{"id":1901,"date":"2023-10-27T15:05:46","date_gmt":"2023-10-27T19:05:46","guid":{"rendered":"https:\/\/johnstonesbenefits.com\/clients\/ila\/?p=1901"},"modified":"2023-09-27T16:26:06","modified_gmt":"2023-09-27T20:26:06","slug":"benefits-administration","status":"publish","type":"post","link":"https:\/\/johnstonesbenefits.com\/clients\/ila\/benefits-administration\/","title":{"rendered":"Benefits Administration"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-qhegd-fa86f95102adfc70ba2a4f9351a2f82d\">\n#top .av-special-heading.av-qhegd-fa86f95102adfc70ba2a4f9351a2f82d{\npadding-bottom:10px;\nfont-size:4vw;\n}\nbody .av-special-heading.av-qhegd-fa86f95102adfc70ba2a4f9351a2f82d .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-qhegd-fa86f95102adfc70ba2a4f9351a2f82d .av-special-heading-tag{\nfont-size:4vw;\n}\n.av-special-heading.av-qhegd-fa86f95102adfc70ba2a4f9351a2f82d .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-qhegd-fa86f95102adfc70ba2a4f9351a2f82d av-special-heading-h2 blockquote modern-quote  avia-builder-el-0  el_before_av_hr  avia-builder-el-first  av-inherit-size'><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >The Journal<\/h2><div class='av-subheading av-subheading_below'><p>Solid Group Plans Made Simple<\/p>\n<\/div><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n<div  class='hr av-6afejh-e263795f297bd47017754a87e69c6958 hr-default  avia-builder-el-1  el_after_av_heading  el_before_av_heading '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ln248z7x-4f9565cd3f46be9494bb611d511d8690\">\n#top .av-special-heading.av-ln248z7x-4f9565cd3f46be9494bb611d511d8690{\npadding-bottom:10px;\ncolor:#c4a106;\nfont-size:3vw;\n}\nbody .av-special-heading.av-ln248z7x-4f9565cd3f46be9494bb611d511d8690 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-ln248z7x-4f9565cd3f46be9494bb611d511d8690 .av-special-heading-tag{\nfont-size:3vw;\n}\n.av-special-heading.av-ln248z7x-4f9565cd3f46be9494bb611d511d8690 .special-heading-inner-border{\nborder-color:#c4a106;\n}\n.av-special-heading.av-ln248z7x-4f9565cd3f46be9494bb611d511d8690 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-ln248z7x-4f9565cd3f46be9494bb611d511d8690 av-special-heading-h2 custom-color-heading blockquote modern-quote  avia-builder-el-2  el_after_av_hr  el_before_av_hr  av-inherit-size'><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Benefits Administration<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3mpz1p-a9f3603a3ce41d4531626b05134cc29a\">\n#top .hr.hr-invisible.av-3mpz1p-a9f3603a3ce41d4531626b05134cc29a{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-3mpz1p-a9f3603a3ce41d4531626b05134cc29a hr-invisible  avia-builder-el-3  el_after_av_heading  el_before_av_one_full '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-35vu25-78bc9c8145bebc847c0b1cbca8ffb691\">\n.flex_column.av-35vu25-78bc9c8145bebc847c0b1cbca8ffb691{\nborder-radius:0px 0px 0px 0px;\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-35vu25-78bc9c8145bebc847c0b1cbca8ffb691 av_one_full  avia-builder-el-4  el_after_av_hr  avia-builder-el-last  first flex_column_div av-zero-column-padding '   ><section  class='av_textblock_section av-ln249nvi-7d78d8e6c9cb0503bafb3cf09beff698'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><a href=\"https:\/\/johnstonesbenefits.com\/clients\/ila\/wp-content\/uploads\/2023\/09\/2023_10-Benefits-Administration.pdf\" target=\"_blank\" rel=\"noopener\">Click here to download pdf<\/a><\/p>\n<p><strong>Knowing the rules and responsibilities <\/strong><\/p>\n<p>We find it a good idea to periodically remind our clients of good benefits administrative practices. Administrators at organizations, third-party providers and insurance companies all have the responsibility to ensure contractual provisions are understood and adhered to, so employees are properly covered, removing the risk that coverage is assumed but not actually in place.<\/p>\n<p>Group insurance plans include contractual participation and eligibility provisions that are established by the insurer in agreement with the employer when the plan is initially set up. These provisions are typically in the contract section \u201cGeneral Information\u201d, and include:<\/p>\n<p><strong>Eligibility and Waiting Period<\/strong><\/p>\n<p>This provision includes a number of definitions for employee eligibility<\/p>\n<ul>\n<li>eligible employees \u2013 ie. permanent, full-time<\/li>\n<li>residence requirements \u2013 ie. reside in Canada<\/li>\n<li>minimum hours of work \u2013 ie. working 30 hours per week or more<\/li>\n<\/ul>\n<p><strong>Effective Dates<\/strong><\/p>\n<p>This provision defines the effective date of coverage, which includes<\/p>\n<ul>\n<li>employee must be actively at work<\/li>\n<li>enrolment forms have been completed<\/li>\n<\/ul>\n<p>There may also be a Waiting Period defining the effective first date of coverage following a defined period of employment \u2013 ie. 1st of the month following three months of employment.<\/p>\n<p><strong>Definition\u00a0of Earnings<\/strong><\/p>\n<p>Most group insurance plans are based on regular earnings, however, \u201cearnings\u201d can also include commission or other forms of income, as determined by the employer as part of the insurance policy contract. Typically bonuses, dividends, and overtime are not included in the definition of earnings. For disability plans, benefits are based on the established percentage of reported pre-disability earnings.<\/p>\n<p><strong>Late Applicants<\/strong><\/p>\n<p>This provision identifies when coverage will be effective for late applicants and any limitations to benefits if forms are not submitted within 31 days of eligibility. Once forms are received, coverage is effective when the insurer approves. Typically, they will limit coverage for a period of time \u2013 ie. dental benefits limited to a maximum of $250 per person during the first 12 months of coverage.<\/p>\n<p><strong>Medical Evidence<\/strong><\/p>\n<p>This provision defines the requirement for evidence of good health for life insurance and disability insurance in excess of no-evidence amounts as shown in the Summary of Benefits section of the plan document.<\/p>\n<p><strong>Opting In or Out of Duplicate Coverage<\/strong><\/p>\n<p>Depending on benefit provisions (levels of coverage) and cost share arrangements, employees can decide whether they want to \u201copt in\u201d or \u201copt out\u201d of their employer-sponsored extended health (EHC) and\/or dental coverage \u2013 whether to take coverage under one plan or to coordinate their benefit plan with their spouse\u2019s plan for optimal coverage.<\/p>\n<p>To \u201copt out\u201d of their group EHC and\/or dental plan, employees are required to complete the \u201cwaiver\u201d section of the Application for Coverage form. If the employee and\/or dependents lose coverage under the spouse\u2019s plan in future, the employee can pick up the waived coverage, without a waiting period, by applying within 31 days of the loss, by completing an Application for Change form.<\/p>\n<p>If an employee wants to \u201copt in\u201d for coverage after 31 days of their effective date of eligibility, but NOT due to a loss of coverage, they will be subject to the Late Applicant provision.<\/p>\n<p><strong>Coordination with Provincial Health <\/strong><\/p>\n<p>All group insurers require employees and their dependents to have provincial health insurance to be eligible for EHC benefits, as EHC provides coverage over and above government health benefits.<\/p>\n<p><strong>Claim Deadlines <\/strong><\/p>\n<p>This provision defines the deadline(s) for submitting claims that the insurers strictly enforce:<\/p>\n<ul>\n<li>EHC and dental claims deadline is typically 12 months from the date of service. This means receipts dated March 15, 2023 must be received by March 15, 2024.<\/li>\n<li>Health Spending Account (HSA) claim deadlines are either 30 or 60 days following the end of the HSA policy year. If the policy year is January to December, clams must be received for reimbursement by the next January 31st or February 28th.<\/li>\n<\/ul>\n<p><strong>Reminder<\/strong><\/p>\n<p>ALL eligible employees should be enrolled for the mandatory benefits, which include life insurance, AD&amp;D and disability insurances. To \u201copt out\u201d, the employee should sign a comprehensive release form.<\/p>\n<p>Group insurers have specific policy provisions that they apply for employees on temporary layoff, specifically for duration of coverage.<\/p>\n<\/div><\/section><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-1901","post","type-post","status-publish","format-standard","hentry","category-news"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Benefits Administration - Johnstone&#039;s Benefits<\/title>\r\n<meta name=\"description\" content=\"Johnstone&#039;s Benefits provides simple employee insurance benefit programs for large and small business.\" \/>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/johnstonesbenefits.com\/clients\/ila\/benefits-administration\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Benefits Administration - 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