beneplan benefits admin workshop - november 2013
DESCRIPTION
Canadian benefits administration can be confusing. There are rules, regulations, exceptions, and all sorts of things to remember. Beneplan holds an annual workshop for its members to help them navigate the insurance system.TRANSCRIPT
Plan Administrator's WorkshopNovember 28, 2013
1Friday, November 29, 2013
Agenda• 10:00am Benefits Admin 101: How to manage your benefit
plan [for beginners]• 10:30am Advanced Benefits Admin: How to avoid lawsuits• 11:30am Guest Speaker: Shane Swinson from FIC: What you
can do if you suspect an employee is abusing sick leave/WSIB• 12:00pm Lunch • 1:00pm Draw• 1:10pm Martin Walker from The Co-operators Life – Q&A on
e-claims, fraud, pricing, and more• 2:00pm Evelyne Mitskopoulos CNP from Beneplan
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Responsibility to inform3Friday, November 29, 2013
Rules are to prevent taking advantage of the system
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Employees who ‘hack’ the system hurt their fellow employees and employer
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Why is the insurer skeptical?
Anti-selection.
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When you join on day 1…
No questions asked.
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You hire us to guard your piggy bank.
We’re the only industry where you give us $100,000 and we aren’t allowed to tell you where it went.
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Job Offer
Hire
Milestone
Sickness
Transition
Lifecycle of Employment
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Hire
• Need original doc• Deadline: 1 month -> effective date• COB• Opt-Out• Eligibility
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+DGL
Please be honest here
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Late Applications
Date of Hire
EffectiveDate
EnrolmentForm
SubmittedWith
Health evidence
Benefits Declined
You must tell the employee that she does
not have benefits
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Late ApplicationsCan pay
health, vision & dental claims
through Cost-Plus.
Must buy travel
insurance separately.
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Milestone
Increase of salary – let us know!
Anything more than 15% increase requires health evidence.
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Milestone
MarriageBaby
New spouse – change beneficiaryCommon law: after 12 months.
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Milestone
New home?
We need the address!
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Report w/in 31 days of the event
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Sickness
“I need to take time off.”
Now what?
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Do you have a
W.I./STD plan?
Does itRequire
Applying toEI first?
Is your planSelf-insured,
And the claimIs legitimate or
Does not involveconfidential info?
Produce an ROE and
sendemployee
to EI
Sickness
NoYes
Yes
No
Pay them From payrollAt a reduced
amount
GiveEmployee
S.T.D. claimForm forinsurance
If you have STD
Yes No
Day 0
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Sickness
Communicate with the employeeat least once per week.
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Do you have an
LTD plan?
Give the Employee The LTD
Claim form
Suggest They apply
To CPPdisability
Sickness
NoYes
Day 60
If they’re still sick… let us know!
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Sickness
Day 65
Follow up on filling out LTD forms
May take up to 2 months for approval
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LTD
Extension of benefits
6 - 12 months is reasonable per common law
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...but it’s the employer’s choice
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LTD
Premium Waiver: Life & LTD
Payment of premiums while off…what happens?
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What if the employee pays a portion of the benefits?
•Employee must continue to pay during leave•Usually done by sending cheques to the order of the Employer
•If he/she does not pay, send 2-3 letters of warning before cutting off the benefit
•However, we recommend you continue paying the premium anyway, and thus continuing the disability benefit, to protect against the worst case scenario
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Owners should consider opting out of LTD
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Funding sick programs-SUB plans
EI premium reduction program
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A program which is designed to reduce the employer’s EI premiums payable if that employer provides wage loss replacement coverage that meets Human Resources and Skills Development Canada’s requirements
To be considered for premium reduction, a plan that provides short-term disability benefits must:
- provide at least 15 weeks of benefits; - match or exceed the level of benefits provided by EI; - pay benefits to employees after 14 days of illness or injury; - be accessible to employees within 3 months of hiring; - cover employees on a 24-hour-a-day basis. - pass on the savings to employees for their portion
EI Premium Reduction Program
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This amount must be passed on to employeesCompany Party / Cash / Benefit Plan …
Src: http://www.servicecanada.gc.ca/eng/cs/prp/0200/0200_020.shtml#a020-433Friday, November 29, 2013
How EI Sickness and WI programs interact• The WI program is a replacement for EI sickness benefit
• You elect to have one or the other
• If you wish to keep the EI sickness program, but you don’t like their maximums, or their waiting periods, it’s possible to co-ordinate both benefits by using the supplementary unemployment insurance sickness benefit (SUB)
• The SUB plan must be registered with EI
• The SUB plan needs to be drafted to indicate exactly what’s offered
• EI requires a 2-week waiting period, the SUB plan can make payments during these 2 weeks without interfering with EI sickness plan
• EI would offset some payments from the employer, however, if a SUB plan is in place, EI will not offset any top-up payments to improve the maximum
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Taxability of benefits
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Don’t Forget…• Life insurance, AD&D, DGL* are taxable benefits – add to T4s• Employees pay for LTD benefit is non-taxable upon collection• If LTD benefit is non-taxable, and you do not charge employees
for their portion of the premium, you must add the premium onto T4s
• New dependents, beneficiaries, etc
*Dependent Group Life
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Transition
Never terminate a sick employee or one on paternal leave.
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Benefits extensions• The employee quits or resigns with notice - The termination date would be the last day worked.
• The employee is being fired for cause - Terminate the coverage on the day the employee is fired.
• Voluntary leave of absence - The company may choose to suspend or extend benefits
- Let us know before you offer to extend benefits.
- Your decision must be communicated in writing to the employee.
- If the company chooses to extend benefits, LOA is required.
Transition
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Terminations / Non Active Employees
• Company Lay off – the layoff expected to be less than 13 weeks
• The Employment Standards Act (ESA) states that companies that lay employees off temporarily up to 13weeks, are not deemed to have terminated these employees;
• In this case, the company may choose to suspend benefits during such layoff or may choose to extend benefits during the layoff.
• If the company chooses to extend such coverage, the company must apply for a Letter of Agreement (LOA).
• All benefits, with the exception of short/long-term disability, out-of- country coverage and weekly indemnity can be continued, up to 13 weeks. After 13 weeks, only health & dental may be covered, up to 35 weeks.
• This must be documented by the way of LOA.
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Terminations / Non Active Employees
• Company Layoff – the layoff expected to be more than 13 weeks
The Employment Standards Act (ESA) states that companies that lay employees off for longer than 13 weeks, the employees are not deemed terminated if the company extends all their benefits.
In this case the company must apply for a Letter of Agreement (LOA).
All benefits, with the exception of short/long-term disability and out-of- country coverage can be continued, for a period of up to one year. This must be documented by the way of LOA.
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What happens if the employer changes her mind re: layoff?
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Terminations6. Benefits during the notice period
The ESA requires that all benefits, including disability, must continue, whether the employee is actively working or not, for the number of weeks, set out by the Employment Standards Act (ESA)
For Ontario:Working for 3 months or more; less than 1 year (1 week)
1 year or more; less than 2 years (2 weeks)3 years or more; less than 4 years (3 weeks)4 years or more; less than 5 years (4 weeks)5 years or more; less than 6 years (5 weeks)6 years or more; less than 7 years (6 weeks)7 years or more; less than 8 years (7 weeks)
8 years or more (8 weeks)
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Terminations / Non Active Employees
• Severance - Extension of benefits beyond the “Notice Period” requires legal documentation between the employer and the insurance carrier.
- All benefits would be extended, with the exclusion of any disabilities (short or long) and out-of-country coverage (on health).
- The employer must inform Beneplan if they wish to extend benefits beyond the termination date or notice period.
- An LOA is required in this case.
Ask us before you offer a package!
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Why it doesn’t make sense to extend LTD as part of a severance package
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Out of Country Coverage• Absolutely critical to call the
number on their out of country card before paying the any foreign medical provider
• Upon calling, the insurance company negotiates a fair market price with the medical provider
• If they are not called, it is possible the employee will be overcharged and not be able to claim the full amount upon return to Canada
• Communicate this to all employees
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Many Hospitals are For-Profit $70,000 4-night hospital stay in PA (motorcycle accident)
$15,000 1-day hospital visit in LV (ear infection)
$30,000 4-night hospital stay in India(Owner of company said, “What? I am from that part of the world. I can buy a hospital for $30,000”).
Fair market pricing applies
Canadians are frequently overcharged
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Ontario Trillium Drug Program
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Your Duty of Care
• If an employer sees than an employee is about to do something legal under normal circumstances, but indeed that employee could be causing harm to themselves, the employer has a duty of care to warn the employee
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“Ought to have known”
• If an employee is acting in a certain fashion that under normal circumstances indicates that they’re facing a problem then the employer, then the employer, having the duty of care to inform, cannot hide behind the expression “I did not know.”
• In the common law, employers “ought to have known” if there is enough circumstantial evidence.
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Refusal of Benefits
• Life insurance and Long Term Disability should be mandatory or a condition of employment
• Refusal of benefits form
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Why you should reconsider your 50/50 plan
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Investigations and Surveillance:When you suspect sick leave abusePresented by: Shane SwinsonVice President, Sales and Marketing
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Reasons for Investigations• Long Term & Short Term Disability Claims• WSIB/WCB Claims• Legal support for civil & criminal litigation• Irregular Absenteeism• Harassment • Intellectual property• Espionage• Conflict of Interest Issues• Drug/Alcohol Abuse• Time Theft• Labour Disputes
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Expectations of Private Investigation firms and Investigators
• Licensed firm with the Ministry of Community Safety and Correctional Services
• PI maintains a valid Private Security and Investigative Services License
• Experience in solo surveillance vs. spin surveillance• Abides and understands PIPEDA restrictions around the
expectation of privacy • Has proper surveillance vehicle• Has video, still and pinhole cameras• Experience in preparing court-ready evidence• Has access to MTO
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Suspicious Disability and WSIB Claims
• Verify authenticity of a suspicious disability or WCB claim with court-ready evidence gathered from covert surveillance.
• Consecutive surveillance days to show consistency• Quick turnaround of report before subject returns to work• Surveillance focused around employees normal work hours• Daily updates of activity• Surveillance around IME or doctor appointments• Clear understanding of limitations and/or restrictions
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• Injuries and limitations as per the Physiotherapist:•Employee should be prevented from prolonged and
repetitive cervical flexing, rotation, upper body use, lumbar bending, twisting, lifting etc.
• Cannot lift ANY weight from floor to waist• Cannot lift more than five pounds from waist to shoulder• Unable to sit longer than 15 minutes but OK to drive• Requires a break every 5 minutes after walking• Limited use of left and right hands for gripping• Standing up to 15 minutes only
Recent Corporate InvestigationEmployee fell at work
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Investigation RequestVideo Surveillance
•To conduct 3 consecutive days of video surveillance at claimants residence.
•Client would like conclusive and complete video evidence of the employee violating limitations as defined.
•Regular updates from investigator of daily activity.
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Surveillance Conclusion
After conducting one day of surveillance the investigator and client decided that enough evidence was collected and sufficient and that consecutive days were not required.
The claimant was observed and video documentation was obtained with the following activities:
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Activities of Claimant•Driving for more than half an hour and not stopping for a rest.•Lifting her child up above her waist.•Climbing on monkey bars supporting her weight and her
child’s weight.•Carrying her child on her back.•Attending to garage sales and purchasing a sewing machine.
Loading and unloading the machine without assistance.•Performing Yoga moves and balancing on one foot.•Attending to a child’s carnival and participating in the events
with her child. •Conducting activities on a rock climbing wall.
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Red Flags•History of self employment or trade person who can readily
work for cash•Involved in seasonal work that is about to end•Rehabilitation report describes Claimant in a manner
inconsistent with claimed incapacity•Claimant can not be reached at home during working hours•Claimant has history of unexplained or excessive time off prior
to claimed injury•Claim conveniently made close to a possible plant
closure, layoff, job relocation•Frequently changes physician
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Red Flags•Changes physician to obtain second opinion following a release to
return to work•Fails to keep appointments with medical provider•Invisible injuries – subjective complaints, back pain, strain,
headache, depression, chronic pain, fibromyalgia.•PO Box and cell phone rather than physical address and land line•Claimant near retirement age or spouse has recently retired•Claimant exhibits calloused hands/muscular development as
length of disability claim continues•Dueling doctors – one says disabled – other says healthy•Injury is inconsistent with normal healing process•Anonymous tip regarding claimants condition
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Contact Information
Shane SwinsonFIC Vice President, Sales and Marketing
[email protected] 777-4653
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Lunch
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Martin WalkerThe Co-operators Life Insurance Co.
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Cooperators & Beneplan Group Plan
November 28, 2013
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Client experience survey
0%
23%
45%
68%
90%
79% 88%64%
Professionaland
CourteousStaff
Ease ofdoing business
Benefits NowWebsiteLayout
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What’s new
Drug plan changes
Disability management
E-claim submission
Benefits Now™
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E-claim submission
Speed Convenience Sustainability Security
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Fraud prevention
Prevention and detection tools
Random audits
Medical and dental consultants
Red flags
Canadian Health Care Anti-fraud
Association
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Drug plan changes
• Mandatory generic substitution
• Adverse reaction process
• Prescription contraceptives
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• E-claim submission
• French site• Added reports
Benefits Now™ Updates
Benefits Now™ for Advisors
Benefits Now™ for Plan Members
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Disability management
• Claims Analytics• Nervous / mental claims
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CPP advocate
Gather medical information
Complete formsSubmit application
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On the horizon
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Reporting
Enhanced suite of reports available through Benefits Now™
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Evidence-based drug formulary
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Thank you!
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Change your employees’ lives and claims experience
Evelyne Mitskopoulos C.N.P.
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Disclaimer
The advice given in this presentation is the result of recommendations from medical doctors and researchers in the allopathic and complementary health community.
All recommendations are based on clinical evidence and studies which were published in peer-reviewed journals.
Any additional advice expressed here is opinion. Please conduct your own research. Everyone is unique and requires different lifestyle changes. Prior to making changes,
please consult your doctor.
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
80Friday, November 29, 2013
Lunch & Learns
1:1
Phone / Email Advice
Articles on Beneplan website
Complimentary for members
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Q: Who has benefited?
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
A: Everyone who asked
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Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
•Heart Disease•Diabetes•Osteoporosis•Weight Loss•Hormonal Balancing• Back Pain• Sports Nutrition• Immune System• Arthritis• Stress•Depression• Anxiety• Alternatives to meds
TopicsTopics
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Turn up your Metabolism and Energize your Life
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Energy Loss
•Fatigue•Brain fog•Headaches•Muscle twitches•Weight gain•Exhaustion with exercise•Body aches•Drowsy even after 8hrs sleep•Mood changes•Not a normal sign of aging
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Causes of Loss of Energy
1. Stress and WorryDecreased noradrenalin
(“happy hormone”) = decreased brain function.
2. Mitochondria Dysfunction 3. Adrenal Fatigue (FMS/CFS)4. Poor Sleep5. Nutrient Deficiencies
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
6. Hormonal imbalances7. Sugar cravings8. Overweight /
Underweight 9. Acidic Environment ! - Causes oxygen level
to drop causing fatigue
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BreakfastCut Caffeine - stimulant that delivers quick boost of energy but wears off
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Adopt a Natural
High
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Positive thinking - Increases noradrenalin
Stress saps nutrient stores
Cut alcohol & cigarettes
Balance hormones
Reduce inflammation
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
Practice Meditation
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Energetic Diet Include magnesium-rich foods for the mitochondria (320 mg a day)
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Energy Supplements
D-Ribose, 5 grams daily (sugar to make ATP)CoQ10, 150-300 mg dailyBioactive whey isolate powder, 4-5 tbs dailyMagnesium Citrate, 300 mg and up dailyL-Carnitine – 500 mg daily
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Complex B Vitamins, 50 mg, 2X daily
Adrenal glandulars, 400-1000 mg daily “Adaptogens” e.g. Rhodiola rosea plant = remedy for anxiety, as it normalizes function and stimulate healing of cells,340 mg, 2X daily
Asian Ginseng aka Panaz (adaptogen and boosts energy) and boosts immune system, 200 mg, 3X daily
Vitamin D – 5,000 IU daily (get blood test)
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Benefits of ExerciseEvelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Let’s not Forget that…
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc 1 (800) 387-1670 x 226 [email protected]
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Thank You
Beneplan.ca 1 800 387 1670 x226
[email protected]@[email protected]@scm-fic.ca
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