Group Benefits

• provides basic life insurance to eligible employees
• benefit ranges usually from $25,000 – $500,000
• certain amounts are provided on a non-medical basis
• formula is generally a nominal flat amount or an amount linked to salary (i.e. 2x salary)
• most carriers decrease the life insurance by 50% for employees reaching age 65
• life insurance terminates at age 70 or when leaves employer unless employee has selected a conversion option at time was no longer eligible

• provides nominal life insurance to spouse and children of employee
• Spouse Amount generally between $5,000 and $25,000
• Child Amount is usually ½ of spouse’s amount and typically starts from the 15th day following a birth

This is an optional component of a Group Insurance package.

• provides short term disability coverage for an illness or injury that occurs while an eligible employee
• protection while on or off the job
• can select different waiting periods before benefit becomes payable generally options are:
  · Accident = 0, 7, 14, consecutive calendar days
  · Sickness = 3, 7, 14 consecutive calendar days
• benefits can be payable for 15, 17 or 26 weeks
• Formula for determining benefit amount is usually:
  · either 55% or 66.75% of earnings if the benefit is taxable
  · either 60-66.7% of earnings + graded formulas if benefit is to be non-taxable
• first day hospital protection can be selected
• for occupational coverage this benefit will be supplementary to Workers Compensation benefits
• there is an EI premium reduction for employers who offer this benefit through a group insurance program
• now WI provides a maternity sickness benefit consisting of 6 weeks for normal birth and 8 weeks for caesarian section

• provides disability protection for employees who are off work for longer periods of time with a disease or injury
• for most groups will be able to apply up to a certain level without providing any medical information
• waiting period 120 days
• disability definition can be based on own job at first and then any job after a certain period of time normal 24 months
• taxable benefit formula: 66.67%-75% of earnings
• non-taxable benefit formula: 60%-66.67% of earnings + graded formulas
• can select benefit periods from 2 years, 5 years or to age 65
• can include cost of living adjustments to protect benefit from being eroded by inflation
• usually include a conversion privilege
• may have a pre-existing condition exclusion for a limited period (usually 90 days)

• cover eligible medical expenses that are not reimbursed by provincial health care program
• generally provided on a co-insurance basis where the employee pays a certain predetermined percentage of the cost or benefits are payable at 100% after the employee has first paid a deductible
• semi-private or private hospital can be selected
• most plans will cover either all or a portion of the following benefits:
  • ambulance
  • acute/convalescent care
  • private duty nursing (annual maximum selected during design)
  • medical supplies
  • hearing aids
  • orthopedic shoes
  • Paramedical practitioners: chiropractors, naturopaths, osteopaths, speech therapists, dieticians, acupuncturists, massage therapist, chiropractors, physiotherapists, psychologist, social workers
• out of country coverage usually included and covered at 100%
• select a vision benefit that will provide $100, $150, $200 or $250 every 24 months per person
• select prescription drug coverage with either manual reimbursement or drug card for either generic or brand name drug coverage, can also select unlimited prescriptions or an annual drug limit
• for drug coverage can have a deductible, co-insurance, or have employee pay a certain amount per prescription

Depending on the group size, you may be able to select between basic, major and orthodontic benefits.

Basic

• usually covers oral exams, x-rays, fluoride, sealant, fillings, extraction, endodontics, periodontics, oral surgery, injections and anaesthesia

Major

• usually covers crowns, onlays, dentures, bridgework and denture related surgery

Orthodontal

• usually covers diagnostic orthodontic services and orthodontic appliances for children under 18, in some circumstances may be able to add adult orthodontic
• usually institute an annual maximum of $1,000, $1,500, $2,000, $2,500 per person per year
• recall can usually select between every 6, 9 or 12 months for routine dental recall
• usually institute a deductible and various co-insurance levels for the different types of dental coverage

• can offer a basic lump sum benefit, usually a percentage of life insurance or AD&D benefit
• will pay a lump sum within a certain period after a person has been diagnosed when a critical illness
• covered conditions usually include: heart attack, stroke, life threatening cancer, kidney failure, Alzheimer’s disease, blindness, coma, coronary artery bypass surgery, deafness, loss of speech, major burns, multiple sclerosis, muscular dystrophy, organ transplant, paralysis, Parkinson’s disease
• the payment can be used by the insured in any manner they wish, for instance they can use the money to alter their home, seek special medical treatment or pay off debts