Distinct Benefits

Outsourcing Opportunities
The Aon survey found that while only 27% of respondents outsourced benefits administration three years ago, more than half of respondents do so now. As plan administration becomes more complex, many are turning to outsourcing or looking for leading-edge technological solutions that are modular, adaptable, easy to use and compliant with provincial legislation. However, in Quebec, developing efficient and reliable tools requires a good understanding of the nuances of the landscape.

For example, organizations in Quebec have more complex payroll considerations with different taxable benefit rules. The provincial sales tax increases plan complexity if flex credits are involved, as organizations must find tax strategies that ensure fairness across the entire employee group. Automating these calculations is critical to facilitate the development of interfaces for deductions and calculations with the plan sponsor’s payroll solution.

Legislation requires plan sponsors to ensure not only that their drug insurance complies with the rules of the Régime Général d’Assurance Médicaments (RGAM), but also that all eligible dependents are covered. Discussions between the Canadian Life and Health Insurance Association (CLHIA) and the Régie de l’assurance maladie du Québec (RAMQ) are ongoing to resolve issues concerning eligibility, the domicile of students and common-law spouses in the first year of cohabitation. The CLHIA is confident that the changes it has asked for will be implemented in 2009 but, until then, carriers will maintain their long-standing practices.

Written proof of other coverage is required for the employee to waive coverage, and the burden of documentation management is now on the plan sponsor or administrator. Further issues arise with the management of beneficiaries. Irrevocable designations are accepted in Quebec; therefore, systems and processes are needed to manage these designations.

For Quebec plan sponsors and national sponsors with employees in Quebec, insurance carrier Web solutions may not be the panacea to benefits administration that they had hoped for. These “boxed solutions” have left many sponsors struggling to achieve the efficiencies and savings promised, as well as dealing with internal and employee satisfaction issues.

Private Healthcare
Before leaving his job as Quebec Health Minister, Philippe Couillard passed legislation that empowers the government to expand the list of services performed in private health clinics far beyond cataract surgery and hip or knee replacements. There is a great deal of confusion around what can be reimbursed by private plans, given that doctors cannot charge a fee for procedures covered by RAMQ. This raises concern about the controls exercised by carriers. It also creates the need for plan sponsors, carriers and consultants to define criteria to choose a preferred private healthcare provider. Furthermore, there is uncertainty about the legal implications of problems resulting from surgeries performed in private clinics.

Although the reaction of carriers and private plan sponsors has so far been muted, the difficulty that a growing number of Quebecers face in finding a family doctor; the desire of employers to control disability costs and promote early return to work; and the growing interest in managing those 20% of individuals who are responsible for 80% of the plan’s total costs will likely increase pressure to cover the costs of these services.

According to the Aon survey, flexible benefits plans are gaining momentum as a method of managing benefits costs. In Canada, almost one-quarter of employers intend to switch to flex plans, and 20% intend to introduce healthcare spending accounts (HCSAs). This trend may become more prevalent in Quebec in an effort to distinguish insurance needs from total compensation.

Health Promotion
The Group for Promotion of Prevention Strategies has been working with the Bureau de normalisation du Québec to develop the Healthy Enterprise Standard, which aims at improving and maintaining health in the workplace by encouraging favourable organizational practices for employee wellness. This standard was developed in accordance with the requirements of the International Organization for Standardization (ISO) and is the first of its kind in the world, placing Quebec at the forefront of health prevention and promotion. ISO-certified companies could publicly advertise their commitment to maintaining and promoting employee health by setting up a management process based on best practices.

This standard leads organizations to adapt their practices in four different areas recognized for having a significant impact on employee health: lifestyle habits, work/life balance, working environment and management practices. Certification is a five-step process.

1. Endorsement from upper management (through written policy).

2. Formation of a health and wellness committee.

3. Data collection (drug and disability claims, workers’ compensation, etc.).

4. Action plan and implementation of the program (including a communication plan).

5. Evaluation and follow-up.

A Healthy Enterprise must demonstrate that it has implemented activities in the lifestyle habits area, as well as one of the other three areas. To be recognized as an Elite Healthy Enterprise, the organization must implement all four areas of intervention.

The Healthy Enterprise Standard is evaluated by the National Quality Institute in Ontario and may eventually be adopted across Canada. There are currently some discussions with international organizations, such as the ISO, the World Health Organization and the International Labour Office, to expand the program internationally within the next few years. Meanwhile, it certainly raises interest for a reliable methodology that integrates all components of individual and organizational health and allows plan sponsors to measure the financial return on investment in health promotion programs—especially for those who wish to be certified as an Elite Healthy Organization.