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Frequently Asked Questions

I only have one employee, can I get a plan for just the two of us?

Absolutely! We recommend the Chambers of Commerce Group Insurance Plan for small employers because of its strength and stability.  We are pleased to be the authorized Chamber representative in the Durham Region. 

Why shouldn’t I always go with the “cheapest” plan?

Not all plans are created equal. If you have not had group benefits before, let us help you get started. We can assist with plan design so that you are able to minimize the risk of high claims and their effect on your future plan costs.

If you already have group benefits, we can assist with helping you understand how group pricing works along with plan design changes that will help you better control costs.

Do I really need a group plan? Why can’t I just expense medical and dental costs through my business?

The Canada Revenue Agency (CRA) sets out the guidelines for claiming medical and dental expenses through a business.  The guideline stipulates that there must be a third party administrator (a benefit provider) to administrate the claims and that your business must be charged a fee for this service.  If such an arrangement is in place, an employer’s benefit premium may be tax deductible and the health and dental benefits are tax free to your employee.   

But, I’m an owner . . . ?

A cost plus arrangement may be set up with an insurer to cover other CRA approved expenses for owners which may be outside the scope of the regular health and dental plan. *

* While we will help make this arrangement, please seek the advice of your tax consultant regarding the tax treatment for your plan for owners and employees. 

Why can’t I have more than one group benefit broker?

It’s about the relationship.

As an employer your focus should be on building a relationship, not how many brokers you work with. Working in partnership with your broker facilitates on-going, long term risk management advice.

At HMA, we focus on creating a partnership with you based on the needs and philosophies of your business. We take great pride in our client relationships.

Why must employees be enrolled within a specific time frame of their hire date?

If not enrolled within their employment terms (usually 90 days from full-time hire date) group benefit providers consider an employee a “late entrant”.

This means that an employee and their dependents will be subject to health questions, could be excluded or declined outright, along with having restrictions on dental claims, if approved. As an employer/administrator you do not want to be liable for this occurring in the event it frustrates the employment contract. Timely enrollment provides true risk sharing in costs and claims for the sustainability of your group plan as defined by the group industry processes.

Aren’t all group plans “pooled”?

While group benefit providers do pool life, accident death benefits, long-term disability, dependent life and critical illness, it is common for health and dental benefits within a group plan to not be pooled.  Each group plan is assessed annually on their own claims and the rates are adjusted to recoup past discounts and pay expected future claims.

* For Groups of 1-9 employees the Chamber of Commerce Group Plan does pool health and dental claims. You are collectively assessed each April with 30,000 other businesses across Canada. This provides long term stability ideal for small and growing companies.

Why can’t I opt out of my employer’s plan if my spouse has a plan?

You can “waive” health & dental benefits if your spouse has coverage but you should still enroll for the core benefits to ensure you are a participant.

All plans are not alike. For example, your spouse’s group plan will not provide you with long-term disability income protection and other employer features.

Why can’t I have my staff pay for the group plan?

Because group plans are employer sponsored and a component of employee compensation, providers do not approve of this practice. An employer should be paying a minimum of 50% of the cost, although some pay the entire amount to attract and retain the right employees.

What is an IBNR?

An “incurred but not reported” factor is a means of building a reserve within your plan.

Because an insurer is usually taking a 12-month snapshot of your claims to establish next year’s renewal pricing, there is a time lag in between the snapshot dates and the implementation of your new pricing. There is an assumption that within that lag, there are claims not yet submitted but will have to be paid. Providers levy an “IBNR” factor into your renewal pricing.

This could be a percentage of your health rate (9%) that is added to your health rate, or a pro-rated amount. It is for this reason that it does not make sense to change carriers based solely on a 5-10% savings as the new carrier has not levied your IBNR until the end of your first year with them, while your old IBNR stays with your previous carrier.

Enrolling New Employees

This is a basic function of the plan administrator.  It is important for the employer and employee to provide all information requested on the enrolment form. Enrolments may be sent at any time between hire date and end of the waiting period and no later than 31 days after the employee becomes eligible for coverage.  This ensures enrolment without the requirement of medical evidence. After the 31 days, the employee is considered a late entrant and medical evidence will be required.

What is a waiting period?

This is the length of time of an employee’s probationary period of employment (typically 3 to 6 months). All employees must serve the waiting period unless the employer chooses to waive this before the employee can begin to receive benefit compensation.

Effective dates of coverage

A new member’s effective date of coverage cannot be chosen arbitrarily.  It is calculated by taking the full-time date of hire as indicated on the enrolment form, and adding the waiting period.  If the employer is waiving the waiting period, the effective date of coverage becomes the date of hire or the first of the month following the date of hire.

Claim status

As your plan administrator, HMA will be with you throughout the claim period and will answer any questions that you may have. At HMA we do not address claims or track all the particulars of claims. Due to privacy guidelines, this information may be given to the member only. We encourage all members to call their provider’s customer service line or use online access to inquire about a claim status.

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