A routine plan review uncovered an unpleasant surprise for one of our largest clients. Their plan had been hit hard by a biologic therapy that was new to the market. This drove a tough conversation with the business owner about the future of the company’s employee health benefit plan.
His first question was how they can prevent this from happening in the future; what if another employee needs this drug or a different high cost therapy?
The discussion quickly turned to provincial integration, specifically the Ontario Trillium drug program. However there was one problem, the Ontario Trillium drug program requires individuals to reach a set deductible before the provincial coverage will take over. This deductible must be paid out-of-pocket and not through a private insurance plan. Our client had generously provided a 100% co-insurance for prescription drug coverage so their employees did not have any out-of-pocket expenses. This meant they would never reach the deductible, never qualify for provincial coverage, and the company’s plan would be on the hook to pay.
Removing coverage for certain medications was an option but out of the question for the business owner who wanted to support his employees. What about reducing their prescription drug co-pay to 80%? That seemed to solve the problem; however once presented to the owner they felt that it would be too drastic for their employees and in turn, would drive complaints to their already overwhelmed plan administrator.
The best solution was to add a Health Spending Account (HSA) for each employee to offset the 20% decrease in drug co-pay. Employees were able to choose to use their HSA dollars to reimburse any out-of-pocket prescription drug expenses, or use the funds for other eligible products and services that were not covered under their group plan.
There were two main benefits of this solution:
- It allowed employees with high cost drug claims the ability to access government funding by reaching the out-of-pocket deductible.
- It provided every employee with the flexibility to customize their plan to the individual needs of their families.
Benecaid supported the roll out of this solution with our client, even hosting a live employee webinar to walk through the changes and to highlight the many additional benefits of their new HSA. This is just one example of how we strive to work with our Advisors to develop creative solutions and provide your clients with a sustainable long-term health benefits plan.
For more information on different ways to incorporate HSAs into group plans, contact your Benecaid Benefits Consultant by phone 1-866-361-2998 or by email at advisors@benecaid.com.
