Recent Benefit News

By January 10, 2020 No Comments

Group Benefits changes are becoming more frequent both legislatively and in the employer market. As such, Matheis Financial Group (MFG) is pleased to provide you with the following recent industry related changes and how they may affect your Group Benefit Program.

OHIP Out of Country Coverage

In the fall the Ontario Government announced the termination of OHIP’s Out of Country coverage (except for dialysis services), with the effective date later being confirmed as January 1, 2020. The government sited that as 95% of the claims that were paid through the program were paid by insurance companies making the administration of the program compared to the benefit to Ontario residents inefficient.

Beginning January 1, 2020, insurance providers have become first payers with affinity plans (such as credit card plans) becoming second and tertiary payers. If Out of Country coverage is included in your benefits plan, your benefit provider will continue to be the first point of contact for any covered individuals. Though we may see future increase in Out of Country premiums to account for the additional risk to the providers, the process remains the same for you as the policyholder and your covered members.

Dental Care for Seniors
More and more Canadians are working past age 65, therefore you may have one or more individuals in this higher age band covered under your benefit program. In the late fall of 2019, the Ontario Government announced that low income seniors will now have access to routine dental services. Individuals with an annual net income of $19,300 or less; or a combined “couple” income of $32,300 or less can apply for the program. Program details are available at

This program is in addition to the “Healthy Smiles” program that provides free preventive, routine, and emergency dental services for children and youth 17 years old and under from low-income households. Details of this program can be found through the following link:

WSIB Rate Changes
WSIB released a lot of information on line for employers to understand what the changes mean, however the impacts of some of the changes remain unclear, specifically how the changes are being implemented and what the costs of these changes will be. Here are a few highlights of the changes:
For the fourth year in a row there is a reduction to the average premium rates for Schedule 1 businesses. The Maximum Insurable Earning ceiling for 2020 is $95,400.
Classification System: the North American Industry Classification System (NAICS) will be used to set premium rates for every industry class – this is an important change as up to 30% of Employers are currently mis-classified. The System will be implemented over three years.
Claims Statements: Claims will now show on your (NEER) statement for six years (previously four).
Rating – The final risk band rating criteria is a work in progress as the new system is implemented.

Employment Insurance Maximum Change
Starting January 1, 2020, the Employment Insurance (EI) maximum yearly insurable earnings will increase from $53,100 to $54,200. As a result, the maximum weekly EI benefit amount will rise from $562 to $573.
If your Short Term Disability Benefit for your employees is based on the EI maximum, MFG will be communicating with you about amending your current benefit coverage to reflect this change.

Vision Coverage
Effective September 2019 THE Quebec government launched the “See Better to Succeed” program. Under this program, the Régie de l’assurance Maladie due Québec (RAMQ) reimburses a flat amount of $250 every two years for prescription glasses or contact lenses for eligible participants.

Medical Services Plan (MSP)

As of January 1, 2020, BC has changed MSP (BC’s Public Health Insurance Program) from a premium paying system to a payroll tax. MSP is mandatory for all BC residents. Previously, all individuals were responsible for monthly premiums by either paying individually, or through an employer Group. If the employer paid the premiums on behalf of the employee, the amount was a taxable benefit to the employee. The fee schedule in the prior system was the same for all (single and family rates with few exceptions), making the system inequitable for low income earners. The new payroll tax will increase disposable income for all BC residents, however employer costs may rise.

Biosimilar Drugs – Update
As of May 27, 2019, BC Parmacare required that all individuals taking three biologics Enbrel, Remicade and Lantus to transition to biosimilar drugs during one of two phases depending on their condition. A biosimilar drug is a highly similar version of the original biologic medication, known as an originator drug, but less expensive.

Phase 1 – Patients had until November 25, 2019 to have their physician change their prescriptions.

Phase 2 – patients using Remicade for gastrointestinal conditions have until March 5, 2020 to consult with their physician to change their prescription to Inflectra or Renflexis. BC Pharmacare has been communication with the affected individuals. Patients under the age of 18 will be transitioned at a later date.

Biosimilar Drugs
Beginning July 1, 2020, Alberta plans to follow BC’s lead and implement a transition to biosimilar drugs. The list of Brand name drugs in Alberta is a little broader than BC as Alberta will transition six drugs.