EMPLOYEE BENEFITS AND INSURANCE FAQ

Are Employee Benefits Important to Employees?

Yes, employee benefits are extremely important and highly valued by employees. We often see employees leave a business to move to a competitor that provides benefits with similar or even lower pay. Many employers approach us because their staff have expressed a need for the protection and security that an employee benefits plan can provide.

What Are the Top Three Benefits That Employees Want?

Employees tend to be most interested in health benefits, dental benefits and prescription drug coverage.

What Is an Employee Assistance Program?

An employee assistance program (“EAP”) is an employment based program designed to assist in the identification and resolution of a broad range of employee personal concerns that may affect job performance. An EAP can deal with situations such as substance abuse, marital problems, stress, financial difficulties, health education and many more topics. An outsourced and confidential EAP can be added to an employee benefits plan for a very low cost.

What Is a Drug Formulary?

A drug formulary is a list of prescription drugs that will be covered by a health insurance plan. Criteria for placing a drug on a formulary are often based on what is deemed to be the most effective and economical. Drugs not listed on a formulary may not be covered or covered at lower percentage.

What is Cost Plus?

Cost Plus is a proven, tax-effective means of covering health, dental or vision care expenses not eligible under your regular employee benefits plan. Used correctly it can be considered a Private Health Services Plan (“PHSP”), recognized by Canada Revenue Agency (“CRA”) as a vehicle which allows businesses to deduct health-related expenses eligible under the Income Tax Act.

I Have Health Issues, Will I Be Approved for Personal Health Insurance?

Not all personal health insurance plans require a medical, or proof of good health. If someone is not eligible for a medically underwritten plan, we have options that require no medical for approval. A no medical, personal health insurance plan will not pay for everything, but it can definitely help you cover some of the costs associated with pre-existing medications, medical supplies, health practitioners and more.

What is Predetermination of Dental Benefits?

Dental insurance plans will include a predetermination provision that applies to procedures expected to exceed a predetermined amount (e.g. $500.00). This is necessary to asses and confirm the necessity of the procedure and its estimated cost prior to treatment. The Insured is typically provided with an estimate of the cost, a breakdown of what will be covered and what will have to be paid out-of-pocket prior to going ahead with the dental treatment. Through this process you can avoid being stuck with a bill that is not covered by your insurance plan.

Why do I even need life insurance?

If you pass away, your income will disappear. With your income gone, will your family be able to continue to pay their mortgage? Will your family be able to pay their other bills? Will your family be left with debt? Will your children be able to obtain a post-secondary education? What about final expenses? If your family counts on your income, then you need insurance to protect them should something happen to you. What type of insurance you need and how long you will need it for will be based on your own personal needs and situation.

What Is a Dental Fee Guide?

Each provincial dental association sets an annual recommended fee guide listing the recommended charge for each dental procedure, and the dental benefit plan covers procedures up to the recommended maximum only. While most plans pay dental benefits based on the current fee guide, there are some plans with fixed or frozen fee guides which are frozen in a previous year and some that lag a year or two behind the current year. A plan that is based on a past fee guide could result in the insured having to pay for service charges in excess of it.

What Is Personal Catastrophic Health Insurance?

Catastrophic health insurance is designed to help cover the costs of medical care and medications from unforeseen and serious accidents or illness. Catastrophic health insurance covers qualifying expenses once you reach your threshold, or deductible. Personal catastrophic health insurance can pay for catastrophic health and medication costs in excess of government, personal or group benefit plans.

To What Age Are My Dependent Children Covered To?

Typically, health and dental coverage offered through an employee benefits plan will cover the plan member’s unmarried; natural, adopted or stepchild under age 21, or age 25 (age 26 in Quebec) if in full time attendance at an accredited school or university and wholly dependent on the employee.

Is Provincial Health Coverage “OHIP” Required to Enroll in An Employee Benefits Program?

Yes, it is mandatory in or order to be eligible for employee health benefits.

I Run a Home-Based Business on My Own, Can I Obtain Employee Benefits?

Yes, although not all insurers will offer coverage for home based businesses. However, we have unique offerings to accommodate your needs.

Will Our Employees Have a Waiting Period When We Set-Up Our Plan?

When you set-up a new employee benefits plan, your existing staff can all have coverage on the plan’s effective date. Future employees will be subject to the waiting period of your choosing. For example, three (3) months from the date of hire for new employees.

I Am a Solo Entrepreneur and Have Pre-Existing Health Issues, Can I Get Coverage?

Yes, we have employee benefit plan options that include prescription drug coverage, health benefits and dental benefits that do not require a medical for one and two-person firms.

Some of Our Employees Are Covered by Their Spouse, Do They Have to Take Both Plans?

When one has coverage through another plan for health and dental benefits, they can waive the health and/or dental benefits under either plan. For example, one can coordinate coverage between the two plans to top up their coverage or opt out of whichever plan has the lesser coverage. Some benefits other than health and dental are however, considered mandatory and must be elected.

Do I Have to Pay HST On My Employee Benefit Plan Premiums?

No, in some provinces, a retail sales tax is levied on group insurance premiums. Ontario charges 8% on all benefits.

What Happens to My Benefits If I Retire?

Retiree plans are extremely expensive and small businesses do not typically extend this option to an employee upon retirement. Typically, the only option for an employee is to apply for a personal health and dental insurance plan that is convertible within 60 days of your benefits plan termination. The coverage will likely not be the same as what your employee benefits plan covered. Some insurers offer a retiree plan that is unique to the insurer, for owners and management of a business to transfer to.

What Is AD&D?

AD&D is short for accidental death and dismemberment. It is not intended to supplement or replace group life insurance. AD&D provides a lump sum benefit if death occurs as a result of an accident and provides payments for injuries as sustained or loss of use of specified body parts or faculties.

Is It a Lot of Work to Administer an Employee Benefits Plan?

With the majority of the work being done online, plan administration is easier than ever. Once you get the hang of everything it’s a walk in the park. You will always have your local advisor on standby to help with anything new or complex whenever you need them.

I Forgot to Submit My Claim, Is There a Deadline?

Yes, for health and dental benefits, claims must be submitted within 12 months of the date of service. Other benefits have shorter time frames. Ensuring timely submission of all claims is highly advisable.

What Is a Fully Pooled Employee Benefits Plan?

A fully pooled plan like The Chambers Plan can help you avoid drastic changes in your premiums from year to year. This is possible because with over 30,000 companies participating in the program, if one of your employees files a large claim, it’s spread over a large pool – so you’re guaranteed more stable rates from year to year. Why is this unique? With traditional insurers, your group’s own usage dictates your rates at renewal. In summary, your group’s own claims are absorbed by the pool.

Can Medical Marijuana Be Covered Under Traditional Employee Benefits?

No, unfortunately medical marijuana cannot currently be covered under most traditional employee benefits plan. There are other ways to cover medical marijuana, give us a call and we’d be happy to discuss some solutions.

What Happens When an Employee Leaves Our Employment?

You can simply terminate the employee either online or by paper and the employee’s coverage will be terminated. Typically, the premium is non-refundable up to the first of the next month following the date of the termination.

Is My Business Too Small for A Group Benefits Plan?

No. In fact, the Chambers of Commerce Group Insurance plan offers group benefit plans to small businesses in Scarborough starting at one person and up. The Chambers Plan also grows with you into the hundreds as your businesses get larger. Additionally, if you are a self-employed contract worker without group benefits, the Chambers Plan could be a perfect fit for you.

Can A Startup Company Get a Group Benefits Plan?

Most insurers prefer that a business be in operation for at least 12 months to show stability. There are however, some insurers that will set-up a group benefits plan for a new company and exceptions may be possible on a case by case basis.

Our Group Benefit Plan Rates Keep Skyrocketing, Can You Help?

Yes, The Chambers Plan provides a unique offering in Scarborough. With the Chambers Plan’s built-in rate stability, you will not have to shop your plan every year. That is because with over 30,000 companies participating in the program, if one of your employees files a large claim, it is spread over a large pool – so you are guaranteed more stable rates from year to year.

What Does Vision Care Cover?

Vision care benefits can pay for prescription eyeglasses, including frames and lenses, as well as contact lenses. Safety glasses, prescription sunglasses and anti-reflective coatings are typically excluded under many plans. Coverage for laser eye treatment may be offered as well. Benefits maximums typically range from $100.00 to $200.00 every 24 months for adults and every 12 months for dependent children under the age of 18. Most plans will also include eye exams every 12 or 24 months, subject to a fixed dollar amount or a reasonable and customary charge.