Half of plan members say coverage of certain benefits limits their ability to seek treatment: survey

Plan members reported coverage most often fell short for dental services (25 per cent) and massage therapy (19 per cent), followed by prescription drugs (16 per cent), mental-health therapy (14 per cent) and physiotherapy (13 per cent).

Read: 80% of U.S. workers view mental-health coverage as critical: survey

When asked to estimate how much they personally spent on these benefits in the past year, beyond what was covered by their benefits plan, the average out-of-pocket expenditure was $3,515. The highest single average out-of-pocket expenditure was for mental-health therapy ($1,739), followed by dental services ($1,383) and other paramedical services ($1,136). Plan members aged 18 to 34 had higher average out-of-pocket expenditures.

When asked how often they used certain benefits in the past year, 26 per cent of plan members were categorized as heavy users (11 times or more) of their prescription drug plan and 20 per cent were medium users (four to 10 times). Between one in eight and one in 14 were medium users of paramedical services and 17 per cent of members were heavy (five per cent) or medium (12 per cent) users of the dental plan.

While seven per cent of members were heavy users of chiropractic, this percentage jumped to 48 per cent among heavy users of massage therapy, 35 per cent among heavy users of mental-health therapy and 31 per cent among heavy users of physiotherapy.

Read: Employers seeing paramedical claims return to pre-pandemic levels

The top new or lesser-known benefits plan members said they or their family would use was a health-care system navigation service (28 per cent), followed by genetic testing to determine personal risk for certain diseases (26 per cent).

Among members with chronic conditions, the desire for navigation support was highest for those with chronic pain (45 per cent), diabetes (38 per cent) and obesity (35 per cent). Interest was also higher among caregivers of ageing parents or other family members (41 per cent).

A third (33 per cent) of plan sponsors reported already covering services for health-care system navigation and another 33 per cent were interested in doing so. Plan sponsors were most likely to already be covering services to help reduce substance use (39 per cent), navigation (33 per cent) and meditation apps (24 per cent).

“There are so many benefits and details about benefits, it’s easy to see how plan members can be confused,” said Barb Martinez, national practice leader of drug solutions at Canada Life and a member of the survey’s advisory board, in the report. “As carriers, we have an opportunity to help plan members understand which tools and solutions their plan sponsors have made available. It helps the member access their benefits more fully and relieves some of the burden from the plan sponsor.”

Read: How BMO’s navigation guides are supporting employee well-being