Costs remain a big concern in employee benefit plan design. Is your our organization torn between offering an innovative health benefit plan and affordability? It is a struggle to offer a generous benefits package while keeping costs to a minimum – delivering value in addition to cost-containment.
Here is a good strategy to transform your employee health benefit plan that can save you money and support your workforce.
If, like many employers, you decide to limit certain employee health benefits while investing in new ones, it will fall on you to make sure that systems are in place to support plan members when these plan design changes occur.
Communicating the option of individual health insurance and connecting plan members to SBIS for guidance can deliver the support system plan members need to successfully manage transitions – like removing drugs or major dental coverage, or capping paramedical maximums.
Personal health insurance – also known an individual health insurance – can provide coverage for individuals and their dependents. When faced with changes to their group plan, your employees need to know that they can purchase individual health coverage personally, and it is issued and owned in their name. The coverage is for life, regardless of where they work, or if they are working at all.
Where your group health plan provides very good coverage, the individual plan can deliver flexibility and coverage for the health benefits each employee wants most, like major dental costs or visits to massage therapists. Most importantly, the individual health insurance plan co-ordinates coverage to increase overall protection.
When introducing the concept of individual health insurance as a complement to your group benefit package, it is important to establish three key points of understanding with plan members:
1. The advantages of having individual health insurance
If the plan member doesn’t have personal health insurance already, it makes sense for them to carefully review the group plan. Is it meeting their needs and their family’s needs?
Personal health insurance coverage can serve as an important financial cushion for a member if
- they would like additional drug coverage or an “emergency back-up” for when prescription drug costs get out of hand because of a chronic issue
- there is concern about high healthcare costs that may result from an accident or illness, and they want a “safety net” in place
- their work is in transition or they are thinking of becoming self-employed. Having personal insurance in place ensures an individual won’t have gaps between those times they have group insurance and those times that they don’t
- they will soon be retiring. Plan for retirees may be more restrictive than coverage available when you are younger and healthier.
2. How to submit claims to two plans
An employee covered by a group plan may be confused about how individual health insurance claims can be used to maximize their health benefits. You can help build understanding of how to co-ordinate the plans. Review how the plans work together.
According to Canadian Life and Health Insurance Association Guidelines (CLHIA), the first payer is the Group Plan. The second payer is the individual Plan. When submitting a claim to the individual insurer, the employee should attach all copies of original receipts along with the explanation of benefits (EOB) they received with their claim from the group plan. This individual insurer will calculate the amount of the eligible expenses it must pay, which is the lesser of
- the amount the insurer would have paid had it been first payer
- 100% of the eligible expenses reduced by the benefit amount paid by the first payer.
3. How the plan maximums work together
It is important for employees to recognize that the group and individual health insurance plans are almost always going to have different types of coverage, maximum visits per year, and deductibles. Some health insurance plans limit the number of visits to a health or dental practitioner per year – for example, once every 9 months – and some plans have an annual dollar maximum. When one of the plans (first or second payer) pays out any benefit for a visit, it will count as a visit towards the maximum under both plans.
The important thing to know is that the plans will work together to permit coverage of up to 100% of eligible expenses. Group health insurance always pays benefits first, and individual health insurance pays eligible remaining expenses. Coordinating the benefits provided by the two plans could be very useful if someone in the employee’s family needs an expensive pair of glasses or orthodontic appliance.
At SBIS, we are ready to help with your communication plan. Employees have the option of using our website, where they can see all that we have to offer, or they can call us. We’ll find out exactly what they’re looking for and what kind of coverage they can afford. As a broker we have up to 50 different health and dental plans to choose from, so their options can be daunting without help. Speaking to someone who can put the different plans in laymen understandable terms is invaluable.
Alternatively, we’ll provide you (the employer) with all the information you need on individual health insurance options, and support information you can share with employees by email or on paper. We can even help with education sessions to make your choice and your employees’ choices easy and convenient.
Providing a support system that includes information on individual health plan options can go a long way to satisfying employee needs when you make group health benefit plan changes.
Take the opportunity to be your employees’ health support hero with a support strategy that includes individual health insurance. Coverage is available for employees aged 18 and over, regardless of occupation, tenure or full or part-time status, and is for life. In fact, individual health insurance provides coverage for consultants and retirees, too.
At SBIS we’re ready to answer all of your questions. Just give us a call or go online to discover the wide range of small group and individual health and dental insurance options we offer.