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Tag: employee benefits

What You Need to Know When Considering a Switch in Employee Benefits Providers

Posted on by Immix Group

When selecting a benefits provider, ensuring the right match for your organization is essential. When it comes to the benefits offering, as we’ve spoken about before, ‘one size fits all’ is not an ideal approach to take. Different insurance carriers have various strengths and weaknesses. But what is the right match? What are the important factors to consider? How do you assess when it’s time to shop around?   

It’s common to hear benefits advisors state that they ‘test the market every 3-5 years’ or within some other similar date range. At the Immix Group, we have a bit of a different take on this, as it’s our belief that switching carriers should be based on ongoing dissatisfaction in a key area:

  • Service
  • Systems
  • Coverage
  • Pricing

The desire to shop the plan with competing carriers can be driven by any of the above factors. Before we delve into each of these areas, we want to be clear: we certainly don’t think a benefits program should go without a frequent in-depth review. In fact, we conduct a thorough annual renewal review meeting as well as a mid-year update for all groups. Depending on your needs, this may include benchmarking, suggestions for plan design changes, analysis of program usage or other updates. In short, we are deeply involved on a routine basis in ensuring the smooth management of your program, the appropriateness of the coverage, the evolution of the benefits and adaptation to the changes your organization experiences.

As we say at the Immix Group, we want you to love your benefits plan! But what does that look like? To us, it means ongoing satisfaction in the areas we have named above. Sure, things go wrong sometimes. People make mistakes, systems and processes fail, or miscommunications can occur. While at the Immix Group we aim to prevent problems, a big part of our job is swiftly resolving issues that may arise. Sometimes, however, it’s time to make a move.

 

Exceptional Service, from both your advisory team and the carrier.

There is nothing more annoying than waiting on hold, other than waiting on hold and then not getting the answer you need! Unfortunately, one of the main complaints we hear is that insurance carriers fall short when it comes to the call centre support for employees and administrators. That said, some are better than others in this area.

We want those in our Client Community to come to us with questions rather than going directly to the carrier. Sometimes, this requires us to work behind the scenes with the carrier to obtain answers and resolve problems. There are also limitations due to privacy rules, but we do our very best to provide direct support at each level. Our partnered carriers are those with whom we have great confidence in their ability to deliver accurate and prompt assistance.

If you are feeling unsupported or employees are complaining, it’s important to examine where the service issues lie. Is it your broker or your provider? Where are the hiccups, and where does responsibility lie?

We often see instances of a switch in provider or advisor that is intended to solve an ongoing servicing issue but, unfortunately, the problem remains unresolved as there is a misunderstanding as to the true source of the issue. The most common service issues relate to claims not being adjudicated correctly or in a timely manner, unacceptable delays in obtaining information, or incorrect information being provided. If employees are complaining, it can be worthwhile to get an objective opinion from another advisor in order to assess where things are going wrong, before making a switch.

 

Systems and technology – these vary significantly between carriers.

To us, it is unacceptable in today’s world to not have information at your fingertips (i.e. on your phone)! The member application and online site, as well as the administrative portal, should be easy to navigate and provide the capability to complete most transactions online.

Additionally, insurance carriers today must be able to facilitate direct billing for most claims, which means providing software that makes it simple for pharmacies, dental offices, and other practitioner offices to engage with the program.

It is well established that the greatest indication of satisfaction with a benefits program comes down to the ease with which the member can interact with the plan. This means clear information as to what is covered, combined with simple and efficient claims adjudication. Ideally, the processing of the claim is directly at point of service, whether at the pharmacy, the dentist, or the chiropractor. The days of routinely mailing paper claims and waiting for a cheque should be far behind us.

Complaints related to systems tend to be connected to the inability to direct bill at a particular point of service or for certain types of items, difficult or manual processes for making employee changes, or overly complex billing statements.

Program coverage – not all carriers are identical in what they can provide.

Just as systems and service differ, carriers differ in the program coverage they will offer to a particular group. Sometimes a switch in carrier may be driven by the desire to access program features that are unavailable through your current provider.

When a program is being marketed and an ‘apples-to-apples’ quote is requested, there will always be deviations between carriers. For certain items, a carrier may be agreeable to matching what would normally fall outside their standard provisions (i.e. dental scaling units, specific non-evidence limits, or a unique paramedical practitioner reimbursement schedule); other items they may not match.

Any quote for coverage should also be examined carefully. Carriers do not “contract match” so there will always be minor deviations, even for what appears to be a comparable program. Carrier requirements and plan offerings differ in many areas, such as:

  • Minimum number of employees
  • Minimum number of employees to form a class of coverage
  • Ability to structure the invoice (billing divisions, subtotalling etc.).
  • Industry type they will insure
  • Funding structures available to different types of groups
  • Non-evidence limits and maximum benefit limits available
  • Paramedical reasonable and customary limits
  • Drug programs (available formularies vs open formularies)
  • Long term disability provisions; cost of living adjustment, own occupation definition, definition of disability, non-evidence and maximums
  • Health and wellness spending account availability and cost structure
  • Network in specific areas; for example, some providers are more well known in certain regions compared to others

As well, providers vary considerably when it comes to embedded and optional services and programs. The list is long, but Employee and Family Assistance programs, virtual care, medical Second Opinion and drug management programs are commonly compared. It is important to consider who the third-party provider is for these programs and if the service is embedded or an additional cost.

If you are considering moving carriers because you believe your current provider is unable to provide adequate coverage in a certain area, we urge you to ensure this is accurate. Plan designs are highly customizable with most carriers.

That said, there are times when a particular group and provider are not a good match because of limitations in coverage offerings. For example, we have recommended a switch in carrier to access higher quality disability coverage, or because an employer was expanding from one province into multiple provinces. As always, working with a qualified advisor who understands the nuances of various providers will help guide you in whether a switch is the right move.

 

Benefit Plan Pricing- should you switch carriers to get lower rates?  

High inflation has hit us all, and it is very possible you experienced an increased premium the last time your benefits program renewed.

You can almost always get a premium discount with a switch in carrier; however, a discount connected to a switch in carrier may be temporary. Unless you are reducing the administrative costs on the plan, which can be achieved in a variety of ways (membership in a pricing pool, reduced advisor commission, or elevated Target Loss Ratios, which may come from the previous two), you may just have a carrier ‘buying your business’ with an enticing price discount.

That said, benefits program pricing is complex and you really need to get into the details of how a new provider will price your program. Often the ability of your broker to negotiate or otherwise control the pricing (for example, through our broker-managed pools) is more important.

Comparing your claims to your premiums is a good indicator as to whether the discount is potentially sustainable, or whether it seems likely your premiums will increase at the expiration of the initial rate guarantee (assuming claims remain similar). For a typical insured non-refund plan, it cannot run at a loss year over year. This forecasting is tricky, and there is a good reason you should work with your benefits advisor to understand potential outcomes.

If you are otherwise happy with the provider, plan members are happy with the systems and the provider is able to support your desired program components, making a switch based solely on a short-term pricing discount may be shortsighted.

Moving carriers, while much easier today with advancements in technology and the ability to do mostly digital file transfers, is still disruptive to employees, including benefits admin staff and HR. Meetings, memos and training will need to occur to learn the new provider.

 

So, is it time to switch carriers, advisors, or both?

We are happy to market a program on your behalf, however, we need to truly understand why you wish to seek a different provider. We encourage you to think about the following:

  • Service; we want to be clear on where the problem lies. Is it solvable?
  • Systems; the ability to easily process claims is paramount, and comprehensive but simple systems are a must. Are there concerns in this area?
  • Coverage; if you’re unhappy with the plan offering, can you work with your current provider to amend coverage or are they unable to support your desired program?
  • Pricing; this is complex and it’s essential to be aware if a rate decrease appears temporary or sustainable.

Ultimately, our goal is to ensure that your program meets your needs at every level. Properly marketing a plan with appropriate alternative carriers and deep diving into the nuances of the coverage (especially for a more complex program), is a time-consuming endeavour for advisory groups, which we will gladly undertake.

 

Want a second opinion?

At the Immix Group, we offer a complimentary benefits program review which offers a detailed audit of your plan design, usage, rate history, and pricing. Our experts ensure your plan design is competitive and that your pricing is fair and reasonable in today’s evolving market.

Click the link to get a second look at your employee benefits package today!

Did you know? 

The vast majority of the Immix Group’s new clients come as referrals from our existing clients! This is great news to us; this means our clients are happy with our service, their benefits program, and most importantly, they want to share this with a friend!

Key Takeaways:

 

  • When to Consider a Change: Regular review of your benefits program is crucial, but switching carriers should be based on dissatisfaction in areas like service, systems, coverage, or pricing, rather than arbitrary timelines.
  • Importance of Service and Systems: Effective communication and accessible technology are critical to employee satisfaction. Benefits programs should offer easy claim processing and responsive support to enhance the member experience.
  • Understanding Pricing Dynamics: Navigating benefits pricing can be complex. It’s important to analyze your claims versus premiums to determine if a temporary discount from a new carrier is sustainable, rather than switching for short-term savings.
  • In-Depth Reviews Matter: Regular, thorough evaluation of your benefits program can help identify gaps and ensure it remains competitive and sustainable in the face of rising costs, particularly with inflation impacting premiums.

FAQ

The right time to switch is when you experience dissatisfaction with service, outdated systems, insufficient coverage, or unfavourable pricing, rather than adhering to a fixed timeline.

Evaluate response times, accuracy of information, and overall support from both your advisor and the insurance carrier. Your satisfaction with claim processing is a good indicator.

Modern benefits providers should offer user-friendly online platforms and mobile apps that facilitate easy claim submission, access to information, and direct billing options.

While switching carriers can provide initial discounts, it’s important to evaluate whether those savings are sustainable and if the new plan meets your organization’s needs.

Switching carriers involves training and communication for employees and benefits administrators, which can be disruptive. Proper planning is essential to ensure a smooth transition.

Read More:

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

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

Check to Ensure your Benefits Quote is Actually for a Comparable Plan – Latest News from Immix Group

Renewing Employee Benefits in 2021? – Here are things to know going forward to keep costs down. – Latest News from Immix Group

Employee benefits: What you need to know about discounted group benefits pricing – 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

EAPs – how these programs can benefit both employees and organizations

Virtual Health Care is Everywhere

Dig Deeper into Disability Insurance

Lindsay Byrka

Lindsay Byrka BA, BEd, CFP

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

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 BA, BEd, CFP

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 BA, BEd, CFP

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

Top Benefits Conversations of 2022

Posted on by Immix Group

It’s a wrap! As we begin the New Year with refreshed energy and excitement for what 2023 may bring, we wanted to share a recap of the key stories in benefits over 2022.

 

Extreme Difficulty in Hiring

The theme of our client meetings this year can be summed up in one simple sentence “Where did all the people go?” Businesses struggled to hire (and retain) qualified people. Employers told us they had candidates ‘ghosting’ interviews or simply not showing up to their first day, a trend that most had never previously experienced.

Time and again we were told by employers that they were desperately in need of staff, and that their existing team members were stretched too thin or in roles they were not hired or properly qualified to fill. The labour shortage is evident with a record-tight labour market, according Stats Canada: Labour shortage trends in Canada (statcan.gc.ca).

“Salary and benefits” continue to top the list of most important job factors for employees. Providing and more importantly communicating and highlighting a competitive benefits offering will make you stand out.

top benefits2

The Shift to Hybrid Work

There has been a massive shift in how we work over the past few years. Hybrid work, or working partly remote and partly in-office became the norm post-pandemic, with most employees reporting they prefer working from home.

This has had a big impact in terms of managing and hiring, measuring performance, and ensuring engagement. We wrote about hybrid work and posed the question: Is working from home an employee benefit in two parts. The basic takeaways are that remote work is here to stay, employees prefer a hybrid model, and a formalized WFH policy is a must. 

 

The Great Resignation, or rather, the Great Retirement

The much-discussed Great Resignation did not occur in Canada like it did in the US, but what Canada experienced is actually more concerning:  a record number of retirements.

A record 300K people retired in Canada in the 12 months up to July 2022 (up 30% from the same period the previous year). Early retirement, so those between age 55-65, made up almost half of the overall number of retirees. With our demographics here in Canada, it will only grow larger. With the most experienced people exiting the workforce, there is a real risk to businesses due to the lack of mentorship and transfer of knowledge for younger generations.

How does this tie into benefits? Offering those in the final stages of their career enhanced coverage and work flexibility are potential solutions to entice your most experienced people to stay a few additional years.

 

Continued Focus on Mental Health and Well-being

As we transitioned out of the pandemic, the focus on mental health remained at the forefront. Employers continued to ask for resources and coverage options to ensure their staff had access to the mental health support they required.  

Far beyond the EAP or the dollars available for counselling visits, employers sought various ideas to support mental health including: return to work plans, 4-day work weeks, assisting employees with financial concerns through financial literacy and group savings plans and other programs designed to provide the flexibility needed to better support individuals and families and remove barriers to care.

More than one third of all 2022 Long Term Disability claims are mental health related. Claims for mental health are up 75% from 2019, and experts anticipate this will rise in 2023.

 

High Inflation

A key conversation in 2022 was the inflation we saw across the board; this was especially noticed with the cost of groceries. After years of low interest rates, Canada experienced eight interest rate adjustments in 2022. For many people, this directly impacted their borrowing costs, affecting both personal and business expenses and decisions.

2022 saw increases to the Dental fee guides far higher than historical averages. Unfortunately, it appears that the Dental Fee Guide increases for 2023 will once again be much higher than usual, with 8.5% for Ontario and 9.8% for Quebec already reported. With costs for practitioners and other insured expenses also rising, we anticipate larger than typical increases to claims across plans.

 

Federal Dental Plan

The Federal Dental Plan was rolled out the end of 2022. Employers had many questions on this program, wondering the impact to their Employer-sponsored insured dental plans. Generally speaking, there is little or no impact on existing plans, due to the qualification parameters for the new Federal plan.

The program provides 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). The government states that this is the first stage in developing a more comprehensive federal dental plan; only time will tell!

 

Change to EI Sickness Benefits

Effective for December 18th, 2022, the Federal Government announced a change to EI Sickness benefits, extending the duration of pay from 15 weeks to 26 weeks. Employers had many questions about this and the impact on their insured Long Term Disability programs which typically begin at week 17, at the expiration of EI Sickness payments.

In short, Employers are not required to adjust their LTD plans. Generally speaking, it is not in the best interest of those who are insured under LTD plans to remain on EI Sickness rather than transitioning to LTD. 

top benefits3

Flexibility in Benefits

 
Finishing up the list, an underlying theme to benefits conversations in 2022 was the desire for flexibility and customization. As we know, one size does not fit all when it comes to benefit plans, which these days must include elements of flexibility to ensure everyone’s needs are met. We saw employers embracing customized work arrangements including hybrid work models and four-day work weeks.

From a product standpoint, the Immix Group set up more Health & Wellness Spending Accounts than ever before as Employers sought a simple way to provide spending flexibility to their team.

As always, we are happy to discuss your program with you!

Please reach out to us to discuss how we can help with your program; we love to hear from you.

 

Read more:

 

Labour Shortage Stats Can:

https://www.statcan.gc.ca/en/subjects-start/labour_/labour-shortage-trends-canada

 

Retirement:

https://www.theglobeandmail.com/business/commentary/article-the-great-resignation-has-arrived-in-canada/

https://thehub.ca/2022-09-20/trevor-tombe-canadas-not-so-great-resignation-its-retirements-we-should-really-be-worried-about/

https://www.benefitscanada.com/benefits/health-wellness/how-can-employers-turn-the-great-resignation-tide/

 

Hybrid Work:

https://www.benefitscanada.com/news/bencan/survey-finds-78-of-canadian-employees-prefer-working-from-home/

https://www.benefitscanada.com/news/bencan/61-of-canadian-employers-using-hybrid-work-model-survey/

https://immixgroup.ca/blog/index.php/2022/03/23/the-hybrid-work-model-is-working-from-home-an-employee-benefit-2022/

https://immixgroup.ca/blog/index.php/2022/04/19/part-2-the-hybrid-work-model-is-working-from-home-an-employee-benefit/

 

Inflation:

https://www150.statcan.gc.ca/n1/en/catalogue/62F0014M2022014

https://www.sunlife.ca/workplace/en/group-benefits/focus-updates/over-50-employees/provincial-dental-fee-increases-for-2022/

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

 

Mental Health:

More than a third of disability claims in 2022 due to mental-health reasons: survey | Benefits Canada.com

Mental health claims soar by 75 per cent | Canadian HR Reporter

https://www.benefitscanada.com/benefits/health-wellness/hybrid-work-four-day-workweek-shaping-employee-well-being-expert/

https://www.benefitscanada.com/benefits/health-wellness/2022-healthy-outcomes-conference-centering-employee-well-being-in-return-to-office-plans/

 

Flexibility in Benefits:

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

Lindsay Byrka

Lindsay Byrka BA, BEd, CFP

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 BA, BEd, CFP

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 BA, BEd, CFP

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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Part 2: The Hybrid Work Model: Is working from home an “employee benefit?

Posted on by Immix Group

In the first part of this two-part article on the hybrid work model, we discussed remote work from a productivity perspective. For the most part, the numerous studies that are coming out are stating that productivity is either unaffected or increased, and this is especially true for knowledge workers.
In addition, most employees prefer working from home, or at least having this option part of the time. We will now take a closer look from an HR perspective as to why maintaining or implementing a permanent hybrid work model may be the smartest choice for your organization. We will seek to answer:

 

What do employees want? Do they prefer a Hybrid Work Model?

Yes, the stats are clear. The majority of employees want the option to work remotely, at least part of the time, and they feel very strongly about this! Some survey results show:

  • 76% said support for flexible work post-pandemic is important to them
  • 62% want to work from home at least 40% of the time
  • 30% want to work remote at least 3 days per week.
  • 27% of Canadian office workers would prefer to be fully remote

In fact, just 12% said that working entirely from the physical workplace would be most ideal. While many employees missed the social connections and other benefits of being in the workplace, the benefits of hybrid work far outweigh the in-office advantages.
As quoted in the HR Reporter: 

It’s clear that the role that the physical office plays in the day-to-day work and satisfaction of employees has changed dramatically during the pandemic. We’re not going back to how things were before, and businesses need to adjust to the many operational realities that come with that,” says Nick Georgijev, country manager for Amazon Business Canada.


Why do employees prefer remote work? What does remote work offer?

Turns out that positive workplace culture is much more than ping pong tables and endless snacks, which don’t actually provide employees with key things they really want to feel valued, which include flexibility, work-life well-being and autonomy. Among other benefits, working from home at least part of the time offers:

  • Reduced costs in commuting; transit and vehicle maintenance
  • Time gains, including from lack of commute 
  • Location flexibility, such as the ability to live in a lower cost area
  • Flexible working hours
  • Customizable office spaces and the comforts of home
  • Mental health benefits and general improved well-being
  • Increased productivity for many
  • Overall healthier people, according to studies on long-term hybrid workers

 

To expand on a few of these points, for many, the ability to work from home is a key part of improved work-life well-being. Flexibility as to where one works can be an integral piece in achieving a balance that minimizes work related stress while optimizing health and general well-being.

For example, for those with young kids, working from home instead of commuting to a physical workplace can mean many extra hours spent with young children, per day. It can mean easily integrating simple household tasks, rather than being absent from the home for eight or ten hours or more.

Many of the benefits are both financial and reduce stress: reduced or no commute, less time and money spent on office apparel and physical appearance, and the potentially most significant, housing. When it comes to housing, being able to work remotely could mean the ability to live in a lower cost region, rather than near the major city centre where the office is located.  In fact, 48% of those who moved since the pandemic began, factored remote work into their decision.

Hybrid Work Choice

How can the Hybrid Work Model be an advantage for Employers?

 

Many of the advantages that may be seen as beneficial to employees are equally beneficial to employers. Implementing the ability to work remotely, offers employers:

Notably, when employers can recruit from a wider, more diverse group of people due to location flexibility, there is the potential to attract more and better candidates, including those who desire a hybrid work model due to their unique circumstances. And of course, it works both ways: Just as a broader talent pool benefits you as an employer, employees have opportunities that are not limited or defined by geography.

Remote work also appears to increase employee retention: “72% of employers say remote work has a high impact on employee retention—employees are sticking with their employer when they have remote work options.”

 

 

How are employers viewing the movement towards hybrid or even fully remote work?

According to a BDC study, 74% of SME owners say they will offer their employees the opportunity to continue to work remotely. This varies between organizations and person to person, but generally, employers appear to be understanding the dual benefits to offering a hybrid work model.  

 

 

Will offering a Hybrid Work arrangement help me in recruiting great employees?

Yes. Job seekers are asking for work location flexibility at an increasing rate and many are completely unwilling to take jobs where at least some remote work is not a possibility. Today, to be competitive, offering hybrid work is becoming more and more essential.

According to the BDC, 54% of employee say “access to remote work will be a determining factor” in both applying for or taking a job. When Arianna Huffington posted a poll to Linked In February 2022, asking ‘if you were to look for a new job, what’s most essential to you’? the results confirmed people have balance in mind. “Being able to work from home” got 34% of the vote, with 40% going to “Better life-work integration,” These two go hand-in-hand, one could argue.  

hybridwork April3

Will my employees leave if I don’t allow for a Hybrid Work Model?

For many, it’s a dealmaker/ dealbreaker. When surveyed, employees indicate they would consider leaving their job if they were forced to return full time to the office.

  • 43% are likely to look for a new job if their employer mandates a return to the office full time.
  • Almost 50% of Gen Z and Millennials would consider quitting if their employer didn’t offer remote work.

While it may seem extreme, the reality is that employees have many options now. With so many having been given the opportunity to experience working from home due to the pandemic, they are not willing to turn back.  

“Companies that refuse to support a remote workforce risk losing their best people and turning away tomorrow’s top talent.”- Stephane Kasriel, CEO of Upwork

With more and more progressive employers embracing the mindset that ‘it doesn’t matter where or how you work, just that the job gets done,’ why wouldn’t employees seek out these roles, given the majority of our workforce is telling us they want this?

Hybrid Work

How do Employers implement a formalized Hybrid Work model?

If you’re like many employers, prior to the pandemic, you may have had few or no employees working remotely, so never required a remote work policy.

The challenge? Determining how to integrate this work model in a more formalized way. If you’re like the majority of employers, you may lack a strategy.  As with any employee benefit, your approach needs to consider the values of your organization, the purpose of the benefit, in addition to the actual details of the new structure.  Consider:

  • Roles; which roles can be done fully remotely, versus those that require a worksite presence?
  • Put it in writing; details your expectations and employee responsibilities and revise employment contracts where applicable.
  • Structure; How many days in vs out? Is it a set policy? Is it different for different people/ different roles?
  • Personal circumstances; what works for one employee may be different from another and considering personal circumstances show employees you value them as individuals.
  • Support and Supplies; What will you provide employees to support their work from home? Tech equipment, supplies? Ensuring smooth tech is key to success.
  • Virtual check-in’s. How many are needed, and what are the requirements? Camera on or off?
  • Rethink your Key Performance Indicators; what was measured in the past may shift in a hybrid work model.
  • Management; ensure equal time for those in-office and those working remotely, and ensure communications and decisions do not favour one employee type over the other
  • In-person events and meetings; occasions to bring people together in person are valuable and a great opportunity to team build and improve morale.

There are many factors to consider, and like all employer decisions, taking the time to think through all the pieces is important. The impact of decisions surrounding WFH can be significant and deserve proper attention.

Is providing the option to work from home an ‘employee benefit’?

I would argue that this falls solidly under ‘total compensation.’ The flexibility to work from home is invaluable to so many people, and could be the difference in securing amazing team members. There is value in offering workplace flexibility, and it’s no surprise this is showing up as a key feature in many job postings.

hybridwork April5

Empower your employees: the smart choice to optimize productivity

At the end of the day, if you’re hiring good people that you trust, and the job is getting done, why not empower employees to make the choice as to the best place for them to be most productive? Trust goes a long way, in fact, according to the Harvard Business Review, employees in “high-trust companies” report

  • 74% less stress
  • 106% more energy
  • 50% higher productivity
  • 13% fewer sick days
  • 76% more engagement
  • 29% more satisfaction with their lives
  • 40% less burnout.

Adopting a hybrid work model shows you trust employees to get their work done effectively and on time, even when you can’t physically look over their shoulder. While it means making changes to how you manage and measure work, ultimately, it’s a work model that is here to stay and offers numerous benefits for everyone. However, like any employer decision, it’s best to formalize your expectations when it comes to working under a hybrid model.

Looking for assistance in developing your own employee benefits program and policies? We love to hear from you!

Sources:

 

Courtney, Emily.  The Benefits of Working From Home: Why the Pandemic isn’t the only Reason to Work Remotely. (Flex jobs).  https://www.flexjobs.com/blog/post/benefits-of-remote-work/

BDC.(June 15, 2021). Remote work is here to stay: BDC study. BDC. https://www.bdc.ca/en/about/mediaroom/news-releases/remote-work-here-stay-bdc-study

Birkinshaw, Julian, Cohen, Jordan, Stach, Pawel. (August 31 2020). Research: Knowledge Workers Are More Productive from Home. Harvard Business Review. https://hbr.org/2020/08/research-knowledge-workers-are-more-productive-from-home

Munro, Matt. (May 31, 2021). How Working from Home Increases Productivity. WBM Technologies.https://www.wbm.ca/blog/article/how-working-from-home-increases-productivity-infographic/

Kelly, Jack. (March 16th, 2022). Hybrid Will Be The New Work Style, But 72% Of Businesses Lack A Strategy, AT&T’s ‘Future Of Work’ Study Shows. Forbes.com. https://www.forbes.com/sites/jackkelly/2022/03/16/hybrid-will-be-the-new-work-style-but-72-of-businesses-lack-a-strategy-atts-future-of-work-study-shows/?sh=1c351e083989

Staff. (April 7, 2021). 90% of Canadian remote workers say working from home hasn’t hurt productivity: survey. Benefits Canada. https://www.benefitscanada.com/news/bencan/90-of-canadian-remote-workers-say-working-from-at-home-hasnt-hurt-productivity-survey/

Staff. (2022). Key Benefits of the Hybrid Work Model for Employers and Small Businesses. Rocketlawyer.https://www.rocketlawyer.com/business-and-contracts/employers-and-hr/company-policies/legal-guide/key-benefits-of-the-hybrid-work-model-for-employers-and-small-businesses

Staff. (October 4th, 2021). Majority of Canadians want to continue working remotely post-pandemic: survey. Benefits Canada. https://www.benefitscanada.com/news/bencan/majority-of-canadian-workers-want-to-continue-working-remotely-post-pandemic-survey/

Lindsay Byrka

Lindsay Byrka BA, BEd, CFP

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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