Emergency travel coverage

How plan members can use their emergency travel coverage

New sights, great weather, quality time with family and friends – a spring vacation is an ideal way to relax, have fun and escape the last throws of Old Man Winter. Before your plan members board their flights to the sunny south, their Ski destination or even a quick jaunt across the border, it’s a good time to remind them how to use their Emergency Out-of-Country coverage during a travel emergency abroad.

What to do in a travel emergency

Provincial health insurance covers a limited amount of the costs for emergency health services outside Canada. Your Emergency Out-of-Country coverage takes care of certain expenses related to emergency medical treatment beyond what’s covered by provincial plans. Help is available 24 hours a day, seven days a week through the travel assist provider.

Plan members should call the number on their Pay Direct Drug card or Emergency Medical Travel Assistance card to:

  • Locate a local medical service provider
  • Confirm coverage
  • Arrange advance payment
  • Find service in a language other than English
  • Document and share your care and progress with the attending doctor and your doctor in Canada

It’s also a good idea for plan members to review the applicable maximums and reimbursement levels under their group health care plan, listed in their benefits booklet. Any plan members who will be outside Canada longer than the maximum number of days included in your group insurance plan should consider buying top-up coverage to ensure protection for their entire trip.

Registration of Canadians Abroad

For those travelling outside of Canada, it’s a good idea to register for updates from the Canadian Government. They’ll notify you in case of an emergency at home or in the area you’re visiting – such as a natural disaster or civil unrest.

Additional coverage for non-medical expenses

Your Out of Country coverage, available in most group plans, also provides coverage for many non-medical expenses, such as:

  • Transportation costs for bedside attendance by a friend or family member
  • Trip delay transportation charges
  • Transportation costs for return of dependent children
  • Out-of-pocket allowance for living expenses
  • Return of remains or cremation expenses for plan members and dependents
  • Cost of economy airfare for a family member to identify the deceased

For assistance or more information about this additional coverage, call us at 604-681-7759 or email for a free consultation!

*Not all plans include Emergency Out-of-Country coverage. Before leaving Canada, plan members should check to make sure their plan includes this coverage. If not, they should consider purchasing separate travel insurance.

Cannabis in the workplace

The Cannabis Act has received Royal Assent. As of October 17, 2018 recreational use of cannabis will become legal.The rapid and significant changes to the legal status of marijuana raise new questions and challenges for Canadian employers. Here, we provide a general overview of the most important things employers should know about cannabis in the workplace: 

Medical vs Recreational

It is very important to distinguish between medical and recreational use of cannabis. Nearly one in 5 adults in Canada suffers from chronic pain. Many have seen better results managing pain with cannabis based products, rather than opioid prescription drugs. Most patients use the CBD and not THC products. THC is the part of marijuana that is responsive for "getting high". CBD component on its own doesn't have the psychoactive properties.

Policies for cannabis use

Legalization of recreational use doesn't mean that employees can show up for work "high". Employers have the right to set rules for non-medical use of marijuana in the workplace in much the same way that employers currently set rules for use of alcohol. In particular, employers may prohibit the use of marijuana at work or during working hours and may also prohibit employees from attending work while impaired.    

Duty to accommodate

Currently medicinal cannabis is being prescribed to cancer patients, to those suffering from multiple sclerosis, PTSD, epilepsy and chronic pain. Employers must have policies in place permitting the medical use of marijuana in the workplace where supported by appropriate medical evidence, as a form of accommodation. As part of the accommodation inquiry, employers should require not only medical proof of prescription but also sufficient medical indication that the employee actually has to ingest marijuana during their working hours, together with sufficiently detailed information regarding the frequency, volume and method of ingestion relating to such prescribed medical use. 

Group Benefits plans considerations

In the recent study conducted by Human Resources Professionals Association 11% of respondents said they had to accomodate an employee that requires medical cannabis. With respect to group benefits plan coverage 2% said they already included marijuana in their coverage, 20% are planning to do so and the rest 78% would not consider it. 

Currently medical cannabis is not approved under Food and Drugs act and therefore doesn't have DIN and can't be claimed as a prescription drug. Some providers, like Sun Life created options for adding medical marijuana coverage to plans, where it is being covered under the Medical Services. Others allow this coverage only under HCSA/HSA plans. 

For more guidance on medical cannabis and group benefits plans contact our employee benefits team. 

Group Benefits Disability Insurance

Short and long term disability insurance can provide employees with income replacement should they become disabled due to an injury or an illness. It is a great feature to add to your group plan.
Typically, a group plan through your place of employment provides three different levels of coverage:

Sick leave
If employee is sick or injured, they receive full pay for a short period of time (usually a few days or up to a few weeks, sometimes longer, depending on the employer). This is coverage provided by the employer, usually at no cost to you.

Short Term Disability (STD)
This coverage begins when your sick leave runs out. Most short term disability plans pay a percentage of normal earnings – for example, 70 per cent – up to a certain length of time. Typically, this can be up to 15, 26 or 52 weeks. Some employers, however, choose not to provide short term disability benefits, relying
instead on Employment Insurance (EI) disability benefits.

Long Term Disability (LTD)

This coverage starts when your short term disability (or EI) benefits run out. Typically, the goal is to replace 60 to 70 per cent of your normal income, but there is always a maximum dollar amount (e.g., $5000 per month). Given this, if you earn a high income, group LTD plans may replace less than 60 to 70 per
cent of your pre-disability earnings. LTD benefits are usually paid for up to two years if you are unable to perform your regular occupation. After that period of time, you may have to be disabled from performing any occupation for the benefits to continue.
Many plans include rehabilitation provisions designed to assist you in getting back to work. In most cases, you are required to participate in programs that are appropriate to aid in your recovery.
LTD benefits are usually reduced (or “offset”) by any benefits you may receive from CPP, QPP or WCB/WSIB. You can also receive disability benefits from other sources that could be taken into account when your group disability benefits are calculated by the insurance company. Read your benefits information carefully to find out what types of other benefits or situations could lead to a reduction in the benefits from your group disability insurance plan.
Your employer may pay the full cost of your disability coverage, or you might have to contribute through payroll deductions. Generally, if you pay the full cost of the premiums, any disability benefits that you receive will be tax free. If your employer, union or association pays all or any part of the premiums for you, then any
disability benefits you receive will be taxable.

Why Long Term Disability should be a part of your Benefit Plan.

Long Term Disability (LTD) is a benefit that may not be the first thing your employees consider but it definitely is a great addition to any group benefit plan. The employees usually pay it and benefit in this case is tax free to them. Group rates are cheaper for employees over premiums they can obtain individually. Employee does not need to go through approval process when applying for disability insurance through the group plan (unless plan allows and plan member decides to purchase additional coverage, in that case insurance company will require information about the individual’s health status to increase the benefit). Last, but not least is that LTD benefit gives employees valuable financial safety net. Although employees will often express a greater demand for more visible benefits, a Long-term Disability benefit is far more important in protecting the financial well-being of employees. Very few employees will ever be forced to sell their homes because they need eyeglasses or dental work. However, a loss of income can have much more serious repercussions.

Here are some factors to take in consideration when choosing the LTD piece for your Group Benefits Plan:

Elimination Period.
It is the period of time that the claimant must be disabled before receiving benefits. The most common elimination period is 17 weeks so that the LTD benefit integrates with the Employment Insurance (EI) plan. However, the elimination period may be as short as 3 months and as long as one year. The length of the elimination period has a direct impact on the LTD premium as a longer elimination period will result in fewer claims. For plans that include a Short Term Disability benefit, the Long Term Disability plan is designed so that the elimination period ends and benefits begin as soon as Short Term Disability benefits cease.

Benefit Schedule.
The benefit schedule is generally based on a percentage of the employee's pre-disability gross earnings. It will consider the tax status of benefit and any offsets. When determining an appropriate benefit schedule, it is also important to consider the plan's "All Source Maximum". The purpose of the all source maximum is to prevent situations in which an employee's total income (from all sources), while disabled, comes too close or exceeds his/her pre-disability earnings effectively eliminating the financial incentive for the employee returning to work.

Benefit Maximum.
a non-evidence maximum and an overall benefit maximum. These maximums are determined by the size of the group, the volume of insurance and the nature of the business.
The non-evidence maximum (NEM) is the amount of insurance that the insurer will provide to employees without providing medical evidence of good health. A high non-evidence maximum is therefore an important feature of the LTD plan as it guarantees employees a minimum level of coverage (subject to eligibility based on income). For employees who are eligible for coverage in excess of the non-evidence maximum, medical evidence must be provided to the insurer. The insurer will generally grant the excess coverage only to those individuals who are determined to represent a normal level of risk. The overall maximum is the maximum amount of insurance that the insurer will provide under the terms of the contract.

Benefit Period.
The benefit period is the maximum amount of time for which LTD benefits are payable. The most common benefit period is to age 65.

Benefit Definition.
There are two basic definitions of disability, both relating to an individual's ability to work: own/regular occupation and any occupation. Under the own occupation definition of disability, an individual is considered disabled if he/she is determined medically to be unable to perform the essential duties of his/her own/regular occupation. Under the any occupation definition of disability, an individual is considered disabled if he/she is determined medically to be unable to perform the essential duties of any occupation for which he/she is reasonably qualified by training, education or experience.
Most insurers will provide LTD coverage with an "own/regular occupation" definition available for the first 2-5 years. The less restrictive the definition the higher the premium.

Our dedicated Group Benefits Team will provide you with a qualified advice and guide you through creating and setting up LTD plan that is right for your business.

Rising Drug Costs and how to control them

Protect your benefits plan from rising costs

Spending on prescription drugs is steadily increasing in Canada. We now have the second highest drug prices in the world, after the United States. In 2015, Canadians spent $29.4 billion on prescription drugs, which represents 625 million dispensed prescriptions.

Specialty drugs account for just 2% of prescription drug claims submitted in Canada, but that actually represents 30% of total drug claim costs. These drugs allow people with debilitating conditions, such as multiple sclerosis or cancer, to lead normal lives or, in some cases, be cured. By 2020, it’s expected that the cost of specialty drugs will increase to 42% of total drug claim costs.

What’s behind the numbers?

To understand the trend, it’s important to consider contributing factors:

  • We have an aging population with a longer lifespan.
  • More chronic conditions are being diagnosed and prescriptions for these conditions are increasing.
  • More medical conditions are being diagnosed and treated earlier.
  • Patients are driving demand for some treatments as they take a more proactive approach to their health.
  • An increased number of new and more expensive specialty drugs are available to treat these chronic conditions.

As a plan sponsor, you know that escalating health-care costs mean rising premiums, which can result in more strain on your benefits budget.

Finding the right balance between plan benefits and plan cost is key to the overall success of your benefits plan.

Controlling costs for affordable coverage.

There are a number of available plan design options that can contribute to significant savings while still providing comprehensive benefits to your plan members.

Mandatory generic drug substitution means that the pharmacist dispenses the lowest priced equivalent, usually the generic version, of the prescribed drug if one is available. Mandatory generic substitution ensures that all claims for drugs with a generic version are cut back to the lowest priced equivalent, even if a physician indicates on the prescription that there can’t be a substitution.

Co-insurance and co-pays are effective tools for cost sharing. Plan sponsors can set a per-prescription deductible and choose the percentage plan members are reimbursed for each claimed prescription.

Limiting dispensing quantities can help reduce waste and benefit dollars spent on drugs that cause adverse reactions. When an acute drug becomes a maintenance drug, the pharmacist can fill a 100-day supply to reduce dispensing fees.

A dispensing fee maximum encourages plan members to research which pharmacy provides the best value.

For more Information and customized solution for your plan please contact us.