Core Benefits for Group Plans

Here are the basic building blocks of a Group Insurance Corporate Benefit Program

Pooled Benefits

  • Life Insurance
  • Accidental Death & Dismemberment (AD&D)
  • Dependent Life Insurance
  • Long-Term Disability Programs (including return-to-work programs)
  • Group Critical Illness Plans (lump-sum payout upon diagnosis of major illnesses or conditions, e.g. heart disease, stroke, or cancer.

Extended Health

  • Prescription Drug Plans: e.g. traditional, generic, or mandatory generic formularies
  • Paramedical Professional Services: e.g. physiotherapy, chiropractic treatment, massage therapy
  • Medical Services & Supplies 
  • Vision Care
  • Expanded Hospital Care: Semi Private and full private
  • Private Duty Nursing
  • Out-of-Country Emergency Medical Coverage and Travel Assistance
  • Out-of-Country Referral Coverage
  • Survivor Benefits: extension of coverage after death of plan member
  • Best Doctors – receive a second written opinion at no cost from an expert medical practitioner.

Dental

  • Preventative: diagnostics (including x-rays), routine cleaning, scaling, etc.
  • Maintenance: periodontics (gum treatment, root canals), endodontics (fillings), minor surgery, etc.
  • Major restorative: crowns, inlays, bridgework
  • Orthodontics 

Long term Disability (LTD)- (optional for many employers)

LTD will support sick or disabled employees over the period that the employee is unable to work. An LTD benefit should be accompanied by a pro active return to work program to cost justify this benefit. Modified duties or retraining are an example of such initiatives. At Group Insurance Toronto we will never endorse this benefit without these additional programs.

Plan Design

There are many combinations and permutations of how the above core products can be combined to create a group benefits plan. Not all plans will include all of the above products. The plan design will be dictated by company budgets and corporate objectives for offering the group benefit plan in the first place. Plan designs will have different co-insurance limits on each benefit. For example prescription drugs may require the employee to pay 20% to 30% of the cost typically. Dental plans may have an annual plan maximum of $1,000 to $1,500 and a co-insurance of between 20% to 30%. Vision care could be designed to pay $150 to $250 every two years. Paramedical coverage could provide for $300 per practitioner per year or could provide a combined maximum of say $900 for all practitioners per year.

Finally employers may elect to pay 100% of employee premiums or considerably less, perhaps 50% of the premiums. Within the plan design the employer will need to evaluate and choose an appropriate plan model which will impact on the monthly cost of operating the plan. The employer will in most cases be unable to do this evaluation without the assistance of a brokerage like GTI Benefit Solutions who offers the complete spectrum of plan models listed under the tab “Group Insurance Unraveled and most importantly has the tools to provide this very important comprehensive analysis.

Employee Benefits