Benefit Costs in 2018

Based on a study released by Aon Hewitt recently, costs for extended health care plan are expected to increase by six per cent this year.

A primary cost driver continues to be Drugs which are still projected to increase by 6.1% per year. For those employers in Ontario, the recent introduction of OHIP+ coverage for dependents under age 25 should have a positive impact. For those employers with locations outside of Ontario, strategies such as prior authorization, extending dispensing frequency for maintenance drugs and researching preferred provider networks are a few options to consider.

Medical Marijuana – The Latest

Insurance companies are changing their approach to providing coverage for treatment using Medical Marijuana (MM). Previously, insurers refused to cover it and cited the fact it did not have “an approved Drug Identification Number (DIN)” as the reason. Most would however, provide for coverage through a Health Care Spending Account if the plan had one in place.

One of the conclusions in the 2017 study – The Health Effects of Cannabis and Cannabinoids, The Current State of Evidence and Recommendations for Research – is that there is substantial evidence of MM’s effectiveness for treatment of chronic neuropathic pain, spasticity due to multiple sclerosis, as well as nausea due to cancer chemotherapy.

There are varying approaches being taken depending on the insurer but those that are providing coverage are doing so for specific conditions (the number of conditions also vary by insurer) and typically will have an annual maximum ranging from $1,500 to $6,000.

For more information on this approach, you will need to get input from your provider and you can access the report at www.nap.edu/read/24625/chapter/1#xi.

Drug Costs Reducing --- Really ??

On January 29, 2018, the pCPA (pan- Canadian Pharmacy Alliance) and CGPA (the Canadian Generic Pharmaceutical Association) announced an initiative to reduce the cost of approximately 70 prescribed generic drugs. These include drugs used to treat conditions such as high blood pressure, high cholesterol, and depression.

This plan took effect April 1 and is expected to reduce prices of these generic brands by 25 to 40 per cent. This will be as low as 10% to 18% of the cost of the brand name equivalent. Most insurers will provide information on whether any of these drugs are covered by your drug plan formulary through the employee and plan administrator websites and/or through their helpline.

Saskatchewan Tax Refunds

The provincial sale tax (PST) introduced by the Government of Saskatchewan and as reported in our Current trends in August 2017, has been repealed. The tax was effective August 1, 2017 and insurers now need to issue refunds or credits retroactive to that date for PST collected on certain life and health insurance products.

The timing of these refunds may vary by insurer but they should be done by June 30, 2018.

Provincial Dental Fee Guide Increases for 2018

Each province establishes their own fee guide for Dental procedures. Your plan administrator or insurer will typically use the “average” when negotiating prices for the annual renewal.

The province of Alberta introduced a fee guide for the first time in September 2017 (as reported in the November edition of Current Trends) and that continues to be what many administrators/insurers are using.

At this time, the fee guides for Northwest Territories, Nunavut and Yukon are not yet available. It is expected that any fee guide changes for Northwest Territories and Nunavut will be effective January 1 while the fee guide for Yukon is expected to be effective April 1.