Coinsurance, evidence of insurability, coordination of benefits, reasonable and customary - all terms that feature in employee benefits but are not necessarily a part of the everyday vernacular of employees and their families. Navigating your personal health and dental needs can be complicated enough without having to decode the jargon included in your employee benefit booklets and summaries.
So what do all of these terms mean?
We are here to help you out - our quick vocabulary guide will define those terms most commonly featured in you benefit booklet and used when discussing coverage.
Beneficiary - The person(s) or entity you name in a life insurance policy to receive the death benefit.
Coordination of Benefits - When two or more insurance plans work together to pay claims for the same person.
Coinsurance - Cost sharing between the insurance company and plan member. If the coinsurance is 80%, the insurance company would pay 80% of an incurred expense and the plan member would pay 20% of the incurred claim.
Deductible - The amount a plan member pays out of pocket for health and/or dental services before your plan starts to pay. Deductibles can be per claim or per year and can be based on single or family status.
Evidence of Insurability - An application process in which a plan member provides medical information for themselves and/or dependants which is considered for approval of insurance coverage. This is most often requested when a member's coverage exceed the non-evidence maximum for a specific benefit line, applies for optional benefits or is a late applicant.
Explanation of Benefits - A statement sent to a plan member and/or health/dental provider from an insurance company explaining what treatments/services were paid or will be paid on a member's behalf. An explanation of benefits may come with a bill or predetermination and may include insurer codes when payment is limited or more information is required.
Non-Evidence Maximum - The maximum amount of insurance an individual can receive on a group benefits plan without providing evidence of insurability. This amount is normally dependent on the size of the group.
Pre-determination - Submission of a benefit expense estimate to confirm level of coverage for a particular health/dental care item.
Reasonable and Customary - The amounts to be paid by an insurer for a particular device or service. Reasonable and Customary amounts are determined by the general cost of a particular product/service in your geographic area.
Scaling Unit - A specific measure of time in relation to plaque removal. One scaling unit is equal to 15 minutes of scaling, or plaque removal, at a dental office.
These are not the only terms that you may encounter when reading through your benefit booklet as an employee, or during your annual renewal if you are a plan administrator or business owner. If you have any questions about benefit plan vocabulary, feel free to contact us at the office 403-346-2191 and we will be happy to clarify!
2018 was a year that brought big changes to the landscape of employee benefits - from a new dental fee guide to a new Employment Standards Code, our HR professionals and business owners have had to stay very much aware of how these changes not only affect employee benefits, but their business practices in general.
January 1, 2018
Employment Standards Code changes: job protected leave periods changed significantly this year with the protected period extending for the following:[i]
Overtime banking policy changes and a minimum wage increase also impacted our client payroll departments processing procedures.
January 1, 2018
Alberta's Dental fee guide, put into effect September 1, 2017, is updated and posted online as a reference for acceptable dental fees across the province. This published recommended fee guide is used by insurers to determine reasonable and customary fees for procedure codes.
February 26, 2018
Saskatchewan Taxation of Benefits: the provincial taxation of group life and health insurance premiums in Saskatchewan is reversed and any tax paid from the original implementation date of this taxation, August 1, 2017, will be reimbursed retroactively.
April 1, 2018
Generic Drug Prices Cut: the pan-Canadian Pharmaceutical Alliance and Canadian Generic Pharmaceutical Association announces that generic drug prices for 70 of the most commonly prescribed drugs in Canada will be reduced by 25% to 40%.[ii] Along with this change, a dispensing fee maximum of $12.15 was implemented for prescription drugs with the exception of diabetic supplies and compound medications.
April 17, 2018
WCB Alberta Benefit Extension Changes: "employment health benefits must continue while a worker is absent from work due to a work injury, if, when the accident occurred, the employer was making contributions for the worker"[iii]. This coverage must remain in place for one year after the date of accident and cover the worker as well as any eligible dependents covered under the employer's policy on the date of the accident. Employee's must continue to pay their contribution amount while absent to maintain coverage - it is the employer's responsibility to make the employee aware of any contribution amounts owing.
October 17, 2018
Legalization of Recreational Cannabis: Canada becomes the second country to legalize cannabis for recreational use. Though this does not have a direct impact on employee benefits as medical cannabis is considered entirely separate from its use recreationally, the legalization had a very obvious impact on businesses in our country as they updated their HR policies to come in line with the changes this brought with it. Along with updating HR policies, the legalization of recreational Cannabis has brought increased attention to the medicinal uses and insurance companies have been increasingly accommodating to the addition of medical cannabis through both their health spending accounts as well as their core plans for specific conditions with strong correlated effectiveness.
As we move into 2019, and beyond, we look forward to continuing to be a valuable resource for your business in the sharing of information that could influence your benefit and total compensation strategy decisions.
Please note, the above is not an exhaustive listing of changes that have occurred in 2018 and is meant to be a reference only. For more detailed or source information, please contact our office directly to discuss with your advisor
With the legalisation of marijuana close on the horizon, and medical marijuana use continuing to become more prevalent, it is important for employers, and employees, to understand their rights and responsibilities surrounding its usage.
Medical marijuana refers to the whole, unprocessed marijuana plant or extracts used to treat symptoms of illness and other conditions. Legal access to dried marijuana for medical purposes was first made available in 1999 under the Controlled Drugs and Substances Act (CDSA) but discussion surrounding medical marijuana has come more prevalent as updates to the CDSA have been made to increase accessibility (Health Canada, 2016). Since 1999, policies surrounding the production of and access to medical marijuana have evolved drastically and individuals that medically require marijuana, and have the authorisation of their health care provider, can now access cannabis by purchasing from a licensed producer, registering with Health Canada to produce a limited amount of cannabis for their own medical purposes or by designating someone else to produce this for them (Health Canada, 2016). With the rules surrounding medical marijuana changing and the correlated benefits of it usage for medical purposes becoming more wide spread, the taboo associated with the drug has begun to disintegrate and its usage for medical purposes has come more in line with that of any other prescription medication.
As with any medication, simply having a prescription for medical marijuana does not mean that an employee has the right to take their prescription without limitation in the workplace. An employer does have a legal duty to accommodate an employee's individual needs and, as per the Alberta Human Rights Act, this means that an employer cannot refuse to continue to employ or discriminate against any person with regard to employment due to a physical or mental disability (Alberta Queen's Printer, 2018). The duty to accommodate is not infinite and is limited to the point of undue hardship; included in the consideration of undue hardship are factors such as financial costs, disruption of operations and, most significant when looking at the usage of prescription medications, health and safety concerns (Alberta Human Rights Comission, 2001). It is important to note that, under no circumstance does an employer have to accommodate impairment in the workplace and that, should the use of any prescription medication lead to impairment, alternate measures can be taken to accommodate medication usage including a change of duties when available and adjustments in work and break periods.
Marijuana, consumed for any purpose other than as prescribed by a medical professional is considered recreational and is currently illegal but the legalisation of cannabis for recreational use is fast approaching. After legalisation, marijuana usage should be considered closely aligned with alcohol usage. its usage should be considered like alcohol usage. Because both alcohol and marijuana can cause intoxication, much of the wording surrounding the use of marijuana in the workplace should already be included in a comprehensive alcohol and drug policy but, once legal, marijuana no longer fits under the "illegal drugs" umbrella and should be explicitly listed under all policies addressing impairment and drug and alcohol usage. It is important to review current policies to ensure that they do discuss your company's approach to employees having possession of, or using, marijuana on company property, while on duty, or coming to the workplace while intoxicated. Some areas that require focus include:
It is common to have rules and regulations surrounding where and when employees can smoke at the workplace. Because some do view smoking marijuana as closely aligned with tobacco usage, it is important to clearly outline that smoking marijuana recreationally, on or off the premises during working hours is strictly prohibited. Likewise, it is important to specifically note that coming to work intoxicated , or becoming intoxicated at work, is not allowed. An employer does have a duty to accommodate medical marijuana usage but the employer has the right to choose the least disruptive accommodation option which can include requesting the employee to consume their medical marijuana privately and away from designated smoking areas.
Substance abuse policies
Substance abuse policies prohibiting intoxication on the job include wording most commonly touching on "alcohol, prescription and illegal drugs" which does not encompass the approaching legal usage of marijuana. Substance abuse policies should be updated to include wording surrounding the usage of and intoxication through the usage of recreational marijuana.
It is not unusual for workplaces to have a "zero tolerance" policy for alcohol and drugs especially when employees work in, or in close proximity to, safety sensitive positions.
Safe driving policies
Like alcohol, the use of marijuana can lead to intoxication, delayed reaction time and impaired judgement. Employer's should make it clear to employees that driving after use of alcohol and/or marijuana will not be tolerated.
A safe driving policy can include not only alcohol, marijuana and illegal drugs but also prescription medications that may cause impairment. For the purpose of a safe driving policy, and all policies relating to usage and impairment, a clear definition of impairment should be outlined.
Marijuana usage for medical reasons is coming more to the spotlight and company policies are being updated to ensure that they encompass the potential risks that medical marijuana, and prescription drugs in general, can present in the workplace. The legalisation of marijuana is likely to increase the potential exposure of a company to its effects in the workplace. With advancements in testing technology, clearer methods of establishing impairment will be coming available so it is important for employers to continue to remain up to date on the latest updates in testing and laws.
The included information is for reference purposes only, prior to establishing, or updating, any workplace policies, Integrated Benefits recommends seeking your corporate lawyer's advice and approval .
Feeling a little under the weather? Check in with your digital assistant to see if it might be able to help you out with your minor health concerns.
Prior to getting too in depth about how your digital assistant can help to navigate minor ailments, it is important to note that the information provided here, or through any of the medical advice applications, should not be used in an emergency situation or used in place of a physician's advice and should only supplement the information that is provided by a trained professional.
With digital assistants being one of the most popular holiday gifts this year, it is safe to say that these voice activated speakers have made an appearance in many homes for 2018. Whether it be Google, Siri, Alexa or Bixby, these digital home additions are impacting the way we listen to music, obtain recipes, find answers to our burning questions and, it turns out, determine how to cope with the common cold, a stomach ache or fever, among other common minor ailments. Online search engines have long been used by those with a nagging cough or obnoxious sniffle, to determine a potential diagnosis or at home treatment plan so it is no surprise that this new digital forum is being utilized for this same service.
The advent, and increasing popularity, of the voice activated home assistant has allowed for a surge of functions you can "teach" your device and these capabilities are valued by consumers because they offer ease of access; to explore health related topics, you simply have to speak to your voice activated assistant and the response will come from the enabled application.
WebMD - according to their website, the WebMD medical team works closely with over 100 health experts and physicians nationwide to provide accurate, relevant content that helps users to live a healthier life. The resources available online can now be accessed from your favorite voice activated device.
Mayo Clinic First Aid - currently an Alexa exclusive, the Mayo Clinic First Aid skill offers self-care instructions for a variety of everyday situations that can be better dealt with hands free including how to treat a cut, burn or fever.
Boston Children's Hospital KidsMD - first launched with Amazon Alexa in 2016, this app can be used to determine whether common childhood symptoms including fever, cough, headache, rash, vomiting, fatigue or shortness of breath warrant a call, or visit to your physician.
Healthtap's Doctor A.I. - using the expertise of more than 105,000 licensed doctors across 141 specialties, Dr. A.I. listens to your symptoms and provides a recommended course of treatment from its vast database. Dr. A.I. converses with its "patients" with compassion and sympathy to mimic a live physician.
Besides being used as an at home medical resource, AI voice assistants are now being utilized in some hospitals to aid with patient treatment. From patient communication, ER wait times and scheduling, these devices are making an impact. Each of the hospitals currently using this technology have built their own voice assistant projects which meet their goals but are offering advice and direction for additional institutions who may want to get on board - it may not be long before you will be visiting your local hospital for a routine surgery or emergency room sprain and start the conversation "ok Google, what are the wait times for the hospitals near T4N 2J4 and what are they serving for lunch today".
With digital assistants being the new popular electronic gadget, our insurers are moving from the world of mobile apps to voice assistant technology. Manulife has created a skill, currently running on Amazon Alexa, which allows you to easily check in on your current benefit balances answering questions like "Alexa, ask Manulife Benefits how much I have left for new glasses" or "Alexa, ask Manulife Benefits how much Harold has left for physiotherapy". Sun Life's Ella, available on Google Home, was the first interactive digital coach and offers updates on your benefits to make sure you are well informed and making the smartest decisions regarding your health benefit dollars. Ella provides current balances and last claims information as well as offering the opportunity to rate your providers and update participants on changes to their coverage including overage dependents. Both the Manulife Benefits skill and Sun Life's Ella, allow for you to request current information easily and hands free which, like many of the skills and applications available for digital assistants, fits into the increasingly busy lives we are living in the twenty first century.
As the Digital Assistant becomes increasingly common, we are excited for the further developments of healthcare, wellness and benefit applications that will add another portal of information for our plan sponsors and their members.
(2018). Skills from Mayo Clinic, Retrieved from https://www.mayoclinic.org/voice/apps
(2018). Who We Are, Retrieved from https://www.webmd.com/about-webmd-policies/about-who-we-are/
(2018). Discover Manulife skills for Amazon Alexa, Retrieved from https://www.manulife.ca/for-you/smarthome/alexa.html
(2016, December 15). HealthTap laounches DR. A.I - Meet your new, personal AI-powered physician, Retrieved from https://medium.com/@HealthTap/dr-a-i-80b4cf06be30
Comstock, Jonah. (2016, April 12). Boston Children's Hospital launches KidsMD, an app for Amazon's Alexa, Retrieved from http://www.mobihealthnews.com/content/boston-childrens-hospital-launches-kidsmd-app-amazons-alexa
Jackson, Brian. (2017, September 14). Sun Life's 'Ella' will serve as digital coach on Google Home, mobile, web, Retrieved from https://www.itworldcanada.com/article/sun-lifes-ella-will-serve-as-digital-coach-on-google-home-mobile-web/396566?template=A
Siwicki, Bill. (2018, February 1). Special Report: AI voice assistants have officially arrived in healthcare, Retrieved from http://www.healthcareitnews.com/news/special-report-ai-voice-assistants-have-officially-arrived-healthcare
Living in Canada, we grow accustomed to the chill of winter weather. Often, we take the snow and cold as permission to curl up in front of the television, curled in a blanket and binge watch our favourite TV program. We are completely on board with taking the occasional day off, relaxing with a big bowl of popcorn or mug of hot chocolate, but the length of our winter season can make it easy to become sedentary. Though it can be a bit daunting to venture outside, there are many great, fun, indoor or cold weather only activities that you can take part in this winter:
Although winter time can be a major influence in leading a more sedentary lifestyle for the colder months of the year, some of us have a compounded risk for inactivity which can include works factors such as a sedentary or desk job or lifestyle factors such as stress and technology. Some of the dangers associated with inactivity include:
Even if you aren't able to dedicate time to one of our winter activity suggestions every day, small lifestyle changes can have a huge impact. Take five minutes in the morning to get your circulation going by completing a full body stretch or use your coffee breaks at work as an opportunity to take a walk around the block or building.
Let's work together to stay healthy and active this winter!