We have become a society of expectation. Many of us expect the government and our employer to take care of us from the cradle to the grave. Canadians expect the government to provide income at retirement, 100% reimbursement of all services and medications from the provincial medical system and services not covered by the government should be reimbursed by their employee benefit plans.
When adequate reimbursement is not received they complain.
The Current Situation
With the average monthly cost for medications in Canada currently at $765 per person and specialized medical supplies (such as C-Pap machines) doubling in the last few years, keeping Canadians healthy has gotten extremely expensive. Even paramedical and dental services continue to increase yearly and it is very difficult for governments and/or employer sponsored employee benefit plans to provide 100% reimbursement at a reasonable price.
In order to help keep costs down a procedure for claiming medications has now been put into place requiring employees to research out all resources providing reimbursement of medications and any services required.
The first place a person is asked to request reimbursement from is the Provincial Government, secondly to request help from societies such as the cancer, or MS society and then finally through employee benefit plans. A combination of all these resources will help individuals receive support for the cost of medications.
Not every province offers drug reimbursement so it is important individuals research help from any and all services available.
Related: 3 Expensive Mistakes Employers Make When Purchasing Their Employee Benefit Plans
Why Are Insurance Companies Requesting Cost Saving Procedures?
Would you believe many insurance companies did not know about the drug coverage provided by Provincial Governments or many societies? Taxpayers could be funding a drug reimbursement system in their Province but are not advised on how to access the service.
Many insurance companies are now requiring “Special Authorization forms” to be submitted to the government for approval on medications. The form is completed by your doctor at the time the drug is prescribed and then sent for a government decision, which usually takes about 3 days to receive your answer.
To further help keep costs down employees should shop around for low cost dispensing fees for prescription. Don’t be afraid to ask! Dispensing fees can range from $4.00 to almost $13.00 per prescription so it can make quite the difference.
Expect Reasonable & Customary Reimbursement?
Most insurance companies pay for expenses that are “reasonable and customary” but what does that really mean? That doesn’t pertain simply to wheelchairs and breathing devices but services including chiropractic, massage and physiotherapy.
When an insurance company gets a massage bill for over $100, they’ll question it and may not pay for it because it isn’t reasonable and customary. A 45-minute massage in Nova Scotia may cost $45 but in BC the same service is around $75 – the variance between provinces is massive.
As each province has a different reimbursement and cost for medical and dental services, each province also has a different insurance premium cost for extended health and dental, whether it is pooled or experience priced. Everything is different because every government has a different price on the services they are required to offer under the Canada Health Act.
Ontario has the highest extended medical premiums in the country, not counting Quebec as they have their own system. Ontario has nearly 45-50% higher extended medical premiums than BC because BC offers prescription coverage to residents.
Related: Taking Your Employees Mental Health Seriously
Using The Plan Responsibly
If a worker has a benefit plan with 100% reimbursement and/or the premiums are paid 100% by the employer, they have no incentive to shop around for the best price for needed services. These practices contribute to rising costs of employee benefit plans for employers. Although some employees might protest, there are many reasons and benefits to employees and employers to have 80% reimbursement rates.
Higher claims eventually result in higher costs, especially if you are not on a pooled plan. Once employees are aware they are contributing toward benefit premiums, they become more conscious of their spending habits and how their style of purchasing can have a negative impact on premiums. That said, companies and their employees generally find costs much more reasonable and manageable when on pooled pricing. For an explanation on how pooled pricing can help control costs and see if your employee benefit plan is taking advantage of this type of pricing, click here.
Employees need to be educated on what cost saving measures can be taken to reduce claim expenses. There are many simple things all employees can do to help maintain cost and quality of employee benefit plans but it is up to the employer to make them aware of the options!