September 2013 Bulletin

IMPORTANT BENECO NOTICE!

Beneco Inc. is excited to announce the addition of our new Beneco online administration system. This system will now allow you and your employees the ability to submit claims online and also allow you to keep track of pending claims that have already been submitted. Plan Administrators will now be able to enroll, and terminate employees instantaneously. Plan Administrators will also now have the ability to track usage, pending claims, declined claims, and much more.

Implementing the Beneco online system will benefit your company in the following ways:

• Faster claim submission and approval. Claims will now be paid out in five business days or less after the date of submission.
• Approved claimed amounts will now be instantly transferred to the account of the eligible employee. No more waiting for cheques in the mail or having them lost in the mail!
• Employees will now have the ability to download our app to their smart phone so that they can submit their claims from anywhere and at anytime.
• Employers will now have the ability to control and track their Beneco PHSP plan like never before.
• No increase in FEES!
• Plus much more.

Beneco Inc. will be making this change mandatory for all clients over a period of time and we will be in contact shortly to discuss the transition period.

If you would like to get your company on the fast track to implementation please contact us and we will be happy to do so. We are truly excited for this change and hope we can serve you even better going forward.

 Mandatory Contracts and Non Mandatory/Mandatory Contracts require 100% Participation of all eligible employees who are actively at work and satisfying the hourly requirements outlined in the booklet. Non Mandatory requires either 75% or 85% of all eligible employees. The plan administrator in this case is responsible for ensuring that 75% or 85% of all eligible employees are on the plan at all times.

This also means that when an employee is hired, and the participation is either 75% or 85%, and they choose to refuse benefits, they refuse all benefits. The employee cannot pick and choose what benefits they want. It is all or nothing.

The employee can waive health and dental if they have a spouse who is covered under a plan through their employer, he/she would then take the Pooled Benefits (Life, Accidental Death and Dismemberment, Dependent Life (if common-law or married) Disability, Critical Illness (if employer has taken this option). In fact if the member waives the health and dental, it is mandatory that they take all other benefits.

Even though your contract may state non mandatory, meaning it is only required for 75% or 85% of all eligible employees working 20 hours a week, it is important to explain to the employee why they should be on the plan.

Example - You have an employee who you have just recently hired and your policy has a three month waiting period to enroll the employee. This employee is adamant that they do not want coverage at all. In this situation you can have this person fill out a refusal of all benefits form, with dates and signatures of both parties involved for the personnel file.  They have now agreed that they do not want to be part of the plan.  If down the road, the member then states they want to be a part of the plan, they then fill out a detailed medical form. This is called the late applicant process.  If single they answer medical questions about them, if married or common-law they answer medical question about themselves, their spouse and any dependent children. Once they send this in to the medical underwriting department, a couple of things might happen.  

1) the employee gets approved, but because they are a late applicant they are subject to basic dental of $250 for one full year from the date of approval, but are put on the plan for all other benefits.  

2) the employee gets declined all together - this means they are not approved for any benefits for themselves or family members when they need the plan the most.  

The bottom line is that so many employees indicate that they do not need the benefit plan because they feel healthy and that nothing serious will happen to them. What they need to understand is that the vast majority of people who have become sick or disabled have felt healthy at one point or another in their life.

Advances in medicine have brought life saving drugs and hope to people suffering serious health problems.  Of particular note are biologic drugs, which are highly effective, however can be expensive.

Ten years ago, one of the most expensive drugs in Canada was Remicade, which cost $20,000 a year.  Today, a drug called Solirus rings in at $400,000.  While that's unusually high, many drugs on the market today cost tens of thousands of dollars a year. 

This increase in prescription cost is affecting claims experience of our clients (premiums vs. claims): the number of claims over $25,000 has been going up by 20% per year since at least 2008.

At the same time, more and more people have more and more chronic conditions that require medication.  New diagnostic technologies and treatment guidelines mean that doctors prescribe medication sooner than they would have in the past.  These and other trends are putting pressure on employee benefit plans.

As for now we as an industry are discussing ways to handle this trend. Going forward, group benefit plans as they are today, may cease to exists as the costs continues to rise. 

Current options to protect bad claims experience due to Biologics include implementing prescription drug caps, or changing the amount of co-insurance within a drug plan.