Changes to Health & Dental Plan

 

The GSI Board is introducing changes to the ELCIC Health & Dental plan, effective January 2021. GSI is developing two plan designs, which will be known as Enhanced and Core.

The move to Enhanced and Core streams of coverage reflects GSI’s desire to support a sustainable group benefits plan, while still providing excellent coverage for plan members. The specific details of the coverage for both streams are detailed in our Plan Member newsletter and will also be available on this page.

Keep checking back for additional information about the Enhanced and Core streams of coverage.

Introducing Health & Dental Plan Redesign

Upcoming Changes to Health & Dental Benefits

GSI, in its role as Plan Sponsor, recently undertook a market review of the health and dental benefits and found that it is competitive with other Canadian organizations and specifically not-for-profit groups. We also noted that more than 90% of plan members made a claim last year. It’s a good Plan and you, our members, are making good use of it.

However, we have also heard from your congregations/employers regarding the increasing challenges of rising premium costs. Health care inflation in Canada has risen at a faster pace over the past decade than economic inflation or Canadian salaries.

In light of all these factors, the GSI Board examined ways of improving the plan while striving to secure its long-term sustainability.

The following changes will be effective January 2021:

A Move to Enhanced and Core Plan Designs
Currently, the health and dental benefits are the same for all plan members, even though there is wide salary range among members. This means that congregations are paying the same premium whether the member is earning the minimum or the higher end of the scale.

GSI is addressing this situation by developing two plan designs with different cost profiles that may better match the compensation package. The two plan designs will be known as Enhanced and Core. Members will be enrolled in a respective design based on earnings criteria. Members earning YMPE* or greater will be in the Enhanced Plan, and those earning less than YMPE will be assigned the Core Plan. The Enhanced Plan is similar to the current plan, while the Core Plan’s coverages are reduced to support the premium differential.

Though the coverage levels will be different, both the Core and Enhanced streams will include prescription coverage, health coverage including eye exams, as well as a dental plan.

Added Flexibility
Recognizing that Plan members have different health needs and priorities, both plan designs will include a Health Care Spending Account (HCSA). With this new feature, each Plan member will have the flexibility to allocate their HCSA funds towards specific costs not otherwise covered.

Health and dental benefits will remain the same until these changes take effect in January 2021.

The move to Core and Enhanced coverage reflects GSI’s desire to support a sustainable group benefits plan that is manageable for all congregations/employers while still providing excellent coverage for plan members. The specific details of the coverage for both streams will be detailed here in our newsletter in the months to come. Any questions about this upcoming change may be directed to GSI.


*YMPE stands for Yearly Maximum Pensionable Earnings and is set annually by Canada Revenue Agency

Changes to Health and Dental Benefits - Q&A

Question

When will the changes to the health and dental benefits happen?

Answer

Changes to the plan will take effect January 2021.

Question

Will my benefits change between now and when the changes take place?

Answer

The current plan benefits will remain the same until these changes take effect in January of 2021. Benefits may change for individual plan members before that time, if their eligibility changes.

Question

Why is the health plan being redesigned and how did GSI decide to make these specific changes to the health plan?

Answer

The mandate of GSI is to create, review, negotiate and provide a benefits plan on behalf of ELCIC congregations and organizations for their employees. To do so, GSI board and staff undertake education, keep current on trends in the industry and engage consultants to provide information when needed. GSI also carefully reviews the experience of the ELCIC plan members and overall plan results to help fulfil their mandate.

In fitting with our mandate, GSI has been closely watching national health plan costs and trends in both claims and future innovations in the healthcare industry. Health care inflation in Canada has risen at a faster pace over the past decade than economic inflation or Canadian salaries. This type of inflation has the effect of increasing healthcare premiums and we have heard from congregations/employers regarding the increasing challenge of meeting these rising premium costs.

Considering all these factors, the GSI Board examined ways of improving the plan, while striving to secure its long-term sustainability. Changes were made that would reflect GSI’s desire to support a sustainable group benefits plan that is manageable for all congregations/employers while still providing excellent coverage for plan members.

Question

Why do we need a Core and Enhanced plan?

Answer

For employers with plan members at the lower end of the earning scale, the current health premiums are disproportionately high within the overall compensation package. Introducing a Core stream will provide more balance, while ensuring that these employees will still have a good benefits plan. Core plan members who wish to access the benefits of the Enhanced plan have the option of paying the difference themselves (or their employer can if the employer so wishes).

Question

Can I choose the Core stream even though I’m eligible for the Enhanced stream?

Answer

No. Active Members who qualify for the Enhanced stream may not select Core while active. However, Members enrolled in Enhanced while active, may choose the Core stream at time of their retirement.

Question

Can I switch streams later if I change my mind or my circumstances change?

Answer 

Plan members eligible for the Core stream will be given a one-time option to choose the Enhanced stream, with the premium differential at their own cost.

This may be done at the following points:

  • January 2021 or
  • at initial employment or
  • at the time of a life event, such as a change in marital status or loss of a spouse’s employment benefits

Question

What if I don’t want to be in any plan at all?

Answer

While employed by an ELCIC congregation or other subscribing employers, all employees meeting minimum  eligibility of 25% YMPE are required to enroll in the group benefits plan. The option to waive coverage is allowed only if the employee’s spouse has similar coverage with their employer.

Enrollment in the national group retiree health plan is a one-time option for the plan member at time of termination from employment.

Question

Does GSI support the concept that all employees should have health benefits beyond what is covered by their provincial insurance?

Answer

Yes – that is why premiums will continue to be 100% employer paid and all employees meeting a minimum threshold are required to enroll (unless they provide evidence that their spouse has coverage provided by their employer).

Question

Who will these changes benefit?

Answer

Changes to the plan have been made to benefit both employers and plan members. GSI has assessed both the long-term financial impact to the employers and the member needs to develop this redesign. Employers will experience a better overall allocation of plan costs and employees will enjoy added flexibility through the addition of a Health Care Spending Account (HCSA). Details on how to use the HCSA and what it covers, can be found on the GSI website. (link)

Question

Would it make more financial sense for the ELCIC to explore the idea of joining the benefits plans of another organization?

Answer

Benefit plans for other organizations follow the same general structure as the ELCIC plan. Premium costs, for any plan, are based on claims and adjudication expenses. If ELCIC members join another plan with the same benefits and make the same claims, the costs would ultimately be the same.

GSI regularly compares our plan design to the market and has found that the ELCIC plan is very competitive. While other plans may have different specific benefits, the cost of premiums for each plan is ultimately determined by the level of benefits it contains. GSI has worked to ensure that the ELCIC plan has both an affordable and sustainable premium, with benefits that meet the healthcare needs of plan members.

Question

How do I get more information about the health redesign?

Answer

Please read the monthly newsletter for any updates and check the GSI website page called Health & Dental Redesign 2021 for updated information. If you have specific questions, please call GSI at 1-877-352-4247.

Question

How can plan members share comments and feedback on the upcoming changes?

Answer

Plan members are always welcome to speak with GSI by placing a call or visiting us at various ELCIC gatherings.

Summary of Redesign to Health & Dental Benefits

Changes to Health & Dental Benefits 

In October, GSI announced some changes to the structure of the health and dental benefits that will take effect in 2021. These changes strive to ensure the long-term sustainability of the plan and add flexibility to the benefits.  

Starting in January of 2021, the health and dental benefits will move to Core and Enhanced streams of coverage. Plan members will be enrolled in either the Core or Enhanced stream, based on eligibility criteria.  

Eligibility for each stream will be determined solely by a member’s salary basis in relation to YMPE1. Members earning YMPE or greater will be enrolled in the Enhanced stream, and those earning less than YMPE, but meet the minimum eligibility of 25% YMPE, will be enrolled in the Core stream.   

 

Health Care Spending Account 

Something new to the plan will be a feature called a ‘Health Care Spending Account’ (HCSA).    Both Enhanced and Core streams will include an HCSA that will allow the plan member flexibility in covering benefits costs and offset the reductions in the maximum coverages as described below. The HCSA can also be used to cover eligible expenses not currently in the ELCIC Group Benefits Plan. 

 

Prescription Drugs, Vision Care & Paramedical Services 

The covered amount for prescription drugs will be reduced from the current 80% to 70% for the Enhanced stream and reduced to 60% for the Core stream. Plan members in both streams will still have a drug card that they may use at their pharmacy. The out-of-pocket maximum will also be removed from the prescription drug benefit. The prescription drugs plan will become a mandatory generic plan where only the amount of the lowest cost of an available drug will be applied.  

For vision care, the Enhanced stream will cover eye exams and prescription glasses and contact lenses, as in the past, while the Core stream will cover only eye exams. The covered amount for paramedical services will be reduced to 70% for Enhanced plan members and reduced to 60% for Core plan members. Also, those in the Core stream will see the paramedical maximums somewhat reduced.  

 

Dental Benefits 

The basic dental benefit will see the deductible removed and replaced with co-insurance. Both streams will have 70% coverage on basic dental expenses. The major dental benefit remains at 50% for both streams, but orthodontic coverage will be removed from the Core stream. Also, the overall maximum for the Core stream will be reduced from $2,000 to $1,000.  

Health and dental benefits within the current plan, will remain the same until these changes take effect January 2021.   

The move to Core and Enhanced streams reflects GSI’s desire to support a sustainable health and dental benefit plan that is manageable for all congregations/employers, while still providing excellent coverage for plan members. In the months to come, we will continue to share these details with you in our e-newsletters.  

You may also check-out the ‘Health & Dental Redesign 2018’ Q&A section of our website with answers to questions you might have.  If you have any additional questions about this upcoming change, please direct your inquiries to GSI. 

Health Care Spending Account Q&A

Health Care Spending Account (HCSA)

Question

What can I pay for with my HCSA? 

Answer

Your health care spending account acts as a supplement for expenses that may not be covered in the plan. It can also be used to ‘top-up’ healthcare costs that exceed your plan’s maximum coverage.

The HCSA can be used to cover: 

  • your portion of the co-insurance 
  • benefit costs in excess of the maximum under the plan (e.g., glasses, additional visits to chiropractor, etc.)  
  • eligible health expenses that are not covered in the ELCIC Group Benefits Plan. Eligible expenses are generally those that can be claimed as medical expenses on your personal tax return as per the Income Tax Act. A list can be found on the Canada Revenue Agency website.

Question

What is the annual amount of my HSCA? 

Answer

The specific amount of money available in your health care spending account will be announced before January 2021. Amounts will vary between single and family coverage and between Enhanced and Core designs.

Question

When will I be allocated my HCSA funds? 

Answer

The full annual HCSA amount will be available at the start of the calendar year. Any unused HSCA dollars at the end of the year will be added to next year’s HCSA balance. HCSA dollars can be carried over for one year. 

Partialyear enrollment  

 

Situation  HCSA amount 
new plan member starting mid-year  annual amount x # months remaining / 12 
move between congregations during the year with no gap in employment  annual amount continues with no interruption 
a call ends mid-year; there is a gap, and a new call begin later that year  annual amount x (# months remaining in year + months previous worked in year) / 12 

less HCSA claims made 

Question

When can I make a claim to the HCSA? 

Answer

The company providing the health benefit, such as the pharmacy or dental office, will continue to submit expenses directly to Manulife. If you also have coverage under your spouse’s plan, any unpaid portion must then be submitted to that plan. If there is a balance owing, you will pay that amount and then claim reimbursement from your HCSA.  

If you have exhausted the maximum on a previous claim, or the medical expense is not covered by the ELCIC Group Benefits Plan but is eligible as a medical expense, you will pay the medical expense and then claim reimbursement from your HCSA. 

Question

How do I make a claim for reimbursement from my HCSA? 

Answer

The fastest and simplest way is to use the Manulife app, which can be downloaded to your smart phone. Another option is to use the Manulife website. Follow the steps to make a claim, and it will provide the option to use your HSCA.  

Question

How will I be paid? 

Answer

All reimbursements will be made by direct deposit to your financial institution. If you haven’t already, you will need to create a user account and provide your banking information. 

Question

Is there a time limit to make my claim? 

Answer

Yes. You have 90 days after the calendar year-end to make a claim for the previous year. For example, you will have until March 31, 2022 to make a claim that was incurred in 2021.  

Question

Is adding the Health Care Spending Account (HCSA) an administrative burden for plan members?

Answer

The HCSA will add flexibility with minimal administrative work by plan members. Plan member will be able to use the Manulife app, which will make submitting very simple.

Summary of Dental Benefits Redesign for 2021

Dental Benefits

The move to Enhanced and Core coverage reflects GSI’s desire to support a sustainable health and dental benefit plan that is manageable for all congregations/employers while still providing excellent dental coverage for plan members.

In this section, we take a closer look at the new Dental Benefits under both the Enhanced & Core streams of coverage.

While the current plan has a $25 deductible for singles and $50 for families, in the new plan, neither stream will have a deductible for dental visits. Instead, plan members will co-pay a portion of the cost. While there is a shift from deductibles to co-pay, the type of work covered for basic and major dental procedures will remain the same for both the Enhanced and Core streams. However, the Core plan will be capped at $1,000/year, with no change made to the cap of $2,000/year for the Enhanced plan. Orthodontic coverage has been eliminated from the Core Plan while the Enhanced plan continues at the current limit.

These differences are summarized in the table below:

Dental Benefits

Current Plan Enhanced Plan Core Plan
Deductible single $25

family $50

none none
Reimbursement  basic 100%
major 50%
ortho 50%
basic 70%
major 50%
ortho 50%
basic 70%
major 50%ortho none
Annual Maximum Basic & Major $2,000 $2,000 $1,000
Lifetime Maximum for Orthodontics $2,000 $2,000 $0

Health Care Spending Account

One new feature of coverage is the addition of a ‘Health Care Spending Account’ (HCSA), for both the Core and Enhanced plans. Plan members will have flexibility in how to spend their available funds, which can be used to top-up dental or orthodontic coverage if so desired.

If you have any additional questions about this upcoming change, please direct your inquiries to info@elcicgsi.ca