What the New Changes to OHIP+ Mean to Employees

The new Conservative government in Ontario hasn’t wasted any time announcing changes to the previous government’s OHIP+ drug program for children.  Even though this means slightly higher costs for companies, I think that this change is better for employees.

Firstly, due to rushed implementation, coordination was an issue for many employees, especially when it came to drugs that fell under the OHIP+ Exceptional Access Program (EAP).  For these claims, employees were often left paying the full amount out of pocket until their EAP paperwork, which included physician recommendations, was completed, reviewed, and approved.

Secondly, the number of drugs that require EAP approval is relatively small, but it does include several alternative forms of medications that are prescribed to children.  This caused confusion for employees, many of whom became upset with their employers and insurers as a result.  The new program eliminates this issue.

The OHIP+ program sounded great for employers, but when you look at the low volume and cost associated with claims for the covered medications, the savings are not significant, and the issues related to the EAP caused more issues for employers than the savings were worth. 

While the implementation date is not yet known, the change that will impact members and sponsors of private plans most is that OHIP+ will now only provide payment if a private plan doesn’t. This means that the small savings that employers were hoping to get from this program won’t have time to materialize.

 

Large Amount Pooling

It has been hard to avoid the news stories in the last couple of years about rising drug prices and new drugs with very expensive price tags.  This is both great leap forward for those in need of treatment, and a cause for anxiety for sponsors of private drug programs.  One thing that it shouldn’t be is an opportunity for insurance companies to line their pockets.

Some of the insurers in Canada have taken advantage of the uncertainty around these drug claims to increase their rates by up to 20% beyond a reasonable level, and create disparity in premiums from one client to another.  While other advisors accept this as a reality of the market, HCG has taken action.

For clients who meet certain criteria and whose insurer is over-charging for Large Claim Pooling protection, HCG offers appropriately priced coverage without changing your insurer.  Our proprietary product allows us to place the Stop Loss risk with a separate insurer while having your claims paid by your current provider.

The result is lower costs for the benefits plan with no changes in your coverage or liability and with absolutely no change to the claiming process for employees.  The savings are permanent as there is no marketing investment by the insurer in our proprietary rates.  This means that the savings are sustainable from year to year, unlike those that are often received when marketing the entire benefits plan.

Some clients choose to re-invest these savings in expanding wellness programming or other benefits coverage, while others see it as an opportunity to offset rising costs in other areas of their benefits plans.

To see if your organization is eligible and would benefit from our Stop Loss Pooling product, contact HCG today.

OHIP+ - The Ontario Youth Drug Plan

Effective January 1, 2018, the Ontario government will provide “free” drug coverage for everyone under the age of 24.  The plan is similar to the Ontario Drug Benefit (OBD) which is available for seniors.

What does this really mean:

For Families:

·         Children under 24 will now have coverage through the OHIP+ program for most prescribed drugs

·         No application is required, just give the child’s health card to the pharmacist along with the prescription

·         If your employer’s benefits only covered a portion of the drug or dispensing fee cost, you may receive more coverage under this program

·         You will still need to keep insurance information up to date with your pharmacist

For Employers:

·         OHIP+ is the first payor for these drugs

o   Drug claims should decrease slightly

o   Most of the drugs that would be prescribed to this group are covered by the province

o   Drugs not covered by the ODB (which include most high cost drugs currently being claimed on employer plans) will continue to be claimed under the company plan

·         Employees may have questions

o   If employees do not provide the child’s health card, your insurance carrier’s systems should reject the claim.  Employees may interpret this as an issue with their coverage.

o   The ODB list covers many, but not all drugs.  You may get questions about why some are covered and others aren’t, especially if your plan has a deductible or co-pay

·         Should you ask your insurance company for a rate adjustment?

o   Especially for groups with lower than average drug claims and higher than average family sizes, claims that will now be shifted to the ODB could make up a significant percentage of overall drug claims

o   The impact to the average group will be minimal as many of these drugs are inexpensive and are claimed with a low frequency

o   Since most high cost drugs are not included, this change will have no impact on your Large Claim Pooling rates.  If these are a concern for you, ask how HCG can help.

Overall, the financial impact of this change to employers is minimal, but could be significant under certain circumstances.  Communicating this change to your employees will help them understand and navigate the new system and ensure that they continue to see the company’s Drug plan as a value added benefit.

Brian Reynolds

Principal - HCG

How will recent changes at WSIB impact my benefits plan?

Effective January 1, 2018, the WSIB has implemented several changes that will impact future rates both for WSIB and Long Term Disability (LTD) insurance benefits.  Much of the literature on these changes is complex and a bit of a confusing read but the essence of these changes is:  Some disability claims that wouldn’t qualify for WSIB historically will now be considered going forward.

In theory, this will benefit Insurance Companies as these claims will now go to WSIB instead of being paid by the insurer. 

-       Will this translate into lower LTD rates for companies?  Not yet.

-       Will this mean higher rates for WSIB?  Not yet, but it will.

-       New claims that now qualify for WSIB would have been eligible under the company’s LTD benefit, so total claims (and costs) should be the same, in theory.

This change should not significantly impact an employer’s cost, except:

-       Benefits paid by WSIB are generally higher than most LTD plans.  This means more dollars will be paid out for the same claims

-       Businesses with a history of WSIB claims pay a higher WSIB rate.  While this is also true for LTD benefits, a company’s historical claims “credibility” (the part of your rate that is based on your own claims history) is calculated differently by WSIB and LTD insurers.  WSIB generally gives more weight to your actual claims experience which is bad news for companies with less favorable histories.

Some additional complications:

-       WSIB is reducing the number of rated industries to simplify their processes.  Your rate may change if you were in one of the groups that were eliminated under these changes

-       Chronic Mental Stress claims are now eligible

o   What constitutes a Chronic Mental Stress Injury is not clear

o   Over the next couple of years, appeals and adjudication will determine how many claims are paid and will set case law for the future

What should employers do?

-       Document everything.  Workplace stress can have many contributors, including the environment, industry, coworkers and managers.  These are factors that WSIB will be looking at when determining the eligibility of claims.

-       Involve your insurer.  Even if a claim looks like it will likely be going to WSIB, complete the insurer’s paperwork to ensure that timelines are met and that the employee is not left without a benefit.

-       Support your employees.  The best outcome is a speedy return to work.  Now is a great time to take some preventative steps in workplace Mental Health.

 

While case law is being established, we can expect more challenges to rulings for WSIB, especially in the area of Mental Health.  This means more stress and confusion for employees and administrators.  Taking a preventative approach will help make sure that your company is not helping to establish case law for the new WSIB changes.

Brian Hansell

President - HCG

Why Wellness?

We all make decisions every day.  Decisions about our personal and professional lives that impact what we do today and our ability to perform in the future.  Sometimes, these are trade-offs and others, the right decision is clear, but one thing is always true; you can never make progress without effort.

Early in my career, I helped people near retirement make the most of their savings.  Far too often, the discussions I was having were about subsistence and not security.  We all know that we should save for retirement, but many people don’t.  They make the decision to take a dollar today over two dollars tomorrow.  Don’t get me wrong, there are situations where the dollar today is more important, but far too many Canadians are reaching retirement with little or no ability to support themselves.  Education was always the answer put forth, but it’s impact was always minimal.  There had to be a less reactive way to help people save.

My next role took me into the world of Health Benefits.  What an amazingly reactive world this has been.  The cost of a benefits plan is a reflection of the health of employees.  The more medications that employees are taking, the higher the cost of a drug plan and the more likely the employees are to develop a disability.  Still, employers blame insurers for high rates while doing little to help employees remain healthy which would actually impact their costs.  The majority of the biggest problems facing benefits plans today are related to employee health, especially for illnesses such as Hypertension, High Cholesterol, Type II Diabetes and Depression.  Benefits show employers the cost of inaction, but only when it’s almost too late to do anything about it.

For me, the decision was clear.  I had to help my clients get out in front of these problems.  Only by taking a proactive approach to education, programming and engagement can you impact future costs and stop being a victim of your benefits and retirement plans.  So, my choice was to work with HCG, to promote Health and Wellness as the sustainable solution for employers and to help my clients prevent the issues that others have faced. 

“Those who do not learn from history are condemned to repeat it.” George Santayana
 

Brian Reynolds

Principal - HCG

Mr. Brian J. Hansell Announced as a Winner of CAMH 150 Difference Makers.

 400 #Convoplates in circulation, 10s of 1,000s of conversations, $300,000+ in funds raised for mental health.

400 #Convoplates in circulation, 10s of 1,000s of conversations, $300,000+ in funds raised for mental health.

PHF PRESS RELEASE

Mr. Brian J. Hansell Announced as a Winner of CAMH 150 Difference Makers.  The CAMH 150 Difference Makers honours people influencing change in mental health, giving new reasons for hope.  

Mr. Brian Hansell is the Founder of the Paul Hansell Foundation (PFH) and President of Hansell Consulting Group Inc. (HCG). This award is an honour for Brian, his team, and his community supporters.

After losing his son to suicide in 2010, Brian built a foundation in his name and began a movement that puts mental health on an equal footing with all other forms of health. The flagship initiative of PHF is the successful #ConvoPlate.  Part art therapy and part global pass-it-forward movement, the #ConvoPlate inspires people to have conversations about mental health regularly. Brian believes wholeheartedly that by encouraging connected conversations at the youngest possible age we can successfully support the mental and emotional wellbeing of children and youth.

In his professional life, Mr. Hansell is known for his innovation in workplace wellness.  Hansell Consulting Group supports organizational sustainability by delivering implementable workplace solutions with his team specializing in Wellness through benefits, pension, mental health, and communications.

Brian’s continued dedication in youth mental health is served through his roles on the Mental Health Management Advisory Committee at Brock University, as a member of the Burlington Foundation Mental Health Round Table, and the founding co-chair of the Mental Wellness Alliance.

Quote: “Many of the 150 Difference Makers have dedicated their lives to put us where we are today. I am merely following the path and focus that they forged. The tragedy that has occurred in my life has kept me focused on positively contributing to the mental health movement. None of this would be possible without the selfless effort of countless Canadians.”

FOR MEDIA INQUIRIES CONTACT:

Brian Hansell, President, Paul Hansell Foundation

Phone: 905-520-6960

Email: Brian@PaulHansellFoundation.com

 

Dr. Stanley Kutcher on Mental Health Literacy

Is all our talk about mental health making us sick?  How our knowing about something is not the same as knowing something. 

HCG is pleased to sponsor our next event features the internationally renowned leader in adolescent mental health, Dr. Stanley Kutcher. It takes place on November 1st at 7pm, located at Corpus Christi Catholic Secondary School, 5150 Upper Middle Road, Burlington.

Dr. Kutcher will present a critical view of how increasing mental health awareness is not being supported by mental health literacy, and the challenges to youth, parents, schools and health care providers that brings.  Building on the understanding that “knowing about something is not knowing something”, he will use a mental health literacy approach with the audience to illustrate how good mental health literacy is so important for improving health.

Stan Kutcher flyer.jpg

Wellness Index Survey Results Seminar 2017

The Wellness Index is designed to create a Wellness Benchmark for organizations. This year, nearly 200 Business Owners, Executives, Finance and Human Resource Professionals took part in our online survey to share their organizational attitudes, strategies, programming and successes. This year's seminar highlighted the aggregate results and provided attendees with insight into creating and maintaining a successful program. Speakers included:

Brian Reynolds - Principal @ HCG

Wellness Index Results & The Importance of Data Analysis to Wellness

Jim Harding - Manager, Health Services & Rehabilitation @ Hydro One Networks Inc.

Building a Culture of Wellness, Health & Safety

Linda Marshall - President @ Marshall Connects

Emotional Intelligence; An Asset to Business Wellness

Panel Discussion

Perspectives on Mental Health Disability & Return to Work

Moderator:

Harrison Wheeler - Communications Specialist @ HCG

Panelists:

Dr. Conrad Sichler - Family Doctor & Addictions Specialist

Sue Corbet - Organizational Health Consultant & Disability Manager

Carla Zabek - Labour & Employment Lawyer

Graham Shaw - LifeWorks