Without a doubt, if you are an employer then most employees want Extended Health Care (EHC/Drugs), Dental and Vision Care.

These benefits represent the highest percentage of claims in a benefit plan and an employer can choose between a number of different benefits and limits, customizing to budget and expectation.

Extended Health Care

Extended Health Care (EHC) covers a wide range of expenses and services which are otherwise not covered by provincial health plans.  EHC plans might include some or all the following:

  • Prescription Drugs: A variety of plan options to consider
  • Semi-Private or Private Hospital Room
  • Out-of-Canada (Province) Travel Coverage
  • Vision Care (optional)
  • Paramedical Practitioners include: Chiropractor, Podiatrist, Osteopath,  Naturopath, Massage Therapy, Speech Therapist, Physiotherapist and Psychologist
  • Medical Services, Equipment & Supplies
  • Ambulance
  • Accidental Dental Treatment

Drug Plans

Drugs represent the largest expenditure equalling between 65 to 80% of all paid health claims.  A drug plan will have a combination of the following:

  • Definition of eligible drugs (Brand-name or Generic Drugs; Generic only etc.)
  • Inclusion of life-style drugs
  • Payment method (Cash/Re-imbursement or Pay-Direct)

Each plan might have a combination of Deductibles, fee caps or co-insurance to help control the cost of the plans and shift some responsibility to the hands of the employee.

Co-ordination of Benefits (COB) is possible between spouses.

Coverage generally terminates at either retirement or age 70.

Dental Care

Perhaps the most valuable of all benefits because many families will not need health coverage, but all will use the dental plan.  Three levels of coverage are available, but limited if group size is small:

  • Basic and Preventative Treatment covers routine services such as exams, x-rays, cleaning, fillings, endodontics, periodontics, extractions and oral surgery
  • Orthodontia coverage provides for braces and space maintainers required to straighten teeth
  • Major Restorative Services includes crowns, bridges, onlays and dentures.

Per Person Maximums

  • Various options are available under Basic and Preventative Treatment plans ranging from $750 to $2500
  • Orthodontia has a lifetime maximum per person from $1,000 to $2,500 with usually a level of co-insurance
  • Major Restorative Services are usually capped at $1,000 to $2,500 per year

Fee Guide

Most contracts reimburse all eligible dental expenses with respect to the “current” provincial dental fee guide for General Practitioners.

Pre-Determination of Benefit

It is advisable to submit a detailed treatment plan, for pre-authorization, if the proposed dental procedures are expected to exceed $500.

Each dental plan might have a combination of Deductibles, or co-insurance to help control the cost of the plans and shift some responsibility to the hands of the employee.

Co-ordination of Benefits (COB) is possible between spouses.

Coverage generally terminates at either retirement or age 70.