Disability Insurance: Group
Group Insurance plans consist of some or all of the following benefits:
- Healthcare (e.g. hospitalization, specialists, medical equipment, prescription drugs, out-of-country medical coverage)
- Dental care
- Vision care
- Life Insurance (1, 2 and 3 times salary)
- Dependent Life Insurance
- Disability Insurance (Short Term & Long Term)
- Accidental Death & Dismemberment
It is important to note that there are minimum participation requirements in group plans and that depending on the size of the business and the number of employees, participants may be able to opt out of certain benefits within the plan.
Usually, only full time employees are eligible to participate (minimum of 20 hrs per week) and are covered as long as they work for their employer at their usual place of employment. Home-based employees are normally excluded from the plan. Group plans are only available to individuals who have provincial Medicare insurance (i.e. OHIP). The reason for this is group plans "top up" where provincial plans leave off or cover areas that are not covered such as Dental benefits.
Group benefits can be offered at more affordable rates than individual plans due to unit cost savings. Premiums for group plans are based on two types of "risk" categories; employers with existing benefits in place and employers without benefits in place.
The establishment of rates for employers with benefit plans in place is derived from several items: the occupational rating of the industry for the employer, the current employee census, followed by company's claims experience. For employers without benefit plans in place, insurers still consider the occupational rating of the industry and the employee census data. However, with the absence of any claims experience, insurers will establish a particular company's rates using the average experience from firms of similar size, demographics and industry.
Maximum coverage amounts vary. The higher the amount of coverage the more the premium cost. However provisions can be put in place to reduce the premium cost such as deductibles and co-insurance factors Employer/Employee premium share structures.
Medical underwriting may or may not be necessary depending on the size of the group. A simple enrollment form is all that would be required if no medical underwriting is deemed necessary. If large amounts of life insurance and or disability insurance benefits are applied for than employees will be required to complete a medical form and they will be assessed based on their prior health.
Pre-existing medical conditions are excluded in group plans during the first year of the plan. In other words, if a participant is taking medicine for a particular condition within 90 days before enrolling in a group plan, that particular condition may not be covered for the first year of the plan.
A successful implementation of a Group Insurance plan consists of a proper needs analysis to determine a company's needs and cost limitations. Reviews are done at annual renewal of the plan and changes to the plan can be made at any point.