beneplan benefits admin workshop - november 2013

Plan Administrator's WorkshopNovember 28, 2013

1Friday, November 29, 2013

Agenda• 10:00am Benefits Admin 101: How to manage your benefit

plan [for beginners]• 10:30am Advanced Benefits Admin: How to avoid lawsuits• 11:30am Guest Speaker: Shane Swinson from FIC: What you

can do if you suspect an employee is abusing sick leave/WSIB• 12:00pm Lunch • 1:00pm Draw• 1:10pm Martin Walker from The Co-operators Life – Q&A on

e-claims, fraud, pricing, and more• 2:00pm Evelyne Mitskopoulos CNP from Beneplan


Responsibility to inform3Friday, November 29, 2013

Rules are to prevent taking advantage of the system


Employees who ‘hack’ the system hurt their fellow employees and employer


Why is the insurer skeptical?

Anti-selection.


When you join on day 1…

No questions asked.


You hire us to guard your piggy bank.

We’re the only industry where you give us $100,000 and we aren’t allowed to tell you where it went.


Job Offer

Hire

Milestone

Sickness

Transition

Lifecycle of Employment


Hire

• Need original doc• Deadline: 1 month -> effective date• COB• Opt-Out• Eligibility


+DGL

Please be honest here


Late Applications

Date of Hire

EffectiveDate

EnrolmentForm

SubmittedWith

Health evidence

Benefits Declined

You must tell the employee that she does

not have benefits


Late ApplicationsCan pay

health, vision & dental claims

through Cost-Plus.

Must buy travel

insurance separately.


Milestone

Increase of salary – let us know!

Anything more than 15% increase requires health evidence.


Milestone

MarriageBaby

New spouse – change beneficiaryCommon 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 itRequire

Applying toEI first?

Is your planSelf-insured,

And the claimIs legitimate or

Does not involveconfidential info?

Produce an ROE and

sendemployee

to EI

Sickness

NoYes

Yes

No

Pay them From payrollAt a reduced

amount

GiveEmployee

S.T.D. claimForm forinsurance

If you have STD

Yes No

Day 0


Sickness

Communicate with the employeeat least once per week.


Do you have an

LTD plan?

Give the Employee The LTD

Claim form

Suggest They apply

To CPPdisability

Sickness

NoYes

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


LTD

Extension of benefits

6 - 12 months is reasonable per common law


...but it’s the employer’s choice


LTD

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

•However, we recommend you continue paying the premium anyway, and thus continuing the disability benefit, to protect against the worst case scenario


Owners should consider opting out of LTD


Funding sick programs-SUB plans

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


This amount must be passed on to employeesCompany Party / Cash / Benefit Plan …

Src: http://www.servicecanada.gc.ca/eng/cs/prp/0200/0200_020.shtml#a020-433Friday, November 29, 2013

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


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 her 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!


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


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


Many Hospitals are For-Profit $70,000 4-night hospital stay in PA (motorcycle accident)

$15,000 1-day hospital visit in LV (ear infection)

$30,000 4-night hospital stay in India(Owner of company said, “What? I am from that part of the world. I can buy a hospital for $30,000”).

Fair market pricing applies

Canadians are frequently overcharged



http://beneplan.clueadvance.com/

http://beneplan.clueadvance.com/

Ontario Trillium Drug Program


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


Why you should reconsider your 50/50 plan


Investigations and Surveillance:When you suspect sick leave abusePresented by: Shane SwinsonVice President, Sales and Marketing


Reasons for Investigations• Long Term & Short Term Disability Claims• WSIB/WCB Claims• Legal support for civil & criminal litigation• Irregular Absenteeism• Harassment • Intellectual property• Espionage• Conflict of Interest Issues• Drug/Alcohol Abuse• Time Theft• Labour Disputes


Expectations of Private Investigation firms and Investigators

• Licensed firm with the Ministry of Community Safety and Correctional Services

• PI maintains a valid Private Security and Investigative Services License

• Experience in solo surveillance vs. spin surveillance• Abides and understands PIPEDA restrictions around the

expectation of privacy • Has proper surveillance vehicle• Has video, still and pinhole cameras• Experience in preparing court-ready evidence• Has access to MTO


Suspicious Disability and WSIB Claims

• Verify authenticity of a suspicious disability or WCB claim with court-ready evidence gathered from covert surveillance.

• Consecutive surveillance days to show consistency• Quick turnaround of report before subject returns to work• Surveillance focused around employees normal work hours• Daily updates of activity• Surveillance around IME or doctor appointments• Clear understanding of limitations and/or restrictions


• Injuries and limitations as per the Physiotherapist:•Employee should be prevented from prolonged and

repetitive cervical flexing, rotation, upper body use, lumbar bending, twisting, lifting etc.

• Cannot lift ANY weight from floor to waist• Cannot lift more than five pounds from waist to shoulder• Unable to sit longer than 15 minutes but OK to drive• Requires a break every 5 minutes after walking• Limited use of left and right hands for gripping• Standing up to 15 minutes only

Recent Corporate InvestigationEmployee fell at work


Investigation RequestVideo Surveillance

•To conduct 3 consecutive days of video surveillance at claimants residence.

•Client would like conclusive and complete video evidence of the employee violating limitations as defined.

•Regular updates from investigator of daily activity.


Surveillance Conclusion

After conducting one day of surveillance the investigator and client decided that enough evidence was collected and sufficient and that consecutive days were not required.

The claimant was observed and video documentation was obtained with the following activities:


Activities of Claimant•Driving for more than half an hour and not stopping for a rest.•Lifting her child up above her waist.•Climbing on monkey bars supporting her weight and her

child’s weight.•Carrying her child on her back.•Attending to garage sales and purchasing a sewing machine.

Loading and unloading the machine without assistance.•Performing Yoga moves and balancing on one foot.•Attending to a child’s carnival and participating in the events

with her child. •Conducting activities on a rock climbing wall.


Red Flags•History of self employment or trade person who can readily

work for cash•Involved in seasonal work that is about to end•Rehabilitation report describes Claimant in a manner

inconsistent with claimed incapacity•Claimant can not be reached at home during working hours•Claimant has history of unexplained or excessive time off prior

to claimed injury•Claim conveniently made close to a possible plant

closure, layoff, job relocation•Frequently changes physician


Red Flags•Changes physician to obtain second opinion following a release to

return to work•Fails to keep appointments with medical provider•Invisible injuries – subjective complaints, back pain, strain,

headache, depression, chronic pain, fibromyalgia.•PO Box and cell phone rather than physical address and land line•Claimant near retirement age or spouse has recently retired•Claimant exhibits calloused hands/muscular development as

length of disability claim continues•Dueling doctors – one says disabled – other says healthy•Injury is inconsistent with normal healing process•Anonymous tip regarding claimants condition


Contact Information

Shane SwinsonFIC Vice President, Sales and Marketing

[email protected] 777-4653


mailto:[email protected]


Lunch


Martin WalkerThe Co-operators Life Insurance Co.


Cooperators & Beneplan Group Plan

November 28, 2013


Client experience survey

0%

23%

45%

68%

90%

79% 88%64%

Professionaland

CourteousStaff

Ease ofdoing business

Benefits NowWebsiteLayout


What’s new

Drug plan changes

Disability management

E-claim submission

Benefits Now™


E-claim submission

Speed Convenience Sustainability Security


Fraud prevention

Prevention and detection tools

Random audits

Medical and dental consultants

Red flags

Canadian Health Care Anti-fraud

Association


Drug plan changes

• Mandatory generic substitution

• Adverse reaction process

• Prescription contraceptives


• E-claim submission

• French site• Added reports

Benefits Now™ Updates

Benefits Now™ for Advisors

Benefits Now™ for Plan Members


Disability management

• Claims Analytics• Nervous / mental claims


CPP advocate

Gather medical information

Complete formsSubmit application


On the horizon


Reporting

Enhanced suite of reports available through Benefits Now™


Evidence-based drug formulary


Thank you!


Change your employees’ lives and claims experience

Evelyne Mitskopoulos C.N.P.

Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]


Disclaimer

The advice given in this presentation is the result of recommendations from medical doctors and researchers in the allopathic and complementary health community.

All recommendations are based on clinical evidence and studies which were published in peer-reviewed journals.

Any additional advice expressed here is opinion. Please conduct your own research. Everyone is unique and requires different lifestyle changes. Prior to making changes,

please consult your doctor.



Lunch & Learns

1:1

Phone / Email Advice

Articles on Beneplan website

Complimentary for members



Q: Who has benefited?


A: Everyone who asked



•Heart Disease•Diabetes•Osteoporosis•Weight Loss•Hormonal Balancing• Back Pain• Sports Nutrition• Immune System• Arthritis• Stress•Depression• Anxiety• Alternatives to meds

TopicsTopics


Turn up your Metabolism and Energize your Life



Energy Loss

•Fatigue•Brain fog•Headaches•Muscle twitches•Weight gain•Exhaustion with exercise•Body aches•Drowsy even after 8hrs sleep•Mood changes•Not a normal sign of aging



Causes of Loss of Energy

1. Stress and WorryDecreased noradrenalin

(“happy hormone”) = decreased brain function.

2. Mitochondria Dysfunction 3. Adrenal Fatigue (FMS/CFS)4. Poor Sleep5. Nutrient Deficiencies


6. Hormonal imbalances7. Sugar cravings8. Overweight /

Underweight 9. Acidic Environment ! - Causes oxygen level

to drop causing fatigue


BreakfastCut Caffeine - stimulant that delivers quick boost of energy but wears off



Adopt a Natural

High



Positive thinking - Increases noradrenalin

Stress saps nutrient stores

Cut alcohol & cigarettes

Balance hormones

Reduce inflammation


Practice Meditation


Energetic Diet Include magnesium-rich foods for the mitochondria (320 mg a day)



Energy Supplements

D-Ribose, 5 grams daily (sugar to make ATP)CoQ10, 150-300 mg dailyBioactive whey isolate powder, 4-5 tbs dailyMagnesium Citrate, 300 mg and up dailyL-Carnitine – 500 mg daily



Complex B Vitamins, 50 mg, 2X daily

Adrenal glandulars, 400-1000 mg daily “Adaptogens” e.g. Rhodiola rosea plant = remedy for anxiety, as it normalizes function and stimulate healing of cells,340 mg, 2X daily

Asian Ginseng aka Panaz (adaptogen and boosts energy) and boosts immune system, 200 mg, 3X daily

Vitamin D – 5,000 IU daily (get blood test)



Benefits of ExerciseEvelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]


Let’s not Forget that…



Thank You

Beneplan.ca 1 800 387 1670 x226

[email protected]@[email protected]@scm-fic.ca








beneplan benefits admin workshop - november 2013

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