental programs may require provincial healthcare to be in place, as the two programs are complementary.  

For most full-time permanent employees in skilled positions, the expectation is that the employer will provide an employee benefits program with a range of coverage. However, providing an employee benefits plan is not mandatory (please note the province of Quebec has special requirements) and coverage levels differ significantly from employer to employer. Many employers do not provide any extended benefits at all.

While not mandatory, a comprehensive benefits program is integral in attracting and retaining talent, and in protecting and promoting the well-being of employees.

What coverage does a typical Canada employee benefits plan include?

 

Within Canada, when one refers to their employee benefits plan, they are usually referring to the insurance package their employer sponsors, which is typically facilitated through a major insurance provider (Manulife, Sun Life, Canada Life, Blue Cross, RBC Insurance etc).  

We will indicate the most basic components of an employee benefits program, followed by additional benefit offerings that comprise a more comprehensive offering.

The following are the core components of a group benefits plan:

 

Life Insurance

Life insurance amounts are usually either a small flat amount of coverage such as $25,000 or a salary-based benefit such as 1 x earnings, to a maximum. Higher amounts of coverage are usually extended to those in larger companies, or for more highly skilled professional firms employing those in more “white collar” occupations.

Accidental Death & Dismemberment (AD&D) is usually included alongside the Life insurance benefit, for the same amount of coverage.

For small groups, Life Insurance and AD&D are usually a very inexpensive component of the program, often running just a few dollars per employee, per month. The cost varies depending on the demographics of the group, and the overall volume insured.

Extended Health Care

As mentioned previously, Canada has universal health care. Extended Health Care is exactly that – an extension of the basic components provided through the provincial programs. Provincial healthcare is complex and differs across the country. The most simple way to understand what an employee benefits plan provides is to focus on the core components of a typical extended health care package:  

  • Prescription drugs
  • Paramedical practitioners (massage, physiotherapy, chiropractor, naturopath, therapists etc).
  • Vision Care (eye exams, contact lenses, glasses)
  • Medical Equipment (orthotics, knee braces, crutches, wheelchair)
  • Emergency Medical Travel Insurance

The categories listed above fall outside the scope of what is covered through our provincial health care, which provides coverage for doctor visits (including specialists), hospital care, surgeries, diagnostics etc. There are exceptions to all of the above, for example, for low-income households, children, or certain medications such as those dispensed in hospitals.

In short, while we have a robust universal healthcare system in Canada, many day-to-day routine medical expenses are not covered for average working people, and thus, an employer-sponsored group benefits program fills this gap.  

A typical extended health care program will provide coverage for the areas listed above; where a plan becomes more competitive than another is based on the percentage of reimbursement and dollar limits included for various items. It is important to use a qualified advisor who knows the market in order to ensure you are providing a competitive program for your industry, size and location.

Dental Care

For most people, dental coverage comes via their employer program. It is not part of Canada’s universal healthcare system, although programs exist to provide dental coverage to low-income individuals (including the new Canadian Dental Care Plan).

A typical dental plan provides at minimum “basic” coverage which includes cleanings and routine maintenance procedures. The second level of coverage is for “major” dental, followed by a third level, for orthodontics.

It would be common to see a small employer provide only basic coverage, whereas a larger company, or those with highly skilled professionals on the higher end of the income spectrum, tend to provide better dental coverage.

 

In addition to the core components listed above, many programs provide:

  • Long Term Disability insurance
  • Short Term Disability insurance
  • Critical Illness insurance
  • Health & Wellness Spending Accounts
  • Retirement Savings Plans

Long-Term Disability Insurance

Group Long Term Disability insurance provides salary continuance for those who are unable to work due to injury or illness and are therefore deemed “disabled” per the terms of their contract. Typically, Long Term Disability begins after 120-180 days of disability.

During these initial months, a person would be either on Short Term Disability coverage or would claim EI Sickness benefits through Service Canada (the federal government). This is a program that people pay into, as part of payroll taxes.

Many smaller employers do not provide group long-term disability insurance; they may not qualify to obtain this coverage, or they may choose to exclude it due to reasons such as cost.

Short-Term Disability Insurance

While most employers rely on Employment Insurance Sickness Benefits rather than insuring Short Term Disability, insuring this benefit does make sense in certain industries and for specific demographic profiles. Federal EI Sickness Benefits are 55% of weekly earnings to $668 per week (taxable, 2024 amount) so an obvious reason to insure this benefit is for greater coverage amounts that provide for greater income replacement levels. There are other advantages as well, which a qualified advisor can assist you in understanding.

Critical Illness Insurance

Critical Illness insurance provides a lump sum payment based on the diagnosis of one of the covered illnesses (cancer, heart attack, stroke, MS, for example). This is different than Long Term Disability insurance in that it provides a lump sum payment, rather than an ongoing income stream, and you can claim while still actively at work. Comprehensive programs often include this coverage in amounts ranging from ~$10K to $50K per employee.  

Health & Wellness Spending Accounts

An extremely popular offering, Health & Wellness Spending Accounts provides a lump sum dollar amount to be used at the employee’s discretion, for health and/ or wellness expenses.

In Canada, Health Spending Accounts usually refer to non-taxable medical expenses that the Canada Revenue Agency lists as “eligible.” In contrast, Wellness or Lifestyle Spending Accounts cover other items related to fitness and lifestyle and are a taxable benefit to employees. The amounts extended to employees vary significantly between employers, but it is important to remember that a Health Spending Account is intended to supplement insurance, rather than replace it.  

As HSA in the U.S (“Health Savings Account”)  is commonly used, please note that HSA in Canada (Health SPENDING account) should not be used or googled interchangeably. They have some similar aspects but operate totally differently.

Group Retirement Savings Plans

 Many employers provide their employees with Group Retirement Savings plans. In Canada, these typically take the form of a group Registered Retirement Savings Plan (RRSP), often in combination with a Deferred Profit Sharing Plan (DPSP). The purpose of these programs is to assist employees in saving for retirement, in a tax-advantaged way. The Immix Group has written extensively as to the benefits of group retirement savings plans for both employers and employees.

Also, please note that both the employer and employee contribute to the Canada Pension Plan (CPP) or Quebec Pension Plan (QPP). The contribution rates change annually. This is a mandatory payroll tax and would not be considered an ‘employee benefit’ here in Canada, although it does provide income in retirement.

  

Other Important Considerations

 

Maternity and Parental Leave

We are often asked about Canada’s well-known maternity and parental leave policies. In short, Employment Insurance (which provides for Sickness benefits) also provides benefits during maternity and parental leave. The formula used is the same, at 55% of weekly earnings, to a maximum ($668 per week, 2024). The choice of either 12 months or 18 months of leave is indicated upfront; you receive the same amount of total pay (i.e. if you choose the 18-month option, your payment is lower than under the 12-month option).

There is extensive information on the Service Canada website regarding EI Maternity and Parental benefits. There is very little involvement by the Employer in this matter; employees apply directly to Service Canada and are paid directly.  

Additionally, some employers will provide ‘top-up’ pay for those on maternity leave either for a portion or for the entire duration of the leave. This practice varies significantly between employers.

 

Vacation / Paid Time Off

The Employment Standards legislation in each province and territory sets out the minimum legal requirements. In practice, many employers exceed these minimums when it comes to Paid Time Off. Depending on the province, employees may have minimum paid sick days as well; for example, in BC, employees are entitled to 5 paid sick days which is available to both part-time and full-time workers.


Workers’ Compensation Insurance (WCB):

Certain industries require employers to set up workers’ compensation insurance; this is managed at the provincial/ territorial level. Employers fund workers’ compensation through premiums. This program coordinates with other insurance; for example, an injury on the job would result in disability paid via worker’s compensation, rather than through the long-term disability insurance program.

 

Working with a Licensed Employee Benefits Advisor

 Insurance providers require that Employers work with licensed insurance advisors in order to obtain pricing and implement and manage a group benefits program on an ongoing basis. In addition to being a requirement, employee benefits experts such as those at the Immix Group can advise you each step of the way. Advisors provide:

  • Knowledge of Providers: Recommend reputable insurance providers and benefit administrators who operate in Canada. This often is part of the market survey process.
  • Customize Benefits Package: Tailor the benefits package to align with the specific needs and preferences of your Canadian workforce. Consider utilizing templates from the advisory team to conduct surveys or interviews to understand the group’s priorities.
  • Compliance with Collective Agreements: Ensure that your benefits package adheres to the regulations of the province(s) where your employees are based. Be aware of any collective agreements that may apply.
  • Effective Communication: Having benefits is one thing, clearly communicating the benefits package to your Canadian employees is another. Provide written materials and in-person/online meetings explaining the benefits, enrollment procedures, and other relevant information.
  • Smooth Enrollment Process: Implement an efficient enrollment process for Canadian employees. This could involve online portals, paper forms, or a combination of both.
  • Training and Support: Offer training and support to your HR staff responsible for administering the benefits package. Ensure they understand Canadian regulations and can address employee inquiries.
  • Regular Review and Updates: Periodically review the benefits package to keep it competitive and compliant with Canadian laws.

 

What do you need to get started?

When it comes to branching out into Canada, here are some key considerations:

  • Are the employees Canadians or relocating to Canada?
  • Is the company incorporated in Canada?
  • Is Canadian payroll established?
  • Do you have at least 1 or 2 employees already hired?

 

Expanding your business into Canada offers tremendous opportunities, but understanding the local landscape, particularly when it comes to employee benefits, is crucial. With Canada’s unique healthcare system, employment standards, and regional variations, it’s essential to work with experts who can guide you through the complexities. By aligning your offerings with the expectations of Canadian employees, you set a strong foundation for your company’s success in this new market.

If you’re ready to get started, our team at Immix Group is happy to help! Email us at info@immixgroup.ca or call us at (604) 688-5559. We love to hear from you!

FAQs

The first step is to determine whether your company is incorporated in Canada and whether you have established a Canadian payroll. This ensures compliance with Canadian regulations and allows you to provide benefits that meet local standards.

Canada’s universal healthcare system covers basic medical needs, but it does not cover services like prescription drugs, dental care, or vision care. Employer-sponsored benefits typically supplement these areas, providing additional coverage for employees.

A typical benefits plan in Canada includes life insurance, extended health care (covering prescription drugs, paramedical services, and more), dental care, and possibly long-term disability insurance and retirement savings plans.

Yes, there are regional variations in healthcare coverage and employment standards across Canada’s provinces and territories. It’s important to tailor your benefits program to align with the specific regulations and needs of employees in each province where you operate.

While it’s possible to offer a standard benefits plan, it’s often beneficial to customize the plan based on the specific needs of your Canadian workforce, industry, and location. Consulting with a local advisor can help you make these adjustments.

Licensed advisors are essential in helping you navigate the Canadian market. They recommend reputable insurance providers, ensure compliance with local regulations, customize your benefits package, and assist with effective communication and enrollment processes.

Clear communication is key to ensuring employees understand and appreciate their benefits. This can involve providing written materials, holding in-person or online meetings, and offering ongoing support to answer any questions your employees may have.

Read more:

Government of Canada – Employee Benefits Overview

Canada Life – Group Benefits for Employers

Prescription Drug Insurance | Régie de l’assurance maladie du Québec (RAMQ) (gouv.qc.ca)

How Does Workers Compensation Work in Canada? – Canadian Payroll Services

Manulife – Employee Benefits Solutions

Sun Life – Employee Benefits and Group Insurance

Blue Cross – Employee Benefits Plans

Howard 2

Howard Cheung | BBA | Employee Benefits Consultant

Disability Insurance

Posted on by Immix Group

by Lindsay Byrka, BA, BEd, CFP®

 

Dig Deeper into Disability Insurance

Trying to wrap your head around Long-Term Disability insurance? Wondering about the differences between your group Long Term Disability and an Individual Disability plan?

Group benefits plan administrators, have you done your part to ensure your employees understand their coverage and the monthly amount they would receive in the event of a disability?

As benefits advisors in Vancouver, BC, we strongly believe in the need for thoughtful, quality disability insurance products. The focus of this article is to provide deeper insight into the importance of disability insurance, the basics of group Long Term Disability, and how an individual policy may come into place.

Key Takeaways:
  • 1 in 6 people will experience a disability before age 65.
  • Mental health is the largest category of claims, at 31%.
  • Just under 50% of people have group Long Term Disability plans through an employee benefits program. Of those without workplace coverage, only around 15% have individual plans.
  • Even with a group Long Term Disability plan in place, many do not have adequate coverage (amount or quality can be lacking).
  • It’s essential to know how much coverage you have and to understand how your plan works.
  • Employers must be diligent in ensuring employees understand their coverage level and plan parameters.
  • Employers can help bridge shortfalls in coverage by organizing for underinsured employees to place top-up disability policies.
  • Group Long Term Disability is typically provided through an employer and has set coverage limits and parameters, while individual disability insurance is personally obtained, customizable, portable, and not tied to employment.

It’s more common to experience a Long-Term Disability than most people realize

 

Everyone knows someone that’s been diagnosed with a serious illness, or experienced a significant injury – unfortunately, it’s all too common. This almost always means a significant amount of time off work, or in the most serious situations, the inability to work again due to a permanent disability.

While many people consider the medical and lifestyle implications, people often fail to think through the financial impacts of no longer being able to work. There is an expression in the insurance industry- “Your health is your wealth” – and this couldn’t be more true! For most people, being healthy directly ties into their ability to provide for themselves and their families.

 

Disability insurance is income replacement insurance

Most people are familiar with disability insurance, but they may not think of it for what it really is, which is “income replacement insurance.” But how much do you need? When people are asked “What percentage of your income would you need if you were no longer able to work?” many people state: “All of it.” The fact is, becoming sick or injured usually means more expenses, not fewer. Having your income reduced or eliminated for a period of time can completely derail your ability to stay on track with goals for yourself, your family, and your business.  

The statistics are surprising: 1 in 3 Canadians will become disabled and unable to work before the age of 65 (RBC Insurance).

disability insurance

Source: RBC Insurance. “Sales Resource Centre.” RBC Insurance, June 2024, www.rbcinsurance.com/salesresourcecentre/file-777224.pdf. Accessed 28 June 2024.

A common misperception surrounding disability insurance

Many people believe that all medical costs relating to serious life-impacting illness and injury are insured either through provincial health care or your employer-sponsored extended medical plan.

Unfortunately, this is rarely true. Many expenses arise in connection with disability, including:

  • Uninsured medical expenses for equipment, drugs, and practitioners (physiotherapy, orthopedic braces etc)
  • Time off work for the other spouse to be a caregiver
  • Modifications to your home (ramp, grab rails, renovations to relocate bedrooms, etc.)
  • Assistance with childcare, cleaning, cooking or other daily activities

Disability insurance provides you with a continuing income while you are unable to work.

 

Far too many people are not insured or are under-insured

Just under 50% of people have group Long Term Disability plans through an employee benefits program. Of those without workplace coverage, only around 15% have individual plans.

Unfortunately, many people are completely uninsured in this area. This means if something were to happen, they would be reliant on just EI Sickness benefits through Service Canada. The 2024 maximum payment is 55% of your weekly earnings, to a max of $668 a week (taxable) for a maximum of 26 weeks duration. There is some coverage through the Canada Pension Plan, but again, it’s difficult to qualify and benefits are minimal.

For most people, this is totally inadequate. The bottom line, relying on government coverage is not ideal.

 

Why don’t all employers offer group Long Term Disability?

While we encourage employers to implement group long term disability coverage, stats show under half of workplace plans include this crucial coverage line!

A few common reasons are:

  • Cost of coverage: Long Term Disability premiums should be employee-paid to create a tax-free benefit in the event of a claim; it can be difficult to get employees on board with paying a portion of the benefits premiums, especially if the plan has traditionally been an employer-paid benefit. Unfortunately, employees often misunderstand the importance of this coverage line and simply do not want to pay the premium.
  • Uninsurable industries: Some industries are difficult or impossible to insure due to the risk of claim; different insurers have different requirements, but all have industry lists of occupations they will not insure.
  • Size of the group: Some insurance providers will not implement group Long Term Disability for groups under a certain headcount, although there has been increasing flexibility in this area. For many small employers, they feel they cannot afford to offer more than a basic health and dental plan, or they do not feel the need to offer comprehensive coverage.
  • Misperceptions: Many employers and employees fail to understand the importance of this coverage and may have incorrect assumptions regarding government programs.

From our perspective at the Immix Group, education in this area is key! While we don’t think twice about insuring our valuable physical possessions (our house, car, boat, jewellery), and most people understand the need for life insurance, disability coverage is too often overlooked.

 

A typical group Long Term Disability plan provides good coverage for most people

Firstly, let’s address group Long Term Disability coverage; it’s our belief that this should be included in all employee benefits programs. A typical group long term disability plan is set up as follows:

  • 67% of monthly earnings to a maximum benefit amount (for example, $5,000 per month);
  • A Non-Evidence Maximum (NEM) applies, which is the amount of coverage you can get without providing evidence of good health (for example, $3,000);
  • Coverage (and potentially benefit payments) continue to age 65;
  • A two-year ‘own occupation ‘period usually applies.

These limits are based on the group: average income, occupation, and overall size. Generally speaking, the larger the group and the higher the average income, the higher the NEM and Max Benefit.

Many people find themselves under-insured through a group Long Term Disability plan

For a percentage of groups (this varies greatly depending on the group) the higher earners find themselves underinsured through a group plan. While advisors can request for increases to the group limits, there are often outliers who simply cannot be adequately insured due to the limits the insurer imposes. Consider the following simplified example:

  • Annual Income: $200,000 ($16,667 monthly gross, ~$10,000 net)
  • Group Long Term Disability: $5,000 per month max
  • Income Replacement Percentage: 50% ($5,000/$10,000)
  • Shortfall: ~$5,000 per month

In the example above, the individual insured may have no idea they would be receiving only around half their pre-disability income; many people simply do not pay attention to the specific details of their coverage.

The most common types of claims? This may surprise you, but Mental Health claims are the largest category of disability claims.

Types of disability claims

Source: RBC Insurance. “Sales Resource Centre.” RBC Insurance, June 2024, www.rbcinsurance.com/salesresourcecentre/file-777224.pdf. Accessed 28 June 2024.

We strive to ensure HR personnel and other leadership are aware of potential shortfalls

At the Immix Group, we review the list of those with a disability shortfall at every program renewal; it’s important that those with shortfalls are aware they are not fully insured. It is the role of the plan administrator to ensure this information is clearly passed along to affected plan members. Individuals may be able to apply for amounts above their Non-Evidence Maximum, or they may wish to pursue a top-up disability plan. But the first step is ensuring the details are made clear to the member.

Bridging the gap with Individual Disability top-up plans

Many people seek out individual disability policies, and in fact, we assist with this every day.

For those with a shortfall in coverage, it’s important that plan administrators ensure they are presented with their options and assisted through the process by a qualified advisor.

Whether you are seeking an Individual Disability policy because you do not have access to a group plan, or you are seeking to “top-up” the coverage on your group Long Term Disability plan, the process is similar.

In contrast to a group disability plan, individual policies are usually fully underwritten which means a medical and financial assessment is made by the insurer. An exception is with Guaranteed Standard Issue group disability policies, which in short, is a group of individual policies issued to a group of qualifying employees, with limited underwriting.

What about Short Term Disability coverage?

A small percentage of companies provide insured Short Term Disability coverage, and some companies provide some form of in-house continuing income. However, this is not required and the majority of employers default to Government Employment Insurance Sickness Benefits for the duration of time prior to Long Term Disability benefits beginning.

Key differences with Individual Disability policies compared to group Long Term Disability plans

Beyond increasing the amount of coverage to ensure you are fully covered, there are many features available within individual policies that are superior to most standard group long term disability:

  • Portability; The contract is not connected to your employment, you take it with you wherever your career takes you.
  • Individually underwritten; this means the contract is customizable, to an extent. For example, a situation that would result in a “decline” of coverage over the non-evidence maximum under a group plan might be listed as an exclusion under an individual plan.
  • Key riders: individual contracts often allow for popular and beneficial riders to be included:
  • Future Income Option: this allows for your coverage to be increased as your income rises, without medical underwriting.
  • Cost of Living Adjustment: this ensures your benefits during a claim are increased to keep pace with inflation.
  • Controlled cost: Pricing is locked in for the duration of your contract, which is typically to age 65.
  • Own Occupation to age 65: This means you are covered for your “own occupation” to age 65, and not for the typical 2-year duration (details below).

While in some circumstances these features can be included under group Long Term Disability plans, they are not common and are more costly to include.

 

The “definition of disability” is the most important feature of your plan

A certain “definition of disability” applies- in short, this is how the insurer will define what is considered “disabled”, and under what exact circumstances the contract will pay out to the sick or injured claimant. Very broadly (please note insurers differ):

  • “Own Occupation” refers to being unable to perform all or the majority of the duties of your occupation
  • “Any Occupation” refers to being unable to work in any capacity or at any job.

Under a typical group plan, the first two years of disability cover the insured person for their “own occupation.” After two years, the person is considered disabled based on meeting the definition of disability for “any occupation,” a more restrictive definition.

In contrast, many individual plans cover the insured person on an “own occupation” basis to age 65. This varies between plans, and availability varies based on the insured’s unique characteristics and occupational duties.

The wording used in the contract is crucial and differs between insurers; our role is to understand this and ensure that coverage is appropriate based on the unique needs of the group or individual.

 

Long Term Disability coverage is essential and needs to be understood

For the majority of people, the coverage through a group benefits program will provide them with income replacement to the allowable limits (you cannot be insured for greater than your pre-disability income), meaning they are adequately insured, with regards to the dollar amount of coverage in place.

But, as we have alluded to, the quality of the coverage requires a deeper dive, and one size does not fit all.

 

What should employee benefits plan administrators and HR personnel do?

Know the numbers– do shortfalls exist for your team? If so, to what extent? Can this be addressed adequately through the group insurer? Have you clearly communicated to each plan member the details of their group Long Term Disability coverage and ensure they understand how to apply up to the maximums available, whether this is through the Group Long Term Disability or through a top-up policy?

 

The Immix Group is here to help

Part of our role as Canadian benefits advisors involves analyzing and making recommendations on the appropriate Long Term Disability program for your company, and by extension, ensuring full coverage options are made available for the individuals within your organization. The Immix Group works with businesses and individuals across Canada and across all sectors. If you would like to ensure you or your team members are adequately covered, we invite you to reach out and engage with one of our qualified advisors to discuss your options. – we love to hear from you!

Contact Us: Immixgroup.ca or call us at (604) 688-5559.  

Read More

The Power of Protection: Understanding the need for Living Benefits Insurance

– The importance of living benefits insurance: protect your financial stability in the face of illness or injury

Fewer Canadians have disability coverage through workplace benefits, leaving them more at risk

– Despite the risks, a significant number of Canadians lack disability coverage, facing financial vulnerability in case of disability

Disability: A Canadian Reality

– It’s more common than you think. Protect your most valuable asset – your ability to earn income.

Disabled Workers Face a Perfect Storm

– Canadians off work due to disability face a perfect storm.

 

Top 7 FAQs

Group LTD insurance is provided by employers and has set coverage limits and parameters. Individual disability insurance is personally obtained, customizable, portable, and not tied to employment.

Understanding your coverage is crucial because many people are under-insured and unaware of the shortfalls in their plan. This knowledge ensures you can address any gaps and be adequately protected financially in the event of a disability. 

LTD insurance provides income replacement when you are unable to work due to a disability. Group plans typically cover 66.67% of monthly earnings up to a specified maximum, continuing until age 65, with a two-year ‘own occupation’ period followed by ‘any occupation’ criteria.

Common reasons include the cost of coverage, difficulty insuring certain industries, the size of the group, and misconceptions about the necessity and importance of LTD insurance.

Yes, you can have both. Individual policies can act as a top-up to ensure you have sufficient coverage beyond what is provided by your group plan.

Individual policies offer portability, customizable coverage, key riders like Future Income Option and Cost of Living Adjustment, controlled costs with locked-in pricing, and often an ‘own occupation’ definition until age 65.

Employers should clearly communicate the details of the group LTD coverage, identify any shortfalls, assist employees in applying for maximum coverage, and offer guidance on obtaining top-up policies if needed.

About Us:

Immix Group Employee Benefits Ltd., headquartered in Vancouver, British Columbia, is an independent employee benefits consulting firm with a history spanning over 30 years. Our client-centric approach has led to successful partnerships with over 400 employers across various sectors and regions.

With longstanding supplier relationships spanning decades, we collaborate closely with insurance and investment providers, fostering a culture of mutual respect. Our role is to partner with our clients in the design, implementation, and ongoing management of benefits programs. Our consistent engagement with HR personnel, financial and operational staff, and plan members guarantees exceptional service, comprehensive coverage, and sustainable costs.

Have any questions? Contact us at: info@immixgroup.ca or call us at (604) 688-5559 – we love to hear from you!

Disclaimer:

The Immix Group is an Employee Benefits firm based out in Vancouver, B.C. The information provided in this article is for general informational purposes only and is not intended as legal, financial, or professional advice. While we strive to ensure the accuracy and reliability of the information presented, we make no warranties or representations of any kind regarding its completeness, accuracy, or suitability for any particular purpose. Readers are encouraged to seek independent advice from qualified professionals regarding their specific circumstances. The authors and publishers of this article are not liable for any losses or damages arising from the use or reliance on the information provided.

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Mental Health Support: A Simple Guide to Providing Mental Health Coverage within your Employee Benefits Program

Posted on by Immix Group

How employers can support employee well-being within an employee benefits program

As defined by the Canadian government: mental health refers to one’s general state of psychological and emotional well-being. We acknowledge this is a complex and nuanced topic, and that an employer’s role in supporting positive well-being extends far beyond the insurance coverage they offer to employees. However, our focus here is on employee benefit products and services that fall under the ‘mental health’ umbrella.

We are often asked “what more can we do” when it comes to mental health coverage. We have outlined the key areas of coverage for mental health and addressed how they should be reviewed, potentially amended or enhanced, and additional layers or adjacent programs you may wish to consider.

 

Supporting Mental Health: Crisis Response vs Ongoing Care and Support

One thing to consider is an emergency or crisis situation versus an ongoing situation an employee may be struggling with. One may lead to another. While there are many quality resources available for those reaching out during a crisis (there are a plethora of hotlines available to members of various communities, for a wide range of issues or just general support), when an issue requires ongoing professional support, a financial barrier to care may present itself. In this article, we have outlined the various layers of support.

 

Employee & Family Assistance Program; the First Level of Support

Employee & Family Assistance Programs or EFAPs (also called Employee Assistance Programs or EAPs) are well-known for their ability to provide 24-7 phone-based, online or direct support to members experiencing any sort of life event for which they need assistance. As we’ve written about, they offer benefits to both employers and employees. Most EFAP providers have extensive online resources available on a large variety of topics, and these often do not require membership or a login.

Most plans offer some level of face-to-face or virtual counseling. While this varies depending on the EFAP, they are typically best suited to issues that can be resolved in the shorter-term, or where the member would benefit from referral to relevant online or community resources. 

Our experience is that most members who require ongoing support desire to continue with face-to-face or virtual sessions directly with a counsellor of their choosing, who specializes in their area of concern. A downfall of EFAPs can be the inability to continue sessions with the same practitioner, once the limited free sessions expire. In this situation, a member may look to claim under their extended health care program.  

 

Paramedical Practitioners; Reimbursement for Therapist Visits

Paramedical practitioners are a key component of an extended healthcare offering, and depending on the group, may make up a large percentage of overall extended healthcare claims.

While we still see Massage, Physiotherapy and Chiropractor as the top claimed practitioners, those that fall under the ‘mental health’ umbrella have risen in ranking over the past several years. These practitioners include:

  • Certified Clinical Counsellor
  • Registered Clinical Counsellor
  • Registered Professional Counsellor
  • Mental Health Therapist
  • Psychiatrist
  • Psychologist
  • Psychoanalyst
  • Psychotherapist
  • Psychoeducator
  • Social Worker
  • Marriage and Family Therapist

 

This list is not inclusive of many other related practitioners that some carriers are willing to include. If you’re unfamiliar with your offering, we recommend reviewing the booklet or contract to determine which practitioners are included; you may want to expand this offering to allow members a greater breadth of choice.

 

How much paramedical coverage should we provide?

As you may be aware, counselling sessions are extremely expensive, usually well over $100 per visit, depending on the practitioner, type of therapy and region.

A typical plan has $500 of coverage, per practitioner, per person, per year. But keep in mind the providers listed above are usually combined under the dollar limit for “mental health practitioners.”

We often see $750 of coverage these days, and some plans still have lower amounts such as $300. If you do the math, a standard paramedical schedule does not offer many visits to a private therapist.

In an effort to expand the coverage for these categories of practitioners, in recent years we have implemented a higher combined limit (i.e. $1,000 of coverage for these practitioners, while the remainder of practitioners are kept at a lower dollar limit per person per year).

Alternatively, we have provided a specific number of visits, rather than a dollar limit (i.e. 12 visits for mental health practitioners). This is considered a more costly option due to the average per-visit cost.

 

Health Spending Account dedicated to Mental Health support  

For those facing ongoing expenses, for example, routine visits to a therapist, EFAP and paramedical coverage can run out very quickly. To provide an additional layer of support, a Health Spending Account can be used to provide much-needed dollars to employees.

In fact, while barriers to ongoing care due to stigma or lack of resources may have been removed, financial constraints could be the last remaining reason an employee may discontinue therapy, or not seek professional assistance at all.

As you may be aware, Health Spending Accounts can be fully customized these days to include and exclude items, depending on the Employer’s choice. A Health Spending Account can be used to cover mental health-related expenses; however, the employer may choose to define this.

Coinsurance can also be applied (i.e. 60% coverage) with a Health Spending Account, which is an effective tool in directing employees first to their EFAP (potentially), then paramedical coverage under their insured program, and then to their HSA.

 

Long Term Disability Coverage for mental health claims

Unfortunately, many people find themselves unable to complete the duties of their occupation due to mental health issues. Rest assured, so long as the ‘definition of disability’ within the contract is met, a claim related to mental health can be approved and benefits paid. In fact, a large percentage of claims today are mental health-related, with a larger percentage defined as mental health adjacent. 

Members can receive an ongoing monthly income (a disability benefit payment) so long as they continue to meet the definition of disabled. It is important that employers understand this and communicate this to members who may need to explore a long-term disability claim.  

 

Financial well-being and mental well-being are connected

While we consider this adjacent to the more direct mental health support and benefits detailed above, a groups savings program can play a role in supporting wellbeing. As we have written about, personal finances are their number one source of stress, according to employee surveys.

Implementing an employer-sponsored group savings program provides twofold support: employer funds via an employer contribution to the savings plan, and additionally, education and tools to assist employees in creating a plan and getting control over their finances.

 

Steps for Employers:

  • Ensure an Employee & Family Assistance Program is in place; these are often included within your extended health care plan.
  • Review the paramedical offering and ensure appropriate practitioners are included and that coverage levels are as high as affordable to your company.
  • Consider a Health Spending Account to provide additional dollars, as well as flexibility and choice
  • Ensure employees understand the coverage and how to access support and map out how each layer of coverage works.
  • Curate a list (with the help of your advisor!) of good online resources with brief summaries of the support they provide. A simple handout dedicated to this topic, with websites and phone numbers clearly listed, can go a long way.
  • Lastly, include details on all of the above as part of onboarding, but also routinely communicate and update your mental health support program.

 

By offering resources like Employee & Family Assistance Programs, coverage for various mental health practitioners, Health Spending Accounts, and long-term disability coverage, employers can provide additional support for their employees’ mental health and overall well-being.

At the Immix Group, we emphasize the importance of regularly reviewing and communicating the specific benefits offered to employees through their employee benefits program. This ensures they know how to access and utilize these benefits both efficiently and effectively. For any questions about your employee benefits program and whether you can do more to support your employee’s mental well-being, visit us at immixgroup.ca or call us at (604) 688-5559. We love to hear from you!

There are a plethora of free resources and guides available online. Here are a few:

Top 8 FAQ’s

Mental health refers to one’s general state of psychological and emotional well-being. When employers actively support mental health, they show they care about their employees’ overall well-being, which can lead to a happier, more productive workplace with less absenteeism and stronger company morale.

An EFAP, also known as an Employee Assistance Program (EAP), provides 24/7 phone-based, online, or direct support to employees experiencing life challenges. It offers short-term counseling, referrals to specialized resources, and extensive online materials on various topics, helping employees manage their mental health effectively.

Paramedical practitioners, such as psychologists, psychiatrists, and social workers, provide specialized mental health care. Coverage for these practitioners is a key component of extended healthcare plans. Ensuring a broad range of covered practitioners allows employees to choose the best support for their needs. 

Typical plans offer around $500 per practitioner per person per year, but this can vary. Increasing coverage to $750 or more, or offering a specific number of visits (e.g., 12 visits), can provide better support for employees needing ongoing mental health care. 

An HSA allows employers to allocate additional funds for employees’ health-related expenses, including mental health services. It can cover costs not fully covered by standard benefits, helping employees to better afford ongoing therapy and other mental health support. 

Long-term disability coverage provides financial support to employees unable to work due to mental health issues. If the ‘definition of disability’ in the contract is met and the claim is approved, employees can receive ongoing monthly income, ensuring financial stability during recovery. 

Financial stress is a major contributor to poor mental health. Employer-sponsored group savings programs, which include education and tools for financial planning, can alleviate financial stress and support overall well-being.

Employers should ensure EFAPs are in place, review and enhance paramedical coverage, consider implementing HSAs, communicate coverage details clearly, provide accessible resources, and regularly update and promote the mental health support available.

Read more:

EAPs – how these programs can benefit both employees and organizations

Mental Health Week – CMHA National

72% of Canadian workers prioritizing mental health: survey

79% of Canadians would use mental-health services more if cost wasn’t a factor: survey

May Wellness Spotlight

 Embracing compassion in everyday life 

3 Action Steps Employers Can Take to Reduce Employee Financial Stress and Increase Financial Literacy

Government of Canada: About Mental Health

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Claim Confusion

Posted on by Immix Group

Claim Confusion: Common Reasons Why Your Benefits Claim May Leave You "Out-of-Pocket"

Uncovering why you may be left ‘out-of-pocket’ when claiming under your benefits program

Wondering why you’re left ‘out-of-pocket’ despite having a robust benefits program? There is nothing more frustrating than submitting your claim, only to find it’s not covered, or not covered up to the level you expected.

Here are some common scenarios that explain why your reimbursement might fall short of your expectations.

Is it just the plan design?

Of course, benefits programs differ significantly from employer to employer. Often, the reason for a decline is simply the plan design selected by your employer. While a previous employer may have included certain items, your current employer may have opted to exclude the item.

Largely speaking, while insurance companies have varying default plan provisions, most can customize coverage to meet the employer’s preferences. For example, there is a broad range of paramedical practitioners that can be included, beyond the standard practitioners that most people expect to see. Less common practitioners such as Dieticians, Athletic Therapists, Kinesiologists, and Clinical Counsellors can often be included, but may not be standard for the provider.

While the blame is typically placed on the insurance carrier, more often than not, a decline has nothing to do with the carrier’s ability to cover something, but rather to do with the plan design implemented by the employer, based on a range of factors such as benchmarking information, budget, employee feedback, coverage availability for the industry etc. That said, there are many common rules and plan parameters, as outlined below, that are often the reason for a decline.


Is it the timing?

Many items have frequency limits attached to them, or a certain duration of time that must pass before you can claim the item again.

Understanding how the limits are applied is especially important. For example, does the benefit period apply to the calendar year (i.e. 2 calendar years apart), or at the 24-month mark from when the service was last claimed?


Routine Dental Visits  

The most commonly known frequency limitation is the ‘6-month recall’ often attached to routine dental visits. In short, this means that a routine exam and cleaning will only be covered every six months. If you book an exam too soon, your coverage will likely be declined. To clarify, if it is determined during a routine visit that you require follow-up procedures such as a filling, this does not mean you need to wait 6 months for the filling. It is only the routine exam that falls under the 6-month recall frequency limitation.

Some programs use a 9-month recall in order to help reduce costs. If this is not communicated, you may find yourself un-insured if your recall exam takes place too soon.


Vision Care Cycles

Vision care is commonly run on a 2-year or 24-month cycle, and the distinction is important. For example, your plan might provide vision care coverage defined as one of the following:

  • $200 per 24 months- this means you cannot make a second claim until 24 months from the date of the first claim.
  • $200 per 2 years- this means you could claim in 2022 and then again in 2024, even if your claims were as little as 13 months apart, so long as they fall two calendar years apart.

Frequency limits apply to many other common items including procedures for teeth, hearing aids, medical equipment, and medical supplies. Understanding and carefully reading the wording is important.


Does your coverage reset for the calendar year, or for the benefits year? 

While it’s becoming less common, some programs have their benefits reset to match the ‘benefits year’, which is often the anniversary date of the program, or the renewal date (and yes, these can be different!). This could be at any month of the year. This is in contrast to the benefits resetting for the calendar year, which is the more common plan structure.

For example, a plan may indicate a Benefits Year of May 1st– April 30th. If the program offers $500 per practitioner per benefits year, this means you will have the full amount available to you every May 1st.

The norm, and our preference, is to have benefits reset for the calendar year. This is easier for everyone to understand and aligns with the tax year.


Reasonable and customary limits

If you haven’t heard this phrase before, it’s simply the dollar amount of reimbursement that the insurance company will provide, for a particular item. These amounts adjust periodically, and they differ based on location and insurance carrier.

So, in contrast to naming a dollar value in the benefits booklet, it would indicate that the R&C limit applies:

  • Eye Exams once per year to $100 vs.
  • Eye Exams once per year to R&C limit

Often, the R&C limit is higher than a defined dollar limit. When a program has not been updated in a long time, the defined dollar limit can become very outdated and not representative of the average cost of the service in the area. The choice the employer makes in this regard has an impact; implementing fixed dollar amounts can assist in containing claim costs. 

Charging above the dental fee guides

Here’s the scenario: you have 100% basic dental insurance. You go for a regular cleaning, and nothing unusual occurs. When the dental office submits your claim to your insurance provider, you owe a portion of the total. Why would this be? Why is 100% not actually 100%?

In short, most insurance carriers reimburse based on the current dental fee guide in your province of residence. Dental offices, however, can charge beyond these guidelines. 

Did you know?

You can address out-of-pocket expenses effectively with a Health Spending Account (HSA). Many individuals wonder if HSAs can be used to cover uninsured expenses or supplement coverage for partially covered or capped items and the answer is yes!

Learn how a Health Spending Account can enhance your benefits program and provide additional financial support where needed.

In higher-cost areas, this is particularly common (downtown Vancouver or Toronto, for example). So, when the insurer reimburses at 100%, the fine print is that they reimburse 100% of the applicable provincial fee guide.

In some instances, a plan will provide a percentage in excess of the fee guide or will allow for excess reimbursement for specialists (i.e. Endodontist, Periodontist). Again, this differs from carrier to carrier.  

Dental fee guides adjust each year. As we have written about and discussed with our clients extensively, 2022 and 2023 saw much higher than usual increases, whereas 2024 saw a return to more moderate adjustments.

 

Claiming under two plans

Remember earlier when we discussed R&C limits? Well, this comes into play when you are claiming under two plans.

If you are covered under two plans, you claim through your own employer-sponsored plan first, then claim second under your spouse’s plan for any unpaid balance. Many people assume that the result should be $0 left out-of-pocket. However, this is not always the case.

Consider this scenario: You go for a physiotherapy visit, the charge is $160, and you claim under your employer’s plan. In your province with your provider, the Reasonable & Customary limit is $120, which is paid out. This leaves you $40 out-of-pocket.

You then claim the $40 to your spouse’s plan, which covers $0 of the remainder. But why? The reason is that the second provider has an R&C limit that is equal to or lower than your own plan’s limit. The plans have coordinated to the R&C limit.

Unfortunately, having two plans does not always mean you will be reimbursed for a higher dollar amount than under one plan.

Please note: R&C limits can differ quite significantly between carriers and by location; for example, with Manulife Financial, the R&C for physiotherapy ranges from $80 (PEI) to $165 (NWT and Nvt) for a regular visit.

 

Outdated, but standard, coverage limits

Within a program, there are certain extended health care items that have a defined dollar limit of reimbursement, in contrast to others, which do not (i.e. the full cost is covered, at the coinsurance of the program).

These defined dollar limits tend to be quite similar, carrier to carrier. Unfortunately, reimbursement falls short of the actual cost of an item, simply because the industry standard has not kept pace with the actual retail cost of the item. Two examples are:

  • Eyeglasses (especially progressive lenses); while Vision Care amounts can be customized by the Employer, it’s quite common to see $200 per 24 months, which is below the typical cost for certain glasses.
  • Hearing Aids; notably, hearing aid coverage is often at $500 per 5 years, which is far below the typical retail cost for hearing aids which can be thousands of dollars.

In these instances, the employer can request for these plan provisions to be increased beyond the standard insurer provisions. However, these increased coverage limits typically come with a cost.

 

Errors happen, by providers and members

Quite simply, people make mistakes. Most of the time, when we dig into a denied claim, we learn that the provider or member has made an error when entering the claim. A common issue is claiming for the wrong practitioner (i.e. Acupressure instead of Acupuncture), claiming for the wrong duration of the visit (i.e. a physio receipt says subsequent visit and the member claims for initial visit), or simply keying in the wrong numbers from the member ID card.

In one instance, a claim was repeatedly denied, and we learned the child had been entered by the pharmacist as ‘male’ rather than ‘female’ and the system was therefore not aligning the enrolled dependent to the claimant. A simple error, but frustrating nonetheless for the member standing at the pharmacy watching the claim get repeatedly denied!

Periodically, we come across a denied claim for a very uncommon item (often, a medication). In many instances, the item is simply not coded into the insurer’s system, and with a special request, we can often have the item included.

 

Understanding the details, matters

As we have outlined, there are many reasons why your extended health or dental claim may be unexpectedly denied or cut back.

We know that the number one indicator of employee satisfaction with a benefits plan is smooth and understandable claims reimbursement. Denied claims are frustrating and at the Immix Group, we want our clients to reach out to us when they encounter issues with their claims.

Even better, proactively, our goal with our clients is to ensure they understand the structure of their plan, and the various rules and procedures surrounding claims.

Employee education sessions where members can delve into the details of their program and ask questions are very useful and can prevent unneeded frustration for members.

At the Immix Group, we are here to help you make the most of your benefits program and ensure a smooth claims experience.

If you encounter issues with claims or need assistance understanding your coverage, don’t hesitate to reach out at info@immixgroup.ca or (604) 688-5559 – we love to hear from you! 

Key Takeaways

  • Many benefits claims are denied because of the plan design implemented by the employer- they may have chosen not to cover certain items or have implemented specific timelines for cost-saving purposes. It’s important to be aware of these limitations to avoid unexpected out-of-pocket expenses.
  • If in doubt, always ensure you obtain pre-approval for any benefits services or items before proceeding with treatment. Pre-approval helps prevent claim denials and ensures you understand what is covered under your plan.
  • Familiarize yourself with any timing limitations in place for your plan. For example, some services may have frequency limitations or waiting periods between claims. If you’re unsure about any details, reach out to your benefits provider for clarification.
  • Understand the Reasonable & Customary (R&C) limits for services covered under your plan. These limits determine the maximum amount your insurer will reimburse for specific services and usually differ by region.
  • Check with your dentist to understand how they bill for services. Some dentists may charge in excess of fee guides, which could impact your out-of-pocket costs depending on your benefits coverage.
  • Navigating benefits claims can be complex, but understanding the ins and outs of your benefits program is essential for maximizing coverage and minimizing out-of-pocket expenses. Take proactive steps to educate yourself about your benefits plan—review your plan documents, ask questions, and seek clarification from your benefits provider or advisor.

FAQ

Longer durations, such as a 9-month dental recall, are often implemented as a cost containment strategy to reduce claims expenditures within a 12-month period, thereby helping to manage overall program costs.

You or your healthcare practitioner can submit a request for pre-approval. This process is common for dental procedures and other more costly healthcare services, ensuring clarity on coverage and reimbursement amounts before proceeding with treatment.

Not necessarily. While flexibility in coverage can increase with larger employers, insurers must work within provincial health coverage guidelines and adhere to CRA rules/Canadian tax laws. Underwriters may also limit plan designs to avoid excessive claims that could jeopardize the financial stability of the program.

For instance, a smaller group might not have the capacity to offer non-standard coverage like 80% coverage for Major Dental services with an unlimited annual limit. The financial risk associated with such extensive coverage could be prohibitive, especially considering that non-refund insured plans can be terminated without any deficit obligations.

Refer to your benefits booklet or contact your benefits administrator for a detailed list of covered services and items. As well, details are generally available online or through your providers mobile app. Understanding your plan’s coverage terms will help you make informed decisions about healthcare expenses.

Pre-existing condition limitations may apply to certain health conditions that existed before your benefits coverage started. These limitations can impact coverage eligibility for related treatments or services; this is more typically applicable for disability claims or travel claims.

Reasonable and customary charges apply to practitioner services such as these. Coverage for practitioners varies by province and provider and are generally updated annually. Check your benefits booklet or contact your benefits provider to confirm eligibility and coverage details for these services.

  1. If your claim is denied, request an explanation from your benefits provider (an EOB or Explanation of Benefits is usually produced automatically). Sometimes, claims are denied due to incomplete information or misunderstandings. Your benefits advisor can assist in resolving claim issues.

Yes, coordination of benefits (COB) allows you to maximize coverage if you are covered under more than one insurance plan. You’ll first send the claim to the plan you are a member of (primary coverage) for adjudication and payment. Then you can submit any eligible outstanding amount to your other (secondary) coverage. Coordinate with both insurers to ensure you receive the maximum allowable reimbursement for eligible expenses.

Further Reading

Key Conversations in Benefits 2023

Health Spending Accounts

One size fits all? Not when it comes to employee benefits.

Dental Fee Increases for 2024

 

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Three Reasons to Implement a Group Savings Plan

Posted on by Immix Group

We write often about Group Savings Plans, as it’s our belief that one of the best ways employers can assist their employees is by offering them the opportunity to plan and save for the future.

This is a sentiment that is echoed by many in our industry. In their recent 2023 recap, iA’s Director of Plan Member Wellness and Education stated the need to evolve our thinking when it comes to group savings programs, and more specifically, to “develop engagement strategies that focus on supporting people to achieve their personal goals.”

Our interpretation of this comment is that your purpose in setting up a Group Savings Plan should extend beyond simply finding a way to provide more funds to your team, or setting up a plan just because you need to be competitive with similar employers. Employees are self-reporting that they are feeling significant stress, and the number one reason is due to finances. It goes without saying that everyone has many and varied personal goals related to achieving financial peace of mind.

The three reasons to implement a group savings plan we are focusing on here focus on these facts: the support is needed, the tactic is effective, and implementation is simple.

 

 

1. Employees need support when it comes to financial literacy training and tactics to get them on track in this area of their lives

 

As we wrote about previously, a Group Savings Plan targets a key stressor for employees- their finances. The stats are clear, as reported via the 2023 Benefits Canada survey as well as through the Financial Consumer Agency of Canada:

  • 32% of Canadians report feeling a high level of anxiety, stress, or worry over money.
  • Only 49% of Canadians describe themselves as financially knowledgeable.
  • 36% feel they are just getting by, financially speaking.
  • 67% of Canadians said their debt increased by more than $5,000 in the past 12 months.
  • 53% have an emergency fund (2023), down from 64% in 2019.

As the image from the Benefits Canada Survey shows, “Personal Finances” continues to rank #1, followed by Workload and Work-Life Balance.

Screenshot 2024 02 29 at 10.04.40 PM

The answer is not simply to ‘pay people more’. Equipping people with the ability to save in a systematic and tax-effective manner, and contributing to these savings through an Employer match goes a long way. Additionally, and most importantly, Group Savings Programs provide employees access to education resources, planning tools, and financial advisors that they may otherwise not bother to seek out. Access to financial advisors to help employees achieve their personal financial goals, even if it’s as simple as developing a budget to assist with living within one’s means, can create a lasting impact and potentially redirect the trajectory of one’s financial future.

Simply put, a Group Savings Program is an opportunity to assist your employees where they need it most.

 

2. It provides an immediate, twofold beneficial impact as savings grow and taxes are reduced

 

Contributions to an RRSP (Registered Retirement Savings Plan) reduce taxable income. The difference with a Group Savings Plan is that contributions are made directly via payroll deductions.  When employees contribute to an RRSP directly from their paycheque, they experience income tax savings in real-time, as they are taxed on their after-contribution income.

We mentioned earlier the perspective that employers should seek strategies to assist employees in reaching their personal goals. Many employees identify financial goals, and particularly the development of a retirement savings account, as incredibly important.

Over time, and with engagement with the many planning tools available, an employer-sponsored program assists in creating a sense of achievement and tangible progress as retirement savings grow.

An added bonus? The Employer contribution. While not mandatory, this of course serves to boost an employee’s account value, taking them more quickly towards their goal.

 

3. Simple, low touch, high ROI

 

Lastly, it cannot be overstated how simple it can be to implement and manage a group savings plan. In contrast to the requirements of a pension plan, a simple group RRSP or group RRSP-DPSP combination plan is very low touch from an administrative perspective.

Even a very small employer can easily implement a Group Savings Plan that provides similar access to all the features (online platform, resources, investment funds, planning tools, etc.) that a much larger employer offer. It’s a way to recruit, retain, and remain competitive. In short, implementing a group savings plan provides a great return on investment.

Already have a group savings plan in place? Here are a few checkups:

  • Have you taken advantage of our offer to host an education seminar?
  • When was the last time you assessed the contribution level made by the Employer? Has it kept pace with inflation?
  • When was the last time you reviewed Employee contribution levels? Have employees been reminded that they can increase their payroll deductions, again, to keep pace with inflation or changing circumstances?
  • When did you last run an audit of participation levels? Is everyone who is eligible to participate enrolled?
  • Are you aware of and communicating the many comprehensive resources available through your provider and advisor?
 

Help employees to save for the future

 

In summary, implementing a Group Savings Plan is a direct response to the financial stress reported by employees. Beyond immediate benefits like tax-effective contributions and employer matches, it offers a straightforward and high-return solution to recruit, retain, and stay competitive. By addressing employees’ financial concerns holistically, it not only eases stress but also fosters financial growth and supports personal goals.

At the Immix Group, we recognize the importance of financial literacy which is why we offer lunch and learn seminars where we explain, simplify, and guide our clients through their programs to help them maximize their benefits. Additionally, our clients have direct access to our sister company, Ciccone McKay Financial Group, where dedicated advisors are available and ready to provide personalized assistance.

It’s desired, it’s beneficial, and it’s simple to implement and administer! If it’s been on your mind to look into a plan for your employees, we’re happy to help you discuss options.

FAQ

Beyond just funding your team or competing with other employers, it addresses the top stressor reported by employees—financial concerns.

By enabling systematic savings and offering tax-effective contributions, it directly tackles the rising anxiety and lack of financial knowledge reported by Canadians. It also provides employees access to education resources, planning tools, and financial advisors that they may otherwise not bother to seek out.

It offers real-time income tax savings as contributions are made directly from paycheques, creating tangible progress toward personal financial goals.

While not mandatory, this of course serves to boost an employee’s account value, taking them more quickly towards their goal.

It’s simple, low-touch, and offers a high return on investment, making it easy for employers to implement and manage.

It requires minimal administrative effort, making it accessible even for small employers to provide features similar to larger employers.

Implementing a Group Savings Plan enhances competitiveness, contributing to employee satisfaction and loyalty.

Regularly assess Employer and Employee contributions, participation levels, and leverage available resources for ongoing plan success.

Further Reading

Add to your Recruitment and Retention Toolkit with a Group Savings Plan – Latest News from Immix Group

3 Action Steps Employers Can Take to Reduce Employee Financial Stress and Increase Financial Literacy – Latest News from Immix Group

Business Owners: How to Design the Best Group Savings Plan for your Company

This might just be the right time for you to implement an employee group savings plan – here’s why and how

Canadians’ Financial Well-being: Summary of FCAC survey findings – Canada.ca

Report | Benefits Canada.com

Key Conversations in Benefits 2023

Posted on by Immix Group
Employee Benefits Conversations

Last year our blog “Top Conversations of 2022” proved to be among our most popular articles for the year! Once again, this year, we have compiled a recap of the Top Conversations in Benefits, from our perspective as benefits advisors.

Last year we recapped the top conversations in benefits, which can be summarized as:

  • The ongoing extreme difficulty in hiring reliable, qualified staff;
  • The permanent shift to a hybrid work arrangement;
  • The “Great Resignation” or rather, in Canada the “Great Retirement;”
  • The brand new Federal Dental Plan;
  • The change to the duration of EI Sickness benefits;
  • The continued focus on mental health and wellbeing;
  • And lastly, high inflation.
 

Has it Become Easier to Hire Great People?

According to experts, we should expect the unemployment rate to rise, with the population increasing at levels that are outpacing hiring, due to the arrival of many newcomers. With the job vacancy rate down, employers are able to be more selective with hiring. While this may sound like great news, we are still hearing from our Client Community that it is incredibly challenging to find skilled, reliable employees.

 

Remote or Hybrid Work Arrangements are Still a Key Request for Job Seekers

Related to this, we saw many in our Client Community move to remote workforces or hybrid workforces; not as a hangover from the requirements of the pandemic, but as a desired new norm. The recruiters in our network tell us this is still in the top 2 or 3 for job requirements for job seekers these days.

We wrote about this extensively back in 2022, in our two-part article ‘Is Working from Home an Employee Benefit?” where we looked at many of the considerations and statistics surrounding the (at the time) new reality.

 

Inflation is Impacting Benefits Costs

We touched on inflation in our January 2023 recap, but this became the dominating topic of many benefits conversations as we saw costs increase across a wide spectrum of services: practitioner visits, equipment, drugs, and dental costs. While it’s easy to blame inflation on the rising cost of benefits, the reality is that insurance providers are paying higher per-claim costs in many instances, even when coinsurance and maximum reimbursement limits are in place. This especially impacted dental claim costs, and unfortunately, we anticipate the dental fee guide to increase once again in 2024. The bottom line? Inflation is affecting everyone. This is a global economic issue and is certainly not isolated to those of us here in Canada.

Related to inflation and hiring, wage increases are expected to be modest this year, and economists are not expecting to see wage costs as a notable factor in driving inflation.

 

Pay Transparency Legislation Implemented

It will be interesting to see the potential impacts of pay transparency legislation taking effect in some provinces, including BC. Will pay transparency legislation drive wages up?

With the stated goal of closing the gender pay gap, effective for November 1st 2023, employers were required to post salary ranges for publicly advertised jobs. Furthermore, employers will be required to publicly post gender pay gaps (staggered based on the size of the company, beginning now, and expanding to smaller companies through to 2026.  The stated goal is to reduce unconscious bias around gender and ethnicity.

 

How Should the Employer and the Employee Split the Cost of Benefits?

In 2023, we received many requests for advice and changes related to the sharing of benefits premiums between employers and employees.

Many employers made adjustments this year. For some, in an effort to reduce the burden placed on employees, employers were shifting a greater percentage of the cost to the employer. Other employers went the other direction, looking to see employees cover a great percentage of their benefits premiums. As a reminder, the employer must cover no less than 50% of the total cost of benefits, and tax efficiency is an important consideration when arranging your cost split. We wrote about strategies and common practices back at the end of 2023.

 

Federal Adjustments: EI Sickness Benefits and Long-Term Disability 

The change to EI Sickness benefits via Service Canada which saw the maximum payment period increased from 15 weeks to 26 weeks (6 months), resulted in very little disruption for those with Long Term Disability plans in place. The vast majority of employers kept their Long Term Disability benefits intact with the waiting period at the standard 119 days/ 17 weeks. While this was matched to the previous EI Sickness benefits duration, employers agreed that it was more desirable to have employees move more quickly to long term disability benefits rather than remain on the more limited EI Sickness benefits. Additionally, there were negligible cost savings in adjusting the Long Term Disability waiting period. 

 

The Federal Dental Plan and T4 Reporting Requirements

After years of discussion and development the Federal government launched the Federal Dental Plan, providing coverage for children under 12 only. In order to qualify for any level of coverage, family income must be under $90K, and the children must not have access to private dental coverage (i.e. Employer plans).

As a result of this program, on 2023 T4’s Employers are required to report on Box 45 whether as of December 31st, 2023, their employees were ‘eligible to access dental insurance or dental coverage of any kind, including health spending and wellness accounts, due to their current or former employment”.

The following codes are to be used:

  • Not eligible to access any dental care insurance, or coverage of dental services of any kind
  • Payee only
  • Payee, spouse, and dependent children
  • Payee and their spouse
  • Payee and their dependent children

 

Please note if you have a benefits program that provides dental coverage, the vast majority of employers will report code 3 “Payee, spouse and dependent children.”

The codes above have created a lot of confusion, as they are based on access and not actual enrolment in the benefit for all eligible individuals within the family unit. Specially, if a plan offers family coverage but the member has waived benefits for either themselves or family members, Code 3 still applies as that is the type of coverage available. 

Please note employees must have been eligible for coverage as of December 31st, 2023, for Code 3 to apply (i.e. not still in the waiting period). 

As expected, the Federal Dental plan did not impact existing employer-sponsored dental plans, but changes may be coming, given this was indicated as the first stage in a more comprehensive Federal program.

 

Mental Health Support Discussions Continue to Expand and Evolve

When it comes to discussions with our supplier partners (i.e. providers such as Manulife, RBC Insurance, Pacific Blue Cross, Canada Life and myHSA), we have noticed a movement towards branding themselves as health and wellness driven. More and more services are geared at healthy living, whether this is aimed at improving activity levels, diet and prominently, mental health. In many instances, they are tapping into the data they have on hand to produce customized solutions.

A cornerstone of this is mental health support; all carriers are providing resources and coverage solutions. This is an area where we continue to see plan sponsors increasing their coverage, along with their communication and promotion of available services. Employers added to their mental health offerings in a variety of ways, most commonly:

  • Adding Health/ Wellness Spending accounts to remove financial barriers to mental health practitioners
  • Adding or promoting Employee & Family Assistance Programs
  • Ensuring coverage for applicable practitioners with paramedical services: psychologist, clinical counsellor, social worker
  • Enhancing coverage for the paramedical practitioners with higher limits.

The availability of online, high quality and often free resources is enormous and continuously evolving.

 

An Emerging Trend: Inclusive Coverages

As iA stated in a January 18th communication “today’s employees expect their organization to support them fully in their multiple and diverse needs.” For providers, conversations have focused on a few key areas:   

Gender Affirmation: the cost for gender affirmation procedures not covered under provincial medical has been widely discussed the past few years, and we now have providers including this coverage. For example, Equitable Life rolled this coverage out late 2022, with the stated aim of “offering solutions that support diversity, equity and inclusion.” We expect to see more providers rolling out gender affirmation coverages.

Fertility, Surrogacy, Adoption: despite fertility problems affecting one in six couples hoping to conceive, fertility coverage has traditionally been limited to drugs and often with a defined annual limit. A concern for many was uncovered related costs, such as for procedures.

iA is one provider that has provided what they call “Family Support” coverage, where in addition to drugs, care and treatments such as doctors’ fees and lab services, are also covered, including for surrogates.  Additionally, on an ASO basis, iA is offering Adoption coverage for costs related to the adoption of a child.

While many of these costs have been eligible through Health and Wellness Spending Accounts, it is new to see insurance providers identifying and defining these coverage areas.

 

Diabetes and Adult ADHD Medications on the Rise

Adult ADHD claims have steadily increased over the past several years. We now routinely see Vyvanse, a leading amphetamine-based drug for ADHD as one of the top claimed medications for the employers with whom we work. As Manulife shared, this is “recognized more widely as a condition that continues into adulthood.” In short, the kids diagnosed and medicated for ADHD are now adults, who have continued to be medicated. In addition to this, there is major rise in adult diagnosis of ADHD, which is being credited in part to increased awareness through social media. In particular, there is an increased diagnosis for women, as we now have a greater understanding of how differently the symptoms present in men vs women.

Diabetes has been on the rise for many years now; 30% (12M Canadians) live with diabetes or prediabetes, with over 90% Type 2. As well, the data shows diabetes diagnoses are increasing among younger age groups.  We are seeing diabetes medications such as Jardiance, Trulicity and Metformin continually in the top ten claimed drugs for many clients.

 

Ozempic Dominates Drug Conversations

But without a doubt 2023’s “most frequently asked question” relates to the costly Type 2 diabetes medication Ozempic (Semaglutide) which is a daily injectable. This blockbuster drug is approved in Canada for the management of Type 2 diabetes; however, it is extremely popular for its well-known side effect, weight loss. This drug was all over the news, with celebrities endorsing it for its ability to curb one’s appetite, leading to quick and significant weight loss.

In short, members wanted to gain access to the drug, most often for weight-loss purposes. However, the drug here is BC requires Special Authority approval. To be approved, you must require it for treatment of type 2 diabetes, “After inadequate glycemic control on maximum tolerated dose of metformin.” Unfortunately, in Canada, getting Ozempic is not as simple as just requesting it from your doctor!

 

What to Expect for 2024?

Here at the Immix Group, 2024 has been very busy so far! Many employers are asking for ideas to better meet the needs of their employees, and looking for details on what their employees are claiming in order to better customize their benefits offerings.

We unfortunately continue to see claims rising and expect this to continue through 2024, and therefore expect to have many conversations with employers regarding cost containment strategies.

As always, we welcome you to reach out to discuss optimization strategies for your benefits programs.

FAQ

The key topics revolved around the challenges in hiring, the shift to hybrid work arrangements, the “Great Retirement,” the Federal Dental Plan, changes to EI Sickness benefits, a focus on mental health, and the impact of high inflation.

Employers are able to be more selective, with many newcomers meaning there are many job seekers; however, employers are still reporting a difficulty in finding skilled employees.

Yes, remote or hybrid work arrangements continue to be a top priority for job seekers, indicating a shift from a pandemic necessity to a desired norm.

Inflation has driven up costs across various services, impacting practitioner visits, equipment, drugs, and dental expenses. Insurance providers are facing higher per-claim costs, especially in dental claim costs.

Pay transparency legislation, effective from November 1st, 2023, requires employers to post salary ranges for publicly advertised jobs in an effort to close the gender pay gap.

Many employers adjusted their benefits cost-sharing strategies in 2023. While some shifted more costs to employers, others leaned towards employees covering a greater percentage. Employers must cover at least 50% of the total benefit cost.

EI Sickness benefits saw an increase in the maximum payment period to 26 weeks (end of 2022). This change had minimal disruption for those with Long Term Disability plans, with waiting periods mostly unaffected.

Employers must report on Box 45 of 2023 T4s whether employees were eligible for dental coverage as of December 31, 2023. Specific codes are provided for different eligibility scenarios.

Carriers are increasingly focusing on mental health, providing resources and coverage solutions. Employers enhance mental health offerings through various means, including Health/Wellness Spending accounts and Employee & Family Assistance Programs.

There is a growing trend towards inclusive coverages, including gender affirmation procedures, fertility, surrogacy, adoption, aiming to support diverse needs and promote diversity, equity, and inclusion.

Adult ADHD claims have increased steadily, with a rise in adult diagnoses, attributed to increased awareness. Diabetes diagnoses, particularly Type 2, are on the rise, impacting medication claims. The most frequently asked question is about the costly Type 2 diabetes medication Ozempic (Semaglutide), frequently sought for its weight-loss side effect.

Read more:

Canadian jurisdictions enacting pay transparency legislation, but more work to be done | Benefits Canada.com

How B.C.’s pay transparency legislation could impact employers | Benefits Canada.com

rolled this coverage out late 2022

Inclusive coverage (ia.ca)

Canadian Dental Care Plan – Canada.ca

T4 reporting changes for 2023

Employee Health Trends | Manulife

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Understanding Cost-Sharing in Employee Benefits

Posted on by Immix Group

Understanding Cost-Sharing in Employee Benefits: The Employer’s Role in Premium Contributions and Standard Practices

 

Introduction

In the fiercely competitive job market, employee benefits play a crucial role in attracting and retaining top talent. Among the many decisions that employers face in crafting an appealing benefits package, one of the most significant is determining the benefits premium cost-sharing arrangement between the company and its employees.

This article aims to delve into the complexities of ‘cost-sharing’ and shed light on standard practices for designing sustainable and attractive employee benefit programs.

Firstly, if you were not aware, it’s quite common for part of the cost of the benefits program to be paid for by employees via payroll deduction. This is typically a ‘condition of employment’ and is outlined in a contract of employment. Premium amounts can vary significantly depending on the scope of the program, the demographics of the group and other factors, meaning the dollar amount of the payroll deduction can differ significantly from employer to employer. No greater than 50% of the overall cost can be passed along to the employee, per insurer guidelines. The “cost sharing” per benefit line is indicated to the insurance carrier at the implementation of a program, and most carriers will indicate the “employee” and the “employer” premiums, per benefit line, on each monthly invoice simply to assist with payroll.

 

What should Employers consider when determining cost-sharing?

The cost-sharing ratio between employers and employees is not a one-size-fits-all equation. It depends on a multitude of factors, including:

  • the size of the company,
  • plan design,
  • the premiums in dollars for various benefit lines,
  • demographics,
  • employee classifications,
  • and of notable importance, the tax implications.

Striking the right balance requires careful consideration, and the differing taxation of various benefits (link to taxation of benefits page) is usually one of the primary considerations.

 

Three different ways to view Cost Sharing:

An employer might approach cost sharing by considering the benefits to be covered by the employee:

  • Employee pays Long Term Disability premiums only
  • Employee pays all pooled benefits premiums (Life, AD&D, Disability and Critical Illness).
  • Employee pays all pooled benefits premiums plus 50% of health and dental premiums

In all the above scenarios, the Employer must ensure that no greater than 50% of the overall cost is passed along to the employee.

Alternatively, the employer might apply a percentage to the entire cost of the program, with the maximum allowable percentage of 50%. For example:

  • Employee pays 25% of total premium costs.
  • Employee pays 50% of total premium costs

In the event that a percentage is applied, the premium should be applied first towards the benefits for which an employee-paid premium ensures a tax-free benefit (most notably, Long Term Disability). The tax implications of cost sharing should be carefully considered in order to reduce or eliminate the possibility of a taxable benefit.

Less commonly, an employer might charge a flat dollar amount:

  • Employee pays $25 per pay period towards benefit premiums
  • Employee pays $100 a month towards benefits premiums

Regardless of the approach to cost sharing, the formula must be viewed with the actual dollar amount of premiums taken into consideration, per benefit line.

 

How should an organization approach cost-sharing? What is typical?

As mentioned, it is essential to understand the cost for the various benefit lines (and yes, these change year to year!) and the tax implications. In addition, employers must consider how their cost-sharing arrangement compares to their industry, and to their particular company’s philosophy. Beyond the tax implications, there are several factors that influence the cost-sharing structure:

  1. Plan Design: The specific design of the benefits plan can impact the appropriate cost-sharing scenario. For example, a plan with high life and disability coverage may see higher premiums for these benefits.  If the employee is covering these premiums for tax reasons, the employer may wish to cover 100% of the remaining benefits.
  2. Industry Norms: Employers often look to industry benchmarks to ensure their contribution levels remain competitive and appealing to potential employees; what are your main competitors doing? If your primary competitors are advertising that they cover 100% of benefit premiums, you may need to follow suit.  
  3. Company Size and Financial Resources: The financial capabilities of the company, combined with its size, can influence the employer’s ability to contribute significantly. Generally speaking, larger, most established companies tend to cover a greater share of benefit costs, because they can afford to do so. 
  4. Talent Demand: In high-demand talent markets, employers may need to offer higher contribution levels to attract and retain top performers, in addition to offering a more comprehensive program.
  5. Company Philosophy: what are the core values of your company, and how does your cost-sharing formula fit into this?

 

Balancing Employee Needs and Cost Containment

Employers face the delicate challenge of balancing attractive benefits with cost containment. While it is vital to provide robust benefits that meet the diverse needs of employees, it is equally crucial to manage expenses efficiently.

Beyond the cost-sharing of the premiums, please keep in mind that the plan design itself offers an element of “cost-sharing” through coinsurance and deductibles, and additionally, through reimbursement limits. Please consider:

  1. Deductibles: flat deductibles are paid out-of-pocket before coverage is applied; while deductibles can incentivize employees to be more conscious of their benefit usage, thus reducing unnecessary expenses, they penalize lower claimers and are less common these days.
  2. Co-Insurance: this refers to the percentage of coverage, such as “80%” for basic dental. Co-insurance requires employees to share a portion of the costs for specific services, encouraging them to make more informed healthcare choices.
  3. Reimbursement limits; items may have limits that leave the employee out-of-pocket for the remainder of the cost (i.e. orthotics that cost $500 for which the employee only receives $300 back). Potentially in combination with points 1. and 2. above, reimbursement limits can erode the overall percentage of an expense for which an employee is covered. 

All of the above can encourage employees to make informed choices when it comes to their healthcare spending. However, with most employers stating that the overall goal of a benefits program is to facilitate employee health and wellness, employers should be mindful that employees are not bearing too great of a costs for their coverage, from a holistic perspective.

As we said, approaching the cost-sharing that is right for your company is not one-size-fits-all; you need to carefully consider the factors outlined above, and work with an experienced advisor to ensure the right approach that allows for excellent coverage in combination with cost-sustainability.

Conclusion

Decoding cost-sharing in employee benefits is a complex task that demands careful consideration of multiple factors. Employers must keep abreast of industry trends, assess their financial resources, and regularly evaluate their benefit packages to ensure competitiveness and relevance in the job market.
In today’s competitive landscape, employers must recognize that ongoing evaluation and adjustment of benefits packages are necessary to attract and retain top talent. By striking the right balance between attractive benefits and cost containment, employers can demonstrate their commitment to their workforce’s well-being while maintaining financial sustainability. The key lies in crafting a benefits package that aligns with the company’s values, meets the evolving needs of their employees, and supports the organization’s overall goals.

FAQ

Cost-sharing in employee benefits refers to the arrangement where both the employer and the employee contribute to the cost of the benefits program. It helps strike a balance between providing attractive benefits and managing expenses.

Several factors influence the cost-sharing ratio, including company size, plan design, benefit premiums, demographics, employee classifications, and tax implications. Striking the right balance is crucial for an effective cost-sharing strategy.

Employers can approach cost-sharing by considering the benefits to be covered by the employee, applying a percentage to the total premium costs, or charging a flat dollar amount. Each approach has its considerations and implications.

Industry benchmarks and norms are essential considerations when determining cost-sharing arrangements. Employers often align their contribution levels with industry standards to remain competitive and appealing to potential employees.

Employers must balance attractive benefits with cost containment strategies. This includes considering elements like deductibles, co-insurance, reimbursement limits, and designing a benefits program that promotes employee health while managing expenses efficiently.

The ultimate goal of a benefits program, including cost-sharing strategies, is to facilitate employee health and wellness while ensuring employees are not burdened by excessive costs. It’s about providing excellent coverage in a sustainable manner.

Employers should regularly evaluate industry trends, assess their financial resources, and work with experienced advisors to ensure their cost-sharing approach aligns with industry standards and meets the needs of their workforce.

Decoding cost-sharing in employee benefits requires careful consideration of multiple factors. Employers need to maintain an ongoing evaluation and adjustment of benefits packages to attract and retain top talent while ensuring financial sustainability. The key is crafting a benefits package aligned with company values and employee needs.

Key Takeaways

  1. Importance of Cost-Sharing: Cost-sharing in employee benefits is a vital strategy that helps strike a balance between providing attractive benefits and managing expenses, ensuring both employers and employees contribute to the cost of the benefits program.

  2. Factors Influencing Cost-Sharing: Several factors, including company size, plan design, benefit premiums, demographics, and industry norms, influence the cost-sharing ratio between employers and employees. Employers must carefully consider these factors to determine an effective cost-sharing arrangement.

  3. Diverse Approaches to Cost-Sharing: Employers can approach cost-sharing in different ways, such as defining specific benefits for employee contribution, applying a percentage to total premium costs, or charging a flat dollar amount. Each approach has its considerations and implications.

  4. Balancing Employee Needs and Cost Containment: Employers face the challenge of balancing attractive benefits with cost containment. Elements like deductibles, co-insurance, and reimbursement limits play a crucial role in promoting informed healthcare choices while managing costs effectively.

  5. Ongoing Evaluation and Adaptation: Employers must regularly evaluate industry trends, assess their financial resources, and work with experienced advisors to ensure their cost-sharing approach remains competitive and relevant. It’s essential to align the benefits package with company values and the evolving needs of employees for long-term success.

Howard 2

Howard Cheung | BBA | Employee Benefits Consultant

Virtual Health Care is Everywhere

Posted on by Immix Group

Virtual Health Care is Everywhere: Employer vs. Free Options, and the latest in Offerings.  


Back in 2020, we wrote about virtual care offerings, at the time prompted by the pandemic and the lockdown we were experiencing, which made routine doctor visits close to impossible.

While virtual care was available pre-pandemic (in fact, it dates back to around 2006), it was inconsistent and sometimes difficult to navigate. One silver lining of the pandemic is that the virtual healthcare space has exploded with new and expanded platforms, offering individuals and businesses a variety of options to meet a range of needs.

The shortage of family medicine providers, compounded by a severe cold and flu season has made virtual care offerings even more valuable in recent months. A huge number of Canadians do not have a family doctor, and for those that do, booking a same-day appointment is often extremely difficult, if not impossible. While an in-person visit is certainly warranted in many instances, sometimes a virtual visit will suffice, and it can definitely be more convenient: no commuting, parking, waiting rooms.

Studies show that over 50% of doctor’s visits could be handled without direct contact, meaning a virtual visit will suffice to resolve the concern. Through most virtual providers, you can access:

  • Diagnoses
  • Prescriptions
  • Sick Notes
  • Lab work orders, such as blood tests
  • Referrals to specialists
  • Imaging referrals (Xray, Ultrasound)
  • Mental health inquires and referrals

While all providers prescribe medications, they do not prescribe or refill narcotics and addictive controlled substances.

Table of Contents

Free vs Paid Options


You may have noticed the existence of free virtual health care offerings versus paid programs that can be purchased either by businesses for their employees, or even by individuals.

Why pay for a Virtual Health Program, with so many free options?


Employers can add Virtual Care programs to their benefits line-up. A typical paid employer-sponsored program means an enhanced experience, such as:

  • Wait times: free options are becoming heavily used, and wait times are becoming longer. Paid options guarantee quicker access.
  • Longer hours of availability; many paid options offer 24-7 care, in contrast to free versions.
  • Coverage for those in provinces/territories where virtual visits are not insured: currently only BC, Ontario, Alberta and Quebec cover virtual doctors visits under provincial care
  • Direct access to many specialists: often common specialists like dermatologists or pediatricians can be accessed through enhanced programs
  • Beyond regular medical doctor’s visits: practitioners are often available through enhanced paid programs such as counsellors and dieticians, naturopaths and most notably, mental health services.
  • Reporting: usage / ROI data is available through some providers

While the cost ranges, many of these programs are available as add-ons to your existing benefits program for a few dollars per employee, per month.

For example, Manulife’s program is provided through Telus Virtual Health Care and is available as an add-on to an insured plan for $3.95 per employee per month. Like other similar programs, it offers an app with 24-7 on-demand access to health providers via secure text, video, and live chat. Maple Virtual Health is another well-known and highly regarded offering that is also available through many insurance providers (RBC Insurance, for example). Maple Virtual Health can also be purchased stand-alone by employers, and it does provide some ability for free visits to non-members in qualifying provinces, but they are tapering this back to focus on employer-sponsored programs. Telus Health is the best known and largest of the virtual health platforms and offers employer-sponsored programs. It is worth noting that Telus Business mobility customers have access to the paid version of the Virtual Care program for free!
Virtual Health Care is Everywhere: Employer vs. Free Options, and the latest in Offerings

Free Virtual Healthcare Options


Depending on your province of residence, you may be able to access free doctor’s visits through some virtual providers. Some provinces cover virtual doctor visits, meaning you will pay no fee to access a doctor online (the doctor will bill the province, as they usually would with an in-person visit).

For residents of BC, Alberta, Ontario and Quebec, visits are free under some platforms. For those in other provinces, accessing a virtual provider typically costs around $30-40 per visit.

Most of these virtual providers connect via phone, live chat, video or secure text in order to connect with patients. The following are two notable virtual health care providers:

  • Telus Health – Telus has acquired numerous other providers and continues to dominate the virtual healthcare landscape. As mentioned previously, Telus Business mobility customers have access to the paid version of the Virtual Care program for free. The Telus Health MyCare app can be downloaded for free, and in covered provinces, doctor’s visits are billed to the province.
  • Tia Health One of the most well known and highly regarded platforms, with an easy to navigate system, Tia offers access to doctors, nurses and pharmacists by phone, video or secure messaging. Tia has also acquired a number of other virtual health providers, so has greatly expanded its network of clinicians.
  • Well Health Virtual Clinic Branded as a virtual walk-in clinic, this provider focuses on doctors visits, simple access to prescriptions and requisitions, and is free in covered provinces. A unique feature is you are able to choose your doctor from their listing.
  • Cover Health– Another virtual “walk in clinic” this platform is free in Ontario under OHIP and offers same day appointments, 7 days per week.

Virtual Mental Health Platforms


Accessing quality mental health services is difficult, and a significant barrier for many people is simply leaving the house. Accessing support through easy to navigate virtual platforms can be life changing. While the cost of the programs can be notable (the per-visit cost can be similar to an in-person session with a credentialed therapist), this can typically qualify under Extended Health paramedical coverage or through a Health Spending Account.

Two notable mental health platforms are:

  • MindBeacon With a focus on mental health support, specifically, Cognitive Behavioural Therapy, MindBeacon is highly regarded in the virtual mental health support space. As the online practitioners are credentialed psychologists or social workers, fees can typically be submitted through benefit plans.
  • Inkblot Launched in 2018, Inkblot Therapy strives to alleviate the extremely long wait times that many people face in accessing mental health support. As a platform focused exclusively on mental health, Inkblot offers confidential virtual therapy, CBT, continuity of care, webinars and training, trauma and treatment services, chronic disease management, psychiatric consultations and collaborative care, work and life support

Virtual Health is here to Stay!

The pandemic provided the opportunity for expansion and innovation in the virtual health landscape. While there will always be the necessity for in-person medical treatment and virtual offerings should not be exclusively relied upon, they do solve numerous problems people face in accessing healthcare, and provide a comfortable and convenient alternative, where appropriate.

Whether you choose to implement an employer-sponsored paid program or not, employers should take the time to ensure employees are aware of the virtual health landscape, and the options available to them. There are many educational materials available that can be distributed to employees to assist in spreading the word.

Please feel free to reach out if you’d like to learn more. We love to hear from you!

FAQ’s on Virtual Care

Can a virtual health care provider prescribe medication?

Yes, this is one of the core services, however they will not prescribe controlled or addictive substances.

Can I see a specialist through a virtual care provider?

Sometimes, yes but more commonly you must still be referred to a specialist by a regular GP. Under some paid programs, specialists can be accessed.

Can I access virtual care if I’m not in one of the provinces where it’s insured under provincial coverage?

Yes, the same service is available, but a per-visit cost is charged that starts around $30. Subscriptions to virtual care platforms are available as well.

Can I see my own doctor through virtual care?

It depends! If your doctor works for one of the providers, you may be able to see them through a virtual care platform. Or they may provide this through their clinic.

How do I connect with a virtual provider?

Typically, you will engage online through your computer, table or smartphone. Once booking an appointment, you can usually choose a phone call, text, live chat or video conferencing for the appointment.
telehealth plan insights by Immix Group

Key Takeaways

• Virtual health platforms today offer a convenient and effective solutions for many medical concerns.
• There are numerous free virtual health platforms available today.
• Paid options typically provide enhanced services, namely guaranteed quicker access.
• All Employers should promote virtual health care offerings to their employees, whether or not you provide an Employer-paid version.

Further Reading:

Canadian Online Doctor Appointments | Tia Health | Book in Minutes

Virtual Care | TELUS Health Care Centres

Lifeworks/Telus  report Mental Health Index

Healthcare Online – On-Demand Healthcare Access | Manulife

Trends & Free Resources in Digital, Virtual & Telehealth Care for British Columbia – Latest News from Immix Group

Tia Health: https://tiahealth.com/

InkBlot Effective Mental Health Care for Everyone | Inkblot Therapy

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

8 Reasons for Increases to your Employee Benefit Plan Premiums   

Posted on by Immix Group

Pondering the question: “Why do my benefit plan costs keep going up?” We’ve got answers.

If you’ve walked away from your renewal meeting scratching your head at the rate adjustment, you’re unfortunately not alone. Many advisors don’t do a great job explaining a rate change, and the math used by insurers can be quite (unnecessarily!) complicated. Our goal with this article is to give you insight into what causes rates to increase or decrease, and hopefully help you to better understand your program and what you can do to achieve cost sustainability.

Renewal rate reductions DO happen! We promise.

Before we get into why rates increase, we’d like to point out that for many of our clients, they see their rates reduce from time to time! Approximately 30-40% of our clients in a given year experience an overall rate decrease, rather than an increase.

We conducted a quick review of our block of business, and for their 2022 renewal rates:

  • 43% of our clients saw a reduction to their Extended Health Care rates
  • 30% of our clients saw a reduction to the Dental Care rates
  • 75% of our clients saw their pooled rates held without change

It’s a fact! Employee benefit program rates do not always increase, even in times of high inflation.

We want our clients to understand how benefit plan pricing works

During a renewal meeting, one of our primary goals is to ensure that our client understands WHY rates adjust. One of our key values at Immix is transparency; showing the details of the claims experience and how the rates are calculated is important to us.

First, as your advisor, we are responsible for determining fair pricing is presented to you for the year ahead. On a typical non-refund insured program, this means assessing the claims experience and projecting the required premiums for the upcoming renewal year, using some basic mathematical formulas. We look closely at the composition of the claims, the inflationary trends applied, the IBNR (Incurred But Not Reported) factors etc., but once we are satisfied we have arrived at fair pricing, our goal is to ensure you also understand.

However, if you’ve walked away from a meeting with your benefits advisor and you’re googling to attempt to understand why your pricing has increased, here are some insights:

1. Your claims experience is high.
This is the obvious one! In short, what was paid out in claims was too high relative to the premiums you paid for the benefit. This applies to health, dental, and to an extent, short term disability.

In very simple terms, if you paid $100 in premiums, and the claims paid back to members were $125, you have a Paid Loss Ratio of 125%. If you paid $100 in premiums, and the claims paid back were $50, you have a Paid Loss Ratio of 50%. While other factors come into play some of which are described below, in short, the premiums need to be sufficient to cover the claims, at a certain break-even mark.  

2. Your group is not fully credible/ has low credibility.
What is credibility? The simple explanation is that it’s the portion of your own claims experience used in the renewal rate calculation, versus the percentage that is based on the insurer’s block of business or manual rates. This is expressed as a percentage.

With Credibility of 25%, this means that 75% of the experience used to calculate your rate adjustment is based on the insurers block of business or manual rates, not your own claims experience. This can have the effect of helping or hurting your renewal rate calculation, depending on whether your claims experience is better than or worse than the insurer’s.

Credibility is based on the size of the group and the number of years with the insurer. The larger and longer you are with a carrier, the higher the credibility. It’s worth noting that within Immix Group’s broker-managed pools, we have full credibility for all groups, from day one.

More Reasons for Increases to your Employee Benefit Plan Premiums

3,Inflationary trends come into play.
Benefit programs are not immune to basic inflation, and an inflationary factor is incorporated into rate calculations.

Firstly, inflation affects claim costs, including fees charged by benefit providers such as paramedical practitioners, medical supply offices and dental clinics. In particular, we saw a huge increase to the 2022 Dental Fee Guide in BC, at 7.35%. With inflation hitting everything right now from groceries to gas to wages, you can also expect to see claims dollars increasing, across the board.

When calculating the renewal rates, the anticipated higher cost of future claims is taken into account.

An inflationary trend* is typically applied to the paid claims (along with the change in IBNR reserve) to arrive at the Incurred Claims, the number that is used in the calculation to project the required premium for the year ahead. Although the term “Incurred Claims” is a bit confusing, it’s basically your claims, trended for inflation and reserve adjustments.

4.You have a low Target Loss Ratio.

This might be based on the size of your group, how long you’ve been with the carrier, or perhaps you are inside of a pool. Nevertheless, this directly affects your renewal rate calculation under a typical insured plan.

If you’re not familiar with this term (read more here), Target Loss Ratio refers to the ‘break-even’ mark for the experience-rated benefits (typically health and dental, and partially, short-term disability). The Target Loss Ratio is the goal as far as where the Incurred Loss Ratio will fall, for the plan to not lose money. Assume the following:

  • 75% Incurred Loss Ratio, and 72% Target Loss Ratio
    • 75/72= 1.0417 (a 4.17% rate increase applied)
  • 75% Incurred Loss Ratio, and 84% Target Loss Ratio
    • 75/84= 0.8929 (a -10.71% rate decrease applied).

As illustrated, Target Loss Ratio is a key factor in your renewal pricing calculation. It’s a reflection of the costs to run the plan and includes the payment to the advisor.

5.You’re inside a pool where the experience of the pool drives your pricing.

Perhaps you had very low EHC claims, but the rates are still going up 15%, because under the pool model you are in, everyone in the pool gets the same adjustment based on the overall experience of the pool. Fair? Not at all. However, that’s how many pools are managed.

Even worse (in our opinion!) if you’re inside a pool where you are not allowed to see a breakdown of the types of claims or even the claims dollars compared to the premiums, you have no way of knowing if your pricing is fair. While it’s a lot easier for the advisor and insurer to give everyone the same rate adjustment, in addition to unfairly punishing groups with low claims experience, it doesn’t provide the transparency needed to properly manage the program.

6.You have aging demographics or a generally ‘older’ group.

We have discussed mostly the factors that affect health and dental pricing, but the pooled benefits (Life, AD&D, Dependent Life, Disability, Critical Illness) are also subject to rate changes. These are primarily driven by shifts in the overall group of people with regards to the headcount, male vs female split and the distribution over age brackets. As a group becomes “older” or there are higher concentrations of people in the older age brackets, rates tend to increase for pooled benefits.

A higher percentage of males vs females will drive life insurance rates up, whereas the opposite is true for disability pricing; proportionately more females drives the disability pricing up. This is simply a reflection of mortality and morbidity tables (likelihood of death or disability, respectively).

For the health and dental, an “older” group also will impact claims. Older groups are more likely to claim for prescription drugs, and often the more costly and ongoing drugs associated with chronic conditions. When it comes to Dental, older people are also more likely to be claiming for more expensive procedures such as crowns, bridges and dentures as opposed to just regular cleanings.  

Other Reasons for Increases to your Employee Benefit Plan Premiums

7.Your plan was set up with manual pricing.

Perhaps you are setting up group benefits for the first time meaning there is no claims history for your group of employees. The pricing that is implemented when a group is first established is based primarily on the demographics of the group, in combination with the selected plan design (known as book rates, or manual rates). As there is no information as to the medical or dental needs of the group, the pricing is really just an estimate based on data held by the insurance carrier. After the expiration of the initial rate guarantee period (15-24 months, or even longer for some benefits), the rates will be adjusted based on the factors described above for a typical non-refund insured plan. What may happen is that claims are far higher than estimated, meaning a rate increase is required. Alternatively, you could see your rates drop.

8.Your plan was set up with discounted pricing when you moved carriers.

Perhaps you decided to switch insurance carriers due to the reduced pricing presented to you. If it was not carefully analyzed and explained, you may be surprised to see a large increase at the first renewal with the new carrier. One reason for this is to recoup the sales discounts that were applied to entice you to make a move.  As we have written about, sometimes a discount is warranted (i.e. in assessing the claims ratios, the rates were too high) and sometimes they are illogical (the premiums proposed are far less than the historical claims). It is when the proposed rates seem far too low, where one needs to be cautious.

These discounts can be significant; insurers can offer 15%, 20% even beyond 30% discounts to obtain business, along with lengthy rate guarantees. As moving a group can be onerous, they anticipate they will likely retain the business for at least a few years, so will have the opportunity to increase the rates and recoup any sales discounts.

 

The answer? There are a lot of reasons for pricing to go up, but also reasons it can reduce.

 

As you can see, there are a variety of reasons why benefit plan pricing changes, whether it relates to your people, your pricing model, the broker and/or insurer you’ve engaged, or quite simply factors going on in the world. Working with an experienced and qualified employee benefits consultant is essential in ensuring your program remains sustainable for your organization.  

*Inflation: This is often expressed with a time lag factored in, so the number you see is higher than the annual expected inflation. For example, if the inflationary trend is displayed as 14%, this is divided by 12 and spread over the full year plus the additional months to the point the rates will change. Therefore, 14% over 16 months is actually 14/16×12= 10.5% inflation.

FAQ’s

Not always. For fully-insured non-refund plans, rates can increase or decrease depending on the claims experience of the group or shifts in the demographics.

The credibility of a group refers to the portion of the groups own experience that is included in the renewal rate calculation.  

This refers to the ‘break-even’ mark for the program, or the projected point of profit vs loss for the experience-rated benefits, for the insurance carrier.

The ratio of paid claims, trended and with reserve adjustments factored into the premiums, expressed as a percentage.

The ratio of the paid claims to the premiums, expressed as a percentage. 

These are the ‘book rates’, or the rates used by an insurance company based on the demographic composition of the insured group, in combination with the plan design.

Read More:

Sunlife: Increase to Dental Fee Guide: https://www.sunlife.ca/workplace/en/group-benefits/focus-updates/over-50-employees/provincial-dental-fee-increases-for-2022/

Reuters: Inflation Canada may need a recession to cool down inflation | Reuters

HR Reporter: New salary survey: ‘Significant’ increases predicted for 2023 | Canadian HR Reporter

Target Loss Ratio: https://immixgroup.ca/blog/index.php/2021/04/20/renewing-employee-benefits-in-2021-here-are-things-to-know-going-forward-to-keep-costs-down/

What you need to know about discounted group benefits pricing: https://immixgroup.ca/blog/index.php/2020/12/04/employee-benefits-what-you-need-to-know-about-discounted-group-benefits-pricing/

Setting up Benefits for the First Time?: Top 8 FAQs for Business Owners when Implementing an Employee Benefits Plan – Latest News from Immix Group

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

One size fits all? Not when it comes to employee benefits.

Posted on by Immix Group

Yes, it’s possible to gain the pricing advantage found within a benefits pool while also having control over your plan design!

When we begin discussing the strategy that Immix has created when it comes to group benefit plans one of the first questions we are asked is whether belonging to a benefits pool means having to implement a specific benefits plan design for your company. The short answer? Absolutely not! We know that one size does not fit all. The needs and wants of an organization when it comes to benefits vary dramatically, and our role includes not only ensuring you’re able to implement exactly what you want, it’s helping you to design the right program.

 

 

Standard plan designs don’t make sense- because every business is different.

Businesses view their benefit plans differently, and the structure and offerings of the programs reflect this. There is no real ‘right or wrong’ but there is effective and ineffective at reaching your desired outcomes.

Ensuring your benefits plan fits into your overall compensation model, matches your business’ philosophy and values, and does what it’s intended to do is not simple! This is where experienced advisors play a huge role. We know the market, we know how to design cost effective strategies, and we can help you achieve your goals.

 

 

But you know your people best

You probably have a good gut instinct as to the needs of the people that comprise your organization, especially if you’re a smaller team. You likely have demographic data on the age and sex breakdown of your group as well. But the key word here is ‘people’! It’s easy to get caught up in making assumptions based on the demographic profile of an organization.

And yes, there are many generations in the workplace today and there are certain characteristics we tend to assign to different generations. Generations in the workplace is one thing, but people are still people. Just because you’re 25, doesn’t mean you don’t have a chronic illness.  And just because you’re 65, doesn’t mean you don’t want a wellness spending account to cover your gym memberships and supplements.

While we tend to focus on age groups when we’re discussing benefits, we want to acknowledge that as individuals, we have vastly different needs, regardless of where we fall in the generational tagging system. There are also geographic and industry differences that affect what the benefits plan offering should look like. Understanding exactly who your people are is the key to designing just the right program.

 

A little data goes a long way

Knowing your people is one thing, but translating this into the correct scope for your benefits offering is something else. This is where the team at Immix Group comes in; you might need our help to survey your staff, to analyze your historical claims experience, or to walk you through programs and services that may be new to you. If you’re like a lot of employers, you might be seeking to add flexibility and choice to your benefits offering. The good news is that this is now easy to achieve!

beyond traditional health benefits

Because the right program makes a difference

The phrase ‘recruit and retain’ gets tossed around a lot when it comes to discussing the purpose of a great benefits plan. To break it down, you want the right benefits to help keep your best people. Salary compensation is important too, but what your organization brings to the table that adds to the total compensation package could be enough of a difference-maker to keep your best staff over the long term. The same applies when you’re recruiting; recruiting is challenging, and more and more people are asking up front about benefits offerings.  

Benefits beyond a traditional health and dental plan

A shift we have seen is towards asking about non-traditional benefits (so beyond the typical health insurance/ dental plan). Potential hires are asking about things such as health spending accounts, wellness/lifestyle spending accounts, group savings plans or a virtual care/mental health support program (or all of this!). People want the details on paid parental leave and paid time off, which goes hand in hand with the focus on work-life balance, and organizational flexibility as a whole.
employee benefits life balance

We designed our pools with flexibility and customization in mind

 One of the key benefits of how we have structured our broker-managed pools is that they actually have the reverse effect of a typical pool; we are able to provide MORE flexibility, including a choice from multiple major carriers.

Because we are working with our insurance carrier partners in a unique way, we are not always subject to the typical constraints imposed by underwriters for small groups (limits on life insurance, limits on dental coverage for new groups, limits on paramedical amounts). Our partners consider you part of our overall block of business, rather than treating you as a stand-alone company. While you’ll always be able to see your own claims experience and dollars in and out of the plan, being viewed as part of the Immix ‘block’ behind the scenes provides you with more than just pricing advantages.

 

Benefit plans must be cost effective

Even a fully customized, flexible benefits plan can be cost effective. The pricing model we’ve created at Immix is ideal for achieving the balance between customization and the low admin fees associated with inclusion in a pricing pool. Because we are negotiating the overall admin costs with the insurance provider on behalf of a large number of businesses, we’re able to pass the savings along to you, and spend the time needed to get the plan right- rather than haggling over pricing with the insurer on a group-by-group basis.

 

Not all pools are created alike

We understand that when you hear the term ‘pool’ you may jump to the conclusion that your business will be forced to implement a standard plan design or choose from a few plan options. Or, that you won’t be able to see any of the claims experience for your group. While other benefit pool offerings do take this approach, this is simply not the case with the Immix Pools.

Customization does not need to be expensive or complicated. Offering benefits that meet the needs of your employees regardless of age, sex, health or other identifying criteria can be done, and on your budget.

That’s why our model is so effective; low administrative costs, total customization and transparency, and experienced advisors who can work with you in a dedicated way to get it right.

Please reach out to us to discuss how we can help with your program; we love to hear from you.

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Check to Ensure your Benefits Quote is Actually for a Comparable Plan

Posted on by Immix Group

5 Key Areas to Check to Ensure your Benefits Quote is Actually for a Comparable Plan

Inflation is on everyone’s mind; wherever you look, prices are rising. Unfortunately, benefit plans are not exempt from this. When the cost of dentist visits, medical items and procedures goes up, the result is often higher claims. This can sometimes end up passed along to employers as a renewal rate increase. 

Many of you may be considering getting a quote on your benefits plan or may have already received quotes from alternative providers.  Before you make a decision on moving your program, there are a few key points to check to ensure your quote is not too good to be true.

Is it truly apples-to apples?

Consider this scenario: you’ve been presented with a quote for a benefits plan. You had asked for the quote to be apples-to-apples to your current plan. The good news is the price is significantly cheaper than what you’re paying, and supposedly, the plan designs are equal. But are they?

In our line of work, it’s not uncommon to come across what is positioned as a comparable plan, only to find there are many details that have resulted in the lower price. They can be glossed over in a plan summary, and when the time is not taken to examine every nuance to the coverage, it can leave owners- and their employees- disappointed. There is nothing worse than rolling out a new program only to hear from an employee that their prescription -which was always covered under the old plan- is now excluded.

As we have written about in the past, it’s very common to get discounted pricing from an insurer. In short, the carriers usually need to extend some level of reduced pricing in order to gain your business.

And certainly, there are opportunities for true savings on administration costs.  But discounts aside, and beyond the summary of the coverage, we have compiled a list of specific plan elements to check and compare. 

 

Top 5 things to Review if a Benefits Quote seems Too Good to be True

 

  1. Review the details of the Prescription Drug Plan:

What are the details of the drug plan? Is there a managed drug formulary, excluded drug categories or drug caps? Does the plan mandate generic substitution or not?

A drug formulary is simply a list of the drugs that are covered on the plan. Oftentimes, a drug formulary is designed to exclude certain medication categories (fertility drugs or oral contraceptives are typical examples), in order to cut costs. In some instances, a drug plan may even exclude specialty drugs, the expensive but often lifesaving/ lifestyle saving drugs. While it’s often positioned as a benefit to employers, this could leave your employees with major uncovered drug expenses.

It is important to understand the implications of the drug plan. Generally speaking, a drug plan is a key part of the extended healthcare and is intended be an insurance plan. A plan that covers antibiotics (roughly $10-15) but excludes drugs for MS or Chrohn’s disease ($10K+ per year) is not providing coverage against a financially significant, often unexpected expense. While it’s true that a more open drug plan could mean higher drug claims than under a more restricted, managed formulary, the program’s stop-loss max will typically work to limit the plans exposure to high-cost drugs.

How the program adjudicates brand name versus generic drugs should also be clearly known; it’s standard these days to have generic substitution on a program, but this can work differently depending on the carrier or how the plan is set up (for example, will the plan allow the doctor to indicate ‘no substitution’ and therefore cover the brand name version of a drug?). Differences in this area have cost implications.

Lastly, is the annual limit for prescription drugs ‘unlimited’ or is there a dollar limit? You may be okay with implementing a capped drug plan, but again, you need to understand the details and implications. A qualified and experienced benefits advisor will be knowledgeable on all the above points, and most importantly, should be open and transparent about what you are getting.

Reviewing the health benefits plan
  1. Check the Dollar Maximums and Limits for Key Items:

You may have checked in the plan summary that the coinsurance is the same; 80% on certain lines of coverage, 100% on others. But what are the per item or category maximums?

 

The following are the most common items where benefit maximums may be listed, in the fine print:

      • per visit limit for paramedical services, such as $10 or $25 per visit reimbursement, rather than up to the practitioners reasonable and customary limits (i.e. $100 for massage visit)
      • annual per person dental limits in dollars; is this per level of coverage, or combined?
      • dental procedure limits such as scaling units
      • dental recall limits; is it the standard 6 months or has it been pushed to 9 months or even 12?   
      • eye exam limits; is it set to “reasonable & customary” meaning it will adjust with inflation, or is it a set amount? Is the amount reasonable given the cost in your area?
      • Orthotics, surgical stockings and other medical items
      • and as mentioned, is there an annual drug maximum, vs an ‘unlimited’ drug plan

 

While item reimbursement limits are standard practice, they do vary by carrier and many can be customized in a quote. It is important to understand how this may compare to your current plan, and whether the limits are reasonable, given the overall cost of the item, and the intent of your program.

 

 

  1. Check the Contract Wording and Coverage Details of the Disability Insurance

 

We say it all the time: long term disability coverage is the most important but often the most overlooked part of a benefits plan. This is an area to pay close attention to; in the event of a claim, how the claim is handled depends on the contract that is in place which could greatly impact the plan member, potentially for decades. Things to watch for:

      • What is the definition of disability, in words? How does this compare to your current plan?
      • Are commissions, bonuses and overtime pay or T5 earnings properly addressed? If the contract covers salary only, and this is a small percentage of total compensation for certain people, that could leave them grossly underinsured.
      • Cost of Living Adjustment; is there a COLA clause, or an inflationary adjustment included for the benefits payments? Is this important to you?
      • Is the program set up as taxable or non-taxable (is the employer or the employee paying the premiums?)
      • Is the duration of disability benefits to age 65? While this is the norm, we are seeing a trend towards a 5 or even 2 year benefit duration, to reduce costs. If someone goes on disability, they could be disabled for the duration of their life; an insurance plan that only pays them for a few years may not meet your requirements as an employer.

 

There is no bigger waste of money and potential liability than a disability plan that fails to cover people adequately and accurately; reviewing this area with an expert is crucial.

Reviewing details of a health benefits quote
  1. Check the Termination Ages: How long can people remain on various parts of the plan?

Different benefit lines typically have age-based termination or reduction schedules. For example, many life insurance benefits reduce the coverage by 50% at age 65, and then terminate completely at age 70 or 75. For health and dental, coverage is often in place right to age 75 or even ‘retirement’, meaning there is no actual termination age so long as someone is still actively at work.

We have noticed a trend towards lowering termination age and have seen coverage ending at 65 or even 60! For many employers, this is a big deal and it’s often not highlighted in a summary of benefits as a deviation. It is a good idea to additionally check the travel coverage and ensure this part of the extended health care is retained in alignment with the EHC, if possible.      

  1. Review the Mechanics of the Pricing:

Many people fail to review how the quoted premiums compare to the historical claims, or to do a basic ‘reality check’ on a too-good-to-be-true quote. On a typical experience-rated program, the premiums must be adequate to pay the claims, with the other pricing factors such as inflation, IBNR and target loss ratio taken into account.

Some questions to ask are: What is the actual discount that the carrier is investing? What is the duration of the rate guarantee?  What will be the process (financially speaking) when the plan is renewed? What is the Target Loss Ratio? If the plan is to be part of a pool, how does it work? Many times, you can find this out and often the carrier will be transparent as to how they plan to recoup any losses. A qualified benefits advisor should be able to explain this in detail and understand exactly what the renewal process will look like with a specific provider.  

 

Some plan design differences may be acceptable to you

There are always going to be nuances to carriers that are unique to them, and where they simply won’t directly align with your existing plan. Sometimes this means a slight improvement, and sometimes this could be perceived as a takeaway. At the end of the day, what’s important is that you understand the small deviations and that you are not buying something under misleading or mistaken circumstances.

An experience and qualified benefits advisor will do a detailed analysis

With the help of an experienced benefits advisor who knows the terminology and nuances to a quote and contract, the details can be understood. You may review any differences and be totally fine with the program not providing the same level of coverage. The key is to be aware, understand any implications, make an informed decision, and communicate any changes to your staff.

At the Immix Group, our benefits experts can help you obtain a quote, understand the quote and what it means for the future, and manage not only the onboarding of your new program, but the ongoing plan management. 

As always, feel free to reach out to us. We love to hear from you!  

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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Business Owners: How to pivot your employee benefits to adapt to the changing landscape of employee needs

Posted on by Immix Group

By Howard Cheung, Account Executive, Immix Group: An Employee Benefits Company

 

The year 2020 has certainly been a year of change. All aspects of life have adapted to a new normal, and this includes businesses and what it means to provide valuable benefits to employees. As business owners and managers of employee benefits, what can you do to continue providing high-value benefits to your employees, while maintaining your budget?

 

Traditional insured plans are simple, and the chosen structure for most SMEs

The majority of SMEs (5-99 employees) in Canada historically have traditional insured employee benefits programs. It’s quite simple; you pay premiums to an insurance company, and in turn, they cover employees for a set schedule of benefits. Premiums are adjusted annually, partly based on the spending patterns of the employees, relative to the premiums you have paid.

 

Studies show employers and employees both want flexibility

However, based on the latest 2020 Sanofi survey results, what many employees are missing in having only this type of benefit is flexibility and choice, something that caters to them as individuals. The overwhelming response from both employers/ plan sponsors and employees is the desire for some level of “Flex Plan.”

health spending accounts
health sponsors with a flex plan

 

The perfect addition to your insured program

Health care spending accounts or health spending accounts (aka HSAs) are the perfect solution to the desire for flexibility in a benefits offering.

 

A Health Spending Account works as follows:

 

Health Spending Accounts can cover both non-taxable and taxable items

HSAs are used to reimburse plan members for a very broad set of health and dental related purchases (eligible expenses are matched to the CRA list of eligible expenses, in a tax-free HSA). This list is far more expansive than what is typically covered under a regular insured benefits plan. Given a set dollar amount for the year, members choose when and how to use their allocation, depending on their own personal needs.

For programs that also allow for non-CRA eligible expenses (typically considered ‘Wellness’ expenses), items such as vitamins, gym memberships, fitness equipment, alternative practitioners and even childcare can be claimed. These items create a taxable benefit for the employee.

From the employer’s perspective, the key difference from traditional insured benefits is full control as to how much you want to spend. HSAs offers stability and flexibility, with no surprises. Probably the most under-utilized CRA- approved benefits offering, HSAs are cost effective and simple.

 

However, health spending accounts are not intended to replace insured benefits

Are HSAs the ultimate solution for benefits? No. HSAs provides flexibility and choice for a certain segment of expenses. Ultimately, there is very little or no insurance component which means members are not protected from long-term, significant health costs.

When it comes to long term protection such as for expenses associated with severe illnesses or catastrophic events, your health and dental benefits need an insurance component, where high expenses can be covered, without a dollar limit. This is where the traditional benefits serve as your foundational base. For example, a costly dental accident, a travel mishap or the diagnosis of a serious illness requiring lifelong medication; these all require traditional ‘insurance.’

As well, other coverages such as long term disability, life insurance or programs such as group savings plans, employee assistance plans or wellness and workplace culture programs are all valuable parts of a comprehensive benefits package, typically under an insured structure.

 

The role of a Health Spending Account

Health Spending Accounts are the perfect complement to your insured program and can often be carefully designed to replace certain items within an insured plan. HSAs are certainly a solution that is often overlooked, but that can provide a highly valued benefit that sets your company one level above the competition. Best of all? You control the cost.

ImmixGroup provides innovative customized benefits solutions. Feel free to reach out to me howard@immixgroup.ca if you would like to see how we can set your benefits apart from the competition!

 

https://www.hmabenefits.ca/blog/health-spending-account-versus-group-benefits-plan

https://www.benefitscanada.com/news/sounding-board-ground-is-shifting-benefits-plans-must-focus-on-individuals-147983

https://www.sanofi.ca/-/media/Project/One-Sanofi-Web/Websites/North-America/Sanofi-CA/Home/en/Products-and-Resources/sanofi-canada-health-survey/sanofi-canada-healthcare-survey-2020-EN.pdf?la=en&hash=F1C763AA6B2F32C0BF2E623851FD05FD

Howard 2

Howard Cheung | BBA | Employee Benefits Consultant

New Year, New Benefits?

Posted on by Immix Group

A fresh year — and a refresh opportunity

By Lindsay Byrka, Vice President, Immix Group: An Employee Benefits Company

 

At the start of a new year, we all make resolutions. With 2020 also being the start of a new decade, perhaps we’re even more motivated to make improvements!

When it comes to benefits, consider: Is this the year for minor benefits housekeeping or is your company due for a benefits overhaul?

Granted, every year should be the year for benefits housekeeping! That said, here is an outline of a few areas to review on an annual basis, and how to determine if your program requires more significant changes.

Hopefully, this will help you to decide just how much to address in 2020.

 

Keep things current

Before the year gets going full-steam, check that all your documents — hard copy and/or digital — are current. Ensure all forms, applications, benefits booklets and other items on file are the up-to-date versions. Toss any old ones.

 

Personal details

Next, check that all employee data is up to date. Have your employees confirm personal details, including: their address on file, dependents, a change in single vs. family status, and their named beneficiary. Employees don’t always remember to keep you in the loop!  

 

Access those tools

If your employees aren’t already using online and mobile applications to manage their benefits, the New Year is a logical time to send out instructions and encourage them to sign up. Some may be slightly less-than-savvy with technology; that’s understandable. But once they see the advantage of these fast, efficient tools, they’ll gladly adapt.

 

Pay attention to benefits lines where reductions/ terminations may apply

Check for any plan members who may be reaching the age where certain benefit lines may reduce or terminate. You will want to prepare to advise them of this, and ensure your billing accurately reflects the change when the time comes. For example, is anyone turning 65? Despite your best communication efforts, they may have missed that their long term disability coverage will likely be coming to an end.

 

Changes to Laws or rules

Have any laws or rules changed that may impact your program? Are you compliant with any applicable collective bargaining agreements? If you’re even remotely concerned about this, drop everything and address it immediately. An experienced benefits consultant can assist you in understanding the fine print.

 

Plan for your benefits renewal  

Lastly, when is the plan’s renewal date? Based on this date, you’ll need to find out and prepare for:

  •  When  the renewal meeting will be held
  •  What you would like to discuss this year
  •  When you will receive an update on the claims experience
  •  Whether you need to pass new rates along to your payroll company; and,
  •  What other dates are important in the year ahead from a benefits perspective?

Basic administrative housekeeping for a benefits program is essential on a routine basis. But when is it time to take a deeper look at your plan, i.e., take a strategic-perspective view? If any of the following statements ring true, that time might just be now:

 

Think big-picture

You aren’t sure if your benefits plan takes into account your company philosophy with regard to health and wellness. Or, you have not yet developed a company philosophy!

When it comes to the benefits plan, what is your goal as a company? Have you defined a goal? Or are you somewhere between ‘bare minimum’ and ‘comprehensive and effective health and wellness offering that truly impacts your employees’ well-being’ but uncertain if you’re on track? If you haven’t taken the time to really think about this, it’s a worthwhile endeavor.

Your company may not yet have developed a philosophy and goal. But when it does, your benefits plan, like every other aspect of your organization, should be aligned.

 

Is your team happy with the program?

You haven’t recently surveyed your staff to assess whether the program is meeting their needs. You’re not really sure whether people are happy with the program, or what they may want to see changed. Or worse, you know they’re not happy!

If you haven’t checked on this lately (or ever!), it’s understandable. Other priorities come up, and another year goes by, with the same plan in place. But a new year is a good time to reassess. Consider surveying staff about whether the benefits program is still meeting their needs. They’ll appreciate the chance to let you know things they’d like changed. Again, this is worthwhile. As you know, a happy team is a team that stays. You want to be the company good people come to, not the one good people leave.

 

Get ahead of the game

At some point in your organization’s history, someone decided an employee benefits plan should be put in place, and hopefully, they were thoughtful in considering the scope of the program. There was a defined goal, and everyone was happy with the plan that was implemented. The question is, how long ago was this done? Has your organization changed, while the plan stayed the same?

When it comes to your plan design, coverage, carrier or plan structure, you may be surprised to learn your program is totally outdated in certain areas and that change is required to bring you up to speed. This might be as simple as expanding the list of covered paramedical practitioners, or more significant, such as switching carriers to take advantage of innovations that were not available when the plan was first implemented.

It is important to assess whether you are taking advantage of what the market has to offer, and weigh whether the current plan still makes sense. This is especially advisable if your plan hasn’t been thoroughly reviewed for a while by a benefits specialist.

 

A benefits expert — for the help you need

All this may sound overwhelming, even daunting. If you don’t even know where to begin, a benefits consultant can help. Benefits consultants can help take care of every aspect we’ve mentioned above — and more. We want to ensure as part of our process, we’re answering key questions, such as:

 

The challenges

Does the program take into account the challenges of your business, such as high employee turnover or low employee engagement? What’s next for your business and industry? We raise this point because it is important to consider the plan in terms of business growth and structure. It may be time to implement/abolish different classes of benefits, change waiting periods or eligibility criteria, or expand the group saving plan.

 

Who are you?

What are the areas that particularly affect or matter to your employee demographic? Are there specific health concerns within your employee population? When it comes to wellness, what are you already doing and could you be doing more?

Ultimately, a benefits plan should be dynamic, and provided the proper management and attention essential to ensuring you make the most of every dollar that goes into it.
At the Immix Group, we always say we consider ourselves to be an extension of your HR department. That’s because we work with you in a meaningful, in-depth and results-oriented way. As benefits consultants, we’re here to help with everything from discussing your benefits philosophy to surveying your team; from analyzing your program to making recommendations and implementing changes.

Our job isn’t to simply process instructions from our clients; it’s to collaborate, bring our expertise to the table, and ultimately, to partner with you in ensuring you make the most of your benefits dollars.

For more information, please feel welcome to contact me: lindsay@immixgroup.ca

Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

Employee benefits for start-ups: the long-term vs. short-term outlook

Posted on by Immix Group

Once they grow above three employees, many small businesses start thinking about getting a benefits program. After all, benefits are a key attraction in hiring the best talent.

From a human resources perspective, small businesses scaling up should make sure the benefits package they settle on is competitive. Contrary to popular belief, it’s not enough to shop around for providers that offer the best rates. Let’s look at the factors to be aware of — and if they align with your business philosophy.

A lot depends on whether you’re in it for the long or short term. Pose this specific question to potential providers: “How do benefit premiums work and what are they going to cost in a five-year timeframe?” Be aware that insurance providers can offer seemingly discounted rates to lure you in initially — then, a year or two later, significantly bump up those rates. Now, if your initial budget is tight and you know that your rates will go up by double digits annually, then that’s fine. But this eventual bump in rates should be made transparent to you from the get-go.

 

Other options

Then there’s the opposite scenario: A provider advises you to sign on for higher-than-average rates for your group. The reasoning is that, with higher rates, the provider will have more room to play with should you run into a high-claims situation. So, do you want low rates with higher risk or higher rates with lower risk?

Or, you could opt for the right optimal rates. But what determines an optimal rate? To get a better idea, you have to understand how premiums are derived. Ultimately, premium rates are based on a combination of factors:

  •      claims paid vs. premiums paid (a.k.a. experience)
  •      trend factors
  •      pooled vs. non-pooled benefits
  •      profit margin/admin cost/commissions (a.k.a. target loss ratio).

We won’t go into exact technical explanations, but it’s important that you are aware of the above. In our consultations and renewal reviews, we delve deeper into each factor and explain how it is intertwined with your premiums. Interestingly, most people are aware of the first three factors; few know about the fourth one. Many clients have found it eye-opening to understand how brokers and insurance companies get paid. Understanding all this, we are often able to optimize costs in the long term.

In short, if you have a long-term outlook, don’t just focus on the surface rates of quotes and benefits. Rather, think about the underlying factors that will affect your company’s experience and rates in the long term. Consider doing an audit on your benefits with the above perspectives in mind.

ImmixGroup are group benefits specialists who provide transparent consultation and optimization of benefits for businesses.

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Howard Cheung | BBA | Employee Benefits Consultant

HR managers: Here are three useful tips to help you efficiently manage employee benefits

Posted on by Immix Group

Employee benefits are an integral part of both the employee-value proposition and the overall working experience. As an HR manager, you might well ask, “Just how deeply should I be involved in employee benefits?”

Let’s be frank. The discipline of employee benefits can be overwhelmingly complex. It takes in administrative processing, financial analysis, reconciliation and compliance. And, given that the cost of benefits is huge, you may even be responsible for negotiation and auditing.

To help you efficiently manage employee benefits, here are three tips:

Use and take advantage of online technology

Check with your broker to set up your group plan with:

  •  a plan administrator’s online platform
  •  members’ online platform
  •  a mobile app for members.

At a minimum, most insurers have an online administration platform to do a majority of traditional tasks: enrolment/termination/changes for members; viewing invoices; viewing coverage; etc. As for implementation of benefits, don’t sift through hundreds of paper applications. Instead, ask your broker if they can support electronic enrolment of members.

Encourage employees to use the members’ online platform to check coverage balance, replace lost cards and use best practices for travel/special claims. As well, more and more insurers have mobile app support. This allows easy, at-their-fingertips access to all of their benefit details. The more self-servicing resources provided to members, the less manual work falls to the HR department.

 

Implement an employee assistance program (EAP)

A key role of HR is to support employees in cases of workplace crises stemming from a variety of factors: mental illness, personal issues, financial stress, substance abuse, etc. All these can lead to performance issues and absenteeism. As well, they put a lot of stress and burden on the HR department.

Fortunately, a strong EAP is a powerful partner for HR and can help address all of the above with minimal disruption to business.An EAP is designed to assist employees in resolving the above issues via: counsellors over the phone or online; referral services; and wellness resources. Many EAPs also offer coaching and assistance to managers and HR in dealing with employee issues, such as workplace conflicts.

The key benefit of such a program is that it is anonymous and confidential, with expert resources for employees. Often political and privacy factors are at play that prevent employees from seeking help through their employer. As issues continue to linger, performance and ultimately the efficiency of the business will be adversely affected. All businesses, small or large, should consider taking advantage of a strong EAP as a cost-effective solution in alleviating workplace crises.

 

Work with a dedicated benefits broker

Benefits can involve many layers of management. It is a good idea to work with an employee benefits brokerage that has a dedicated team for servicing and consultation. This means not using the insurance company or an independent financial advisor without an in-house team. By contrast, a dedicated benefits service team can help coordinate and negotiate claims that could otherwise be declined by the insurer.

A specialized benefits broker can provide better insights; they have a wider range of tools and better pooling arrangements with insurers. These advantages lead to optimizing the cost of your employee benefits program. This is especially important at renewal time, when a benefits broker can make sense out of your multi-page renewal report and guide you through the nuances of benefits analysis.

At Immix Group, we believe implementing the above three tips will significantly optimize the administration of benefits in HR. As employee benefits specialists, we work closely with HR so that we are the ones doing the brunt of the heavy lifting in:

  •  market surveying
  •  benchmarking
  •  financial analysis
  •  negotiation with insurers
  •  securing pooling arrangements
  •  auditing.

When benefits are efficiently managed, both you as the HR manager and your workforce are better able to focus on running your business.

Further reading

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Howard Cheung | BBA | Employee Benefits Consultant

Employee benefits renewal is simpler than you think – here’s the key

Posted on by Immix Group

You may be an accountant, or work in human resources. Or perhaps you are a cost controller, chief financial officer or small-business owner. In any of these roles, you face the same daunting challenge every year: At employee-benefits-renewal time, how best to deal with rate adjustments while keeping costs under control?

Renewal reports can be mind-bogglingly complicated. They don’t have to be. Yes, you have a great deal of data to consider in understanding your group’s claim usage. But there’s a key factor that defines your renewal adjustment.

This factor has to do with:
1.) target loss ratio, or TLR, and
2.) two formulas that will help you understand where your renewal should stand.

TLR, sometimes also called a break-even ratio, is a percentage that indicates the expense level of the insurance carrier. This expense level directly affects how much your group can claim before the insurance carrier loses money.

For example, let’s assume your TLR is 80%. First we need to calculate the loss ratio, which is claims paid/premiums paid. In this case, let’s assume claims paid were $90 and premiums paid were $100:

  • loss ratio = total claims paid/total premium paid
  • estimated adjustment = loss ratio/target loss ratio.

This would yield a 90% loss ratio. Then, to find the estimated adjustment, you would divide the loss ratio of 90%/the TLR of 80%, which would yield +12.5%.

There is a lot more that goes into calculating a renewal, especially when it comes to larger groups. For illustration purposes, we didn’t take into account a few other factors, such as trend (inflation) and reserves (claims lag). But the above, in a nutshell, is essentially how renewals are calculated. It’s a quick and easy way for a plan administrator to do the math to see where their group should stand.

 

How is the TLR determined?

You might ask: How is the TLR determined? Usually, it’s determined at the time of inception and illustrated on the initial quote. Included in the TLR calculation are the insurance company’s costs in handling servicing and claims adjudication, as well as any commission paid to the broker. As the group size grows, typically the TLR will increase and the administration cost will be lower relative to the amount of premium the insurance carrier is receiving.

So, the lower the TLR, the greater the portion of your premium going into expenses and administration and commissions.

You want to ensure that your TLR is updated accordingly and is negotiated to be as high as possible. And you can do this by working with specialized employee benefits brokers that have preferred pooling arrangements.

If you would like to have an in-depth discussion about understanding your renewals, please feel welcome to contact me with any questions.

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Howard Cheung | BBA | Employee Benefits Consultant

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