Tag: Employee Wellness Programs

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!