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September 2018 Bulletin

News from The Benefit Specialists Corp.

From: The Benefit Specialists Corp. <>
Subject: News from The Benefit Specialists Corp.

Dear Ann,


We hope you enjoy the September 2018 edition of our bulletin.  Please feel free to contact us if you ever have any questions or concerns, we are here to help!

 The Benefit Specialists Corp. Newsletter



                                                                 September 2018

In This Issue
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The Benefit Specialists Corp. is more than willing to answer any questions you or anyone you know may have had.  If you know someone who has questions regarding the insurance industry or anyone who wants to join our mailing list please contact me, or forward this email to them and get them to click the join our mailing list button below. 



A Health Spending Account (HSA)  is an innovative way

 to complement your group benefit plan. HSAs provide the

 ultimate blend of flexibility and cost containment, while enabling

 your employees to pay for medical and dental expenses not

 otherwise covered by your plan-with non-taxable dollars. Offering

an HSA to your employees not only helps maintain a healthy,

 productive workforce, but gives you an edge for attracting

 and retaining high-calibre employees.


 For .62 cents a day, your employees can prepare their wills, obtain unlimited phone consultations, 3 letters or phone calls per quarter, 5 (10) page documents reviewed, emergency access if arrested or detained and preferred member discount for complex issues.

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The Future of Prescription Drugs

Source: InnoviCares Card


Ms. Wong-Rieger adds that ensuring patients are on the right drug is critical to improving the odds of them actually taking the drug, the drug working and the patients avoiding becoming more sick or even hospitalized.


"Two-thirds of patients do not take their medications as prescribed, "she notes. "The more we can do to ensure patients get the most appropriate therapies, the more we can be sure we will get the right outcomes."Ms. Wong-Rieger says that a new patient benefit card that allows patients to continue on brand-name medications at a cost equivalent to generics, with the branded companies picking up the cost difference, is a step-in the right direction. 


The free card allows for continuity of care for patients who want to stay on drugs that are working for them. Halifax-based STI Technologies Ltd. launched the innoviCares program earlier this year, and it's being used in thousands of pharmacies across the country. Patients simply present the card (which they can obtain from their physician, pharmacist or at the website) along with their prescription search time they are filled. With generic medications successfully used by millions of Canadians every day, programs like innoviCares simply provide an option for those people who need to stay on brand medications.


source: Globe & Mail - Oct 8, 2013


What is Reasonable and Customary?

Source: Manulife Financial Employee Benefits News



"Reasonable and customary" (R&C) is a concept used by health and dental payers to ensure claim costs under benefits plans do not become excessive. R&C basically refers to the maximum amount allowable for a health or dental claim. Insurance carriers use R&C fees to protect employers from unreasonably high claims that increase the cost of benefits.


R&C permits reimbursement of eligible health and dental expenses based on the normal range of charges for services or supplies in the area where a charge is incurred. The normal range is determined by comparing costs of comparable services or supplies. In simple terms, R&C refers to the typical fees charged by local practitioners in a particular industry, in a particular geographic area.


For example:


Let's say that an employee who needs orthotic supplies has unlimited coverage for such things under her group benefits plan. If her orthotic provider's charge is $1,000 but the R&C limit for this type of service is $400, she would be reimbursed for $400 - even though she has unlimited coverage through her group benefits plan.


How can you find out what is considered reasonable and customary?


Unfortunately, there is no easy answer because most insurance carriers do not publish R&C fee schedules. The amounts are variable and may change significantly with a patient's individual medical condition, and are generally decided on a case-by-case basis. Also, the R&C fees reflect the maximum amounts payable. Most providers charge less than the maximum. If all R&C fees were published, the maximums would risk becoming the standard fee charged by individuals providing services. If health care providers all charged the maximum amount, and that amount was paid in every case, claim costs would increase dramatically, and so would your premiums.


Information courtesy of Manulife Financial's "Employee Benefits News", Volume 8, Issue 4, Fourth Quarter



The information contained in this bulletin is for general information purposes only. The articles published in this bulletin have been collected by The Benefit Specialists Corp. (TBSC) and we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability or availability with respect to the information, products, services, or related graphics contained.  Any reliance you place on such information is therefore strictly at your own risk.  In no event will we be liable for any loss or damage including without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever arising from loss of data or profits out of, or in connection with, the use of the information contained in this bulletin.  Through this bulletin you are able to link to other websites which are not under the control of TBSC.  We have no control over the nature, content and availability of those sites. The inclusion of any links does not necessarily imply a recommendation or endorse the views expressed within them.
Ann Hauk
The Benefit Specialists Corp.
(403) 547-5236

The Benefit Specialists Corp., 339 Tuscany Estates Rise NW, Calgary, Alberta T3L 0C6 Canada
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