FEATURE STORY / TRENDS IN EXTENDED HEALTH INSURANCE
of EHB plans. Often times these
individuals can be found in a company’s
human resources department. They are
where the rubber meets the road. They
are the ones who hear feedback from
plan members, combine those insights
with business realities and objectives
from their companies and then look
for a plan that meets as many of their
requirements as possible — no easy feat.
From this tension, however, innovative
ideas are often born. Accordingly their
perspectives and requirements are a
very significant economic driver for the
extended health insurance industry.
Plan Member Requirements &
Satisfaction:
The views of individual plan
members are often thought to be
secondary to economic considerations.
That is likely an overstatement. EHB
plans are an enormously important tool
for companies in the management of
employee recruitment, retention and
productivity. What’s more, employees
increasingly see EHB plans as a right. The
2014 Sanofi Canada Health Care Survey,
a benchmarking report in the insurance
world, points out that the newest crop
of professionals — millennials — are the
most likely to see EHB plans as a right of
employees. 50% of millennials surveyed
saw it that way, the most of any other
generation. As a comparison, 76% of
plan sponsors see health benefits as a
privilege, not a right. Put another way,
EHB plans are a major asset when it
comes to recruiting and retaining great
people. They also come in handy when
an employee is being recruited, as they
navigate through a challenging time and
considering a change in their career.
Market Trends:
Market trends are linked in some
ways to plan member requirements
and satisfaction. How a specific plan
stacks up against the prevailing view
of a standard (or even a premium)
plan is relevant data to plan members
and sponsors. Does the plan have
vision coverage? What hoops do plan
members have to jump through to
see a chiropractor or psychologist?
How big is the major dental coverage?
These questions and many more like
them represent the way individual plan
members and sponsors evaluate the
quality of their plan against what other
people get. The more often the plan
stacks up well against plan members’
expectations the better. One specific
example is a trend towards making
paramedical coverage available for
WHAT'S DRIVING EHB ECONOMICS?
01 Plan Utilization Trends
$77
Billion
03 Plan Member Satisfaction
04 Market Trends
67%
paid to Canadians
in EHB benefits
annually
of Canadians have
Extended Health
Benefits
Rx Costs vs. Biologics
Plan Quality
Major Dental
MSK
Expectations
MSK
Mental Health
Competition
Mental Health
02 Employer Requirements
57%
$1.6
of Employers called
improving health &
well-being a priority
Employee Satisfaction
Team Productivity
Financial Pressures
24
05 Fraud & Abuse
SPRING 2015
Billion
Plan Managers reconcile
competing priorities then establish
and maintain the plan.
Referral Payments
Kickbacks
Unlicensed Practice