What is a Plan Administrator?
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Plan Administrators are one of the most important components of a group benefits plan, but they are also regularly one of the most overlooked. The role of a Plan administrator is to serve as a key contact between the employees and the insurance company, providing...
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What is Incurred But Not Reported (IBNR)?
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There can be a significant delay in the reporting of claims, particularly for the higher volume benefits such as Dental and EHB. This can range from a few days to several months. This creates an issue, as a group's renewal rates are based on their claims experience,...
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What is an Employee Assistance Program (EAP)?
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An Employee Assistance Program (EAP) is an optional service offered as part of an employee benefits package that provides 24/7 assistance to employees on a wide variety of topics. EAP is often considered as a complimentary service to a benefit such as Long Term...
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What is Out of Country coverage?
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Out of Country coverage (sometimes referred to as OoC, Out of Province or OoP) is a benefit that provides protection for employees that travel outside of their home province or outside of Canada. Depending on the insurance carriers plan design options, OoC will either...
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What is Paramedical coverage?
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Paramedical coverage, often referred to as simply Parameds is a subcomponent of the Extended Health Benefit (EHB). Parameds are an important part of the EHB benefit and typically account for 25-30% of EHB claims in an average group plan (second only to drugs). While...
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What is Critical Illness?
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The Critical Illness benefit is a relatively new addition to the Group benefits space. It pays out a lump sum benefit when an employee is diagnosed with one of a specific list of illnesses. These life altering conditions often come with financial burdens…
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What is a Healthcare Spending Account?
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Healthcare Spending Accounts (often referred to as HCSA or HSA) are essentially a bucket of money that can be spent on anything on the CRA eligible medical expenses list. HCSA's can be used to supplement or replace parts of a traditional benefits plan. For example, a...
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What is Dental coverage?
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The Dental benefit covers all or a portion of certificates dental work. Dental is considered a highly desirable and relatively low risk benefit, due to most certificates utilizing the benefit at least once a year. The claims themselves are predominantly low to mid...
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What is Group Life insurance?
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Group Life insurance is the same concept as Individual Life insurance, in that the benefit is paid upon the death of the insured and is paid to a defined beneficiary. However, unlike Individual Life insurance, the employee has limited control over how much coverage is provided…
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What is Medical Underwriting?
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One of the major advantages of Group insurance over individual coverage is that it is underwritten at the group level. Everyone in the same class pays the same rate, regardless of the risk they represent, wether they are young or old, healthy or unwell. However, this...
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What are mono-parental and couple rates?
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It is the catch all nature of the family status that led to the creation of mono-parental and couple rates. These options are typically not included unless requested. Note that one or both of these can be added, meaning you could opt to add couple rates but leave single parents in the family class.
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What is Administrative Services Only (ASO)?
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Administrative Services Only, most commonly referred to as ASO, is a type of insurance where the client takes the responsibility of covering claim costs and uses the insurance company primarily to administer the plan. This means the client is accepting a higher degree...
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What is Experience rating?
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When a benefit is experience rated it means that some portion of previous claims is taken into consideration when setting rates. This is far from an exact science, you are in effect using the past to try to predict the future. Every group has it’s own unique set of circumstances…
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What are Pooled rates?
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There are two primary methods used to calculate rates for group insurance, pooled rating and experience rating. Today's blog post is going to explore pooled rating. Benefits such as Life, AD&D, Dependant life, LTD and Critical Illness are all typically rated using...
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What is a Target Loss Ratio (TLR)?
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This month we'll be taking a closer look at various components of rating, starting with the Target Loss Ratio (TLR). A TLR, put simply, is a representation of the % of a groups premium that is available to pay claims. Every group has expenses, such as claims...
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What is AD&D?
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Accidental Death & Dismemberment coverage, most often referred to as AD&D, provides protection in the event that an employee is killed or seriously injured in an accident. Most group plans include AD&D insurance due to it's low rate. It's worth noting that...
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What is Short Term Disability (STD)?
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Short Term Disability (STD) is also known as Weekly Indemnity (WI). It provides an almost immediate income in the event that an employee is unable to work due to an accident or sickness. It is often used once an employee has run out of available sick/health days...
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What is Long Term Disability (LTD)?
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Long Term Disability (LTD) provides a monthly source of income in the event that an employee is unable to perform the duties of their role, and meets the carriers definition of disabled. This provides an essential income during a difficult time in the employees life,...
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What is Mandatory Generic Substitution?
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What is Mandatory Generic Substitution? Mandatory generic substitution is an option on the drug plan that controls on what basis a drug claim is paid. In situations where a lower cost generic alternative exists to a brand name drug, the drug plan will only cover the...
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GiO Advisor portal – Creating a new RFP
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We've put together a quick video to show you how easy it is to create a new Request For Proposal in the GiO Advisor portal. https://www.youtube.com/watch?v=Lm0-M4soFQg We're planning to do more of these videos on the various features and functions available. We'd love...
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GiO-pinion: Large recurring claims and transferability
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Having a group with a large recurring drug claim can sometimes make moving that group to a new carrier a challenge. This could limit the groups options and make it harder for them to maintain competitive rates. This may leave the group with little choice but to accept...
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What is Stop Loss/EP3?
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Stop Loss, often referred to as large amount pooling, EP3 or drug pooling, is additional protection sold as part of the Employee Health Benefits (EHB) portion of a Group insurance plan. Stop Loss is best compared to a more traditional insurance like house...
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What is a Non-Evidence Maximum?
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Non-Evidence Maximums, also referred to as NEMs, Non-Evidence Limits or NEL's are the highest amount of coverage a plan member can have without providing medical evidence of good health. Providing NEM's is an advantage to both the plan members and the insurance...
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