It's a big responsibility to be a benefit plan administrator. You wear many hats, co-ordinate amongst lots of different parties and are always balancing between adhering to strict policies and offering a human experience. As an agent of the insurance company, you have a duty to report any material changes that would impact your employees' policies. Here's a checklist to help you better deliver a health plan through the key lifecycles of an employee.
- Employee Contract: Ensure your employment contracts have a termination clause that discusses what happens to employee benefits in the event of a termination. Staying silent about it might mean that your company defaults to the common law benefits extension as opposed to the minimum legislated extension. We recommend talking to your employment lawyer, HR consultant, or a Beneplan representative for a template.
- Premium Deductions: Consider inputting wording around how benefit premium deductions are handled in your company.
- Cost Plus or Medical Reimbursement Plans: If Cost Plus is used, define the amount and class of employees eligible for this benefit. Check with your accountant regarding the use of Cost Plus by company shareholders due to recent CRA rule changes.
Hiring - First Day of Hire
- Deductions: Obtain sign-off from the employee regarding any premium deductions that will come off their pay-check.
- Enrolment Form and Student Eligibility Form: Supply the employee with an enrolment form to be signed by the employee and approved by the employer. Return the signed copies to your insurer.
- Booklets and Brochures: provide the employee with a copy of their group insurance booklet(s) and any applicable brochures for add-on products (EAP, Personalized Prescribing, Telemedicine, Best Doctors, Second Opinion, etc).
- Drug Cards: When they arrive, hand off the drug cards to your employees along with 1 to 3 out-of-country cards (depending if they have a spouse and the number of dependents).
- Probation: Add a calendar reminder for yourself to reach out at the end of their probation period. At the end of the probation period, check in with the employee if they have received their drug card and if they have any questions. Remind the employee to notify HR if they have a life change relevant to benefits (see below for details).
- Communications: Encourage them to speak to their insurers directly if they have specific questions about any private or personal medical or dental claims.
- Private health information: It's best practice to destroy any communication you have around an employee's private health information that has been shared with you. This is to protect their health privacy.
Employee Life Events
Please notify your insurer as soon as possible when there are significant life changes with an employee. Here are the ones that must be reported:
- The full legal name of employee as matched with government ID
- Change of salary
- Change of job title
- Changing class (for example, from manager to C Suite Executive)
- Change in full-time status (lower # of hours, part-time, temporary worker, contract based, etc.)
- Change in employment status (any type of leave, termination, etc.)
- Home address
- Marital Status
- Adding or removing dependents
- Adding or removing beneficiaries
- Opting into health/dental
- Change in provincial health insurance coverage
- Adding or removing a second benefit plan to co-ordinate
- Any type of leaves (sick leave, vacation longer than 4 weeks, parental leave, compassionate leave or any ESA leave)
- Death of the employee or their covered dependents
Taking Extended Time Off
If the employee(s) take voluntary leave of absence, the company can choose to suspend or extend the benefits for the employee(s) during the leave. If the company wants to extend the benefits of the benefits, please notify your insurer with the following information:
- Full name of the employee(s)
- Certificate number of the employee(s)
- Reasons for taking voluntary leave
- The last day the employee(s) worked
- The time the employee(s) is expected to come back to work
If the employee is taking sick leave, here are the general rules of thumb:
- Short term disability (no plan in place): issue a record of employment (ROE) for sickness.
- Short term disability (plan in place): provide the employee with their claim forms, fill out the employer form, and send it to the carrier with a copy to your Third Party Administrator (if applicable).
- Long term disability (plan in place): provide the employee with their claim forms, fill out the employer form, and send it to the carrier with a copy to your Third Party Administrator (if applicable).
If sick leave is a common occurrence in your workplace, there may be some underlying issues that aren't being addressed.
If an employee has been terminated, please notify your insurer with their name, last day worked, and type of termination. Here are the common types of termination and how they impact benefits:
- Quit / Resigned - benefits end as of the last day worked.
- Terminated with cause - benefits may end as of the last day worked (check with your lawyer).
- Terminated with no cause - benefits end as of the minimum notice period or common law period (check with your lawyer).
- Temporary lay-off - employer's choice to suspend benefits or maintain. Talk to your benefits advisor or lawyer.
Some terminations may require a Letter of Agreement (LOA) from the insurance carrier. Please check with them before issuing a termination as LOAs may take up to 2 weeks to arrive from the insurer.
We also put together a more succinct version of this guide specifically designed for small business owners who may to get the skinny on these key matters. If you have any detailed questions about this checklist, feel free to reach out to us at firstname.lastname@example.org, we are happy to assist you even if you aren't a member of our co-operative ❤️.