NS, NB & PEI Group Health Insurance

Are you paying too much for your group health insurance? What if you could offer your employees the same or better coverage for less money? What if you didn’t offer health insurance to your employees at all? After all, there is no law exists that says you have to provide it.

However, if you paid your best employee the same as a competitor but the competitor offered health insurance, would your employee leave? If not right away, they might start looking elsewhere which would be very disruptive for your business.

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Group health insurance is the most crucial part of a benefits package for obtaining and retaining the kind of employees you are relying on to help grow your business. It is no secret that in our current environment, it has become a challenge for small employers to maintain affordable health coverage for their employees due to ever increasing costs.

Today, more than ever before, employers need to understand the requirements in offering a group plan. Health insurance is becoming more complicated every day. We are committed to educating employers and helping you to streamline your plans during these difficult economic times.

Costs are driven by the coverage you want to obtain for your employees, and the number of employees you have. The average per-person premium for small group health insurance was about $400 a month in 2018, compared to $440 for an individual plan.

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    Types of Group Health Plans

    • HMO: This managed care plan gives your employees the security of lower out-of-pocket expenses, comprehensive coverage and virtually no claim forms to fill out. Employees choose a primary care physician who will manage medical care and refer employees to specialists and hospitals within the network.
    • POS: Your employees have the freedom to use the managed care network of physicians or choose doctors and hospitals outside the network. In network, the employees select a primary care physician (PCP) to coordinate their needs and to refer them to in-network specialists. By going out-of-network employees may encounter higher out-of- pocket expense and more paperwork.
    • Direct Access: This open access plan provides employees with direct access to all primary care and specialists within the network without a referral. They do not need to select one primary care doctor. While employees have the freedom to choose from doctors and hospitals within the network, they may also go outside the network. By going out- of-network, they will encounter higher out-of-pocket expenses. Employers can choose from various plan designs to meet their budget and benefit needs.
    • PPO: This preferred provider organization gives the employees the largest selections of network doctors and hospitals. If the employee uses the network, he receives a higher level of coverage; if he chooses out-of-network physicians or hospitals, he pays a higher share of the cost. Various plan designs are available.
    • HSA: A Health Savings Account is like a 401K for healthcare. It is a tax advantaged personal savings or investment account that individuals can use to save and pay for their qualified healthcare expenses, now or in the future. Paired with a qualified high deductible plan, the HSA is a powerful tool that empowers consumers to be more actively involved in their health care decisions. AA Munro Insurance has the necessary knowledge and expertise to assist both employers and employees who are considering Health Savings Accounts.
    • COBRA: (Consolidate Omnibus Budget Reconciliation Act of 1985 requires businesses to extend their group health insurance coverage to an employee who leaves or is terminated for reasons other than cause. The employee must pay the premium to the employer, who in turn includes it with his monthly payment to the company. In Nova Scotia, companies with two to nineteen employees must continue to provide coverage for the employee and their family for twelve months after termination.
    • Dental Coverage: May be purchased as a standalone plan or as a rider (an add-on) to a group health plan.
    • Vision Coverage: May also be purchased as an add-on to group health plans.

    Important Definitions

    • Office Visit Co-Payment: Employee payment for office visits (Options from $5-$50)
    • Deductibles: An amount that may be deducted by the insurance carrier from the total that they will pay toward hospital and other services, in-network and/or out-of-network (Options from $500-$2500)
    • Network of Participating Physicians: Doctors who are contracted with the plan
    • RX Coverage: Coverage for prescribed medications. Many plans include 50 % coverage. Tiered RX plans may be available for Generic/Name Brand/Non-Formulary Drugs (i.e. $10/25/50)
    • Guaranteed Issue: In Nova Scotia, no one can be declined due to a pre-existing condition. They may however, be subject to a pre-existing condition exclusion for six months if they have had a lapse in coverage of over two months.
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