GROUP BENEFITS |
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Employee
Group benefits
may include:
●
Life
insurance
●
Extended
health benefits
●
Prescription
drugs
●
Travel
insurance
●
Dental
care
●
Disability
insurance
●
Critical
illness
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LIFE INSURANCE |
You
can select
from
two coverage options:
Flat
Amount: may be from $10,000 to $1,000,000
Salary
Based: 1, 2 or 3 times earnings, with a maximum amount
up to $1,000,000. The salary-based schedule has the added
advantage of keeping the benefit amount in step with
inflation and with the employee's changing financial
circumstances.
Waiver of Premium: The
premium for this benefit
may be
be waived if an employee becomes totally disabled while
insured.
Conversion
Privilege:
An
employee has the right to convert the Employee Life
Insurance to an individual policy without medical evidence
if group coverage terminates. Application for conversion
must be made within 31 days of the termination date.
The
Dependent Life benefit provides life insurance coverage for
an employee's dependents. For example, coverage for spouse is up to
$25,000 and for dependent child is up to $12,500.
Taxation:
Premiums for life and AD&D insurance are a taxable benefit for the
employee. Benefit is non-taxable when received.
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EXTENDED
HEALTH
CARE BENEFIT |
The
Extended Health Care benefit provides employees and their
eligible dependents with coverage for various medical
expenses that are not covered by the Provincial Plans.
This benefit may include:
-
Drug Benefit
-
Hospital services (semi-private
room, private room,
chronic care facility)
-
Vision
care may cover various
combinations of the following options:
-
eye
examinations (one per
calendar year);
-
glasses
or elective contact lenses,
to the maximum chosen for
the plan;
-
medically
necessary contact lenses,
subject to a benefit maximum
-
Professional/paramedical
services
-
chiropractors;
-
osteopaths;
-
podiatrists;
-
massage
therapists;
-
naturopaths;
-
speech
therapists;
-
physiotherapists;
-
psychologists;
and
-
other
practitioners
-
Medical services, supplies and equipment;
Medical services:
Medical supplies:
Other supplies:
-
artificial eyes, limbs and
breast prostheses;
-
braces,
trusses, collars, leg
orthoses, casts, splints;
-
stock-item orthopedic shoes,
including modifications or
adjustments to stock-item
orthopedic shoes or regular
footwear;
-
charges
for casted custom-made
orthotics;
-
custom-made shoes required
because of a medical
abnormality;
-
surgical
stockings;
-
surgical
brassieres;
-
wigs and
hairpieces.
-
Survivor Dependent Benefit:
This benefit
provides for the continuation of Extended
Health Care coverage for dependents, up to a
maximum of 24 months, if an employee dies
while insured.
See an example of
Health
& Drug Plans
for your business.
Taxation
(except in Quebec) :
Employer-paid premiums for Extended health benefits
are not a
taxable benefit for the employee. The
employee contributions are
eligible for the medical expense tax credit.
Benefits are not taxable when received by the plan
member .
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DRUG
BENEFIT |
This benefit will reimburse a group member and his/her
family for the purchase cost of prescription drugs. Maximum
annual reimbursement may be from $1,000 to unlimited.
Drug Plan Basis Types:
●
Brand
What are brand name drugs?
Companies that develop brand name drugs
hold a patent on the formula. A patent gives the drug maker
the sole right to produce and sell the drug.
Patents do not last forever and in
Canada, the patent lasts for 20 years. When they end, other
companies can make a drug that is like the brand name drug
in every important way. These drugs are called generic
drugs. They also cost less. But
they have the same key ingredient(s). Both generic and brand
name drugs follow the same quality and safety standards.
●
Voluntary
Generic
Generic drug substitution is a
widespread cost-saving measure on drug plans. It means that,
when a doctor prescribes a drug, the pharmacist dispenses
the lowest-priced equivalent (usually the generic) version
of that drug, if one is available. Generic drugs use the
same active ingredients as brand-name products, but usually
cost significantly less. However, if a physician writes "no
substitution" on a prescription, the higher-cost brand drug
may still be dispensed.
●
Mandatory
Generic
Mandatory generic substitution works
by targeting “multi-source” drugs, which are drugs that are
available as both a generic and
a brand. When a plan member is prescribed a multi-source
drug, the
plan
member is reimbursed based on the lowest cost alternative,
typically the cost of the generic drug. This holds true even
when a physician has indicated “no substitution” on the plan
member’s prescription.
When the drug prescribed is not a multi-source drug, meaning
it does not have a generic, interchangeable option, the
reimbursement is based on the cost of the brand drug.
●
Provincial
Formulary
Covers prescription drugs listed in the
Provincial Formulary.
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DENTAL CARE
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This
benefit provides employees and their eligible dependants
with coverage
for
expenses
incurred for dental treatment.
The Plan may include:
Basic and Supplementary Services
(preventive
care basic care, restorative services): oral exams, scaling and
polishing, fillings, pit and fissure sealants, diagnostic
and laboratory procedures, minor surgical procedures,
extractions, space maintainers, denture
repairs, relines and rebases periodontal services (treatment
of gum disease), including deep scaling, endodontic services
(root canals), surgical procedures - other than extractions.
Major Services:
initial placement of
dentures ,replacement of dentures,
crowns and onlays, inlays, replacement of crowns,
bridges (including replacements).
The group must have at least 3 participants for Dental coverage
to be eligible for Major Services.
Orthodontic Services for
dependent children prior to reaching age 19. The group must have at least 5
members with family coverage to be eligible for Orthodontic
Services
Survivor
Dependent Benefit:
This
benefit provides for the continuation of Dental Care
coverage for dependents, up to a maximum of 24 months, if an
employee dies while insured.
See an example of
group dental options for your business.
Taxation
(except in Quebec)
:
Premiums for Dental Care benefit paid by the employer are not a taxable
benefit for the employee. The
employee contributions are
eligible for the medical expense tax credit.
Benefits are not taxable
when received by the plan member.
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TRAVEL INSURANCE |
Coverage for treatment required as a result of a medical
emergency which occurs during the first 60*
days outside the province of residence (provided provincial
plan coverage is in place).
*
Number of days may be
different with different insurance providers.
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DISABILITY INCOME
INSURANCE |
●
The Short
Term Disability benefit
Provides an employee with partial
replacement of lost income for short periods of total
disability. Benefits commence following the completion of
the elimination period and are payable up to the maximum
benefit period.
Elimination (waiting) period may be :
-
0 days for
accident, 3 days for sickness
- 0 days
for accident, 7 days for sickness
- 14 days
for accident, 14 days for sickness
Benefit
period may be 15 weeks, 17 weeks and 26 weeks.
Benefit
Amount: 55%, 60%, 66.7%, 70% or 75% of weekly earnings.
●
The Long
Term Disability benefit
Provides an employee with partial
replacement of lost income if the employee becomes totally
disabled while insured for this benefit.
Elimination (waiting) period: 15 weeks, 17 weeks or 26
weeks
Benefit
period: 2 years, 5 years, to age 65.
Benefit
Amount: 60%, 66.7%, 70% or 75% of monthly earnings.
Maximum
benefit: up to $10,000 (monthly)
Partial
disability: 50%
of the total disability benefit under the contract for up to 24 months of
partial disability
Taxation:
Employer-paid premiums are not
a taxable benefit to the employee.
Benefit: If the employer makes any
contribution to the disability insurance premiums, the
employee will pay income tax on the disability benefit
received. If the employee pays a 100% premium for disability
insurance, benefit is not taxable when received.
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CRITICAL ILLNESS
INSURANCE |
Critical
Illnesses, which may be covered by this benefit:
Cancer (Life-Threatening), Coronary
Artery Bypass Surgery, Heart Attack (Myocardial Infarction),
Stroke (Cerebrovascular Accident),
Alzheimer’s
Disease, Aortic Surgery,
Benign
Brain Tumour,
Blindness,
Coma, Deafness, Heart Valve
Replacement, Kidney Failure (End Stage Renal Disease), Loss
Of Limbs, Loss Of Speech, Major Organ or Bone Marrow Failure
and On Waiting List, Major Organ or Bone Marrow Transplant,
Motor Neuron Disease, Multiple Sclerosis, Occupational HIV
Infection, Paralysis, Parkinson’s Disease , Severe Burns.
The amount of coverage available depends on the size of the
group: minimum of $10,000
and up to $50,000.
Taxation:
Employer-paid premiums for Critical Illness insurance are
a taxable benefit for
the employee. Benefit is non-taxable when received.
NOTE:
The
information above provides a
brief description of benefits
and some of the taxation rules
for group insurance plans.
For detailed tax information, please consult with your
business accountant.
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