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  • The Trillium Drug Program, part 4: What advisors need to do | Small Biz Advisor
    to control costs says Spark For example if you have 500 employees you may think a 25 000 stop loss is the right level because you re big enough and what are the odds of getting many claims that are higher than that That thinking was sound when cancer drugs were the biggest claims With hepatitis C I m saying to these businesses Let s get down to a 10 000 to 15 000 level of risk because if you get three hepatitis C claims you re at 75 000 and that s significant What employers need to know A key piece of information for employers is that they cannot apply to Trillium on their own or an employee s behalf Applications are available at pharmacies and individual plan members need to fill them out themselves and submit them When I mention Trillium sometimes employers will say Send me this stuff and we ll register says Spark But that s not how it works This is all about motivating individual plan members to take care of it If they don t employers will end up covering their share of the cost which is usually anywhere from 80 to 100 of it Communicating the complexities Spark suggests employers adopt a proactive approach towards employee education about Trillium that does not single anyone out Simply say that very expensive drug treatments are increasingly available but could make it difficult for the company to continue providing comprehensive health benefits for all if employees do not do their part by approaching Trillium directly for coverage It s important says Spark because hepatitis C may be only the tip of the iceberg How many more drugs like that may be coming The bottom line At the end of the day says Dave Patriarche president of

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/the-trillium-drug-program-part-4-what-advisors-need-to-do-3709 (2016-04-26)
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  • The Trillium Drug Program, part 3: Coping with catastrophic drug claims | Small Biz Advisor
    extraordinarily high drug claims related to these illnesses The key to avoiding some of the worst consequences of such claims says Dave Patriarche president of Mainstay Insurance Brokerage Inc in Thornhill Ont is getting Trillium not insurance companies to be the first payer Although the onus is on insurance companies themselves to process claims properly small businesses also need to understand how Trillium works and communicate this to employees They also need to know what their best options are when high drug claims have already led to renewal increases Four choices Employers facing unaffordable insurance costs after employees file high claims have essentially four choices says Patriarche They can eliminate their benefits plan and offer no coverage they can share the costs putting more of the burden on employees they can cap drug costs which penalizes the few employees who have particularly high costs or they can switch to offering a health spending account None of these arrangements is ideal he points out since each in their own way represents a considerable scaling back of benefits And none would be necessary had Trillium been the first payer on the catastrophic drug costs that drove the increase in the first place he adds Drug caps are not a panacea For many small businesses facing a spike in renewal rates the quick Band Aid solution to high drug costs is the drug cap A business could decide to cap drug costs at 5 000 for example after which employees whose costs are higher need to pay the balance out of pocket or look elsewhere for reimbursement Ideally they would find Trillium However Trillium only covers drugs that are on the Ontario Drug Benefit formulary which many drugs are not Therefore employers who opt for a drug cap as a knee jerk response

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/the-trillium-drug-program-part-3-coping-with-catastrophic-drug-claims-3704 (2016-04-26)
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  • The Trillium Drug Program, part 2: Avoiding quick fixes | Small Biz Advisor
    resulting from new drugs are driving renewal increases to new heights because many insurers use an experience based model where businesses with higher claims pay higher costs Too few advisors are aware of how claims for these sorts of treatments will affect renewals because they are uniquely non recurring says Patriarche Small businesses naturally want to avoid sharp renewal increases but when it comes to hepatitis C they need to be wary of responding with short term fixes that don t make sense for the long run as these are one time claims The crux of the issue is that the simplest way for many employers to cope with dramatic renewal increases is to impose a drug cap but since drugs to treat hepatitis C represent a complete cure the reality is that the spike is likely to be a one time event for any given employee and possibly for the entire business Solving the problem by implementing a drug cap or switching to a health spending account model penalizes all other employees in company for years to come The takeaway is that advisors and employers both have to understand there is no quick fix says Spark Every route has obstacles he says You can t just cap everything and dump the rest to Trillium It s going to take a lot of work and cooperation from numerous people involved However complicated it is say advisors having Trillium pick up the tab for catastrophic drug claims instead of insurers is key Who s at fault Done properly Trillium becomes the first payer of an employee s eligible drug costs once the person has reached their out of pocket deductible 4 of net income from the previous taxation year But instead insurance companies have been paying first As a result Trillium

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/the-trillium-drug-program-part-2-avoiding-quick-fixes-3699 (2016-04-26)
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  • Genetic testing and its insurance implications | Small Biz Advisor
    actress Angelina Jolie went public with her decision to prophylactically undergo a mastectomy and oophorectomy to reduce her risk of developing breast and ovarian cancers after testing positive for the BRCA 1 gene the topic of genetic testing has been front and centre Especially for employers and advisors In this piece on Advisor to Client from Advisor ca Susan Goldberg examines how genetic information can affect the ability to qualify

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/genetic-testing-and-its-insurance-implications-3697 (2016-04-26)
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  • The Trillium Drug Program, part 1: What’s happening now | Small Biz Advisor
    Dave Patriarche president of Mainstay Insurance Brokerage Inc in Thornhill Ont is this For the past 20 years every insurance company in Canada has processed claims for high cost drugs in Ontario wrong They ve done it to their benefit not to the benefit of our clients the employers For the most part nobody s blaming Trillium The problem say those in the know is that insurers are not integrating eligible high cost claims with Trillium but rather are paying them at the employer s expense continuing to put more claims in stop loss pools when the province should be paying Compounding the problem too few small businesses are aware of Trillium and are not educating their employees about it Meanwhile employers are looking for options and some are feeling cornered into choosing short term solutions that are not smart for the long term Why now One reason this is big news now is the recent arrival on the market of extremely costly drug treatments that may be needed by at least 1 in 100 Canadians Biologics to treat autoimmune diseases such as Enbrel or Remicade for rheumatoid arthritis have already made the issue urgent for small businesses says Patriarche The treatments can cost 20 000 or 30 000 a year and it s estimated that about 1 in 150 Canadians could be using them Biologics are are pricier than conventional drugs both to make and to administer But the matter is even more pressing now that hepatitis C drugs are here as well Revolutionary new treatments for hepatitis C offer a complete cure but can cost as much as 125 000 per patient and about 1 in 100 Canadians have the disease The total cost to treat them all says Patriarche will be in the realm of 30 billion

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/the-trillium-drug-program-part-1-whats-happening-now-3691 (2016-04-26)
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  • Helping managers tackle mental health in the workplace | Small Biz Advisor
    resume happy productive lives As with many health issues early detection and treatment can be key toare key in minimizing the impact on a person s life and returning them to health The unique role of managers Managers are ideally situated to be the first responders in helping employees who are experiencing mental health issues They interact with employees on a regular basis are familiar with employees job duties and personality and understand the workplace and the culture of the organization The issue is that But many managers lack the ability to recognize a mental health issue and steer struggling employees to potential solutions Mental health training can help managers do three key things 1 Recognize the potential signs of employee mental health problems 2 Address mental health issues within a workplace context 3 Provide employees with support and referral to workplace resources Managers therefore can have an active and very important role to play However what managers shouldn t do is step beyond the boundaries of potential detection and support to provide diagnosis or treatment Managers are not counselors psychologists or physicians nor should they be expected to assume any of those roles The benefits of manager training do not stop at helping individual employees Training managers to be more aware of employees health and wellbeing has shown to have an effect on an organization s overall culture leading to improved employee relations lower stress levels among both managers and employees and improved workforce engagement according to research in the Journal of Occupational Health Psychology Effective programs require equip skilled trainers with Strong knowledge of mental health and mental health problems Personal or professional experience with people who have mental health problems Good teaching communication and interpersonal skills An understanding of the responsibilities of managers and supervisors A good

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/helping-managers-tackle-mental-health-in-the-workplace-3685 (2016-04-26)
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  • Employers need help managing rising drug costs | Small Biz Advisor
    is also expected to grow in the coming years Innovative managed solutions that leverage actionable data behavioural science techniques clinical expertise and patient support tools help patients manage their health conditions and make better decisions which lower costs and can improve health outcomes Pharmacy benefits have become one of the most high profile areas of employee health plans from both an economic and employee satisfaction standpoint says Michael Biskey President Express Scripts Canada However current trends show that Canadian businesses should act today to implement innovative solutions to sustain this important benefit Additional key findings from the study include Specialty spend represents only 2 of claims but continues to grow as a percentage of total drug spending steadily increasing from 13 2 in 2007 to 26 5 in 2014 This increase is primarily driven by high treatment costs and an increase in utilization Spending on traditional prescription drugs those used to treat common conditions such as high blood pressure declined by 0 3 This slight downward trend is driven by lower generic prices resulting from pan Canadian Pharmaceutical Alliance pricing agreements as well as an increase in the availability of generic options due to patent expiries Drug benefit costs are

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/employers-need-help-managing-rising-drug-costs-3688 (2016-04-26)
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  • What a five-generation workforce expects in a benefits plan | Small Biz Advisor
    life insurance and critical illness to family coverage and vision care to hospital semi private coverage And what they wish their benefits plan included also ranges from more dental to work life balance and wellness to financial planning to retiree benefits But with different generations wanting different things how can employers cope Get support from service providers consultants and community partners and find ways for greater personalization at low cost Mark said And widen the benefits net to include non traditional offerings such as pet insurance tuition assistance paid travel and financial counselling When rethinking a benefits strategy she said employers need to use a holistic three pronged approach taking into consideration the financial physical and mental And include social under the mental health prong she added And while Mark noted that it s easy to generalize when it comes to communication employers need to ensure they re using the right sources to communicate to each demographic group While survey respondents from generations Y and Z said they enjoy communicating via texts blog posts and Facebook the Xs want concise emails with links as well as meetings and follow up conversations Boomers wanted live interactive teleconferences and traditionalists wanted someone

    Original URL path: http://www.smallbizadvisor.ca/group-benefits/what-a-five-generation-workforce-expects-in-a-benefits-plan-3671 (2016-04-26)
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