Sample plans

Sample plans

Under normal underwriting arrangements, prescription drug plans and dental care benefits are partially experience rated, while group life benefits are fully pooled. The life insurance and dependent life insurance benefit are based on the age/volume distribution of the group plan.

Under an experience rated basis, the annual renewal action is based on the financial results generated by the utilization of each individual employee benefit plan under a given type of insurance and taking into account the past performance where applicable, together with market conditions and general market rates.

The larger the enrollment, the more emphasis is placed on your individual experience. Conversely, the smaller the population the less emphasis is placed on the experience of the group and more so, on the pool of the insurer.

Under a fully pooled situation, the carrier assumes the entire financial risk and there is no accountability of premiums versus claims and experience. Renewal premium rates for fully pooled benefits such as group life and group long term disability is based on a combination of aggregate experience of the insurer's pool of similar business.

In the examples below, Plan B is approximately 25% lower in cost than Plan A.

Life insurance

Sample Plan A Sample Plan B
Flat $25,000. The coverage reduces by 50% at age 65 and terminates at age 70. Flat $25,000. The coverage reduces by 50% at age 65 and terminates at age 70.

Accidental Death & Dismemberment

Sample Plan A Sample Plan B
As per the principal sum above As per the principal sum above

Dependent Life

Sample Plan A Sample Plan B
· Spouse: $5,000
· Child: $2,500
· Spouse: $5,000
· Child: $2,500

Health care

Sample Plan A Sample Plan B
Deductibles
None apply (can be included as an option to reduce cost) · Family: $50 per year
· Single: $25 per year
Drugs
· 100% pay direct with a drug card
· Dispensing fee is covered
· Unlimited maximum
· 80% pay direct with a drug card
· Dispensing fee is not covered
· $5,000 annual maximum per person
 
Supplementary health care
100% coverage 80% coverage
Hospital coverage
Semi-private ward, health care deductibles and reimbursements apply where applicable Semi private ward not covered
Nursing care
$10,000 per calendar year $10,000 per calendar year
Ambulance
Transport to nearest hospital Transport to nearest hospital
Accidental dental
Covered Covered
AIDS Services Supplies
· Purchase of prosthetic supplies
· Purchase or rental of wheelchair, hospital bed or other durable equipment
· Purchase of prosthetic supplies
· Purchase or rental of wheelchair, hospital bed or other durable equipment
Out of province/country
· Emergency Medical Treatment and travel assistance
· Travel 100% co-insurance
· Emergency Medical Treatment and travel assistance
· Travel 100% co-insurance
Paramedical
$500 per practitioner per year $350 per practitioner per year with a $25 per visit maximum

Vision

Sample Plan A Sample Plan B
None None

Dental care

Sample Plan A Sample Plan B
Deductible
· Nil
· Basic and preventive
· Family $50 per year
· Single $25 per year
· Basic and preventive
 
Recall
6 months
80% co-insurance on covered charges
Current fee guide
9 months
80% co-insurance on covered charges
Current fee guide
 
Major dental
None None
Annual maximum
$1,500 per person $1,000 per person

Long term disability

Sample Plan A Sample Plan B
 
Monthly benefit
67% of monthly earnings to a maximum benefit of $5,000 --
Waiting period
120 days of total disability --
Benefit period
To age 65 --
Own occupation definition
24 months and then an any occupation definition will apply --
Offsets
Primary offsets with EI, WSIB, CPP/QPP --

If the Long Term or Short Term Disability Premiums are paid by the employee then the benefit is not taxable.

Short Term Disability can also be included and where requested, this benefit will be quoted as an option as is the case with Long Term Disability as well.

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