Group Benefits
1. Drug Coverage (picture of drugs or medic with drugs)
Drug benefits are an important feature of a comprehensive Group Benefits program. Drugs represent approximately 70% of health care expenses and so effective claims management, controls, and innovative plan designs are the keys to selecting the right drug plan.
2. Extended Health Care:
The Extended Health Care (EHC) benefit provides reimbursement of necessary medical expenses incurred by plan members only, or plan members and their eligible dependants. EHC benefits are designed to supplement the hospital and medical care available through provincial plans.
EHC benefit includes (but is not limited to) coverage of the following (subject to policy limitations as determined by the plan sponsor):
- Drugs;
- Hospital services;
- Vision care;
- Professional/paramedical services (for example, chiropractor, physiotherapist, psychologist, massage therapist);
- Medical services, supplies and equipment;
- Private duty nursing;
- Out-of-province/out-of-Canada medical services;
- Out-of-province/out-of-Canada medical and after hours assistance;
3. Dental Coverage:
Dental care benefits provide comprehensive dental services and supplies for plan members and their eligible dependants. It is the second most popular benefit sold and is typically sold with the Extended Health Coverage.
Dental treatment is generally not covered by any government plan but the coverage is used by almost all plan members.It provides reimbursement of expenses incurred by plan members, or plan members and their eligible dependants, for dental care services and supplies.
4. Health Care Spending Account
A Health Care Spending Account (HCSA) is a health and dental benefit administration feature that can be part of a traditional or flexible benefits plan. It operates in a similar fashion to a bank account:
Plan members submit health and dental expenses against the account until the balance is zero or is no longer available for use.
HCSAs are an effective tool to assist plan sponsors in managing overall plan costs. With an HCSA a plan sponsor can:
limit liability while increasing benefit flexibility;
retain benefits at a predetermined level instead of providing additional coverage through their core plan; and
help provide employees with greater satisfaction.
5. Cost Plus
Cost Plus is a non-insured, ASO benefit arrangement where the plan sponsor requests the processing of certain ineligible claims under the core policy. The plan sponsor reimburses Manulife Financial for the cost of the claim as well as the corresponding administrative expenses.
Cost Plus is applicable to Extended Health Care (EHC) and dental benefits and is available to all segments. It provides flexibility to reimburse non insured expenses for plan members, usually those in classes eligible for the most extensive coverage.
6. Employee & Family Assistance Program
A service or suite of services implemented in the workplace to assist employees and their immediate family in coping with or addressing issues related to the effects of daily living.
It typically offers solution-focused counselling that teaches plan members skills to help them problem solve and become more resilient when faced with adversity.
EAP’s are an early intervention or preventative solution – they are not intended to replace long-term couselling or the need for residential placement to address serious mental health issues or addictions.
EAP’s are designed to provide the first line of support for the most common issues including, but not limited to:
- Stress;
- Marital/family/separation issues;
- Alcohol/drug abuse;
- Personal adjustment problems;
- Psychological disorders;
- Anger management;
- Pre-retirement planning;
- Aging parents/eldercare concerns;
- Sexual harassment;
- Conflict resolution;
- Gambling addiction;
- Bereavement.
EAP’s are traditionally thought of as more of a psychological service, however, more recently EAP’s often include services such as nutritional counselling and programs that target improved physical health.