Health and Dental Insurance

Health and dental insurance, while popular with employees, is becoming increasingly expensive, and employers are looking for ways to control costs.  Many employers ask employees to share in the cost of premiums (e.g. 50/50; 60/40; 80/20) and some plans pay after the employee has reached a set deductible amount.

Goup Insurance covers many of the medical expenses not covered by the provincial health plan (OHIP).  The company pays a premium to an insurance company to cover the cost of benefits paid out, plus administrative services.

  Examples of Group Health Insurance:

  •          prescription drugs
  •          ambulance services
  •          private or semiprivate hospital coverage (OHIP pays for a ward)
  •          out-of-province/country emergency medical services
  •          paramedical services (physiotherapy, massage, psychology, etc) 
  •          eye glasses

Examples of Group Dental Insurance:

  •          basic dental (checkups and fillings) – 80% to 100% of costs
  •          major restorative (crowns) – 50% of costs
  •          orthodontics – often for children only, and with a lifetime maximum

 

Another health and dental insurance option popular with some employers is an “Administrative Services Only (ASO)” contract with an insurance company.  The employer pays the insurance company to administer and adjudicate claims, but the claims are paid by the company.  This may be more cost-effective than the full group insurance plans, but companies bear the full risk of large claims.

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