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.