How we work

teamworkThere are many components to a comprehensive plan review with the assistance of our proprietary simulation diagnostic software. Each module diagnoses a different element of your plan and recommends a course of action based upon your corporate objectives and plan budget.

Components of our review

1Market Diagnostics

2. Prevention Diagnostic

3. Claims Diagnostic

4. Demographics Diagnostic

5. Administration Diagnostic

6. Company Policy Review


1. Market Diagnostic

Using the online quote systems, provided to brokers only, from Canada’s largest group insurance carriers, we attempt to establish a baseline for your existing plan (if your company has a plan) from which to discuss other plan models and benefit designs. 

If it has been more than 3 or 4 years since your plan was marketed, this is the first step regardless of if the company goes the fully insured route or not. It is up to the advisor and the plan sponsor to keep the carriers fair in their pricing. Once we have this marketing benchmark, we can then simulate the future plan performance using funding models.

2. Prevention Diagnostic

Preventing the underlying conditions that ultimately lead to drug claims is the ideal way for employers to maintain a productive workforce, and a necessary feature for reaching employee satisfaction thresholds. Every company depends on employees to run its business. It is in the employer’s best interest to minimize any conditions that can lead to costly claims. Studies show that employees want to be healthy, engaged, and productive. What actions can the employer take before the drug plan is used? Employee assistance programs (see below), is a proactive tool that can have very favourable results in helping an employee work through stress related issues that may lead to medication as the solution if not dealt with early.

One of the major challenges in getting a company like yours onboard with a Prevention Plan is the perceived difficulty in seeing returns on the investment. The reality is that the evidence is clear that these programs do work and should complete any group benefits program.

Wellness Initiatives delivered through in house or on-line seminars have shown to be very cost effective in enhancing the health of employees and are very much appreciated by employees may of who without these programs may never take action to improve their health.

Employee Assistance Programs (EAP) are a tried and true means of getting plan members timely and accurate medical advice and treatment as they need it and in many circumstances before resorting to drug or disability options when used correctly.

Health Risk Assessments make sure that active employees are aware of their health status – early and reliable intervention is the key to avoiding long term problems.

Manager Assistance Programs offer your leadership and HR team a confidential, secure place to which you can turn when health-related issues in your group arise.

Executive Coaching services make sure that the key people at the heart of your company are properly trained to work with their fellow employees and also are looked after. Everybody wants to work in a friendly and comfortable environment.

All of the above prevention like programs really can have an impact on reducing claims, either drug related and disability related .We can help you cut claims. It is not as difficult as it may sound.

3. Claims Diagnostic

As a plan sponsor, it is your responsibility to understand the plan’s exposure to potential claims it faces or will face, without impeding your employees’ ability to get the treatment they need to stay healthy and working to their potential. Getting an accurate picture of the true origins of your claiming patterns (drug audit) and specific demographics (demographics analysis) allow you to confirm whether or not your plan is right for your employees and your goals.

We will walk you through ways to reduce the cost to the plan and plan member for long-term treatment regimens in order to sustain health and functionality in the most effective way possible. 

Overall Plan Design Analysis A lot has changed over the last ten years in Canadian healthcare and employment trends. Is the plan you pay for still doing what it is meant to do? How do you know?

Prescription Drugs Audit– Since the vast majority (65-75%) of Extended Health claims usually come from prescription drugs, this is where smart plan management solutions can have the greatest impact. The miraculous revolution that biologic medications have brought to patients’ lives carries with it a significant price tag for drug costs hitting the drug plan. We make it our goal to stay on top of the latest solutions for shifting some of the burden of essential medications from struggling Group plans to government- and industry-sponsored programs. The Provincial Trillium Plan in Ontario is one such government sponsored plan for large consistent claimers. This will require some minor restructuring of your plan design to make these government plans work.

Risk Assessment will insulate a plan as a whole from the extreme risk posed by certain high-impact claiming patterns. It is no longer enough to employ stop-loss (large amount pooling) insurance on a per individual basis. These risks can include:

  • Acute claim spikes (eg. high-cost biologic drugs, many of which start at $10,000 per year);
  • Continuous claim patterns, often stemming from chronic conditions (eg. a relatively high proportion of claims stemming from treatment of diabetes);
  • or a combination of the above.

Each of these risk profiles has several management options available, with varying degrees of impact on cost today, claiming patterns down the road, and plan member comfort levels.

Industry-Specific Plan Design Benchmarking. With access to one of the largest supplier blocks in the Group Insurance industry, we place your plan design in the context of similarly sized companies in your sector or subsector. This is extremely helpful for plan sponsors to see where their plan sits relative to the competition, as well as to lend support any changes that must be acted upon.

4. Demographics Diagnostic

The people on a group plan are just as important as the chosen plan design. Demographics are proven to be a major determining factor for health-related risk exposure today and down the road. 

5. Administration Diagnostic

There are a number of ways to fund your Group Benefits program, and many small- and medium-sized clients are now open to less ‘traditional’ funding and administrative arrangements. We will provide the best options for the specific needs of your firm.

6. Company Policy Review

There are a number of corporate policies related to the employee benefits coverage that employers should include in support of their compensation strategy. 

Here are just a couple of company policies that can protect both plan and plan member from severe risk and liability:

Extension of benefits coverage for transitioning employees toward retirement or termination, either through the core plan or by directing to another source (eg individual life, AD&D, disability, heath & dental, or critical illness insurance coverage)

A protocol for regular updating of income information for the employees/executives (so they are entitled to the full benefit for which you are paying)

Administrative error rider to the Corporate Liability Insurance program to cover the Employer in the event of clerical errors regarding the benefit program

Set policies that help you know your employees and allow you to gauge the success or failure of any preventative measures you unroll? Every employer should be surveying trends and changes in their employees’ behaviour such as: 

  • absenteeism
  •  excessive or progressive lateness
  • presenteeism’ (employees showing up but at noticeably and chronically reduced productivity)

We will walk you through a questionnaire to make sure you and your plan members are protected against issues relating to your group benefits offering so that your focus can remain on managing the plan itself. 

Employee Benefits