Benefits Assumptions & Standards
What assumptions does Benefits by Design make in quoting group insurance plans?
The following assumptions are in place for Benefits by Design to quote on providing coverage:
- Group has been in business for a minimum of one year
- Not more than 50% of the group is related (family) unless otherwise indicated in the Request to Quote
- All eligible employees listed in the census data provided have Canada Pension Plan (CPP) and Employment Insurance (EI) deducted at the source
- At the time of quoting, there are no employees off work due to disability — if so, they are disclosed at the time of quoting
- All employees have Workers Compensation Board (WCB) coverage unless otherwise indicated
- Must be at least 50% common ownership of the participating companies in cases of common ownership of multiple companies
- There are no claims exceeding stop-loss unless otherwise indicated in the Request to Quote
- There are no employees currently with Native Status on the plan, as this would impact the taxability status of disability benefits for these employees
- Quotes are based on the assumption that any employees on work visas have provincial replacement coverage and work visas that have expiry dates that are at least two years from the effective date or that there are no employees on work visas
What are Benefits by Design’s benefits standards?
The following outlines Benefits by Design’s standards for group benefit plans:
- Employers must pay a minimum of 50% of the total premium for their plan, excluding Long-Term Disability (LTD) premiums, which are 100% employee-paid when non-taxable
- 75% participation is required for contributory plans, and 100% participation is required for non-contributory plans when a group has 10 or more employees
- 100% participation in the plan is required for groups with less than 10 employees
- Employees must be under the age of 70 in order to be eligible for Life Insurance, Accidental Death & Dismemberment (AD&D) Insurance, Dependent Life Insurance, Short-Term Disability (STD) Insurance, Extended Health Care (EHC), Dental Insurance, and Critical Illness Insurance benefits (unless current coverage is in place)
- Waiver of premium commences after six months of total disability
- Prescription drug reimbursement is based on Direct Pay Mandatory Generic substitution
- Groups with less than 10 employees whose family content is more than 50%, may not be eligible for Critical Illness Insurance through Industrial Alliance Insurance and Financial Services Inc. (iA Financial)
- For groups with 10+ employees whose family content is 51% to 75% (inclusive), iA Financial is prepared to consider coverage provided the family members submit medical evidence
- Standard Termination age for long term Disability is 65, and short term disability is 70
- Standard Termination age for Life Insurance, Accidental Death & Dismemberment (AD&D) Insurance, Dependent Life Insurance, Extended Health Care (EHC), and Dental Insurance is 75
- Annual trend/inflation factors are Health 10.5% for renewals and Dental 7.5% for renewals
What are Benefits by Design’s rate guarantees?*
For Accidental Death & Dismemberment (AD&D) Insurance, Life Insurance, Dependent Life Insurance, and Long Term Disability (LTD), rates are guaranteed for 28 months from the effective date. Please note that a 15% or greater change in demographics renders the 28-month guarantee void, and rates then renew after 16 months.
For Critical Illness Insurance, Dental Insurance, Extended Health Care (EHC), and Short-Term Disability (STD), rates are guaranteed for 16 months from the effective date.
*See proposal for expiration of proposed rates.
How does Benefits by Design define salary?
Salary means regular monthly salary, not including bonuses, overtime, or commissions.
- In the case of commissioned employees, salary means commissions averaged over the previous 24 months, not including bonuses or overtime
- If self-employed, salary means the average of the income received from employment, less deductible expenses, as reported for federal tax purposes in the last two calendar years
- For owners of an incorporated company, salary means the average of the salary received from the incorporated company, and the share of the profit (net of expenses and after income tax) of the same company, as reported for federal tax purposes in the last two fiscal years
Are there any grandfathering maximums to be aware of?
Yes. For Empire Life® benefits, grandfathering maximums are based on the number of lives participating in the benefit. The maximums are outlined below; any amounts in excess of the grandfathering maximums will require medical underwriting.
|Group Size||Life Grandfathering Maximum||Long Term Disability Grandfathering Maximum|
|3 – 14 lives||$300,000||$5,000|
|15 – 30 lives||$400,000||$6,500|
The No Evidence Maximum (NEM) will be calculated based on the group size at time of sale.
What is Benefits by Design’s eligibility requirement for plan members?
In order to qualify to be on a Benefits by Design group plan, employees must work a minimum regular schedule of 20 hours/week. We do have options for individuals requiring coverage – ask your Benefits by Design Regional Director about these.
Can Seasonal or Temporary Employees Obtain Coverage on a Benefits by Design Plan?
Seasonal and temporary workers can be covered through our Standalone Health Care Spending Account (HCSA) product line, provided the company is incorporated.
For traditional, fully-insured benefits, employees must work for at least eight consecutive months at a minimum of 25 hours per week, with a maximum layoff period of four months. It is expected that employers remit a full 12 months of premium based on the employee’s real earnings. A flat Life Insurance benefit and a waiting period of at least six months are required. If Disability Insurance is included, payments would not begin until the later of a return to work or completion of the elimination period.
Can Coverage be Provided to Independent Contractors?
Yes, we are able to provide coverage to contract workers, provided they work for the plan sponsor on a regular, full-time basis (i.e., at least 25 hours per week). Standard participation requirements apply at the group level and also separately within the contractor class itself.
Depending on group size, participation for contract workers must be 100% and at least 75% for all other employees. A minimum 12-month contract is required for Benefits by Design to provide coverage to the contractors, and benefits will cease when the individual’s contract with the plan sponsor ends.
Only income earned from the plan sponsor is considered insurable for Disability Insurance benefits (or multiple of earnings Life benefits). If the contract worker receives earnings from other employers, they are typically not eligible for coverage.
Coverage for contract workers is intended to protect “permanent” workers, meaning those employees who have set themselves up as contract workers for beneficial tax reasons. However, it is important to note that extending benefits to contract workers could jeopardize the tax treatment of the benefit plan for the plan sponsor.
Does Benefits by Design offer products and services beyond traditional benefits that could help my clients?
Yes, we do! Our aim is to help grow your relationships with your clients by providing for their continued good health and financial security. The alphabetical list below outlines additional dimensions to help groups proactively manage their health and support employees. Contact your Benefits by Design Regional Director to talk about any of the following:
- Benaccount® – a plan that combines the cost-certainty and flexibility of a Health Care Spending Account (HCSA) with the catastrophic coverage of a traditional insured plan.
- Standalone® – an easy-to-use digital platform that enables employers to offer a Health Care Spending Account, Wellness Spending Account (WSA), or a combination of the two. The product is cost-contained yet grants flexibility for employees to use their funds for what they choose. With no monthly invoice or regular payment required, coverage is provided via a completely paperless system with two- to four-day turnaround on claims reimbursement.
- Wellness/Personal Spending Accounts (WSA/PSA) – an add-on feature of benefits, a Wellness or Personal Spending Account introduces flexibility and choice to employees while helping them be proactive about good health. Available from a number of providers, these types of Spending Accounts are increasing in popularity as employers introduce cost-effective ways to help employees make healthy choices.
- Critical Illness Insurance – coverage for 25 pre-determined illnesses, while allowing for multiple claims for unrelated illnesses. Provides an advance of 10% benefit payment on specific non life-threatening conditions.
- Diagnostic and Specialist Access Insurance (DSAI) – access for insured employees to diagnostic exams (MRI, CT Scans) and specialist consultations in Canada within 21 days if on a medical waitlist.
- Employee Assistance Programs (EAP) – available from a variety of providers, and with differing solutions included. Provides counselling and support for employees for when life happens, and their work could be impacted.
- HumanaCare EAP – $3.31 per month, per employee.
- Ceridian EAP – $4.50/month/employee.
- Health Care Spending Account (HCSA) – an affordable way to help employees access required services without the hardship of being out-of-pocket for the expense. These can be offered as part of a group benefits plan, or on a standalone basis.
- Supplementary Travel Insurance – to top up current coverage, or to purchase as a one-off, it’s help for seniors, snowbirds, extreme athletes and even non-Canadians to have coverage for their travels!
Does Benefits by Design have products available for individuals who require coverage?
Yes! There are a range of options available for individuals you may work with who require benefits coverage and who are not part of a group plan. Ask your Benefits by Design Regional Director for more information.
I would like clarification on paramedical services and how Benefits by Design defines/includes them?
The following is a list of paramedical services provided under Extended Health Care (EHC) plans.
- Acupuncturist – physician/surgeon or anyone licensed through the Acupuncture Foundation of Canada
- Chiropodist or Podiatrist
- Registered Massage Therapist
- Physiotherapist or Certified Athletic Therapist
- Clinical Psychologist or Master of Social Work or Clinical Counsellor (only the services of a registered Psychologist are eligible)
- Speech Therapist
- Registered Dietician (Physician (MD) recommendation is required. Dieticians must be registered with their Provincial Association and a provider number is required for all claims. Registered Nutritional Consultants (RNC) and Registered Nutritional Consulting Practitioners (RNCP) are not eligible.
Requesting a Quote
Can I email Benefits by Design a request for a quote?
Please email all request for quotes to the following email address: firstname.lastname@example.org
What are Benefits by Design’s service standards?
We strive to return quotes within five business days of receiving complete quote information. Please note that any quote received after 12:00 PM is noted as received on the next business day.