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What is a Benefits Consultant?

A benefits consultant is an important intermediary in the group insurance and employee benefits marketplace. If you want to get a better understanding of what a benefits consultant is, how they can help manage your employee benefits plan, the services they provide, and how to go about choosing one, then check out this article.

Underwriting: Fully Pooled

Fully pooled is a fully insured underwriting method typically used for smaller groups as well as those benefits that have a low incidence of claim but a high claim amount irrespective of size. Typical for out-of-country and accidental death and dismemberment benefits as well as Basic Life and Long Term Disability for smaller employer groups.

Group Health Insurance – Medical Supplies and Services

Almost all group insurance health plans provide coverage for medical supplies and services to assist employees recovering/living with a disability due to illness or injury. These benefits provide coverage for the purchase, rental and repair for devices such as wheelchairs, crutches, elastic stockings and orthopedic shoes. These benefits are included under the provisions of a health care plan and are typically subject to any applicable deductible or coinsurance provisions.

Group Health Insurance – Hospital

Group health insurance plans cover most of the basic hospital and surgical expenses in Canada that any resident incurs during a period of hospital confinement, including accommodation at the ward level, the services of a doctor/surgeon, diagnostic procedures and drugs. Employer-sponsored hospital benefits plans cover only the additional cost of preferred accommodation such as semi-private or private, during hospital treatment in Canada

Group Health Insurance – Out of Country

A description of the out-of-country coverage typically provided within a group health insurance plan, covering employees for limited travel either outside of their province of residence, or out of the country. Coverage typically includes protection for both personal and business travel for 60, 90, or 120 days up to a one million in coverage (lifetime) per covered individual.

Group Health Insurance – Vision

Vision benefits, coverage for eye exams, lenses, frames and contacts, typically account for between 5% and 7% of a group health insurance program. Vision benefits typically have a very high perceived value to employees, usually higher than the actual cost of providing vision benefits. More recently, group health insurance plans have expanded provisions to include coverage for laser eye surgery, which has become more common place as technology has advanced and pricing has decreased.

Canadian Provincial Drug Reform Overview

Drug reform has swept across Canada with 5 provinces making changes in 2010 and 2011 to the way generic drugs are regulated in Ontario, Alberta, British Columbia, Quebec and Nova Scotia. The proposed changes drastically change the drug landscape and the delivery of drug benefits, both from the public’s perspective through government-funded programs, and from the private perspective and employer-provided group health insurance programs.

What is Mandatory Generic Substitution?

Mandatory Generic Substitution is a drug plan feature that limits the ingredient cost of a drug charge to that of the lowest cost alternative.  Where there is a generic interchangeable drug (a generic equivalent) then the generic drug will be dispensed or the plan member will be reimbursed up to the cost of the generic […]

How A Claim is Defined

A discussion of how a claim is defined by benefit category – Life Insurance, Accidental Death and Dismemberment Insurance, Critical Illness, Short Term Disability, Long Term Disability, Health and Dental – who it applies to, and general commentary surrounding market prevalence

Underwriting: Refund-Accounting

A group that uses the refund accounting underwriting arrangement to fund it’s plan is essentially prospectively rated however choosing to share in the financial results of the program through an annual accounting of surplus/deficit completed by the insurer.