2014 beneplan plan administrator's workshop

The Beneplan Co-operative !

Plan Administrator’s Workshop

��1November 2014

Agenda !• 10:00 - Clean Plan Management • 11:00 - Break • 11:10 - Dealing with Tough Situations • 11:30 - Reformulary • 12:00 - Lunch • 1:00 - Benefits Law w/ Davies Howe

Partners LLP • 2:15 - 7th Inning Stretch • 2:20 - The Co-operators w/ Martin Walker • 3:00 - Wellness Evelyne Mitskopoulos CNP

What happens when you give a contractor $100,000 to renovate your house? !

Do you watch to see where that money went?

The quality of the materials? !

The integrity of the trades? !

!Our industry is the only one where you can give someone $100k and

they are by law not allowed to show you where that money went!

When you trust us to spend your $ wisely, we need to set guidelines to prevent people from ‘hacking’ the system.

What if the gov’t allowed people to opt out of OHIP? !

What do you think would happen to the cost of health care?

…it would

become a pyramid scheme

This is called anti-selection.

Insurance companies are paranoid. !

They think that we are trying to take advantage of them. !

Consumers think it’s the other way around!

How insurers set premiums. !

Health & dental benefits are not insurance. !

They are the opposite of insurance.

Premiums are set in the same way that your hydro bill is calculated. !

Usage == Premiums.

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Job Offer

Milestone

Sickness

Transition

Lifecycle of Employment

Job Offer

• Need original enrolment!• Deadline: 1 month -> effective date!• Consistent waiting period for all!• Co-ordination of Benefits (COB)!• Opting Out & In!• Eligibility

Eligibility

• No OHIP? Buy bridge coverage for Ex-pats.

https://www.ingleinternational.com/

https://www.travelinsurance.ca/en/public/Our-Products/Plans-For-Visitors-To-Canada/Pages/Inpatriates-to-Canada.aspx

Ref#8513

Eligibility

• Avoid covering contractors (self-employed individuals; not people ‘on contract’)

http://www.cra-arc.gc.ca/E/pub/tg/rc4110/rc4110-e.html

Please be honest here

Late Applications

Date !of Hire

Effective!Date

Enrolment!Form!

Submitted!With!

Health !evidence

Benefits !Declined

You must tell the employee that she does

not have benefits

Late Applications

Date !of Hire - !

Part Time

Probation !Period !

Complete

Date !became !

Full Time

!Effective date.!

No medical requirement

Late ApplicationsCan pay

health, vision & dental claims

through Cost-Plus.!

Must buy travel

insurance separately.

Eligibility of Dependents

• Dependent child under 21!• Under 25 if full-time student!• Legal spouse!• Can only cover one legal spouse at a time!• Parents!• Grandchildren - unless by court order / legal

guardianship!• Residing in Canada

Milestone

Increase of salary – let us know!!!

Anything more than 15% increase requires !health evidence.

Milestone

Marriage!Baby!

New spouse – change beneficiary!!

Common law: after 12 months.

Milestone

New home?!!

We need the address!

Report w/in 31 days of the event

Sickness

“I need to take time off.” !!

Now what?

Do you !have a !

W.I./STD !plan?

Does it!Require !

Applying to!EI first?

Is your plan!Self-!

administered?

Produce an !ROE and !

send!employee !

Sickness

NoGive!

Employee!S.T.D. claim!

Form for!insurance

If you have STD

Sickness

Communicate with the employee!at least once per week.

Do you !have an !

LTD !plan?

Give the !Employee !The LTD !

Claim form

Suggest !They apply!

To CPP!disability

Sickness

Day 60!!

If they’re still sick… let us know!

Sickness

Day 65!!

Follow up on filling out LTD forms!!

May take up to 2 months for approval

Extension of benefits!!

12 months is reasonable

...but it’s the employer’s choice

Premium Waiver: Life & LTD!!

Payment of premiums while off…what happens?

What if the employee pays a portion of the benefits? !•Employee must continue to pay during leave •Usually done by sending cheques to the order of the Employer

•If he/she does not pay, send 2-3 letters of warning before cutting off the benefit

Never terminate the benefit plan when someone needs to take sick leave.

Which plan which will attract the best talent? !

��42 Photo credit Richard Pardon / 500px !

Teachers want travel insurance !

��43 Photo credit Lori Denehy 500px !

White collar needs psychologists (but wont’ ask for it) !

��44 Photo credit Jesus Municio/ 500px !

Depends on your industry. !

Teachers want travel insurance. !

Truckers want disability insurance. !

Fitness pros want physiotherapy. !

New immigrants want dental. !

White collar needs psychology (but won’t tell you).

Which benefits do employees want? !

The young want DEN/PAR/VSN The old want DRG/LTD Regardless of the industry.

How do you please them all?��47

Should you ask your employees which benefits they want? !

We don’t recommend it.

The CRA invented our industry. !

First, you must understand that all you are doing is hiring an insurance co to pay your claims.

To what extent should employees share the cost of the plan? !

Employees should never pay a portion of the premium (Disability excluded) - tax inefficient.

Instead: !

Share costs at the POS.

What do you do when an employee needs to take a sick leave?

Never pay their full payroll. Top up EI if you can afford it.

EI Premium Reduction Program

A program which is designed to reduce the employer’s EI premiums payable if that employer provides wage loss replacement coverage that meets Human Resources and Skills Development Canada’s requirements !

To be considered for premium reduction, a plan that provides short-term disability benefits must: ! - provide at least 15 weeks of benefits; - match or exceed the level of benefits provided by EI; - pay benefits to employees after 14 days of illness or injury; - be accessible to employees within 3 months of hiring; - cover employees on a 24-hour-a-day basis. - pass on the savings to employees for their portion

EI Premium Reduction Program

http://www.servicecanada.gc.ca/eng/cs/prp/010.shtml

Discount (multiply x payroll)

New multiplier (Instead of 1.4)

http://www.servicecanada.gc.ca/eng/cs/prp/0300/0300_170.shtml

E.x. !

$1 million in payroll x 0.33% discount = $3,300 annual savings

http://www.servicecanada.gc.ca/eforms/forms/sc-nas5022(2014-07-004)e.pdf

5/12ths of the savings must be shared with employees.Company Party / Cash / Benefit Plan …

How EI Sickness and WI programs interact • The WI program is a replacement for EI sickness benefit • You elect to have one or the other • If you wish to keep the EI sickness program, but you don’t like their

maximums, or their waiting periods, it’s possible to co-ordinate both benefits by using the supplementary unemployment insurance sickness benefit (SUB)

• The SUB plan must be registered with EI • The SUB plan needs to be drafted to indicate exactly what’s offered • EI requires a 2-week waiting period, the SUB plan can make payments

during these 2 weeks without interfering with EI sickness plan • EI would offset some payments from the employer, however, if a SUB

plan is in place, EI will not offset any top-up payments to improve the maximum

Avoiding over-insuring the LTD benefit

CPP Disability

Instead of: “66.67% of salary to a max of $6,000” !

Use: “66.67% of the first $2,250, 50% of the remainder, to a max of $6,000”

Owners’ LTD - the dilemma !

“85% all source maximum”

NEMs Non-evidence maximums

HEMs Health evidence maximums

Taxability of benefits

Don’t Forget…• Life insurance, AD&D, DGL* are taxable benefits – add to T4s • Employees pay for LTD benefit is non-taxable upon collection • If LTD benefit is non-taxable, and you do not charge employees

for their portion of the premium, you must add the premium onto T4s

• New dependents, beneficiaries, etc !

*Dependent Group Life

Transition

Never terminate a sick employee or one on paternal leave.

Benefits extensions• The employee quits or resigns with notice - The termination date would be the last day worked. !• The employee is being fired for cause - Terminate the coverage on the day the employee is fired. !• Voluntary leave of absence - The company may choose to suspend or extend benefits ! - Let us know before you offer to extend benefits. ! - Your decision must be communicated in writing to the employee. ! - If the company chooses to extend benefits, LOA is required.

Transition

Terminations / Non Active Employees

• Company Lay off – the layoff expected to be less than 13 weeks !• The Employment Standards Act (ESA) states that companies that lay

employees off temporarily up to 13weeks, are not deemed to have terminated these employees; !

• In this case, the company may choose to suspend benefits during such layoff or may choose to extend benefits during the layoff. !

• If the company chooses to extend such coverage, the company must apply for a Letter of Agreement (LOA). !

• All benefits, with the exception of short/long-term disability, out-of- country coverage and weekly indemnity can be continued, up to 13 weeks. After 13 weeks, only health & dental may be covered, up to 35 weeks. !

• This must be documented by the way of LOA.

• Company Layoff – the layoff expected to be more than 13 weeks !The Employment Standards Act (ESA) states that companies that lay employees off for longer than 13 weeks, the employees are not deemed terminated if the company extends all their benefits. !In this case the company must apply for a Letter of Agreement (LOA). !All benefits, with the exception of short/long-term disability and out-of- country coverage can be continued, for a period of up to one year. This must be documented by the way of LOA.

What happens if the employer changes their mind re: layoff? !

Terminations6. Benefits during the notice period !The ESA requires that all benefits, including disability, must continue, whether the employee is actively working or not, for the number of weeks, set out by the Employment Standards Act (ESA)

For Ontario:Working for 3 months or more; less than 1 year (1 week)

1 year or more; less than 2 years (2 weeks)3 years or more; less than 4 years (3 weeks)4 years or more; less than 5 years (4 weeks)5 years or more; less than 6 years (5 weeks)6 years or more; less than 7 years (6 weeks)7 years or more; less than 8 years (7 weeks)

8 years or more (8 weeks)

• Severance - Extension of benefits beyond the “Notice Period” requires legal documentation between the employer and the insurance carrier. ! - All benefits would be extended, with the exclusion of any disabilities (short or long) and out-of-country coverage (on health). ! - The employer must inform Beneplan if they wish to extend benefits beyond the termination date or notice period. ! - An LOA is required in this case.

Ask us before you offer a package!

Applying for Life Insurance Conversion !• Within 31 days of group life insurance termination, the employee may

obtain an individual policy with The Co-operators without providing evidence of good health.

!• The employee has to call a Co-operators agent to do so. !Continuing Health & Dental Benefits !Contact Co-operators “ContinYou” program or Beneplan for other options.

Why it doesn’t make sense to extend LTD as part of a severance package

Your Duty of Care• If an employer sees than an employee is about to do

something legal under normal circumstances, but indeed that employee could be causing harm to themselves, the employer has a duty of care to warn the employee

“Ought to have known”• If an employee is acting in a certain fashion that under

normal circumstances indicates that they’re facing a problem then the employer, then the employer, having the duty of care to inform, cannot hide behind the expression “I did not know.” !

• In the common law, employers “ought to have known” if there is enough circumstantial evidence.

Refusal of Benefits• Life insurance and Long Term Disability should be

mandatory or a condition of employment !

• Refusal of benefits form

Troubleshooting claims !

Co-operators 1-800-667-8164 x1 x1 !

Common Reasons for Declines !

• Incorrect information on file (DOB / name spelling) • Security measures (pain drugs) • Incorrect insurer • Fair market pricing (“R&C”) • Simply not covered !

Out of Country Coverage• Absolutely critical to call the

number on their out of country card before paying the any foreign medical provider !

• Upon calling, the insurance company negotiates a fair market price with the medical provider !

• If they are not called, it is possible the employee will be overcharged and not be able to claim the full amount upon return to Canada !

• Communicate this to all employees

Other Leaves-per the Employment Standards Act (ESA)

• Compassionate Leave (Family Medical Leave) - Under the ESA the employee is eligible to family medical leave up to eight weeks job-protected leave. ! - The coverage will be extended for all benefits in effect prior to the leave. Employers must continue paying their share of benefits premiums. !• Pregnancy/Maternity/Paternity Leave -Under the ESA where an employee takes maternity/paternity leave, the employer must keep all of the benefits that were in force prior to the leave. ! - If premiums for WI and LTD are paid during maternity/parental leave and the employee will be eligible for disability coverage. ! - If premiums are not paid, there would be no disability coverage. ! - No letter of agreement is required here.

Other Leaves-per the Employment Standards Act (ESA)

• Emergency Leave - Under the ESA if the employee is entitled to personal emergency leave then the employee will be on an unpaid, job-protected leave of up to 10 days each calendar year. ! - The employer must continue benefits while an employee is on personal leave. !• Vacation Periods Extended - If the employee on vacation (either in or out of country) and the employer decides to allow the employee to extend the employee’s vacation, then coverage for all benefits would continue to be in force. ! - No letter of agreement is required here.

New Leaves-per the Employment Standards Act (ESA)

Family Caregiver Leave!!

•Up to eight weeks of unpaid, job-protected leave for employees to provide care or support to a family member with a serious medical condition.!!

Critically Ill Child Care Leave!!

•Up to 37 weeks of unpaid, job-protected leave to provide care to a critically ill child.!!

Crime-Related Child Death or Disappearance Leave!!

•Unpaid, job-protected leave for parents whose child is missing or has died as a result of a crime.!!Must extend their benefits during this time.

http://www.labour.gov.on.ca/english/es/newleaves.php

Oral chemo !

Biologic Drugs !

Trillium Drug Program !

Drug co-insurance / caps

Patient assistance programs

Future Trends !

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Full Disclosure: Beneplan has invested in the personal genetics industry

The Reformulary

Thorough employee communication required (to be completed by Beneplan in conjunction with Employer)

au2014 !

case-sensitive

• Formed in 2000 based on customer demand

• 250+ member-owners

• Members are Ontario SMEs w/ 20-200 employees

• Annual growth rate 35%

• 60% blue-collar industries; 40% white collar

• The only benefits co-operative in Canada of its kind

The Beneplan Co-operative

• On average, 10% of premiums are refunded as patronage dividends

• 80% of members receive dividends

• Other 20% of members have deficits (claims > premiums) absorbed by co-op

• $8 million in distributions since 2000 as of CY2013

• Source of dividends: health, dental, life ins premiums, tax rebates

• Future sources: drug rebates, paramedical rebates

Patronage Dividends

“As an auto-parts supplier, business has been tough. The $30,000 dividend we received in 2009 helped us through payroll.”

Clover Tool Manufacturing

“Our teachers pay half the premium. We used our $38,000 dividend to subsidize gym memberships for them.”

Bayview Glen School

Davies Howe Partners LLP

7th Inning Stretch

Martin Walker !

The Co-operators

Provider claims portalChiropractors Chiropodists Massage therapists Osteopaths Physiotherapists Podiatrists Speech therapists Vision care providers

Controlling drug costs

• Prior authorization • Dispensing quantity

caps • Generic substitution • Dispensing fee caps • Drug maximums

Health and Dental claims system

1Rules-based

platform

The Co-operators operates a single platform for all Extended Health Care and Dental claims

2Real-time

integration

3Member

web services

Benefits NowTM for Plan Sponsors

User-friendly Secure messaging Real-time updates Education centre E-options

Benefits NowTM for Plan Members

• 24/7 access • E-claim submission • Claims and coverage

information • Ask a question • Pay-direct card • Wellness Now™ Online

Technology enhancements

• Benefits NowTM suite of online services

• ClaimsXchange • E-claims adjudication • E-claims mobile app • Enhanced reporting

Wellness Now™ Online

Assessments Health record Library Goal setting

Disability claims

• Document management

• Automated workflow • Electronic file sharing

Evelyne Mitskopoulos CNP Director of Wellness at Beneplan

Eat Well, Live Better

Are drugs always useful?

Why do you need a Nutritionist?

Disclaimer: Prior to making any changes to your diet, taking supplements or exercising, please consult with your medical doctor or health care practitioner. !

WARNING – the information you are about to receive may cause good health and vitality

If Man made it, Don’t eat it.high in fat & sugar, low in fibre, vitamins & minerals

Resistance from your doctor

• 27% of doctors receive 25 hrs of nutrition education in med school

• Survey of med students: 87% wanted more curriculum devoted to nutrition

• 50% admitted lack of nutritional knowledge when it came to counselling patients

Who do you seek for advice?

evelyne@beneplan.ca

Controversy• Search medical literature under “statin therapy” and

there are 19,400 papers, and these drugs are considered evidence based

• Search medical literature under “Vitamin D therapy” and find 20,723 papers

• Yet recent joint U.S.-Canadian review of Vitamin D came to conclusion that there was still not enough evidence to suggest that Vitamin D had a role to play in preventing any condition other than bone disease – (rickets & osteoporosis) despite the fact that only about 7% of the papers are about bone health

evelyne@beneplan.ca

The argument against Vitamin D for prevention of Chronic Diseases

• Drug – randomized controlled trials (RCTs) (Group taking placebo and group taking drug) Vs. • RCTs approach for vitamin D is difficult as it’s not

ethical or practical to deprive one of vitamin D without making them sick, and you would have to keep out of sunshine for years at a time

Thus RCT of D compares variable and fluctuating levels in both supplement group and controls.

Observational Study

• Vitamin D is considered an observational study • 1950s: researcher Sir Richard Doll showed

smoking caused lung cancer simply by observing if the habit & behavior increased the risk of disease

• Became medical standard & government increased cigarettes tax heavily as a disincentive

• Observational data is strong evidence

Conflicting Data – A Doctor’s Argument

• Body is complex !

• All essential nutrients are needed at all times !

• Testing single nutrients in isolation from other nutrients they interact with, you are likely to come up with conflicting data; e.x. calcium

Problem with Drugs

• Many prescriptive drugs deplete nutrients • Drugs can interfere with absorption • Side effects get treated with another drug that

further depletes nutrients e.g. Antibiotics – B-vitamins, vitamin K, calcium, iron, magnesium, zinc !

Did your doctor advise you about this or is he/she even aware about this problem?

Medications

When you are in need for medications this is a sign that your body processes are not under control.

• www.growyouthful.com • www.preventdisease.com Calculates your biological age based on questions, activity, BMI, parents, current health

Extended Life does not equal Extended Health

At the root of chronic diseases such as diabetes, heart disease, stroke, dementia, liver disease & arthritis (which all increase with age) is lack of 1. Physical activity 2. Chronic stress 3. Inadequate nutrition !

What is out of our control? heredity, stress, chemical pollutants

Aging body requires more nutrients

1) Low stomach acid causes impaired protein digestion

2) Many people in 40’s, 50’s & older take med’s that suppress stomach acid because of indigestion or acid reflux causing more digestive impairment

3) Stomach acid breaks down proteins into amino acids that are building blocks for hormones, enzymes, & all tissues and organs of body

“I eat really well so I don’t need supplements”

• Canadian Community Health Survey of 2004 by Statistics Canada states mg. & vit. A serious deficiency

• Many Canadians do not meet the standard recommendations for vitamin and mineral intake especially A, B, C (antioxidants)

• Estimated Average Requirement (EAR) is a gov’t health estimates amount of nutrients to meet the daily needs for ½ the population – What about the other half?

• Increased age nutrient needs (mg. zinc, C, B)? • We all vary widely in our need of essential nutrients, e.g.

iron, Vitamin D

• What about when you are sick with the flu or recovering from surgery or cancer treatments? !

• Did your doctor give you nutritional advice to recover or just drugs?

Dr. Bruce Ames, Nutritional ResearcherBiologist at University of California

• Cellular & metabolic damage can occur if intakes of vitamins & minerals fall between the RDAs and the bottom intakes that cause classic deficiency diseases such as scurvy !

• Conclusion: this is cheaply prevented by taking supplements

Dr. John Harvey Kellogg (1852-1943)

• Theory: overfed people had digestive problems causes stagnation in bowel and microbes ferment food, producing toxins that circulate in blood to organs causing disease

• Cure by Dr. Kellogg – daily exercise, open air, pint of yogurt daily (eaten and enema) & along with brother William developed high fibre food (BRAN) – cornflakes and later All-Bran

• Noticed by C.W. Post who commercialized it as did William but popular only due to convenience not nutritional value

• Problem – bran contains phytates that bind minerals which reduces absorption of essential nutrients

Fatigue• #1 cause of doctor visits • Rule out thyroid problems or anemia Usually due to: 1. lack of restorative sleep 2. Vitamin & mineral deficiencies such as magnesium

causes ATP deficiency that reduces energy levels 3. Some medications 4. Sugar and starches due to rapid rise in blood sugar

damages tissues and alters proteins and brain is first to feel it’s effects

5. Stress

– pay attention to your immune system- • a network of cells, tissues, and organs that

work together to defend the body against attacks by “foreign” invaders.

• Invaders = bacteria, parasites, viruses and fungi that can cause infections.

• It is the immune system’s job to keep them out or to seek out and destroy them.

Power of Foods• Stress depletes zinc which lowers immunity • Hair loss can be a sign of serious underlying illness • Lack of Vitamin D affects everything • Slow down grey hair by Vitamins B12, B6 & folic acid • Low intake of veg & fruit and high sugar intake affects eye

health • Inadequate diet causes mood disorders • Probiotics boost the immune system • Garlic is a strong antibiotic • Healthy fats control hormones and inflammation • Take a drug holiday from statin while modifying diet and

lifestyle and see what happens

Beauty of Foods

• How to make your own facial cream to boost collagen naturally

• What cream (hint: food) is suitable and non-toxic to your body?

• Pelvic Floor Dysfunction – no surgery required (kegels)

• Memory – “what’s my name again?” • Why do I bruise easily?

Want to know learn more? !

Call Beneplan for Wellness Presentation that can be tailored to fit the needs of your company. evelyne@beneplan.ca 1-800-387-1670 x226 Cost: Priceless

Thank You !!

Yafa Sakkejha General Manager

yafa@beneplan.ca !

The Beneplan Co-operative 150 Ferrand Drive Suite 500

Toronto Ontario M3C 3E5 1.800.387.1670

beneplan.ca

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2014 beneplan plan administrator's workshop

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