{"id":2099,"date":"2026-01-14T14:44:44","date_gmt":"2026-01-14T19:44:44","guid":{"rendered":"https:\/\/johnstonesbenefits.com\/clients\/ila\/?p=2099"},"modified":"2026-01-14T14:44:44","modified_gmt":"2026-01-14T19:44:44","slug":"group-benefits-faq","status":"publish","type":"post","link":"https:\/\/johnstonesbenefits.com\/clients\/ila\/group-benefits-faq\/","title":{"rendered":"Group Benefits &#8211; FAQ"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-2d9bbcf79d50a3601923aa8844f713a6\">\n#top .av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6{\npadding-bottom:10px;\nfont-size:4vw;\n}\nbody .av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 .av-special-heading-tag{\nfont-size:4vw;\n}\n.av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 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-av_hr-f04ef840c2b66cff6c43fead44ee8d66 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-mkefi06y-3cda30fed413e44fbd663de81f337691\">\n#top .av-special-heading.av-mkefi06y-3cda30fed413e44fbd663de81f337691{\npadding-bottom:10px;\ncolor:#c4a106;\nfont-size:3vw;\n}\nbody .av-special-heading.av-mkefi06y-3cda30fed413e44fbd663de81f337691 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-mkefi06y-3cda30fed413e44fbd663de81f337691 .av-special-heading-tag{\nfont-size:3vw;\n}\n.av-special-heading.av-mkefi06y-3cda30fed413e44fbd663de81f337691 .special-heading-inner-border{\nborder-color:#c4a106;\n}\n.av-special-heading.av-mkefi06y-3cda30fed413e44fbd663de81f337691 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-mkefi06y-3cda30fed413e44fbd663de81f337691 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\"  >Group Benefits &#8211; FAQ<\/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-av_hr-8ddc7023771561a08c2d1878cbb01bdc\">\n#top .hr.hr-invisible.av-av_hr-8ddc7023771561a08c2d1878cbb01bdc{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-av_hr-8ddc7023771561a08c2d1878cbb01bdc 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-av_one_full-7688609b370c0fc22d37f41de2668996\">\n.flex_column.av-av_one_full-7688609b370c0fc22d37f41de2668996{\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-av_one_full-7688609b370c0fc22d37f41de2668996 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-mkefj9pe-123131c66e5b468e748f15907a3d43e9'  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\/2026\/01\/2026_01-Group-Benefits-FAQs.pdf\" target=\"_blank\" rel=\"noopener\">Click here to download pdf<\/a><\/p>\n<p>Sometimes benefit rules can be confusing and claim deadlines can be missed. To help both employers and employees, here\u2019s a quick-reference guide addressing our most frequently asked questions.<\/p>\n<p><strong>Coordination of Benefits<\/strong><\/p>\n<p>When an employee or their dependents are eligible under two group plans, the insurance companies involved will share payment of eligible expenses.\u00a0 Total reimbursement will not exceed 100% of the cost incurred.<\/p>\n<p>Insurance companies have established a &#8216;protocol&#8217; on who pays first.\u00a0 Essentially there are two important rules to remember:<\/p>\n<ul>\n<li><strong>Employee coverage first<\/strong>: Claims must be submitted to the plan under which the individual is directly covered (their own employer\u2019s plan) before submitting to a spouse\u2019s plan.<\/li>\n<li><strong>Dependent children<\/strong> \u2013 the \u201cbirthday rule\u201d: Claims are submitted first to the plan of the parent whose month and day of birth occurs earlier in the calendar year, then to the other parent\u2019s plan.<\/li>\n<\/ul>\n<p>Once the primary payer has processed the claim, the secondary payer will consider the remaining balance\u2014provided the expense is eligible under its plan. The secondary insurer usually requires a copy of the Explanation of Benefits (EOB) from the first insurer.<\/p>\n<p><strong>Coordination with a Health Spending Account (HSA)<\/strong><\/p>\n<p>Claims must be submitted to all available group benefit plans first. Any remaining unreimbursed amount (up to 100%) may then be submitted to the HSA.<\/p>\n<p>The same coordination rules apply when determining which group plan pays first.<\/p>\n<p><strong>Opting Out of Duplicate Coverage<\/strong><\/p>\n<p>Employees who contribute toward their group benefits may choose to waive extended health and\/or dental coverage if they are already covered under a spouse\u2019s plan.<\/p>\n<p>To opt out, employees must complete the waiver section of the Application for Benefits Coverage form.\u00a0 If the employee or their dependents later lose coverage under the spouse\u2019s plan, the employee has 31 days to add the waived coverage without medical evidence or questions.<\/p>\n<p><strong>Claims Deadlines<\/strong><\/p>\n<p>All insurers strictly enforce claim submission deadlines:<\/p>\n<ul>\n<li><strong>Extended health &amp; dental<\/strong>: Claims deadline is typically 12 months from the date of service. This means receipts dated in March 15, 2025 must be received by the insurer by March 15, 2026.<\/li>\n<li><strong>Health Spending Accounts (HSA)<\/strong>: Claims must be submitted within 30, 60, or 90 days after the end of the plan year, depending on your contract. If the HSA policy year is January to December, claims must be received for reimbursement by January 31<sup>st<\/sup>, February 28<sup>th<\/sup> or March 31st of the following year, depending on your contract.<\/li>\n<\/ul>\n<p><strong>Electronic Claims &amp; Payments<\/strong><\/p>\n<p>Dentists, pharmacists, paramedical practitioners and vision care providers have been submitting claims electronically to insurers on behalf of their patients for several years making reimbursements more efficient and timelier. Employees can also use e-claims for many types of expenses, making the claims process easier and reimbursements faster.<\/p>\n<p>Claim reimbursements directly deposited into an employee\u2019s bank account are available for both electronic and traditional claims. Easy to set up with the insurer, the employee provides bank account information and will receive an explanation of payment by email or on the insurer\u2019s website.<\/p>\n<p><strong>Coordination with Provincial Health<\/strong><\/p>\n<p>To be eligible for a group extended health plan, the employee must also be enrolled in the provincial health plan for their province of residence.<\/p>\n<p>Provincial health plans universally cover the basic expenses for doctors, hospital stays and lab tests, and depending on the province, these plans may also cover some other health expenses.<\/p>\n<p>Your employer-sponsored extended health plan is prohibited by law to cover any medical expense covered under the provincial plan, with the exception of Quebec.<\/p>\n<p><strong>No Tax on Health and Dental Benefits<\/strong><\/p>\n<p>Currently premiums paid by an employer for extended health or dental plans are not considered as taxable income to employees, nor are these benefits taxable upon receipt.<\/p>\n<p><strong>2026 Government Benefits Updates<\/strong><\/p>\n<p><strong>Employment Insurance (EI)<\/strong><\/p>\n<p>The maximum insurable earnings is the income level to which EI is paid.\u00a0 In 2026 it increases to $68,900, (from $65,700) resulting in the weekly amount changing to $729 (from $695).<\/p>\n<p>EI premium rate for 2026 is\u202f$1.63 per $100 of insurable earnings for employees.<\/p>\n<p>The EI premium rate for Quebec residents is $1.30 per $100 of insurable earnings for employees.<\/p>\n<p><strong>Canada Pension Plan (CPP)\/<br \/>\nQuebec Pension Plan (QPP)<\/strong><\/p>\n<p>Employee and employer contribution rates will be 5.95%, unchanged from 2025. The maximum employer and employee contribution to the CPP\/QPP for 2026 will be $4,230.45 each. The basic exemption amount will remain at $3,500.00.<\/p>\n<p>Year\u2019s Maximum Pensionable Earnings (YMPE) under the CPP\/QPP for 2026 will be $74,600.\u202f\u202fThe second earnings ceiling, the Year\u2019s Additional Maximum Pensionable Earnings (YAMPE), will be $85,000.\u202f The YAMPE will be used to determine additional CPP contributions (CPP2). \u202fAs a result, pensionable earnings between $74,600 and $85,000 are subject to CPP2 contributions.<\/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-2099","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>Group Benefits - FAQ - 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\/group-benefits-faq\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Group Benefits - FAQ - Johnstone&#039;s Benefits\" \/>\r\n<meta property=\"og:description\" content=\"Johnstone&#039;s Benefits provides simple employee insurance benefit programs for large and small business.\" \/>\r\n<meta property=\"og:url\" content=\"https:\/\/johnstonesbenefits.com\/clients\/ila\/group-benefits-faq\/\" \/>\r\n<meta property=\"og:site_name\" content=\"Johnstone&#039;s Benefits\" \/>\r\n<meta property=\"article:published_time\" content=\"2026-01-14T19:44:44+00:00\" \/>\r\n<meta name=\"author\" content=\"jbadmin\" \/>\r\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\r\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"jbadmin\" \/>\r\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnstonesbenefits.com\\\/clients\\\/ila\\\/group-benefits-faq\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnstonesbenefits.com\\\/clients\\\/ila\\\/group-benefits-faq\\\/\"},\"author\":{\"name\":\"jbadmin\",\"@id\":\"https:\\\/\\\/johnstonesbenefits.com\\\/clients\\\/ila\\\/#\\\/schema\\\/person\\\/45a025705ee9a07b947eac0dc3435375\"},\"headline\":\"Group Benefits &#8211; 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