For Plan Administrators
1. It is now possible to get a benefits plan with as few as one individual. However, smaller groups may require medical underwriting in order to obtain coverage
2. A group plan can have a combination, or all of the following benefits: Life insurance, Optional Life Insurance, Accidental Death and Dismemberment (AD&D), Dependent Life, Critical Illness, Short Term Disability (STD) or Weekly Indemnity (WI), Long Term Disability (LTD), Extended Health Care (EHC), Prescription Drugs, Vision Care, Dental Care, Health Spending Account, Registered Pension Plan, Group RRSP and enhanced Executive Compensation..
3. Yes. As changes to the plan are required, amendments may be done. You will need to check with your insurance carrier as to whether or not there is a stipulation of when the change can be implemented as some prefer changes to be done only at renewal time. You will also want to check as to whether or not there is any cost applicable to any changes made.
4. Costs are determined by various factors, such as the overall number of employees in the group, the number of males versus females and the ages of the employees, etc. Therefore, quotes are sent to market and an evaluation of this material is prepared to determine how much the plan will cost and the top carrier of choice.
5. When a group is set up, the rates are generally effective for next 12 months. Some benefits may have a guaranteed premium for longer. A group has an annual renewal date (12 to 15 months after date of inception), and at that time, the insurance carrier will determine (based on the dollar amount of claims paid versus premium received) what the rates will be for the next year with respect to EHC, Dental and STD. They can go up or down, or even stay the same. Life, AD&D, Dependent Life and LTD rates can also change up or down; however, the rates for these benefits are all based on the average age of the group and volumes of insurance for each age band.
6. Yes. In fact, you must have Alberta Health Care coverage in order to be a member of a group plan.
7. Yes, however, some industries are exempt from paying WCB. Also, owners may opt off of WCB if they have disability coverage.
1. Should you become disabled, your disability payment will be taxable to you if the employer has been paying your disability premium. Some benefits provided for under a Health Spending Account may also be taxable (see Health Spending Account section for further details). All other benefits are non taxable.
2. A contract will be drawn up with the effective date of the plan. This effective date will determine the date your coverage starts providing you were actively at work and were properly enrolled on the plan.
3. As an employee, your premium payments are not tax deductible. In fact, if your employer pays your Group Life Insurance premium on a benefit higher than $10,000, then this premium amount will be a taxable benefit to you.
4. If your child is under age 25 (this is the age typically used by the insurance companies), and attending an accredited post secondary institution on a full time basis, they are covered as a dependent on your benefits plan. Some plans have an additional condition, that they not be working more than 30 hours a week.
5. You need to compare the cost of each plan versus the benefits provided, to determine which plan would be best. However, you can each stay on your own company plan and then coordinate coverage so that benefits that do not provide 100% coverage would then do so. (Note: They will never reimburse over the 100%.)
6. A claim may be submitted through one plan and any unpaid portion can be submitted for payment by the other plan. With respect to dependants, whoever has their birthday first in the year will be first payor. For example, John Doe’s month of birth is March. His spouse, Jane was born in the month of September. John’s plan would be first payor.
7. Generally, group benefit plans do provide emergency medical while outside the province/country. Check with your plan administrator or benefits consultant to confirm coverage, the length of each trip; the co-insurance; and if there is a dollar maximum per trip/lifetime as these may vary from plan to plan.
8. Most plans do not cover trip cancellation; however there are some exceptions, so check with your plan administrator or benefits consultant.
9. Typically, you should contact the administrator of your group plan or your Benefits Consultant.
*These are general answers and not specific to your plan. Please check with your plan administrator or benefits consultant for the details of your plan.
Health Spending Accounts
1. A Health Spending Account (HSA) is similar to a bank account. Your employer allots a pre-determined dollar amount, per calendar year to your account held by a Trustee. This money can be applied to eligible expenses for yourself and your dependents as outlined by CCRA, which governs the HSA.
2. No federal or provincial tax is paid on the money deposited into an employee’s HSA or the reimbursement they receive from their HSA, provided their claim is an eligible medical and/or dental expense.
If it is not an eligible medical and/or dental expense, the reimbursement from their spending account becomes a taxable benefit, which must be recorded on their payroll.
3. Eligible Expenses which are non-taxable
(Medical and/or dental expenses that are not currently covered and/or included in the group benefit plan, or a benefit maximum has been reached)
– prescription drugs
– prescription eyeglasses/contact lenses
– massage therapy
– visits to a psychologist
– laser eye surgery
– whirlpool bath therapy
– nutritional counseling from a registered dietician
– allergy serums
– “extra billing” charged by chiropractors, optometrists, physiotherapists, dentists
– any other expenses permitted and outlined by Canada Customs and Revenue Agency rules.
(expenses that will be reimbursed by your HSA, but will be recorded as a taxable benefit on payroll)
– health club or fitness memberships
– sports mouth guard
– hospital room phone or television
– finance fee for dental expenses