The Ins and Outs of Group Health Insurance

Posted on December 12, 2018 and updated December 21, 2018 in Group Benefits, Insurance Types, Life Insurance Canada News 8 min read
Jason-Julian-Group-Health-Insurance

Jason Julian Bio

I have been in the Financial Services industry for 27 years. I started in the banking sector in 1991 for Canada Trust in Hamilton later to begin an Insurance career as an agent with Prudential of America in 1995. The majority of my selling career was spent in Hamilton Ontario at one of Canada’s leading brokerages, Dan Lawrie Insurance Brokers Ltd. where I spent 11 years building my practice. I grew a client base to over 2500 as well as partnered to service 150 employer group benefit plans, Association plans and co-managed a Pension/Investment book of $100 million in assets.

I went on to work as a Life Member of MDRT and two-time Court of the Table producer along with Top 10 status for 7 years with Unity Life before joining the company in 2007. After selling my book of business, I joined the corporate side serving as Director of Sales for Southwestern Ontario for Unity Life/Foresters 2007 to 2012 before becoming AVP Ontario Sales. In 2014, I worked with National Accounts to oversee growth as well as Business Development in 2017.

In 2018 I took on the role as Senior VP at a growing benefits company (SAFG Benefits Solutions Inc.) to grow the brand and market our unique value proposition to brokers and employers using the latest technology platform and best of class services including Mental Health, Meschino Wellness, EQ Care virtual doctors and Pharmacogenetics.

What is most important to me is my family. I have been married 26 years to Emilia and we have two boys Michael and Matthew. Michael is a musician (24) and Matthew just returned from a successful mission for the church in Anaheim California and will begin school to start a career (21). I am an avid fitness and nutrition fan and always learning from good books! Service to my community is also important as I live my faith.

What is Group Health Insurance?

Group Health Insurance, often referred to as “group benefits”, is an insurance product that provides coverage for Dental and Medical costs such as prescription drugs, paramedical expenses from massage therapy, chiropractic services, physiotherapy, naturopath, and many other covered services.

Commonly offered through employer groups as a way to attract and retain people, these plans can vary greatly in design and the amount of cost sharing with the employee.

These plans can also be purchased individually to protect against unforeseen medical and dental expenses.

Group Health Insurance Plan: What to Look Out For

If you are a member of your company employer benefits plan, some key items to pay attention to include:

  1. Be aware of your plans “renewal date” so you know when your benefit maximums “reload”. For example, if my plan renewal was August then my plan provisions are August to August. Most believe it is calendar year so if they had maximum coverage of $500 for massage therapy and forgot about the renewal month, this could lead to mismanaged planned visits and be deducted out of pocket until the plan renews and resets/reloads maximums.
  2. Know and understand your Dental coverage. Many employees may have the impression they are covered for crowns, caps, root canals, etc, when these are referred to as major restorative services. Your plan may not cover such expenses.
  3. What are your financial responsibilities in correlation to your plan? Know what, if any, deductibles you might have in your plan. For instance, your prescription drug coverage may require you to pay a one time $50 deductible per year as well your coverage amount can vary from 50 to 100% coverage depending on the plan Please add an empty line afterwards.

For individuals considering purchasing a plan, I would consider the following:

The pricing is key to decision making so review what is covered and maximums as you may want to consider a Health Spending Account if you are a sole proprietor. For those that will not be eligible to deduct as an expense, the costs vs the possible claim payout will be an important exercise.

Group Health Insurance: Insiders tips

From my perspective, a Group Health Insurance plan is really about understanding your needs and if you are an employer, it is about understanding the needs of your employees. This needs-based approach will ensure you consider the right plan with the right provisions at the best price.

My regular tip has always been to not toss the benefits booklet in a drawer but rather take the time to be fully aware of what coverages and services you have available. Too many times it is often when something happens that we go searching for answers or I have found many who paid for services without realizing they had coverage through their plan.

Finally, work with your practitioners. I always gave my dentist a copy of my dental coverage page so they can properly guide me on my coverages. The same is true for paramedical services where I would tell the Registered Massage Therapist how much my plan maximum was and the benefit renewal month, so they are able to assist in ensuring I stay within the guidelines.

Illustration of what monthly plan costs could look like:

Company

Number of employees

Life Insurance,
$ monthly

Extended Health,
$ monthly

Dental,
$ monthly

Total,
$ monthly

Tech Start-up example: Assume 50% are single coverage and 50% – family

20 employees

$40

(0.08 per $25,000)

Single: $53

Family: $128

Monthly: $1,810

Single: $30

Family: $80

Monthly: $1,110

$2,950 / month

Dental Office

10 employees

$22.50

(0.09 per $25,000)

Single: $90

Family: $175

Monthly: $1,325

Single: $44

Family: $92

Monthly: $680

$2,028 / month

Construction Company

70 employees

$87.50

(0.05 per $25,000)

Single: $63

Family: $150

Monthly: $7,455

Single: $34

Family: $100

Monthly: $4,690

$12,233 / month

 

Sample Plan Design:

Insurance plan component

Insurance coverage
Basic Life InsuranceFlat $25,000 Dependent Life Coverage $5,000 and Children $2,500
Extended Health Coverage
Prescription Drugs80% covered
Additional coverage includedVision Care, Paramedical practitioners ($500 per practitioner) such as Chiropractor, Massage therapy, Acupuncturist, Osteopath, Naturopath, Physiotherapy, Podiatrist/Chiropodist, Psychologist etc.
Dental Coverage

80% covered ($1000/per year coverage)
Minor Restorative: Teeth cleanings, scalings, fillings, x rays, pit and fissure sealants etc.

Notes: Long Term Disability can be included based on the salaries of employees.

Variables that lead to rates: Plan design, coverage amounts, deductibles, family or single coverage, age, gender and occupation all have impact on rates.

If you are interested in getting a group insurance quote for your organization, our experienced insurance brokers can tailor a group insurance plan for your needs.

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