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Understanding Employee Benefit & Group Benefit Plans

What every Employee should know about their Employer Benefits Plan


Best Doctors

Many insurance companies (i.e. Great West Life, Sun Life, The Chamber of Commerce Group Insurance Plan, etc.) are starting to offer this as a built-in feature. Many employees are not aware that this even exists. It could be considered the most important benefit to be aware of, and not because it is used frequently, but because it could save you, you’re spouse, or your child’s life. Best Doctors offers a second opinion from a world-leading physician, if you or a dependent are diagnosed with a major medical condition. This is all done at no extra charge or expense to the employee, as Best Doctors is 100% covered.

Get your second opinion at www.bestdoctorscanada.com


Trillium Drug Program

Many employers are starting to cap the covered maximum annual payout for prescription drugs. This is true for many small employers who are being largely effected by a couple of employees on high-costing medications (i.e.; biologic drugs). For these employees who are capped out, it is important for them to investigate other avenues where a portion of these unpaid amounts may provide financial assistance. The Trillium Drug Program is designed to help cover the costs of prescription drugs depending on a number of different factors (family income, number of dependents, type and the cost of the drug, etc.). If an individual is approved for this coverage, an annual deductible (paid quarterly) is determined based on household income and the number of dependents.

Download the required application at:



Co-ordination of Benefits

If both you and your spouse have a benefits plan through your employers, you are not typically required to participate in the health and dental benefits on both plans. If you are required to pay a portion of the overall health and dental cost through payroll deduction each month, you may want to consider your options. Depending on the level of coverage and premium commitment, you may choose to just take one or the other instead of paying for both plans.


Dispensing Fee

Every pharmacy has a set dispensing fee in which it charges for each prescription dispensed. Many plans cap the dispensing fee at a certain dollar amount. If this is the case, be sure that you are comfortable with your pharmacy, and if you are price sensitive, you may want to shop around to save money on each prescription that you fill. If you are on a maintenance drug, you may be able to get a 90 days supply rather than a 30 day supply which will save you on unnecessary dispensing fee’s.


Non-Medical/Evidence Limits

Every group insurance plan that offers Life Insurance, Short-Term Disability, and/or Long-Term Disability as part of the coverage, usually offers these benefits on a non-medical evidence basis up to a “certain maximum.” Many small- to mid-sized employers offer coverage above these limits with the proof of medical evidence. If there is a considerable gap that you are eligible to qualify for and if you are in good health, it is suggested that you cap your disability benefits to be as high as possible to ensure that your income and lifestyle are protected in the event of an unexpected illness, accident or injury. It is important to ensure that you check with the insurance company or your group benefits plan administrator on a yearly basis to ensure that your reported income is always up to date.


Online Capabilities

Insurance companies are moving towards a fully online and electronic world. Most group insurance companies now offer a website where employees can submit claims, monitor claims payment history, and view coverage right at their fingertips. Most companies also have free mobile apps which gives you access to your plan information at all times.