Group insurance plans are provided by employers to offer a wide variety of health and accident benefits to their employees such as disability income, extended health care benefits, prescription drugs, and dental plans. Group insurance plans can be customized by each employer and can be broken-up in to two classes, where Class A may offer 100% of paid benefits to the management team, and Class B may offer 80% of reimbursement to the rest of the employees.
Life Insurance Benefits
The most common benefits for life insurance is $25,000 or one/two times one’s salary. You may have more than $25,000 but anything above the maximum is subject to medicals. Depending on the plan, group employees with dependents have benefits for a spouse of $5,000/$10,000 and children $2,500/$5,000 per child.
Accidental Death and Dismemberment
These benefits are paid in a lump sum when the person insured is killed or has one or more dismemberment as a result from an accident only. The plan would pay the full amount if there is an accidental loss of two limbs or two eyes; 75% of the loss of one arm or one eye; 50% for the loss of a hand or foot.
Extended Health Care Benefits
The extended health care benefits are designed to reimburse the person insured and his/her dependents for expenses that are not covered by provincial plans. Some of these expenses include:
- Prescription drugs – depending on the plan, you may have a pay direct card, or a reimbursement plan where you would submit a receipt to the insurer for reimbursement. Some plans will also have a deductible of $25/$50 or $50/$100 and a co-insurance amount per prescription usually 80%.
- Nursing care – usually with a lifetime maximum of $10,000
- Ambulance costs
- Semi-private or private room hospital accommodation
- Vision Care – eyeglasses coverage either $150 or $200 every 2 years
- Services by practitioners such as chiropractors, massage therapists etc. with an annual maximum of $500 per practitioner.
The dental plans that are available to group policyholders can be from simple preventative and maintenance services or complex orthodontic procedures.
- Preventative services would include examinations, X-rays, diagnostic procedures, oral hygiene instruction, scaling, fluoride and polishing treatments. Extractions and fillings are also included.
- Major Restorative services include fixed bridgework, maintenance and replacement of appliances and crowns and inlays.
- Endodontics include treatment of gum disease, root canal work, and major surgery.
- Orthodontics would include services such as braces usually for children.
With dental plans it is very common to see different co-insurance amounts like 100% for preventatives and endodontics, 80% for major restoratives, and 50% for orthodontics.
Long-term benefits are not payable at the same time as the employment insurance benefits. Once the employment insurance benefits cease the disability income from your plans begins. The benefit that is payable to you is usually 66.7% of your income. Most of the disability plans have the “own occupation” clause for only two years and after that the “regular or any occupation” clause takes place. It is recommended that you should have an individual disability income policy to maximize your monthly benefit. This will increase the amount payable from a 66.7% to a possible 90% of your income.
One should also take into consideration that if the employer pays for any portion of the premiums the disability benefits will then become taxable to the employee.