Group Health Benefits

Group Health Benefits

So, you have a normal job. Like, let’s say one with an actual office that you go to, which also has a staff room and a microwave for warming up your lunch. Having passed your three-month probation period at this normal job, your HR department will reach out to you about enrolling for Group Health Benefits.

You, on the other hand, are a Support Worker, and you don’t have a normal job. You don’t have an office to go to, with a staff room or a microwave for warming up your lunch. Your lunch will be whatever you order at a convenient fast-food drive-thru as you race between appointments. As a self-employed person, you also do not have an employer to offer you Group Health Benefits. Sucks! Yet, it’s not entirely despair; there is some hope, which I will shortly get to.

Ok, let’s take a deep dive into Group Health Benefits. For this information, I reached out to my Sun Life Insurance rep. It’s incredible how receptive these reps are when they consider that they can upsell you on your policy or talk you out of canceling it.

So my rep explained that companies that have been incorporated for three to six months and which have a minimum of two employees (three for Manulife) can approach insurance companies such as Sun Life or Manulife for Group Health Benefits proposals. The insurance company will then ask the company to provide demographic information about their employees: their ages, the date they were hired, whether they are Single or Family, and their salaries.

Next, the insurance companies do their number-crunching and provide the companies with usually three proposals for Group Health Plans, often classified as basic, standard, or enhanced. Monthly premiums to be deducted from the company's account will be applied to these plans, with a Single employee paying less than someone who is considered Family. The companies can, in turn, deduct such costs from their employees’ pay, but no more than 50%.

So, what coverages are included in these plans? In the spirit of full disclosure, I have to admit that one of my contractors hired me on, and I am enrolled in their Group Plan, so I am in a good position to explain. Hey! Don’t hate me! For years, I worked without such perks. FWIW, I still don’t have an office to go to or a staff room with a microwave for warming up my lunch. I am still eating out of McDonald’s and Tim Horton’s drive-thrus.

Your typical workplace Group Health Plan includes Life Insurance, Survivor Benefit, and Accidental Death and Dismemberment Insurance coverages. There are also the more popular EHCs (extended health coverage) for drugs, vision, and visits to healthcare professionals. Better Group Plans may also include dental coverage. My wife, who works in the corporate world, has such a plan, but, hey, I guess they have to find ways to incentivize people to stare at a computer all day. I couldn't do it. I tease her:)

Typically, conditions are often attached to these coverages. These often include a deductible, a minimum fee you must pay to get the ball rolling. As well, a co-insurance rate is often assigned, the percentage that the insurance will pay, with you paying the rest. Other conditions often include limits on how much you will be paid in a calendar year for an item, limits on the number of visits for a service, and specifications on the items covered.

Going back to my Sun Life rep, he explained that if the employee loses her job, the plan ends, and she will no longer be eligible for Group coverage. Within 60 days, the person may, however, apply for an Individual Plan, whether Single or Family, without underwriting or a health screening. After 60 days, underwriting applies, and a health screening is conducted. Based on the results, applicants may be rejected, or, if a preexisting health condition is found, conditions may be imposed. For instance, if the person has diabetes, their Individual Plan may exclude coverage for diabetic medicines.

Returning to you, Support Workers, as I promised: being self-employed, you can also apply for Individual Plans. However, because they do not benefit from buying power, these Plans are usually much more expensive than Group Plans. Below is a comparison between a Manulife class 100 --Gold Plan, Sun Life’s Personal Health Insurance (PHI) –Standard Plan, and Sun Life’s Health Care Coverage Choice (HCC)- Standard Plan. Sun Life’s PHI is an Individual Plan without underwriting, and its HCC is an Individual Plan with underwriting. Please feel free to email me for the full documents detailing the Individual Plans and what they cover, which my Sun Life Rep shared.

Notice that the coverages between Manulife’s Group Plan and Sun Life’s HCC are fairly similar, yet the premium for the Manulife plan is $67 monthly, whereas it is $663.33 monthly for the HCC, 10 times more! Even with Sun Life’s PHI Individual Plan, which has inferior coverage, it is still $436.14 per month.

So, Support Workers, mulling things over, is an Individual Health Plan worth it? Indeed, for a support worker with a shaky client base who may earn only $ 3,000 or less per month, giving up $436.00 of those earnings can seem hard, and they may sensibly opt to pass. Consider, on the other hand, a single-mom PSW who consistently earns around $5,000 per month. She may consider that she needs to take care of herself and have medical benefits in place so she can keep working and earning. She may also be concerned about her kids' medical care and seek to avoid unnecessary out-of-pocket expenses. Not to mention, tragedy happens in life, and she may consider it wise for her kids to get something in the event of her unexpected passing. For her, an Individual Plan may be worth seriously considering.

Setting aside the consideration of whether an Individual Plan is suitable for this single-mom PSW, let’s not miss the bigger lesson to be taken from this talk on Group Benefits for Support Workers. That is, working as scattered independent ants is often costly. Sure, many Support Workers want to be self-employed, but I believe many more want stable, full-time employment with benefits. Many more who simply want a ‘normal’ job. For these folks, we must continue to push the conversation about the most effective ways of 'normalizing' the field, and this talk on Group Benefits is meant to be another installment in that saga.

Health Benefits Comparison

Manulife Class- 100, Gold Plan, Group Plan

Drugs

-80% Reimbursement

--$5000 maximum

Vision

--100% reimbursements

--$300 maximum per calendar year

--Visual training to a maximum of $300 per 2 calendar years

Paramedical Practitioners

--80% reimbursements

-$500 per calendar year for Chiropractor, Podiatrist, Massage Therapist, Speech therapist, etc

--$1000 per calendar year for Psychologist, Social Worker, Clinical counselor, Psychoanalysts, etc

Monthly Premium

Employer pays $78.66

Employee pays $62.69

Sun Life’s PHI – Standard Plan

Individual Plan – No Underwriting

Drugs

– pay direct drug cards

--70% reimbursement on first $7000 of annual eligible expenses ($4900 paid expenses)

--100% reimbursement on the next $93000 of annual eligible expenses

--excludes oral contraceptives

-coverage of reasonable and customary dispensing fees up to the plan reimbursement

Vision

--100% reimbursement

--250 maximum every 2 years, including $50 maximum per eye exam

--1-year waiting period before coverage begins

Paramedical Practitioners

--100% reimbursement

--No per-visit maximum

--up to $300 per year, per type of practitioners

--Psychologists/Social worker, no per visit maximum, up to $1000 per year

Monthly Premium

$436.14

Sunlife’e HCC – Standard Plan

Individual Plan – Underwriting

Drugs

– pay-direct drug card

-80% reimbursement

-$1300 annual maximum

--full coverage of reasonable and customary dispensing fees up to the plan reimbursement

Vision

--100 % reimbursements

--200 maximum every 2 years, including $50 maximum per year

Paramedical Practitioners

--100% reimbursements

--no per-visit maximum

--$300 per year per type of practitioner and

combined maximum up to $500 per calendar year

--Psychologists/social workers; $70 per visit, up to 7 visits per year

Monthly Premium

$663.33