# Tuesday, September 10, 2019
                 
Common Group Insurance Questions
Employee benefits are a great way for an employer to attract and retain top talent. In fact, benefits packages often play a major role when deciding whether or not to accept a job offer from a potential employer.

As group insurance brokers we get a lot of questions from Canadians regarding these benefits.

In this article we strive to answer the most common group insurance questions that we get. We hope you find this information useful!

(Please note that while the term "employee benefits" refers to any benefit offered by a company to their employees, this discussion is limited to group health and dental insurance coverage).

1. How much of the premium costs does the employee have to pay for?

Typically, an employer pays anywhere from 50% to 100% of the premiums, with the employee covering the rest of the cost if needed.

It is not uncommon to have the employer pay for the entire premium. However, in order to save on costs, it is becoming more common for the employee to foot part of that bill.

Note that there may be some additional costs incurred by the employee such as annual deductibles, co-pays and prescription drug dispensing fees.

2. Are there medical questions to be answered?

A typical group insurance plan does not require that the insured employees answer medical questions.
However, the insurance company will look at a wide variety of factors during the underwriting process (e.g. age of insured, etc.), and these factors will influence the quoted premiums. (Underwriting is the process whereby the insurance company calculates the risk of injury and disease for a group of insured persons. The higher the risk, the higher the premiums to be paid).

If a group plan offers exceptionally large amounts of life insurance or disability insurance coverage then the medical records of insured employees MAY be investigated.

3. What happens to my coverage if I lose my job?

If you lose your job then you will also lose your employee benefits coverage.

If this happens to you then it is important to know that you can apply for a special type of individual health insurance called "conversion health insurance". Conversion health and dental plans are made specifically for people who have just lost their group coverage. There are no medical questions asked, but you must apply within a set amount of time after losing your benefits (60 days to 90 days is a common time frame).

An example of conversion health insurance is the FollowMe health and dental plan, offered by Manulife Financial.

4. Will my family members also be covered?

Employee benefits usually covers dependents and spouses.

In some cases, however, only the employee is covered. This is done in order to keep the premium costs down.

Also, if your spouse has their own health insurance coverage then your spouse will not be covered by your plan.

On a final note, if an employee benefits plan offers disability insurance coverage then only the insured employee receives that disability coverage (i.e. it will not be available to your spouse).

5. What sort of coverage is offered by group insurance plans?

A typical employee benefits plan will offer extended health, dental, prescription drug and vision care benefits.
There are also other optional coverages that may be offered such as:
  • Disability insurance
  • Weekly income replacement
  • Life insurance
  • Travel medical insurance
  • AD & D (accidental death and dismemberment)
The more coverage a group plans offers, the higher the premiums will be.

6. What if I need coverage not offered by my group insurance benefits plan?

Sometimes an employee benefits plan will not offer employees all the coverage that they want.

If this happens then it is possible for an employee to augment their group coverage by getting an individual insurance plan. Examples of this are private travel medical insurance plans, life insurance plans, etc. 

7. What if an employee is already covered by their spouse’s health plan?

If an employee already has health and dental benefits obtained through their spouse then that employee can "waive" the health and dental benefits portion of their company’s group plan. Note that the employee can still get other benefits offered by their group plan (for example, life insurance, accidental death & dismemberment, etc.)

The employee can also double up on some coverage. For example, major dental expenses are usually covered at 50%. By doubling up coverage the employee could qualify for 100% coverage form major dental costs. 

8. Are there coverage waiting periods?

Depending on the plan there may be a waiting period before a new employee can make a claim.

Wait periods for new employees are usually 3 months in duration, and are used to prevent a new employee from making a large claim and then leaving that company right after the claim is paid out.

There are no waiting periods for existing employees if a business starts a new group insurance plan.

Conclusion

We hope you found our answers to commonly asked group insurance questions useful.

If you have any questions about employee benefits please contact us. As experienced, licensed Canadian insurance brokers it is our mission to help you get the benefits that are just right for you!
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